Carter, Tim

English

Via Medica Journals

www.intmarhealth.pl 245Int Marit Health2011; 62, 4: 245–246www.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 Box1, 5021 Bergen, Norway; e-mail: Tim.carter@mcga.gov.ukMapping the knowledge base for maritime health:conclusionsTim CarterNorwegian Centre for Maritime Medicine, University of Bergen, NorwayA historical review of studies on seafarers’ healthover the last 150 years provided the basis for propo-sing a taxonomy for knowledge about maritime healthbased on the types of information that can be collec-ted, where it may be collected, and the uses for whichit is required. The utility of such knowledge has beenconsidered in terms of both its ability to improve thehealth of seafarers and the anticipatable responsesfrom each interest group to its application.The knowledge base on illness in seafarers, bothabout patterns of disease and about interventions toreduce harm by prevention or treatment, is limited;a few areas are well supported by evidence, but manyare not. In particular there is a sound base on thecauses of death and for cancer and arterial diseasemortality and morbidity. The relative contribution ofoccupational and lifestyle risks to the observed pat-terns of cancer and arterial disease is uncertain, butboth have been shown to be important. The sourcesof this knowledge are the traditional maritime na-tions of the developed world and there are no com-parable studies that enable comparisons to be madewith the major crewing nations of the present day.The long-term risks that have been studied areimportant in the context of a country concernedabout the health of its citizens and the effects of anoccupation such as seafaring on health and life ex-pectancy. However, the main current concerns of thecommercial maritime sector, and perhaps of some ofthe authorities in the major crewing countries whichbenefit from seafarers’ remittances, are less aboutsuch long-term risks and more about effective healthmanagement during each contract of employment.The commercial operator’s aim is to reduce the costsof their responsibilities for treatment and repatria-tion as well as the high costs in the event of opera-tional delays from diversion, evacuation, or treatmentin port; authorities may be complicit in this as theywant to maintain their position as labour suppliers.It can be argued that these economic prioritiesshould not drive scientific activity. But it needs to berecognised that the current limited knowledge baseon seafarer fitness assessment, prevention on board,the treatment of emergencies at sea, including theuse of telemedical assistance, and arrangements fortreatment ashore and repatriation has not been ef-fectively integrated to give the overview that is nee-ded to make a case for improving arrangements andspecifying needs in a way that will convince the shipoperator, the seafarer, or the national maritime regula-tor. The scope for developing an enhanced and usefulknowledge base on these topics is real; the researchquestions can readily be framed, and there are impor-tant untapped sources such as ship’s medical treat-ment records, telemedical contacts, and shore-basedclinical services, which can be studied individually andintegrated to build up information on efficient carepathways. These can be linked to and informed by in-formation from medical assessments of seafarers andinformation about working and living conditions aboard,to enable the value of improved prevention as a meansof reducing harm to be determined. Studies on longer-term risks in the major crewing countries are indeedneeded, but there is not the same local political pres-sure for them as there are few similar investigations onthe lifetime risks of work for the rest of their population.This means that their use to make comparisons of therisks of seafarers as compared with other occupationalgroups will not be possible.By contrast with the current knowledge base onillness and injury to seafarers that on the contribu-tion of health related impairment to accidents andInt Marit Health 2011; 62, 4: 209–290www.intmarhealth.pl246incidents is considerably weaker. The scope for im-proving it is limited, and there are dangers of devel-oping more sophisticated risk management methodsfor health aspects of safety in the absence of a clearlink to incidents or to events that are close surro-gates for them. The two most likely drivers for changeare either new patterns of accidents or concernsabout the discriminatory effect of safety-related healthstandards when they are not grounded in valid evi-dence of risk other than long usage. Any new inves-tigations need to review information on impairmentin the light of a clear understanding of the ways inwhich it can be expected to interact with the taskdemands of modern shipping.A final theme that is rooted both in historical pre-cedent and current practice is that maritime healthis very much in the world of politics, economics, andinterest groups who are driven by these forces ratherthan by concepts of pure science or by the profes-sional concerns of the medical investigator. Maritimehealth expertise is a utility used to solve problems ina complex sector of human activity and needs toaddress those problems that are likely to have sup-port. At the same time, one of its key contributions isto remind all the players that seafarers are humanand so have a set of inherent biological strengthsand vulnerabilities that are immutable. Working andliving conditions at sea have to be designed to takeaccount of these. There are limits to human adapta-tion, and the analysis of the knowledge base formaritime health presented here is concerned withthe small differences in individual limits within a largerframework of the largely consistent characteristicsfor the whole human race.

Mapping the knowledge base for maritime health: conclusions

https://journals.viamedica.pl/international_maritime_health/article/download/26163/20957

Mapping the knowledge base for maritime health: conclusions

Abstract

Similar works

Full text

Available Versions

Via Medica Journals