The use of pesticide in agriculture is on the rise in Pakistan. The studies have identified that due to hazardous use of pesticides, health and environmental effects are mounting. This study answers three questions relating to pesticide use in Pakistan, 1) Whether small and poor farmers use more amounts of pesticides?, 2) Whether poor farmers use more toxic pesticides than non poor farmers?, 3) Is pesticide use and its associated health effects, impacting the poor farmers to a greater extent than the non-poor farmers? Using structured questionnaire, 318 farmers were interviewed in the cotton belt in Punjab, an area known for extremely intensive cotton production and pesticide use. Results show that although the poor are currently using smaller amounts of pesticides, they are using relatively more toxic pesticides. Resultantly, poor farmers reported experiencing relatively higher number of pesticide associated illness. The study recommends that policy measures addressing health and environmental issues of pesticide use should focus on poor farmers.