Climate Change,Workplace Heat Exposure,and Occupational Health and Productivity in Central America

Abstract

Climate change is increasing heat exposure in places such as Central America, a tropical region with generally hot/humid conditions. Working people are at particular risk of heat stress because of the intrabody heat production caused by physical labor. This article aims to describe the risks of occupational heat exposure on health and productivity in Central America, and to make tentative estimates of the impact of ongoing climate change on these risks. A review of relevant literature and estimation of the heat exposure variable wet bulb globe temperature (WBGT) in different locations within the region were used to estimate the effects. We found that heat stress at work is a real threat. Literature from Central America and heat exposure estimates show that some workers are already at risk under current conditions. These conditions will likely worsen with climate change, demonstrating the need to create solutions that will protect worker health and productivity.     

Excessive Heat and Respiratory Hospitalizations in New York State: Estimating Current and Future Public Health Burden Related to Climate Change

Background: Although many climate-sensitive environmental exposures are related to mortality and morbidity, there is a paucity of estimates of the public health burden attributable to climate change.Objective: We estimated the excess current and future public health impacts related to respiratory hospitalizations attributable to extreme heat in summer in New York State (NYS) overall, its geographic regions, and across different demographic strata.Methods: On the basis of threshold temperature and percent risk changes identified from our study in NYS, we estimated recent and future attributable risks related to extreme heat due to climate change using the global climate model with various climate scenarios. We estimated effects of extreme high apparent temperature in summer on respiratory admissions, days hospitalized, direct hospitalization costs, and lost productivity from days hospitalized after adjusting for inflation.Results: The estimated respiratory disease burden attributable to extreme heat at baseline (1991–2004) in NYS was 100 hospital admissions, US$644,069 in direct hospitalization costs, and 616 days of hospitalization per year. Projections for 2080–2099 based on three different climate scenarios ranged from 206–607 excess hospital admissions, US$26–$76 million in hospitalization costs, and 1,299–3,744 days of hospitalization per year. Estimated impacts varied by geographic region and population demographics.Conclusions: We estimated that excess respiratory admissions in NYS due to excessive heat would be 2 to 6 times higher in 2080–2099 than in 1991–2004. When combined with other heat-associated diseases and mortality, the potential public health burden associated with global warming could be substantial.     

Mapping vulnerability to climate change and its repercussions on human health in Pakistan

ABSTRACT: BACKGROUND: Pakistan is highly vulnerable to climate change due to its geographic location, high dependence on agriculture and water resources, low adaptive capacity of its people, and weak system of emergency preparedness. This paper is the first ever attempt to rank the agro-ecological zones in Pakistan according to their vulnerability to climate change and to identify the potential health repercussions of each manifestation of climate change in the context of Pakistan. METHODS: A climate change vulnerability index is constructed as an un-weighted average of three sub-indices measuring (a) the ecological exposure of each region to climate change, (b) sensitivity of the population to climate change and (c) the adaptive capacity of the population inhabiting a particular region. The regions are ranked according to the value of this index and its components. Since health is one of the most important dimensions of human wellbeing, this paper also identifies the potential health repercussions of each manifestations of climate change and links it with the key manifestations of climate change in the context of Pakistan. RESULTS: The results indicate that Balochistan is the most vulnerable region with high sensitivity and low adaptive capacity followed by low-intensity Punjab (mostly consisting of South Punjab) and Cotton/Wheat Sindh. The health risks that each of these regions face depend upon the type of threat that they face from climate change. Greater incidence of flooding, which may occur due to climate variability, poses the risk of diarrhoea and gastroenteritis; skin and eye Infections; acute respiratory infections; and malaria. Exposure to drought poses the potential health risks in the form of food insecurity and malnutrition; anaemia; night blindness; and scurvy. Increases in temperature pose health risks of heat stroke; malaria; dengue; respiratory diseases; and cardiovascular diseases. CONCLUSION: The study concludes that geographical zones that are more exposed to climate change in ecological and geographic terms- such as Balochistan, Low-Intensity Punjab, and Cotton-Wheat Sindh -also happen to be the most deprived regions in Pakistan in terms of socio-economic indicators, suggesting that the government needs to direct its efforts to the socio-economic uplift of these lagging regions to reduce their vulnerability to the adverse effects of climate change.     

