F) Human Element

F.5 Health promotion


What is health promotion?

The World Health Organization's (WHO) 2005 Bangkok Charter for Health Promotion in a Globalized World defines health promotion as ‘the process of enabling people to increase control over their health and its determinants, and thereby improve their health’. [1]

The WHO definition includes health education to improve knowledge about how people may improve their health and this has been the core of most seafarer interventions to date. However, education is only one component and other important aspects include:

  • Securing health promoting behaviour changes at either the individual level based on personal risk factors, for example, weight management or smoking cessation, or more commonly, including the whole target population, for example, exercise.
  • The development of health promoting support networks between members of the target group, but also including those they interact with. An example is seafarer peer group initiatives on health such as exercise targets and family members’ engagement in diet and exercise programmes during leave periods.
  • The provision of measures that assist the group in developing and maintaining health promoting behaviours, for example the development and training of seafarer peer group health educators, the provision of suitable food on board for those seeking to reduce calorie intake, the provision of on board exercise equipment and recreational facilities, making arrangements for sporting events when ashore.
  • The modification of environmental or working conditions to reduce risks to health, for example, avoidance of exposure to hazardous working conditions, the management of working hours to avoid fatigue.
  • Empowering participants to help them secure support networks on board and ashore, to ensure provision of exercise facilities and healthy food options when on board and to be a voice on the management of health risks from maritime working and living conditions.

Application of health promotion methods

A key feature of effective health promotion is that people participating in such activities have a feeling of personal ownership and feel that they are empowered to take action.  The need for empowerment is often given a low profile in workplace based health promotion initiatives as it can be seen as disrupting employer/employee relationships. Fear of empowerment can result in health promotion being limited to health educational initiatives.

Several techniques can be used promote health.

  • Awareness and publicity campaigns, using a range of media.
  • Personal contacts, for example during clinical consultations such as seafarer medical examinations, or as part of a health promotion initiative to explain risks or to encourage action.
  • Group interactions to help secure behaviour change and develop support networks to maintain health-promoting behaviours.

 The contribution of these techniques to each of the components of health promotion as listed above has been analysed based on experience ashore.[2] [3]

In practice, health promotion initiatives have often been framed in terms of the control of a specific risk to health in a target population. The focus may either be on the control of one particular risk factor, such as diet or smoking, or on one particular disease, such as arterial disease or cancer. In the shorter term, similar approaches may be used to improve food hygiene or to prevent transmission of an infectious disease. However, there is now a growing recognition that interventions that integrate all aspects of the health of the target group and which aim to develop a healthy overall lifestyle, rather than to prevent a specific condition, may be more acceptable and effective.[4] They may also make a more positive contribution to a person’s sense of wellbeing.


Maritime health promotion

One of the greatest challenges has been how to deliver interventions to a mobile and often isolated group who spend a part of each year at sea, in port and at home on leave.[5]  Most initiatives have focused on awareness and education, few have sought to change behaviour patterns or to improve the opportunities for maintaining and improving health on board or ashore.[6] [7] To date, such initiatives have not taken advantage of onshore experience in health promotion, where there is now a good evidence base.

Three questions need addressing when developing a strategy on health promotion for seafarers.

  • What matters? Risks to seafarer health, their frequency, severity, variability and timeline.
  • What works? Available forms of intervention, their relevance, deliverability, effectiveness and timeline.
  • Who cares? Aspirations of seafarers for better health and wellbeing, the importance attached to better seafarer health by those able to support maritime health promotion interventions.

These questions need to be considered from different perspectives:

  • the seafarer whose health is at issue
  • the ship owner who is responsible for working and living conditions on board and
  • the health professional who is aware of patterns of health and disease and of the validity of different approaches to health promoting interventions.

Collaboration between seafarers and their representatives, ship owners and health professionals is essential to define answers. The answers to the questions ‘what matters?’ and ‘what works?’ have both scientific and attitudinal components. ‘Who cares?’ is a socio-political issue, but one that will determine whether any initiative has a hope of being successful. 

Seafarer recruitment and patterns of work

Serving seafarers are a selected group. They have self-selected into the profession, an employer has selected them and they have had their medical fitness to work at sea assessed. They are also a survivor group, in that all the selective factors that apply at entry continue to apply throughout their working lives. By contrast, illness may be more prevalent in those who have recently ceased to work at sea, as it is one of the reasons for leaving the industry.

The global recruitment of seafarers influences health as seafarers are:

  • prone to similar patterns of disease to those found in the populations they come from,
  • share their beliefs about health with their home population,
  • may be unable to access the diet of choice,
  • at risk of exposure to infections not present in their home country,
  • liable to mental distress from clashes of culture and from isolation from seafarers from their own country.[8]

The pattern of work for seafarers can make delivery of health promotion difficult. There are three different settings in which most serving seafarers, apart from those on local coastal shipping, can be found:

  1. On board for 50-80% of the time.

At sea, work occupies a large part of the waking hours. Exercise is determined and work demands may constrain participation, food is provided and choices may be limited. Access to support and monitoring of compliance with programme goals is limited and the culture and ethnicity of the crew may determine attitudes to behaviours such as smoking or voluntary exercise in leisure time.

  1. In port, but away from home for 0-10% of the time.

Crewmembers often have more work demands placed on them when in port. If they have leisure time this may expose them to health risks such as traffic accidents, overconsumption of alcohol, casual sex and unhygienically prepared food. However, in some ports they will have access to welfare staff and facilities that provide both support and opportunities for sport and to communicate with home.

  1. On leave for the balance of 10-50%.

Returning home is often a time for celebration and caring relatives and friends are likely to signal this by providing rich food and plentiful alcohol. Exercise patterns established at sea are often lost, unless efforts are made to continue them. Time at home does provide an opportunity to obtain advice on health and has the potential, given co-operation from those close to the seafarer, to allow action to be taken to maintain or improve fitness.

This three-part pattern of life poses challenges to anyone aiming to create viable seafarer health maintenance programmes. In effect, it means that it is the individual seafarer who must recognise the elements of such a programme and keep them in place. This is highly dependent on positive and collaborative  attitudes by both employers and those close to the seafarer while they are on leave.

Motives for health promotion in seafarers

All parties have an interest in healthy seafarers, however their priorities differ:

  • Seafarers can be expected to have an interest in living a long and healthy life. However, the pattern of working and living at sea, as well as the opportunity to feel that leave is a time to treat yourself, does mean that many adopt lifestyles that form the basis for long-term ill health.
  • Employers need healthy and efficient crews but, in the current pattern of short-term crew contracts, may not see the prevention of long-term risks as important, or the costs of healthy diets and exercise facilities as a priority.
  • Maritime insurers, including the P & I Clubs, share the employers’ interest in crew health and have taken the lead in some recent health education initiatives. However, their focus is often on the exclusion of those who they consider may present risks from ill-health while under contract, as they are seen as more likely to require costly medical treatment and repatriation for which the insurer will be liable.
  • Maritime regulatory authorities have responsibilities under the Maritime Labour Convention, 2006 and other conventions to introduce regulations aimed at maintaining certain aspects of health and wellbeing in seafarers on ships that registered with them.
  • A range of organisations and groups concerned with seafarer health and wellbeing all have their own perspectives on health promotion. These include the seafarer missions, port welfare service providers and maritime doctors.

Developing health maintenance programmes for seafarers

A rational programme of health maintenance for seafarers should be based on estimates of the frequency of different medical conditions in the population concerned and, more importantly, on evidence about the effectiveness of any proposed interventions. Intervention may be directed at working and living conditions, lifestyle or indicators of individual risk.

  • Working and living conditions at sea are, in essence, matters for ship operators, while living conditions on leave depend on social factors in the seafarer’s home country.
  • Lifestyle is, to an extent, a matter for the individual. However, individuals need to be both informed of behavioural and other risk factors and to be motivated to take action to adopt ‘healthy behaviours’ that will reduce risk. Often this requires additional support, for instance those who are overweight need to be able to have a satisfying low calorie diet while on board, on leave the same pattern needs to continue with similar calorie control.
  • Individual risk is often identified in the course of seafarer medical examination or because of an episode of ill health. It may be amenable to action by lifestyle modification but will also often need medication, for instance for raised blood pressure or type 2 diabetes.

To date there have been few commercial ship operators who have actively engaged with an overall programme of health maintenance, but there have been initiatives by maritime health and welfare organisations to provide the background information needed to initiate such programmes. Individual seafarers may also be motivated to actively manage any health risks because of both personal self-esteem and the possibility that a risk that is not effectively managed will lead to a condition that prevents them from continuing their career at sea.


What is the pattern of health and wellbeing risks in seafarers?

Despite the lack of an extensive knowledge base on seafarer health, the available information indicates that the predominant causes of serious illness and death in seafarers are broadly similar to those in the same socioeconomic group in their country of residence. The most common causes are the arterial diseases and cancers.

Widespread but non-fatal conditions include musculoskeletal pain, often with limitation of movement, and psychological distress as well as other mental health issues that can be disabling for the individual and may lead to the early termination of a career at sea.  Musculoskeletal and psychological problems may be attributable to personal factors, to duties and job demands on board or to a combination of both.

Other significant contributors are occupational diseases and accidents. These are not considered further here, as there are well defined frameworks for the management of these risks that ship operators are required or recommended to follow. Further information on risk assessment and risk management is available in Ch 2.5.

In addition, the harm from several other risks, such of those from hot and cold climates, from sexually transmitted infections, including HIV, and from exposure to food, water and disease vectors while in port are all largely preventable. Further information on infectious diseases is available in Vol 8.

