Health vs. wealth: Employer, employee and policy-maker perspectives on occupational heat stress across multiple European industries

Figures & data

Figure 1. HEAT-SHIELD recommendations to combat occupational heat stress

Table 1. Questionnaire respondents, primary occupations, perceived threat of occupational heat strain, and reasons to combat occupational heat strain

	Respondents		Perceived threat of OH-Stress		^#Reasons to combat OH-Stress
	Participants (%)	Years of experience (SD)	Hot months per year (SD)	*Effect on performance (SD)	Minimize heat-related health-risks hazards (SD)	Minimize impact on well-being (SD)	For safety reasons (SD)	Regulation compliance (SD)	Productivity maintenance (SD)	Protect individual productivity (SD)	Protect company productivity (SD)
Total	41 (100)	15.3 (9.8)	3.2 (2.3)	2.1 (0.9)	9.1 (1.8)	8.5 (1.9)	8.2 (2.4)	7.4 (2.5)	7.0 (2.1)	6.3 (2.3)	6.3 (2.3)
By location
Florence	11 [24]	20.8 (10.1)	3.2 (0.7)	1.9 (0.6)	9.6 (0.5)	8.6 (2.5)	8.0 (2.5)	6.3 (3.6)	6.1 (1.6)	5.7 (2.5)	5.3 (2.8)
Tønder	8 [9]	10.3 (10.9)	4.9 (3.7)	2.8 (1.2)	7.8 (2.1)	8.7 (1.2)	8.0 (2.2)	6.0 (0.0)	7.3 (1.5)	3.5 (0.7)	3.3 (0.6)
Rome	14 [28]	13.6 (8.2)	1.9 (1.2)	1.9 (0.6)	9.5 (0.8)	8.7 (1.1)	9.2 (0.9)	8.2 (1.7)	7.5 (1.7)	6.4 (2.3)	6.6 (1.4)
Nicosia	8 [9]	16.8 (9.2)	4.0 (2.3)	2.0 (1.0)	8.8 (3.2)	8.0 (2.8)	6.0 (3.8)	7.4 (2.6)	7.1 (3.2)	7.5 (1.7)	7.9 (1.8)
By primary occupation
Health and safety	14 [28]	17.2 (9.5)	3.0 (1.7)	1.8 (0.6)	9.8 (0.4)	8.5 (1.8)	9.0 (1.2)	8.2 (2.0)	7.3 (2.0)	5.9 (2.3)	6.3 (1.9)
Management	13 [17]	13.8 (9.8)	2.8 (1.7)	2.1 (0.9)	8.7 (2.8)	8.6 (2.7)	7.2 (3.6)	6.8 (2.9)	6.1 (2.5)	6.8 (2.4)	6.6 (2.7)
Employee	6 [32]	11.7 (12.4)	5.2 (4.4)	2.8 (1.4)	7.8 (2.1)	8.7 (1.2)	8.0 (2.2)	6.0 (0.0)	7.3 (1.5)	3.5 (0.7)	3.3 (0.6)
Researcher	5 [37]	17.5 (11.6)	3.1 (1.3)	2.3 (0.5)	10.0 (0.0)	9.3 (1.0)	9.3 (0.5)	9.0 (1.4)	7.0 (2.2)	7.3 (2.1)	7.3 (2.1)
Other	3 [2]	17.0 (4.2)	1.7 (0.5)	2.0 (1.0)	8.7 (0.6)	7.0 (1.0)	8.3 (0.6)	5.0 (3.0)	9.0 (0.0)	7.5 (0.7)	7.5 (0.7)

OH-Stress: Occupational heat stress

*Performance impact scores: 1-No/minimal effect; 2-The heat mildly affects my health and performance; 3-The heat moderately affects my health and performance; 4-The heat greatly affects my health and performance.

#Level of importance to combat occupational heat strain on a scale from 1 to 10; 1 being not important and 10 being most important.

Figure 2. Absolute and percent of total answers given to the question: “What heat prevention actions does your company use during hot periods?”

Table 2. What other interventions could be useful?

Intervention	Frequency of answer
Make drinking water available	5
Planned breaks	3
Refrain from working outdoors in the hottest hours	3
Better insulate old buildings, tint windows, etc	2
Comprehensive risk assessment of heat stress for all tasks with each industry	1
Have social security set up for workers who cannot work because of the heat	1
Inform the workers about the signs/symptoms and health affects of heat illness	1
Not having to wear helmets	1
Suck the heat out of the top of the building	1
Add more radiant heat screens	1
Better helmets	1
Surveillance of health indicators	1
Provide saline supplementation	1
Plan interventions	1
Improve canteen controls to stop food spoilage	1
Air conditioning sanitation and revision	1
Evaluate personal protective equipment being used	1
Better clothing	1
Shading	1

Figure 3. Absolute and percent of total answers given to the question: “What are the three best interventions for combatting heat stress?”. PPE: personal protective equipment

Figure 4. Absolute and percent of total answers given to the question: “What barriers do you think exist that would prevent the implementation of the proposed cooling interventions”

Table 3. What further information about the effects of heat stress on work performance would you want from future meetings?

