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

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.

Translating data from research into usable information for policymakers in the private and public sector, and the participants in our research, is essential to ensuring our efforts have tangible impact.
Our partners at La Isla Network (LIN) excels at engagement and dissemination of findings and will add significantly to the value of the outputs related to the results and scientific publications derived from the program. Our engagement and dissemination activities can be broken down into five categories.
1) Scientific
The interdisciplinary and mixed methodology used in this project determines that a broad academic audience in the fields of physiology, nephrology, epidemiology, occupational health and public health will be reached. Dissemination of the projects findings through CENCAM, the International Society of Nephrology International Consortium of Collaborators on Chronic Kidney Disease of Unknown Etiology and the DEGREE initiative will advance work examining the etiology and prevalence of CKDu. Scientific dissemination of PREP's findings will advance work examining the etiology of CKDu. It will also benefit academics designing and evaluating occupational interventions for other industries with similar exposures.
2) Press engagement
We will utilize the press and leading journalists to disseminate our findings in the public sphere. Press coverage of the problem, CKDu among the workforce, and proposed solutions (including safer work practices), will drive interest, increased awareness of CKDu, heat stress, its risks and its amelioration and create a space for more impactful policy design and implementation. This will be beneficial to all stakeholders from workers to the scientific community.
3) Narrative documentation
We will create short photo stories, videos, and other content to document and translate our research findings as well as the impact of the disease and mitigating efforts. Researchers, stakeholders and policy makes all benefit from informed and dedicated documentation of the impact of CKDu and what is being done to address it. This raises awareness and also can serve as a means for study participants to have agency over their experience.
4) Stakeholder empowerment and engagement
PREP's outputs must be translatable for practical applications in industry and governments. An important aspect of our work will be to create actionable toolkits and information for those affected and wishing to improve protections for workers and those that are able to assess the risks in their supply chains and industries. This information will be made available to Development banks, producers, brands, researchers, certification bodies and workers.
5) Policy engagement in the private and public sector
Building off themes I, II and III, if findings are relevant to immediate policy needs (e.g., limiting exposure to high core temperatures among workers with a heavy workload) we will work with organizations such as the Pan-American Health Organization, International Labor Organization and relevant health, labor and environmental ministries to provide guidance on reasonable but effective regulation. By addressing identified risks, via theme III, we will mitigate liabilities and costs for brands and governments, as well as strengthening certification standards. For communities this should translate into fewer affected individuals, and for governments, lower costs in treating those affected.