Feasible maritime health promoting interventions

Many conditions have an evidence base for health promotion in other, shore side settings. It is possible to use this evidence to justify and shape intervention in the maritime setting, for example:

  • Arterial disease: smoking, diet/obesity, exercise, additional clinical interventions to identify and treat high blood pressure, raised blood lipid levels and diabetes.
  • Cancers: lung and several other cancers have smoking as a causal factor and the effect increase with is concurrent or past asbestos exposure. Sun exposure increases the risk of skin cancer, dietary components can contribute to bowel cancers.
  • Musculoskeletal disease: regular training to improve fitness can reduce risks and rapid mobilisation in some conditions such as low back pain can reduce long term disability. There is a parallel need for sound systems of work to ensure that musculoskeletal demands from routine duties do not exceed accepted weight, reach or frequency criteria.
  • Psychological distress: improved understanding of the effects of personal crises and overload or boredom at while at sea, with acceptance that such effects occur and are best discussed, can ameliorate distress. Specialised social networking sites for those in distress, supported by online or face-to-face counselling are promising developments. Port welfare providers may also have a role.

Evaluation of any interventions needs to be published to guide others and different methods include measures of:

  • Distribution or access to materials used in the programme.
  • Awareness of the intervention programme, both in the direct target group and those who need to support the group, including family members during periods of leave.
  • Intentions to change behaviour or to provide the support services required to help individual participants.
  • Actual behavioural change, its speed of uptake, the proportion of those targeted who are complying, the persistence of the change.
  • Maintaining behaviour changes as measured by secondary markers such as weight, smoking habit, participation in exercise programmes.
  • Effectiveness of the programme in terms of primary markers: disease incidence, disability, loss of employment, death.



[1] The Bangkok  Charter for Health Promotion in a Globalized World. https://www.who.int/healthpromotion/conferences/6gchp/bangkok_charter/en/  (accessed 10 April 2019).

[2] Davies M, Macdowall W (Editors). Health Promotion Theory. Maidenhead, OUP. 2006.

[3] Macdowall W et al. (Editors). Health Promotion Practice. Maidenhead, OUP. 2006.

[4] Macdowall W. Personal communication 2016

[5] Carter T, Karlshoej K. The design of health promotion strategies for seafarers. Int. Marit. Health. 2017; 68: 102-107. https://journals.viamedica.pl/international_maritime_health/article/view/IMH.2017.0019/40815 (accessed 10 April 2019)

[6] Seafarers’ Health Information Programme, International Seafarers’ Welfare and Assistance Network. https://www.seafarerswelfare.org/seafarer-health-information-programme  (accessed 10 April 2019)

[7] Healthy Living at Sea, Videotel. Release in 2017. This is a series of ten vidoes covers different aspects of seafarer health.

https://videotel.com/videotel-programme-focusing-crew-health-promotes-good-practice-aid-ship-efficiency/  (accessed 10 April 2019)


[8]  Mellby A, Carter T. Seafarers’ depression and suicide. Int. Marit. Health. 2017; 68: 108-114 https://journals.viamedica.pl/international_maritime_health/article/view/IMH.2017.0020/40816  (accessed 10 April 2019)

F.4 Psychosocial and organisational aspects of work at sea and their implications for health and performance

Joanne McVeigh1,2, Malcolm MacLachlan1,2,3,4, Sam Cromie5,6, Paul Liston5,6, Bill Kavanagh7 and Alison Kay5,6

1. Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland.

2. Assisting Living & Learning (ALL) Institute, Maynooth University, Maynooth, Co. Kildare, Ireland.

3. Health Service Executive, Ireland.

4. Olomouc University Social Health Institute (OUSHI), Palacký University, Olomouc, Czech Republic.

5. Centre for Innovative Human Systems (CIHS), Trinity College Dublin, Dublin, Ireland.

6. School of Psychology, Trinity College Dublin, Dublin, Ireland.

7. National Maritime College of Ireland, Co. Cork, Ireland.



A ship is a ‘hole’ in the water that we put people into.  It contains the complex work dynamics of any group of people working on a common task.  A ship is also a ‘whole’ in the water.  It envelops the seafarer’s existence, not just occupationally, but socially and personally.  Living in a series of confined small spaces and moving through huge spaces, the seafarer’s environment is unique and challenging.  However, working in the maritime sector is, in some ways, the same as working in any other sector – you have good days and bad days, some who cope well with the job and others who don’t, colleagues and bosses who are easy to work with and those who aren’t.  Nonetheless, there are also distinctive features of the sector such as isolation from family and friends for long periods, irregular working hours, and the distinctive working culture of seafarers.  This chapter considers how the psychosocial and organisational environment of a ship is related to the health and performance of its crew and seeks to make readers aware of some key features of this relationship, rather than to provide a comprehensive account of the work in this area.  To begin, a case study is described, which illustrates some of the factors to consider.

Case Study

Task-related factors

Dmitri has one major task to carry out, taking his ship from Hong Kong to Rotterdam.  However, this is comprised of a myriad of sub-tasks.  Each sub-task presents distinct challenges to performance.  Some are complex, some are straightforward, and some are boring, while others require intense concentration.  His performance on these sub-tasks is dependent on the nature of the tasks, the equipment he uses such as radar and electronic charts, the procedures he has been given, and the resources available to him.  These are all task-related factors. These also have implications for his psychological wellbeing.  Specific tasks can induce boredom or stress. The overall task necessitates a lengthy period at sea, isolated from family and friends, and responsibility for a ship, its cargo and crew.

Individual-level factors

However, Dmitri himself also brings a lot to the task that determines his performance.  He brings his training and experience.  He has a personality that affects his way of coping with the demands of life at sea.  He has habits that help or hinder both his performance and his own wellbeing.  Quite apart from his individual strengths and weaknesses, Dmitri is vulnerable to the same individual human factors as anyone else, including fatigue, stress and limitations of his perception, memory and concentration.  These are factors at the individual level.  Also at the individual level are Dmitri’s personal challenges: his chronic stomach ulcers, his worry about one of his children who is struggling at school, and his family history of heart problems.  He also has great personal strengths, personal resilience, good humour, a strong loving bond with his wife and children, and relatively few financial worries.  

Team-level factors

Dmitri carries out his work as a member of a team.  He needs to communicate and coordinate with the other seafarers, engineers, port authorities, other ships, and his own company management.  This communication can be clear, concise, and correct or it can be hindered by misunderstandings, language difficulties, and failure of communications equipment.  He needs to play his part as a team member and as a leader.  The team might be an effective one, communicating openly, sharing responsibility, and working to each other’s strengths or weaknesses.  Or it might be dysfunctional, characterised by distrust, cliques, and inequitable work allocation.  Dmitri might be an effective or poor leader of this team.  These are team-level human factors.  They can represent a significant source of human error and of poor psychological health, such as de-motivation, stress, and isolation.

Organisational-level factors

Dmitri carries out his tasks in the context of a shipping company.  His daily work is facilitated and constrained by the company.  They provide Dmitri with the resources that he uses to accomplish his tasks such as the ship, the crew, the equipment, and the procedures.  They provide the direct instructions that he follows including which ports to sail to and the time frame.  They have set an organisational context of explicit policies and procedures on a whole range of topics that establish the context in which he operates, for example policies on discipline, reimbursement, bonuses, health and safety, and promotion.  There is also an implicit set of values and norms that Dmitri has absorbed through his years in the company.  Examples include how to treat your team, the relative importance of efficiency versus safety, what you report and what you don’t.  This is the organisational culture and these are organisational-level human factors.  They have a strong impact on how Dmitri performs his job, how he manages the crew, and how he runs his ship.  This impact can be positive or negative for the various performance metrics and for the wellbeing of Dmitri and the other team members.

Industry-level factors

In turn, Dmitri’s company operates within an international industry, which provides a wider context that has a direct impact on the working lives of Dmitri and his crew.  Regulations are the most tangible influence.  However, commercial pressures are also present, affecting crewing levels and deadlines.  Additionally, there is the professional culture of sea captains, the generally unspoken set of values, norms and attitudes to which Dmitri and his counterparts generally adopt unconsciously.  These are industry-level human factors, increasingly recognised as having a crucial influence on individuals in the operational environment.

This case study illustrates some of the different levels of factors that can affect performance and wellbeing in the sector.  This chapter can only explore some of these at a very general level.  The aim is to raise awareness of the relationship between how work is done and workers’ health and some of the problems that can arise due to psychosocial issues on board ships.  Figure 1 illustrates the general approach to understanding Dmitri’s challenges and to considering the relationship between work, performance, and health, integrating a systems-based approach at different levels of maritime operations.

Health and Performance Factors

Human performance and psychosocial wellbeing have a complex inter-relationship.  At times, they seem in opposition, whereby the drive for efficient and effective performance can increase stress.  However, generally, they are understood to have a positive relationship, so that healthier people perform better and effective performance contributes to psychological health.

This chapter examines the impacts on health and performance that are embedded or nested in different levels of work – the task, individual, team, organisation and industry levels (see Figure 1). 

Health & Performance FactorsLEGEND: Figure 1. A nested model of psychosocial and organisational aspects of maritime work: Synthesising the STAMINA model of human factors1 with the maritime environment2

Figure 1 illustrates how problems or opportunities at any level do not occur in isolation.  Rather, they are nested in other levels of work and life and can therefore influence and be influenced by other factors.  Some factors are more salient to particular levels, but others cut across several levels at once.  It is important to remember that in the ‘systems thinking approach’, factors happening at one level can, and do, affect factors at other levels.  This is not necessarily problematic, as it also means that problems can be solved by addressing them at several levels.