Answer	Frequency of response
Information on understudied sectors	3
Interplay between heat stress and confounding factors (e.g. medical conditions, habits [smoking and nutrition] and drug use, sex	3
More about weather warning systems	2
Monitorable health metrics	2
Information on how heat affects fatigue and cognition	2
Information regarding heat stroke	1
Considerations of local health unit supervisors	1
How the body responds to heat stress	1
Information on and dissemination to underrepresented workers (immigrants, those on small farms)	1
Cost/benefit analysis of interventions	1
What is being done outside of Europe	1
More information on occupational research	1

Table

Q1. What is your role and area within the company/organization? E.g. manufacturer, laborer, management, etc.

Q2. Do you have any additional roles or titles within the company? E.g. union representative, shop steward, etc.

Q3. How many years of experience do you have with the company?

Q4. Are you aware of local (company) or national “heat-prevention-plans” (procedures initiated when it is hot)? If yes, briefly describe:

Q5. How many months each year is heat in the workplace a problem?

Q6. How often do you think high temperatures affects your personal productivity during the hot months of the year? Select one: i) No/minimal influence in limited period of year; ii) Moderate influence (mainly peak summer); iii) High impact (during major part of summer).

Q7. How often do you think high temperatures affects your company’s productivity during the hot months of the year? Select one: i) No/minimal influence in limited period of year; ii) Moderate influence (mainly peak summer); iii) High impact (during major part of summer).

Q8. How many days per year would you estimate you are affected by high temperatures at work? Give number:

Q9. When it does get hot, how much do you feel the affects your health and performance? Select: i) No/minimal effect; ii) The heat mildly affects my health and performance; iii) The heat moderately affects my health and performance; iv) The heat greatly affects my health and performance.

Q10. Does the company implement heat prevention actions during hot periods? List types of actions implemented.

Q11. List any additional actions/procedures/solutions you find relevant to adopt during hot periods.

Q12. Please rank (score from 1 [low] to 10 [high]) the importance of the listed factors in relation to implementing heat-prevention-procedures: i) Prevent loss of productivity (individual or company capacity); ii) Prevent/minimize risk of heat-health hazards; iii) Comply with company or national regulations; iv) For safety reasons; v) Minimize impact on well-being i.e. reduce heat-related symptoms (such as thirst, thermal discomfort etc.); vi) Benefit income (my individual piecework rate); vii) Benefit income (company economy)

Q13. List and rank any additional factors:

Q14. The currently implemented heat prevention actions, are they effective? Please explain their impact.

Table

Q1. Were there any of the proposed solutions or procedures for heat prevention that you disagreed with or did not understand the rationale behind/need to implement them? If yes briefly describe which:

Q2. List the top-three heat-prevention procedures or solutions (either some of the presented or you own best advice for others):

Q3. Were there any of the proposed solutions or procedures that you were unaware of (or did not find relevant or feasible to use) before the presentation that you would now consider using or suggest others to use for future practice? If yes briefly describe which:

Q4. Do you see any barriers that might preclude you or your company from implementing new or already identified solutions? If yes, please list the main issues you see:

Q5. Is there any general or specific information you are aware of concerning heat stress – recommendations or practices you think would be valuable to share – that you feel were not included in the presentation? If yes, briefly describe which:

Q6. Is there any information about heat stress that you would like to know more about that you feel was not covered in this presentation? If yes, briefly describe which:

Piil JF, Lundbye-Jensen J, Trangmar SJ, et al. Performance in complex motor tasks deteriorates in hyperthermic humans. Temperature. 2017;4:420–428.

 PubMedGoogle Scholar

Morris NB, Jay O, Flouris AD, et al. Sustainable solutions to mitigate occupational heat strain – an umbrella review of physiological effects and global health perspectives. Environ Health. 2020;19:95.

 PubMed Web of Science ®Google Scholar

Tustin AW, Lamson GE, Jacklitsch BL, et al. Evaluation of occupational exposure limits for heat stress in outdoor workers — United STATES, 2011–2016. Morb Mortal Wkly Rep. 2018;67:733–737.

 PubMed Web of Science ®Google Scholar

Shirreffs SM. The importance of good hydration for work and exercise performance. Nutr Rev. 2005;63:S14–21.

 PubMed Web of Science ®Google Scholar

Lam M, Krenz J, Palmández P, et al. Identification of barriers to the prevention and treatment of heat-related illness in Latino farmworkers using activity-oriented, participatory rural appraisal focus group methods. BMC Public Health. 2013;13:1004.

 PubMed Web of Science ®Google Scholar

Jacklitsch B, Williams J, Musolin K, et al. NIOSH criteria for a recommended standard: occupational exposure to heat and hot environments. Dep Health Hum Serv Cent Dis Control Prev Natl Inst Occup Saf Health DHHS NIOSH Publ. p. 2016–2106. 192, [date unknown]. .

 Google Scholar

Flouris AD, Dinas PC, Ioannou LG, et al. Workers’ health and productivity under occupational heat strain: a systematic review and meta-analysis. Lancet Planet Health. 2018;2:e521–e531.

 PubMedGoogle Scholar