Outcomes of a Heat Stress Awareness Program on Heat-Related Illness in Municipal Outdoor Workers

Summarizing Recommendations for the Prevention of Occupational Heat-Related Illness in Outdoor Workers: A Scoping Review

BACKGROUND

Outdoor workers face unique challenges in preventing heat-related illnesses (HRI). Although preventable, HRI and death from heat exposure continue. A review of the most recent recommendation for HRI prevention in outdoor workers in the United States was warranted. A scoping review using PRISMA guidelines was conducted to compile policy statements and recommendations on the prevention of HRI and synthesize them into a three-step plan for prevention using the Haddon Matrix.

METHOD

PubMed, CINAHL, Medline, and websites from organizations and regulating bodies were searched for sources. Key terms such as occupational OR workers OR employers OR policymakers, HRI OR heat stress OR heat, prevention, recommendations OR position statements were used. Inclusion criteria were articles published within the last 5 years written in English and containing recommendations for preventing HRI in outdoor workers. Research not based on U.S. workers was excluded from the review.

RESULTS

Twenty sources comprised the review. Several themes emerged, indicating deficient recommendations for secondary and tertiary prevention.

CONCLUSION/APPLICATION TO PRACTICE

This review's findings can be used by occupational health nurses (OHNs) in developing comprehensive interventions for preventing HRI and injury, using clear language, and following evidenced-based practices to increase workplace health and safety and promote equity.

Climate change and occupational health and safety. Risk of injuries, productivity loss and the co-benefits perspective

BACKGROUND

Climate change is a fundamental threat to human health and outdoor workers are one of the most vulnerable population subgroups. Increasing heat stress and heatwaves are directly associated with the health and safety of workers for a large spectrum of occupations. Heat stress negatively affects labour supply, productivity, and workability.

OBJECTIVES

The aims of this study are to estimate the risk of work-related injuries for extreme temperature outdoor exposure in Italy, to evaluate the loss in productivity and the associated insurance costs for supporting the co-benefits analysis of the adaptation measures.

METHODS

The relationship between air temperature and occupational injuries (in the period 2014-19) was evaluated using a time-series approach, by means of a specific over-dispersed Poisson generalized linear regression model, applied to compensation data. To assess the effect of temperature on workability, the wet bulb global temperature (WBGT) was estimated by different levels of humidity and vapor pressure. The costs of injuries have been estimated according to the potential consequences in terms of paid insurance premium and including all management and human resources costs.

RESULTS

We estimated 25,632 (95%CI 22,353-28,862) occupational injuries in Italy attributed to heat (between 75° and 99° percentiles) in the period 2014-2019, which corresponds to an average of 4272 cases for year. A decrease in productivity of about 6.5% was estimated for workers engaged in physical activities requiring high metabolic rates for every unit degree increase in temperature between 19.6 C° and 31.8 C°. The overall compensation costs associated to extreme heat exposure have been estimated to more than 292 million euros between 2014 and 2019, almost equal to 49 million euros per year.

DISCUSSION

Prevention measures and adaptation strategies for contrasting the occupational exposure to extreme temperatures can help contain both the risk of injury and, productivity loss, in a co-benefits perspective.

Impact of individual and work factors on the heat-related consequences among power plant workers in a hot region

Prolonged exposure to hot environments increases the probability of heat load that may cause occupational heat strain to workers. This study investigates the impact of individual and work-related factors on the heat-related consequences among power plant workers in a hot region. This cross-sectional study was conducted in 2020. The collecting data tool was a validated self-reported 26 item questionnaire and completed in 534 individuals. We used logistic regression, Adjusted odds ratio (AOR) and maximum likelihood evaluations for data analysis. The findings indicated that age, work environment, physical work demands and drinking fluids during work hours are significant with heat exposure perception, heat-related symptoms, and work performance (P-value<0.05). Further, the male workers aged 40-49 are more prone to heat-related symptoms (AOR 1.34, 95% CI 1.18-2.13). The importance of addressing heat stress in occupational settings is necessary and informing strategies to help workers adapt to heat in hot workplaces.

Novel Method for Measuring Ambient Heat Exposure-Acute Healthcare Utilization Associations Within a Safety Net: A Retrospective, Longitudinal Study

BACKGROUND

Extreme and inequitable heat exposures cause weather-related deaths. Associations between maximum daily temperature and individual-level healthcare utilization have been inadequately characterized.

OBJECTIVE

To evaluate and compare demographic and clinical associations for an individual's healthcare utilization between high- and low-temperature periods.

