An evolving workplace intervention protocol

The Worker Health and Efficiency (WE) Program was LIN’s first multi-stakeholder project, directed by La Isla Network at the El Angel sugar mill in El Salvador.

Visit to see how the WE Program evolved into a new system.

It may seem obvious, but a person exposed to temperatures regularly above 32°C (89.6°F) and sometimes exceeding 42°C (107.6°F) should have access to water, rest and shade.

For centuries, these basics were absent in the sugarcane industry.

Visit Adelante Initiative for more information.

The WE Program is the first-ever intervention protocol to evaluate ways to reduce the harmful effects of heat stress and CKDnT among the sugarcane workforce.

The program is improving working conditions for cane cutters by providing them water, rest, and shade, appropriate outerwear, including a hat and breathable shirt, an ergonomic machete, and efficiency training from industry experts. Researchers track resulting improvements in worker health and productivity.

The WE Program is led by La Isla Network and research institutions around the world, with consultation from the U.S. Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and Prevention (CDC), U.S. Army Research Institute of Environmental Medicine (USARIEM), and Australian sustainability experts.

The WE Program provides the foundation for the Adelante Initiative, a multi-sectoral collaboration to improve workplace practices and ensure learnings from the WE Program are applied in the agricultural sector and beyond.

First findings

The WE Program’s first-year pilot study showed improved health outcomes for study participants and productivity increased significantly. The program is compatible with the operational needs of the industry. Workers consumed significantly fewer NSAIDs, and reports of pain, heat stress, and heat stroke also decreased significantly.

Cross-shift study

The journal Environmental Review published results from a cross-shift analysis of workers’ health conducted as part of the WE Program. The results show recurrent dehydration causing kidney damage among sugarcane workers. 1

Next steps

Having just finished its second year of data collection, the WE Program is preparing to scale up to larger sample sizes. Exposure to pesticides and toxins are currently under investigation by representatives of the CDC-NIOSH.

Get involved

The WE Program can be adapted to fit anywhere workers are at risk of CKDnT.

La Isla Network is committed to consulting with researchers, governments, and companies as they design, implement and evaluate similar intervention strategies to save lives around the globe.

Contact WE Program Director, Ilana Weiss for information on consultations and support.


  1. Bodin T, García-Trabanino R, Weiss I, Jarquín E, Glaser J, Jakobsson K, Lucas RA, Wesseling C, Hogstedt C, Wegman DH; WE Program Working Group. “Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1.” Occupational and Environmental Medicine. April 2016. Available at: