Working in Australia's heat: health promotion concerns for health and productivity

Abstract

This exploratory study describes the experiences arising from exposure to extreme summer heat, and the related health protection and promotion issues for working people in Australia.

Twenty key informants representing different industry types and occupational groups or activities in Australia provided semi-structured interviews concerning: (i) perceptions of workplace heat exposure in the industry they represented, (ii) reported impacts on health and productivity, as well as (iii) actions taken to reduce exposure or effects of environmental heat exposure.

All interviewees reported that excessive heat exposure presents a significant challenge for their industry or activity. People working in physically demanding jobs in temperatures>35°C frequently develop symptoms, and working beyond heat tolerance is common. To avoid potentially dangerous health impacts they must either slow down or change their work habits. Such health-preserving actions result in lost work capacity. Approximately one-third of baseline work productivity can be lost in physically demanding jobs when working at 40°C. Employers and workers consider that heat exposure is a ‘natural hazard’ in Australia that cannot easily be avoided and so must be accommodated or managed. Among participants in this study, the locus of responsibility for coping with heat lay with the individual, rather than the employer.

Heat exposure during Australian summers commonly results in adverse health effects and productivity losses, although quantification studies are lacking. Lack of understanding of the hazardous nature of heat exposure exacerbates the serious risk of heat stress, as entrenched attitudinal barriers hamper amelioration or effective management of this increasing occupational health threat. Educational programmes and workplace heat guidelines are required. Without intervention, climate change in hot countries, such as Australia, can be expected to further exacerbate heat-related burden of disease and loss of productivity in many jobs.

In light of projected continued global warming, and associated increase in heat waves, more attention needs to be given to environmental heat as a human health hazard in the Occupational Health and Safety arena. Without adoption of effective heat protective strategies economic output and fitness levels will diminish. Health protection and promotion activities should include strategies to reduce heat exposure, limit exposure duration, ensure access to hydration, and promote acclimatization and fitness programmes, and reorientate attitudes towards working in the heat.

BACKGROUND

Amassing evidence from diverse scientific fields ranging from ice-core analysis, melting of north polar ice, marine and terrestrial biological sciences to weather records all indicate that global climate change has already gained significant momentum. Global warming is intensifying summer temperatures (IPCC, 2007). In an Australian context, large parts of the continent commonly experience extreme heat conditions (Alexander and Arblaster, 2009). Average surface temperatures have increased by 1°C since 1940 (Bureau of Meteorology, 2010), at a rate of 0.13°C/decade on average, and the increase in parts of Eastern Australia has been twice as much (Nicholls, 2009). Each decade has had more days over 35°C and more heat records than the previous decade (Bureau of Meteorology and CSIRO, 2010). The January 2013 heat wave was unprecedented (Bureau of Meteorology, 2013). First identified in 1973, the ‘urban heat island effect’ results in cities developing a heat load where physical structures, such as concrete and bitumen, absorb and retain solar radiation and then lose heat slowly during the night (Oke, 1973). Through this phenomenon, cities are warmer than their surrounding urban fringe or rural areas. In Australia's largely urbanized population, this places an additional heat burden on the population. We present the case that, health promotion, defined as the process of enabling people to increase control over, and to improve their health (World Health Organization, 1986), has an important role to play in protecting health in the face of a warming planet (Patrick et al., 2011).

‘Health protection’ is a term used widely in environmental health to describe the governance responsibility of first, protecting the public from being exposed to hazards which damage their health and secondly, limiting the health impact when such exposures cannot be avoided (The Health Protection Stocktake Working Group, 2011). In occupational settings, this governance responsibility lies with employers, but workers also have a duty of care to protect themselves and their work colleagues. Health protection requires the capacity to handle risk and uncertainty as well as a capacity to respond urgently when required. Our study investigates whether heat exposure is an emerging occupational health and safety (OHS) hazard in need of attention across health promotion and health protection realms to reduce health risk.

