Occupational and environmental medicine

Dr. William Brett Perkison

By Ruth SoRelle
Texas Climate News

Workers whose jobs take them outdoors suffer the worst of Texas’ climate – summer heat and often blistering sun, torrential rain and flooding, the threat of grass fires, air pollution and allergens, diseases borne by water and insects, as well as the anxiety stemming from direct exposure to these factors that will only increase as the world’s climate changes.

In response to these new demands, Dr. William Brett Perkison, assistant professor in the Southwest Center for Occupational and Environmental Health at UTHealth School of Public Health in Houston, and his colleagues on the American College of Occupational and Environmental Medicine Task Force on Climate Change have issued a guidance paper on the responsibilities of experts to identify and mitigate the harmful impacts wrought by a human-disrupted climate.

“This is a position statement for my professional organization,” Perkison said in a recent interview with Texas Climate News. “When people are trying to implement programs to deal with occupational health and climate change, they can cite this paper” to support their plans.

For example, how does an occupational physician prepare for inevitable temperature increases? While the College so far has not suggested specific mitigation efforts, Perkison said, “we have this public health threat. We have to do something about it, especially in our capacity as occupational medicine doctors who have a responsibility for prevention.

“The first obvious measure is one to reduce the effects of heat stress, especially in this area (Houston). When you are at a company or any kind of workplace, you have heat stress protocols. When the temperature gets to a certain level, you implement a buddy system where workers watch each other for heat problems and install drinking coolers out at the workplace.”

The National Institute for Occupational Safety and Health (NIOSH) outlines best practices for this issue.

“It’s a set kind of thing – just like ozone action days,” when levels of ground-level ozone, sometimes called smog, are projected to rise, Perkison said. “You have a yellow zone where you have to implement a certain set of strategies and a red zone for when it gets to a higher temperature. There’s also a set amount of time you should work in that kind of heat. The higher it gets, the less amount of time you should work.

“These programs cost money,” he said. “This is one of the most tangible areas in climate change. The heat stress protocols are going to occur over a wider period of time, and will ratchet up to higher levels.”

Graphs on the websites of NASA and the National Oceanic and Atmospheric Administration (NOAA) show what has happened to date and is anticipated through the year 2050.

“The number of days with temperatures over 110 Fahrenheit in Texas will skyrocket,” Perkison said. “We in occupational medicine have got to plan for this, and we’ve got to know that this will be part of planning overall.”

Heat stress can cause a multitude of problems, but one that has come to light only recently is chronic kidney failure, first identified in sugar cane workers in Central and South America, where it’s a leading cause of mortality. The condition can become more widespread without efforts to protect workers there and in the United States.

“Houston is a poster child for not having prepared….

The state of Texas relies on the federal Occupational Safety and Health Administration regulations and guidelines, which lag those of states like California, Perkison said. However, some measures could protect workers.

Heat surveillance could spark opening of cooling centers for workers and individuals who live in increasing temperatures. “We have an aging workforce that, as with all older people, does not adapt to heat well. They are often not acclimatized because they spend spring and summer in air conditioning. If they go out and work in a hot environment, they are going to be more susceptible to shock.”

Occupational health physicians should monitor these situations, along with exposure to ultraviolet radiation, and help workers and their employers avoid heat-related injury and illness, he said.

Recognizing that hot climates interact with upper-atmosphere ozone-layer depletion, ambient ground-level air pollution and the transport of air toxics, occupational physicians should realize that workers are laboring in increasingly degraded conditions that can have serious implications for their health, he added. Occupational respiratory and allergic disorders may also increase because of the changing climate.

Flooding as a result of hurricanes and other storms encourages increases in pollen and can expose workers to new sources of infection, Perkison said, noting that preparation for these kinds of diseases and disasters can reduce their effects on the population as a whole as well as on the workers who often bear the brunt of the impact.

“Houston is a poster child for not having prepared for these kinds of problems,” he said. However, with three major floods hitting the city in three years, it may be time for people in the city to acknowledge that the climate is changing, he added.

Preparing for natural disasters means having disaster-response teams that are equipped to handle the problems that are naturally going to occur, he said.

“It is not a matter of if it will happen again. With data from NOAA, we know that these 500-year events are now 15-year events,” which means preparation is critical.

Preparing means understanding where flooding happens and having the necessary resources to respond,  he said, and acknowledging that there could be even worse disasters in the offing should spur local residents and leaders to improve response.

“Otherwise it will be bad for our local economy. Houston is not going to be a place where anyone wants to move to.”


Ruth SoRelle, a TCN contributing editor, is a veteran medical and science writer based in Houston. She holds a master’s degree in public health from the UTHealth School of Public Health in Houston. In her first reporting for Texas Climate News, she filed a number of dispatches from the annual meeting of AAAS (the American Association for Advancement of Science) in February.

Image credit: Baylor College of Medicine