Author Dr Narasimha Reddy Donthi, Senior Advisor at PAN India, said Indian doctors are inadequately prepared to identify pesticide-linked illnesses, leading to missed diagnoses, poor surveillance and an underestimation of the health burden associated with agricultural chemicals.

“Pesticide toxicology remains largely confined to forensic and medico-legal teaching in medical colleges, while chronic exposure to modern pesticides, environmental health and occupational history-taking receive little attention in undergraduate medical education. As a result, doctors frequently treat symptoms without investigating whether long-term exposure to agricultural chemicals may be contributing to disease,” Dr Donthi said.

The report points to Maharashtra’s Yavatmal district as a key example of the consequences of this gap in medical practice. The cotton-growing region has witnessed repeated incidents of pesticide poisoning, with farmers reporting vomiting, dizziness, headaches, breathing difficulties and skin disorders after spraying pesticides.

It cites evidence linking long-term pesticide exposure to neurological disorders, respiratory illnesses, endocrine disruption, reproductive health problems, developmental abnormalities, blood disorders and certain cancers. Among these, the report identifies anaemia as one of the most overlooked potential consequences of chronic pesticide exposure.

Despite decades of government-led iron supplementation programmes, National Family Health Survey data continue to show high levels of anaemia among women and children, the report notes. It argues that the persistence of the condition raises questions about whether factors beyond nutritional deficiency, including pesticide exposure, may be contributing to the burden in agricultural communities.

The report calls for investigations into whether pesticide-induced damage to red blood cells and bone marrow function is a contributing factor, particularly in farming regions. It recommends a multi-state study across Maharashtra, Punjab, Andhra Pradesh, Telangana and Odisha to examine links between chronic pesticide exposure and haematological abnormalities.

Drawing on examples from across the country, the report highlights Punjab’s Malwa region, often referred to as India’s “cancer belt”, where studies have documented elevated cancer rates and evidence of DNA damage among pesticide-exposed farmers. It also references Kerala’s Endosulfan tragedy in Kasaragod district, where aerial spraying was linked to congenital abnormalities, neurological disorders and developmental disabilities, and the chronic kidney disease cluster in Andhra Pradesh’s Uddanam region, where environmental exposures remain under investigation.

Dr Donthi said these cases reflect a broader failure to integrate environmental exposure into clinical practice.

Even when pesticide poisoning is suspected, confirming exposure remains difficult due to inadequate diagnostic facilities, the report says.

“Most district hospitals and primary health centres lack laboratory facilities capable of testing for pesticide exposure. Basic investigations such as acetylcholinesterase testing, commonly used internationally to assess organophosphate poisoning, are unavailable in many facilities serving agricultural populations,” he added.

The report also criticises India’s pesticide regulatory framework, arguing that it treats pesticide use primarily as an agricultural issue while largely excluding health experts from decision-making.

“This exclusion is a fundamental flaw in the system. Clinicians who diagnose poisoning, cancers, kidney disease, neurological disorders and developmental problems potentially linked to pesticide exposure have little role in decisions on whether hazardous pesticides should continue to be approved, restricted or withdrawn. Practising clinicians, including specialists in occupational medicine, paediatrics, nephrology, neurology and oncology should be made permanent members of pesticide regulatory bodies and be given the authority to initiate reviews of pesticide molecules based on emerging clinical evidence,” Dr Donthi said.

Among its key recommendations, the report calls for the inclusion of pesticide toxicology, environmental health and occupational history-taking in medical education, mandatory training for doctors working in agricultural districts, compulsory reporting of suspected pesticide-related illnesses within 48 hours, expanded diagnostic facilities at district hospitals, and the creation of a national database to track pesticide-related disease.