Occupational health risks created by climate change: U.S. doctors get Guidelines, France releases expert report

tick_lyme_government of ontario

Warmer temperatures have brought the Black-legged tick  to Ontario, bringing an increase of Lyme’s Disease, especially for outdoor workers.

A  Guidance Document was released by the  American College of Occupational and Environmental Medicine in February 2018.  Responsibilities of the Occupational and Environmental Medicine Provider in the Treatment and Prevention of Climate Change-Related Health Problems  (also appearing  in the Journal of Occupational and Environmental Medicine ) is intended to set standards for physicians specializing in workplace health.  The Guidance Document  provides concise and very current information about  the direct physical impacts related to climate change (heat stress and ultraviolet exposure, air quality, and allergic sensitivities) as well as indirect impacts (disaster zone exposure, stress and mental health, and waterborne and vector-borne disease).  Most of this information is not new:  two previous major reports have covered the same ground: The Lancet Countdown Report for 2017,  (which links climate change and specific health conditions for the population at large, not just workers, and which included a report for Canada ), and the landmark U.S . Global Change Research Program report, The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment (2016)  .

What is important about this new Guidance Document?  It focuses on the workplace, and sets standards for the role of occupational health physicians which include a responsibility to protect workers.  For example:  “Provide guidance to the employers on how to protect working populations in the outdoors or in the field who are potentially exposed to the extreme temperatures…. Quickly identify employees with acute and chronic cardiovascular and respiratory illnesses within the organization who will be significantly affected by increasing temperature and worsening air quality, an increase in ozone, particulate matter, and high pollen count  ….Provide effective guidance to employers about seasonal activity and address the increasing risk of vector-borne disease among the working population…. Deliver support to the employees at risk for mental illness due to disasters, loss, and migration by providing more comprehensive programs through their employment….  The article concludes with: “ OEM providers are called to be on the forefront of emerging health issues pertaining to working populations including climate change. The competent OEM provider should address individual and organizational factors that impact the health and productivity of workers as well as create policies that ensure a healthy workforce.”

There is also a call to action in a new report from France’s Agency for Food, Environmental and Occupational Health & Safety.  The full expert analysis is available only in French ; an English abstract is here .  The report  predicts the occupational risks associated with climate change, from now till  2050, and identifies the main drivers of change: rising temperatures, changes in  the biological and chemical environment, and a change in the frequency and intensity of extreme events.  What’s new in this report?  It highlights the breadth of impact of climate change, stating that it will affect all occupational risks, except those associated with noise and artificial radiation.  The report also makes recommendations,  urging immediate workplace awareness campaigns and training about the health effects of climate change, with a preventive focus. From the English summary: “The Agency especially recommends encouraging all the parties concerned to immediately start integrating the climate change impacts that are already perceptible, or that can be anticipated, in their occupational risk assessment approaches, in order to deploy suitable preventive measures.”  The full report (in French only):  Évaluation des risques induits par le changement climatique sur la santé des travailleurs  (262 pages) is dated January 2018 but released in April. It was requested by France’s Directorate General for Health and the Directorate General for Labour, to support the country’s 2011 National Adaptation to Climate Change Action Plan (PNACC).

New U.S. medical consortium forms to bring the message mainstream: climate change is harming our health

Eleven medical societies in the United States, representing over 400,000 medical practitioners, have joined together to form The Medical Society Consortium on Climate & Health .  Their launch document  on March 15  was  Medical Alert! Climate Change is harming our health , directed at the general public to sound the alarm that climate change health impacts are here and now.

The report gives only a nod to the threats in the workplace, given its goal to reach a general audience. It warns that “anyone can be harmed by extreme heat, but some people face greater risk. For example, outdoor workers, student athletes, city dwellers, and people who lack air conditioning (or who lose it during an extended power outage) face greater risk because they are more exposed to extreme heat. People with chronic conditions such as cardiovascular and respiratory diseases, and those who work or play outside, are especially vulnerable to extreme heat.. ..”  The report also touches on the other major health-related impacts, such as spread of infectious diseases borne by ticks and mosquitos, air pollution,  effects of forest fires, polluted air and food, mental health burden, etc.

