Occupational Heat Stress and Decent Work: Challenges and Prevention Strategies in the Context of Climate Change

Authors

  • Angela Stufano Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  • Valentina Schino Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari
  • RIccardo Ravallese Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari
  • Gabriele Sacino Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari
  • Roberto Ravallese Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari
  • Giovanna Simone Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari
  • Roberta Piccarreta Department of Medical and Surgical Sciences, University of Foggia, Foggia
  • Piero Lovreglio Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari

DOI:

https://doi.org/10.36125/ijoehy.v17i1.598

Keywords:

climate change, occupational heat stress

Abstract

Climate change is reshaping the environmental conditions under which work is performed worldwide, increasing occupational exposure to heat and generating implications for health, productivity and the achievement of decent work. This narrative review critically examines the relationship between occupational heat stress and decent work by integrating epidemiological, physiological, ergonomic and economic evidence with institutional documents and technical materials on prevention and adaptation systems. The findings indicate that heat stress produces a spectrum of acute and chronic health effects—ranging from dehydration and heat exhaustion to heat stroke and exacerbation of cardiovascular and renal diseases—and reduces work capacity through physiological constraints and behavioural adaptations. Productivity loss emerges as a central mechanism mediating the labour market impacts of heat, lowering wages and jeopardizing job security, particularly among piece-rate and informal workers. This dynamic reinforces socio-occupational vulnerabilities and territorial inequalities, challenging multiple dimensions of the International Labour Organization’s decent work framework, including occupational safety, stable income, social protection and equality. Prevention systems grounded in the hierarchy of controls are evolving toward more complex models combining technical, organizational, medical and institutional measures, including wage compensation mechanisms, meteorological alert systems and adaptive governance instruments. The review concludes that occupational heat stress constitutes an emerging determinant of labour vulnerability and that productivity represents a key pathway through which heat undermines the material foundations of decent work. Further research is needed to quantify distributive effects, evaluate policy instruments and design protective frameworks that integrate health, labour rights and climate resilience.

Author Biographies

  • Angela Stufano, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy

    ...

  • Valentina Schino, Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari

    ..

  • RIccardo Ravallese, Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari

    ..

  • Gabriele Sacino, Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari

    ..

  • Roberto Ravallese, Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari

    ..

  • Giovanna Simone, Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari

    ..

  • Roberta Piccarreta, Department of Medical and Surgical Sciences, University of Foggia, Foggia

    ..

  • Piero Lovreglio, Interdisciplinary Department of Medicine, Section of Occupational Medicine, University of Bari Aldo Moro, Bari

    ..

References

1. Barr, D., Reilly, T., Gregson, W., 2011. The impact of different cooling modalities on the physiological responses in firefighters during strenuous work performed in high environmental temperatures. Eur. J. Appl. Physiol. 111, 959–967. https://doi.org/10.1007/s00421-010-1714-1

2. Bonafede, M., Levi, M., Pietrafesa, E., Binazzi, A., Marinaccio, A., Morabito, M., Pinto, I., De’ Donato, F., Grasso, V., Costantini, T., Messeri, A., WORKLIMATE Collaborative Group, 2022. Workers’ Perception Heat Stress: Results from a Pilot Study Conducted in Italy during the COVID-19 Pandemic in 2020. Int. J. Environ. Res. Public. Health 19, 8196. https://doi.org/10.3390/ijerph19138196

3. Chen, H., Liu, X., Liu, J., Wang, F., Wang, C., 2025. Radiative cooling applications toward enhanced energy efficiency: System designs, achievements, and perspectives. Innov. Camb. Mass 6, 100999. https://doi.org/10.1016/j.xinn.2025.100999

4. Climate change and workplace heat stress: technical report and guidance. Geneva: World Health Organization and World Meteorological Organization; 2025. [WWW Document], n.d. URL https://www.who.int/publications/i/item/9789240099814 (accessed 2.18.26).

5. Cramer, M.N., Gagnon, D., Laitano, O., Crandall, C.G., 2022. Human temperature regulation under heat stress in health, disease, and injury. Physiol. Rev. 102, 1907–1989. https://doi.org/10.1152/physrev.00047.2021

6. De Sario, M., de’Donato, F.K., Bonafede, M., Marinaccio, A., Levi, M., Ariani, F., Morabito, M., Michelozzi, P., 2023. Occupational heat stress, heat-related effects and the related social and economic loss: a scoping literature review. Front. Public Health 11, 1173553. https://doi.org/10.3389/fpubh.2023.1173553

7. El Khayat, M., Halwani, D.A., Hneiny, L., Alameddine, I., Haidar, M.A., Habib, R.R., 2022. Impacts of Climate Change and Heat Stress on Farmworkers’ Health: A Scoping Review. Front. Public Health 10, 782811. https://doi.org/10.3389/fpubh.2022.782811

8. Ferrari, G.N., Leal, G.C.L., Thom de Souza, R.C., Galdamez, E.V.C., 2023. Impact of climate change on occupational health and safety: A review of methodological approaches. Work 74, 485–499. https://doi.org/10.3233/WOR-211303

9. Flouris, A., Azzi, M., Graczyk, H., Nafradi, B., and Scott, N., eds. 2024. Heat at Work: Implications for Safety and Health. A Global Review of the Science, Policy and Practice. ILO. [WWW Document], 2024. URL https://www.ilo.org/publications/heat-work-implications-safety-and-health (accessed 2.18.26).

