Protection Resilience Efficiency and Prevention for workers in industrial agriculture in a changing climate

三十多年来，在中美洲的农业和其他重体力劳动者中，特别是甘蔗工人中，发现了一种与糖尿病和高血压等众所周知的风险因素无关的慢性肾脏病（CKD）流行病，因此命名为不明原因的CKD（CKDu）。在斯里兰卡、印度和埃及等其他热点地区，CKDu在农村体力劳动者中也越来越常见。与大多数非传染性疾病一样，CKDu可能有多种风险因素，但越来越多的证据表明，劳动实践，特别是在没有充分休息或水合作用的高温下繁重工作，是这种疾病的重要驱动因素。因此，这种疾病可以被视为与气候变化有直接联系，并且在不久的将来可能会变得更加普遍，除非工作场所的热压力得到缓解。为了应对这一疾病，目前项目联合体的成员在尼加拉瓜的一个大型甘蔗厂集体实施了Adelante倡议。Adelante是对工作场所干预措施的科学评估，重点是充足的水和在阴凉处休息，以及改善人体工程学，旨在防止工人的CKDu，同时保持生产力。PREP计划将建立在Adelante倡议的基础上，并将有三个不同的主题：I。评估水，休息和阴凉干预对制糖业劳动力健康（肾脏健康和热相关症状）和生产力的直接和长期影响; II.研究对受CKDu影响的个人，家庭，社区，公司和卫生系统的经济和社会影响，以及减少热应激和CKDu风险的工作场所干预措施是否有助于恢复能力，包括减轻移民压力;研究政策，或缺乏政策（在多个行政尺度），促成了CKDu疾病，以及需要什么政策来有效地解决它在未来不断变化的气候。该计划是一项跨学科的努力，汇集了具有职业卫生，医学，卫生经济学以及社会和政治科学专业知识的研究人员。研究方法包括先进的生理测量，焦点小组和访谈，文件分析，半结构化访谈和参与式研讨会。使用这种协调的跨学科方法，我们将评估职业健康和安全干预措施如何影响工人的健康，以及在当地社区的社会和经济影响，以及公司的投资回报。我们将与工人、管理层、认证机构、国家当局和消费者一起，为受影响的人和希望改善对工业、农业和其他户外体力工作工人保护的人制作工具包和教育材料。我们的研究结果将通过科学交流、与工人/管理层的研讨会、基于网络的材料制作、面向公众的电影以及与媒体的合作来广泛分享。PREP将增强我们对炎热气候下工业农业工人CKDu风险因素的了解，并制作基于证据的工具包和其他教育材料，以预防热应激及其后果，针对行业，政府和其他利益相关者。通过进一步了解受影响的地点和人员，同时提供可行的解决方案，我们可以帮助政府和行业采取积极主动和具有成本效益的方法来解决CKDu及其相关挑战。有必要证明，这种投资将比因无所作为或不适当地试图处理一个在变暖的世界中可能变得更糟的问题而遭受社会和经济影响更为经济。

For over three decades, an epidemic of chronic kidney disease (CKD), not related to well-known risk factors like diabetes and hypertension, and thus named CKD of unknown origin (CKDu) has been detected in agricultural and other heavy labourers in Central America, especially sugarcane workers. CKDu is also increasingly observed in manual rural workers in other hot regions, such as Sri Lanka, India, and Egypt. There are probably multiple risk factors for CKDu, as for most non-communicable diseases, but there is a growing body of evidence that labour practices, specifically strenuous work in heat without sufficient rest or hydration, is an important driver of the disease. Thus, this disease can be seen as having a direct link to climate change and is likely to become even more prevalent in the near future unless workplace heat stress is mitigated. As a response to this disease, members of the current project consortia have collectively implemented the Adelante Initiative at a large sugarcane mill in Nicaragua. Adelante is a scientific evaluation of workplace interventions that focus on adequate water and rest in shade together with improved ergonomics, aiming to prevent CKDu in workers while preserving productivity. The PREP program will build on the Adelante Initiative and will have three different themes: I. To evaluate the immediate and long-term impact of a Water, Rest, and Shade intervention on workforce health (kidney health and heat related symptoms) and productivity in the sugar industry; II. To examine the economic and social impacts on individuals, families, communities, the company and health systems affected by CKDu and whether workplace interventions to reduce heat stress and the risk for CKDu aids resilience, including mitigating migration pressures; III. To examine the policies, or absence of policies (at multiple administrative scales) that have contributed to the CKDu disease and what policies are required to effectively address it in a future changing climate. This program is an interdisciplinary effort that brings together researchers with expertise in occupational hygiene, medicine, health economics, plus social and political sciences. The research methods range from advanced physiological measurements, focus groups and interviews, document analysis, to semi-structured interviews and participatory workshops. Using this coordinated, interdisciplinary approach we will evaluate how occupational health and safety interventions affects worker's health at an individual level as well as the social and economic effects in the local community, and company return-of-investment. Together with workers, management, certifying institutions, national authorities, and consumers we will build toolkits and educational materials for those affected and those wishing to improve protection for workers in industrial agricultural and other manual outdoor work. Our findings will be broadly shared via scientific communications, workshops with worker/management, production of web-based material, films for the general public, and collaboration with media. PREP will enhance our knowledge on risk factors for CKDu in industrial agricultural workers in a hot climate, and produce evidence-based toolkits and other educational material for prevention of heat stress and its consequences, directed to the industry, governments and other stakeholders. By furthering our understanding of where and who are affected, while providing viable solutions, we can help governments and industry take a proactive and cost-effective approach to address CKDu and its associated challenges. There is a need to demonstrate that such an investment will be more economical than suffering the social and economic impact of doing nothing or inadequately attempting to treat an issue that is likely to get worse in a warming world.