The Consortium  states that “most physicians are aware of the adverse health effects of climate change and feel a responsibility to inform the public, patients and policymakers about them. A majority of survey respondents report they are already seeing health harms from climate change among their own patients – most commonly in the form of increased cardiorespiratory disease (related to air quality and heat), more severe and longer lasting allergy symptoms, and injuries attributed to extreme weather.”

The goal of the consortium is to educate,  and to advocate for reduced fossil fuel consumption and increased clean energy.  Their website offers a library of publications    related to the growing literature on climate change and health. The website  also compiles resources from their member societies, such as the American College of Physicians and the American Academy of Pediatrics,  about how to green medical workplaces.   In this, they join a number of existing associations such as Practice Greenhealth   and Healthcare without Harm, an international organization with Canadian membership.

In Canada, the Canadian Association of Physicians for the Environment , which was established in 1994,   shares a similar mission for policy advocacy, and maintains an active blog  and Facebook presence.  The Canadian Medical Association has a number of policy and position documents on environmental impacts on health; their most recent policy statement on Climate change and Health  was issued in 2010, yet still seems remarkably relevant.

 

More proof that green buildings are better for workers

The health impact of  green workplaces was the subject of a new article,   The Impact of Working in a Green Certified Building on Cognitive Function and Health  , by researchers at the  Harvard T.H. Chan School of Public Health and SUNY Upstate Medical University. Researchers studied 109 workers at 10 buildings and found that employees who worked in certified green buildings had higher cognitive function scores, fewer sick building symptoms and higher sleep quality scores than those working in non-certified buildings.  The research was sponsored by United Technologies.  For an overview of ongoing research at the Harvard T.H. Chan School of Public Health , go to its Nature, Health and the Built Environment website . Other related information is available at the World Green Building Council’s “Better Places for People” website .

From a management point of view, an article in the Harvard Business Review, “Air Pollution making office workers less productive”  (September 29) reports on the effect of air pollution on call-center workers at Ctrip, China’s largest travel agency. The authors conclude that these office  workers are 5%–6% more productive when air pollution levels are rated as “good” (an Air Quality Index of 0–50) versus when they are rated as unhealthy (an Air Quality Index of 150–200). Productivity was measured by completed calls each day, length of breaks, and time logged in.

All this points to the importance of green building.  World Green Building Week  began on September 26, 2016 – preceded by an agreement amongst the national green building councils from 10 countries (including Canada)  to adopt zero net carbon certification programs by the end of 2017.  See the World Green Building Council press release for a description of the meetings, including the definition of “zero net carbon” (ZNC)  as advanced by the architectural network, Architecture 2030   .

Summer’s heat can be deadly for workers

thermometer and sunWe know all know this summer is hot, but what does it mean for workers? In These Times published an article by Elizabeth Grosman in July, “As Temperatures Climb Across the Country, Workers Will Suffer”. Her article examines the situation in the U.S., reporting that in 2015, “the federal Occupational Safety and Health Administration (OSHA) received more than 200 reports of workers hospitalized because of heat-related illness and at least eight deaths associated with heat exposure. In 2014, 2,630 U.S. workers suffered from heat illness and 18 died on the job from heat stroke and related causes. Since 2003, an average of more than 30 workers a year have died of heat-related causes.  The article also point out that 9 of the 30 deaths occurred to workers who had been on the job less than 3 days – making this an issue which might be improved by training and stronger OHS contract language.  In 2014, OSHA launched a “Heat Rest Shade” campaign to remind employers of their obligation to provide respite for workers  , and with online training materials   and information resources  .

The Ontario Ministry of Labour updated their guidance re Heat Stress in 2014, and the Heat Stress Awareness Guide published by the Occupational Health and Safety Council of Ontario in 2007 is still valuable.  It too points out the risks to new employees and those who are not conditioned to heat.  For  Canada-wide information, see the Canadian Centre for Occupational Health and Safety Fact Sheets here  or  see (from 2010)  Protecting Workers from Heat Stress: What are an Employer’s Legal Obligations?

