Sapan News is republishing this piece, with permission, as a public service initiative in the interest of making such views more accessible and promoting cross-border understanding. See the Press Statement: Access is not a threat: A call to lift reciprocal news bans in India and Pakistan. The article below first appeared in The Asia Democracy Chronicles, India and was shared by the Sri Lankan activist Nalini Rathnarajah who moderated a discussion on labour rights for the Southasia Peace Action Network in May for Labour History Month Please credit the original publication and Sapan News when sharing or republishing.
Article below republished from the Asia Democracy Chronicles
Labor’s kidney connection
Experts say that recent labor code changes in India are failing to adequately protect workers or deliver enforceable heat protections that could help them prevent developing chronic kidney disease.
By Kanika Gupta
He often felt pain in his legs and numbness in his toes, along with frequent cramps. But Muniyandi, 52, from Villipakam village in the south Indian state of Tamil Nadu, dismissed all these at first as part of working for years in the salt pans.
Whenever the pain became unbearable, he would simply visit a private clinic in the evening, after a long, hard day of labor. There, he would be given injections and painkillers. “For the time being,” narrates Muniyandi, who uses a mononym, “there wouldn’t be any pain.” He would then return to work the next day.
This cycle continued until he was eventually diagnosed with chronic kidney disease (CKD), a long-term, progressive loss of kidney function over three months or more, preventing these organs from filtering waste and excess fluid from the blood. Doctors told Muniyandi that the disease was incurable and that he would need medication and regular follow-ups for life.
Unfortunately, tens of millions of others in India are also living with CKD. To be exact, the country had 138 million adults living with the disease in 2023, a number second only to that of China at the time, according to a Lancet study. A study published in January 2025 meanwhile estimated the CKD prevalence rate in India as 13.24 percent.
Dr. Vidhya Venugopal, Professor of Occupational and Environmental Health at the Sri Ramachandra Institute of Higher Education and Research in Chennai, says that India’s large number of CKD cases is due to a combination of environmental and lifestyle factors.
Among the key drivers in the phenomenon of “more and more people … developing CKD” are rising temperatures, poor water quality, and dietary shifts, she says. A major concern, she adds, is dehydration among outdoor workers exposed to prolonged heat.
“When you’re working outdoors in high temperatures, dehydration becomes a big issue,” says Venugopal, explaining that repeated heat stress places sustained strain on the body over time. But she emphasizes that the risk is not confined to outdoor labor like those in salt farms, brick kilns, construction, agriculture, and street vending. It is present as well in indoor work, such as that in steel, leather, and car manufacturing, as well as in food preparation. Even nurses in primary health centers are exposed to intense heat.
Venugopal says that her team has studied heat exposure across “about 35 occupations.” Anybody who is exposed to heat faces physiological stress, she says. This has worried some health experts who note that temperatures are getting higher and higher because of climate change. India’s CKD crisis, however, runs deeper than rising temperatures alone.
Senthil Babu, a mathematics historian at the French Institute of Pondicherry who has worked extensively on labor issues, argues that the problem cannot be framed as purely environmental. He asserts: “In India, most environmental issues that are projected only as environmental issues are actually issues of labor and livelihood.”
Lacking enforceable specifics
India’s Occupational Safety, Health, and Working Conditions Code is meant to set standards on work hours, safety, and welfare facilities. The central government has also implemented four comprehensive Labor Codes, effective Nov. 21, 2025, consolidating 29 central labor laws to streamline compliance, enhance worker welfare, and boost ease of doing business. These codes cover wages, social security, industrial relations, and safety, affecting both organized and unorganized sectors.
Legal and labor experts, however, point out that the new reforms fall short of adequate worker protection. As for the Occupational Safety, Health, and Working Conditions Code, it does not spell out concrete minimum standards for rest breaks, hydration facilities, shade, toilets, and heat-exposure limits. Instead, these specifics are supposed to come later via notifications and draft rules, which critics worry may be slower, inconsistent across states, and less enforceable.
Such gaps in the law have raised wider concerns about workplace safety for millions of outdoor and indoor laborers exposed to extreme heat. Without clear, enforceable safeguards, these workers are at risk of dehydration and heat stress, both of which are increasingly being linked to chronic kidney disease.
Indeed, the issue many times is as much about workplace infrastructure as rising temperatures, says Venugopal.
Many workers, especially women, limit their water intake because toilets are either unavailable or far from worksites, she points out. “They would have tea or something and little water,” says Venugopal. “If they drink more, they have to go to the bathroom and the bathroom is not where they are working.”
In several sectors, workers must use paid or distant public toilets. As a result, they avoid drinking water altogether. In the Andhra Pradesh cashew-processing factory where Dilamma, 60, works, there are no toilets. Women step out to nearby fields when they need to relieve themselves. There is no structured rest break, though workers pause for five or 10 minutes whenever they can.