Managing the Health Effects of Temperature in Response to Climate Change: Challenges Ahead

Background: Although many studies have shown that high temperatures are associated with an increased risk of mortality and morbidity, there has been little research on managing the process of planned adaptation to alleviate the health effects of heat events and climate change. In particular, economic evaluation of public health adaptation strategies has been largely absent from both the scientific literature and public policy discussion.Objectives: We examined how public health organizations should implement adaptation strategies and, second, how to improve the evidence base required to make an economic case for policies that will protect the public’s health from heat events and climate change.Discussion: Public health adaptation strategies to cope with heat events and climate change fall into two categories: reducing the heat exposure and managing the health risks. Strategies require a range of actions, including timely public health and medical advice, improvements to housing and urban planning, early warning systems, and assurance that health care and social systems are ready to act. Some of these actions are costly, and given scarce financial resources the implementation should be based on the cost-effectiveness analysis. Therefore, research is required not only on the temperature-related health costs, but also on the costs and benefits of adaptation options. The scientific community must ensure that the health co-benefits of climate change policies are recognized, understood, and quantified.Conclusions: The integration of climate change adaptation into current public health practice is needed to ensure the adaptation strategies increase future resilience. The economic evaluation of temperature-related health costs and public health adaptation strategies are particularly important for policy decisions.     

Health Impacts of Workplace Heat Exposure: An Epidemiological Review

With predicted increasing frequency and intensity of extremely hot weather due to changing climate, workplace heat exposure is presenting an increasing challenge to occupational health and safety. This article aims to review the characteristics of workplace heat exposure in selected relatively high risk occupations, to summarize findings from published studies, and ultimately to provide suggestions for workplace heat exposure reduction, adaptations, and further research directions. All published epidemiological studies in the field of health impacts of workplace heat exposure for the period of January 1997 to April 2012 were reviewed. Finally, 55 original articles were identified. Manual workers who are exposed to extreme heat or work in hot environments may be at risk of heat stress, especially those in low-middle income countries in tropical regions. At risk workers include farmers, construction workers, fire-fighters, miners, soldiers, and manufacturing workers working around process-generated heat. The potential impacts of workplace heat exposure are to some extent underestimated due to the underreporting of heat illnesses. More studies are needed to quantify the extent to which high-risk manual workers are physiologically and psychologically affected by or behaviourally adapt to workplace heat exposure exacerbated by climate change.     

Local heat stroke prevention plans in Japan: characteristics and elements for public health adaptation to climate change

The adverse health effects from hot weather and heat waves represent significant public health risks in vulnerable areas worldwide. Rising temperatures due to climate change are aggravating these risks in a context of fast urbanization, population growth and societal ageing. However, environmental heat-related health effects are largely preventable through adequate preparedness and responses. Public health adaptation to climate change will often require the implementation of heat wave warning systems and targeted preventive activities at different levels. While several national governments have established such systems at the country level, municipalities do not generally play a major role in the prevention of heat disorders. This paper analyzes selected examples of locally operated heat-health prevention plans in Japan. The analysis of these plans highlights their strengths, but also the need of local institutions for assistance to make the transition towards an effective public health management of high temperatures and heat waves. It can also provide useful elements for municipal governments in vulnerable areas, both in planning their climate change and health adaptation activities or to better protect their communities against current health effects from heat.     

Risk-based consumption advice for farmed Atlantic and wild Pacific salmon contaminated with dioxins and dioxin-like compounds

We reported recently that several organic contaminants occurred at elevated concentrations in farmed Atlantic salmon compared with concentrations of the same contaminants in wild Pacific salmon [Hites et al. Science 303: 226-229 (2004)]. We also found that polychlorinated biphenyls (PCBs), toxaphene, dieldrin, dioxins, and polybrominated diphenyl ethers occurred at higher concentrations in European farm-raised salmon than in farmed salmon from North and South America. Health risks (based on a quantitative cancer risk assessment) associated with consumption of farmed salmon contaminated with PCBs, toxaphene, and dieldrin were higher than risks associated with exposure to the same contaminants in wild salmon. Here we present information on cancer and noncancer health risks of exposure to dioxins in farmed and wild salmon. The analysis is based on a tolerable intake level for dioxin-like compounds established by the World Health Organization and on risk estimates for human exposure to dioxins developed by the U.S. Environmental Protection Agency. Consumption of farmed salmon at relatively low frequencies results in elevated exposure to dioxins and dioxin-like compounds with commensurate elevation in estimates of health risk.     

