For more than two years, a group of health experts, economists and lawyers in the U.S. government has worked to address a growing public health crisis: people dying on the job from extreme heat.
In the coming months, this team of roughly 30 people at the Occupational Safety and Health Administration is expected to propose a new rule that would require employers to protect an estimated 50 million people exposed to high temperatures while they work. They include farm laborers and construction workers, but also people who sort packages in warehouses, clean airplane cabins and cook in commercial kitchens.
The measure would be the first major federal government regulation to protect Americans from heat on the job. And it is expected to meet stiff resistance from some business and industry groups, which oppose regulations that would, in some cases, require more breaks and access to water, shade and air-conditioning.
But even if the rule takes effect, experts say, the government’s emergency response system is poorly suited to meet the urgency of the moment.
Last year was the hottest in recorded history, and researchers are expecting another record-breaking summer, with temperatures already rising sharply across the Sun Belt. The heat index in Miami reached 112 degrees Fahrenheit last weekend, shattering daily records by 11 degrees.
The surge in deaths from heat is now the greatest threat to human health posed by climate change, said Dr. John M. Balbus, the deputy assistant secretary for climate change and health equity in the Health and Human Services Department.
“The threat to people from extreme heat is reaching a point where we have to rethink how, at all levels of government, we are preparing and putting in place a response that matches the severity of the problem,” Dr. Balbus said in an interview. “This is new territory.”
Emergency room visits for heat illness shot up around the country last summer compared with the previous five years, according to a study by the Centers for Disease Control and Prevention.
Heat kills more people each year than hurricanes, floods and tornadoes combined, according to the National Weather Service.
President Biden has tried to respond to the threat, notably with a call for worker protections in 2021. His administration tapped Dr. Balbus to be the first senior official to address the health impacts of climate change.
“Even those who deny that we’re in the midst of a climate crisis can’t deny the impact that extreme heat is having on Americans,” Mr. Biden said in July, adding that “it hits our most vulnerable the hardest: seniors, people experiencing homelessness who have nowhere to turn, disadvantaged communities that are least able to recover from climate disasters.”
But Mr. Biden’s efforts to respond to the extreme heat linked to climate change will almost certainly be erased if former President Donald J. Trump returns to the White House, Republican strategists said in interviews. Initiatives like the Office of Climate Change and Health Equity could be wiped away. And the proposed OSHA heat rule would very likely be shelved and ignored.
“So far this rulemaking seems bound up in policy concerns about climate change and structural racism,” said Jonathan Berry, who served as a senior Labor Department official under Mr. Trump. “I don’t see a second Trump administration supporting rules on those bases.”
You could ‘cook an egg up here’
The health effects of extreme heat can be devastating even to the healthy and the young. High temperatures can damage organs, depriving the heart and kidneys of oxygen and blood, and overwhelm the body’s ability to cool down.
Dr. Jerry Snow Jr., a medical toxicologist and emergency medicine physician at Banner-University Medical Center in Phoenix, saw patients last summer with confusion, unresponsiveness and body temperatures above 105 degrees Fahrenheit. Blood tests would reveal kidney or brain damage and muscle that had broken down. People who collapsed on hot concrete or asphalt arrived with burns, he said.
Juan Villalpando, 43, a roofer in Gary, Ind., battled 94-degree temperatures this week. “You can physically cook an egg up here,” said Mr. Villalpando, who has experienced episodes of heat illness, with fatigue, cold sweats, chills and disorientation. “When that happens to guys, they can fall off and die.” (As the heat has broken records in Indiana, Mr. Villalpando’s employer has provided more water breaks and shade.)
Telitha Solis, 57, an airplane cabin cleaner at George Bush Intercontinental Airport in Houston, recalls sweating, shaking and feeling nauseated while working without air-conditioning. “Any kind of air cooling would make a big difference,” she said.
The White House has pushed officials at the Labor Department, which oversees OSHA, to publish a draft heat rule this summer. But even if that happens, it is unlikely to be finalized this year and faces broad opposition from industry groups that say new regulations would be unreasonably complicated and expensive.
