Abstract
Background: Occupational heat stress mediated acute kidney injury (AKI) has been linked to the development of chronic kidney disease of non‑traditional causes (CKDnt) in agriculture workers. Rest–shade–hydration–sanitation (RSH‑S) programs are promising interventions for preventing CKDnt. An obstacle to the implementation of RSH‑S programs is the concern that the reduced work time associated with these programs may reduce productivity and earnings.
Objective: This study analyzes the economic impact of an RSH‑S program implemented at a sugar mill in Nicaragua.
Approach: Data were obtained from the sugar mill over a six‑year, five‑harvest period (Harvest 1: 2017–2018 through Harvest 5: 2021–2022). Data included health and productivity metrics and RSH‑S program costs. During Harvest 1, existing heat mitigation strategies were in place but were not optimal. Thus, 2017 was considered the pre‑RSH‑S (baseline) period. Over subsequent harvests, progressively improved RSH‑S programs were implemented. A cost‑benefit analysis was conducted to estimate the return on investment of the RSH‑S program. The analysis considered both fixed and variable costs associated with the program. Benefits were calculated based on productivity improvements and reductions in AKI cases.
Findings: As soon as 2020, the costs of implementing the RSH‑S program were offset by savings resulting from increased productivity and reduced cases of AKI. The RSH‑S program yielded a positive return on investment from 2020 and onward. The average return on investment over the five‑year period was 0.02 (or a return of $1.02 for every $1.00 invested), which takes into consideration the first two years of the intervention in which there was a negative return on investment. In 2022, every $1.00 invested in the RSH‑S program saw a return of $1.60.
Conclusions: Implementing an RSH‑S program can provide both economic and health benefits, particularly in locations where climate change is increasing the already present risk and burden of occupational heat stress.