Being unemployed is also a factor in heat-releated illness according to an article in Environmental Health Perspectives .   Researchers led by Hung Chak Ho of Simon Fraser University in B.C. developed a block-by-block map of neighbourhoods in Vancouver and discovered that those blocks with a high proportion of low-income earners, a high proportion of renters and a high unemployment rate are at greater risk of mortality than the elderly.  See “Unemployed people, not the elderly, at highest risk”   for a summary.

And amidst the high heat and drought that all of us are feeling in central Canada this summer comes scientific validation of our experience:  the release of State of the Climate 2015  , the 26th edition of the assessment released each summer as a supplement to the Bulletin of the American Meteorological Society.  Canada is profiled in Chapter 7 :  “The annual average temperature in 2015 for Canada was 1.3°C above the 1961–90 average, and was the 11th warmest year since nationwide records began in 1948.” (The warmest year on record for Canada to date has been 2010, at 3.0°C above average.)  Globally, the report catalogues several symbolic mileposts: notably, it was 1.0°C warmer than preindustrial times, and the Mauna Loa observatory recorded its first annual mean carbon dioxide concentration greater than 400 ppm in 2015.  A thorough summary appeared in The Guardian (August 2). ( State of the Climate is compiled by the U.S. National Oceanic and Atmospheric Administration’s Center for Weather and Climate, from contributions from scientists from 62 countries, and is the recognized authority on global climate indicators and  notable weather events).

Low-wage workers, Women, and Migrant workers will suffer most from Climate change-induced heat

Climate Change and Labour: Impacts of Heat in the Workplace   identifies heavy labour and low-skill agricultural and manufacturing jobs as the most susceptible to heat changes caused by climate change.  India, Indonesia, Pakistan, Cambodia, Nigeria, Burkina Faso and part of West Africa are the countries most at risk. Quoting the IPCC’s 5th Assessment Report, it states that “labour productivity impacts could result in output reductions in affected sectors exceeding 20% during the second half of the century–the global economic cost of reduced productivity may be more than 2 trillion USD by 2030.” Even if countries meet their Paris emissions reductions targets, rising temperatures may cut up to 10 percent of the daytime working hours in developing countries.

On the human scale, the authors surveyed more than 100 studies in the last decade which document the health risks and labour productivity loss experienced by workers in hot locations- most recently, 2016 studies from India which concluded that 87% of workers experience health problems during the hottest 3 months, and which highlighted additional problems for pregnant women workers and migrant workers.

Several important indirect effects of heat stress include: alteration of work hours to avoid the heat of the day; the need to work longer hours to earn the same pay for those whose productivity falls due to heat stress, or suffer income loss; increased exposure to hazardous chemicals when workplace chemicals evaporate more quickly in higher temperatures; and possible exposure to new vector-borne diseases.  The report calls for protection for workers , including low cost measures such as assured access to drinking water in workplaces, frequent rest breaks, and management of output targets, incorporating  protection of income and other conditions of Decent Work.

At the regulatory level,  the most relevant standard cited was adopted by the ILO in November 2015:  “Guidelines for a just transition towards environmentally sustainable economies and societies for all”,    which includes occupational safety and health and social protection policies which call on social partners “to conduct assessments of increased or new OSH risks resulting from climate change; improve, adapt or develop and create awareness of OSH standards for technologies and work processes related to the transition; and review policies concerning the protection of workers.”

The report was as a joint effort coordinated by the Climate Vulnerable Forum (CVF), supported by the United Nations Development Programme (UNDP) Secretariat and in partnership with the International Labour Organization (ILO), UNI Global Union (UNI), the International Organization of Employers (IOE), the International Trade Union Confederation (ITUC), the World Health Organization (WHO), the International Organization for Migration (IOM) and the NGO network ACT Alliance. See The Guardian for a summary .