Extreme Heat

Increasing frequency, duration, and intensity of periods of extreme heat heighten the risks of heat-related morbidity and mortality (Smith et al., 2016; Xiang, Bi, Pisaniello, & Hansen, 2014). In addition to outdoor laborers, such as farm, utility, delivery, and construction workers, others who work in environments where there usually is no air conditioning, such as warehouses and railyards, are at increased risk (Gubernot, Anderson, & Hunting, 2014). In general, workers with few or no rest periods and with limited access to water and cool spaces are at an especially high risk (Kjellstrom, Freyberg, Lemke, Otto, & Briggs, 2018).

Acute health effects of exposure to extreme heat include heat exhaustion, heat rash (prickly heat), heat syncope, dehydration, heat stroke, and complications of many chronic diseases, including chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus, and chronic kidney disease. Chronic health effects due to continued heat exposure also include mental health problems such as anxiety, depression, and suicide; chronic kidney disease, possibly due to recurrent dehydration and other factors; and congenital malformations of the heart and brain in infants of women who worked during early pregnancy in physically demanding jobs. In addition to the direct effects of heat on workers’ health, heat may also increase risk of injury, as shown in a study in Thailand (Tawatsupa, 2013) and a study of Deepwater Horizon oil spill clean-up workers (Garzon-Villalba et al., 2016).

Increased ambient temperature due to climate change may cause or contribute to chronic kidney disease of unknown etiology among agricultural workers in tropical areas (Moyce et al., 2017; Nerbass et al., 2017; Roncal-Jimenez et al., 2016; Tawatsupa et al., 2012; Wesseling et al., 2013). From 1993 through 2013 in Mexico and Central America, increased temperature and working conditions with resultant dehydration may have caused deaths related to chronic kidney disease in approximately 20,000 agricultural workers (Roncal-Jimenez et al., 2016).

In some areas in the Middle East and elsewhere, human life may not be sustainable in the near future. In 2015, in the Iranian port city of Bandar Mahshahr, the heat index (which incorporates absolute temperature and humidity) reached 165^oF (75^oC), based on an outdoor air temperature of 115^oF (45^oC), which has a dew point temperature of 90^oF (32^oC) (Samenow, 2015). Agricultural workers in tropical parts of Southeast Asia are expected to be markedly impacted because of high daytime temperatures and agricultural work shifts will likely be shortened dramatically (Kjellstrom et al., 2018). Since heat tolerance and adaptation are generally relative to anticipated heat (Spector & Sheffield, 2014), even in nontropical areas adverse effects of outdoor heat on workers will likely occur more frequently as summers become warmer (Adam-Poupart et al., 2014).

Increased ambient temperature due to climate change may also increase occupational exposure to hazardous chemicals and their adverse effects on workers (Balbus et al., 2013). Climate change will likely increase exposure to many environmental pollutants, such as by increased volatilization due to warmer temperature, which can result in airborne transport of chemicals for long distances (Bourbonnais et al., 2013). In addition, increased temperature and higher moisture content in the atmosphere may increase the environmental persistence of some chemicals.

Wildfires

Climate change is increasing the frequency and severity of wildfires. As a result, the frequency and severity of resultant occupational health and safety hazards, such as falling trees and heat exhaustion, and the numbers of fatal and nonfatal injuries among firefighters and other responders are increasing (Britton et al., 2013; Withen, 2015). Firefighters also suffer burns, smoke inhalation, transportation-related injuries, and cardiac arrest (Adetona et al., 2016; Britton et al., 2013). Smoke inhalation from fires, in addition to excessive heat, is a potential hazard for other workers (Shaposhnikov et al., 2014).

Extreme Weather Events

Many workers are at high risk of occupational hazards from extreme weather events such as hurricanes, which will likely increase in frequency and severity with climate change. Extreme weather events pose a variety of health and safety hazards to rescue and recovery workers, such as injuries from slips and falls and from being struck by airborne objects, inadequate sleep and nutrition because of long and uninterrupted work shifts, physical exhaustion, mental stress, and vehicular crashes (Leon, Hyre, Ompad, Desalvo, & Muntaner, 2007). Floods, landslides, lightning strikes, and wildfires pose serious hazards. Heavy snowstorms can cause roof collapses and related hazards for workers (“Worker dies,” 2015).

