Tim Carter

Exposures and health effects at sea: report on the NIVA course: Maritime Occupational Medicine, Exposures and Health Effects at Sea Elsinore, Denmark, May 2014

The presentations and discussions summarised provide an overview on the current state of knowledge on a wide range of occupational health risks to which seafarers are exposed. The definition of an occupational risk for a seafarer poses problems as their ship provides both their working and their living environment and, because of its mobility, can expose them to diverse climatic and infectious risks. Knowledge about levels of exposure to potential health risks in seafarers is limited when compared to those working ashore while, because of a pattern of working that is often temporary and insecure, there is little valid long-terminformation on ill-health that can be related to risks at sea and in port. The data that do exist mainly come from developed countries, especially those in North Western Europe and extrapolation from these populations to the Asian seafarers who now crew most ships is of uncertain validity.This course, run by the NIVA Foundation and supported financially by the Nordic Council of Ministers, provided a first opportunity to draw a wide range of information and experience together to review exposure and health risks in seafarers. As a result it provided both a forum for deciding on future needs for investigation and gave those attending a range of insights that can help inform their own practices.

British merchant seafarers 1900–2010: A history of extreme risks of mortality from infectious disease

BACKGROUND This study established trends in major infectious disease mortality in British merchant shipping from 1900 to 2010 as compared with the British male working population and the Royal Navy. METHODS A population mortality study of six infectious diseases using annual government mortality returns and death inquiry files for British merchant shipping and the Royal Navy, and official mortality data for the general male working aged population. FINDINGS Relative mortality risks for each disease were increased significantly in British merchant shipping when compared with the general population; malaria by 58.2 fold, yellow fever (6276), typhoid (9.5), cholera (1734), dysentery (20.6) and smallpox (142). For all six diseases combined, relative mortality risks were 21.5 compared with the general population and 3.5 compared with the Royal Navy. Mortality trend patterns varied between diseases, but reductions in mortality in British merchant shipping consistently lagged many years behind those in both the British general population and the Royal Navy. CONCLUSIONS Merchant seamen were at far higher risk of death than probably any other occupational group of the population. Much of these excess risks came from exposure to infection in unhygienic and tropical ports, although some was a result of neglect of feasible preventative measures.

Infectious disease mortality in British merchant seamen and Lascars since 1900: From causes to controls

Trends in mortality rates from infectious disease in seamen employed in British merchant shipping have been compared with those in the Royal Navy and with the onshore male working-age British population. Merchant seamen, and in particular those recruited from Asia (Lascars), had higher mortality rates than men in the navy and in the population ashore. Mortality declined progressively between 1900 and 1960, thereafter it was negligible; the decline was slowest for merchant seamen. The reasons for the high mortality from infectious diseases in merchant seamen are investigated. Some preventative measures, such as vaccination for smallpox, were not universal in merchant seamen. Improvements prior to the 1940s can be attributed to reduced infection risks in foreign ports; improvements in food, accommodation and hygiene standards, and better control of arthropod vectors in port and on board. The rapid subsequent decline can be attributed to the introduction of antibacterial medications and antibiotics.

Mortality from accidents, disease, suicide and homicide in the British fishing industry from 1900 to 2010

BACKGROUND To establish the causes of mortality in the British fishing industry from 1900 up to 2010, to investigate long term trends in mortality and to identify causal factors in the mortality patterns and rates. MATERIALS AND METHODS A longitudinal study, based on examinations of official death inquiry files, marine accident investigation files and reports, death registers and annual death returns. RESULTS Mortality rates from accidents while working at sea remain high in the British fishing industry. Over the twentieth century there has been a progressive fall in the numbers of deaths, much of this relates to changes in fishing methods and in the types of vessels used. However in recent years, and with a fleet of smaller vessels, the mortality rates from accidents have shown little change and a larger proportion of deaths than in the past have arisen from personal injuries and drowning as compared to vessel losses. Disease makes a relatively small contribution to mortality at sea and this has dwindled with the decline in distant water fishing. Suicide and homicide both feature in a small way, but rates cannot readily be compared with those ashore. CONCLUSIONS The pattern of change in vessels, fisheries and fishing techniques over the study period are complex. However, improved injury and drowning prevention is the most important way to reduce deaths, coupled with attention to vessel stability and maintenance. The social, economic and organisational features of the fishing industry mean that securing improvements in these areas is a major challenge.