ACOEM GUIDANCE STATEMENT Responsibilities of the Occupational and Environmental Medicine Provider in the Treatment and Prevention of Climate Change-Related Health Problems William B. Perkison, MD, MPH, Gregory D. Kearney, DrPH, MPH, Poune´ Saberi, MD, MPH, Tee Guidotti, MD, MPH, Ronda McCarthy, MD, MPH, Margaret Cook-Shimanek, MD, MPH, Mellisa A. Pensa, MD, MPH, and Ismail Nabeel, MD, MPH, ACOEM Task Force on Climate Change that may occur as a result of climate quality, and allergen sensitization. Closely Workers are uniquely susceptible to the health 01/04/2019 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3VFjldD2uL9p7SMbj5XQFggscApMlmW/UgXNoK/5MD7Gq31Q2YQqh0A== by https://journals.lww.com/joem from Downloaded Downloaded change. Rising temperatures, reduced air related atmospheric changes affecting hazards imposed by environmental changes. quality, and extreme weather patterns stratospheric ozone concentration also Occupational and environmental medicine impact the health of workers directly and result in increased exposure to ultraviolet from (OEM) providers are at the forefront of emerging indirectly (Table 1).3–5 Occupational health (UV) effects and heat and emissions https://journals.lww.com/joem health issues pertaining to working populations care providers and the American College of that accompany carbon dioxide cause including climate change, and must be prepared to Occupational and Environmental Medicine more severe ground-level or ambient air recognize, respond to, and mitigate climate (ACOEM) are uniquely suited to promote pollution. change-related health effects in workers. This protection of the health of US working guidance document from the American College populations facing these challenges. of Occupational and Environmental Medicine Heat and Ultraviolet Effects by Many working groups are suscepti- BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3VFjldD2uL9p7SMbj5XQFggscApMlmW/UgXNoK/5MD7Gq31Q2YQqh0A== Rising temperatures and increased focuses on North American workers health effects ble to both direct and indirect health that may occur as a result of climate change and air pollution directly impact worker health. impacts of climate because of their job Increased ambient temperatures can exac- describes the responsibilities of the OEM provider type (eg, outdoor workers, laborers, ath- in responding to these health challenges. erbate the risks of injury, illness, and death letes, wildland firefighters) or their exist- for those working in hot environments.7 In ing, underlying health risks (eg, respiratory ver the last century, global climate 2013, the US Bureau of Labor Statistics illness, heart disease, pregnancy). Direct reported that thousands of occupational O changes have resulted in increased health effects due to climate include heat- frequency and intensity of adverse weather heat-related illnesses occur each year and related illness, respiratory disease due to more than 350 civilian worker deaths hap- events including heat waves, droughts, wild- reduced air quality, and increased allergy 1 pened in the past decade due to environ- fires, and flooding. This change has induction; indirect effects include illness 8 impacted all regions of the United States, mental heat exposure. This is may be a secondary to exposures encountered dur- considerable under-estimate of the total, as resulting in loss of life and economic costs in ing a disaster response, stress and mental the billions of dollars. Further costs include many cases are not recognized as such illness secondary to the experience of trau- because heat interacts with other working the loss of worker productivity and expen- matic natural event, and increased suscep- ditures associated with relocation.2 3 conditions to which the cause of death is tibility to vector-borne disease. more likely to be apportioned, and because Currently, the impact of climate on It is important to characterize cli- the health and productivity of workers in heat increases the risk of death from com- mate-related health hazards so that effec- mon conditions such as cardiovascular dis- the United States has not been an area of tive mitigation and adaptation strategies ease and chronic lung disease. high concern. This paper primarily focuses can be developed to protect workers’ health on North American workers health effects Heat-related illnesses result as a mal- and safety by minimizing their vulnerabil- function of the central nervous system and ity. Therefore, this paper identifies direct the body’s adaptation mechanisms during From the American College of Occupational and and indirect climate-related health chal- intense heat.9 The most severe form is heat Environmental Medicine, Elk Grove Village, lenges among workers and describes