Sorveglianza sanitaria e valutazione del rischio in agricoltura : problemi emergenti e necessità di armonizzazione degli approcci

About 1,7 millions of agricultural enterprises are present in Italy, with a total of about 2,500,000 workers, exposed, during their activities, to several risk factors, whose impact on workers’ health is still unclear. Reasonable doubts arise of a possible, significant underestimate of the cases of occupational diseases reported in the sector, in a general picture suggesting that muscle skeletal disorders and hearing loss are the leading cause of morbility. A main cause of underreporting is the relatively small proportion (45-60%) of agricultural workers provided with health surveillance at the workplace, and the fact that no more than 60% of the agricultural enterprises have done an acceptable risk assessment. Improving risk assessment and increasing health occupational surveillance are major objectives for the sector, which probably needs to be addressed by a specific legislation, different from the existing one, mainly addressed at industry. Risk assessment needs to be improved with the creation of specific tools, adequate to provide sound risk estimates avoiding the need of measuring risk factors in any enterprises. Finally, health surveillance must undergo a specific harmonization process, mainly achievable with guidelines, and must be based on structures adequate to reach agricultural workers directly at their workplaces. The problem of self employed workers and family enterprises must be considered, in order to avoid inequalities among workers in the access to prevention.