The Seafarers Hospital Society (SHS) and Yale University published a report called “Seafarer Health: Research to Date and Current Practices”. The report assesses interventions that were most effective while being low cost and minimally disruptive.
This Maritime Worker Health research project incorporates a review of the published literature on seafarer health and wellbeing, including recommendations to improve health and wellbeing among this population, practices implemented by the industry, as well barriers to full implementation.
In fact, the report has been established as the base upon which a discussion paper on seafarers wellbeing by the Seafarers Hospital Society has been published.
Various stressors were documented that are a result of organizational philosophy and conduct. It has been reported that seafarers engage in dangerous work practices and that they lack adequate training and are ignorant of rules and instructions.
At least in part due to current crewing levels, seafarers experience poor sleep quality as well as sleep deprivation. It was noted that there is a lack of rest periods and relaxation on board ships as well as absence of social activities. Poor safety climates and poor safety cultures have been reported as well as an uncaring work environment.
With the globalization of the shipping industry, multicultural crewing has increased. It was noted back in 2002 that 65% of the world’s merchant fleet was staffed with multinational crews. Without minimizing the positives of having multinational, multiethnic, and multicultural crews, they bring with them their own set of cultural stressors.
Living and working with people that have differing cultural norms and beliefs, tied to the hierarchical structure of most ships, can lead to a sense of isolation among seafarers. A multilingual crew can add to this cultural stressor.
Additionally, it takes time to acclimate to a multicultural environment and during this time seafarers may experience acculturative stress. Comparing the percent of ratings and the percent of officers by nationality reveals a disparity whereby European seafarers are more likely to hold officer positions.
This discrepancy can result in stress for the underrepresented seafarers. Lastly, diverse ethnic groups can pose potential for conflict.
Various physical stressors have been recorded in the published literature. Seafarers face harsh working conditions on board. They must contend with the stresses caused by ship noise, vibration, and motion.
Additionally, they work in areas of high temperature and humidity. All of these physical stressors are not only present while they work, but while they are awake off-duty as well as their sleep periods.
It has been reported that there is a lack of physical activity among seafarers which is not good for their health and wellbeing. Lastly, among all seafarers, but especially among maritime pilots, the physical demands associated with boarding and departing vessels is another stressor.
The literature identifies many psychosocial stressors among the seafaring population. Seafarers live and work on board a ship with a limited number of other people.
They have noted that they worry about ship safety as well as the families that they left at home. Published literature has noted their poor quality of life undoubtedly, at least in part, due to their feelings of loneliness and boredom as they live in relative social isolation.
There is a reported high prevalence of seafarers being overweight or obese. These conditions are associated with other wellbeing issues that have been identified from the literature that are physical in nature including high blood pressure, high cholesterol levels, metabolic syndrome, and cardiovascular disease. Peptic ulcers and gastritis have also been noted in the literature.
Joint and back pain have been reported, particularly among female seafarers. Rheumatological conditions as a result of accidents and other external causes have also been noted.
Seafarers have a high prevalence of communicable diseases which is not surprising given that they live and work in close proximity to each other. The physical wellbeing issue that is likely the most prevalent and discussed the most in the literature is fatigue.
Seafarers report having poor quality of sleep and sleepiness.
Seafarers suffer from all the classic psychosocial wellbeing issues. There are reported high levels of anxiety and depression among this workforce. The literature notes that seafarers experience burnout as well as other general psychiatric disorders.
And of great impact to the industry is the high rate of suicide which is likely underreported.
#3 Personal / Lifestyle
The literature identifies many personal or lifestyle wellbeing issues among the seafaring population. Published articles have described substantial rates of smoking, alcohol abuse and drug abuse among this population.
It has been reported that approximately 30% of seafarers smoke tobacco, though others have reported up to 63.1%.
Consumption of alcohol among seafarers has been estimated as low as 14.5% to 53.0%. One study found that cannabis was used by 3.4% of seafarers and that drug use was between 3 and 10%.
All of these issues can not only have health impacts, but can also affect the ability of seafarers to perform the work safely. Unhealthy eating habits including poor dietary intake and malnutrition have also been noted in the published literature.
Lastly, there is a reported reluctance among seafarers to obtain professional help for mental health issues. This may also be tied to organizational structures that may lead to alienation of the seafarer for seeking and/or receiving such services.