“We manage,” she says, having grown used to the conditions through the years. She earns INR 400 ($4.28) a day separating the good nuts from the bad. Widowed long ago, she is the sole earning member of her family. She leaves home at 9 a.m. and returns only by 7 p.m., spending most of the day seated over heaps of cashews.
Many in her village have complained of kidney problems, but Dilamma has never been screened.
“I never felt the need because I don’t have any symptoms,” she says. Told that kidney disease often shows no signs until significant damage has already occurred; she shakes her head. Still, she now says she is waiting to be screened for the sake of her health. She already lives with high blood pressure and diabetes and is on medication for both, but work, she says, has always come first.
Shortened life spans?
Arguably, though, those in the informal sector have it worse, with many of the workplaces lacking formal registration and workers not having fixed employment terms – which often means not only arbitrary wages, but also a stark lack of safeguards, despite the recent labor code reforms.
In and around Tamil Nadu, for instance, are an estimated 50,000 salt workers. The harvest season coincides with hot and humid weather. Workers like Muniyandi spend long hours turning and harvesting salt manually under intense sunlight. The glare reflecting off white salt, sand, and shallow water surfaces, makes ultraviolet exposure exceptionally high.
Arularasan G., a volunteer who works with Babu and documents labor conditions in the salt pans, says that the intensity of the heat is difficult to grasp without experiencing it firsthand.
“When I first stepped into the salt pans in Thoothukudi, I couldn’t stand there for even two or three minutes,” he says. “But they stand on that surface and work until two or three in the afternoon.”
Babu says that the “average age at which you start working in the salt pan is around 15 to 18.” From then on, he says, a salt pan worker faces constant exposure to direct sunlight for almost nine to 10 months of the year.
The consequences are visible in the health profiles of workers. Says Babu: “If you start working around the age of 15, then by the time you are 40 or 45, you are on dialysis.” With limited access to sustained treatment, survival can be short. “You have a maximum of three to five years at the most to live,” Babu says.
The limited access to healthcare can be traced largely to the debate over whether or not salt-pan work is industrial labor. Activists and researchers argue that it is; employers usually describe it as seasonal because production stops during the monsoon. The distinction affects wage protection and access to benefits. “They say because it is only nine months of the year at the most, how can it be factory work?” Babu says, referring to employers.
Umanath, a trade union leader who works closely with salt-pan workers, says that how companies classify workers is among the recurring disputes in the labor sector. “The company is directly employing the workers,” he says. “There is no other way. But they claim these are contractual workers, that some manpower agency is supplying them.”
Two years ago, he says, a government inspection found that companies were indeed directly employing workers despite their claiming otherwise. Their licenses were cancelled, fines were imposed, and they were directed to recognize the workers as permanent employees.
Gathering evidence
When it comes to CKD among salt workers, however, the fight is more complicated, says Umanath, who like Muniyandi uses a single name.
“Many workers in the salt pans are suffering from CKD,” he says. “But it is only through hearsay. There are no proper records.”
Without documented medical evidence linking the illness to their work, workers have little standing in labor courts. “Right now,” says Umanath, “we are not able to fight because there is no proof that what they are facing is because of their profession.”
To change that, the union is planning large-scale screening camps and medical drives. If they can gather medical certificates and documented evidence, Umanath says, they are prepared to push for compensation and legal relief.
“Once that link is established,” he says, “we can fight.”
Forced-labor investigator Rejimon Kuttappan, for his part, says that heat-related problems and poor sanitation disproportionately affect female workers. Yet he notes that the codes “don’t explicitly treat indoor heat as a hazard or mandate gender-specific facilities,” leaving vulnerabilities unchecked in under-regulated spaces.
More broadly, he believes “the codes seem to favor employer flexibility over strong safeguards,” at a time when informal work is expanding.
Venugopal clarifies that local governments are taking steps to address the gaps in labor laws and policies.
“It’s not that they’re doing nothing,” she says. In her view, however, many of the measures are not implemented in ways that make protection routine or practical. For example, she says that instead of initiatives like air-conditioned rest centers, simple, enforceable safeguards built into daily work may be better.
“Every worker should be mandated to take a short rest every hour,” she says, as well as have access to clean drinking water and scheduled breaks — small protective mechanisms that require little infrastructure but make a difference.
Ultimately, says Venugopal, effective heat protection – which can help in CKD prevention – comes down to “water, rest, and shade.”
Kanika Gupta is a journalist and documentary filmmaker from New Delhi. She reports on human rights, conflict, gender, and climate from Southasia and the Middle East.
Lead Image : Image of Kanika Gupta’s article in Asia Democracy Chronicles
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