Heat is killing workers in Europe – and the EU is dragging its feet on legislation
Heat stroke is one of the world’s oldest known medical conditions. But as scientists show that heat stroke and other heat-related illnesses are an increasingly deadly threat to workers in Europe, little is being done to protect them.
By Jared Paolino
Additional reporting by Chris Knapp, Linnea Arden, Rochelle Gluzman, Liv Martin, Kelly Smits, Sorana Horsia, Baptiste Renaut, and Théo Kaissaris
In 1859, Dr. James J. Levick published his “Remarks on sunstroke” in The American Journal of the Medical Sciences. In it, he referred in horror to a four-day stretch in 1847 during which the condition afflicted 37 individuals in New York City, “most of whom died so promptly that it was impossible to convey them to the hospital.”
Levick further reported that cases were “not uncommon” among enslaved persons on Southern plantations, nor among others whose lives were defined by long hours of hard labor, such as launderers, miners, and sailors. He noted with curiosity that most of those treated for sunstroke in the Philadelphia hospital in which he worked were “foreigners.”
“I know of no place other than the field of battle where such sudden destruction of human life occurs,” Levick wrote to describe sunstroke—a condition today more commonly referred to as heatstroke.
Today, Levick’s words carry more weight than ever. Since the 1850s, global average temperatures have increased by more than 1°C (1.8°F) and European average temperatures have increased by nearly 2°C (3.6°F). As global emissions reductions targets go unmet, temperatures continue to rise, and extreme weather events become more common. A near-definitive body of physiological and epidemiological research shows that heat stress—the term describing the net heat load that an individual is exposed to through a combination of metabolic and environmental factors—has impacts on human health. Those impacts include, but also go far beyond, acute conditions like heatstroke.
Workers in intensive outdoor industries such as agriculture and construction are among the most vulnerable. Migrant and informal laborers, who are heavily employed in these sectors, are even more so. And even with Europe warming almost twice as much as other countries over the past three decades, supranational authorities have put forward no legislation offering specific protections against the increasing threat of occupational heat exposure caused by climate change, despite the pleas of trade unions and scientists. On the verge of what could be the hottest European summer ever, experts are urging the EU and Member States to listen to what they have to say: heat is killing workers, and laws are needed to stop it.
The Heat Trap Project reviewed hundreds of pages of documents—including government reports, administrative documents, academic studies, and medical records—and conducted dozens of interviews with union representatives, experts, lawyers, doctors, and officials, as well as workers, victims, and their families. Our investigation has revealed that the EU has failed to adopt legally binding standards to safeguard workers against rapidly rising temperatures. In related articles, it has highlighted the potential culpability of European companies in the deaths of workers at home and abroad, exposed the challenges associated with diagnosing and tracking the role of heat stress in occupational injuries and deaths, and documented the conditions and circumstances that have led to the deaths of outdoor workers in Spain, France, and Italy.
A global danger
Long before Levick, the potentially deadly impact of heat was recorded in the Bible, in the writings of the ancient Greek physician Hippocrates, and in the recorded advice of Alexander the Great’s military advisers who warned the conqueror against marching under the sun through the windswept Libyan desert.
In the millenia since, humankind has witnessed how prolonged exposure to high temperatures can lead to nausea, seizures, loss of consciousness, and in the worst cases, death. Today, we know this phenomenon as heatstroke, and it has the potential to cause permanent disability or death in those who do not receive prompt emergency treatment. Sir William Osler, in his 1892 medical textbook, referred to heatstroke as “one of the oldest of recognized diseases.”
Evidence collected since the latter half of the 20th century, for example, indicates that heat exposure can exacerbate various cardiovascular and respiratory illnesses, as well as endanger reproductive health. High environmental temperatures in the workplace are also associated with an increased risk of occupational injury. And in the early 2000s, the first evidence of a link between occupational heat exposure and a unique type of chronic kidney disease—referred to simply as CKDnT, or chronic kidney disease of nontraditional causes—began to emerge in Central America.
Early researchers attributed CKDnT to heavy metal and pesticide exposure. Jason Glaser, now an epidemiologist, once shared that view. He first encountered CKDnT as a twenty-eight-year-old filmmaker shooting a documentary on the dark side of the banana industry, where he witnessed men his own age dying in hammocks outside the gates of the sugarcane farm where they worked.