Organisational Culture

Organisational culture refers to the beliefs, values and assumptions that characterise organisations or industries.  Similar to ethnic cultures, these include commonly accepted norms, shared attitudes and widespread assumptions.  Bennis and Nanus3 describe a typology of leaders that is salient to the idea of organisational cultures.  Their model refers to collegial, formalistic, and personalistic leaders, whereby a personalistic culture focuses on the person and decision-making powers are afforded to each individual4.  Shea4 empirically explored these theoretical types of leaders using a battery of questionnaires among 700 seafarers from a range of countries and across different types of ships.  He found that collegial and formalistic were the two behaviour types that occurred in the seafarers’ working environment.  The collegial behaviour type describes people who are positive and demonstrably supportive towards subordinate colleagues.  Here the maintenance of cohesion between people is seen as important and is facilitated through team working, discussion, participation and consensus.  Conversely, the formalistic behaviour type describes people who display indifference towards subordinate colleagues and their activities.  Stability, control and coordination are seen as the critical issues here, with the continuity of the organisation seen to be a key objective.

Shea’s research also demonstrates a link between leadership style and safety on ships.  Respondents indicated that the formalistic behaviour type negatively impacted the safety climate of a ship.  More particularly, when seafarers found themselves working in a non-collegial environment, the accident rate increased. As noted by Shea, ‘the existence of a collegial culture on a ship therefore improved the safety culture of the ship’4 (p. 107).  While this is very relevant to the focus of this chapter, it also suggests the possibility that leadership behaviour and organisational culture relate to health behaviours and practices, and indeed to health problems, as well as accidents on board ships.

Organisational Justice

One of the ways in which organisational behaviour and health behaviour may be linked is through the perception of organisational justice, that is how fairly people feel they are being treated in an organisation.  In several spheres, links have been established between feelings of injustice at work, being unfairly treated, and health problems.  Critically, this conception of justice goes well beyond health-related behaviours.  Justice at work significantly influences job satisfaction and dissatisfaction, as well as the intent to leave and broader wellbeing5.  For instance, the amount that seafarers on board ships are paid, at least in part, may be based on where they come from, and in which labour market they have been recruited.  This can mean that similarly qualified crew may have different rates of remuneration.  Different remuneration to different nationalities for the same work causes dissatisfaction amongst seafarers, as it is viewed as an unfair system6.  This sort of discrepancy has been found to relate to worker demotivation in the context of international aid, where more highly paid expatriates work alongside less well paid local workers, who may have the same or more relevant qualifications and experience7.  Such demotivation has been found to relate to people working less hard and the intention to leave one’s present job, as well as being associated with mental health problems8.  Indeed, organisational justice is associated with mental health9.  This suggests that inequities experienced by seafarers from low- and middle-income countries, including the linking of senior positions to nationality, longer tours of duty, and different pay rates for the same job10-14 may significantly affect their mental health.

The idea of developing a just culture has been applied by some in the maritime industry, for example, BP Shipping and Teekay Marine Services.  These programmes have focused on safety and how organisational culture can be changed from the organisationally pathological approach of seeing accidents as inevitable with the people responsible losing their jobs, through a series of steps involving:

  • more positive reactions to accidents
  • developing a systems approach to detect likely accidents
  • developing proactive initiatives to avoid accidents
  • and the ‘generative’ level, where safety is seen as a ’profit centre’.

Here information about accidents, or near accidents, is actively sought as a valuable source of diagnostic information about how the organisation and its components are working15.  In the same way that safety can be seen as a profit centre, so too can health, where healthy and happy workers will perform better. 

Crew Resource Management


Crew Resource Management (CRM) is a system that attempts to minimise errors caused by human behaviour or the human element as it is termed in the maritime environment.  Despite the provision of well-equipped ships and expertly trained crews, accidents still occur, and it is estimated that over 80% of accidents in the shipping sector can be attributed to human error16.  The human element refers to the interaction between humans and the human/machine interface.

CRM in the maritime industry

Crew Resource Management applies to the maritime industry and is derived from Cockpit Resource Management developed within the airline industry.  The introduction of Cockpit Resource Management is considered a factor in reducing air accidents that may be attributed to human factors.  CRM includes elements from separate management systems, such as Bridge Resource Management (BRM) which applies to the navigation crew, Engine Resource Management (ERM) which applies to the engine-room crew, and Maritime Resource Management (MRM) which applies to a combination of navigation and engine-room officers.  CRM includes shipboard personnel that are not part of a ship’s management regime and applies to all ships’ crews.  In essence, all systems execute the same principles with slightly different emphases.  The principles of CRM are delivered in college courses and are designed to change people’s attitudes rather than skill-sets.

CRM encourages the development of good situational awareness and the detection and efficient processing of environmental data.  Good mental and physical health facilitate vigilance, attention, and memory, all key cognitive processes required to achieve the best results.  Team members must be used so that the operation is not controlled by the actions of one person.  A loss of situational awareness can be caused by stress and fatigue, a high workload, or inexperience, and can result in serious adverse consequences for the safe operation of the vessel.

Planning is vital, whether it is routine engine maintenance or navigating a passage from port to port.  All team members are briefed about the plan and changes are made if required.  After the mission is completed, for example, after the ship arrives in port, personnel are de-briefed as part of a learning and developmental process to improve operations. 

Importance of Teamwork in CRM

In the maritime industry, the rank structure within ships’ hierarchies is central, and this frequently leads to communication barriers16,17.  However, teamwork is a central theme of CRM.  Traditionally, the centre of power on a ship lay with the Master.  They were the decision-makers and consultation with other crew was minimal.  Personnel obeyed the Master’s orders, even if the action was considered to be incorrect.  CRM attempts to change the management style and culture on ships.  Seafarers are encouraged to become actively involved in shipboard operations, including the use of advocacy and in particular the right to speak up if they notice problems or errors developing.  Accidents are rarely the results of single point failures, but are rather the end result of error chains.  If a link in the chain is broken, the incident is avoided.  Advocacy, also known as ‘challenge and response’, is a new concept in maritime management.  It requires a change in leadership style and is difficult in practice, particularly in multinational crew environments where power-distances between officers and crew can vary considerably.

The importance of communication

Good communications are essential to foster a teamwork culture.  The use of the Standard Marine Communications Phrases (SMCP) is important.  Ships operate internationally with multi-lingual crews.  Although English is the standard maritime language, many personnel are not fluent English speakers and have difficulty understanding instructions.  This is particularly problematic in crisis management operations.  For port operations, where ships are navigating in confined and high-density traffic waters, safe communications for ship/port interfaces are vital.  The introduction of the maritime pilot can be de-stabilising for a team, as an apparent outsider temporarily joins the team to complete a short-term mission.  CRM principles must be employed in this situation to include teamwork, communications, advocacy and good management.

The use of procedures

Standard Operating Procedures are used to assist the team during operations.  Company and shipboard management develop specific procedures to address routine and emergency tasks.  Personnel may identify unplanned deviations from the procedures and use advocacy to warn the mission co-ordinator.  Procedures in crises are developed by using simulated exercises either on board ship or in college simulation laboratories.  If a planned deviation from the mission is required, managers will discuss the change in mission operation with relevant personnel, assess the advice given and make a decision.  After the decision is made, the team monitors subsequent actions to ensure that they are compliant with the new plan.


In summary, CRM attempts to change the attitude of shipboard and shore side personnel to minimise human error by developing a teamwork culture based on modern management principles.  It is a realm where the interplay between organisational and health behaviour are intimately and sometimes intricately linked.

CRM training will become mandatory under new international shipping requirements for shipping personnel as specified in the international convention, Standards of Training, Certification and Watchkeeping for seafarers (STCW)18.  At present, training courses are varied in their content, delivery and duration

Stress and Fatigue

Stress and fatigue on board

Stress and fatigue are common and difficult problems to deal with on board ships.  A range of factors contribute to fatigue and one of the most obvious is workload.  However, workload is complex.  Should it be considered in terms of external demands placed on someone or in terms of how an individual subjectively experiences their work?  With no good measures of the relationship between external demands, subjective appraisals, and physiological indications of stress19, it is challenging to define objective limits.  Workload can relate to a short intensive peak period of work such as off-loading and taking on cargo, or to the cumulative effects of a monotonous lengthy sea passage.  Thus, having too little to do can be just as fatiguing as having too much to do. 

Seafarers are experiencing increased stress, particularly psychosocial stress20, alongside increased social isolation.  Faster turnaround schedules in ports, increased technology use, decreased personnel, labour intensification, and social isolation have significantly changed on board working and living conditions11,13,21,22As suggested by the ITF Seafarers’ Trust23, fast technological advancement, increased automation, decreased personnel, more diverse crew, lack of shore leave, faster turnaround schedules, and a hierarchical command system may all lead to social isolation on board.  

A range of factors contribute to stress and fatigue at sea including:

  • sleep debt (see below)
  • experience of risk situations
  • degree of interest and engagement in work activities
  • diet
  • fitness and opportunities to move around
  • the time of day that people are working (see below)
  • and the environment.

There is much that can be done to monitor and manage these. 

Reduced Manning and Fatigue

The widespread trend of reduced personnel in the shipping industry has resulted from organisational policies that aim to increase efficiency, often made possible through automation19.  However it has produced some high-profile consequences, such as the Exxon Valdez striking Bligh Reef off Alaska, spilling approximately 11 million gallons of crude oil over 11,000 square miles.  The U.S. National Transportation Safety Bureau’s accident investigators found that the company ‘did not adequately consider the increase in workload caused by reduced manning’19 (p. 47).  However, on a daily basis, seafarers around the world experience the same factors that contributed to the Exxon Valdez accident.  Whether these factors result in accidents or not, it is likely that they take a personal toll on at least some seafarers. 

The Cardiff Fatigue Study impressively indicated the links between fatigue, health and performance, and the association between these and reduced manning practices.  A number of striking findings of the study included:

  • 1 in 4 seafarers reported falling asleep on watch
  • 50% said that they had worked 85 hours per week or more
  • 50% said that their working hours had increased over the last ten years
  • 50% considered their large number of working hours to present a risk to their personal safety and 37% felt that it posed a danger to the safe operation of their ship24.

