Sometimes the heat makes you vomit, said Carmen Garcia, a farmworker in the San Joaquin Valley of California. She and her husband spent July in the garlic fields, kneeling on the scorched earth as temperatures hovered above 105 degrees. Her husband had such severe fatigue and nausea that he stayed home from work for three days. He drank lime water instead of seeing a doctor because the couple doesn’t have health insurance. “A lot of people have this happen,” Garcia said.

There are no federal standards to protect workers like the Garcias when days become excessively hot. And without bipartisan support from Congress, even with urgent attention from the Biden administration, relief may not come for years.

President Joe Biden in 2021 tasked the Occupational Safety and Health Administration with developing rules to prevent heat injury and illness. But that 46-step process can take more than a decade and might stall if a Republican is elected president in 2024, because the GOP has generally opposed occupational health regulations over the past 20 years. These rules might require employers to provide ample drinking water, breaks, and a cool-down space in shade or air conditioning when temperatures rise above a certain threshold.

On Sept. 7, OSHA will begin meetings with small-business owners to discuss its proposals, including actions that employers would take when temperatures rise to 90 degrees.

As this summer has broken heat records, Rep. Judy Chu (D-Calif.) and other members of Congress have pushed legislation that would speed OSHA’s rule-making process. The bill is named after Asunción Valdivia, a farmworker who fell unconscious while picking grapes in California on a 105-degree day in 2004. His son picked him up from the fields, and Valdivia died of heatstroke on the drive home. “Whether on a farm, driving a truck, or working in a warehouse, workers like Asunción keep our country running while enduring some of the most difficult conditions,” Chu said in a July statement urging Congress to pass the bill.

Trade organizations representing business owners have fought the rules, calling the costs of regulations burdensome. They also say there’s a lack of data to justify blanket rules, given variation among workers and workplaces, ranging from fast-food restaurants to farms. The U.S. Chamber of Commerce, one of the most powerful lobby groups in Washington, argued that such standards are nonsensical “because each employee experiences heat differently.” Further, the Chamber said, measures such as work-rest cycles “threaten to directly and substantially impair … employees’ productivity and therefore their employer’s economic viability.”

“Many heat-related issues are not the result of agricultural work or employer mismanagement, but instead result from the modern employee lifestyle,” the National Cotton Council wrote in its response to proposed regulations. For example, air conditioning makes it more difficult for people to adapt to a hot environment after being in a cold dwelling or vehicle, it said, noting “younger workers, who are more used to a more sedentary lifestyle, cannot last a day working outside.”

The Forest Resources Association, representing forest landowners, the timber industry, and mills, added that “heat-related illnesses and deaths are not among the most serious occupational hazards facing workers.” They cited numbers from OSHA: The agency documented 789 heat-related hospitalizations and 54 heat-related deaths through investigations and violations from 2018 to 2021.

OSHA concedes its data is problematic. It has said its numbers “on occupational heat-related illnesses, injuries, and fatalities are likely vast underestimates.” Injuries and illnesses aren’t always recorded, deaths triggered by high temperatures aren’t always attributed to heat, and heat-related damage can be cumulative, causing heart attacks, kidney failure, and other ailments after a person has left their place of employment.

The Toll of Temperature

To set regulations, OSHA must get a grasp on the toll of heat on indoor and outdoor workers. Justification is a required part of the process because standards will raise costs for employers who need to install air conditioning and ventilation systems indoors, and those whose productivity may drop if outdoor workers are permitted breaks or shorter days when temperatures climb.

Ideally, business owners would move to protect workers from heat regardless of the rules, said Georges Benjamin, executive director of the American Public Health Association. “We need to do a better job of convincing employers that there is a trade-off between efficiency and sick workers,” he said.

Garcia and her husband suffered the symptoms of heat exhaustion: vomiting, nausea, and fatigue. But their cases are among thousands that go uncounted when people don’t go to the hospital or file complaints for fear of losing their jobs or immigration status. Farmworkers are notoriously underrepresented in official statistics on occupational injuries and illness, said David Michaels, an epidemiologist at George Washington University and former OSHA administrator. Researchers who surveyed farmworkers in North Carolina and Georgia found that more than a third of them had heat illness symptoms during the summers of their studies — far higher than what OSHA has registered. Notably, the Georgia study revealed that 34% of farmworkers had no access to regular breaks, and a quarter had no access to shade.

