Climatologic Conditions, Chronic Disease and Work: Emerging Evidence and Implications

Posted on by Marie-Anne S. Rosemberg, PhD, MN, RN, FAAOHN; June Spector, MD, MPH; Alyssa McGonagle, PhD; Tara A. Hartley, PhD, MPA, MPH; Tapas K Ray, PhD; Lee Newman, MD, MA; and L. Casey Chosewood, MD MPH


As concerns about climatologic conditions (CC) are rising globally they remain poorly addressed in many settings such as the workplace. Climate-related hazards such as heat exposure and extreme weather events are and will continue to shape workers’ work experiences, risks for chronic disease, other health outcomes, and productivity. As such, central goals for occupational safety and health (OSH) need to include a better understanding of and targeted approaches to prevent and reduce the harms and health inequities resulting from climate-related hazards for worker groups, work environments, and organizations. Particularly, OSH considerations must include effective surveillance, targeted exposure assessment, and interventions that address the short, medium, and long-term implications of CC for workers. Below, the authors provide a brief overview of the definition of CC, describe the potential impact of these conditions within occupational and environmental health settings, discuss implications for worker health, and highlight future efforts needed to combat this complex issue and protect worker health. For more information, please join our webinar on Tuesday June 21st (details below).

CC are changes related to weather and climate variability over time and have multiple underlying root causes including energy, transportation, housing and living environment, agriculture, and socioeconomic systems [1, 2]. CC have direct connections with health inequities, as they disproportionately affect particular individuals and regions, including low-income communities, resulting in significant negative health and economic impacts [3, 4].

Within the context of occupational and environmental safety and health, climate-related hazards present a major concern for particular work environments and industries, including forestry, fishing, agriculture, manufacturing, construction, and public safety [5, 6]. Certain worker groups have heightened risks for climate-related hazards because they are more likely to experience longer exposure duration and greater intensity of exposures compared to the general public. Previous work on CC in this context has highlighted hazards, including high ambient temperature, air pollution, radiation exposures, extreme weather, vector-borne diseases and changes in the built-environment [2, 7, 8]. Between 2000 and 2010, a total of 359 heat-related deaths were identified among US workers with the highest average annual heat-related death rates occurring in the agriculture, construction, and support, waste and remediation services industries [9]. In 2019, 43 US workers died from heat illness and at least 2,400 reported serious heat-related illnesses and injuries [10].

In addition to work fatalities, decreased work productivity and associated economic losses [11], CC may be associated with other negative health outcomes among workers. These health outcomes include kidney diseases, poor mental health, heat-related illnesses, rhabdomyolysis, and traumatic injuries [12-15]. These outcomes may be chronic or have long lasting effects [12-15], and may contribute to adverse outcomes related to cardiovascular disease, diabetes, and other chronic conditions. Some workers are at disproportionate risk for CC-related health effects, including those with pre-existing chronic conditions (e.g., asthma, chronic obstructive pulmonary disease, cardiovascular disease, diabetes, and mental illness), older workers, migrant and racial/ethnic minority workers, and those that work for small businesses [16, 17, 18].

The advancement of OSH requires the ability to both target emerging issues that threaten worker safety and health and increase opportunities for improvements in organizational design and in personal health. The impact of climate-related hazards on worker health and well-being is one such emerging issue. Collaborations between OSH and allied partners are needed to develop and establish policies, effective surveillance and targeted exposure assessments to guide prevention efforts, engineering controls, the redesign of work, the use of personal protective equipment (PPE), strategies for promoting physical and administrative changes within the workplace environment, and other strategic interventions to address the negative impact and inequities of CC for worker safety and health [1, 2, 5-8, 10, 11, 19, 20].

Early efforts have already begun to assist diverse partners to intervene. As a starting point, the authors offer the following suggestions for employers and those in OSH to consider [21, 22]:

  • assess the risks for climate-related hazards in all job assignments and settings routinely;
  • adapt effective approaches to the traditional hierarchy of controls;
  • revise workplace designs and establish key protocols;
  • develop well-established protocols for early warning systems and post-exposures;
  • have a clear procedure for return-to-work after extreme exposures;
  • provide worker training;
  • have a strong surveillance procedure for early identification of illnesses and symptoms;
  • develop effective communication strategies; and
  • offer considerations for workers diagnosed with chronic conditions.

Would you like to learn more about the impact and implications of climatologic conditions within the context of worker health and safety? Join us on Tuesday, June 21st, 2022 from 2:00-3:00 pm EST for a free webinar: Climatologic Conditions, Chronic Disease and Work: Emerging Evidence and Implications, featuring Dr. Paul Schulte who is a NIOSH Consultant, Dr. Cecelia Sorensen from Columbia University, and Dr. June Spector from the University of Washington and the Washington State SHARP Program.

Register Here: Webinar Registration – Zoom ( to attend this webinar presented by the National Institute for Occupational Safety and Health (NIOSH) Healthy Work Design and Well-Being Council (HWD)-  National Occupational Research Agenda (NORA)- Objective 4 Workgroup. The HWD Cross-Sector Council focuses on protecting and advancing worker safety, health, and well-being by improving the design of work, management practices, and the physical and psychosocial work environment. The HWD NORA identifies prioritized areas in which knowledge and actions are needed to protect worker health and well-being in the U.S. The current HWD NORA includes seven objectives, one of which (Objective 4) pertains to work organization-related chronic health conditions. The entire HWD NORA can be found here.