In a sense then, technological advancements have dictated increased workloads for crews, but these have not been supported by advances in ameliorating fatigue, monitoring health, or indeed promoting the health and wellbeing of crews.  As MacLachlan14 (p. 4) suggests, ‘With larger ships, greater mechanisation and reduced manning levels, more is required from seafarers and there are fewer outlets for the sort of affiliation that sustains both a sense of collective identity and individual worth and support’.

Crew Endurance

One response to managing fatigue has been to consider the factors that promote crew endurance, and the United States Coast Guard have adopted Crew Endurance Management Practices.  Crew endurance is defined as ‘the ability to maintain performance within safety limits while enduring job-related physical, psychological and environmental challenges’25 (p. XV).  Crew Endurance Management (CEM) is defined as ‘a system for managing the risk factors that can lead to human error and performance degradation in maritime work environments’25 (p. XVI).  While CEM considers a range of factors, including temperature extremes, stress, caffeine use, and extended separations from family, one of the mainstays of the approach is sleep management.  This remains a critical factor affecting the health and performance of crews on merchant ships.  Seafarers’ sleep may be adversely affected by continuous exposure to noise, vibration, and movement of the vessel and by the need to work in shifts to ensure the continuous running of the ship26,27. 


Extensive research on sleep has demonstrated that brain activity during sleep progresses through distinct stages28.  In stage one, in the first 5-10 minutes, brain activity slows.  If roused during this stage, people often feel that they have not slept at all.  At stage two, after 10-15 minutes, sleep deepens further.  In stage three, also called slow-wave sleep, a person aroused will feel quite sluggish and take several minutes to awaken completely.  However, after 20-30 minutes of slow-wave sleep, the person then returns to a stage two sleep pattern, which is subsequently followed by Rapid Eye Movement (REM) sleep.  This is thought to be the most regenerative stage of sleep and is characterised by rapid eye movements, little muscle tone, and very active brain activity.  This is when you dream.  The full cycle repeats itself several times a night, with the crucial REM periods lengthening as the cycle proceeds.  The first REM episode may only last for 5-10 minutes.  If the cycle is interrupted, it resets from the beginning again. 

Seafarer’s sleep

Seafarers who do not have sufficient sleep periods and/or have their sleep frequently interrupted will develop a sleep debt, which can have the same effects as being drunk on alcohol in terms of ability to work machinery, navigate and so on.  The only effective treatment for a lack of sleep is more sleep!  Individuals keeping sleep logs can be a useful way of monitoring sleep.

A further challenge in the maritime environment is not just the total amount of sleep, or of REM sleep, but also when sleep occurs.  The body’s ability to regulate its hormones, alertness and temperature is mediated by circadian rhythms.  This ebb and flow of energy and alertness is a natural bodily activity that usually occurs in a predictable manner over a 24-hour period and is synchronised by the amount of light that people experience.  Loss of this circadian rhythm results in symptoms similar to jet-lag, when people see natural or artificial light at the wrong time of day, when it should be dark according to their body clock. 

The consequences of a lack of sleep

The inevitable consequences of sleep debt and loss of circadian rhythm are that cognitive performance deteriorates and the body is put under greater stress.  More errors in performance occur, including arithmetical errors in navigation, less vigilance when using machinery, being less likely to identify a hazard, slower reaction times etc.  This combination of being more likely to make mistakes, less likely to detect them and less able to correct them, can of course be disastrous in the engine room, on deck, or on the bridge on watch.  Sleep debt, i.e. getting less than 7-8 hours of continuous sleep per day, is also associated with reduced energy, apathy, withdrawal and depression.  Sleep debt will accumulate and the effects spread further into the day from just after waking up to many hours later and possibly even the whole waking period.  While brief planned napping can be helpful on a short-term basis, it will not address the fundamental sleep debt problem of a lack of REM sleep.  The use of medications, either to delay or to bring on sleep, should be avoided except in the most extreme situations and for short periods of time, as they mask and interfere with the body’s ability to regulate itself and may have negative performance, mood and other health-related effects.  They may be particularly problematic if a heavily-sedated person is awoken to deal with an emergency.   

Occupational Hazards

Occupational hazards on board

Oldenburg et al.29 examined occupational risks among seafarers.  The major categories that they highlighted were accidents and disasters at sea such as vessels foundering or colliding, falling into a hold, being swept overboard in rough seas, incorrect or non-use of safety equipment, and piracy.  For example, in 2008, 774 seafarers were reportedly taken hostage.  They note that, apart from accidents and work-related injuries, the main cause of death at sea is acute cardiovascular disease, accounting for 55-70% of all natural causes of death at sea in the 1980s and 1990s in the British and Danish merchant fleets.  Although the incidence of cardiovascular disease is not necessarily greater among seafarers, the treatment options and access to medical expertise are much reduced.  In a related study, Oldenburg et al.30 found that other significant stressors, particularly relevant to the organisational aspect of seafaring, were separation from family and length of shipboard stay, with the latter sometimes being twice as long for non-European personnel compared with Europeans and sometimes exceeding 12 months.  On German-flagged vessels, average sea times ranged from 3-6 months for European crew and 6-9 months for non-Europeans.

While most research on fatigue and performance has focused on deck personnel, Rydstedt and Lundh36 examined the relationship between psychosocial workload and mental strain among Swedish engineering officers.  Importantly, they found that it was not the intrinsic content of their job but rather the work-role conflict that was associated with mental health difficulties.  Specifically, the perception that they were being required to adopt and fulfil many new and sometimes contradictory regulations, which were often felt to be outside the scope of their original training, was associated with more mental health problems.  Rydstedt and Lundh concluded that ‘to fully understand the work pressures of seafarers, a socio-technical perspective is necessary, which allows us to study the work role and the working conditions of the individual’s interaction with the technical and organisational context’36 (p. 174). 

Occupational Hazards and Suicide in the Seafaring Population

Fatigue, isolation and a lack of social contact have all been adversely influenced by shorter turn-around times for ships in port.  Enhanced ship and port security measures also make it more difficult for seafarers to socialise ashore, even if the opportunity is available.  Perhaps the most distressing consequence of these work conditions is an elevated rate of suicide among seafarers.  Other factors that may contribute to this include difficulties at home for which the seafarer feels powerless to influence, stresses on board and prolonged motion sickness31.  Approximately 1.4% of all deaths globally were due to suicide in 201532.  Among seafarers, this figure is considered to be significantly higher33.  The U.K. Protection and Indemnity Club34 reported that 4.4% of all deaths on board were attributable to suicide from 2014-2015, which proliferated to 15.3% for 2015-2016.  Mellbye and Carter35 conducted a review of seafarers’ depression and suicide and found that investigations of depression and suicide amongst seafarers indicate improvement, although numerous recent case series suggest that suicide remains problematic.   

Cultural Differences

Crews of many nationalities

Multinational crewing, limited opportunities for recreation, and significant environmental stressors such as heat, noise, vibration, confinement, and motion are noted as other important occupational hazards by Oldenburg et al.29.  Further information in this area can be found in Ch 4.5.  Multinational crewing, in the context of health, may present particular challenges, as different cultures may have quite different causes of, experiences of, and expressions of both physical and psychological problems.  Equally, the most effective way of addressing these problems may be different across different cultural groups37.  For example, Nielsen et al.38 conducted a cross-sectional study of 541 seafarers from two Norwegian shipping companies and reported differences between European and Filipino participants in relation to aspects of the work environment and well-being.  Specifically, Filipino crew reported experiencing the work environment as more negative with higher degrees of harassment, laissez-faire leadership, and low safety, although they reported experiencing more team cohesion and their captains as more authentic.  While no difference was found between Europeans and Filipinos concerning job satisfaction, Filipinos reported higher levels of intentions to leave their occupation38.

The impact of different personalities

With any crew on board there will be individual personality differences, and knowing something about someone’s personality means being able to better understand how they will respond to a given situation.  For instance, extroverts are people whose thinking and behaviour is outward-focused.  Introverts are people whose thinking and behaviour is inward-focused.  Introverts tend to be quiet and reserved, preferring to spend time on their own.  They can concentrate well on tasks and tend to be contemplative.  Extroverts, on the other hand, are social and gregarious, preferring to spend time with others.  They are energetic and can find it difficult to concentrate, being easily distracted39.  Given that work at sea involves what might be termed ‘close isolation’ from other people, being in close quarters with other seafarers and far away from family and other friends, it is likely that extroverts and introverts will respond differently to different aspects of living and working at sea.  This may present itself as apparently inconsistent behaviour and changes in mood, as individuals try to cope with the inescapable aspects of their work-life that they find least easy to deal with. 

The effect of culture on individual responses

An individual’s cultural background may also influence how that individual responds to a particular set of circumstances.  Hofstede40 identified several dimensions along which cultures vary in their approaches to work.  Power Distance, for instance, refers to the extent to which less powerful people accept that power is shared unequally.  This score reflects how hierarchical a society is.  For example, Finland scores low on Power Distance, whereby the country does not accept uneven distribution of power and resources, whilst the Philippines scores high on Power Distance and is much more accepting of an uneven distribution of power and resources.  Another dimension, Individualism-Collectivism, reflects whether people see their society in terms of ‘I’ or ‘we’.  Individualism reflects a preference for a loosely-knit society, while collectivism is a preference for tightly-knit social frameworks.  For example, the U.S. is a highly individualistic society, while China scores at the collectivism end of the scale.  Uncertainty Avoidance, yet another dimension, relates to the extent to which a society seeks to avoid or is uncomfortable with uncertainty or ambiguity.  For instance, Russia scores high on Uncertainty Avoidance, indicating that they are more uncomfortable in ambiguous situations, while Ireland scores low. 

