Abstract
The Safety in the Heat program was developed in response to the extreme heat stress conditions experienced by workers in the United Arab Emirates and other Middle Eastern countries each summer, where ambient air temperatures often reach 45°C (135°F) and higher with 90% humidity. A comprehensive, multimedia, economical education and awareness program targeting companies in the region was developed; 465 companies employing 814 996 heat-exposed workers across 6254 work and labor residence sites were reached. Feedback from program participants indicated a high level of support and satisfaction. Results indicated a marked reduction in heat related illness over a period of 2 years (2008–2009) at 2 companies, one of which reported a combined 79.5% decrease in cases (15.3 vs 1.16 cases per 1000 workers) while the other experienced a 50% reduction in serious cases (0.08–0.04 cases per 100 000 work hours).
KEY FINDINGS
Initial data suggests a high level of support, satisfaction, and uptake by participating target groups.
Some evidence of a reduction in heat-related illness with a low per-capita investment per worker and worksite.
It is effective to work with public and academic (e.g., universities) and private (e.g., media companies) partners to achieve a clear outcome.
OUTDOOR WORKERS IN Abu Dhabi, United Arab Emirates (UAE), and other Middle Eastern countries are exposed to significant heat stress during the summer months (Figure 1). There is often a lack of practical awareness among employers, supervisors, and health, safety, and environment (HSE) personnel regarding the risk factors of heat stress and the precautions that protect workers from exposure, which can result in heat illness, heat stroke, and occasionally death. An attempt to address the problem was made by the UAE Ministry of Labor in 2007 by enforcing work stoppages in construction during July and August, 2 of the hottest summer months, between 12:30 PM and 3 PM; however, this measure is purely a time-based approach and does not take into account the actual environmental exposure conditions (i.e., air temperature and movement, humidity levels, and workloads).
In response to the need to take a more sophisticated approach to the issue, the Health Authority of Abu Dhabi (HAAD) created the Safety in Heat program, which refined and validated a novel heat stress index, the Thermal Work Limit (TWL)1 for use in the region. As part of the program, HAAD disseminated information regarding the prevention of heat stress by preparing simple, targeted materials for mass distribution to migrant workers who speak a wide range of languages. In addition, a practical toolkit was developed to educate supervisors, company HSE personnel, and employers and owners. All of these materials were developed based on research conducted in the UAE.2 A media company was engaged to assist in the development of the final toolkit, which was then tested and distributed by HAAD. Promotional materials were mailed to 600 large companies (defined as those with more than 100 employees) in the UAE to encourage participation; a Web site in English and Arabic that offered further information and the opportunity for companies to register was also developed and released to the public at the launch of the program.
PHASED APPROACH
A staged approach was used for the project, with an initial 2-year research phase focused on the refinement and validation of key elements, including the TWL index. Final development and implementation were completed through 5 additional phases (Table 1).
TABLE 1.
Phases of Final Development and Implementation for the Safety in Heat Program
| Phase | Element | Timeline |
| 1 | Development of draft health promotion materials | December 2008–January 2009 |
| 2 | Pilot of implementation in 2 large companies (1 oil and gas, 1 construction), plus evaluation | February 1–12, 2009 |
| 3 | Evaluation of media and health promotion materials from phase 1; refinement for next phase; program launch | March–May 2009 |
| 4 | Full implementation across identified heat stress priority sectors (including oil and gas, construction, agriculture, manufacturing, and transport) | May 20–October 15, 2009 |
| 5 | Final program evaluation (online survey) | October 2009 |
RESOURCE DEVELOPMENT AND DISSEMINATION
During the implementation phases of the program, 4 main groups were targeted: workers, supervisors, HSE personnel, and employers and owners. The final materials and resources that were provided are described in Table 2, which also enumerates the amount of materials distributed during the initial program and provides more information regarding target groups, languages available, and key messages and intent.
TABLE 2.
Resources and Materials Provided for the Safety in Heat Program
| Item | Target Group Involved | Key Messages/Intent | Languages | Items Disseminated |
| Posters | Workers | Increase fluid intake, increase salt intake, take regular breaks, notify supervisor, get plenty of rest | English, Arabic, Hindi, Urdu, Malayalam | 13 250 |
| Illustrated pamphlets | Workers | As above plus check urine color, eat well | English, Arabic, Hindi, Urdu, Malayalam | 36 370 |
| Awareness video (DVD) | Workers | General awareness of heat hazard, symptoms, precautions, and emergency measures | English, Arabic Hindi, Urdu, Malayalam | 640 |
| Pamphlets | Supervisors | General awareness of heat hazard, symptoms, precautions, and emergency measures | English, Arabic, Hindi, Urdu, Malayalam | 27 150 |
| Technical information pack (procedure and training manual, technical information sheets, training and awareness video [DVD]) | Supervisors, HSE personnel | Technical information on environmental evaluation, factors in heat stress and illness, TWL index details, resources, etc | English, Arabic | 640 |
| Roll-up banners | Employers | Create and maintain awareness of key issues as per posters | English, Arabic | 102 |
| Web sites | Employers, HSE personnel | Registration into program, information and resource provision | English, Arabic | NA |
| Branded cooler for small companiesa | Employers | Encouragement for small companies to register in program | English, Arabic labels | 92 |
| Mailing | Employers | Encouragement for large companies to register in program | English, Arabic | > 600 |
Note. TWL = Thermal Work Limit, HSE = health, safety, and environment; NA = not applicable.