Climate change and extreme heat events

The association between climate change and the frequency and intensity of extreme heat events is now well established. General circulation models of climate change predict that heatwaves will become more frequent and intense, especially in the higher latitudes, affecting large metropolitan areas that are not well adapted to them. Exposure to extreme heat is already a significant public health problem and the primary cause of weather-related mortality in the U.S. This article reviews major epidemiologic risk factors associated with mortality from extreme heat exposure and discusses future drivers of heat-related mortality, including a warming climate, the urban heat island effect, and an aging population. In addition, it considers critical areas of an effective public health response including heat response plans, the use of remote sensing and GIS methodologies, and the importance of effective communications strategies.     

Health impacts of climate change and health and social inequalities in the UK

This article examines how social and health inequalities shape the health impacts of climate change in the UK, and what the implications are for climate change adaptation and health care provision. The evidence generated by the other articles of the special issue were interpreted using social justice reasoning in light of additional literature, to draw out the key implications of health and social inequalities for health outcomes of climate change. Exposure to heat and cold, air pollution, pollen, food safety risks, disruptions to access to and functioning of health services and facilities, emerging infections and flooding are examined as the key impacts of climate change influencing health outcomes. Age, pre-existing medical conditions and social deprivation are found to be the key (but not only) factors that make people vulnerable and to experience more adverse health outcomes related to climate change impacts. In the future, climate change, aging population and decreasing public spending on health and social care may aggravate inequality of health outcomes related to climate change. Health education and public preparedness measures that take into account differential exposure, sensitivity and adaptive capacity of different groups help address health and social inequalities to do with climate change. Adaptation strategies based on individual preparedness, action and behaviour change may aggravate health and social inequalities due to their selective uptake, unless they are coupled with broad public information campaigns and financial support for undertaking adaptive measures.     

Impact of climate change on health: what is required of climate modellers?

The potential impacts of climate change on human health are significant, ranging from direct effects such as heat stress and flooding, to indirect influences including changes in disease transmission and malnutrition in response to increased competition for crop and water resources. Development agencies and policy makers tasked with implementing adaptive strategies recognize the need to plan for these impacts. However at present there is little guidance on how to prioritize their funding to best improve the resilience of vulnerable communities. Here we address this issue by arguing that closer collaboration between the climate modelling and health communities is required to provide the focused information necessary to best inform policy makers. The immediate requirement is to create multidisciplinary research teams bringing together skills in both climate and health modelling. This will enable considerable information exchange, and closer collaboration will highlight current uncertainties and hopefully routes to their reduction. We recognize that climate is only one aspect influencing the highly complex behaviour of health and disease issues. However we are optimistic that climate-health model simulations, including uncertainty bounds, will provide much needed estimates of the likely impacts of climate change on human health.     

Change in health risks and work productivity over time

We sought to examine the relationship between changes in health risks and changes in work productivity. Pre- and postanalysis was conducted on 500 subjects who participated in a wellness program at a large national employer. Change in health risks was analyzed using McNemar chi-square tests, and change in mean productivity was analyzed using paired t tests. A repeated measures regression model examined whether a change in productivity was associated with a change in health risks, controlling for age and gender. Individuals who reduced one health risk improved their presenteeism by 9% and reduced absenteeism by 2%, controlling for baseline risk level, age, gender, and interaction of baseline risk and risk change. In conclusion, reductions in health risks are associated with positive changes in work productivity. Self-reported work productivity may have utility in the evaluation of health promotion programs.     

Calculating Workplace WBGT from Meteorological Data: A Tool for Climate Change Assessment

The WBGT heat stress index has been well tested under a variety of climatic conditions and quantitative links have been established between WBGT and the work-rest cycles needed to prevent heat stress effects at the workplace. While there are more specific methods based on individual physiological measurements to determine heat strain in an individual worker, the WBGT index is used in international and national standards to specify workplace heat stress risks. In order to assess time trends of occupational heat exposure at population level, weather station records or climate modelling are the most widely available data sources. The prescribed method to measure WBGT requires special equipment which is not used at weather stations. We compared published methods to calculate outdoor and indoor WBGT from standard climate data, such as air temperature, dew point temperature, wind speed and solar radiation. Specific criteria for recommending a method were developed and original measurements were used to evaluate the different methods. We recommend the method of Liljegren et al. (2008) for calculating outdoor WBGT and the method by Bernard et al. (1999) for indoor WBGT when estimating climate change impacts on occupational heat stress at a population level.     