The effects of increasing heat exposure on the health of working people, and the relationship with climate change, have received relatively little attention globally (Kjellstrom et al., 2009a,b). The need for research to inform mechanisms for adapting to extreme heat is paramount (Maller and Strengers, 2011) and qualitative research on the effects of extreme heat exposure is especially sparse (Jay and Kenny, 2010; Patrick et al., 2011). The health risks of exposure to extreme heat are related to the physiological importance of maintaining a core body temperature within a relatively small optimal range (36.5–37.5°C) (Parsons, 2003). When ambient temperatures exceed a threshold that overwhelms the body's physiological mechanisms for cooling (thermoregulation), the capacity to maintain core temperature within this range diminishes. The resultant net heat gain can become life-threatening (Bridger, 2003; Parsons, 2003). Excessive heat exposure can increase the risk of accidents through a variety of mechanisms, including the adverse effects of heat on cognitive capacity and vigilance and the influence of sweating on reduced grip strength (Meyer and Rapp, 1995). Heat exposure as a rising challenge for health promotion was raised by McMichael et al. (McMichael et al., 2008), and in 2011 by Patrick et al. (Patrick et al., 2011) who highlighted the core competencies health promotion practitioners require to respond to climate-related health challenges. To date the health sector remains slow to acknowledge environmental health determinants in general, and climate change in particular, as health threats of concern (Hanna, 2005; Costello et al., 2009).

Heat exhaustion and heat stroke are particularly relevant to working people, as muscular activity creates surplus intra-body heat (Bridger, 2003; Jay and Kenny, 2010) that adds additional thermal load to external heat exposure. Heat exposure in the occupational setting can be fatal (Parsons, 2003), as highlighted by published reports from different settings (Kjellstrom et al., 2009a,b) including South African mines and US agricultural workers. In Australia, heat is responsible for over 1100 annual deaths (McMichael et al., 2003), representing a greater risk to health than any other natural hazard, and indeed higher than the annual road toll. The 2009 heat waves resulted in several occupational health deaths in Australians (McKean, 2010). Using climate projections, a recent Australian study modelled the number of days in Perth when the risk of hyperthermia in un-acclimatized working people becomes unsafe (Maloney and Forbes, 2011). ‘Unsafe’ is classified as when the core temperature rises by 2.5°C within 2 h. With the projected warming of 6°C of ambient temperatures if no mitigation strategies are adopted, Perth will experience 94 ‘unsafe’ days per year in 2070 compared with 31 days in 2009 (Maloney and Forbes, 2011). In Australia, people who need to work outdoors or in non-cooled environments are potentially vulnerable to heat stress. High-risk groups include construction workers, agriculture and forestry labourers, parks/gardens rangers, road workers and local service workers (Hanna et al., 2011). Indoor workers can also be affected, especially those working near heat-generating equipment, or where ventilation is poor or air conditioning (or other cooling methods) is not available.

Increasing heat exposure will not only impact on the health of workers, but there is great potential for significant reduction in economic productivity (Kjellstrom et al., 2009a,b), as a physically active person exposed to extreme heat has to avert dangerous heat accumulation by either reducing the intensity of physical activity or increasing hourly rest periods. Heat exposure risks are likely to also emerge from intensive outdoor recreational pursuits for amateur and professional athletes.

For individuals, their industries and national economies, we propose there are substantial benefits to be gained by having a better understanding of the effects of hot (and increasingly hotter) environments on workers' health and work capacity, and in developing health protection and promotion programmes to reduce adverse heat-related health effects. To test this proposition, we designed a study to generate preliminary information on the nature and spread of occupational heat risks and serve as a foundational study to guide subsequent tailored research. The key research questions were as follows:

• Is excessive heat exposure an existing threat to health of working people in the Australian context?

• What are the prevailing attitudes towards heat exposure, health promotion and health protection in high heat exposure occupational groups in Australia?