10. Flouris, A.D., Dinas, P.C., Ioannou, L.G., Nybo, L., Havenith, G., Kenny, G.P., Kjellstrom, T., 2018. Workers’ health and productivity under occupational heat strain: a systematic review and meta-analysis. Lancet Planet. Health 2, e521–e531. https://doi.org/10.1016/S2542-5196(18)30237-7

11. Gao, C., Kuklane, K., Östergren, P.-O., Kjellstrom, T., 2018. Occupational heat stress assessment and protective strategies in the context of climate change. Int. J. Biometeorol. 62, 359–371. https://doi.org/10.1007/s00484-017-1352-y

12. Gibson, O.R., James, C.A., Mee, J.A., Willmott, A.G.B., Turner, G., Hayes, M., Maxwell, N.S., 2020. Heat alleviation strategies for athletic performance: A review and practitioner guidelines. Temperature 7, 3–36. https://doi.org/10.1080/23328940.2019.1666624

13. Han, S., Dong, L., Weng, Y., Xiang, J., 2024. Heat exposure and productivity loss among construction workers: a meta-analysis. BMC Public Health 24, 3252. https://doi.org/10.1186/s12889-024-20744-x

14. Ioannou, L.G., Foster, J., Morris, N.B., Piil, J.F., Havenith, G., Mekjavic, I.B., Kenny, G.P., Nybo, L., Flouris, A.D., 2022. Occupational heat strain in outdoor workers: A comprehensive review and meta-analysis. Temperature 9, 67–102. https://doi.org/10.1080/23328940.2022.2030634

15. Khorshid, S., Song, S., 2025. Exploring Intervention Strategies to Prevent Occupational Heat Stress. A Scoping Review. Saf. Health Work 16, 134–144. https://doi.org/10.1016/j.shaw.2025.03.005

16. Li, H., Early, K.S., Zhang, G., Ma, P., Wang, H., 2024. Personalized Hydration Strategy to Improve Fluid Balance and Intermittent Exercise Performance in the Heat. Nutrients 16, 1341. https://doi.org/10.3390/nu16091341

17. Liang, T., Ai, Z., Zhong, H., Xiao, M., Xie, M., Liang, X., Li, L., 2025. The impact of temperature changes on the health vulnerability of migrant workers: an empirical study based on the China family panel studies. Front. Public Health 13, 1519982. https://doi.org/10.3389/fpubh.2025.1519982

18. Morabito, M., Messeri, A., Noti, P., Casanueva, A., Crisci, A., Kotlarski, S., Orlandini, S., Schwierz, C., Spirig, C., Kingma, B.R.M., Flouris, A.D., Nybo, L., 2019. An Occupational Heat-Health Warning System for Europe: The HEAT-SHIELD Platform. Int. J. Environ. Res. Public. Health 16, 2890. https://doi.org/10.3390/ijerph16162890

19. Notley, S.R., Flouris, A.D., Kenny, G.P., 2018. On the use of wearable physiological monitors to assess heat strain during occupational heat stress. Appl. Physiol. Nutr. Metab. Physiol. Appl. Nutr. Metab. 43, 869–881. https://doi.org/10.1139/apnm-2018-0173

20. Parsons, L.A., Shindell, D., Tigchelaar, M., Zhang, Y., Spector, J.T., 2021. Increased labor losses and decreased adaptation potential in a warmer world. Nat. Commun. 12, 7286. https://doi.org/10.1038/s41467-021-27328-y

21. Riesco-Sanz, A., 2026. Collective bargaining and social dialogue as instruments to protect workers from heatwaves and climate change in the European Union. Ind. Health 64, 45–60. https://doi.org/10.2486/indhealth.2025-0112

22. Sainiyom, P., Saengsirisuwan, V., Leow, C.H.W., Lee, J.K.W., Surapongchai, J., 2026. Novel cooling vest with personal protective equipment alleviates heat strain without increasing metabolic demands in the heat. Scand. J. Work. Environ. Health 52, 19–30. https://doi.org/10.5271/sjweh.4261

23. Torbat Esfahani, M., Awolusi, I., Hatipkarasulu, Y., 2024. Heat Stress Prevention in Construction: A Systematic Review and Meta-Analysis of Risk Factors and Control Strategies. Int. J. Environ. Res. Public. Health 21, 1681. https://doi.org/10.3390/ijerph21121681

24. Working on a warmer planet: The impact of heat stress on labour productivity and decent work International Labour Office – Geneva, ILO, 2019, n.d. https://doi.org/10.1163/9789004322714_cclc_2019-0196-546

Downloads

Published

2026-04-07