In 2009, nearly two years after dedicating himself to the sugarcane workers’ cause, Glaser drove his silver Toyota Hilux down a rough-hewn highway in western Nicaragua. Cecilia Torres, a physician pursuing her PhD in epidemiology, sat in the passenger seat. They were traveling back to the city of León from Chinandega – the center of the Nicaraguan sugarcane industry and ground zero of the mystery epidemic plaguing the young men working in it.
“It’s got to be chemicals,” Glaser recounted saying.
“It’s worse than that,” he remembers Torres replying, a cigarette in hand, as usual. “They’re fucking cooking these people to death.”
Torres, who has since passed away, led one of the first epidemiological prevalence studies providing clear evidence of the scale of CKDnT among Nicaraguan sugarcane workers. Glaser, doubtful at first, was soon convinced. He obtained a degree in epidemiology, conducted studies, and supported further research through the La Isla Network—a research and consultancy firm dedicated to protecting workers from the fatal effects of heat. These efforts revealed a clear connection between the backbreaking work of sugarcane workers, the high temperatures in which this work takes place, and the cases of CKDnT affecting up to 41% of them, including many in their 20s and 30s.
Now, a considerable body of evidence has similarly linked high heat and work intensity to kidney disease in other Latin American countries, as well as Asia, Africa, and the Middle East. According to Shouro Dasgupta, an environmental economist working at the intersection of climate change and labor, anecdotal evidence to the same effect has emerged in Europe, though few studies have explored the phenomenon.
“It’s the Venn diagram,” Glaser said. “High heat, heavy labor, poor labor protections. Everywhere that has fulfilled those three things, we’ve seen [CKDnt], and almost everywhere they denied it was there, from the state level and from the private industry level.”
While the greatest heat hazards for workers exist in low-income and tropical countries, Glaser and other experts warn that, in a warming world, the danger is global. According to Eurofound, 23% of workers across the EU are exposed to high temperatures a quarter of their working time, with that figure rising to 36% and 38% among agriculture and construction workers, respectively.
However, while research on occupational heat exposure has moved forward, including through EU-funded initiatives such as HEAT-SHIELD and the European Climate and Health Observatory, it has seemingly failed to generate a sense of urgency in the minds of policymakers, corporate leaders, or the general public.
“Every occupational injury and illness is preventable. Otherwise, you’re saying part of your job is to get sick and die early. That’s absurd,” said Glaser.
Glaser is adamant that “Europe’s behind” and labor advocates in Europe have expressed a similar sentiment. In 2018, the European Trade Union Confederation (ETUC), a major union representing workers at the EU level, adopted a resolution on the need for EU action to protect workers from high temperatures. Last summer, the ETUC again called for greater protections for workers against heat, including the implementation of a Europe-wide maximum permissible temperature.
Glaser and other experts indicate that a universal maximum working temperature is unlikely to be a sufficient measure against occupational heat exposure. They instead advocate for further research on heat impacts for different jobs types and work environments; the development of heat-protective clothing and other technologies; improved risk assessment and monitoring; guaranteed water, rest, and shade; and the linking of measures such as maximum working temperature to work intensity.
However, even pleas for the most basic measures—including a maximum working temperature—have gone unmet. “The problem is that there is no European initiative in this area,” said Ludovic Voet, the ETUC’s Confederal Secretary. “The debate is progressing but without putting binding measures on the table.”
“I could not specifically identify any opponent, apart from the lack of political will. There is no name you can put behind it,” Voet added.
Although EU directives indicate that workers’ health and safety should be protected from any risks, these directives—while legislative acts—merely require Member States to achieve particular goals without dictating how to achieve them.
According to a spokesperson for the European Commission, “the EU legal framework on occupational health and safety already covers the occupational risks related to heat.” In addition, the spokesperson said, the European Agency for Health and Safety at Work has published “practical guidelines” addressing the risks of heat for employers in the construction and agricultural sectors.
It’s true that existing EU directives obligate employers to provide for the health and well-being of employees in general, which can be interpreted broadly to include protections against heat. It’s also true that some specific rules exist regarding heat and temperature in specific work environments, such as construction sites, and regarding protection against “inclement weather.” However, no EU directive or other legislative measure exists to explicitly protect all workers from the increasing threat of occupational heat stress caused by climate change.
Occupational safety and health experts say that such explicit measures are necessary in order to clearly define employer responsibilities. Such measures would ensure the most effective actions are taken, establish legally enforceable rights, and facilitate monitoring and enforcement mechanisms to ensure compliance.