METHODS

Data were gathered via semi-structured telephone interviews with representatives from different industry sectors in Australia during the summer of 2010. Through their inability to provide a cooled environment, many industries and outdoor activities present high heat exposure risks during Australian summers (Hanna et al., 2011). A purposive sampling technique was applied to recruit a diverse selection of industries and activities identified as industries with high risk of heat exposure. We adopted a semi-structured telephone interview strategy, which is an effective method to gain a general account of an area of public health that is not well understood (Marcus and Crane, 1986). Set questions covered relevant areas, and respondents were encouraged to expand on areas of particular importance to their industry. Ethical approval was obtained from the Australian National University's Human Ethics Committee, and the work was carried out in compliance with the Helsinki Declaration.

The question topics focused on the following areas: Respondents were encouraged to extrapolate on their experiences and observations. Each interview lasted between 20 and 40 min and answers were transcribed during the interview.

• Description of activities undertaken in the enterprise/work sector.

• Experience of heat exposure: perceptions of heat discomfort, occurrence of health symptoms, health restorative measures adopted and their perceived efficacy.

• Evidence or estimates of impacts of heat on work activities and productivity.

• Workplace health promotion policies and practices designed to protect workers against harmful heat exposure.

Selection of participants

Purposive sampling methods were applied, with selection informed by a combination of literature search and discussions with key stakeholders to identify a range of workplace types where working people are exposed to heat. Organizations fitting these criteria were then randomly accessed via the internet and telephone directory. Key informants were allocated into three categories according to the type of organization they represented—private organizations, peak industry bodies or unions and government or regulatory bodies. A total of 55 potential interviewees were initially contacted and 8 refused to participate. Of the remaining 47, we interviewed the first 20 available in the limited time allotted for the study (January–February 2010). All interviews were conducted by a single interviewer.

For large organizations, the intent was to interview the organization's nominated OHS representative. In situation without a prescribed OHS position existed. We then sought nomination of the person who best fulfilled this role and was regarded qualified to report on behalf of the organization, and outline the organization's policies. To incorporate workers' perspectives, we also interviewed representatives of unions and industry peak bodies, and self-employed persons. Table 1 shows the category representation and their geographical distribution.

Sporting codes were included due to the increasing number of paid professionals in Australian sport. Sporting activities provide significant community benefits in terms of social capital and fitness, and sports people are also exposed to hazardous summer heat. Inclusion of this group was based on the significance of physical fitness to population health. Fears of heat-related health harm could lead to a reduction in community or professional engagement in sporting activities, and result in negative health outcomes at the population level. The health promotion implications of these interactions are complex, and will be assessed in subsequent analysis.

Data analysis

An inductive approach was used to identify recurring themes in the domains of heat exposure experience and coping strategies. Interviews, transcribing and data analysis were conducted by a single researcher (S.S., lead author). Identification of key themes proceeded through constant comparative analysis, thereby maximizing data familiarization. A coding system was used during this process, which evolved as the transcripts were analysed. Respondents were grouped according to their representational category. Emergent themes were then tabulated using these groupings, and to report attitudes to heat, we present selected quotes articulating respondents experienced effects of heat in Table 2.

RESULTS

Five dominant themes emerged on the effects of heat on the health and productivity of workers: A broad range of occupational types and outdoor activities result in exposure to extreme heat during Australia's summer months, and this is generating widespread adverse effects on health and productivity, as shown in Table 2.

1. Perceptions of excessive heat stress

2. Experience of heat exhaustion while working

3. Reduction in productivity due to heat

4. Powerlessness to influence/reduce heat exposure

5. Barriers to health promotion and protection policy development or compliance with policy.

Respondents provided detailed descriptors in their examples of heat exposure impacts on health and productivity, and outlined a shared sense of inevitability that accompanies involvement in activities deemed core to their business or pursuit. The participant responses present evidence that excessive heat exposure in the Australian workplace is already a threat to health and wellbeing of workers, as illustrated by the selected quotes provided in the following sections.