Climate Change and Older Americans: State of the Science

Background: Older adults make up 13% of the U.S. population, but are projected to account for 20% by 2040. Coinciding with this demographic shift, the rate of climate change is accelerating, bringing rising temperatures; increased risk of floods, droughts, and wildfires; stronger tropical storms and hurricanes; rising sea levels; and other climate-related hazards. Older Americans are expected to be located in places that may be relatively more affected by climate change, including coastal zones and large metropolitan areas.Objective: The objective of this review is to assess the vulnerability of older Americans to climate change and to identify opportunities for adaptation.Methods: We performed an extensive literature survey and summarized key findings related to demographics; climate stressors relevant to older adults; factors contributing to exposure, sensitivity, and adaptive capacity; and adaptation strategies.Discussion: A range of physiological and socioeconomic factors make older adults especially sensitive to and/or at risk for exposure to heat waves and other extreme weather events (e.g., hurricanes, floods, droughts), poor air quality, and infectious diseases. Climate change may increase the frequency or severity of these events.Conclusions: Older Americans are likely to be especially vulnerable to stressors associated with climate change. Although a growing body of evidence reports the adverse effects of heat on the health of older adults, research gaps remain for other climate-related risks. We need additional study of the vulnerability of older adults and the interplay of vulnerability, resilience, and adaptive responses to projected climate stressors.     

Climate change and human health: impacts, vulnerability and public health

It is now widely accepted that climate change is occurring as a result of the accumulation of greenhouse gases in the atmosphere arising from the combustion of fossil fuels. Climate change may affect health through a range of pathways, for example as a result of increased frequency and intensity of heat waves, reduction in cold related deaths, increased floods and droughts, changes in the distribution of vector-borne diseases and effects on the risk of disasters and malnutrition. The overall balance of effects on health is likely to be negative and populations in low-income countries are likely to be particularly vulnerable to the adverse effects. The experience of the 2003 heat wave in Europe shows that high-income countries may also be adversely affected. Adaptation to climate change requires public health strategies and improved surveillance. Mitigation of climate change by reducing the use of fossil fuels and increasing a number of uses of the renewable energy technologies should improve health in the near-term by reducing exposure to air pollution.     

Impacts of climate and climate change on medications and human health

OBJECTIVE: To examine impacts of climate and climate change on medications and human health. METHODS: Literature review and analysis of MIMS. RESULTS: Changed climate associated with the enhanced Greenhouse Effect (e.g. increased temperature) may lead to medication-related health impacts through deterioration of storage conditions, increased heat stress from medication-induced heat intolerance, and by influencing pharmacokinetics. Increases in UV radiation from stratospheric ozone depletion may increase the significance of medications that can lead to an increased sensitivity to the damaging effects of UV radiation (i.e. photosensitivity). CONCLUSIONS AND IMPLICATIONS: Raising awareness of the impacts of climate on medications, and of climate-related side-effects, among both health care professionals and the public, should modify behaviour and therefore reduce the risks of such adverse impacts.     

Measuring health-related productivity loss

The objective of this study was to determine the relationship between health status and productivity loss and to provide estimates of the business implications of lost work performance. Health risk appraisal responses from over 1 million participants were analyzed to determine productivity loss associated with several common health conditions and health risks. Propensity scores and a matching technique were used to create analysis groups that differed only by presence of a particular health condition or risk. Results were monetized and multiplied by the average number of employees with conditions or risks to illustrate the potential impact of productivity loss to employers. Costs of productivity loss were compared to medical costs for the same conditions and health risks. Practical benchmarks of lost work performance may help employers assess the financial impact of suboptimal health in their own companies. Estimates of lost work time can help employers realize the value of maintaining a healthy population.     

