Carter, Tim

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www.intmarhealth.pl 209Int Marit Health2011; 62, 4: 209www.intmarhealth.plCopyright © 2011 Via MedicaISSN 1641–9251ORIG INAL  PAPER Tim Carter, Norwegian Centre for Maritime Medicine, Department of Occupational Medicine, Haukeland University Hospital, JonasLies vei 65, PO Box 1, 5021 Bergen,Norway; e-mail: Tim.carter@mcga.gov.ukMapping the knowledge base for maritime health:introductionTim CarterNorwegian Centre for Maritime Medicine, University of Bergen, NorwayPriorities for improving maritime health, and hence theallocation of resources to them, should depend on esti-mates of the frequency and severity of health risks andon estimates of the effectiveness of the available inter-ventions in reducing the impact of illness and injury. Theyneed to address two questions: ‘what matters?’ (the risks)and ‘what works? (the interventions). Much current mari-time health practice is based upon estimates of risks andeffectiveness that are of limited validity because goodquality evidence has not been collected and analysed. Thepurpose of this series of articles is to review the currentstate of knowledge on the scale of risks and on the effec-tiveness of interventions. The feasibility of improving theknowledge base and the practicability of analysing theavailable evidence and presenting it in ways that makesthe case for more rational resource allocation to improvemaritime health is discussed.This four-part review is structured to first examine thehistorical development of knowledge about maritime healthrisks and interventions, using the UK as a case study. Thisis relevant because of the early development of the UKmerchant fleet, and the early growth in concern about thehealth of seafarers there. A national approach may alsochallenge historians from other maritime nations to under-take and publish comparable analyses. This analysis alsoprovides the basis for proposing a framework for present-ing the various types of evidence about disease, the set-tings where it may be collected, and how it has been used.The presentation and discussion of this framework is thesubject of the second article. The framework will form thebasis for the two following articles. One reviews evidenceabout illness in seafarers and how this may be used to aidprevention and risk management. The other will look atthe available knowledge about the relationship betweenhealth related impairment and maritime incidents and ac-cidents. Analysis will concentrate on the crews of merchantvessels and is largely based on English language articles– again a challenge to others to supplement the knowl-edge base from other sources whenever possible.The impetus for preparing these articles came from theauthor’s concerns in recent years that much of the advicegiven on the health of seafarers lacked a valid foundationof evidence and that much of the ‘knowledge base’ waslittle more than a summation of the experiences of mari-time health practitioners, to which he was adding yet moreunsupported items! In addition, representatives of the WorldHealth Organisation upset many maritime health practitio-ners by saying that there was insufficient valid data to pre-pare an evidence based list of medications and the quanti-ties required for use at sea, a view that, while unpopularwith those in maritime health, was essentially correct.Two further contributions were, first, a period spentdoing a postgraduate course in maritime history, where theinterplay of interest groups concerned about the health ofseafarers was one of his chosen topics for study. Their be-haviour a century ago and now is remarkably consistent,even if the topics at issue and the available technologies tomanage them have changed! Second, a publication fromthe remote medicine and repatriation company ‘Interna-tional SOS’ showed how an easily understood and compel-ling case for corporate action to reduce risks could be madesimply by analysing the clinical information they held interms of the frequency, severity, and cost of the cases theyhandled at different locations in the world [1]. This led himto question why maritime health practitioners could not dothe same. The answer was that this important and poten-tially empowering information was one of the weakest as-pects of the maritime health knowledge base, and one thatcried out for remedy.REFERENCESExecutive Report: International SOS case trends in the energy,mining, and infrastructure sectors. 2009, International SOS, Lon-don 2008.

Mapping the knowledge base for maritime health: introduction

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Mapping the knowledge base for maritime health: introduction

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