January 5, 2024

By Alina Schnake-Mahl, ScD, MPH and Leah Schinasi, PhD, MSPH

Hot Topics in Urban Policy and Health: In a new UHC Policy Core blog series, we’ll highlight important topics in urban policy with implications for health and health equity. We hope the series will help our collaborators learn about various policy areas and potentially spark interest in future research and practice experience on these policies. This month we start with a (literal) hot topic in health policy: extreme heat and worker protections.

Summer 2023 was the hottest on record, and 100-plus degree days are becoming more and more common, particularly in cities in the South, Southwest, and Southeast. Last summer, in Austin, Texas, the temperature stayed above 100 degrees for 69 days. In Phoenix, Arizona, temperatures in July stayed at 110 degrees or higher for all but one day. Extreme heat puts workers at risk of heat exhaustion, injury, illness, stroke and even death. This includes outdoor workers, such as those in construction, agriculture, mail delivery, oil, and gas, as well as indoor workers, such as people who work in warehouses, factories, or in food service.

What are cities and states doing to address these risks?

California, Washington, and Colorado have responded to rising and sustained extreme temperatures by enacting laws and regulations to protect outdoor workers from heat related illness, such as water breaks, cool-down rest periods, and shade requirements. Texas, unfortunately, has gone the opposite direction, using preemption to force its cities to rescind existing workplace policies, including those related to heat, and to prevent cities and counties from creating new work-related regulations. In Austin and Dallas, regulations mandating 10-minute rest breaks for construction workers — enacted in the mid 2010’s after protests related to several heat-related deaths among construction workers — were nullified in September 2023, when the State preemption law went into effect. 

In 2022, 279 people in Texas died of heat related causes, though the documented number of deaths are likely an undercount, given frequent misclassification of heat-related deaths. Specific data on the number of work-related heat deaths for Texas in 2022 was not available, but nationally, The Bureau of Labor Statistics reported an average of 43 annual heat related deaths between 2011-2021 in the U.S. due to environmental heat exposure. Heat-related mortality and ED visits have risen over the past decade with wide variation by state and by metro area. These rates will likely increase as temperatures continue to increase due to climate change, and disparities between states are at risk of widening, given state variation in policies.

Within states and cities, extreme heat does not put everyone at equal risk. Historically marginalized populations experience disproportionately high heat exposures while working and associated heat-related illness, given their high rates of employment in high-risk jobs. These risks are compounded by the fact that many marginalized workers also live in particularly hot environments, such as microurban heat islands or homes without adequate cooling. Even after a hot day at work, they experience little relief.

This issue isn’t just a problem for workers in cities in the South and Southwest. This summer, Pennsylvania had 29 days over 100 degrees, and projections suggest this number of days will increase. Yet the state and the city of Philadelphia have no specific occupational heat regulations.

Despite the increasing risk of extreme heat and high employment-related population health heat burden, the federal government has yet to enact national occupational heat regulations. Occupational Safety and Health Administration (OSHA) has launched a “national Emphasis Program” to improve compliance and enforcement efforts, and is in the process of drafting a heat standard for workplaces, but these regulations often take years to enact. On February 9, 2023, attorneys general from the states of California, Illinois, Maryland, Massachusetts, New Jersey, New York, and Pennsylvania issued a call for an emergency temporary standard to protect heat-exposed workers against adverse heat-associated outcomes. OSHA has not issued a temporary standard since the petition was published. Without OSHA issuing national regulations, workers exposed to high levels of heat — our agriculture, construction, and repair, and cleaning workers — will keep dying on the job. This summer, we hope that workers in Pennsylvania and Texas, not just those in California and Colorado, will have regulations that protect them from heat-related illnesses.