Less than 50 employees.
The program received widespread media coverage over the summer of 2008, with 4 mentions during television news programs, 2 segments in current affairs programs, and 13 newspaper articles about the program, all of which helped increase awareness and company registrations.
Location of Abu Dhabi Emirate, United Arab Emirates.
Source: Wikipedia. Both the globe and the map were adapted from Wikimedia Commons, a freely licensed media file repository. Available at http://en.wikipedia.org/wiki/File:Blank_globe.svg and http://en.wikipedia.org/wiki/File:United_Arab_Emirates_location_map.svg. Accessed January 26, 2011.
Example of Awareness Poster Developed in Multiple Languages.
Source. Health Authority of Abu Dhabi Safety in the Heat program.
Example of Hydration Awareness Materials Developed in Multiple Languages.
Source. Health Authority of Abu Dhabi Safety in the Heat program.
DATA COLLECTION
Program evaluation was based on input metrics (dissemination of materials), process metrics (company registrations, and an online survey for companies and HSE personnel), and health outcomes of workers, provided by
2 large participating companies that maintained occupational health–related statistics.
RESULTS AND DISCUSSION
Uptake was high, with 465 companies registering (mainly in the construction field, n = 285; 61%), all of which in total employed 815 000 workers across 4460 worksites and 1794 labor residences. The majority of registered companies were from Abu Dhabi (n = 354; 76%), 18% were from other emirates in the UAE (n = 85) and .5% were from other Middle Eastern countries (n = 12).
Two large companies in Abu Dhabi that were able to provide internal occupational health statistics indicated a significant decrease in heat-related cases in 2009 compared with 2008: 1 company, with 1371 workers, experienced a 79.5% decrease in heat-related treatment and emergency cases (15.3 vs 1.16 cases per 1000 workers) while the other, with 51 million man hours worked in 2009, had a 50% reduction in serious cases (0.08–0.04 cases per 100 000 work hours).
Company representatives and HSE personnel (n = 142; 30% response rate) showed high satisfaction with the program, with 79.6% rating it as “very good” or “excellent,” and 76% satisfied they had “received adequate materials for their needs.” In addition, the majority of responding HSE personnel rated the response of management, safety officers, and workers to the program as 93.9%, 95.5% and 93.8% in the “good to excellent” range, respectively. The top 3 awareness materials rated “helpful to very helpful” were posters (97.4%), illustrated workers pamphlet (89.5%), and the urine posters (87.7%), which explain how urine color can be used to monitor personal hydration levels. No feedback on recall and awareness was elicited directly from workers. Program evaluation was undertaken 6 months after the launch, which coincided with the end of the summer months in Abu Dhabi.
Example of Use of Awareness Posters in Multiple Languages at Construction Site in Abu Dhabi. Photograph by Darren Joubert.
Table 3 provides a breakdown of the expenditures of the program. Although a formal cost effectiveness study was not completed, the cost of interventions was low (< US$ 0.50 per person covered or US$ 69.85 per workplace or labor residence facility), and employers incurred no direct costs.
TABLE 3.
Research, Development, and Implementation Expenditures for the Safety in Heat Program
| Item | US $ |
| Research | 194 495 |
| Health promotion materials | 224 515 |
| Launch function and pilot testing phase | 17 872 |
| Total | 436 882 |
The program was intended to limit heat-related illnesses through the widespread implementation of a novel approach to evaluating heat stress: the TWL. A practical toolkit was created for use in all sectors, although time constraints for development meant that only construction images were used in the materials, potentially limiting uptake in other sectors. This issue will be addressed in future versions. In addition, program evaluation was limited by a lack of systematic baseline data on heat-related illness; this issue will also be addressed going forward in Abu Dhabi with the implementation (in 2011) of an injury surveillance system within hospitals.
NEXT STEPS
The campaign will be repeated annually in preparation for the summer; subsequent campaigns will maintain the core content, but evolve the materials. For example, the 2010 campaign will include: (1) TWL training for supervisors and HSE personnel, and promotion of the online TWL calculator (available at http://www.haad-safe.ae); (2) increased efforts to engage companies across additional sectors, especially small businesses; (3) additional languages for worker materials and redesign of some items; and (4) monitoring of program effectiveness through a hospital-based injury surveillance system.
Acknowledgments
This work is supported by the Health Authority—Abu Dhabi.
All educational, training and awareness materials are accessible for free download after registration online at http://www.haad-safe.ae. These materials can be freely distributed and used with acknowledgment to the Health Authority—Abu Dhabi.
The authors wish to acknowledge the research work of Graham Bates, PhD, and Veronica Miller, PhD, from Curtin University of Technology, Perth, Australia, and John Schneider, MD, from UAE University, Al Ain, UAE, for their work in developing the components of the applied research work that formed the basis for the awareness and training components of the Health Authority—Abu Dhabi Safety in the Heat program and the validation of the Thermal Work Limit heat stress index.
Human Participant Protection
No protocol approval was required for this public health activity.
References
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