Last summer, when the ETUC led calls for a maximum working temperature, Slovenian members of the European Parliament Milan Brglez and Matjaž Nemec raised the question to the Commission—the institution responsible for initiative legislative action at the EU level. Nicolas Schmit, Commissioner for Jobs and Social Rights, responded on behalf of the Commission, stating existing workplace directives “covers all risks, including those related to heat.” Schmit also noted that a review of the EU “Workplace Directive” is being prepared for 2023 and will consider the question of temperature.
A spokesperson for the European Commission confirmed this review is still underway as of April 2023 and further indicated it’s being undertaken “in view of a possible update of the Workplace Directive.”
The spokesperson also emphasized the role of member states, highlighting their responsibility to “implement and to enforce all provisions arising from EU occupational safety and health legislation” and called on employers “to put in place the resulting necessary preventive and protective measures” related to heat.
However, in practice, the translation of existing EU directives into national policy often fail to ensure companies adequately protect employees. In Spain, the Heat Trap Project unveiled how inadequate laws and corporate negligence led to the death of Rafael Luque, a construction worker who collapsed after spending 13 hours laying asphalt in temperatures as high as 41ºC.
Some European Member States have attempted to tackle the issue at home. Cyprus was the first to include special provisions in its legislation covering heat stress among workers, but the small island nation remains an outlier. Austria, Belgium, and Hungary are among others that have taken legislative action, but only limitedly, and with measures that rely heavily on the good will of employers.
Other countries such as Sweden, Switzerland, and the Netherlands have non-statutory guidelines recommending maximum working temperatures. Few countries have implemented the kind of comprehensive legislative packages that experts say are needed, despite decades of research showing the danger of working in the heat.
A voice in the dark
Tord Kjellstrom has been trying to convince the world of the danger of heat—and the urgency of acting—for longer than most. He has conducted research on environmental and occupational health for more than 50 years. Since the late 1990s, his work has largely focused on the impacts of climate change on human health.
In 1999, Kjellstrom attended a meeting of the Intergovernmental Panel on Climate Change (IPCC) Working Group III in New Delhi. There, his colleague Tony McMichael, the distinguished and now deceased climate epidemiologist, presented their research on the health implications of climate change. Afterwards, Kjellstrom said, other speakers stood and successively discussed their findings regarding the effects of climate change on agriculture, forestry, industry, and other sectors.
“It suddenly struck me that none of these speakers even once mentioned the workers,” said Kjellstrom. Today, having published more than 120 papers on the impact of climate change —and particularly heat—on workers, he worries that the unique risks faced by workers are still overlooked.
As climatologists predict continued and accelerated warming in Europe, they also say that extreme heat events will increase in frequency, severity, and duration. And while most EU member states have developed national heat-health action plans since a heatwave in 2003 resulted in tens of thousands of deaths, the protection of workers is only a small part of these plans—which are also not backed by binding national or European legislation.
According to Kjellstrom, “the current factual knowledge about the serious effects on health and productivity that heat can cause is enough to justify legislation.”
To encourage decision-makers to act, he has largely focused his work on the question of productivity. “I thought all the way from the beginning that if our analysis showed that there could be major economic risks caused by the heat, then government agencies and industries were more likely to pay attention to the problem,” said Kjellstrom.
And in fact, the work of Kjellstrom and his peers has consistently shown that heat-related labor productivity losses are likely to be extremely costly. One study, for example, found that labor productivity in Europe may be reduced by as much as 1.6% by the 2080s, and by as much as 8% in the most affected regions. According to Kjellstrom, as well as the most recent IPCC report, these productivity losses are not just a problem for companies’ profits. They may also threaten food security and worsen poverty.
Dasgupta, the environmental economist, also said the implementation of workplace protections will benefit companies. “We should not let profitability get in the way of protecting workers,” he added. “All labor force regulations are written in blood. Labor protection laws exist because people died.”
Compared to the general population, the risk faced by workers is exacerbated by many factors. Affected workers include indoor workers in the healthcare, manufacturing, and service sectors, but is most pronounced for outdoor workers in agriculture and construction.
Unlike other sectors, workers in these industries often undertake successive days of strenuous labor under heat stress conditions, which research shows increases the risk of developing heat-related pathologies, even for those acclimatized to the temperature. David Azevedo, the Heat Trap Project reported, died on his third day of work at a construction site in central France—after spending all three of those days laboring in the oppressive July heat.