Following an extreme weather event, rescue and recovery workers may be exposed to toxic substances, asbestos and other hazardous dusts, and mold. Clean-up workers after Hurricane Katrina, which hit New Orleans and the surrounding Gulf Coast region in 2005, developed “Katrina cough” from exposure to airborne particles and microbial agents (Noe et al., 2007; Rando, Lefante, Freyder, & Jones, 2012). Following Hurricane Sandy, which hit the New York-New Jersey coast in 2012, tree and landscaping workers suffered from increased injury rates (Ochsner et al., 2018).

Extreme weather events may also undermine safety controls. An example of this problem occurred at the Arkema Chemical plant in Crosby, Texas, following Hurricane Harvey in 2017. Numerous plant workers, first responders, and community residents were adversely affected by a series of chemical explosions at the plant, which resulted from flood waters cutting power to refrigeration units there (Newkirk, 2017).

Worker safety may be compromised after extreme weather events if newly recruited recovery workers are not adequately trained or if safety regulations are not enforced (Campbell, 2017). After three major hurricanes in the fall of 2017, the US Occupational Safety and Health Administration suspended enforcement of safety regulations for more than a month in hurricane-affected areas in Texas, Florida, and Puerto Rico (Gonzalez, 2017).

Air Pollution

Warmer temperatures will likely cause more air pollution, especially with ground-level ozone and fine particulate matter (Bell et al., 2007; Fiore, Naik, & Leibensperger, 2015; US Global Change Research Program, 2016). In addition to wildfires, droughts (with associated wind-blown soil and dust) will contribute to air pollution. Increased pollen production and longer pollen seasons are causing more allergic disorders among workers and others. Workers most likely to be impacted by increased air pollution include outdoor workers in urban environments, firefighters, drivers, and workers in indoor spaces without filtered air.

Biological Hazards and Pesticides

In the United States, many workers are already at risk of tick-borne illnesses such as Lyme disease (Schulte et al., 2016). Climate change is broadening the range of disease vectors (such as ticks and mosquitoes), thereby increasing disease risks of outdoor workers in the construction, utility, recreation, agriculture, forestry, landscaping, and natural-resource-management sectors (Moore et al., 2017). As the incidence of vector-borne diseases rises, there will likely be greater application of pesticides accompanied by increasing pesticide exposure to agricultural workers, landscapers, and pest control workers (Boxall et al., 2010; Gatto, Cabella, & Gherardi, 2016).

Psychological Stress and Productivity Losses

Extreme weather events may increase stress on workers, especially rescue and recovery workers and healthcare workers (Brooks, Dunn, Amlôt, Greenberg, & Rubin, 2016; Leon et al., 2007). Extreme heat will likely reduce worker productivity and increase stress, such as changing work hours, thereby causing conflicts between workers and employers and between workers and their family members (Kjellstrom, 2016; Marchetti, Capone, & Freda, 2016; Sahu, Sett, & Kjellstrom, 2013).

Workplace Strategies

Health and safety management practices, including management commitment and employee participation in hazard recognition, assessment, and control, should address new and increased hazards resulting from climate change. The adaptive management approach promoted by the BRACE framework can help employers and workers adapt to the new normal. Employer preparedness includes:

Employer preparedness may involve dramatic changes in work operations, scheduling, and building safety. It may also involve integration and interaction with other types of preparedness, such as establishing communication links to reach workers at home or involving fire departments in process safety management (Occupational Safety and Health Administration [OSHA], 2018). The Emergency Responder Health Monitoring and Surveillance framework of NIOSH provides recommendations to protect emergency responders in any setting. It can facilitate integration of worker health monitoring into incident command structures and can guide long-term monitoring of potential health effects resulting from emergency-response exposures (National Institute for Occupational Safety and Health [NIOSH], 2018).

