Skip to main content
References

Published on:

Latest update:

Introduction

Occupational safety and health (OSH) has always been influenced by environmental conditions. There is no greater influence on environmental conditions than that now being experienced as a result of climate change. These effects are already being widely felt globally, with the last eight years being the hottest eight on record[1]. Europe is the fastest warming continent on earth, with warming occurring throughout the year, contributing to earlier heatwaves, intensifying drought, and dramatic glacier loss[2],[3],[1]. The frequency and distribution of extreme precipitation, intensifying in most locations in central Europe[4], is changing the risk of flood events. Beyond environmental impacts, climate change is also shaping impacts on population health. In a global study, Vicedo-Cabrera[5] estimated 37% of mortality from heat is specifically attributable to anthropogenic climate change, and once again Europe was found to be more at risk than other regions.

In this context of rapid and significant climatic change, the EU Strategic Framework on Health and Safety at Work[6] (the EU OSH Framework)  identifies three key cross-cutting objectives for the coming years:

  • anticipating and managing change
  • improving prevention of workplace accidents and illnesses
  • increasing preparedness for any potential future health crises.

Within the EU OSH framework, climate change is discussed in relation to anticipating and managing change, with the aim to contribute to the prevention of workplace accidents and illness, and will also assist in increasing preparedness for potential future health crises.

This paper will focus on the specific occupational risk of heat stress and its consequences. The significance of heat stress risks will vary according to different geographic regions, industries and over different time frames.

OSH and Climate Change

Legislative measures

There are a number of EU OSH legislative and non-legislative measures that are relevant to ‘managing change’ in the form of climate change related OSH risk. The central piece of legislation is Directive 89/391/EEC – the Framework Directive[7], which together with related directives, establishes minimum OSH requirements for member states to adopt. Specifically, Article 5 of the Framework Directive states that the employer shall ensure the safety and health of workers in every aspect related to work, and that the employer has the obligation to assess all risks to the health and safety of workers and to put in place the required preventive and protective measures. This also includes risks related to climate change and heat stress.

In relation to heat stress directly, there are more specific requirements set in the Workplace Directive 89/654/EEC[8] and the Extractive Industries Directives (92/91/EEC[9] and 92/104/EEC[10]), which state that indoor temperatures need to be ‘adequate for human beings’ where adequacy is determined in relation to the working methods and physical demands of the work.

For outdoor areas or ‘work areas’, there is an equivalent requirement for two key industries through the Construction Sites Directive 92/57/EEC[11] and the Fishing Vessels Directive 93/103/EC[12] respectively. In these cases, temperatures again need to be ‘adequate for human beings’ relative to the working methods and physical demands of the work.

The EU OSH framework highlights the risks arising from climate change directly, and the risks that emerge from responses to climate change, such as green technologies.

Some Member States have enacted legislation at the national level that institutes further requirements to consider climate change risks to OSH. See Table 1 for examples.

Table 1:Legislative and non-legislative measures relevant to climate change and OSH, including occupational heat stress

Examples of national legislative measures (non-exhaustive list)

Examples of EU non-legislative measures (non-exhaustive list)

Examples of national non-legislative measures (non-exhaustive list):

Discussion and Communication Mechanisms

In addition to the identifying developed examples, there are existing discussion and communication platforms and mechanisms that could be utilized to support the development and dissemination of best-practice in relation to climate change and OSH risks.

At the EU level, dissemination might include development and further use of EU-OSHA’s e-guides and the OSHwiki, respectively.

Non-legislative measures

Beyond the legislative requirements discussed above, there is a wide range of relevant guidance available at EU level and at national level that supports responses to climate-change and associated environmental hazards. See Table 1 for further examples.

The changing climate and OSH risk in the European Union

Climate change will have significant implications for OSH risk by changing the environmental context in which work takes place. Environmental changes include: increased average temperatures; increases in extreme weather (including increased frequency and intensity of heatwaves, storms, floods and droughts); associated increases in the risk of wildfire[13]; increased risk of storm surges[14]; and, increasing UV exposure[15]. Increasing frequency and intensity of such factors increases the exposure of workers across a large number of sectors. Those that are often the most exposed include agriculture, forestry[16], and Emergency Services[17]. Fisheries and a range of offshore and inshore operations have also been identified as experiencing changed or increased risks to safety[18], including in Europe[19],[20].

However, many climate change-related risks emerge more indirectly. For example, as temperatures warm, vectors such as ticks and mosquitos will spread to new regions, exposing new and larger populations of workers to the risk of biological hazards, such as Lyme disease. Exposed worker populations include those involved in agriculture, forestry and food production plants. Other indirectly affected hazards from warming temperatures include increasing air pollution, particularly ground-level ozone, and longer pollen seasons. Air quality risks are also intensified by climate-change driven phenomena like droughts, wildfires, and dust storms, putting outdoor workers or those with unfiltered air at particular risk[21],[11],[22]. EU-OSHA has considered these risks extensively[23], including in relation to the Biological Agents Directive 2000/54/EC (Table 2).

Table 2: Tools for forecasting - and projections-based risk assessments and risk management

Example list of tools and resources

For real-time and daily observations, employers can choose to deploy their own environmental monitoring equipment. Environmental monitoring equipment is available at a range of price points. Such equipment is designed with certain index outputs in mind, such as WBGT or UTCI. However, care should be taken to ensure the equipment is scientifically validated, maintained and calibrated.

Climate change impacts and resilience data is often available at the national level. In relation to OSH specifically, an example is :The Finnish Institute of Occupational Health (FIOH) has developed indicators and a survey to monitor the impacts of climate change on work life. This includes the Occupational Safety and Health Panel (a questionnaire for occupational safety and health personnel on topical working life issues): Occupational safety and health and climate change.

Climate Change Adaptation activities and changing OSH risk

Across the EU, from local to multi-national levels, there are a wide variety of adaptation efforts taking place which aim to reduce climate change risks to various social, economic or natural exposure units. In so far as these are successful and broadly reduce climate change impacts, thereby stabilizing or improving socio-economic and socio-environmental systems, they contribute to an environment in which OSH is more likely to be supported. However, OSH is not necessarily explicitly or widely considered in adaptation efforts. There may be opportunities to leverage efforts across both policy arenas of OSH and Adaptation more systemically. For example, the EU OSH Framework closely resonates with the EU Adaptation Strategy[24]. See Table 3 for more detail.

Table 3: Climate change terminology and policy context

The terminology of climate change related risk management sometimes varies from that of hazard management as it is used in the occupational safety domain. To avoid confusion, key definitions are provided below.

