Our transdisciplinary research organization, La Isla Network (LIN), has developed and implemented occupational interventions to mitigate CKDnt and other heat-driven occupational injuries and illnesses (OIIs), focusing primarily on the Central American sugarcane sector where prevalence is high. This is exemplified by our Adelante Initiative, a multi-stakeholder initiative involving: Nicaraguan National Committee of Sugarcane Producers (CNPA); Bonsucro, the leading certifier for sustainable sugarcane production; Ingenio San Antonio (ISA), Nicaragua’s largest sugar mill; and FairTrade USA. Through development of a Rest-Shade-Hydration-Sanitation (RSH-S) intervention the Adelante Initiative has reduced hospitalizations due to heat-driven acute kidney injury by 94% while generating a ~27% return on investment for the participating mill. 

The program success has spurred multiple RHS-S project expansions within the sugar sector and other heat-vulnerable industries. This includes the Belmont Forum/European Commission funded PREP program, part of the ENBEL project – a member of the WHO-Civil Society Working Group on Climate and Health. It also includes PREP 4 Change (P4C), a cooperative agreement with the US Department of Labor to address occupational injuries and illnesses (OIIs) (especially those due to heat exposure) and build safe and equitable workplaces across Northern Central America.

While we have demonstrated success at mitigating heat-health risks using our RSH-S intervention, RSH-S has thus far only been evaluated within the context of formal labor (i.e. where workers are directly employed by organizations). PREP will addresses the urgent need to test, evaluate, and refine RSH-S in the informal sector. With an estimated two-billion working in informal labor globally, (many of those employed in climate-vulnerable manual labor roles in low- and middle-income countries of the Global South), there is a clear need to translate established heat adaptations in the formal sector to this context.