Santos Brizuela spent more than two decades laboring outdoors, persisting despite a bout of heatstroke while cutting sugarcane in Mexico and chronic laryngitis from repeated exposure to the hot sun while on various other jobs.

But last summer, while on a construction crew in Las Vegas, he reached his breaking point. Exposure to the sun made his head ache immediately. He lost much of his appetite.

Now at a maintenance job, Brizuela, 47, is able to take breaks. There are flyers on the walls with best practices for staying healthy — protections he had not been afforded before.

“Sometimes as a worker you ask your employer for protection or for health and safety related needs, and they don’t listen or follow,” he said in Spanish through an interpreter.

A historic heat wave that began blasting the Southwest and other parts of the country this summer is shining a spotlight on one of the harshest, yet least-addressed effects of U.S. climate change: the rising deaths and injuries of people who work in extreme heat, whether inside warehouses and kitchens or outside under the blazing sun. Many of them are migrants in low-wage jobs.

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