With PLAGSALUD support, pesticide illness surveillance has extended to all seven Central American countries, producing 7,000 poisoning reports in 2000, but governments' use of the surveillance data has been limited by inadequacies of data management, interpretation, and reporting and an influential pesticide industry in weak economies. Overrepresented reports of suicides minimize occupational hazards. In six countries, 32,245 questionnaire responses indicated 98% underreporting of pesticide poisonings and a regional estimate of 400,000 poisonings per year (1.9% of the population), 76% work-related. A potentially far-reaching measure to come out of this surveillance is an agreement of the ministers of health of Central America and the Dominican Republic (RESSCAD 2000) for a harmonized list of banned and restricted pesticides, including the 12 most frequently reported. The RESSCAD agreement has met considerable resistance from industry. Its achievement versus failure will disclose the ability of Central American governments to prioritize protection of human health against commercial corporate interests. Surveillance data have potential for policy reform, but a more aggressive health sector is needed, linked with the environmental sector, grass-roots organizations, and universities.