While Hofstede’s dimensions have been highly influential in academic psychology, they have also been criticised on theoretical and practical grounds and in terms of the original research methodology used to derive these dimensions41.  There is more support for some dimensions than for others.  There is also the danger that people can over-read culture and see an individual’s behaviour to be overly culturally-determined, rather than being a background factor to which the individual responds37.  Notwithstanding these caveats, some of Hofstede’s dimensions appear to have relevance to the maritime sector too.  Bao and Yip42 examined the relationship between culture and vessel detention, using Hofstede’s dimensions.  They found that high individualism and high uncertainty avoidance correlated with low detention rates.  


Psychosocial Maritime Health


MacLachlan et al.43 reviewed 192 publications in International Maritime Health from 2000 to 2010 to establish the coverage of the journal and the scope of research in maritime health.  They identified six broad thematic categories:

  • healthcare access, delivery, and integration
  • telemedicine
  • non-communicable diseases and physical health problems
  • communicable diseases
  • psychological functioning and health
  • safety-related issues.

Within these themes, ‘psychological functioning and health’ and ‘telemedicine’ had the fewest publications. 

However, psychological functioning incorporates many health problems long recognised in the industry, including suicide, depression, anxiety, and alcohol or drug dependence, to name a few.  Psychological health also relates very strongly to many lifestyle-associated health problems found in the other thematic categories such as cardiovascular disease, diabetes, and sexually transmitted diseases.  Finally, MacLachlan et al. noted a trend for more papers on telehealth, stress, fatigue and other psychological issues. 


Mental Health Initiatives

The significance of psychosocial aspects is increasingly acknowledged in the maritime sphere by seafarers, employers, unions, insurance companies and international regulatory bodies44.  The growing awareness of mental health problems at sea is encouraging and there have recently been some very practical initiatives in this area.  On ships and in docks, leaflets are increasingly becoming available in an attempt to give access to mental health information and address the strong stigma around mental health in many cultures.  For instance, the booklet by the International Committee on Seafarers’ Welfare (ICSW), entitled ‘Mental care – you are part of it!’, provides a very good and user-friendly information leaflet that covers monotony, stress, anxiety, depression, harassment and bullying, fatigue, psychosis, drugs and alcohol, and job satisfaction.  Importantly, it highlights that ‘having a useful job as a member of a mutually supportive team can be one of the best protections against mental health problems’.  It further emphasises that ‘sensitivity to the mental problems of your fellow crew members remains at the heart of good management and efficient ship operations’45.  These messages resonate strongly with the ethos of this chapter, that organisational aspects of work and personal health, welfare and performance are intrinsically braided, at each layer of activity in the ship and the maritime industry.  This implies that, in the maritime sector, a work environment that is perceived as supportive and just is pivotal to providing a good platform upon which individually-focused psychosocial interventions can be optimally applied46-48.

Complementary to the ICSW work is an Australian initiative, partnering Melbourne Port Welfare Association, Beyond Blue (the national depression initiative), The Rotary Club, Stella Maris Seafarers’ Centre, and the Mission to Seafarers Victoria49, on a project that has also produced an accessible leaflet on ‘The Mental Health of Seafarers’.  The leaflet focuses on depression, including a nine-point checklist to help people identify the core symptoms of depression.  In addition, it mentions aspects of anxiety and stress, including some explanation of treatment options.  The leaflet states that ‘the purpose of this booklet is to provide masters and other ships’ officers with basic information about the mental illness of depression so seafarers who are depressed may be identified and helped’.  The leaflet may also be useful to seafarer ratings, if provided in accessible formats.  This is important as having your boss identify your mental health problems may be felt by some to simply add to such problems and is also potentially open to abuse.  Some may be concerned that such a label could constitute reason for a company to terminate their employment.  This project, however, is very well-motivated and has been based on a concern to address the very serious problems of depression and suicide at sea50.  It is also one of the few projects that recognises the problem of workplace bullying.

Detection of Psychosocial Health Problems

Before identifying the extent or nature of a mental health problem, it is often necessary to identify when such problems might exist, and some indications of this may come from aspects of work and social behaviour.  According to the U.K. Health and Safety Executive51, behavioural signs of stress may include rushing around, skipping or rushing meals, swings in mood, worsening work relationships, irritability, becoming more indecisive, confused thinking and forgetfulness.  Increases in smoking or drinking and drug abuse may all be associated with poor attempts to cope with stress.  Increased complaints about health and feeling tired all of the time may also occur.  Physical symptoms may include headaches, problems with the digestive system (such as indigestion, stomach pains, and ulcers), as well as increased blood pressure and its natural consequence, an increase in cardiovascular disease including stroke.

Usually at sea, treatment options for mental health problems are limited.  Furthermore, some forms of psychopharmacology may promote dependence and affect attention and performance at sea.  It is generally accepted that the long-term prescription of psychoactive medication is not desirable for the majority of mental health problems.  Evidence-based clinical guidelines developed through centres of excellence, such as the U.K.’s National Institute for Clinical Excellence (NICE), recommend psychological interventions as the first line of response for common mental health problems such as depression.

Assessing Psychosocial Health across Cultural Groups

The evaluation of psychosocial health, particularly across different cultural groups, is fraught with complexities.  Many mental health problems may present differently in different cultures.  For instance, a perennial debate with regard to major depression is whether the high levels of somatisation (expressing distress through physical symptoms) that are common among South-East Asians and the high levels of psychologisation, that isexpressing distress through psychological symptoms among North Americans, constitute variations within the broad syndrome of depression or quite distinct disorders37.

The most common way of identifying or diagnosing mental health syndromes is through a clinical interview or standardised psychometric questionnaire.  The former often takes considerable training but can be guided by structured interview schedules, and these could be used by another seafarer or through telemedical practitioners.  However, individuals’ responses to such interviews and the use of established questionnaires may also be problematic.  A psychometric assessment instrument is never valid and reliable in itself.  These attributes always exist relative to the population samples it has been used on.  A psychometric assessment for anxiety may have excellent specificity and sensitivity in a French sample, but the translated versions, even if perfectly and accurately translated, may not work in the same way for a different linguistic or cultural group who construe and express their mental health problems differently.  Very few psychometric instruments that assess mental health problems have been extensively used across cultural groups and therefore allow us to have confidence in their validity and reliability, while at the same time being short and simple to administer. 

One of the few mental health measures that has been used across many cultural groups, and shown to be valid, is the General Health Questionnaire (GHQ), which comes in various versions.  Its short form, the GHQ-12, is as good a measure as is available.  However, the trade-off with its validity is its lack of ability to diagnose the exact nature of the mental health problem.  Rather, it can detect the extent of a mental health difficulty along a continuum.  It also suggests levels of scoring along this continuum that may be of a clinical severity to warrant intervention of some type, but does not automatically place people into a category of ‘you have a problem’ or ‘you don’t have a problem’.  This of course reflects more of a psychological and a medical, categorical approach to diagnosis, but also allows reported measures to determine how an individual varies along a continuum over time.  The GHQ-12 can be downloaded and is available in a number of different languages.  It can be self-administered or used by any seafarer who would like to help another to establish how severe their distress is.  However, as noted, the consequences of using it may be problematic.  If a seafarer is labelled as having a psychiatric problem, they may be discharged by their company at the earliest opportunity.  This may be far from home, potentially turning a problem into a crisis.  Thus, the identification of significant mental health problems at sea will require sensitivity, confidentiality, and support from people who have a real likelihood of being able to intervene effectively.

Integrated Occupational Health Systems for Promoting, Protecting and Responding to Psychosocial Maritime Health

Jensen et al.52  have called for a better integrated approach to maritime health, and the advent of telemedicine presents the prospect for health monitoring to move beyond pre-employment medical screening to incorporate ongoing psychological and biological monitoring of seafarers on board.  This may be through regular checks and individually-tailored advice, ranging from personal healthcare and fitness to continual professional and self-development modules.  Such a holistic approach can seek to combine each of the elements described in Figure 1, although obviously this requires high-level buy-in in terms of attitude and resources and funding.  

The relationship between health and work is changing and becoming more complex.  Not only is how much they are interlinked being increasingly recognised, but in high-income economies, more people in aging populations want to continue to work for longer, even when they have significant health problems53.  The concepts of the right to work and of managing health problems at work may also permeate the maritime industry in time.  Mental health in the workplace was the topic of World Mental Health Day 2017, whereby the World Health Organization stated that ‘employers and managers who put in place workplace initiatives to promote mental health and to support employees who have mental disorders see gains not only in the health of their employees but also in their productivity at work’54.  As indicated, mental health and performance are bedfellows.  So too are the many behavioural factors, from diet, to exercise, to relaxation, which are strongly implicated in serious physical illnesses such as cardiovascular disease.  

The containment of life on board a ship is often seen as problematic, and indeed this text has highlighted some of the psychosocial challenges associated with it.  However, this encapsulation also offers unique opportunities for the development of occupational health and performance programmes that more comprehensively integrate work and leisure.  One area that may hold particular promise in this regard is positive psychology55, where the focus is on facilitating positive health, positive attitudes, and positive work behaviour, rather than correcting or addressing a ‘lack of”, ‘failures’, ‘errors’ or ‘dysfunctions’.  Whilst beyond the scope of this chapter, moving forward, it would be beneficial for health and occupational practitioners in the maritime industry to more effectively utilise the characteristics of maritime work to develop intervention programmes that stimulate strengths, health and good work at sea, whilst also being responsive to the sort of health challenges and their multiple levels of contributing factors that we have discussed here.


Joanne McVeigh and Mac MacLachlan are grateful to Shell International B.V. for funding some of their research in this area.  Mac is also grateful to the Masters and crew of Arklow Shipping’s Arklow Meadow and the Irish Lights vessel Granuaile for kindly affording him the opportunity to spend sea time with them.    