Marie-Anne S. Rosemberg, PhD, MN, RN, FAAOHN, is an Assistant Professor at the University of Michigan School of Nursing and a Core Faculty member of the University of Michigan’s NIOSH-Funded Education and Research Center (ERC) program.

June Spector, MD, MPH, is a researcher at the Washington State Department of Labor and Industries’ Safety & Health Assessment and Research for Prevention (SHARP) Program and an Associate Professor at the University of Washington.

 Alyssa McGonagle, PhD, MA is an Associate Professor at UNC Charlotte and Core Faculty, Psychological Science & Organizational Science.

Tara A. Hartley, PhD, MPA, MPH is a Senior Scientist and Epidemiologist in the NIOSH Associate Director for Science Office.

Tapas K Ray, PhD, is a Senior Economist in the NIOSH Economics Research and Service Office.

Lee Newman MD, MA, is a distinguished university professor in the Departments of Environmental & Occupational Health and Epidemiology at the Colorado School of Public Health. He is the founding director of both the Center for Health, Work & Environment and the Mountain & Plains Education and Research Center

L. Casey Chosewood, MD, MPH is Director of the NIOSH Office for Total Worker Health® and co-manager of NIOSH’s Healthy Work Design and Well-being Cross-Sector.



  1. Rudolph, L., et al., Climate change, health, and equity: A guide for local health departments. Public Health Institute and American Public Health Association, 2018.
  2. Knowlton, K., C. Sorensen, and J. Lemery, Global climate change and human health: from science to practice. 2021: John Wiley & Sons.
  3. Tol, R.S., The economic impacts of climate change. Review of Environmental Economics and Policy, 2020.
  4. Smith, G.S., et al., Climate change, environmental disasters, and health inequities: the underlying role of structural inequalities. Current Environmental Health Reports, 2022: p. 1-10.
  5. Bourbonnais, R., et al., Identification of workers exposed concomitantly to heat stress and chemicals. Industrial Health, 2013. 51(1): p. 25-33.
  6. Tigchelaar, M., D.S. Battisti, and J.T. Spector, Work adaptations insufficient to address growing heat risk for US agricultural workers. Environmental Research Letters, 2020. 15(9): p. 094035.
  7. Schulte, P., et al., Advancing the framework for considering the effects of climate change on worker safety and health. Journal of Occupational and Environmental Hygiene, 2016. 13(11): p. 847-865.
  8. Kiefer, M., et al., Worker health and safety and climate change in the Americas: issues and research needs. Revista Panamericana de Salud Pública, 2016. 40: p. 192-197.
  9. Gubernot, D.M., G.B. Anderson, and K.L. Hunting, Characterizing occupational heat‐related mortality in the United States, 2000–2010: An analysis using the census of fatal occupational injuries database. American Journal of Industrial Medicine, 2015. 58(2): p. 203-211.
  10. U.S. Department of Labor. US Department of Labor announces enhanced, expanded measures to protect workers from hazards of extreme heat, indoors and out. 2021; Available from:
  11. Kjellstrom, T., et al., Public health impact of global heating due to climate change: potential effects on chronic non-communicable diseases. International Journal of Public Health, 2010. 55(2): p. 97-103.
  12. Johnson, R.J., C. Wesseling, and L.S. Newman, Chronic kidney disease of unknown cause in agricultural communities. New England Journal of Medicine, 2019. 380(19): p. 1843-1852.
  13. Sorensen, C.J., et al., Workplace screening identifies clinically significant and potentially reversible kidney injury in heat-exposed sugarcane workers. International Journal of Environmental Research and Public Health, 2020. 17(22): p. 8552.
  14. Hrabok, M., A. Delorme, and V.I. Agyapong, Threats to mental health and well-being associated with climate change. Journal of Anxiety Disorders, 2020. 76: p. 102295.
  15. Spector, J.T., et al., Heat exposure and occupational injuries: review of the literature and implications. Current Environmental Health Reports, 2019. 6(4): p. 286-296.
  16. D’Amato, G., et al., Climate change and respiratory diseases. 2014, Eur Respiratory Soc.
  17. De Blois, J., et al., The effects of climate change on cardiac health. Cardiology, 2015. 131(4): p. 209-217.
  18. Sinclair, R.C., Cunningham, T.R., and P.A. Schulte, A model for occupational safety and health intervention diffusion to small businesses. American Journal of Industrial Medicine, 2013. 56: p.1442-1451.
  19. Nabeel, I., et al., ” How Can Climate Change Impact the Workplace and Worker Health?” Part 6: Operational Support-Related Responsibilities of Occupational and Environmental Medicine Experts to the Employer in the Context of Climate Change. 2019, LIPPINCOTT WILLIAMS & WILKINS TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA …. p. E317-E319.
  20. Rudolph, L. and S. Gould, Climate change and health inequities: A framework for action. Annals of Global Health, 2015. 81(3).
  21. NIOSH Heat Stress – Recommendations web page.
  22. Nabeel, I., et al., Proposed mitigation and adaptation strategies related to climate change: Guidance for OEM professionals. Journal of Occupational and Environmental Medicine, 2021. 63(9): p. e650-e656.
Posted on by Marie-Anne S. Rosemberg, PhD, MN, RN, FAAOHN; June Spector, MD, MPH; Alyssa McGonagle, PhD; Tara A. Hartley, PhD, MPA, MPH; Tapas K Ray, PhD; Lee Newman, MD, MA; and L. Casey Chosewood, MD MPH

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Page last reviewed: June 15, 2022
Page last updated: June 15, 2022