Adaptation: The IPCC defines adaptation (in human, as opposed to natural systems) as “the process of adjustment to actual or expected climate and its effects, in order to moderate harm or exploit beneficial opportunities” (IPCC, 2021a: 2216). Adaptation objectives are shaped by the norms and values of the actors who devise them.

Mitigation: In the safety management and natural hazards literature, ‘mitigation’ or ‘risk mitigation’ typically refers to preventing a hazard from causing hard or reducing the resulting risk to an acceptable level. In the climate change context, ‘mitigation’ has come to be used specifically in relation to the risk of global warming or climate change per se, and thus refers specifically to reductions of greenhouse gas emissions, or the use of sinks for absorbing greenhouse gasses (IPCC, 2021a).

Maladaptation: The IPCC refers to maladaptation or maladaptive actions as “Actions that may lead to increased risk of adverse climate-related outcomes, including via increased greenhouse gas (GHG) emissions, increased or shifted vulnerability to climate change, more inequitable outcomes, or diminished welfare, now or in the future. Most often, maladaptation is an unintended consequence” (IPCC, 2021a: 2238). This indicates there is an increased onus on decision-makers to think systemically across space and time (short term adaptation actions may lead to longer term maladaptation, e.g. increasing individual air-conditioning use to reduce heat stress contributing to increased heat stress at the city scale and contributing to increased greenhouse gas emissions thereby worsening climate change over time.

The policy context: There are international, EU and national legislative and non-legislative efforts to adapt to and mitigate climate change that may have implications for OSH. At EU level, these include: The 2013 Adaptation Strategy, which requires all Member States (MS) produced a National Adaptation Strategy (NAS) or Plan; the 2021 EU Strategy “Forging a climate resilient Europe – the new EU Strategy on Adaptation to Climate Change”; the Paris Agreement; the current proposal for a European Climate Law (covering mitigation and adaptation); the EU Green Deal (which includes adaptation actions building on the 2013 EU Adaptation Strategy), such as the: Circular Economy Action Plan, Biodiversity Strategy, Farm to Fork Strategy, Forest Strategy, Renovation Wave, Zero Pollution Action Plan, Smart and Sustainable Mobility Strategy and Soil Strategy. At national level, Adaptation Plans may specifically include OSH considerations. For example, Finland’s “Climate Change Adaptation Plan of Ministry of Social Affairs and Health (2021–2031)” explicitly considers Occupational Safety and Health.

While adaptation to climate change should ideally reduce OSH risks, in some instances it may create or intensify them. Considering OSH systematically in the development of adaptation measures as suggested above will not always be sufficient to avoid such risks. If severe, or if supplementary control measures are not introduced, some of these may be considered adverse side effects of adaptation or potentially lead to maladaptation. For example, pesticide use is anticipated to increase as a result of climate change, with attendant health risks for those working with it, such as farmers[20],[21]. Multiple hazards may also intensify such risks, for example when hotter conditions reduce willingness to wear appropriate PPE while handling pesticides, thereby further increasing exposure[19]. The Strategic Framework highlights such considerations, pointing to the need to think not only systematically but systemically in the development of adaptation actions and strategies.

Climate Change Mitigation activities and Changing OSH risk

The EU OSH framework also highlights that the potential for inadvertent OSH risk also pertains to climate change mitigation actions. Renewable energy technologies, for example, aim to reduce overall climate risk by mitigating greenhouse gas emissions and therefore reducing the magnitude of climate change. While mitigation activities aim at reducing climate change and therefore climate change related risk (including for OSH) in the long term (see Table 3), in the short term these activities may change OSH risk in and of themselves, and support may be needed to ensure risk assessment and management measures are effective. For the EU context, EU-OSHA has provided an in-depth examination of this topic in their foresight report on green jobs[25] and the circular economy[26]. As such, OSH input is needed in the development of mitigation actions to ensure that unanticipated health and safety risks do not emerge.

Loss and Damage

A final category of climate change response is ‘Loss and Damage’ (L&D). L&D refers to the residual negative effects that occur when adaptation and mitigation efforts are not sufficient to avert climate change impacts[27]. These negative effects are typically categorised as economic or non-economic, the latter including impacts on health (including mortality) and mobility[28].  Under current conditions, although L&D is most often considered in relation to less developed economies, loss and damage does already occur in Europe, primarily as a result of major natural disasters such as floods and heatwaves[29]. It will increasingly also occur as a result of slow-onset events, including sea level rise, glacier retreat[30] and increases in average temperature[31]. The extensiveness of responses to such large-scale and/or long term impacts, can increase exposure to OSH risks or create new ones. For example, sea level rise and the increased risk of coastal flooding can trigger the loss of low-lying coastal areas which may require hazardous work to clean-up and relocate major industrial facilities[32]. Agricultural land may be lost for similar reasons or may no longer be usable for growing traditional crops, while alpine regions will experience losses of snow days or glacier retreat. All of these impacts can contribute directly to psychological impacts on those who work in these environments, and contribute indirectly to mental health issues through increasing employment insecurity and job strain[33],[34],[35],[36]. In a similar fashion, the increasing frequency and severity of extreme events increases the exposure of emergency services workers to sources of job strain, thereby increasing the risk of burnout[15].

Climate change related increases in extreme heat and resulting OSH risks

Extreme heat OSH risks – the role of the changing climate

For at least 20 years, the European continent has experienced the impacts of climate change and extreme heat, notably brought to attention by the 2003 heatwave, which resulted in more than 70,000 deaths in the general population[37] and was identified as being 75% more likely due to anthropogenic climate change[38]. Anthropogenic climate change has increased global surface temperatures an average of 1.59°C from the baseline between 2011-2020, and increased heat extremes including heatwaves in Europe as a result[12]. Long term projections are for a further temperature increase of minimum 1°C to 5.7°C[12] for 2081-2100. Depending on the emissions pathway, the rate of warming will change with resulting extreme heat impacts being felt sooner or later, and spreading from southern to northern Europe at a different pace. Even under the most extreme warming of this century, the most northern countries of the EU, such as Sweden and Finland, are not anticipated to experience daily extremes likely to cause hyperthermia at a level that causes mortality. By contrast, Spain and Italy will experience such conditions for up to 10 days per year[12].

Both chronic and acute exposure to extreme heat are significant for human health and for OSH[39],[29]. Working populations that are exposed to these conditions, for example in outdoor or uncooled environments and/or who are exposed to additional heat sources, PPE, or engaged in high levels of physical exertion are much more exposed to heat stress than the regular population[40]. As such, the thresholds at which environmental conditions become dangerous for these populations may be lower than for the regular population. It is of critical importance that not only heatwaves, but also daily conditions are considered when assessing their risk, and that the operation of alert systems and associated control measures reflect working conditions.

