Migrant workers bear the brunt of heat stress

and that's what's on the agenda. This episode grueling, punishing weather in Paris athletes have been braving the heat that's gone up to as high as 37 °C and fans have had to bake under full on sun exposure for open air events. Our correspondent in France, Ross Collins spoke to a few of them. We were sat in the sun for like three hours watching the basketball, but yeah, an ice cream afterwards. So it's been really hot here. Very sweaty. What's the weather like here?

It's not just France and the Olympic athletes and fans wrestling with this weather though, here in our part of the world, things are also heating up and we're putting the spotlight on a very different group of people dealing with the brunt of it.

They are our workers laboring in the elements. Migrant workers at construction sites, landscapers and gardeners tending to urban greenery, painters and cleaners and people whose livelihoods require that they work outdoors and with temperatures breaking records in Singapore, what risks do these folks face and what options are there to cool down and keep safe here with me to answer these questions is Associate Professor Jason Lee who is also the Director of the Heat

Resilience and Performance Center at the Yong Luin School of Medicine at N US. Thank you, Doctor Lee for joining us here today. Now doctor Li, if I understand correctly, your field is physiology and you study the impact of heat stress on the human body to find ways to limit the impact and improve performance and productivity. Now, we recently saw that on 21st July, the planet recorded its hottest day ever.

It's certainly feeling a lot hotter here in Singapore. What does all this mean for Singapore and the region and the people here? It means we get more and more uncomfortable and it really depends who you are for most of us because we can avoid the heat. And we thought ok, since we have air con cooling facilities and therefore we

are not paying the price of a warming world. No, in fact, we are paying the price indirectly, lack of incidental physical activity, lack of outdoor exposure, which means our physical health, mental health, even eye health will be compromised. But there are other sectors like the workers who don't have a choice to avoid the heat and they still have the toy out there. And the usual concern in that sector is there could be increased heat injuries, severe work productivity losses. And then

when you are uncomfortable, right? If I put you in the context where you are too hot, too cold, too noisy, too smelly, the default human response is I want to finish the work and get out of here as soon as possible. And therefore our decision making can also be compromised leading to accidents at workplaces. So we are after hi injury, productivity loss and then decision making leading to the increase in accidents. Yeah. Speaking of accidents, this really

is a matter of life and death, isn't it? We had the case last year, I believe of a migrant worker who fell from the roof of a seven story building. I think that one got a lot of attention and the coroner said it was likely because he was just oriented from the heat. We're talking about not just the impact on our physical health from the heat stress, but all these other repercussions from it. How bad is this situation?

What is a clear and present danger? Yeah, if I may just to speculate on that case, of course, we didn't measure him during that incident, but basic physiology, tell us you get hot right immediately, you will need to shun your blood onto the skin to dissipate it onto the environment. And then if that is insufficient, we usually need to sweat to fight the heat. So there is this vassal

dilation that is this uh increase in sweating. And hopefully, if the environment is dry enough, you can evaporate the sweat and therefore you lose the heat. Ok. In our context, the letter is also compromised because you can sweat. But it doesn't mean you can evaporate all your sweats and therefore your heat will be building up continuously. So in that case, it is not difficult to speculate when you have it in the vision. And remember that in the individual wasn't a young man,

so probably have limited physiological capacity. So when the blood get shuns to the skin to lose the heat, right, there could be a drop in blood pressure and then you get lightheaded and then you could fall off. That happens quite commonly in other contexts where you go to Onsen and Sauna, you experience the acute experiences p that the experience, you feel some lightheadedness because the blood now is being shunned to the skin.

And you experience that acute light hitters. In most cases, you see you lie down, you know, but in few cases, you didn't have a chance and you collapse. And then in this case, he fell from heights. What specific risks do construction workers, migrant workers face that most of us cannot fully appreciate if we now zoom into occupational workers. Right? There are two type of work in general. One is what we call a salary. You are paid by time, as long as you are there long enough you get pay.

And in that case, most of the time you expect huge productivity loss, you know, because there's no motivation for them to work harder because they get the same pay and then you will definitely suffer huge productive losses. In fact, in project hit safe, they just concluded it was a 3.5 years project, we found there's a lot of productive implications because you tend to slow down when you are uncomfortable.

