One of the pressing challenges facing the world is the impact of increasing global temperatures and water shortage (driven by both climate change and population expansion) on human health and productivity. Heat stress is a physical hazard that negatively affects productivity while also increasing accident rates and the risk of heat illness or injury in workers. Importantly, dehydration, which can occur quickly when undertaking physical work in hot environments, conflates the effects and risks of heat stress. Common incentives such as piecework exacerbate these risks. Thus, excessive heat exposure is a serious occupational health problem that will rapidly escalate as global temperatures and water shortages increase.

In some parts of the world, excessive heat exposure already presents a serious threat. An example of this is the epidemic of chronic kidney disease of non-traditional origin (CKDnt) that is highly prevalent in sugarcane workers in Central America and has resulted in tens of thousands of early deaths in this region over the last 30 years.

The risk factors for CKDnt are probably multiple, but there is a growing body of evidence that labour practices, specifically strenuous work in heat without sufficient rest or hydration, is an important driver of the disease. Thus, this disease has a direct link to climate change, with prevalence likely to increase in the near future unless workplace heat stress is mitigated.

As a response to this heat stress related disease, the Adelante Initiative has been implemented at a large sugarcane mill in Nicaragua. Adelante is a scientific evaluation of workplace interventions that focus on adequate water and rest in shade together with improved ergonomics, designed to prevent CKDnt among workers while preserving productivity. Due to the high prevalence of CKDnt among sugarcane workers, this initiative is primarily focused on this sector; from there it will be adapted to other geographies and industries.

A major challenge is getting key stakeholders and industry regulators to recognise the serious and far-ranging impacts of excessive heat exposure on human health and productivity.

A further challenge is the widespread use of piece rate work in developing economies. Piece rate work determines that workers are paid according to the number of units produced as oppose to the time spent on the job and can strongly influence workers to ignore or temper necessary worker protections.

Engaging key stakeholders in all parts of the global commodity chain (e.g., from local industry to the global consumer) in the promotion and practice of meaningful worker protections and sustainable production/consumption is a complicated process in itself.

As part of the Adelante Initiative, a set of evidence-based recommendations (such as on installing shade tents and water containers), actionable toolkits and educational materials has been created and distributed among those affected and those wishing to improve protections for workers in industrial agricultural work, and other manual outdoor work.

The experience and knowledge gained from the Adelante Initiative is also being used to inform work with other industries with workers at-risk of excessive heat exposure.

Following the implementation of a workplace intervention that improved access to water and rest in shade together with improved ergonomics, there was a reduction in the number of heat stress events and heat-related hospitalization in the cohort. Furthermore, the proportion of workers with kidney injury decreased following an enhanced rest schedule and improved intervention implementation.

The evidence gain from the Adelante Initiative was used to advocate and insert improved worker protections in the certification standards of Bonsucro and Fair Trade USA – both leaders in certification of sustainably produced sugarcane and other key food commodities.

Other Sugar mills have begun to address excessive heat exposure for their workers by implementing programs informed by Adelante’s intervention.

The benefit to industry is clear on an ethical plane, but this study has also demonstrated a positive return on investment for those undertaking such worker protection measures.

• When aiming to improve worker protection and work conditions, productivity and potential changes to productivity must be considered and measured, as productivity reductions (perceived or real) will undermine the successful implementation of a workplace intervention.
• Safer work practices can improve productivity and return on investment. It is critical to demonstrate this where possible to support the promotion and implementation of worker protection policies.
• Successful workplace intervention implementation depends on understanding the objectives at all management and worker levels. To be successful, worker protections and workplace interventions must align with these objectives otherwise “doing things as we always have” will win out.
• Successful and effective workplace intervention must be culturally appropriate.
• It is critical to engage early and regularly with all key stakeholders so that stakeholders are involved in the design, adoption, adaption (if necessary) and implementation. Identifying stakeholders’ key objectives (e.g., economic, health, social) is important to successfully implementing effective and enduring interventions.
• The positive impacts of successful worker protections and workplace interventions can be far ranging. Where possible, it is important to disseminate outputs to worker communities, industry policy makers and regulators (e.g., management, certifying institutions, governing bodies) and funders (e.g., development banks, consumer associations) and health systems.

As the fundamentals of intervention implementation and work to improve systems management is being refined, the organisers of the Adelante initiative are collaborating with leaders in technology to allow employers, and workers affordable ways to monitor their health and provide improved protection at work. They are working towards implementing workplace interventions that reduce occupational heat exposure in other at-risk occupations (e.g., construction) and populations (e.g., migrant workers), and also on improving law and certification standards at local and international levels while advising development institutions and programs. Finally, this initiative is aiming to examine the effects of early-life exposure due to child labour and provide adequate protections on lower resource farms and worksites.