Perception of excessive heat stress

All interviewees reported that exposure to high temperatures was routine for workers during the summer months, and many reported varying degrees of symptomatology of heat-related illnesses. They described a range of observable negative health effects and reductions in work efficiency, which required operational adjustments to manage, as the following quotes indicate:

‘During summer most of the calls to our workers disputes hotline are related to heat'

(Union Representative)

‘Ceiling spaces feel 10 degrees warmer than outside so heat exposure is a massive issue'

(Insulation Installer)

‘Every day in summer I have to structure all of my work around heat'

(Self-employed Gardener)

‘The annual production schedule of a typical sheep farm is structured around the weather'

(Farming Peak Body)

Experience of heat exhaustion while working

Heat exhaustion, a serious but temporary problem that offers quick recovery (Parsons, 2003), is a common occurrence, where more than half of respondents (15/20) reported known cases in their industry, and several offered that there were frequent episodes each summer amongst the workforce. For example:

‘I've seen plenty of cricketers suffer heat exhaustion'

(Cricket Administrator)

‘We have one or two volunteers faint on the job every summer'

(Zookeeper)

‘During our pre-season practice in summer the big chaps frequently drop out of training not just with exhaustion, but exhaustion combined with nausea, cramping and headaches'

(Rugby Coach)

‘I get heat exhaustion around ten times every summer'

(Lawn-mowing Operator)

‘During a typical job in a four stand shed in January you'd expect one of the guys to drop out with heat exhaustion whilst working'

(Shearing Contractor)

Despite ‘heat exhaustion’ inferring a temporary ailment, difficulties in establishing full health recovery were reported:

‘Anyone that suffers from heat exhaustion never really recovers from it. Even when you think you are better, when you get back to work, you have very limited energy'

(former shearer and industry union representative)

Furthermore, union representatives explained that the number of cases of heat exhaustion is likely to be significantly understated by managers due to the stigma and consequences of this diagnosis:

‘Managers are not keen to formally label someone as suffering from heat exhaustion as this might trigger ‘cease work’ action by other workers at the workplace'

(Union Representative)

Reduction in productivity

A link between heat exposure and reduction in productivity and daily output was a unanimous finding, although few interviewees had attempted to quantify this effect. Instead they reported a slowing of the pace of work which resulted in tasks taking longer to complete:

‘I can't work when it is above 40 [degrees] and when it's around 35 I'd say that I'm a good one third slower in completing a lawn'.

(Lawn-moving Operator)

‘One in five ceiling installations are delayed because of the extra heat in summer'

(Insulation Installer)

‘The average shed output during comfortable weather would be 600 sheep a day. On the hottest days in summer this drops to 400'

(Shearing Contractor and Shearing Workers Union Representative)

Two final themes indicated an accepted inevitability regarding heat exposure is driving a widely held sense of powerlessness to ameliorate the hazard. This was accompanied by a range of reported barriers to address the associated health risk; some of these were institutional and others attitudinal.

Powerlessness

The theme of powerlessness reflects participants' statements that there is little they can do about heat in Australia's summers, therefore ‘one should not worry about it’. Respondents explained that their managers would not accept heat as a valid OHS risk, or that people would be considered ‘soft’ if they spoke out about their heat concerns. A union representative reflected:

‘We often hear managers claim that heat exposure is simply part of working in this industry, so workers just have to deal with it and continue'.

A representative from a farming peak industry body explained the difficulty in considering OHS regulations in the farming environment:

‘Occupational safety and health [sic] is a low priority on a farm. A contractor's rights, when it comes to occupational health, depend primarily on their relationship with the farm owner and not the law'.

The Health and Safety manager of a large public utilities organization explained how the demands to meet deadlines could result in OHS being marginalized. Heat safety policies are particularly vulnerable to neglect when they are not established as a core safety consideration. Health advocates face significant challenges attempting to encourage industry to adopt greater appreciation of the health risks of heat exposure in the face of an outcome-based approach to management, where the primary ‘outcome’ variable of interest is productivity. He added:

‘Management is driven by Key Performance Indicators which means there is pressure to work quickly to meet deadlines. Heat is not accounted for in these KPIs so it's very difficult to get recognition for this hazard'.