1. Cromie S, Ross D. (2012) Conceptualising and Communicating Human Factors: The STAMINA framework. In preparation.

2. MacLachlan M, Kavanagh B, Kay A. Maritime Health and Global Health: Common Challenges and Opportunities. Paper presented at the International Maritime Health Conference. Odessa, Ukraine, 2011.

3. Bennis W, Nanus B. Leaders: The Strategies for Taking Charge. Sydney: Harper & Row; 1985.

4. Shea IP. The organisational culture of a ship: A description and some possible effects it has on accidents and lessons for seafaring leadership. Unpublished PhD thesis. University of Tasmania; 2005.

5. Furnham A. Justice at work. In: Carr SC, MacLachlan M, Furnham A. (eds.) Humanitarian work psychology. Basingstoke, United Kingdom: Palgrave Macmillan; 2012. p. 52–79.

6. Bhattacharya Y. Employee engagement as a predictor of seafarer retention: A study among Indian officers. The Asian Journal of Shipping and Logistics. 2015;31(2): 295–318.

7. Carr SC, McWha I, MacLachlan M, Furnham A. International-local remuneration differences across six countries: Do they undermine poverty reduction work? International Journal of Psychology. 2010;45(5): 321–340.

8. Marai L. Double de-motivation and negative social affect among teachers in Indonesia. South Pacific Journal of Psychology. 2003;14: 1–7.

9. Ndjaboué R, Brisson C, Vézina M. Organisational justice and mental health: A systematic review of prospective studies. Occupational and Environmental Medicine. 2012;69(10): 694–700. doi:10.1136/oemed-2011-100524

10. Baylon AM, Santos EMR. Attractions, problems, challenges, issues and coping strategies of the seafaring career: MAAP seafarers perspectives. In: Weintrit A, Neumann T. (eds.) Safety of marine transport: Marine navigation and safety of sea transportation. Leiden, The Netherlands: CRC Press; 2015. p. 21–30.

11. Borovnik M. Occupational health and safety of merchant seafarers from Kiribati and Tuvalu. Asia Pacific Viewpoint. 2011;52(3): 333–346. doi:10.1111/j.1467-8373.2011.01459.x

12. Carter T. Working at sea and psychosocial health problems: Report of an International Maritime Health Association Workshop. Travel Medicine and Infectious Disease. 2005;3(2): 61–65. doi:10.1016/j.tmaid.2004.09.005

13. Dimitrova DN, Blanpain R (eds.). Seafarers' Rights in the Globalized Maritime Industry. Alphen aan den Rijn, The Netherlands: Kluwer Law International; 2010.

14. MacLachlan M. Maritime psychology: Definition, scope and conceptualization. In: MacLachlan M. (ed.) Maritime psychology: Research in organizational and health behavior at sea. Cham, Switzerland: Springer; 2017. p. 1­­–18.

15. Hudson PTW, Parker D, Lawrie M, v d Graaf GC, Bryden R. How to win Hearts and Minds: The theory behind the program. Proceedings 7th SPE International Conference on Health Safety and Environment in Oil and Gas Exploration and Production. Richardson TX: Society of Petroleum Engineers; 2004.

16. Turan O, Kurt R, Arslan V, Silvagni S, Ducci M, Liston P, et al. Can we learn from aviation: Safety enhancements in transport by achieving human oriented resilient shipping environment. Transport Research Procedia. 2016;14: 1669–1678. doi:10.1016/j.trpro.2016.05.132 

17. Bielic T, Predovan D, Culin J. The role of the master in improving safety culture onboard ships. TransNav: The International Journal on Marine Navigation and Safety of Sea Transportation. 2017;11(1): 121–124. doi:10.12716/1001.11.01.14

18. IMO. Standards of Training Certification and Watchkeeping Convention and Code for Seafarers (Manila Amendments). London: International Maritime Organisation; 2011.

19. Gregory D, Shanahan P. The human element: A guide to human behaviour in the shipping industry. Maritime and Coastguard Agency; 2010. Available from:

https://www.standard-club.com/fileadmin/uploads/standardclub/Documents/Import/publications/standard-safety/2013/51854-MCAGuidev10ae_2010.pdf [accessed 19th June 2021].

20. Oldenburg M, Jensen HJ. Merchant seafaring: A changing and hazardous occupation. Occupational and Environmental Medicine. 2012;69(9): 685–688. doi:10.1136/oemed-2011-100619 

21. Allen P, Wadsworth E, Smith A. The prevention and management of seafarers' fatigue: A review. Int Marit Health. 2007;58(1-4): 167–177.

22. Project MARTHA. Project MARTHA: The final report. Project MARTHA; 2016. Available from: https://www.su.se/polopoly_fs/1.410319.1542102856!/menu/standard/file/Project%20MARTHA%20the%20final%20report.pdf [Accessed 15th June 2021].

23. ITF Seafarers’ Trust. Summary report from the ITF Seafarers’ Trust Autumn 2016 workshop on social isolation, depression and suicide (SIDS). London, England: ITF Seafarers’ Trust; 2017.

24. Smith A, Allen P, Wadsworth E. Seafarer fatigue: The Cardiff Research Programme. 2006. Available from: https://orca.cf.ac.uk/48167/1/research_report_464.pdf [accessed 15th June 2021].

25. United States Coast Guard (USCG). Crew endurance management practices: A guide for maritime operations. Groton, CT: United States Coast Guard Research & Development Centre; 2003. Available from: https://madden-maritime.com/wp-content/uploads/2016/04/guideformaritimeoperations.pdf [accessed 15th June 2021].

26. Bal BeşİkÇİ E, Tavacıoğlu L, Arslan ö. The subjective measurement of seafarers’ fatigue levels and mental symptoms. Maritime Policy & Management. 2016;43(3): 329–343. doi:10.1080/03088839.2015.1047426

27. Jepsen JR, Zhao Z, van Leeuwen WMA. Seafarer fatigue: a review of risk factors, consequences for seafarers' health and safety and options for mitigation. International Maritime Health. 2015;66(2): 106–117. doi:10.5603/imh.2015.0024

28. Barnes CM. Working in our sleep: Sleep and self-regulation in organisations. Organizational Psychology Review. 2012;2(3): 234–257.

29. Oldenburg M, Baur X, Schlaich C. Occupational risks and challenges of seafaring. J Occup Health. 2010;52: 249–56.

30. Oldenburg M, Jensen HJ, Latza U, Baur X. Seafaring stressors aboard merchant and passenger ships. International Journal of Public Health. 2009;54(2): 96–105.

31. Low A. Seafarers and passengers who disappear without a trace from aboard ships. International Journal of Maritime Health. 2006;57: 219–29.

32. WHO (World Health Organization). Mental health: Suicide data. WHO; n.d. Available from: http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ [Accessed 15th June 2021].

33. Slišković A. Occupational stress in seafaring. In: MacLachlan M. (ed.) Maritime psychology: Research in organizational and health behavior at sea. Cham, Switzerland: Springer; 2017. p. 99–126.

34. Velankar A. Mental health and wellbeing of a seafarer. Singapore: Thome Group; 2017.

35. Mellbye A, Carter T. Seafarers’ depression and suicide. Int. Marit. Health. 2017;68: 108–114. doi:10.5603/IMH.2017.0020

36. Rydstedt LW, Lundh M. An ocean of stress? The relationship between psychosocial workload and mental strain among engine officers in the Swedish merchant fleet. Int Marit Health. 2010;61(3): 168–175.

37. MacLachlan M. Culture and Health: Towards Global Health. Chichester: Wiley; 2006.

38. Nielsen MB, Bergheim K, Eid J. Relationships between work environment factors and workers' well-being in the maritime industry. International Maritime Health. 2013;64(2): 80–88.

39. Jonassen DH, Grabowski BL. Handbook of Individual Differences, Learning, and Instruction. Hillsdale, NJ: Lawrence Erlbaum; 1993.

40. Hofstede G. Culture's Consequences: International Differences in Work-Related Values. Beverly Hills, CA: Sage Publications; 1980.

41. Jones M. Hofstede – Culturally Questionable? Oxford Business & Economics Conference, 24-26 June, 2007. Oxford, UK.

42. Bao LS, Yip TL. Culture effects on vessel detention. IAME 2010: Annual Conference of the International Association of Maritime Economists, Lisbon, Portugal, 7th–9th July, 2010, p. 1–22.

43. MacLachlan M, Kavanagh B, Kay A. Maritime health: A review with suggestions for research. Int Marit Health. 2012;63(1): 1–6.

44. MacLachlan M. Preface. In: MacLachlan M. (ed.) Maritime psychology: Research in organizational and health behaviour at sea. Cham, Switzerland: Springer; 2017. p. v.

45. International Committee on Seafarers’ Welfare. Mental care – You are part of it!:  Seafarers’ health information programme. 2009.

46. McVeigh J, MacLachlan M. A silver wave? Filipino shipmates’ experience of merchant seafaring. Marine Policy. 2019;99: 283–297. doi:10.1016/j.marpol.2018.10.012

47. McVeigh J, MacLachlan M, Kavanagh B. The positive psychology of maritime health. Journal of the Institute of Remote Health Care. 2016;7(2): 20–28.

48. Doyle N, MacLachlan M, Fraser A, Stilz R, Lismont K, Cox H, et al. Resilience and wellbeing amongst seafarers: Cross-sectional study of crew across 51 ships. International Archives of Occupational and Environmental Health. 2016;89(2): 199–209. doi:10.1007/s00420-015-1063-9

49. Melbourne Port Welfare Association (with Beyond Blue, The Rotary Club, Stella Maris Seafarers’ Centre, and The Mission to Seafarers Victoria). The mental health of seafarers. 2009. Available from: http://rcms.squarespace.com/storage/Mental%20Health%20of%20Seafarers.pdf [accessed 15th June 2021].