DESIGN

Retrospective, 5-year longitudinal study of acute care utilization comparing high-temperature periods (HHP) and low-temperature periods (LHP) defined by local maximum daily temperature. Using duration of observation, cases served as their own controls. Temperature-dependent utilization was reported as unadjusted incident rate ratio (IRR) using Poisson regression and log-transformed variable coefficients. IRRs were adjusted (aIRR) for demographic characteristics, heat-sensitive conditions/diagnoses, and neighborhood heat vulnerability score; false discovery rate p-values were adjusted for multiple comparisons.

SUBJECTS

Patients aged ≥ 4 years visiting Denver Health between 4/10/2016 and 12/31/2020, with ≥ 2 visits over ≥ 365 days.

MAIN MEASURES

Comparison of an individual's acute care visit rates in HHP versus LHP, stratified by demographic characteristics and heat-sensitive clinical conditions.

KEY RESULTS

While acute care utilization occurred at similar or higher rates during LHP compared with HHP, certain groups (i.e., Native Americans and those with congestive heart failure, liver failure, and/or alcohol use) had higher rates of utilization during HHP. Significant associations existed for acute care utilization by age, sex, racial and ethnic groupings, clinical characteristics, and neighborhood heat vulnerability. Adjusting for demographic and environmental covariates, individuals with any heat-sensitive clinical condition had higher HHP vs LHP utilization compared to those without (aIRR = 1.93).

CONCLUSIONS

Significant heat-related utilization occurred among individuals with heat-sensitive clinical conditions compared with those without. Demographic characteristics (e.g., older) and specific clinical conditions (e.g., liver failure) demonstrated higher utilization. In real-time, chronic disease management programs could proactively identify at-risk individuals for interventions which reduce heat-related morbidity and healthcare utilization.

Extreme Heat and Occupational Health Risks

Climate change poses a significant occupational health hazard. Rising temperatures and more frequent heat waves are expected to cause increasing heat-related morbidity and mortality for workers across the globe. Agricultural, construction, military, firefighting, mining, and manufacturing workers are at particularly high risk for heat-related illness (HRI). Various factors, including ambient temperatures, personal protective equipment, work arrangements, physical exertion, and work with heavy equipment may put workers at higher risk for HRI. While extreme heat will impact workers across the world, workers in low- and middle-income countries will be disproportionately affected. Tracking occupational HRI will be critical to informing prevention and mitigation strategies. Renewed investment in these strategies, including workplace heat prevention programs and regulatory standards for indoor and outdoor workers, will be needed. Additional research is needed to evaluate the effectiveness of interventions in order to successfully reduce the risk of HRI in the workplace.

Outcomes for a Heat Illness Prevention Program in Outdoor Workers: A 9-Year Overview

OBJECTIVE

To describe the outcomes effect of removing the medical surveillance component from a heat illness prevention program (HIPP) for outdoor workers from a Central Texas municipality.

METHODS

Heat-related illness (HRI) frequency and workers' compensation (WC) cost were assessed retrospectively in a cohort of 329 workers from 2011-2019. During 2011-2017, the HIPP included training, acclimatization, and medical surveillance. In 2018-2019, a modified (mHIPP) was implemented that included training and acclimatization, but without medical surveillance.

RESULTS

The HRI rate during HIPP averaged 19.5 per 1000 workers during the first 4 years, dropped to 1.01 per 1,000 workers over the next 3 years, (2015-2017), and increased during mHIPP, to 7.6 per 1,000 workers.

DISCUSSION

Although the case increase during the mHIPP was small, medical surveillance may be an important component in lowering workforce HRI.

Current and projected heatwave-attributable occupational injuries, illnesses, and associated economic burden in Australia

INTRODUCTION

The costs of global warming are substantial. These include expenses from occupational illnesses and injuries (OIIs), which have been associated with increases during heatwaves. This study estimated retrospective and projected future heatwave-attributable OIIs and their costs in Australia.

MATERIALS AND METHODS

Climate and workers' compensation claims data were extracted from seven Australian capital cities representing OIIs from July 2005 to June 2018. Heatwaves were defined using the Excess Heat Factor. OIIs and associated costs were estimated separately per city and pooled to derive national estimates. Results were projected to 2030 (2016-2045) and 2050 (2036-2065).