Even cases in which workers are hospitalized might not be attributed to heat if doctors don’t make note of the connection. Many studies link occupational accidents to heat stress, which can cause fatigue, dehydration, and vertigo. In a study in Washington state, farmworkers were found to fall off ladders more often in June and July, among the hottest and most humid months. And in a 2021 report, researchers estimated that hotter temperatures caused approximately 20,000 occupational injuries a year in California between 2001 and 2018, based on workers’ compensation claims.

Heat-related kidney injuries also come up in OSHA’s database of workers severely injured on the job, like an employee at a meat processing plant hospitalized for dehydration and acute kidney injury on a hot June day in Arkansas. But research finds that kidney damage from heat can also be gradual. One study of construction workers laboring over a summer in Saudi Arabia found that 18% developed signs of kidney injury, putting them at risk of kidney failure later.

In addition to quantifying the injuries and deaths caused by heat, OSHA attempts to attach a cost to them so it can calculate potential savings from prevention. “You’ve got to measure things, like what is a life worth?” Michaels said. To workers and their families, suffering has far-reaching consequences that are hard to enumerate. Medical costs are more straightforward. For example, OSHA estimates the direct cost of heat prostration — overheating due to heatstroke or hyperthermia — at nearly $80,000 in direct and indirect costs per case. If this seems high, consider a construction worker in New York who lost consciousness on a hot day and fell from a platform, suffering a kidney laceration, facial fractures, and several broken ribs.

Putting a Price Tag on Heatstroke

Researchers have also tried to tease out the cost to employers in lost productivity. Work moves less efficiently as temperatures rise, and if workers are absent because of illness, and if they have to be replaced, production diminishes as new workers are trained to do the job. Cullen Page, a line cook in Austin, Texas, and a member of the union Restaurant Workers United, works for hours in front of a pizza oven, where, he said, temperatures hovered between 90 and 100 degrees as heat waves blanketed the city in August. “It’s brutal. It affects your thinking. You’re confused,” he said. “I got a heat rash that wouldn’t go away.” Because it’s so hot, he added, the restaurant has a high employee turnover rate. An adequate hood vent over the ovens and improved air conditioning would help, he said, but the owners have yet to make upgrades.

Via 313, the pizza chain where Page works, did not respond to requests for comment.

Page is not alone. An organization representing restaurant employees, Restaurant Opportunities Centers United, surveyed thousands of workers, many of whom reported “unsafely hot” conditions: 24% of those in Houston, for example, and 37% in Philadelphia.

“Workers have been exposed to working temperatures of up to 100 degrees after air conditioners and kitchen ventilators were broken, making it uncomfortable and hard for them to breathe,” wrote another group that includes members in the fast-food industry, the Service Employees International Union, in a comment to OSHA. “There is no reason to further delay the creation of a standard when we know the scale of the problem and we know how to protect workers.”

Researchers at the Atlantic Council estimate the U.S. will lose an average of $100 billion annually from heat-induced declines in labor productivity as the climate warms. “It costs employers a lot of money to not protect their workers,” said Juley Fulcher, the worker health and safety advocate at Public Citizen, an advocacy organization in Washington, D.C., that is lobbying for the Asunción Valdivia bill to allow OSHA to enact regulations next year.

For a template, Fulcher suggested looking to California, Maryland, Nevada, Oregon, and Washington, the only states with rules mandating that all outdoor workers have access to water, rest, and shade. Although the regulations aren’t always enforced, they appear to have an impact. After California instituted its standard in 2005, fewer injuries were reported in workers’ compensation claims when temperatures exceeded 85 degrees.

Michaels said OSHA has shown it can act faster than usual when Congress permits it. In the early days of the HIV/AIDS epidemic, the agency rapidly passed rules to prevent doctors, nurses, and dentists from being accidentally infected by needles. A similar urgency exists now, he said. “Given the climate crisis and the lengthening of periods of extreme heat,” he said, “it is imperative that Congress pass legislation that enables OSHA to quickly issue a lifesaving standard.”

By Amy Maxmen
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.