Barriers to health promotion and protection policy development and implementation

A variety of initiatives to help cope with heat were identified, but almost all participants remarked that either the development of heat exposure policies would be futile in their industry or that the existing policies were flawed, impractical or ignored. A former shearer remarked:

‘Even if there was a heat stress policy it would be impossible to implement it'.

Many participants reflected on the conservative approach to change in their industries, which compromised attempts to introduce new safety concepts such as reducing heat exposure. A representative from the cricket association explained the difficulty in implementing new regulations in their sport:

‘Australian cricketers have a dinosaur-ish response to change'.

In circumstances where institutionally initiated policies reportedly existed, it was common for them to be poorly understood, as indicated by a Human Resources manager for a regional airport:

‘Our workers are concerned that they will not get paid if they reduce their duties during hot days, even though such reductions do not occur'.

Strategies recommended to minimize excessive heat exposure include rescheduling shifts: working early in the cooler parts of the day, such as morning or night, and splitting shifts on extremely hot days to allow workers to rest during the hottest part of the day. Several reported these strategies to be impracticable in their industries:

‘We'd love to work early in the morning or late at night but we are not allowed to disturb residents (with noise that the work causes.)'

(Industry Representative)

‘It's impossible to split shifts despite what the regulators say. Once a roof comes off you can't leave the site until you've got one back on'.

(Roofing Manager)

Findings suggest that the shearing industry may be particularly isolated from health and safety regulation and union representation. The output-based method of payment encourages workers to continue working at maximum pace, regardless of the conditions as remuneration is directly determined by output: the number of sheep shorn per day. The manager of a shearing contractor organization reflected:

‘Even if there was a policy, shearers would ignore it, and determine the temperature by how much they sweat … these guys are paid by output, of course that drives them to keep working (even in extreme heat.)'

Certain industries are compelled to continue working, regardless of the level of occupational heat exposure risk. Respondents indicated that the option of reducing working hours in the face of extreme heat was impractical given the necessity of their work:

‘We always have to fulfil our duties no matter what the temperature … if there was a heat safety standard, it would be ignored by greater than 90% of providers in this industry'.

(Security Firm Manager)

‘We are here for the animals (there is always work to be completed for them, even on extremely hot days'.

(Zookeeper)

Contradictions between a heat exposure policy and other safety programmes were identified as a common barrier to implementation. A prominent example is the Sun Smart campaign, which has been promoted heavily in recent years (Cancer Council Victoria, 2010). This campaign encourages those exposed to the sun to cover the skin by wearing long sleeved clothing, as well as avoidance of the sun during the middle of the day. A variety of interview participants explained how this programme has resulted in more heat-related complaints from workers:

‘Our workers reject the standard UV radiation policy because it is too hot to wear long sleeved shirts in summer'.

(Construction Firm)

‘The sun smart policy recommends no physical activity in the sun between 11am and 4pm … our games are scheduled at this time; so of course we do not observe that'.

(Cricket Representative)

Another widely promoted safety measure is to replace manual labour with automated processes during hot weather. However, this can also contradict safety policies, notably fire risk minimization strategies:

‘They want us to use more machines when it's hot, but there is a fire service restriction for using machinery in very hot conditions'

(Farmers' Federation Member)

A variety of heat exposure coping strategies were identified by interviewees; however, these were not implemented on a systematic basis at workplace or industry level. A common theme indicted by respondents described preventive actions as principally the responsibility of the individual worker, and in turn, workers often felt powerless to implement protective measures for the collective good, especially when such measures involved operational changes. Table 3 outlines these coping strategies.

DISCUSSION

This study provided preparatory work for a larger follow-up study investigating health effects arising from occupational heat exposure. In addition to answering nominated research questions, investigating the attitudes, experiences and protective strategies in the Australian workplace relating to heat exposure, this was a foundational study. It served to test appropriateness of interview methodologies to generate primary data on occupation heat-related health risks. We sought to assess willingness of workers and managers to be interviewed about heat as a health issue and to identify any relevant sensitivities. We found that the semi-structured interview format and the list of questions used were well accepted by a variety of highly susceptible occupational groups and industries. Management, workers and workers' OHS representatives demonstrated an acceptance of heat as problematic and their openness revealed a lack of sensitivities around the topic. Indeed the high participation rate, enthusiasm to engage and offer their experiences, plus the universality of ‘having a story to tell’ indicate a high level of concern.

To our knowledge, this is the first Australian study to examine heat exposure among a broad range of industries. The few previous studies on heat exhaustion in Australian have all been industry specific, such as studies on miners (Donoghue et al., 2000) shearers (Gun and Budd, 1995; Budd, 2001) and fire fighters (Raines et al., 2011). Donoghue et al. (Donoghue et al., 2000) found that the incidence of heat exhaustion in workers at the Mount Isa Mines was 94.2 per 1000 workers per year, where highest rates are found in summer and at increasing mine depth. The capacity of shearers and fire fighters to continue working in extreme heat is principally determined by behavioural factors, such as the rate of water replacement through drinking and the use of ‘self-pacing’ to slow productivity in response to heat stress (Gun and Budd, 1995; Budd, 2001). Raines et al. (Raines et al., 2011) investigated heat as one of several health risks among Australian fire fighters. Through extensive OHS training and mandatory adoption of full protective personal equipment, occupational heat exposure for this group now comprises only 2–6% of reported injuries. However, it is important to note that criteria for inclusion in WorkSafe statistics involve extended days off work, which excludes predominantly short-lived injuries such as heat exhaustion.

None of these listed studies explicitly recorded the experiences of workers with regard to heat exposure. Despite its limitations in size, our study demonstrates that heat exposure is a broader occupational health problem than suggested by these few studies. Hazardous exposure to heat is evidently a widespread phenomenon confronting a diverse array of industries. As temperatures are projected to rise further with climate change, more frequent and more hazardous extreme heat events are projected (Orlowsky and Seneviratne, 2012). Future health risks for heat exposed workers are therefore high.

High exposures were also reported by representatives from sporting and recreational activities during Australian summers. It is perhaps important to note that attitudes acculturated in sporting codes closely mirrored those in occupational settings. It may be possible that this attitudinal consistency across industries and sporting codes reveals a commonality that stretches beyond these occupational groups and activities and represents broadly held views within the Australian community. Efforts to address heat safety in the workplace are therefore likely to be influenced by reigning attitudes in settings external to work, and we postulate that these may best be addressed simultaneously. This will need to be tested.

Whether the refusals (who comprised <15% of those contacted) declined as they believed heat not to be an issue remains unknown. It is noteworthy however that all our respondents stated that excessive heat exposure presents a significant problem for workers in their industry. Respondents also consistently suggested that under-reporting might be widespread as cases of heat exhaustion were seldom reported to management or authorities. Many are managed by first aid provided by colleagues on-site, and medical help is not sought unless recovery is severely prolonged, which greatly increases the risk of morbidity and mortality (International Association of Athletics Federations, 2011). Notably, responses indicated that heat as an occupational health risk is almost uniformly regarded as the responsibility of individual workers, rather than an issue primarily warranting systematic OHS intervention.

All interviewees reported productivity losses due to heat, but only a few could quantify heat-related productivity decline. On the basis of the statements provided, productivity is significantly reduced at 35°C, and approximately one-third of baseline work productivity can be lost in certain physically demanding jobs when working at 40°C. The heat exposure levels during the hottest parts of the days in the hot season are already causing difficulties for many working people as the interviews describe. Over the past 50 years, there has been a significant increase in the frequency of days over 35°C in Australia (CSIRO and BoM, 2007). If the observed trend of rising maximum temperatures continues, heat extremes will be more intense, more frequent and the distribution of these extreme temperatures will expand to more locations, affecting more workplaces. Occupational heat stress and resulting heat strain are therefore a major health concern arising from climate change for Australians, and also for working people in other countries that experience very hot summers. An organized health response is clearly required to avert a worst-case scenario of epidemics of occupational heat stress in future heat waves.

