Summary
A BMJ editorial calls for enforceable heat-stress standards and workplace protections, including measures that cover informal workers. It argues that controls should address both exposure and workers’ ability to rest or stop work without losing income.
A BMJ editorial published on 19 October 2026 calls for enforceable, locally appropriate standards to protect workers from rising heat. The authors recommend using heat-stress measures such as wet-bulb globe temperature (WBGT), alongside workplace changes that reduce exposure and give workers time to recover. The piece is a commissioned editorial, not a new intervention study, and was not externally peer reviewed.
The scale of the problem is substantial. The editorial cites estimates that 2.41 billion workers are exposed to excessive heat each year, contributing to 22.85 million injuries and 18,970 deaths. It also cites a meta-analysis of 111 studies across 30 countries and more than 40 occupations: 35% of workers exposed to heat experienced heat strain, while 30% reported productivity losses. For 2024, the editorial reports estimates of 639 billion lost working hours and $1.09 trillion in lost income.
Heat risk depends on the work and the workplace
Air temperature alone does not describe a worker’s heat exposure. Humidity, radiant heat, air movement, physical workload, clothing, time exposed and acclimatisation all affect risk. So do access to water, sanitation, shade and breaks.
The burden often falls hardest on people with less power to change their working conditions. Around two billion people worldwide work informally, the editorial says, often without the reach of labour inspection, occupational health services or paid sick leave. In a cross-sectional study in southern India cited by the authors, 45.2% of 1,053 outdoor informal workers reported heat-stress symptoms, compared with 39.1% of 1,051 indoor employed workers. These are reported symptoms from a comparison between groups, not evidence that a particular workplace measure caused a difference.
Controls should change working conditions
The authors recommend starting with measures that reduce heat at its source, such as insulation, shading, ventilation or cooling. Work can also be reorganised through scheduling, reduced workloads, paid rest periods, stop-work procedures and acclimatisation. Water, sanitation, shaded or cooled recovery areas, training, first aid and emergency referral are additional protections.
WBGT is a heat-stress index that incorporates environmental conditions beyond ordinary air temperature. Using it can help make work-rest rules responsive to the conditions workers face. The editorial gives Belgium’s workload-specific WBGT thresholds and prescribed work-rest arrangements as one example; it says Qatar requires work to stop when WBGT exceeds 32.1°C.
A stop-work rule is less protective if workers lose wages or risk retaliation for using it. The authors therefore argue that protections need income continuity and must include informal, migrant, seasonal, self-employed and domestic workers—not only people in standard employment. They also call for health services to ask about occupation and heat exposure, and for heat illness or clusters of cases to prompt workplace investigation as well as clinical care.
The editorial says evidence for multicomponent programmes is uneven across sectors, with further research particularly needed in manufacturing, construction and agriculture. Its central recommendation, however, is to use existing evidence to implement worker-centred protections now, while evaluating how well those measures work in different settings.