But when we went to South Korea and profile a group of workers, they were doing delivering job and they were paid by peace. The ambient conditions were much milder than what we experienced in Singapore in Singapore, hovering about 30 plus and minus in South Korea. Then it was 20. I was surprised the physiological strain was much higher in those workers working in cooler conditions. Why? Because they were paid by peace and therefore had the intrinsic motivation to work as hard

as possible when you work as hard as possible. That is where you produce a lot of heat resulting in the hot human body. Also a point to emphasize is not always the case that hot environment means a hot human it depends on the context. Wow. So it cannot be looked at in isolation. That's what you're saying. Just the heat, the heat temperature alone broadly what equates the hot worker as a function of the environment,

the attire and the work. So environment is just one factor we need to account for the attire and the kind of work. Singapore's Manpower Ministry last year imposed heat safety rules that employers need to follow. These include regular breaks, a lot of water and hydration, a place to cool down. But in a recent news report, the ministry said nearly 30% of some 250 work sites inspected in the second quarter of the year did not have those measures in place.

Fines were imposed on some of them but should penalties be heavier in order to actually get these rules implemented the recommendations made last year, they called it enhanced hi measures. There's a list of things, but you mentioned a few get yourself heat acclimatize rest drink and when you rest, rest under shade, these are evidence based options. And so we don't have to innovate for the sake of innovation. They are proven solution in this case, very low cost,

very sustainable. We just say that you know this because your body temperature can recover and therefore you can be more productive to your point on whether we should punish eventually. Well, there's always a space for that. But before that, I think there is still room for us to increase the awareness. Why we are talking about providing these measures because I think you talk about rest, right? Immediately the employer would assume

more rest. Yes, more welfare but bad business. I think that's the number one thing we need to debunk because in project he safe, we found when we introduce more rest productivity increases. Remember a lot of these workplaces are not paid by time ie they are not paid by peace, right? So if you don't give them rest, humans are very creative, I can slow down, I can go to the toilet in higher frequency. No one is going to stop me. So I'll find ways to rest

huge present to occur in workplaces. Ah, so I think number one, we need to increase awareness. Convince the boardroom say that when we introduce hid measures, it's not just welfare is for good business. So if everyone believes and convince right, it is good for welfare, good for business, right? I would assume most will come on board. I think that 30% that Dean, right is because number one, they probably didn't appreciate said no, no, no. At the end of it

is bottom line, we need to profit. There are other priorities so I cannot afford to give more rest. Number two, you have to see it from a recipient's perspective. We are saying now if you don't do this right? There's a risk of getting hit injured if I'm the worker. If I'm the delivery man, I said you're talking about risk, Jason, I'm talking about if I don't deliver more, right? It's not risk. I will earn less at the end of the day. You know, so I'm willing to take the risk

and also from a behavioral and implementation sciences consideration. I think we need to incorporate that. We cannot assume when there are solutions, human will use the solution. So you must create a value why they should respond to these enhanced policies? If not, I think the the mindset will be wow, this is new set, then they will do the audit, they will check us out. You know, I think the spirit of which we conduct this will be wrong. I think there is still room

for us to augment maybe be 100%. But I think there's still this 30% of poor adherence we can continue to reduce. So 30% of poor adherence. Do you think the owners then should be on the companies or the individual? Both? Yeah, I think the individuals must first understand because at the end of it, we talk about heat injury, right? It goes down to the last man that he must be aware. If there are signs, I must take actions, but they will tell you I don't have the resources

to incorporate all these measures. So my supervisors or employers have to be responsible and therefore going back to my earlier point, we must create a value why they should react in the first place. So you talked about simple low cost solutions to regulating body temperature. But what about long term innovative solutions that could viable? So swimming the proven solutions like getting yourself aerobically feed heat, acclimatize, optimizing your work rest cycle cooling and