50. Iversen RTB. The mental health of seafarers: A brief review. Actual Problems of Transport Medicine. 2011;3: 38–48.

51. HSE (Health and Safety Executive). Work-Related Stress: A Short Guide. London: HSE; 2004.

52. Jensen OC, Lucero-Prisno III DE, Canals ML. Integrated occupational health care for seafarers across the continuum of primary, secondary and tertiary prevention. International Journal of Integrated Care. 2010;10: 1–2.

53. Vickerstaff S, Phillipson C, Wilkie R (Eds.). Work, Health and Wellbeing: The Challenges of Managing Health at Work. Bristol, UK: The Policy Press; 2012.

55. Linly PA, Harrington S, Garcea N. (Eds.) Oxford Handbook of Positive Psychology and Work. Oxford: Oxford University Press; 2010.


Bullying and harrassment


Harassment and bullying can be of concern given the shipboard living and working environment, isolation, size and proximity of cabins and the necessity to remain at the workplace during rest periods or free time.
Bullying and harassment in any shape or form is totally unacceptable.

Harassment and bullying on board ships can have serious consequences:
    -for the physical and emotional health of seafarers,
    -lead to decreased motivation and increased sickness, 
    -can compromise effective teamwork, and
    -have negative effects for companies, resulting in a deterioration of working conditions and potential organisational, economic and legal consequences. 


There is no legal definition of bullying but is defined here as: ‘A threatening or intimidating work environment in which a group of people or an individual may become fearful or intimidated because of the negative or hostile behaviour of another group of people or individual’[1]

Harassment, on the other hand, has the following legal definition:

 ‘A form of discrimination when unwanted conduct takes place which has the purpose or effect of violating the dignity of a person and of creating an intimidating, hostile, degrading, humiliating or offensive environment’[2]

How to address bullying and harassment

In order to ensure a ship culture that is resilient to bullying and harassment, it is important for seafarers to consider and discuss with others onboard, how to:

-Respect other cultures,
-Tolerate the personalities and styles of others,
-Recognise boundaries,
-Be curious to get to know others,
-Challenge unacceptable standards.

Many issues can be resolved informally, however, if the person is persistent:
-Tell the person to stop,
-Consider writing down what it is you are subjected to,
-Keep a diary/log of all incidents,
-Lodge a formal complaint or grievance.

The ECSA and ETF guidelines offer further ideas on how to safeguard employees onboard.


[1] www.ecsa.eu/sites/default/files/publications/053_0.pdf.

[2] https://www.equalrightstrust.org/content/eu-council-directive-200078ec-27-november-2000-establishing-general-framework-equal 

Gender Issues


For a long time the maritime industry has been recognised as a workplace for men. However, in recent years, the awareness of women as an important human resource has been increasingly raised within the industry. This section covers key elements of gender issues in maritime professions and how they are relevant to maritime health. 

Women as a minority group in the maritime industry

Traditionally in many parts of the world, the maritime industry has been dominated by men. For example, the percentage of women seafarers was reported as 1% of the participants of a large work force survey by BIMCO and the ICS in 2015 (1). In fact, the majority of women seafarers are found in the hotel and catering sections of cruise ships and passenger ferries. Hence, those women in ship operation sections, such as deck and engine officers/ratings, are much fewer and Drewry, ILO, & ITF (2) report their population as 0.12% of the total seafarers. On the other hand, women in shore-based maritime professions are estimated between 3% and 30% (3).

It is worth noting that women’s representation in maritime organisations vary by country’s policies. For example, in the Philippines where the government sets up a gender and development budget, approximately 40% of employees in the Philippine Port Authority (PPA) are women and some occupy senior positions (4). In Saudi Arabia, without policies, it is reported that women represent only 1% in the maritime business (5).

What is gender?

The terms, “gender” and “sex” are used commonly, sometimes in a similar context. However, in the early 1970s, the differentiation of terms “gender” and “sex” was first attempted. Money and Ehrhardt (6) define that the term “sex” should be used as a classification of biological differences between males and females while the term “gender” should be used as a socially constructed norm of what are appropriate behaviours as men or women. This claim is widely acknowledged today and the discussions on gender equality often focus on social aspects of women or men’s experiences. Nevertheless, gender discourses do not overlook the significance of the male or female body.

Body and gender

Under the culture of macho or masculinity, as may be seen in the maritime industry, the male body is already emphasized in its expectations of work. Both physical and emotional toughness were, and to some extent still are, regarded as a virtue of ideal mariners (7). This idea is probably less significant with technological development that has transformed part of seafarers’ work from physically demanding tasks to more monitoring and documenting of ship operations. Having said that, such mentalities may still exist.

Kitada and Langåker (8) argue how a woman’s “body” can become a reminder of heterosexuality on board vessels where men are dominant. Without any intentions of emphasizing women’s sexuality, women seafarers may receive unwanted attention by their male colleagues. In order to avoid further problems on board, for instance, some women try to hide their bodylines as much as possible by wearing baggy clothes (9). 

Gender stereotypes

Stereotypes are often used when describing the typical idea about a particular social group (10).  It is also a cognitive process of making a judgement about someone before knowing him/her based on a certain assumption that one already has. It is a risky behaviour as stereotypes can mislead or sometimes stop further communications, and it can be difficult to modify an already fixed idea or be too late by the time one realises that the idea was wrong or inaccurate.

Pilcher and Whelehan (11) define gender stereotypes as “a standardised and often pejorative idea or image held about an individual on the basis of their gender” (p. 167). Certain attributes to men or women are given as socially constructed gender norms. For example, men are rational and instrumental while women emotional and unpredictable. Hence, men are good at leading people and making decisions; women are suitable for caring and assisting men.

In the maritime industry, stereotypes towards men and women are generally strong. Women are often seen as unsuitable for working on board ships due to the stereotypes towards maritime women professionals (12).

Gender identity and sexual orientation

Gender identity is considered one of many identities that one has in terms of race, class, gender, nationality, ethnicity, religion and any other particular communities to which they may belong (13). The sense of belongingness to the community can become extremely important if one is a minority in the community. For example, women seafarers often find themselves as the only woman on board a ship. The occupational culture of seafaring tends to mirror masculine norms and values. In order to become a part of the male crew, women’s gender identity can be in constant negotiation by its capacity of being changed, reshaped and redefined (14). This research reveals that women seafarers tended to use various gender identity management strategies both on board and ashore. Through gender identity management, women try to fit into the male work environment and avoid possible gender-related problems, including sexual harassment as discussed in Chapter 7.3.13 and 7.4.15.

In recent years, so-called sexual orientations, including gay, lesbian, bisexual, and transgender (LGBT) have been highlighted, in addition to gender issues in general. There is very little research on LGBT in the maritime sector, however they exist (15). Queer theory was developed in the mid-1980s through the work of Michel Foucault, by denying the privileges of heterosexuality and questioning dominant ideas of what is normal and appropriate in people’s behaviours. Since the maritime sector tends to be old-fashioned in its way of thinking, it seems to be almost a taboo subject to talk about. Nevertheless, considering the fact that rapid digital transformations are changing the traditional patterns of maritime jobs, it is possible to assume that the industry may be forced to adopt changes by accepting new ideas and approaches in the coming years.

Practical issues 

Gender equality should be achieved not only by quantity but also by quality in the maritime sector. The needs of a minority group, such as women seafarers, may not always be seen as a priority, but there are on board female specific needs. Access to a sanitary bin is known as one of the common challenges faced by women seafarers. According to the 2015 survey(16), approximately 40% of women seafarers responded that they did not have access to sanitary bins. Under the Maritime Labour Convention (MLC) 2006 (17), Standard A3.1, Accommodation and recreational facilities of the Maritime Labour Convention, as Amended, 4(d) sanitary facilities shall be implemented by the competent authority. A similar standard was originally stated in the ILO Convention No. 92 (C092) (18), Accommodation of Crews Convention (Revised), 1949, which applies to those States that ratified C092 regardless of their ratification of MLC, 2006. The problem is that sanitary bins are not specifically mentioned in the description of sanitary facilities in the above two conventions.

To ensure occupational safety and health (OSH) on board ships, Personal Protective Equipment (PPE) is important to protect workers from occupational hazards, accidents, and physical injuries. PPE includes safety helmets, boots, cloves, and coveralls. Several studies claim that PPE in the maritime sector often fails to be tailored to women. For example, female coastguard officers found that their overall or boiler suit with a double zip at the front design was very inconvenient and impractical to go to the bathroom (19). Immersion suits for the maritime operation are also designed based on the assumption of male bodies (20). The ergonomic problem of PPE needs to be addressed in order that workers, including women, feel safe and comfortable to do their job.

Notably, the design of facilities and equipment on ships often fails to address gender perspectives and considerations in terms of crew’s OSH. The effective regulations and guidelines are clearly lacking. The problem should not burden individual seafarers nor affect the attraction of the job. A women-friendly, safe work environment is an important area for further discussions and improvements in the industry.