 Weather forecasts and climate projections information

As a climate change signature is already detectible in current weather extremes, weather forecasts are the first port of call for immediate risk assessments and adaptation, which seek to manage, prevent or ensure preparedness, in the terminology of the EU OSH framework. All EU states have their own weather services, and these utilize a variety of definitions and approaches to assessing and developing warnings about extreme heat and/or heatwaves[41]. For examples at the national and supranational level, see Table 2. 

Temperature is not the only environmental variable that creates heat stress for the human body. Humidity in particular, but also wind and solar radiation, are very significant. So, while temperature-only thresholds are easier to implement, more complex indices are often recommended as a more accurate basis for risk assessments. Wet Bulb Globe Temperature (WBGT) has historically been favoured, while more recently developed indices such as Universal Thermal Comfort Index have been found to be more accurate[42],[43]. Each index has inbuilt assumptions that must be considered in ensuring the most appropriate index is selected for the environmental conditions and target population.

As occupational heat stress can result from heat sources other than weather conditions, exertional heat production and wearing PPE, approaches to assessing and managing heat stress risk are most accurate and effective when they include such variables[44]. For more information on such tools, see Table 2.

Medium- long-term projections

The weather forecasts and associated risk assessments discussed above are useful on a daily, weekly and seasonal basis. However, given that the last 8 years have been the hottest 8 on record and that we are currently on track for warming of over 4 degrees by the end of the century[1], there is a need to think strategically about the heat conditions that will be encountered by 2027, the period covered by the EU OSH framework, and beyond. Climate projections information is essential for these longer-term risk assessments and adaptation plans[45].

At the global level the most comprehensive assessment of climate change risks and adaptation is that provided by IPCC – including in the latest assessment report (AR6) contributions from Working Groups I and II[46],[47]. More readily useable information is provided by the European Climate Adaptation Platform Climate-ADAPT. It provides an Adaptation Support Tool and associated Urban Adaptation Support Tool, which link to a database of guidance and information on observed and expected climate change in Europe, drawing on the Copernicus Climate Change Service C3S, the Climate Data Store and the European Climate Data Explorer, among others[48]. It also provides information on current and future vulnerability of particular sectors.

In selecting and developing heat stress risk projections information, it is important to note that, as for weather forecasts, the issue of using an appropriate heat index remains, such that temperature-only projections, while less complex to generate, should be used with caution. Recent discussions of the merits of using different indices in climate projections and risk assessments include Matthews[49] and Schwingshackl et al.[50], while Russo et al.[51] provide an example of projections of humid heatwaves in Europe for different warming levels, and Naumann et al.[52] of heat extremes for the EU.

For a more systemic/ecological approach that helps to illustrate the complex ways heat stress risk emerges, it may be worth considering climate analogues[53]. For example, Berlin by the end of the century will experience a climate like that of current day Madrid[54]. Identifying city analogues may be useful in guiding how learnings are shared across Europe – roughly east-west for current conditions, and south to north for longer term planning.

Extreme heat OSH risks as a function of changing exposure, vulnerability, and adaptive capacity

The risk of heat stress in occupational contexts is shaped by several factors. Geographical location plays a major role in shaping exposure to extreme heat and to the changing climate. At present, this means European populations have lower exposure than those in tropical regions; high risk of heat stress was assessed to be 0.4 % across Europe in 2018. However, that is projected to increase dramatically to between 20-48% of the European population by 205053, especially in the southern, eastern and western-central regions[55].

While current heat stress risk is low for the general population, the risk of heat stress is high for those working in certain occupations. These include occupations that are outdoors or in non-climate controlled environments that expose workers to extreme conditions when they do occur, or where work entails high levels of physical exertion resulting in endogenous heat production[56],[57]. Work in proximity to additional heat sources or requiring PPE that restricts natural thermoregulation processes is also a cause of exposure to heat, increasing the risk of heat stress[58]. It should be noted that the occupations or roles most at risk are shaped not only by climatic conditions, but by any shifts in work practices, such as increasing automation and thereby reducing physical exertion or engaging in novel industries, tasks and roles which may change exposure to sources of heat stress (including through exertion and environmental exposures).

Changing vulnerability will also affect occupational health and safety risks associated with heat stress. There are a large number of factors that affect vulnerability to heat stress. These include fitness, body mass and surface area, aging, sex and chronic health conditions[59]. In practice, many of these elements also tie together with the aging process: aging is significant in negatively affecting various physiological functions that are essential for managing heat exposure, including cardiovascular, thermoregulatory and thermal perception responses[59]. It is also associated with weight gain and increased rates of chronic disease and medication use, all of which contribute further to vulnerability to heat stress[60],[61]. Crucially, reductions in ability to effectively manage heat stress can set in from age [40],[62], although it should be noted that in many labour-intensive industries, it is often employees under the age of 25 who have a higher incidence of heat-related illness and injury, most likely due to higher levels of physical work and lower levels of risk mitigation behaviour connected to lack of experience[63]. In the EU, heat stress vulnerability factors associated with aging become increasingly significant given the trend of the aging workforce. Significantly, the highest number of workers over age 65 are found in forestry, agriculture and fisheries[64], all of which have a high proportion of labour-intensive and outdoor roles, with high potential exposure to heat stress.

For climate change risk assessments, one final aspect to consider is adaptive capacity, that is, the “ability of systems, institutions, humans and other organisms to adjust to potential damage, to take advantage of opportunities, or to respond to consequences” of actual or expected climate change[27]. Adaptation typically does this by modifying exposure or vulnerability to the environmental hazard. The EU OSH Framework and the governmental and institutional actions it entails are indicative of the adaptive capacity of the EU and member states. However, progress on adaptation and capacity to adapt varies across EU member states and within them[47]. Identifying gaps in adaptive capacity at various scales, and among employer types is a complex task[65], but a priority in this context.

 In the specific case of occupational heat stress, there is growing evidence that adaptive capacity across sectors and domains has complex knock-on effects. As heat-health impacts can develop over a period of days, the ability to cool down at home is often a crucial but unrecognized variable in heat-related safety and health at work. As such, risk assessments need to be cognizant of wider social factors – such as the quality of housing and access to cooling. This lag-effect of heat exposure and impacts across time and domains indicates that employers either need to ensure their workers are sent home fully recovered and/or that there’s a need for occupational health authorities to collaborate with public health and housing authorities for a systemic response[66], including considering the impact of gender roles and the additional weight of domestic work on recovery from formal work[67].