Despite a growing body of literature, heat exposure remains an under-recognized health concern in the health promotion arena, especially in the occupational setting. A recent study interviewed health promotion practitioners in Victoria (Australia) to establish the core competencies required by community health leaders in dealing with the health effects of climate change (Patrick et al., 2011). Although comprehensive, their approach did not consider working people as a vulnerable group in the context of climate change. Our findings suggest that working people need to be incorporated in such frameworks, and that health promotion practitioners have a role to play in advocating and mediating for the protection of workers from heat-related morbidity and work productivity losses.

To address the occupational health effects of climate change, a multi-pronged and multi-staged approach is therefore required, involving awareness raising, behaviour change and policy development. In this regard, health policy implementation presents specific challenges, particularly where economic imperatives generate competing demands against prioritizing worker' health. Pro-health responses are therefore likely to be problematic and may attract resistance. Our key informants indicated that profit, production and performance targets are overshadowing due to diligence in protecting workforce health. Notable Australian examples include the collapse of the Westgate Bridge and the Longford Gas Explosion (Braithwaite, 2011).

Due to a concerted effort, Australia's OHS record rates among the best in the world, and in January 2012, a nationally consistent set of Workplace Health and Safety laws was introduced to provide harmonization of OHS laws. Documentation costs for this could serve as a disincentive for small businesses (OHS Policy Manual $395 + GST, Work Health & Safety Management Plan $895 + GST). Safe Work Australia reports that the majority (86%) of Australian workers believe ‘management corrects unsafe situations or unsafe practices when they become aware of them’, however less than half of workers in Agriculture, Forestry or Fisheries reported receiving any training in, or having any representative for their OHS needs (Braithwaite, 2011). Attitudes amongst workers towards occupational safety remain an issue of concern. Up to 28% of young workers report resenting dealing with work health and safety requirements, 42% ‘get so involved with work that they forget about safety’ and 25% ‘sometimes skylark at work and take risks that jeopardize each other's safety’. Engagement with work health and safety is regarded as problematic for small business, where over half (53%) regard it impossible to satisfy all the work health and safety requirements, and 36% only do the minimal they are legally required to do to make a workplace safe (Braithwaite, 2011).

Evidence presented by our study elucidates the complexity involved in OHS guidelines, policy development, and also, addressing attitudes and achieving compliance. Initial workplace-initiated attempts at providing protection were often deemed inappropriate, and therefore ignored, because they either conflict with the essential core business, or with important upstream or downstream responsibilities. This highlights the critical need for flexibility in heat protection policies in order to maximize compliance and efficacy. Physical activities generate heat that cannot be dissipated in hot ambient temperatures, and unless cooling is available, continued physical effort results in heat gain, and risks over-heating (Parsons, 2003). The body must work slower, or rest, which reduces productivity (Kjellstrom et al., 2009a,b).

Prioritizing profits over worker health presents a powerful barrier to action. This was reported by the self-employed as well as employees, managerial and worker representatives, and in a warming world, increasing heat carries the potential to intensify this tension and exacerbate risks to worker health. This approach establishes a culture that can entrench poor attitudes to safety or justify those barriers with the (misguided) belief that concerns for one's health are somewhat weak or feeble, and the onus of responsibility is on the individual, rather than the collective.

Many high heat exposed industries are male dominated, with strong masculine cultures. And although attitudes to occupational health have improved over recent years, respondents in this study confirmed Safe Work findings; there remains room for improvement, especially among certain sectors. When adhering to traditional masculine values, it has been argued that men often take a ‘tough attitude’ toward illness and health protection (Courtenay, 2000). Other researchers have described the agricultural sector exhibited ‘an attitude among many in the industry that at best might be regarded as self-sufficient, at worst, uninformed and occasionally foolhardy’ (Guthrie et al., 1997). Whereas male attitudes towards protecting health and reducing personal risk have shifted in recent years, this study demonstrated that vestigial stereotypical attitudes to heat tolerance persist in the Australian workforce.