Wastewater irrigation and environmental health: implications for water governance and public policy

Climate change is a large-scale and emerging environmental risk. It challenges environmental health and the sustainability of global development. Wastewater irrigation can make a sterling contribution to reducing water demand, recycling nutrients, improving soil health and cutting the amount of pollutants discharged into the waterways. However, the resource must be carefully managed to protect the environment and public health. Actions promoting wastewater reuse are every where, yet the frameworks for the protection of human health and the environment are lacking in most developing countries. Global change drivers including climate change, population growth, urbanization, income growth, improvements in living standard, industrialization, and energy intensive lifestyle will all heighten water management challenges. Slowing productivity growth, falling investment in irrigation, loss of biodiversity, risks to public health, environmental health issues such as soil salinity, land degradation, land cover change and water quality issues add an additional layer of complexity. Against this backdrop, the potential for wastewater irrigation and its benefits and risks are examined. These include crop productivity, aquaculture, soil health, groundwater quality, environmental health, public health, infrastructure constraints, social concerns and risks, property values, social equity, and poverty reduction. It is argued that, wastewater reuse and nutrient capture can contribute towards climate change adaptation and mitigation. Benefits such as avoided freshwater pumping and energy savings, fertilizer savings, phosphorous capture and prevention of mineral fertilizer extraction from mines can reduce carbon footprint and earn carbon credits. Wastewater reuse in agriculture reduces the water footprint of food production on the environment; it also entails activities such as higher crop yields and changes in cropping patterns, which also reduce carbon footprint. However, there is a need to better integrate water reuse into core water governance frameworks in order to effectively address the challenges and harness the potential of this vital resource for environmental health protection. The paper also presents a blueprint for future water governance and public policies for the protection of environmental health.     

Climate change and vector-borne diseases: a regional analysis

Current evidence suggests that inter-annual and inter-decadal climate variability have a direct influence on the epidemiology of vector-borne diseases. This evidence has been assessed at the continental level in order to determine the possible consequences of the expected future climate change. By 2100 it is estimated that average global temperatures will have risen by 1.0-3.5 degrees C, increasing the likelihood of many vector-borne diseases in new areas. The greatest effect of climate change on transmission is likely to be observed at the extremes of the range of temperatures at which transmission occurs. For many diseases these lie in the range 14-18 degrees C at the lower end and about 35-40 degrees C at the upper end. Malaria and dengue fever are among the most important vector-borne diseases in the tropics and subtropics; Lyme disease is the most common vector-borne disease in the USA and Europe. Encephalitis is also becoming a public health concern. Health risks due to climatic changes will differ between countries that have developed health infrastructures and those that do not. Human settlement patterns in the different regions will influence disease trends. While 70% of the population in South America is urbanized, the proportion in sub-Saharan Africa is less than 45%. Climatic anomalies associated with the El Niño-Southern Oscillation phenomenon and resulting in drought and floods are expected to increase in frequency and intensity. They have been linked to outbreaks of malaria in Africa, Asia and South America. Climate change has far-reaching consequences and touches on all life-support systems. It is therefore a factor that should be placed high among those that affect human health and survival.     

城乡基层医疗人员对气候变化及其健康风险认知的差异

目的探究基层医疗人员对气候变化及其健康风险认知的城乡差异。方法采用分层随机整群抽样,抽取广东省21家城区和10家乡镇基层医疗卫生机构的医疗人员进行问卷调查,收集其基本信息和对气候变化及其健康风险的认知情况,通过卡方检验、秩和检验和logistic逐步回归分析探究气候变化认知的城乡差异。结果63.8%(468/733)的基层医疗卫生人员认同气候变化正在发生,55.4%(406/733)的人认为气候变化主要归因于人类活动。城区卫生人员对气候变化正在发生的认同程度高于乡镇,而城区与乡镇对气候变化发生原因的认知差异不明显。城区人员在高温热浪的健康风险认知上略高于乡镇,而对于气候变化与传染病关联的认知略低于乡镇,但差异不具有统计学意义。乡镇人员识别气候变化脆弱人群的能力略高于城区,差异具有统计学意义。此外,职称级别越高越能感知气候变化健康风险;临床医生相比于护士和公共卫生人员更认同气候变化正在发生且更能识别其发生原因。结论城区基层医疗卫生人员在气候变化正在发生的认同程度上略高于乡镇,但是乡镇医疗卫生人员比城区的更能识别脆弱人群。城区与乡镇基层医疗卫生人员对气候变化及其健康风险认知均不容乐观,应积极采取措施提升风险认知以增强其应对气候变化健康风险的能力。