Iran Occupational Health

Background: Outdoor workers are vulnerable to heat stress and climate change due to their occupational and environmental conditions. Short-term exposure to extreme heat (acute exposure) can lead to rise the core body temperature, which it may directly cause heat related illnesses such as mild rash, cramps, heat exhaustion and heat stroke. It is reported that long-term chronic exposure to heat leads to chronic kidney diseases, cardiovascular diseases, and mental health problems.
 The vulnerability consists of three components including sensitivity, exposure, and adaptability. According to the third assessment report of the intergovernmental panel on climate change (IPCC), the defiition of vulnerability is the degree to which a system or an individual is sensitive to, or unable to adapt to the adverse effects of Heat Stress and Climate Changes. Sensitivity is the physical capacity of workers to be affected by a hazardous agent like the heat. Sensitive is an intrinsic and internal factor that indicates how the person is vulnerable to heat stress. Individual risk factors in heat stress may decrease the individual’s tolerance to heat stress. The ability of system to cope with climate changes and adapt to extreme heat to reduce the risks and consequences resulted from these conditions is called adaptive capacity. Adaptation leads to reducing the vulnerability and increasing heat tolerance. Adaptive capacity is definedas“Theabilityof asystemtoadjusttoclimatechange, to moderate potential damages, to take advantage of opportunities, or to cope with the consequences”.
Therefore, it should be necessary to reduce the level of vulnerability through providing the control programs and strategies. Since there are no national laws, regulations, guidelines to protect outdoor workers against heat stress in the country, only the relevant policy in this area is the permissible occupational exposure limit. Therefore, the present study aimed to develop a comprehensive operational program to reduce the vulnerability of outdoor workers to heat stress and climate change. The results of this study can be very effective in decision making of the macro-management as well as planning of control measures in the country. Also, the program presented in this study can be helpful for organizations in charge of health and safety such as the Ministry of Health and Medical Education and the Ministry of Cooperatives, Labor and Social Welfare (which are responsible for maintaining, protecting and promoting the health of the workforce).
Methods: According to the objective of the study, which was the development and implementation of an operational plan to reduce the vulnerability of outdoor workers to stress and climate change, several technical panels and brainstorming sessions were held   with the cooperation of the Institute for Environmental Research, Tehran University of Medical Sciences by eminent experts in the fields of industrial hygiene, environment engaging in  Medical Sciences University, Department of Environment and Ministry of Health and Medical Education during the 2014-2016.  The main components of the vulnerability, the areas and strategies for application of an operational program to reduce the effects of exposure to heat stress and climate changes in outdoor workplaces were taking into account in the meetings. Also, the Delphi technique (due to the lack of access to some of the professors and executives directors), the study of text books and articles have also been used in this study.
Delphi, as an effective and highly flexible technique, is used to achieve consensus or forecast future events. It is a proper method to collect the opinions of experts, who cannot easily meet each other due to geographical distance. Using Delphi as a research method is useful when there is no integrated knowledge about a specific issueorproblem.
Results: According our finding, six main components including general plans and policies (16 Strategies), prevention programs (6 Strategies), conservation programs (11 Strategies), training programs (11 Strategies), management planning (14 Strategies) and research and future study programs (11 Strategies) were proposed in the form of 69 strategies with three goals: reduction of sensitivity, reduction of exposure levels and increase of compatibility.
Conclusion: The proposed program and strategies in present study, can be used to prepare guidelines for work in hot environments. Our results can be of great help to the occupational health and safety -related organizations such as the Iran's Ministry of Health and Medical Education and Ministry of Cooperatives, Labour, and Social Welfare for planning and providing preventive procedures and control measures, in order to take effective action to maintain and improve employees' workplace health. Should be noted that the development and implementation of the mentioned policy require the cooperation of all members including employers, health and safety committee, supervisors and employees.