Beyond emergencies, employers need to recognize worker health and safety hazards and integrate occupational health and safety into long-term planning. Detailed guidance for employers already exists for some recognized hazards faced by workers, such as extreme heat (Jacklitsch et al., 2016). However, this guidance may need to be adapted for climate change-related hazards that vary and are unpredictable (Bethel, Spector, & Krenz, 2017). In addition, new training will be required to create worker awareness of new or more intense hazards due to climate change and to inform employers on how work may need to be modified to address these hazards (Chan, Yi, Wong, Yam, & Chan, 2012; Nag, Dutta, & Nag, 2013; Riley, Delp, Cornelio, & Jacobs, 2012; Singh, Hanna, & Kjellstrom, 2013). In the United States, federal agencies are improving worker training for disaster response and clean-up workers (National Clearinghouse for Worker Safety and Health Training, 2015; OSHA, 2018). Nevertheless, employers are responsible for providing training and equipment to protect workers (Delp, Podolsky, & Aguilar, 2009). New technologies and equipment, including sensors and climate-adapted personal protective equipment, are being developed to improve protection of workers facing threats due to climate change (Chan et al., 2016).

Prevention Through Design

Prevention-through-design strategies can be implemented to embed worker health and safety into building a more resilient infrastructure and energy-efficient buildings. For example, renewable energy facilities, such as wind-turbine farms, can be designed to prevent injuries to maintenance workers. In addition, standards for office buildings that previously focused on energy use can be revised to comply with ventilation and other requirements for workers (NIOSH, 2018).

Research

Occupational safety and health research should be expanded. It should include (a) investigating climate change-related hazards and at-risk populations; (b) using surveillance data on diseases, injuries, and occupational hazards to guide research agendas; and (c) developing, implementing, and evaluating new adaptation measures (Adam-Poupart et al., 2013; Schulte & Chun, 2009).

Surveillance

Public health surveillance is the “ongoing, systematic collection, analysis, and interpretation of health data, essential to the planning, implementation, and evaluation of public health practice, closely integrated with the dissemination of these data to those who need to know ” (National Academies of Sciences, Engineering, and Medicine, 2018, p. 21). Surveillance can be used to identify the impact of climate change on worker health; to help establish research agendas; and to help plan, implement, and evaluate preventive measures. Data from “sentinel events” due to climate change can be analyzed so that lessons can be learned to prevent similar problems in the future (Pierce, 2017).

Current public health surveillance systems that depend upon employers’ reports to government agencies are not sufficient to detect the impacts of climate change on workers’ health (Harduar Morano et al., 2017). New approaches will be needed. For example, data from emergency departments may be necessary for surveillance of worker injuries due to extreme weather events, such as storms and heat waves (Harduar Morano et al., 2015; Ochsner et al., 2018). In the United States, the Council of State and Territorial Epidemiologists is addressing this need by developing climate-change indicators that could obtain data related to occupational health and safety problems (English et al., 2009; Harduar Morano et al., 2017).

Occupational Medicine and Clinical Response

Clinicians have important roles to play in recognizing, diagnosing, treating, and preventing workers’ adverse health effects caused by climate change (Patz, Frumkin, Holloway, Vimont, & Haines, 2014). Clinicians should educate themselves and their colleagues about these adverse health effects, especially those that are temporally and geographically relevant to their communities. They should also educate their patients who are at high risk for specific disorders due to climate change, such as older people and outdoor workers who are at increased risk of heat-related disorders and patients with chronic respiratory disorders who are more frequently exposed to hazardous levels of air pollutants. Public health surveillance systems depend on clinicians’ diagnoses and their cooperation in sharing data with health departments. In addition to their roles in advising their patients to take individual preventive measures, clinicians can play important roles in supporting policies to mitigate the production of greenhouse gases and supporting programs to help communities adapt to the consequences of climate change, such as increased frequency of heat waves, wildfires, and extreme weather events.

Workplace Standards and Policies

Regulations and guidelines for the prevention of climate change–related occupational hazards, such as extreme heat, will need to be developed and implemented (Parsons, 2013). Safety regulations for hazards caused by extreme weather events may need to be applied to more workers and work situations. Regulations and guidelines to encourage employer preparedness will need to be improved (Bruce, 2012; Lucchini et al., 2017).