September 14, 2021
Heat Stress Regional Information Hearings Maryland Occupational Safety and Health (MOSH) - Division of Labor and Industry
Submitted by: Amy Liebman and Leslie Rodriguez
We are writing on behalf of Migrant Clinicians Network, a national organization serving clinicians who care for farmworkers and rural communities across the country. Our office that focuses on worker health and safety is located in Salisbury, Maryland.
Migrant Clinicians Network has a long history of striving to protect the health and working conditions of those who harvest our nation’s food. We support farming practices that provide a safe work environment and seek to decrease the exposure of farmworkers and their families to hazards. Farmworkers are also predominantly Latino workers, including many from indigenous or Afro-descended backgrounds, and often earn wages below the federal poverty level. Farmworkers play an important role in our nation’s agricultural success and we should do all we can to ensure adequate safeguards for their health.
We are extremely pleased that Maryland will issue a standard requiring employers to protect their workers from heat-related illnesses in 2022. While all workers doing tasks outside and in unconditioned indoor spaces will benefit from a statewide standard, we urge you to promulgate a strong heat standard in Maryland that considers the unique health and safety concerns for workers employed in agriculture.
The workers most vulnerable to heat illnesses are those that work outside, are socially isolated, economically disadvantaged, have chronic illnesses, are part of certain communities of color, and are migrants. The demographic that meets most if not all those criteria are farmworkers, specifically migrant farmworkers.
Farmworkers are at the front line in terms of increased risk. According to the CDC, farmworkers’ risk of dying because of heat exposure is 20 times higher than workers in other industries.1 Most of the deaths occur in men aged 20 to 54 years.
Migrant Clinicians Network has developed, Heat-Related Illness Clinician’s Guide -June 2021, to assist healthcare providers in preventing and treating heat-related illness in farmworkers. Please see attached. It may also be found at this link https://www.migrantclinician.org/issues/heat.
Much of risk to farmworkers is due the nature of their work:
- Farmworkers labor outside for long hours, largely during the hottest time of the year. Each year we continue to see both record high temperatures and a record number of days at extreme high temperatures. Heat’s impact on farmworkers is not an imminent future threat. It is a present danger that is already impacting their daily lives.
- Many farmworkers are paid piece-rate, often per the weight of produce picked, a system which discourages rest breaks and bathroom breaks, since time away for the task will result in less money. Limited time for bathroom breaks also discourages employees to drink sufficient amounts of water. Recent studies show that workers are showing up to work largely dehydrated and becoming more dehydrated as the workday progresses.2 Many farmworkers do not have air conditioning in their living spaces, limiting their ability to cool down after work. Remaining in a hot environment could contribute to workers arriving to their job already dehydrated.
- Farmworkers often are low income and may not have authorization to work in the United States, making them fearful of job loss or even deportation should they complain or report poor working conditions.
- Food ripens faster in higher temperatures, so workers may feel pressure to work even faster, which compounds the risk of heat illness in the already hot weather.
- Many farmworkers also work with pesticides which require that they wear heavy protective clothing that is not conducive to staying cool.
- Many farmworkers come directly to Maryland for the harvest from different states or countries and may not have been used to working in high heat conditions. Acclimatization is needed so workers can adapt to the working conditions. Many workers who die from heat exposures do so in the first few days on the job, so acclimatization to heat is an essential part of any standard. Acclimatization may take five to six days or more in some cases. Workers should start at a limited workload and gradually increase their workload, take more frequent breaks, and drink water frequently within this acclimatization period.3
Given these heat-related risks facing farmworkers, we urge you to include the following components in Maryland:
- Workers and employers must be trained in how to prevent heat-related illness and what to do in case of a medical emergency.
a. The trainings must be provided in a manner and in a language that workers understand.
b. The trainings must be annual, the workers must be paid to attend the training and the training must be provided prior to the worker initiating job tasks.
c. The trainings must include:
i. Signs and symptoms of heat-related illness
ii. Ways to prevent heat-related illness
iii. What to do in case of a medical emergency
iv. Worker rights and responsibilities regarding the heat standard
- Workers must be given rest breaks and must be paid for required breaks. Rest breaks should be at least 10-15 minutes, every two hours, when temperatures are between 80 and 90 degrees Fahrenheit and every hour when above 90 degrees Fahrenheit. As the temperature and heat index increase, more and longer breaks are need. Workers also have to have access to bathroom breaks which might have to be more frequent as a result of water consumption.
- Sufficient water must be provided, and workers should be encouraged to drink water regularly.
- The standard must also consider the additional risk posed by radiant heat exposures, metabolic heat from high workloads, and the heat burden from clothing that impairs sweat evaporation.
- Employers must be trained on how to develop clear workplace safety policies, including an emergency plan.
- Employers must be trained and should be supported to apply engineered controls.
a. Maryland should consider giving funding to farmers to assist in the implementation of engineering controls such as slow-moving, shaded trailers to protect workers from the sun as they harvest.
- Clear acclimatization guidance must be included. New workers should spend no more than an hour and a half working in the heat on their first day and their exposure to heat should increase gradually each day, at no more than a 20% increase each day. Workers with experience can spend up to four hours in the heat on their first day of work, five on their second and six and a half hours on their third. By the fourth day, most workers should be able to work up to eight hours assuming they have access to adequate hydration and appropriate rest breaks.
- The standard must include protection for workers from job loss or loss of pay for complying with the heat standard requirements or for reporting unsafe conditions. This should include financial penalties for employers who retaliate against workers.
- Emergency medical provisions and first aid are needed with special procedures for workers who work remotely or by themselves.
- The standard must include a surveillance system for heat-related illnesses including requirements for employer and clinician reporting.
- Clinician training regarding the Maryland standard and clinician guidelines for managing and preventing heat-related illness among workers should be offered. Please see attached Heat-Related Illness Clinician’s Guide June 2021.
Amy K. Liebman, MPA, MA, Director of Environmental and Occupational Health, Migrant Clinicians Network. Ms. Liebman heads MCN’s Eastern Region Office based in Salisbury, MD.
Leslie Rodriguez, JD, Bilingual Program Manager, Migrant Clinicians Network, Salisbury, MD.
1 “Heat-Related Deaths Among Crop Workers --- United States, 1992--2006.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention. 19 June 2008, ww.cdc.gov/mmwr/preview/mmwrhtml/mm5724a1.htm. Accessed 13 Sept. 2021.
2 Mac VV, Tovar-Aguilar JA, Flocks J, Economos E, Hertzberg VS, McCauley LA. Heat Exposure in Central Florida Fernery Workers: Results of a Feasibility Study. J Agromedicine. 2017;22(2):89-99. doi: 10.1080/1059924X.2017.1282906. PMID: 28118110; PMCID: PMC5682629.
3 Jacklitsch, Brenda. ‘Adjusting to Work in the Heat: Why Acclimatization Matters.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention. 14 July 2014, blogs.cdc.gov/niosh-science-blog/2014/07/14/acclimatization/. Accessed 13 Sept. 2021.