Marc Freedman, a vice president at the U.S. Chamber of Commerce, the country’s largest business lobbying group, wrote that such a rule would present huge challenges for employers and that “it is extraordinarily difficult for them to determine when heat presents a hazard because each employee experiences heat differently.” Mr. Freeman said the unpredictable nature of heat creates “a substantial barrier to efforts to determine when employees require protection.”
The rule, which would set clearer standards for employers, would most likely include two heat index thresholds, one at 80 degrees Fahrenheit and the other at 90 degrees, for worker protections in both outdoor and indoor settings, according to an outline that OSHA officials presented in late April. The heat index is a measure of how hot it really feels outside, factoring in humidity and other factors along with the temperature.
At the first, lower threshold, employers would be required to offer drinking water and break areas and to allow workers to start with lighter workloads. The higher threshold would require breaks and monitoring for signs of heat illness.
Since April 2022, OSHA, which has nearly 2,000 inspectors, has conducted about 5,000 inspections related to heat exposure. That resulted in 54 citations to employers for heat-related violations of the agency’s general duty clause, which requires companies to maintain workplaces free of hazards, said Mandy McClure, an agency spokeswoman. Out of those 54 citations, a dozen were issued after heat-related hospitalizations and 25 after heat-related deaths, she said.
Representative Greg Casar, a Texas Democrat who went on a thirst strike in July to pressure OSHA to expedite the heat rule, said that “it would take OSHA nearly 150 years to inspect every workplace in the country, because they’re constantly underfunded.”
About half a dozen states have implemented their own protections for outdoor workers. But some of those protections have faced backlash from conservatives.
Gov. Ron DeSantis of Florida and Gov. Greg Abbott of Texas, both Republicans, signed legislation to prevent local governments from requiring heat protections for outdoor workers.
According to data compiled by the Health and Human Services Department, 445 people died of heat exposure in Texas last year, and 77 died in Florida.
The Texas measure was designed to prevent a patchwork of local laws that conflict with or exceed state laws in a number of areas, including workplace safety. Mr. Abbott has said the goal was to “remove the barriers of government to encourage competition, and empower consumers to choose,” and that the measure “increases economic liberty while still ensuring customer safety.”
The Florida law was enacted after Miami-Dade County sought to enact a worker protection rule over the objections of the business community. “I think they were pursuing something that was going to cause a lot of problems down there,” Mr. DeSantis said.
The agency denied the request, responding that “precedent is to evaluate discrete events and impacts, not seasonal or general atmospheric conditions.” The 1988 Stafford Act, which authorizes the federal government to declare a disaster or emergency, does not include extreme heat in its list of 16 causes. No president has declared an emergency in response to heat.
Local officials and health providers say FEMA’s requirements for activating an emergency response typically involve things like property damage from a disaster. A heat crisis that stresses human health can be harder to measure.
A heat crisis “is not a big visual episode,” said Jane Gilbert, the chief heat officer of Miami-Dade County.
The most perilous heat-related health crisis could come if heat takes down an electric grid. Extreme heat can send demand for electricity soaring, straining transmission, and can damage equipment, hobbling production. The result is a steamy community, in the dark, without air-conditioning, refrigeration or relief. “That would be an overwhelming situation where I think you would probably have to see a federal response,” Dr. Balbus said.
Blackout events that leave more than 50,000 people without power for at least an hour have increased more than 60 percent in the United States between 2015 and 2021 as climate change has intensified heat waves, according to research published in the journal Environmental Science & Technology.
In Atlanta, Detroit and Phoenix, a multiday blackout event during a heat wave would more than double the estimated rate of heat-related deaths, a 2023 study found.
“In Atlanta, we have an undersized network of cooling centers, mostly high school gymnasiums,” said Brian Stone Jr., a professor at the Georgia Institute of Technology and an author of the study. “And not a single cooling center has backup generators.”
Kate Brown, a former Oregon governor, recalled that Portland had used air-conditioned city buses as cooling sites during heat waves.
“Emergency management was designed to deal with huge disasters that cause great destruction to public infrastructure,” she said. “This is people dying in their homes because of the heat.”