RESULTS

The risk of OIIs and associated costs increased during heatwaves, with the risk increasing during severe and particularly extreme heatwaves. Of all OIIs, 0.13% (95% empirical confidence interval [eCI]: 0.11-0.16%) were heatwave-attributable, equivalent to 120 (95%eCI:70-181) OIIs annually. 0.25% of costs were heatwave-attributable (95%eCI: 0.18-0.34%), equal to $AU4.3 (95%eCI: 1.4-7.4) million annually. Estimates of heatwave-attributable OIIs by 2050, under Representative Concentration Pathway [RCP]4.5 and RCP8.5, were 0.17% (95%eCI: 0.10-0.27%) and 0.23% (95%eCI: 0.13-0.37%), respectively. National costs estimates for 2030 under RCP4.5 and RCP8.5 were 0.13% (95%eCI: 0.27-0.46%) and 0.04% (95%eCI: 0.66-0.60), respectively. These estimates for extreme heatwaves were 0.04% (95%eCI: 0.02-0.06%) and 0.04% (95%eCI: 0.01-0.07), respectively. Cost-AFs in 2050 were, under RCP4.5, 0.127% (95%eCI: 0.27-0.46) for all heatwaves and 0.04% (95%eCI: 0.01-0.09%) for extreme heatwaves. Attributable fractions were approximately similar to baseline when assuming theoretical climate adaptation.

DISCUSSION

Heatwaves represent notable and preventable portions of preventable OIIs and economic burden. OIIs are likely to increase in the future, and costs during extreme heatwaves in 2030. Workplace and public health policies aimed at heat adaptation can reduce heat-attributable morbidity and costs.

Effects of Temperatures and Heatwaves on Occupational Injuries in the Agricultural Sector in Italy

The effects of heat on health have been well documented, while less is known about the effects among agricultural workers. Our aim is to estimate the effects and impacts of heat on occupational injuries in the agricultural sector in Italy. Occupational injuries in the agricultural sector from the Italian national workers' compensation authority (INAIL) and daily mean air temperatures from Copernicus ERA5-land for a five-year period (2014-2018) were considered. Distributed lag non-linear models (DLNM) were used to estimate the relative risk and attributable injuries for increases in daily mean air temperatures between the 75th and 99th percentile and during heatwaves. Analyses were stratified by age, professional qualification, and severity of injury. A total of 150,422 agricultural injuries were considered and the overall relative risk of injury for exposure to high temperatures was 1.13 (95% CI: 1.08; 1.18). A higher risk was observed among younger workers (15-34 years) (1.23 95% CI: 1.14; 1.34) and occasional workers (1.25 95% CI: 1.03; 1.52). A total of 2050 heat-attributable injuries were estimated in the study period. Workers engaged in outdoor and labour-intensive activities in the agricultural sector are at greater risk of injury and these results can help target prevention actions for climate change adaptation.

Impact of climate change on occupational health and safety: A review of methodological approaches

BACKGROUND

The working population is exposed daily to unavoidable climatic conditions due to their occupational settings. Effects of the weather such as rain, heat, and air pollution may increase the risk of diseases, injuries, accidents, and even death during labor.

OBJECTIVE

This paper aims to summarize the impacts of climate change on workers' health, safety and performance, identifying the risks, affected workplaces and the range of methodological approaches used to assess this problem.

METHODS

A thorough systematic mapping was conducted in seven scientific international databases: Emerald, IEEE Xplore, Science Direct, Scielo, Scopus, SpringerLink, and Web of Science. Three research questions guided the extraction process resulting in 170 articles regarding the impacts of climate change on occupational health and safety.

RESULTS

We found an accentuated trend in observational studies applying primary and secondary data collection. Many studies focused on the association between rising temperatures and occupational hazards, mainly in outdoor work settings such as agriculture. The variation of temperature was the most investigated impact of climate change.

CONCLUSIONS

We established a knowledge base on how to explore the impacts of climate change on workers' well-being and health. Researchers and policymakers benefit from this review, which explores the suitable methods found in the literature and highlights the most recurring risks and their consequences to occupational health and safety.

Impact of occupational heat stress on worker productivity and economic cost

Heat stress is a growing concern in the occupational setting as it endangers worker health, safety, and productivity. Heat-related reductions in physical work capacity and missed workdays directly and indirectly cause productivity losses and may substantially affect the economic wellbeing of the organization. This review highlights the physiological, physical, psychological, and financial harms of heat stress on worker productivity and proposes strategies to quantify heat-related productivity losses. Heat stress produces a vicious-cycle feedback loop that result in adverse outcomes on worker health, safety, and productivity. We propose a theoretical model for implementing an occupational heat safety plan that disrupts this loop, preventing heat-related productivity losses while improving worker health and safety.