Projected OSH Risks arising from Heat Stress

Extreme heat events or heatwaves are commonly known to result in excess mortality and morbidity. However, such characterization glosses over complex and numerous physiological pathways of heat-health impacts, 27 of which can lead to organ failure and death[68]. Health impacts range from temporary and mild symptoms such as headache to nausea to loss of consciousness, cardiac arrest or respiratory distress, heat exhaustion and heat stroke, organ damage and death[69],[70],[71]. Impacts can be chronic as well as acute; there has been increasing evidence in recent years that prolonged and frequent exposure to heat stress can result in chronic illnesses such as Chronic Kidney Disease, and permanent loss of brain function[68],[72].

Heat also has implications for safety beyond the direct effects of heat on health. This is because heat strain can reduce brain function and contribute to loss of concentration and decision-making[73], increases fatigue and reduces skill and physical power, motor control, ergonomics and physical comfort[74],[75]. These effects are causally linked to the increased risk of accidents. In countries with marked seasonality to extreme heat, statistical analysis has demonstrated a strong correlation between heat exposure and rates of occupational accidents, with rates increasing as conditions worsen[63]. In Brazil, it was found that as heat conditions became more severe, so too did the likelihood of more severe accidents including those resulting in death[75]. In Spain, occupational injuries associated with extreme heat were found to account for 2.72% of injuries at a cost of €370 Million per year[76]. In Europe, high-intensity outdoor work, predominantly agriculture and construction, have the highest risk of increased injury but uncooled manufacturing and service sectors may also be affected[47].

Heat stress and related physiological health outcomes also have impacts on mental health and wellbeing. In the most immediate sense, heat strain can contribute to irritability at work, but chronic occupational heat exposure is also associated with increased rates of social isolation, violence, depression and suicide[77],[78],[79],[80].

Building on these physical and psychological pathways, heat stress is known to impact on work capacity, performance and productivity, and therefore has potential to contribute in turn to additional job strain. In the absence of adaptation, by 2080 productivity is projected to be 1.6% lower across Europe on average, but in more exposed states, such as Greece, it is projected to reduce by approximately 5.4%[81].

Potential Adaption Actions to reduce the risk of heat stress and its effects on OSH

Existing EU legislation provides a basis for adaptation to extreme heat by requiring employers to protect workers from all risks to safety and health. A number of directives further specify that workplaces should ensure temperatures either indoors or outdoors are adequate for human beings, in relation to the type of work they engage in. Finally, the EU-OSH framework encourages the identification of climate change risks to OSH, including of increased ambient temperature and risks resulting from adaptation and mitigation actions.

There is a wide literature and array of practical guidance and resources available to support identifying and managing the risk of heat stress occurring, as well as the occupational health, safety and wellbeing risks that arise from exposure to heat stress. Drawing from a recent Delphi review of best practice in the United States[82], Morrissey et al. categorise OSH responses into eight core areas: 1) heat hygiene, 2) hydration, 3) heat acclimatization, 4) environmental monitoring, 5) physiological monitoring, 6) body cooling, 7) textiles and personal protective gear, and 8) emergency action plan implementation.

Heat hygiene is understood as managing the health risks associated with heat exposure, including providing adequate worker education and conducting risk assessments prior to the commencement of the shift, including in relation to worker vulnerability. In practice it includes the other categories mentioned above, but as these are significant in and of themselves, Morrissey et al.[82] draw them out separately. Other commonly considered heat hygiene practices also include reducing environmental heat, by for example, providing air-conditioning in enclosed spaces or shading outdoor spaces; automating work practices to reduce labour and thus endogenous heat production; changing work hours or the timing of tasks so they occur during cooler periods; and, rotating staff between more and less heat exposed tasks[83],[58].

Hydration is a major consideration that interacts in complex ways with heat stress and heat strain. Ensuring adequate hydration supports the body’s natural thermal regulation and electrolyte balance, and prevents dehydration related health impacts as well as reducing the likelihood of heat strain[84]. Although employers cannot (and should not) force employees to drink, a number of educational and behavioural strategies to support appropriate hydration in the workplace can be identified[82].

Heat acclimatization, where workers systematically and gradually engage in physical activity in hot conditions, triggers physiological adaptations to reduce vulnerability. It is particularly useful for new workers, workers returning after an absence, or for a workforce entering hotter periods of the year. Although widely used in military and elite sport contexts, it is less often used in other occupations and for smaller businesses. There is substantial guidance available to support employers to develop heat acclimatization plans. For recent reviews see Morris et al.[85] and Morrissey et al.[82].

Environmental monitoring has been discussed above in relation to weather forecasts and climate projections, but there is also significant value in providing site-specific environmental monitoring capabilities, particularly if additional heat sources or materials that absorb and radiate heat (such as concrete surfaces) are present. An accurate understanding of actual conditions is an essential basis to developing appropriate risk assessment and control measures, such as work/rest ratios or work cessation rules. Specialised meteorological data or sensors are required to assess environmental conditions. WBGT is the most commonly used index, but there are others that may be more appropriate, as previously discussed[41],[82]. The measurements need to be used in conjunction with a heat stress risk assessment framework that provides guidance on work rates, work/rest ratios and similar measures, such as that provided by ISO 7933:2004[86] and 7243:2017[87],[88].

Physiological monitoring of individuals represents the best possible level of evidence of actual thermal strain but is expensive and complex to administer. However, there is a rapidly expanding market of wearables that may make real-time monitoring of individuals possible in the near future, particularly in developed contexts. It should be ensured that such tools are scientifically validated and appropriate for use in field conditions[82],[89].

Body cooling as a category reflects a shift in the scientific literature from passive cooling (such as resting in the shade) to active cooling strategies[82]. Crucially, body cooling actions can be utilised pre-shift, during shift and post-shift to prevent and manage heat strain. Examples include sitting in cool refuges (air-conditioned spaces), immersing parts of the body in cold water or bringing them into contact with wet or cold surfaces (towels or cooling vests), or ice ingestion. Strategies vary in their physiological effectiveness, costs and their feasibility in different occupational contexts, depending on, for example, access to electricity for air-conditioner use or the time requirements and complexity of doffing and donning PPE for water immersion[90],[91].

Personal protective equipment (PPE), such as clothing from protective materials or respirators, is crucial to the management of many occupational risks, such as contamination or burns, and is often required by law or institutional policy. However, PPE contributes to heat stress by trapping metabolic heat and vapor transfer[82]. Where possible, consideration of the best possible textile type, fit, structure and design should be considered to limit heat strain contribution while meeting other OSH requirements.