According to Kjellstrom, it is important to note that heat stress conditions may occur even at temperatures not considered extreme, especially if adequate protections are not in place. “In many places, days that are not defined as heat waves can still cause serious health risks and productivity loss among workers.” In addition, agricultural workers are often required to undertake the most grueling tasks during the hottest part of the day or year, and most construction work is found in cities, where workers are subject to the urban heat island effect.
Agriculture and construction are also among the sectors with the highest rates of poverty and informal or precarious employment. Those living in poverty are more often exposed to heat stress outside the workplace, as they are more likely to travel to work by foot or in vehicles without climate control, and their homes are less likely to be well-insulated or have air-conditioning.
Among these workers, migrant laborers are especially vulnerable. In regard to heat, research has shown that migrant workers are often engaged in more physically demanding tasks, spend more time working outdoors, and are more likely to be exposed to occupational heat stress, particularly in the agriculture and construction industries. The Heat Trap Project revealed how migrant farmworkers living in informal settlements in Italy, for example, have become entangled in a web of exploitation that leaves them especially vulnerable to rising temperatures.
Hotter summers ahead
Andreas Flouris, a researcher at the University of Thessaly in Greece, is an expert in the ways heat affects the human body. For much of his career, he has applied that expertise in the field of sports science, figuring out how to optimize athletic performance in high temperatures.
In 2019, Flouris participated in a study to assess occupational heat strain and mitigation strategies in Qatar, where the Heat Trap Project has highlighted the potential failure of European companies to protect workers from extreme heat in the lead up to the 2022 World Cup. It was then that he realized the similarities between athletes and construction workers—with one key difference:
“They’re working in extreme conditions, their bodies are asked to deliver a tremendous amount of work, a tremendous amount of power output—the same power output that athletes are requested to deliver—but they don’t get any support,” said Flouris.
He decided to investigate occupational heat stress further; a review of the existing literature led him and his colleagues to a second startling revelation:
“There was almost no data coming out of any kind of European lab or any other European organization,” Flouris said. “And we felt that we needed to fill this gap.”
Flouris and others thus sought funding through the EU’s Horizon 2020 funding scheme, and their project, HEAT-SHIELD, was selected as one of only three out of more than a hundred projects in its category to receive funding.
The support for HEAT-SHIELD spurred optimism in Flouris. When a high-ranking European Commission official, Commissioner for Transport Violeta Bulc, attended the project’s kick-off meeting in December 2016, he was even more optimistic. Now, seven years later, he is worried.
“It’s unacceptable that the EU hasn’t moved forward with a legislative framework to protect both the workers and the employers,” says Flouris. “We clearly know it’s an issue. There should not be any argument for not moving forward.”
The HEAT-SHIELD project officially ended in 2021, but its research continues to be released. So far, more than 70 papers on occupational heat stress have been published in academic journals, and while there’s more work to be done, the gap that existed years ago is no longer there. According to Flouris, we have all the evidence we need to put forward legislation at the European level.
“We need to at least create an initial battery of measures to protect workers,” he said. “We have the evidence for that.”
“It doesn’t matter whether you live in Sweden, or in Cyprus,” he added. “This needs to be addressed.”
In May, an Occupational Safety and Health Summit will take place in Stockholm, co-organized by the Commission and the Swedish Presidency of the Council of the EU. According to the Commission spokesperson, “climate change and specifically the exposure to heat will be one of the main topics to be discussed.” The “high-level event” will gather “relevant stakeholders” in the field of occupational safety and health, including national labor ministers; Members of the European Parliament; representatives from other EU institutions, international organizations, and European social partners, which include employer organizations and trade unions; and academic experts.
The agenda of the event has not been finalized, and preparations are still ongoing. At this time, Flouris has not been invited to the meeting, nor have any of the other experts interviewed for this article.
“No scientific experts have been invited that I know,” added Flouris. “I fear that they are just not going to be informed.” But even without an invitation, Flouris is lobbying officials in European institutions and national governments to ensure that evidence of the deadly impact of heat on workers is presented at the event.
“The outcome of this meeting should be that they need to create a committee that develops an EU Directive on addressing heat stress. Unless they do that it’s just kicking the can down the road,” said Flouris, “we have the evidence, we need to move towards creating guidance and then implementing it.”
In the meantime, the hottest months of this year are just around the corner.
“I think it’s going to be a very bad summer,” he said.