Prevention of Occupational Heat-Related Illnesses

High ambient temperatures and strenuous physical activity put workers at risk for a variety of heat-related illnesses and injuries. Through primary prevention, secondary prevention, and treatment, OEM health providers can protect workers from the adverse effects of heat. This statement by the American College of Occupational and Environmental Medicine provides guidance for OEM providers who serve workers and employers in industries where heat exposure occurs.

Heat Safety in the Workplace: Modified Delphi Consensus to Establish Strategies and Resources to Protect the US Workers

The purpose of this consensus document was to develop feasible, evidence-based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus-based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best-practices and protect worker health and productivity.

Occupational heat stress and economic burden: A review of global evidence

BACKGROUND

The adverse effects of heat on workers' health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change.

METHODS

Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English.

RESULTS

Twenty studies met criteria for inclusion. Eighteen studies estimated costs secondary to heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.4-2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, medium-sized businesses, amongst males, and workers aged 25-44 years.

CONCLUSIONS

The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted. Key messages. The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies.

Heat Stress-Related Symptoms among Bakery Workers in Lebanon: A National Cross-Sectional Study

Heat exposure is linked to a range of heat-related illnesses and injuries. This study assessed the association between workers’ perceptions of the work environment and reports of heat stress-related health symptoms in bakery workers in Lebanon. A national cross-sectional survey of workers was carried out in 504 bakeries in Lebanon. One worker in each bakery was interviewed using questions relating to the workplace environment and heat stress-related health symptoms. Heat and humidity measurements were recorded in bakeries. Descriptive analyses were performed, and logistic regression assessed relationships between the workplace environment, worker perceptions, and reports of heat stress-related health symptoms. In total, 47.2% of workers experienced heat stress-related symptoms, 83% perceived workplace temperatures as hot, and 48% perceived these temperatures as affecting their health. Humidex readings showed that 49% of bakeries had conditions unsafe for routine work tasks. Working under pressure (AOR = 1.65; 95% CI = 1.12-2.43), job dissatisfaction (AOR = 1.76; 95% CI = 1.12-2.79), and perceptions that high temperatures negatively affected health (AOR = 2.73; 95% CI = 1.87-3.99) were all significantly correlated to reports of heat stress-related symptoms. Females were more likely to experience heat stress-related symptoms (AOR = 1.96; 95% CI = 1.13-3.39). Workers who reported low levels of water consumption at work were also more likely to experience heat stress-related health symptoms. We conclude that heat exposure potentially impacts workers’ health in Lebanese bakeries. Improvements in workplace conditions, adequate infrastructure, and workers’ training are key interventions for maintaining workers’ health.

Evaluating the effectiveness of labor protection policy on occupational injuries caused by extreme heat in a large subtropical city of China

On March 1, 2012, the Chinese government implemented the Administrative Measures on Heatstroke Prevention (AMHP2012) to combat the occupational health impacts of extreme heat, and reducing occupational injury was one of the main purposes. This study aimed at quantifying the intervention effects of the AMHP2012 on extreme heat-related occupational injuries and subsequent insurance payouts in Guangzhou, China. Data on occupational injuries and insurance payouts were collected from March 1, 2011, to February 28, 2013, from the occupational injury insurance system of Guangzhou. A quasi-experimental design with before-after control was adopted. Interrupted time series analysis was performed to quantify the change of occupational injuries and insurance payouts after policy implementation. The distributed lag non-linear model was used to explore whether injury claims and insurance payouts due to extreme heat decreased. A total of 9851 injury claims were included in the analysis. After policy implementation, the risk of occupational injuries and insurance payouts decreased by 13% (RR = 0.87, 95%CI: 0.75, 0.99) and 24% (RR = 0.76, 95% CI: 0.58, 0.94), respectively. The attributable fraction of extreme heat-related occupational injuries decreased from 3.17% (95%eCI: 1.35, 4.69) to 1.52% (95%eCI: -0.36, 3.15), which contributed to 0.86 million USD reduction of insurance payouts. Both males and females, low-educated, young and middle-aged workers, workers at small or medium-sized enterprises, engaging in manufacturing, and with both minor and severe injuries were apparently associated with decreased rates of extreme heat-related occupational injuries. The AMHP2012 policy contributed to the reduction of extreme heat-related occupational injuries and insurance payouts in Guangzhou, China, and this research provided novel evidence for decision-makers to better understand the necessity of implementing health protection policies among laborers under climate change.