Construction workers are at an elevated risk of heat stress, due to the strenuous nature of the work, high temperature work condition, and a changing climate. An increasing number of workers are at risk, as the industry’s growth has been fueled by high demand and vast numbers of immigrant workers entering into the U.S., the Middle East and Asia to meet the demand. The risk of heat-related illnesses is increased by the fact that little to no regulations are present and/or enforced to protect these workers. This review recognizes the issues by summarizing epidemiological studies both in the U.S. and internationally. These studies have assessed the severity with which construction workers are affected by heat stress, risk factors and co-morbidities associated with heat-related illnesses in the construction industry, vulnerable populations, and efforts in implementing preventive measures.

Migratory and seasonal agricultural workers (MSAWs) are a historically under-served population that experience poor access to health care. The aim of this study was to describe the demographic, socioeconomic, and health status of U.S. agricultural workers and their dependents who were patients of a Migrant Health Center in 2012. The authors used the Uniform Data System to examine demographic, socioeconomic, and health variables for 793,188 patients of 164 Migrant Health Centers during 2012. Means, proportions, and period prevalence was calculated for all variables. Results showed that 80% of MSAWs earned family incomes below 100% of federal poverty level. Among the reported diagnoses, the most common were hypertension, diabetes mellitus, and mental health conditions. Fifty-three percent of all MSAWs and 71% of adult MSAWs were uninsured, indicating that Migrants Health Centers continue to play a vital role in providing access to primary health care for MSAWs and their families.

Background: Approximately 5000 people are killed by an injury at work every year, but the U.S. Occupational Safety and Health Administration (OSHA) only investigates 25%-35% of these deaths. The aim of this study was to identify industry, geographic, and worker demographic disparities in the proportion of fatal workplace injuries that are investigated by OSHA. Methods: This cross-sectional analysis drew from 2 years of public data (2014-2015) from the Census of Fatal Occupational Injuries and investigation data from OSHA. Differences by worker age and sex, geographic region, industry, and State Plan-versus Federal Plan-state were examined. Results: Nationally, OSHA investigated about one in four (27.5%) of the 9657 fatal workplace injuries that occurred. Higher odds of uninvestigated fatalities were observed for female workers compared to male workers (odds ratio, 2.35; 95% confidence interval, 1.89, 2.93), for workers over age 65 compared to those aged 18-24 (3.05; 2.44, 3.82), for worker deaths occurring in State Plan states compared to Federal Plan states (1.64; 1.49, 1.79), among other differences. Conclusions: Although some of the disparities could be explained by OSHA jurisdiction restrictions, other areas of potential reform were identified, such as investigating a greater number of workplace violence deaths and increasing focus in industries with a low proportion of investigations but a high number of fatalities, such as transportation and warehousing. Consideration should be given to adapt policies, expand OSHA jurisdiction, and to increase OSHA resources for conducting both fatality investigations and proactive investigations that can identify and abate hazards before a worker is injured.

Texas' unique elective system of workers' compensation (WC) coverage is being discussed widely in the United States as a possible model to be adopted by other states. Texas is the only state that does not mandate that employers provide state-certified WC insurance. Oklahoma passed legislation for a similar system in 2013, but it was declared unconstitutional by the Oklahoma Supreme Court in 2016. This study examined 9523 work-related hospitalizations that occurred in Texas in 2012 using Texas Department of State Health Services data. We sought to examine work-related injury characteristics by insurance source. An unexpected finding was that among those with WC, 44.6% of the hospitalizations were not recorded as work related by hospital staff. These unrecorded cases had 1.9 (1.6-2.2) times higher prevalence of a severe risk of mortality compared to WC cases that were recorded as work related. Uninsured and publicly insured workers also had a higher prevalence of severe mortality risk. The hospital charges for one year were $615.2 million, including at least $102.8 million paid by sources other than WC, and with $29.6 million that was paid for by injured workers or by taxpayers. There is an urgent need for more research to examine how the Texas WC system affects injured workers.

The increased likelihood of receiving rest breaks at work in a RBO city suggests that, in the absence of enforceable national standards, city-level RBOs can be an important first step to effective prevention of heat-related illnesses (HRIs) and heat-related fatalities at work.