Do medical examinations fit into the general

seafarer health risk management structure?

Henrik L Hansen

The Norwegian Sea Health Conference 2014 Medical examination of seafarers - towards international consensus?

Session 7: Medical examinations and their relevance

Medical intervention in the maritime sector:

What are the goals and for who?

Interests:

Business:

• Avoid interruption of business due to poor health of seafarers

and fishermen (evacuations, deviations)

• Avoid unnecessary losses due to diseases among the crew

(repatriations, direct medical costs).

• Avoid loss of qualified personnel due to health problems or

potential health problems.

The seafarers and fishermen:

• Stay healthy –and stay in business.

The effects of pre-employment

health examinations

First pre-employment health examination: - Important diagnoses:

Statutory examinations:

• Epilepsy

• Diabetes

• Psychiatric diseases

• Drug abuse

Examinations focusing on liability (PEME schemes):

• Hepatitis B

• Abnormal liver function

The effects of pre-employment health

examinations

Pre-employment health examination of the mid-aged seafarer:

Life-style related morbidity and diseases:

• Hypertension

• Cardiovascular diseases (heart attacks,

arrhythmias, stroke)

• Diabetes Type 2

• Overweight and obesity

• Alcohol overuse or abuse

• Gallbladder diseases

Other diseases and conditions

• Kidney diseases

• Hepatitis B

Pre-Employment Medical Examination (PEME) schemes

“The aim of the programme is to reduce the volume and value of crew illness claims which are caused by pre-existing disease or disorders”.

The effect of expanded schemes focusing

on selection

…Since it began, the scheme’s rejection rate has dropped from 12% to just 3%”.

Source: Press Release, 10/04/2014

Does the health examination focus on areas that

are really important?

Smoking is estimated to increase the risk —

- For coronary heart disease by 2 to 4 times

- For stroke by 2 to 4 times

- Quitting smoking cuts cardiovascular risks. Just 1 year after quitting smoking, your risk for a heart attack drops sharply.

- Within 2 to 5 years after quitting smoking, your risk for stroke could fall to about the same as a nonsmoker’s.

The effects of health examinations

Increasing health problems with age - Some are forced to leave the business

Health problems may increase the number of seafarers voluntary leaving the business (self-selection)

Direct effect

Indirect effect age

Highly qualified seafarers and fishermen are lost from

the business:

- is it a problem?

Recruitment of seafarers in Liberia

Recruitment of seafarers in Manila

The basic changes in recent decades

• Ships demand increasingly skilled seafarers

• Increasing skills requires investment in education.

• Increasing costs in educating seafarers.

• Long-time employment supports quality shipping.

The shipping industry is used to long term investments in ships… Crews may also last 30 years in service!

Where do we want to go?

• The long term goal:

- a stable and healthy workforce

Is it possible to stay healthy while you

are an active seafarer or fisherman?

60 year old males

With physical limitations

Without physical limitations

The challenges of today - Focus on improvement on health status in general

What are the main health challenges among experienced seafarers today?

Lifestyle related diseases – cardiovascular disease, cancer,

diabetes and many others

• Sedentary lifestyle with insufficient physical activity.

• Smoking.

• Overweight and inappropriate nutrition.

- Diabetes

Lifestyle related diseases in

an international setting

The Philippines is one of the world’s emerging diabetes hotspots. Ranked in the top 15 in the world for diabetes prevalence, Philippines is home to more than 4 million people diagnosed with the disease

Diabetes is growing alarmingly in India, home to more than 65,1 million people with the disease, compared to 50.8 million in 2010.

The Philippines

India

Ref.: The International Diabetes Federation (IDF)

Can selection actually ensure healthy

seafarers? –an example

33,0 %

15,4 %

0

5

10

15

20

25

30

35

Seafarers

Ashore

Overweight among Danish seafarers

Officers, 45 – 64 years of age

Proportion with a BMI on 30 or above

Officers, 45 – 64 years of age, BMI on 35 or above: 9.8%

- Send 10% of the senior officers ashore overnight?

Present status

We establish more and more sophisticated screening procedures because we want to avoid active seafarers getting sick while employed. We find some, who actually will be sick (true positive in the screening process) - But the majority will, despite positive screening markers, not be sick (false positive)

RESULT: Many highly qualified seafarers and fishermen are lost from the business

Can you actually change things and make a

difference?

Yes!

1970’ties Music and beer on board

EXOON VALDEZ 1989 Drug and Alcohol Policy

Can you actually change things and make a

difference?

•

Yes!

2014: Designated smoking rooms on board… - and fewer smokers.

Smoking cessation and elimination of passive smoking on board are realistic goals already achieved in many ships…

Lack of physical activity is a

high risk situation on board

• Physical inactivity unhealthy food will be the next challenges to overcome

Can the pre-employment health examinations

improve the health of seafarers?

Conclusions:

• General health checks did not reduce morbidity or

mortality, neither overall nor for cardiovascular or

cancer causes.

• The number of new diagnoses increased.

• General health checks are unlikely to be beneficial.

Can the examinations improve the health

of seafarers if they are used as a general

health check?

The COCHRANE COLLABORATION

Pre-employment health

examinations may have side effects

• Creating a potential for harm from unnecessary testing which does not provide useful information.

• “Diagnosis” and treatment of diseases or conditions which should not be treated or treated in another way.

Where do we want to go?

- what are the options?

Present status

Focus on selection processes attempting to find those at highest risk of developing life-style related disease

Tomorrow

Investments in the health of seafarers and fishermen.

- Screening is simply not the right tool to lift the mean health status of a group

Conclusions Present status - Pre-employment health examinations are a

part of the business and have come to stay.

- Statutory health examinations, especially the first one, will ensure the basic safety needs of the industry.

The future - Healthy seafarers will be increasingly

important to ensure safe shipping.

- Focus needs to move from selection towards creation of healthy seafarers by health promotion and the industry must create the necessary framework to support this.