The published literature repeatedly recommended that shipping companies encourage regular physical activity. The promotion of sporting activities was recommended for seafarers while they are on board the ship and when they are at home.
The creation of an exercise center as an area in which seafarers could work out was also suggested.
A non-specific recommendation was to focus on methods to prevent musculoskeletal disorders as these not only have short term implications but and lead to long term issues, including incapacitation for the seafarer to work.
It was also recommended that maritime companies prioritize the replacement of safety shoes based upon the condition of the outsole to reduce injuries due to slipping.
#2 Psychological Health
There were several recommendations with regard to maintaining the psychological wellbeing of seafarers. Some of these were relatively nonspecific which would make them more difficult to operationalize.
These included the recommendation to improve the work environment and the quality of life on board. One specific recommendation was to introduce anti-bullying and antiharassment policies.
The provision of mental health education and the creation, or strengthening, of prevention programs for psychological wellbeing were suggested. It was recommended that shipping companies provide professional counseling to resolve seafarer psychological difficulties.
It was thought that seafarers should be provided training in coping methods for interpersonal contact/conflict to increase psychological wellbeing. One published article suggested the use of social media to disseminate health information to, and promote wellbeing of, seafarers.
#3 Personal / Lifestyle
As with the psychological recommendations, the personal / lifestyle recommendations also included some relatively nonspecific items. These included the recommendations to promote health and to reduce addiction, both worthy goals but without specifics.
Other recommendations in this category were to reduce smoking, to reduce alcohol use, and to create interventions to reduce body mass index (BMI).
A bit more specific were the suggestions to run anti-smoking and anti-alcohol campaigns among seafarers. It was recommended that health promoting conditions on board be optimized with regard to behavior patterns including focusing on a balanced healthy diet and motivating seafarers to exercise.
It was also suggested that the promotion of a diet containing less fat, sugar, and salt could be assisted through the incorporation of dietary assessment methods that perform menu analysis with new technologies such as a mobile based platform.
Another recommendation was that shipping companies promote sleep hygiene, that is, minimize negative external stimuli. One other personal / lifestyle recommendation was that shipping companies advise seafarers on reducing exposure to UV-light.
It should be noted that overexposure to ultraviolet radiation is associated with increased risk of skin cancer, premature aging and other skin damage, cataracts, and immune system suppression.
It was recommended that shipping companies ensure all seafarers on board have a high level of fluency in the working language of the vessel. Furthermore, it was suggested that the companies have a system in place to ensure, and if necessary, improve, superiors’ communication and leadership skills.
The inclusion of a telecommunication system on board ships was recommended. As the purpose of this investment would be to allow seafarers to communicate with their families back home, it was also suggested that shipping companies support the home-based needs of the seafarer family for this type of communication.
The literature recommended improving the medical services available to seafarers. More optimized medical treatment procedures on board are required. The use of telemedicine to access healthcare professionals, including physicians, is recommended as is improved access to land-based medical facilities.
Telepsychiatry should be included within the telemedicine realm. It was also suggested that seafarers be provided access to health information while on board the ship.
This could be provided through printed materials that are kept on board or, more desirably, through the internet. In any case, it is stressed that this information would need to be kept confidential to protect the seafarer’s privacy.
The overarching recommendation is that a culture of care needs to be developed within the maritime industry. As part of this paradigm shift to a more caring setting, the work environment and the quality of life on board need to be improved.
It was recommended that sympathetic management and intercultural leadership need to be put in place. This culture should include policies to encourage seafarers to obey safety rules and instructions and to be able to speak up without fear if they have concerns.
There were two overarching topics regarding recommendations to reduce fatigue among seafarers. The first of these was to increase effective sleep. More specific recommendations included extending sleeping hours, promoting sleep hygiene, the creation of periods for unbroken sleep and rest.
The use of Limited Wake Shift Work (LWSW) schedules was also recommended. LWSW schedules redistribute time-at-work into smaller aliquots that are spaced equally across the 24-hour period.
One working definition of LWSW schedules are that they are fixed shift work schedules that occur for two or more consecutive days where individuals work for periods not exceeding 8 hours on rosters that allow for an average of more than one sleep period per day.