In the context of Australia's existing thermal environments, and increasingly hot summers, this study revealed a misalignment of perceived risk with current and future health risk. Risk perception is a subjective judgement about the felt likelihood of encountering hazards when objective information is minimal, and hence is an inherently psychological construct (Gierlach et al., 2010). Health protection—of self and others—may benefit from health literacy (Nutbeam, 2000). A combination of health education and interventions designed to combat dismissiveness towards personal safety with regard to heat exposure and to promote safe health behaviours is required. These should adopt a holistic approach and be targeted at all levels, employers and workers. Workplace policies must encourage mutually supportive safe working environments where heat risks are understood and avoided, and people are vigil in their assessment of risks. Initiating First Aid Programmes to teach recognition of symptoms and delivery of first aid in the workforce would limit workplace heat injury.

Safe work reports statistically significant differences exist in attitudes to work health and safety depending on the industry type, age and size of business (Braithwaite, 2011). Alertness to injury prevention has risen, yet we found institutionalized and personal acceptance of heat as a health hazard remained low across a range of industries and sporting agencies. Further research is required to increase understanding of the determinants of belief patterns and current practices and to inform the design of well-tailored programmes to suit the diverse heat exposed industries, regions and work cultures.

Limitations of this study include the small sample of key informants and so we caution the generalizability of the results. We have no information on the eight individuals who declined to participate, and this may introduce bias. Nonetheless, as an exploratory study, this project delivered a rich source of novel information, and has provided an initial assessment of the impact of heat across different industries, and indications of underlying beliefs, attitudes and practices, and potential barriers to health promotion actions. This study sets the groundwork for the focus of future research and provides a foundation for the design of a series of detailed studies to explore the issues raised.

CONCLUSIONS

This study offers readers a window into the experiences of Australian workers in dealing with heat extremes in a variety of settings. In the current Australian climate, heat has a prominent impact on both the health and productivity of workers across a diverse range of industries and workplace types. Recreational activities also present heat exposure risks. Analyses of maximum daily temperatures over recent decades indicate that heat exposures are trending upwards and hazardous environmental heat levels are already affecting health and productivity. Continuing global warming will amplify those health risks.

In asserting that healthy environments are fundamentally important for health, it is clear that the Ottawa Charter, by implication, calls for healthy working environments, which demand the implementation of health protective strategies in the workplace, to avoid injury among existing workforce.

Our findings suggest that current heat exposures are already at a hazardous level and existing workplaces are ill-equipped to protect worker health. Attitudinal challenges also prevail. In order to better understand the workplace impact of climate change in Australia and to develop adaptation strategies, these findings provide a strong argument for the need for health promotion in occupational settings as Australia continues to warm. Further quantitative analysis of current workplace exposures and qualitative studies are required to better understand the experiences and coping strategies among differing worker demographics and workers in different heat-exposed industries. There is also an urgent need for implementation of health promotion strategies, alongside systematic evaluation to determine, which are most effective in protecting the health in differing sectors of the workforce. Our analysis indicates that the impact of increasing environmental heat on working people is a significant aspect of how climate change will affect peoples' lives in the coming decades.

AUTHORS’ CONTRIBUTION

S.S. contributed to interviews, transcription, data analysis and drafting of the manuscript. E.G.H. contributed to project supervision and assisted drafting manuscript. T.K. contributed to initial project inception and assisted drafting manuscript.

FUNDING

Part funding for this study was acquired from the Australian National University (ANU), including a summer research scholarship for S.S. In addition, funding was provided by an Honours scholarship for S.S. from the University of Auckland. Funding for T.K. and L.H. was received from the ANU climate change and health research program coordinated by Professor Tony McMichael.

CONFLICT OF INTEREST

We have no competing interests to declare. None of the data collected or methods used are linked to any copyright by other persons or institutions.

REFERENCES