When heat protection becomes an economic risk for workers

As global temperatures continue to rise, vulnerable groups face disproportionate health risks. One risk is poorer kidney health. 

Among those at risk of heat-related kidney injury, outdoor workers are especially exposed because they experience prolonged or repeated heat exposure.¹ Around nine in ten workers in India are employed in the informal sector, while agriculture employs nearly half of the country’s workforce and accounts for about 16% of GDP.^2,3 Agricultural workers are particularly vulnerable to heat stress and dehydration because of physically demanding outdoor labour.⁴ For these workers, heat is much more than an environmental concern; it is a hidden occupational hazard compounded by socioeconomic circumstances. 

It also has economic consequences. According to a report from the International Institute for Environment and Development, chronic kidney disease (CKD) may lead to around 4.5bn lost workdays every year in India, translating to almost $23bn in lost wages and $78bn in total from reduced ability to work caused by heat-related kidney problems.⁵ This is particularly concerning because India is already seeing a rise in CKD, a disease with many causes, with age-standardised prevalence increasing by 5.6% between 1990 and 2017, reaching about 9.5% in 2017.^6,7

When basic protections become unaffordable

Limited access to safe water and adequate sanitation among agricultural workers in India can contribute to poor kidney health. When toilets and restrooms are inadequate, workers may deliberately restrict fluid intake as a coping strategy, increasing dehydration risk.⁸ These kidney conditions—often silent and invisible—gradually compromise health; one study in western India reports diagnoses at nearly three-quarters presented at stages 4 or 5, when kidney damage likely becomes irreversible.⁹ If working conditions are poor, this can leave workers with little protection against the heat’s kidney effects. Without adequate safeguards, the toll on workers could be substantial.

Financial pressures worsen these risks. Piece-rate pay is a common arrangement for hired agricultural field workers, with payment based on the amount of work completed, such as the volume or weight harvested.¹⁰ These arrangements incentivise maximum productivity and limit breaks for water, restroom use and rest. Lost time means lost wages, leaving workers to trade off health against income.¹¹ Workers may avoid medical care because treatment is costly and can mean lost earnings.^12,13 As Dr Vidhya Venugopal, Professor and Country Director, NIHR Global Health Research Centre at Sri Ramachandra Institute of Higher Education and Research, notes, “Financial pressure often overrides the body's own warning signs.” These workers are now locked into a cycle of heat exposure, increased risk to kidney health and delayed care, financial pressure from lost income, and deepening inequalities.

Protection beyond the heat alert

Breaking this cycle requires more than treating kidney disease after it emerges; it requires protecting workers before heat exposure becomes a health and economic problem. India’s Ministry of Labour released a heat advisory statement in early 2026 calling for worker protection.¹⁴ But Dr Venugopal argues that such alerts should be only the starting point. “A heat alert shouldn't just tell people it's hot; it should trigger concrete steps that protect workers in real time.” She notes that India's Heat Action Plans and labour advisories have made important progress, but that the next challenge is reaching informal agricultural workers, who often fall outside workplace-based protections. Gaps remain in translating heat alerts and advisories into occupational action, including access to water, cooler working hours, shaded rest breaks, and adequate restroom facilities.

When workers cannot afford to rest

As heatwaves increase in frequency, the risk of heat stress is going to be felt.¹⁵ Considering India’s geographical location and demographic workforce, the rise of heatwaves is especially alarming, as more informal agricultural workers may be at risk of acute and chronic kidney disease. These workers are forced to choose between protecting their health and their economic security. Stakeholders must take shared accountability to develop solutions that, as Dr Venugopal puts it, "are practical, scalable and built around the realities of informal agricultural work.” These workers cannot afford to rest, so their kidneys may pay the price.

From pockets of progress to coordinated protection

Some local efforts offer signs of progress. In Tamil Nadu, a construction workers’ union (Tamizhaga Kattida Thozhilalargal Mathiya Sangam) successfully pushed for heat protections, including limits on outdoor working hours.¹⁶ Also, Watershed Organisation Trust, a nonprofit delivering localised heat-health advisories, specifically targets farmers in rural Maharashtra.¹⁷ Together, these successes point to what is needed: stronger enforcement of heat protections and targeted outreach to rural workers.

Moving forward means not moving in isolation. Dr Venugopal emphasises that a coordinated multisector and multilevel approach is necessary for translating policy into action. “Success shouldn't be measured just by how many water stations or shade structures get built, but must be judged by real health outcomes,” she argues. She would like to see heat-specific provisions built into labour regulations and employer guidance, and heat protection integrated into existing agricultural and rural programmes.  She would also like to see a stronger role for local bodies (such as panchayats), farmer and worker collectives and civil society organisations. Ultimately, heat protection will only work when workers no longer have to choose between their health and their livelihoods.