appropriate hydration is in place. And we find that oh it is still not enough, right? That is where it give us the motivation. Maybe innovation can fill the gap. So they work on automation. Do we need that labor intensive efforts every time that can come in specific to heat management? The workplace safety and Health institute also tested out the provision of ice slushy. OK, not the slurpee we get at the 7-Eleven, those are high in sugar but you can say pour any kind of sports ring

that usually low in sugar with some electrolyte. It makes wonderful tasty ice slushy. So they have trial that the size is convincing and the biggest takeaway from that uh testing by WSH I was the workers like it so much. They say if this were to be implemented, they will pay for it today how it works in workplaces. They get their drinks from the vending machine, they pay back and then they get it. So we are asking for vendors to come on board to say now, can those vending machine also

dispense isolate? There's also a concept especially from insights from project heat safe. We found actually most of the workers are were OK in terms of a physiological screen, in fact, as an average mean group response, right? We found that if anything they were under working, which picks the general impression if you if you are not paid by peace, right? I would slow down to preserve my health. And therefore,

there's huge productivity implications. Having said that there were few individuals who were pushing the limits physiologically. And these are the individuals, they could be more vulnerable. They could be for other reason, very motivated individuals, even I'm not paid by piece, right. I'm just a motivated worker. I will give all out and the physiological strain were

dangerously high above 39 °C while working, for example. So from an innovation perspective, we are exploring whether we can first profile the group of workers who are more vulnerable to heat, right? There's this concept called the heats vulnerability index that incorporates a lot of inputs, parameters, know your age, whether you are on medication, so and so forth and give you a score. So imagine we have that. Then we picked out these five guys out of 100 who are already more vulnerable.

We could layer heart rate monitoring. That's another innovative approach, right? There are proven heart rate solutions there and then develop that threshold individually. So where no you cross a certain number, your heart rates, for example, I can pull you out by doing So, right, you pick out those who are high risk, then you can use this also to say, oh actually there are a group that is not pushing hard enough, they want to because

they have more physiological reserve to do so. So the whole work model can also be revisited. So maybe there are some more intensive work you can segment then since you are healthier, you can push more. I will group you and you get paid more and those who are not so strong, maybe they are ok not to be overused. So especially when the manpower is shrinking, right? We need to job fits every worker in a more

targeted manner. And don't assume everyone is the same in terms of a lot of these migrant workers, the issue for them isn't just outdoors though, right? Dormitories are also an area of concern. Given the number of people who are housed in an enclosed area, air conditioning rooms is also often too costly, not an option and not very climate friendly either. So space is a real issue. What can we do or what can companies do to better manage this indoor heat factor?

Yeah, that's an important point, right? Because our life is not just during the work exposure, we assume when we come home, in this case to the dormitories, they will

be well rested. Most of the dorms based on my knowledge are not air conditioned, I think for the right reason also air con, by the way, is a great invention is the allocation of air con like a lot of other big ticket items of in our society just disproportionately allocated usually the most vulnerable to have access to all the bells and whistles. But coming back to the conversations, we need to also ensure they rest well at night and thermal discomforts will degrade your sleep quality and some

duration. This is all the more relevant in our context where the recent V three projection says that by mid century, OK, the scary statement is that based on best case scenario. So we don't have to imagine it will happen almost every night will be a warm night. So not rocket science if you don't recover, well, you keep on working

over days, overweight, right. Then when you return to work next day, you don't expect you are fully sound and therefore as a higher risk, not just productivity losses, your concentration, therefore accidents and plus the accumulative work exposure, right? I think turns things will turn even worse if you don't ensure sufficient recovery at rest.

So that is another segment through project heats, right? In collaboration with overseas partner, we are also now looking at the dormitories condition and approaching the fan first approach design, the dormitories to make sure that we can optimize thermal comfort while they are resting. And earlier, you also touched

on air conditioning, which really isn't the solution. And what struck me was that, as I mentioned earlier, I just came back from France and I don't know if you've been there in the dead heat of summer, it gets so hot that it's almost like the weather here. But this is not an air conditioned country. So it's not like you can just run into a shopping center or go back home or your hotel or airbnb and turn on the

air con. So for about two weeks, we had no air con and then I came back to Singapore and I had a climatized and you don't, it really struck me how two weeks away without air con and you're back in Singapore and you feel like there's less of this dependence or addiction to it and it just became a really tangible way for me to think about. Oh, maybe I don't need to use my air con so much. There's somebody in your field. Do you look at how people can acclimatize better? Yeah.

