Community Health Impacts of Pesticide Exposure: Pathways, Vulnerable Populations, and Public Health Responses.

Pesticide use remains important in modern agriculture, vector control, and household pest management. However, exposure to pesticide active ingredients and residues remains a persistent public health concern. In addition to active ingredients, people may also be exposed to other constituents of commercial pesticide formulations, such as adjuvants and solvents, which can influence overall toxicity and health outcomes. These exposures may occur among direct applicators and may also affect other populations through contaminated air, water, soil, food, clothing, and household surfaces. This narrative review examines pesticide exposure from a community health perspective, emphasizing occupational, para-occupational, residential, dietary, drinking-water, airborne, and cumulative exposure pathways. It highlights vulnerable groups, including agricultural workers, children, pregnant women, women in agricultural communities, older adults, people with chronic illness, and marginalized rural populations. Evidence reviewed in this article links pesticide exposure with acute poisoning, respiratory effects, neurobehavioral and neurodevelopmental outcomes, cancer-related risks, reproductive and developmental effects, endocrine and metabolic disruption, cardiovascular outcomes, dermatological reactions, immune dysregulation, and biomarker-based subclinical changes. Beyond disease endpoints, pesticide exposure may also affect household income, education, mental well-being, food security, livelihoods, and intergenerational health. Major challenges include weak exposure assessment, underreporting, limited biomonitoring in low- and middle-income settings, and inconsistent community-level indicators. Strengthening surveillance, risk communication, integrated pest management, safer storage and disposal, protective regulation, and community-centered biomonitoring is essential to reduce pesticide-related health burdens.