the stroke, in which the body is unable to cool Illinois. responsibilities of the occupational and down, resulting in confusion and possible This position paper was developed by the ACOEM environmental medicine (OEM) provider Task Force on Climate Change, under the aus- coma, seizures, or death. Other heat-related pices of the Environmental Health and the in responding to these health challenges. illnesses include heat exhaustion, heat syn- Underserved Occupational Populations sec- The issues discussed in this paper are an cope, heat cramps, and rhabdomyolysis.4 tions, reviewed by the Committee on Policy, essential part of ACOEM’s core competen- Workers exposed to extreme heat are more on Procedures, and Public Positions, and approved cies,6 and therefore OEM providers should 01/04/2019 by the ACOEM Board of Directors. ACOEM prone to accidents and injuries and have requires all substantive contributors to its docu- possess the core skills that make them lower productivity due to sweaty palms, ments to disclose any potential competing inter- specifically qualified to address and miti- fogged safety goggles, discomfort, agita- ests, which are carefully considered. ACOEM gate the impacts of climate change on tion, and fatigue.4 Temperatures above emphasizes that the judgments expressed herein worker health and productivity.1 represent the best available evidence at the time 95 8F have been shown to decrease produc- of publication and shall be considered the posi- tivity and increase work injuries and mis- tion of ACOEM and not the individual opinions DIRECT IMPACTS OF CLIMATE takes.10 Even weather events that are not of contributing authors. CHANGE ON WORKER The authors declare no conflicts of interest. extreme on a world scale can result in lethal Address correspondence to: Marianne Dreger, MA, HEALTH heat-related fatalities in places where the ACOEM, 25 Northwest Point Blvd, Suite 700, Direct health effects likely to impact climate provides little opportunity for accli- Elk Grove Village, IL 60007 ([email protected]). workers due to rising temperatures and matization,11 and when the worker is sus- Copyright ß 2017 American College of Occupa- tional and Environmental Medicine changing weather patterns include heat, ceptible due to age, pre-existing condition, DOI: 10.1097/JOM.0000000000001251 respiratory effects from reduced air medications, obesity, or lifestyle. e76 JOEM Volume 60, Number 2, February 2018 Copyright © 2017 American College of Occupational and Environmental Medicine. Unauthorized reproduction of this article is prohibited JOEM Volume 60, Number 2, February 2018 Climate Change-Related Health Problems TABLE 1. Impacts of Climate Change on Worker Health Exposure Pathway/ Potential High-Risk ACOEM Core Climate Event Mechanism Health Effect Occupational Groups Competencies Heat waves Increased temperatures, Heat stress related morbidity Outdoor trades workers, Environmental health, hazard hotter than usual and mortality athletes, firefighters, recognition, evaluation, and summers and milder military, migrant farm control, OEM-related law and winters workers. Older, isolated regulations, work fitness and or poorer workers more disability management, OEM at risk for heat stress- population management, health related illness; workers and productivity, OEM-related without access to air management and administration, conditioning. clinical OEM Solar ultraviolet radiation Increased solar UV Cataracts, cutaneous Outdoor workers, Environmental health, hazard (concomitant risk radiation from ozone- malignant melanoma, construction trades, recognition, evaluation, and affecting many of depleting gases in the immune system and agricultural workers, control, public health, same populations) atmosphere (overlap sunburn military, displaced surveillance, and disease with greenhouse workers, courier and prevention, OEM-related gases) delivery service workers management and administration, clinical OEM Ambient air pollution Increases in carbon Respiratory disease Older workers and/or those Environmental health, hazard emissions, particulate exacerbation including with pre-existing recognition, evaluation, and matter, airborne asthma, COPD, allergic respiratory illness control, toxicology, public aeroallergens and rhinitis, bronchitis; health, surveillance, and disease other respiratory premature death, acute prevention, health and exposures from and chronic productivity wildfires and ground- cardiovascular level ozone Flooding Increased variation, Drownings, injuries, skin Outdoor workers, first Environmental health, public health, geographic and infections, mosquito, tick responders surveillance, and disease seasonal distribution and other vector borne prevention, disaster preparedness of vectors diseases