La Isla Network, 2023

Implementing Partners: La Isla Network, University of Gothenburg, San Antonio Sugar Mill, University of Birmingham, University of Indiana, University of Texas, Lund University, UNAN-Leon, Costa Rica Institute of Technology, Bonsucro

Published In: COP28 Prospectus of Climate-Health Solutions, 2023

Implementing occupational health interventions to prevent heat stress among sugarcane workers in Nicaragua, including fatal Chronic Kidney Disease of undetermined causes (CKDnT).

 

Context

Many laborers are confronted with occupational heat stress from physically demanding work in high environmental temperatures with inadequate protections. Heat stress has multiple well-established adverse health outcomes, including increased accidents, heart attacks, heat illness, stroke, and organ damage including kidney diseases. All are potentially fatal and associated with decreased productivity. Heat stress and its health effects harm workers, communities, employers, and health systems. Active intervention in a warming world is required. Chronic Kidney Disease of undetermined causes (CKDnT) is a fatal progressive loss of kidney function that has killed more than 40,000 people in Mesoamerica and Sri Lanka alone in the last 10 years. Treatment is out of reach for most ensuring an early death for those affected.

Approach

La Isla Network are leading the PREP intervention program aimed at addressing heat stress among sugarcane workers in Mesoamerica. The PREP program has four key components:

  1. Prevention of heat stress through:
    • scheduled and mandated rest in shade
    • mandated hydration including electrolyte breaks
    • sanitation initiatives
    • personal protective equipment to prevent injuries including sweat-wicking shirts
    • reduction in workload from shorter shifts (14 versus 6 hours) and shorter working weeks (7 versus 6 days).
  2. Resilience of communities and health systems facing socioeconomic challenges from heat-related illnesses.
  3. Efficiency in organizational systems to increase production, expediting uptake of prevention in affected industries.
  4. Protection findings to inform policies for protecting workers in both the public and private sector.

The project was implemented through multi-stakeholder collaboration. A transdisciplinary team of La Isla Network assessed current practices and their impact on worker health and productivity, addressed the current gaps via occupational safety and health (OSH) protocols co-designed with workers and employers, and assisted in implementation through organizational management and technological support

Communities and workers informed the prioritization of efforts and the practical design of the intervention. Sugarcane producers were essential in the provision of a venue and the design of the program. Brands and certification bodies such as Fair Trade helped prioritize heat stress within relevant supply chains. Governmental and UN agencies were engaged early to identify what data was required for decision makers. Unions and worker groups were provided with data as it became available for their own advocacy. Engagement was achieved through direct outreach in person and online, commercial, and scientific conferences, and media appearances including press, documentaries, and photo stories.

The initial funding received for the project was approximately $2.5 million financed by Germany’s KfW, DEG, Federal Ministry for Economic Cooperation and Development (BMZ), and German Agency for International Cooperation (GIZ).

Impact and next steps

This PREP program has reached 4,500 field workers at a sugarcane mill in Nicaragua. Each part of the program had an impact:

  1. Prevention: interventions were assessed through a longitudinal measurement of selected health metrics of workers, as well as a measurement of the quality and consistency of implementation. Findings showed:
    • an immediate 72% improvement in severe reduction of kidney function in workers across the harvest
    • 94% reduction in hospitalizations from acute kidney injury among sugarcane workers
    • Over 80% adherence to full compliance with intervention protocols, improving significantly after an organizational management intervention.
  2. Resilience: although health system data is still being analyzed, it is clear that the cost burden of heat related illnesses cost the Nicaraguan social security system a near 1:1 equivalent of wages lost for those covered.
  3.  Efficiency: the intervention provided a 10-15% increase in productivity and a ROI of more than 21%.
  4.  Protection: policy engagement was carried out in direct communication with regulatory authorities and key actors along the value chain. This work is now informing both EU and US work on heat stress standards.

Intervention with the PREP program cost $150 per worker per year. There is a clear cost benefit for the public system as the social security payments in Nicaragua for laborers unable to work due to heat stress are >$1,200.

The PREP program is already being scaled to sugarcane production in other South and Central American countries. Additionally, the program has now reached the apparel factories in El Salvador, construction companies in the USA, and related work in Nepal and Eswatini. The program has received funding from private industry actors such as Under Armor, Adidas, Turner Construction, Diageo.

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