In fact, you have just unintentionally put yourself through two weeks of heat acclimatization and you are feeling the benefits, right? If I got to deal with this stress or called heat, right, then I expose myself. And in this case, exactly two or three weeks, that is actually the same recommendation or two or three weeks of exposure to heat will induce certain physiological responses and also behavior

responses for you to better deal with heat. So you have increased skin blood flow, you have increased sweat loss. These are all favorable physiological adaptations. You also know how to pace yourself better upon exposure to heat. You say, oh Singapore after two weeks, surprising is not as hot because it was hotter elsewhere. The key difference between these two context is a population that only deal with heat. In France, right? Every summer for us in Singapore,

we deal with heat. So our behavior response is really quite a thing, not so much that we will face the heat because we are living in the tropics, especially in Singapore coupled with the air con facilities almost everywhere, right? We are quite good in avoiding the heat too by hiding in your malls, cooling facilities. So actually most Singaporeans are actually not as

physiologically heat acclimatized. As many assume when we travel, you're from Singapore, you must be tropical heat acclimatized, not true. You know, we are very good in avoiding the heat. And we thought and therefore look at our epidemiological evidence or data, we hardly have any heat stroke death. And that has been the exact reason why for the longest time, we have not take urgent action because we say usually we see heat news if somebody dying summer

heat waves, you know fronts. But in Singapore, we don't have therefore, heat is not a problem. And we explain because we are very used to heat. We are very used to heat in Singapore because we have options to avoid the heat and that itself will incur a lot of indirect implications. You know, lack of incidental physical activity, outdoor your activity count, you must almost like proportion time for it, right? You cannot

say no this morning, I just walked five K to work. No, it won't happen in Singapore because you will get uncomfortable mental health, which is a hot topic these days. And with no lack of outdoor exposure, we will exacerbate mental health. Have we link our eye health huge prevalence, you know, on eye health because of lack of outdoor exposure. So we are actually paying the price

for most of us here, not the workers for eye health. Yeah, lack of vitamin D. And there is evidence to say that there is a dopamine pathway that affects your eye and therefore your eye health can also be compromised, you know, but for the workers, right, this chronic heat exposure, not just the acute heat injury you will get, there are evidence coming from overseas. One of those things are li if you don't measure, we assume it's not

a problem until you measure. Oh, you know this also because it's a function of whether you bother to find in the first place. So now in Central America and we see it happening in India and elsewhere that they begin to see long term exposure working in hot environment, you may not die due to heat stroke, but you will have this condition called chronic kidney disease. And they bracket it of an unknown source or nontraditional.

So not the CD, usually because you have, have diabetes or you get it at the older age, you have young men in their thirties, early forties who are now performing dialysis, often diy dialysis back home because of the chronic heat exposure. Of course, heat is just one and the leading hypothesis is chronic heat stress, the other confounders. Is it because a lot of this? Ok. This worker I was just describing the sugar cane cutters.

So they are being paid by peace. So in the whole psyche, I want to cut as much as possible. And if I keep on going to the toilet, it means I will cut less. So not just the heat, I will deliberately not drink. And then you see you have all the metabolic waste produced by hard work. You don't flush it out by hydration and then overweight over months, over years, right? You pay the price and the more obvious case was probably during the building of the World

Cup stadiums. A lot of migrant workers were in Qatar and many died. Those who didn't die, many are now back home performing dialysis and we are still uncovering what are the acute and chronic implications of working in the hot environment? Thank you so much, Associate professor, Doctor Jason Lee, director of the Heat Resilience and Performance Center at the YL Lin School of Medicine. And a big thanks as well to our listeners and the team behind this podcast, Tiffany Joan Chan,

Jaini, Johari, Sae Wind and Christina Robert. We'll see you again next week along with Jack Board who will be back from vacation until then. I'm Li Ling Tan. Bye for now.