Finally, to avoid the worst OSH outcomes such as heat stroke, particularly in highly exposed sectors, it is recommended to develop medically appropriate and up to date emergency action-plans. This includes training staff on understanding and recognising the symptoms of heat-related illness, and how to respond[92],[82].

All of the above approaches are employed across the EU to varied degrees, and there are a wide range of resources within the EU and internationally to support such measures. See Annex 4 for further information.

Most of the categories of measures above are, in climate change adaptation terms, incremental, no-regret or low-regret adaptation options[27]; they are relatively easy to implement, not particularly costly, and have an immediate benefit. However, adaptation to extreme shifts in environmental conditions, such as those projected toward the end of the century, or for highly exposed sectors, may require greater engineering and systemic change to offset the risk posed. An example of this would be re-designing a factory so that it can be air-conditioned or relocating a company or indeed an industry to a cooler region. Adaptation at this level is costly and socially disruptive. Such radical moves have been most commonly projected in agriculture due to the climate-sensitivity of crops, but it may be anticipated that occupational heat stress could be a contributing factor to such adaptation decisions. The need to consider such systemic effects has been highlighted by the shift to identifying compound and cascading risks in AR6, and the role of soft and hard adaptation limits[47]. Adaptation limits are unlikely to be encountered in Europe by 2027, but any short-term adaptation actions should be undertaken in view of the level of lock-in they entail to particular adaptation pathways, and what this means for future adaptation limits.

The need to avoid maladaptation is a related concern. An example of this is the development of ‘work/rest schedule’ based on historical or current extremes. However, in the context of climate change, the increasingly common exceedance of historical temperature thresholds may reduce labour supply to the point the work activity or even industry is no longer viable[93]. Similarly problematic is applying a measure universally across climatic zones that does not account for localised physiological acclimatization, behavioural adaptations[94],[91], or differences in urban form[95]. Another example of maladaptation is the widespread adoption of air-conditioning: while seeking to reduce heat exposure indoors, it has the unfortunate outcome of increasing exposure outdoors by warming the urban space and contributing to the emission of greenhouse gasses, while also potentially reducing physiological tolerance of heat stress[96],[97].

OSH risks from adaptation and mitigation actions

OSH risks also occur from climate adaptation and mitigation actions themselves. For example, adaptation through rescheduling high-intensity or exposed work to night-time hours to reduce heat stress, may generate other OSH risks such as those arising from low visibility, higher accident rates, fatigue and the psychosocial impacts of shift work[98],[99]. Possible heat-related OSH risks from climate change mitigation actions include higher exposure to heat as a result of increased pressure to install and maintain renewable energy technologies such as solar panels[21].

Loss and Damage

Loss and damage from exposure to heat has already occurred in the EU, notably through the morbidity and mortality impacts of the 2003 heatwave, as well as subsequent extreme heat events including for occupational injury and productivity as discussed above. In principle, such loss and damage is avoidable. However, over the longer term it may be that no combination of adaptations is financially or logistically sufficient to keep working conditions tolerable at the hottest times of day or the hottest time of year in some regions (as a result of soft and hard limits to adaptation). As such, there may be an effectively unavoidable loss of work capacity for these regions, although this is not anticipated before 2027 in the EU[100],[101],[50].

Conclusion

In order to effectively address OSH risks arising from climate change, including those related to heat stress, a number of adaptation actions can be taken. In the first instance, there is a need for a shared understanding of these issues within the OSH community, to be supported through making use of existing discussion and communication platforms that are available. A shared understanding should ensure up-to-date scientific information on the environmental causes of risk are utilized, drawing on the most appropriate indices and climate projections available. While this lends itself to a common basis for risk assessment and response development, as well as knowledge-sharing, this should not be understood as necessitating a universal response per se - climate change is one of several drivers of changing OSH risk, and its impacts will vary by region. This is true for occupational heat risks, as extreme heat itself, vulnerability, exposure and adaptive capacity vary between and within Member States spatially and over time.

Possible actions to support these considerations might include the provision and dissemination of a shared resource on how existing OSH legislative and non-legislative measures at EU and Member State level covers climate change and/or extreme heat risks, appropriate means of risk assessment and adaptation measures, which would contribute to awareness raising and enforcement as identified in the EU-OSH framework. Some of this material is already gathered in Tables 1, 2, and 4 of this document. There is potential in particular for awareness raising in the form of cross-EU sharing of learnings, particularly between cities/regions that are current and future climate analogues. Such activities may require explicit institutional and financial support. There may be a need to extend awareness raising activities into the formal development of adaptation action plans or guidelines at national level, supported by education and dissemination plans, particularly for vulnerable groups and exposed sectors.

Table 4: International Occupational Heat Stress guidance

Beyond the guidelines and advice provided within Europe mentioned above, there are many international examples that provide useful resources. Examples include:

ISO standards

There are a number of ISO standards that can be utilized to monitor, assess and manage heat stress risk. These include:

As OSH risks have also been identified as arising from adaptation and mitigation measures, it is also suggested that identifying ways to mainstream OSH-engagement into climate change risk assessments, adaptation and mitigation strategies is necessary to avoid the risk of adverse side effects or maladaptation. This implies a greater level of social dialogue beyond the OSH community.

Finally, in order to assess the efficacy of risk management or adaptation actions in relation to heat stress, there is a need for better surveillance of heat impacts from heat-strain to heat-related illness, morbidity and mortality. This extends from the workplace level to hospital-based coding of injuries and illness, but would require extensive engagement with employers as well as with public and emergency health providers. Initial scoping research would be required to assess the viability of this option at Member State and pan-EU level. There is a similar need for systematically collecting and using data on climate change impacts on OSH more broadly. See Table 2 for examples.

Climate change is changing the physical and socio-economic environment, both as an environmental phenomenon and as a result of efforts to mitigate and adapt. Places of work and working populations will be affected, with significant implications for OSH risks. One of these includes OSH risks associated with heat stress, which is already significant in Europe (particularly in southern, eastern and central regions), and which will grow exponentially over the coming decades. However, resources exist to support governments, businesses, and other actors, to identify and respond to changing climate and heat risks, including through engaging in adaptation strategies to reduce vulnerability and exposure (prevention) and increase resilience (preparedness) for occupational health and safety impacts. Better sharing and awareness of these resources, as well as the collaborative development of response measures and monitoring and evaluation approaches will contribute to more robust adaptation.

References

[1] WMO (2022) Provisional State of the Global Climate 2022. Reportno. Report Number|, Date. Place Published|: Institution

[2] Twardosz R, Walanus A and Guzik I (2021) Warming in Europe: Recent Trends in Annual and Seasonal temperatures. Pure and Applied Geophysics 178(10): 4021-4032.

[3] Luterbacher J, Werner JP, Smerdon JE, et al. (2016) European summer temperatures since Roman times. Environmental Research Letters 11(2): 024001.

[4] Zeder J and Fischer EM (2020) Observed extreme precipitation trends and scaling in Central Europe. Weather and Climate Extremes 29: 100266.

[5] Vicedo-Cabrera AM, Scovronick N, Sera F, et al. (2021) The burden of heat-related mortality attributable to recent human-induced climate change. Nat Clim Chang 11(6): 492-500.

[6] EU Strategic Framework on Health and Safety at Work 2021-2027: Occupational safety and health in a changing world of work

[7] The Framework Directive: Council Directive 89/391/EEC of 12 June 1989 on the introduction of measures to encourage improvements in the safety and health of workers at work, OJ L 183, 29.6.1989, p. 1

[8] Council Directive 89/654/EEC of 30 November 1989 concerning the minimum safety and health requirements for the workplace, OJ L 393, 30.12.1989, p1

[9] Council Directive 92/91/EEC of 3 November 1992 concerning the minimum requirements for improving the safety and health protection of workers in the mineral- extracting industries through drilling, OJ L 348, 28.11.1992, p. 9

[10] Council Directive 92/104/EEC of 3 December 1992 on the minimum requirements for improving the safety and health protection of workers in surface and underground mineral-extracting industries, OJ L 404, 31.12.1992, p. 10

[11] Council Directive 92/57/EEC of 24 June 1992 on the implementation of minimum safety and health requirements at temporary or mobile construction sites, OJ L 245, 26.8.1992, p. 6

[12] Council Directive 93/103/EC of 23 November 1993 concerning the minimum safety and health requirements for work on board fishing vessels, OJ L 307, 13.12.1993, p. 1

[13] Levy BS and Roelofs C (2019) Impacts of Climate Change on Workers’ Health and Safety. Oxford University Press.

[14] IPCC (2023) AR6 Synthesis Report: climate change 2023. Reportno. Report Number|, Date. Place Published|: Institution|.

[15] Schulte PA, Bhattacharya A, Butler CR, et al. (2016) Advancing the framework for considering the effects of climate change on worker safety and health. Journal of Occupational and Environmental Hygiene 13(11): 847-865.

[16] Jones A, Jakob M, McNamara J, et al. (2020) Review of the future of agriculture and occupational safety and health (OSH) Reportno. Report Number|, Date. Place Published|: Institution|.

[17] EU-OSHA (2011) Emergency services: a literature review on occupational safety and health risks. Reportno. Report Number|, Date. Place Published|: Institution|.

[18] Finnis J, Shewmake JW, Neis B, et al. (2019) Marine Forecasting and Fishing Safety: Improving the Fit between Forecasts and Harvester Needs. Journal of agromedicine 24(4): 324-332.

[19] Fleming LE, McDonough N, Austen M, et al. (2014) Oceans and Human Health: A rising tide of challenges and opportunities for Europe. Marine Environmental Research 99: 16-19.

[20] Climate-ADAPT (2022) Enhancing operational safety in offshore and inshore operations. Available at: https://climate-adapt.eea.europa.eu/en/metadata/adaptation-options/enhancing-operational-safety-in-offshore-and-inshore-operations (accessed 26.03.23).

[21] Lan T, Goh YM, Jensen O, et al. (2022) The impact of climate change on workplace safety and health hazard in facilities management: An in-depth review. Safety science 151: 105745.

[22] Adam-Poupart A, Labreche F, Smargiassi A, et al. (2013) Climate change and occupational health and safety in a temperate climate: potential impacts and research priorities in Quebec, Canada. Industrial Health 51(1): 68-78.

[23] Meima M, Kuijpers E, Berg Cvd, et al. (2020) Biological agents and prevention of work-related diseases: a review. Reportno. Report Number|, Date. Place Published|: Institution|.

[24] European Commission (2021) Forging a climate-resilient Europe - the new EU strategy on adaptation to climate change. COM (2021) 82 final. Brussels: European Commission.

[25] Bradbrook S, Duckworth M, Ellwood P, et al. (2013) Green jobs and occupational safety and health: Foresight on new and emerging risks associated with new technologies by 2020. Reportno. Report Number|, Date. Place Published|: Institution|.

[26] Daheim C, Prendergast J, Rampacher J, et al. (2021) Foresight Study on the Circular Economy and its effects on Occupational Safety and Health: Phase 1 Macro-Scenarios. Reportno. Report Number|, Date. Place Published|: Institution|.

[27] IPCC (2021a) Annex VII: Glossary. In: Matthews JBR, Möller V, Diemen Rv, et al. (eds) Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, United Kingdom and New York, NY, USA: Cambridge University Press, pp.2215–2256.

[28] Mechler R, Singh C, Ebi K, et al. (2020) Loss and Damage and limits to adaptation: recent IPCC insights and implications for climate science and policy. Sustainability Science 15: 1245-1251.

[29] UNEP (2016) Loss and Damage: The role of Ecosystem Services. Reportno. Report Number|, Date. Place Published|: Institution|.

[30] Pill M (2021) Linking solidarity funds and philanthropic giving to finance loss and damage from climate change related slow-onset events. Current Opinion in Environmental Sustainability 50: 169-174.

[31] Oppermann E, Kjellstrom T, Lemke B, et al. (2021) Establishing intensifying chronic exposure to extreme heat as a slow onset event with implications for health, wellbeing, productivity, society and economy. Current Opinion in Environmental Sustainability 50: 225-235.

[32] Kont A, Jaagus J and Aunap R (2003) Climate change scenarios and the effect of sea-level rise for Estonia. Global and Planetary Change 36(1): 1-15.

[33] Cianconi P, Betrò S and Janiri L (2020) The impact of climate change on mental health: a systematic descriptive review. Frontiers in psychiatry 11: 74.

[34] Comtesse H, Ertl V, Hengst SM, et al. (2021) Ecological grief as a response to environmental change: a mental health risk or functional response? International Journal of Environmental Research and Public Health 18(2): 734.

[35] Daghagh Yazd S, Wheeler SA and Zuo A (2019) Key risk factors affecting farmers’ mental health: A systematic review. International Journal of Environmental Research and Public Health 16(23): 4849.

[36] Hayes K, Blashki G, Wiseman J, et al. (2018) Climate change and mental health: Risks, impacts and priority actions. International journal of mental health systems 12(1): 1-12.

[37] Robine J-M, Cheung SLK, Le Roy S, et al. (2008) Death toll exceeded 70,000 in Europe during the summer of 2003. Comptes rendus biologies 331(2): 171-178.

[38] Stott PA, Stone DA and Allen MR (2004) Human contribution to the European heatwave of 2003. Nature 432(7017): 610-614.

[39] Bolitho A and Miller F (2017) Heat as emergency, heat as chronic stress: policy and institutional responses to vulnerability to extreme heat. Local Environment 22(6): 682-698.

[40] Spector JT and Sheffield PE (2014) Re-evaluating occupational heat stress in a changing climate. Annals of Occupational Hygiene. meu073.

[41] Casanueva A, Burgstall A, Kotlarski S, et al. (2019) Overview of existing heat-health warning systems in Europe. International Journal of Environmental Research and Public Health 16(15): 2657.

[42] Staiger H, Laschewski G and Matzarakis A (2019) Selection of appropriate thermal indices for applications in human biometeorological studies. Atmosphere 10(1): 18.

[43] Foster J, Smallcombe JW, Hodder S, et al. (2022) Quantifying the impact of heat on human physical work capacity; part II: the observed interaction of air velocity with temperature, humidity, sweat rate, and clothing is not captured by most heat stress indices. International Journal of Biometeorology 66(3): 507-520.

[44] Morabito M, Messeri A, Noti P, et al. (2019) An Occupational Heat–Health Warning System for Europe: The HEAT-SHIELD Platform. International Journal of Environmental Research and Public Health 16(16): 2890.

[45] One well known factor affecting rates of warming in Europe is the Gulf Stream. Projections of how it will be affected by climate change and affect temperatures regionally in turn are factored into the IPCC projections. The Gulf Stream is expected to weaken over the current century. Surface temperature warming would be even faster in its absence, but its presence, even weakened, is not enough to prevent a warming trend. See FAQ 9.3 in Chapter 9: Ocean, Cryosphere and Sea Level Change of IPCC (2021b) Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, United Kingdom and New York, NY, USA: Cambridge University Press.

[46] IPCC (2021b) Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, United Kingdom and New York, NY, USA: Cambridge University Press.

[47] IPCC (2022) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, UK and New York, NY, USA: Cambridge University Press.

[48] Climate-ADAPT (2023) The Adaptation Support Tool – Getting started: Climate Impacts in Europe. Available at: https://climate-adapt.eea.europa.eu/en/knowledge/tools/adaptation-support-tool/step-0-1 (accessed 27.03.2023).

[49] Matthews T (2018) Humid heat and climate change. Progress in Physical Geography: Earth and Environment 42(3): 391-405.

[50] Schwingshackl C, Sillmann J, Ana Maria VC, et al. (2021) Heat Stress Indicators in CMIP6: Estimating Future Trends and Exceedances of Impact‐Relevant Thresholds. Earth's Future 9(3).

[51] Russo S, Sillmann J and Sterl A (2017) Humid heat waves at different warming levels. Scientific Reports 7(1): 7477.

[52] Naumann G, Russo S, Formetta G, et al. (2020) Global warming and human impacts of heat and cold extremes in the EU. JRC PESETA IV Project—Task 11.

[53] Rohat G, Goyette S and Flacke J (2018) Characterization of European cities’ climate shift–an exploratory study based on climate analogues. International Journal of Climate Change Strategies and Management.

[54] Rohat G, Goyette S and Flacke J (2017) Twin climate cities—an exploratory study of their potential use for awareness-raising and urban adaptation. Mitigation and adaptation strategies for global change 22(6): 929-945.

[55] Bednar-Friedl B, Biesbroek R, Schmidt DN, et al. (2022) Europe. In: Pörtner H-O, Roberts DC, Tignor M, et al. (eds) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, UK and New York, NY, USA: Cambridge University Press, pp.1817–1927.

[56] Ioannou LG, Foster J, Morris NB, et al. (2022) Occupational heat strain in outdoor workers: A comprehensive review and meta-analysis. Temperature 9(1): 67-102.

[57] Ioannou LG, Mantzios K, Tsoutsoubi L, et al. (2021) Occupational Heat Stress: Multi-Country Observations and Interventions. International Journal of Environmental Research and Public Health 18(12): 6303.

[58] Gao C, Kuklane K, Östergren P-O, et al. (2018) Occupational heat stress assessment and protective strategies in the context of climate change. Int J Biometeorol. 62: 359-371.

[59] Foster J, Hodder SG, Lloyd AB, et al. (2020) Individual responses to heat stress: implications for hyperthermia and physical work capacity. Frontiers in physiology 11: 541483.

[60] Aghamolaei R and Lak A (2022) Outdoor thermal comfort for active ageing in urban open spaces: reviewing the concepts and parameters. Ageing International. 1-14.

[61] Speakman JR (2018) Obesity and thermoregulation. Handbook of clinical neurology 156: 431-443.

[62] Larose J, Boulay P, Sigal RJ, et al. (2013) Age-Related Decrements in Heat Dissipation during Physical Activity Occur as Early as the Age of 40. PLoS ONE 8(12): e83148.

[63] Binazzi A, Levi M, Bonafede M, et al. (2019) Evaluation of the impact of heat stress on the occurrence of occupational injuries: Meta‐analysis of observational studies. American Journal of Industrial Medicine 62(3): 233-243.

[64] Eurostat (2020) Ageing Europe: Looking at the lives of older people in the EU. Reportno. Report Number|, Date. Place Published|: Institution|.

[65] Siders AR (2019) Adaptive capacity to climate change: A synthesis of concepts, methods, and findings in a fragmented field. Wiley Interdisciplinary Reviews: Climate Change 10(3): e573.

[66] Jay O, Capon A, Berry P, et al. (2021) Reducing the health effects of hot weather and heat extremes: from personal cooling strategies to green cities. The Lancet 398(10301): 709-724.

[67] Pogačar T, Casanueva A, Kozjek K, et al. (2018) The effect of hot days on occupational heat stress in the manufacturing industry: implications for workers’ well-being and productivity. International Journal of Biometeorology 62: 1251-1264.

[68] Mora C, Counsell CW, Bielecki CR, et al. (2017) Twenty-seven ways a heat wave can kill you: deadly heat in the era of climate change. Circulation: Cardiovascular Quality and Outcomes 10(11): e004233.

[69] Lundgren K, Kuklane K, Gao C, et al. (2013) Effects of heat stress on working populations when facing climate change. Industrial Health 51(1): 3-15.

[70] Flouris AD, Dinas PC, Ioannou LG, et al. (2018) Workers' health and productivity under occupational heat strain: a systematic review and meta-analysis. The Lancet Planetary Health 2(12): e521-e531.

[71] Ebi KL, Capon A, Berry P, et al. (2021) Hot weather and heat extremes: health risks. The Lancet 398(10301): 698-708.

[72] Liu J, Varghese BM, Hansen A, et al. (2021) Hot weather as a risk factor for kidney disease outcomes: A systematic review and meta-analysis of epidemiological evidence. Science of The Total Environment 801: 149806.

[73] Levi M, Kjellstrom T and Baldasseroni A (2018) Impact of climate change on occupational health and productivity: a systematic literature review focusing on workplace heat. La Medicina del lavoro 109(3): 163.

[74] Morabito M, Cecchi L, Crisci A, et al. (2006) Relationship between Work-Related Accidents and Hot Weather Conditions in Tuscany (Central Italy). Industrial Health 44(3): 458-464.

[75] Ferrari GN, Ossani PC, de Souza RCT, et al. (2023) Impact of rising temperatures on occupational accidents in Brazil in the period 2006 to 2019: A multiple correspondence analysis. Safety science 161: 106078.

[76] Martínez-Solanas È, López-Ruiz M, Wellenius GA, et al. (2018) Evaluation of the impact of ambient temperatures on occupational injuries in Spain. Environmental Health Perspectives 126(6): 067002.

[77] Carter S, Oppermann E, Field E, et al. (2020) The impact of perceived heat stress symptoms on work-related tasks and social factors: A cross-sectional survey of Australia's Monsoonal North. Applied Ergonomics 82: 102918.

[78] Berry HL, Bowen K and Kjellstrom T (2010) Climate change and mental health: a causal pathways framework. International Journal of Public Health 55(2): 123-132.

[79] Tawatsupa B, Lim L-Y, Kjellstrom T, et al. (2010) The association between overall health, psychological distress, and occupational heat stress among a large national cohort of 40,913 Thai workers. Global Health Action 3(1): 5034.

[80] McDermott KM, Brearley MB, Hudson SM, et al. (2017) Characteristics of trauma mortality in the Northern Territory, Australia. Injury Epidemiology 4(1): 15.

[81] Szewczyk W, Mongelli I and Ciscar J-C (2021) Heat stress, labour productivity and adaptation in Europe—a regional and occupational analysis. Environmental Research Letters 16(10): 105002.

[82] Morrissey MC, Casa DJ, Brewer GJ, et al. (2021) Heat safety in the workplace: Modified Delphi consensus to establish strategies and resources to protect the US workers. Geohealth 5(8): e2021GH000443.

[83] Morris NB, Piil JF, Morabito M, et al. (2021) The HEAT-SHIELD project — Perspectives from an inter-sectoral approach to occupational heat stress. Journal of Science and Medicine in Sport 24(8): 747-755.

[84] Piil JF, Lundbye-Jensen J, Christiansen L, et al. (2018) High prevalence of hypohydration in occupations with heat stress—Perspectives for performance in combined cognitive and motor tasks. PLoS ONE 13(10): e0205321.

[85] Morris NB, Jay O, Flouris AD, et al. (2020) Sustainable solutions to mitigate occupational heat strain–an umbrella review of physiological effects and global health perspectives. Environmental Health 19(1): 1-24.

[86] ISO 7933:2004. Retrieved from https://www.iso.org/cms/render/live/en/sites/isoorg/contents/data/standard/03/76/37600.html

[87] ISO 7243:2017. Retrieved from: https://www.iso.org/standard/67188.html

[88] Parsons K (2006) Heat Stress Standard ISO 7243 and its Global Application. Industrial Health 44(3): 368-379.

[89] Nazarian N and Lee JKW (2021) Personal assessment of urban heat exposure: a systematic review. Environmental Research Letters 16(3): 033005.

[90] Bach AJ, Maley MJ, Minett GM, et al. (2019) An evaluation of personal cooling systems for reducing thermal strain whilst working in chemical/biological protective clothing. Frontiers in physiology 10: 424.

[91] Brearley M, Norton I, Rush D, et al. (2016) Influence of chronic heat acclimatisation on occupational thermal strain in tropical field conditions. Journal of Occupational & Environmental Medicine 58(12): 1250-1256.

[92] McDermott BP, Casa DJ, Yeargin SW, et al. (2007) Recovery and return to activity following exertional heat stroke: considerations for the sports medicine staff. Journal of Sport Rehabilitation 16(3).

[93] Oppermann E, Strengers Y, Maller C, et al. (2018) Beyond Threshold Approaches to Extreme Heat: repositioning adaptation as everyday practice. Weather, Climate, and Society 10(4): 885-898.

[94] Oppermann E, Brearley M, Law L, et al. (2017) Heat, health, and humidity in Australia's monsoon tropics: a critical review of the problematization of ‘heat’in a changing climate. Wiley Interdisciplinary Reviews: Climate Change 8(4).

[95] Ward K, Lauf S, Kleinschmit B, et al. (2016) Heat waves and urban heat islands in Europe: A review of relevant drivers. Science of The Total Environment 569: 527-539.

[96] Antoci A, Gori L, Sodini M, et al. (2019) Maladaptation and global indeterminacy. Environment and Development Economics 24(6): 643-659.

[97] Krüger E, Drach P and Bröde P (2015) Implications of air-conditioning use on thermal perception in open spaces: a field study in downtown Rio de Janeiro. Building and Environment 94: 417-425.

[98] Cunningham TR, Guerin RJ, Ferguson J, et al. (2022) Work‐related fatigue: A hazard for workers experiencing disproportionate occupational risks. American Journal of Industrial Medicine 65(11): 913-925.

[99] Laske MM, Hinson PE, Acikgoz Y, et al. (2022) Do employees’ work schedules put them at-risk? The role of shift scheduling and holidays in predicting near miss and incident likelihood. Journal of Safety Research 83: 1-7.

[100] Sherwood SC and Huber M (2010) An adaptability limit to climate change due to heat stress. Proceedings of the National Academy of Sciences 107(21): 9552-9555.

[101] Hanna E and Tait P (2015) Limitations to Thermoregulation and Acclimatization Challenge Human Adaptation to Global Warming. International Journal of Environmental Research and Public Health 12(7): 8034-8074.

Thermal climate

Select theme

Related articles

Physical agents
Heat at work - guidance for workplaces Read the article
Physical agents
Thermal risks Read the article
See all