  • BIMCO, ICS. Manpower report: The global supply and demand for seafarers in 2015. London: Maritime International Secretariat Services Limited; 2016.
  • Drewry, ILO, ITF. Manning 2009. London: Drewry; 2009.
  • Calderon M, Illing, D., Schipperen, I., Antão, P. Improving the current regime for ship safety inspections: Opportunities for technology research and women employment. In: Kitada M, Williams E, Froholdt LL, editors. Maritime Women: Global Leadership. Heidelberg: Springer; 2015.
  • Kitada M. Advancing “good practices” that promote gender equality in the maritime sector. In: Papanicolopulu I, editor. Gender and the Law of the Sea. Leiden: Brill; forthcoming in 2019.
  • Spinnaker Global. Maritime HR Association: Gender Fact Sheet. London: HR Consulting from Spinnaker Global; 2017.
  • Money J, Ehrhardt AA. Man and Woman, Boy and Girl: The Differentiation and Dimorphism of Gender Identity from Conception to Masculinity. Baltimore: Johns Hopkins University Press; 1972.
  • Creighton MS, Norling, L. . Iron Men, Wooden Women: Gender and Seafaring in the Atlantic World, 1700-1920. Baltimore: The John Hopkins University Press; 1996.
  • Kitada M, Langåker L. “The Body” Matters in Maritime Employment Contracts. International Association of Maritime Universities (IAMU) General Assembly; 11-14 November; Varna; 2017.
  • Kitada M. Code of Behaviour at Sea: Women Seafarers’ Shipboard Identity Management. WMU Journal of Maritime Affairs. 2013;12(2):213-27.
  • Macrae C, Stangor, C., Hewstone, M. , editor. Stereotypes and Stereotyping. London: The Guildford Press; 1996.
  • Pilcher J, Whelehan, I, editor. 50 Key Concepts in Gender Studies. London: Sage; 2004.
  • Belcher P, Sampson, H., Thomas, M., Veiga, J., Zhao, M. . Women Seafarers: Global employment policies and practices. Geneva: International Labour Organization; 2003.
  • Woodward K, editor. Identity and Difference: Culture, Media and Identities. London: Sage; 1997.
  • Kitada M. Women Seafarers and their Identities. Cardiff: Cardiff University; 2010.
  • Baker P, Stanley, J. Hello Sailor! The hidden history of gay life at sea: Gay Life for Seamen. London: Routledge; 2003.
  • IMHA, ISWAN, ITF, SHS. Women Seafarers’ Health and Welfare Survey. 2015.
  • Maritime Labour Convention 2006 as amended. https://www.ilo.org/global/standards/maritime-labour-convention/text/lang--en/index.htm
  • https://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_ILO_CODE:C092
  • Personal protective equipment and women: Guidance for workplace representatives on ensuring it is a safe fit. ; Trades Union Congress; 2017.
  • Chan F M. Female engineer officers: breaking the glass ceiling. Malmö: World Maritime University; 2018.

Sexual harassment


In 2014, the International Maritime Health Association (IMHA), International Seafarers’ Welfare and Assistance Network (ISWAN), International Transport Workers’ Federation (ITF) and Seafarers Hospital Society (SHS) conducted a survey of women’s health and welfare (1). According to this survey report, 17% of women seafarers answered that sexual harassment is an issue. It is also noted that in their pilot survey nearly a half of the participants mentioned that they experienced sexual harassment on board. This gap is explained because the majority of respondents in the pilot survey were rather junior while women in supervisory roles answered the main survey. It is therefore concluded that women with less power in the workplace are more vulnerable to sexual harassment (1).

The definitions of sexual harassment

The International Labour Organization (ILO) provides useful explanations about sexual harassment. It is defined as ‘a sex-based behaviour that is unwelcome and offensive to its recipient’ (2). The following two conditions were identified where sexual harassment exists:

  • ‘Quid Pro Quo’, when a job benefit, such as a pay rise, a promotion, or even continued employment, is made conditional on the victim acceding to demands to engage in some form of sexual behaviour; or;
  • Hostile working environment in which the conduct creates conditions that are intimidating or humiliating for the victim” (2). 

Behaviours considered sexual harassment include three elements:

  • Physical behaviours, for example, physical violence, touching and unnecessary close proximity. Verbal behaviours such as comments and questions about appearance, life-style and sexual orientation, offensive phone calls and so on.
  • Non-verbal behaviours including whistling, sexually suggestive gestures, display of sexual materials and other covert signals (2).

Sexual harassment can happen between members of the opposite or same sex. Women tend to be victims in male-dominated occupations; however, men can be victims of sexual harassment by either females or males (3). Many cases, regardless of the level of sexual harassment, are unreported (see below); so it is difficult to understand the actual number of cases and their character.

Examples of sexual harassment in the maritime sector

There are a limited number of surveys and research on sexual harassment in the maritime sector. Sea-based female professionals are more vulnerable to sexual harassment in the form of physical behaviour, compared to shore-based women. This may be because of the confined space on board, presenting opportunities for a higher risk of sexual harassment (4) and examples include:

  • A male colleague visited a woman seafarer’s cabin or forced her to enter his cabin (4, 5),
  • A couple of holes were created in the female toilet room (4),
  • Constant telephone calls and love letters to a female seafarer’s cabin (5, 6).

During the field study, Kitada also heard that some women experienced a male colleague’s attempt to kiss and/or hug as well as touching her shoulders or lap on duty (6). Verbal and non-verbal sexual harassment are also common on board, for example, male seafarers comment about a female seafarer’s appearance and a calendar with pictures of naked women displayed in the workplace (6).

Shore-based maritime female professionals tend to experience gender-based discriminations. In the Caribbean, although some progress has been made in the past decades, women are still recipients of lower-paying professions, lesser opportunities for education and training as well as for leadership positions (5). In the UK, a gender pay gap was reported in several major shipping companies. The NYK Group (Europe) Ltd is one of the top three Japanese shipping companies and their women employees earn 60.5 pence for every pound their male colleagues make. Within Carnival Plc, the world’s largest cruise operator, women receive 61.6 pence in comparison with their male counterparts, making every pound.  In the case of V.Ships UK Ltd, women are earning 51.6 pence for every pound a male colleague earns, which shows the worst rate of all (6). Such structural gender-discriminations can lead to Quid Pro Quo type of harassment as well as verbal and non-verbal sexual harassment in their workplace where men are dominant and privileged.

Reporting sexual harassment

The Amendment of the Maritime Labour Conventions (MLC), 2006, regarding harassment and bullying for seafarers, became effective in January 2019. Although it is a guideline, meaning it offers recommendations only, the Amendment emphasizes the responsibility of ship owners to ensure a safe and healthy work environment on board for crew. Without such an emphasis, seafarers tend to feel the pressure of losing their job if they report any incidents to the company. This applies to women seafarers as well, who do not want to project themselves as a trouble-maker or feel helpless about finding effective solutions when the incident happened (4, 6). Inappropriate male behaviours towards women seafarers often remain unchallenged anyway (4). The lack of reporting mechanisms as well as seafarers’ fear of losing their jobs can be a major factor resulting in many cases of sexual harassment going unreported.

In the wake of social media campaigns, such as ‘#metoo’, sexual harassment has become more visible and women’s voices are collectively being raised inside and outside the cyber space. In the maritime sector, Swedish maritime women show a good example of active social media campaigns about sexual harassment. More than 1,150 Swedish maritime women joined a Facebook group under the hashtag #lättaankar, Swedish for anchors away. It is a closed group in which women share their experiences of sexual harassment and bullying.  Some women have never told their stories until this opportunity (7). More information on ISWAN and the helpline is available in Ch. 4.6.

Preventative measures against sexual harassment

Reporting is very important in terms of understanding what is happening on board, applying laws and policies, and providing appropriate support to victims. However, such reactive measures should be combined with more proactive measures to prevent seafarers from sexual harassment and bullying. Because they are away from family and friends for long periods, seafarers tend to be vulnerable to feelings of isolation. This mental aspect of seafarers’ health should not be under-estimated and if sexual harassment or bullying occurs, one can feel even more isolated and find it difficult to cope with life on board. In the Nautilus survey on bullying, discrimination, and harassment, 79% of respondents felt that their experience of being bullied, discriminated, or harassed affected their morale at work and their performance (8).

By recognising the importance of seafarers’ mental and physical health, preventative measures are important tools to enhance on board occupational health and safety (OHS). In addition to MLC, 2006, the IMO’s instrument – International Safety Management (ISM) Code should be used for preventing sexual harassment under the section of OHS. The International Chamber of Shipping (ICS) and the International Transport Workers’ Federation (ITF) co-published a Guidance on Eliminating Shipboard Harassment and Bullying (9) and the Ship Operations Cooperative Program, Inc. in United States made the best practices guide available (10).


  • Stannard S, Vaughan C, Swift O, Robinson G, Altaf SA, McGarry A. Women seafarers’ health and welfare survey: A joint initiative of the International Maritime Health Association (IMHA), International Seafarers’ Welfare and Assistance Network (ISWAN), International Transport Workers’ Federation (ITF) and Seafarers Hospital Society (SHS). International Maritime Health. 2015;66(3):123–38.
  • Sexual Harassment at Work Fact Sheet. Geneva: International Labour Organization; n.d.
  • Johnson PA, Widnall SE, Benya FF, editors. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. Washington D.C.: The National Academies Press; 2018.
  • Belcher P, Sampson H, Thomas M, Veiga J, Zhao M. Women Seafarers: Global employment policies and practices. Geneva: International Labour Organization; 2003.
  • Stevenson CJ. Sustainable Development Issues in Shipping: Women, the Under-Represented Human Resource. In: Kitada M, Williams E, Froholdt LL, editors. Maritime Women: Global Leadership. Heidelberg: Springer; 2015.
  • Kitada M. Women Seafarers and their Identities. Cardiff: Cardiff University; 2010.
  • Raun KG. Over 1000 women seafarers share sexual harassment experiences ShippingWatch. 2018 19 January.
  • Report: Bullying, Discrimination & Harassment survey 2010. London: Nautilus; 2010.
  • ICS, ITF. Guidance on Eliminating Shipboard Harassment and Bullying. London: International Chamber of Shipping, International Transport Workers’ Federation; 2016.
  • The Best Practices Guide on Prevention of Sexual Assault & Sexual Harassment in the US Merchant Marine. Woodinville: Ship Operations Cooperative Program, Inc.; 2017.


F.2 Influence on safety


The crucial influence of the human element on safety, security and environmental protection has been recognised by the IMO, including in its ