Vulnerable to heat stress: gaps in international standard metric thresholds.

Exposure time to heat is increasing with climate change. Heat exposure thresholds are important to inform heat early warning systems, and legislation and guidance for safety in the workplace. It has already been stated that thresholds can be lower for vulnerable groups, including the elderly, pregnant women, children, and those with pre-existing medical conditions due to their reduced ability to thermoregulate their temperature or apply cooling strategies. However, the Wet Bulb Globe Temperature (WBGT) proposed by the international standard organisation (ISO 7243:2017), only takes into account thresholds based on acclimatization status. Therefore in this study we carried out a PRISMA systematic keyword search of "Wet Bulb Globe Temperature" of the Scopus abstract and citation database in August 2023 and a meta-analysis of text extracted from the identified 913 international studies published between December 1957 and July 2023, to investigate heat stress thresholds for different population groups. We find that different thresholds are considered as an indication of heat stress for different population groups. However, critical gaps were identified for the most vulnerable populations, and there are lower numbers of studies on women. Most studies researched adult populations between the ages of 18 and 55 (n = 491), failing to include the youngest and oldest members of society. Based on these findings, we call for targeted investigations to inform effective heat action policies and set early warning thresholds to ensure the safety and wellbeing of the entire population.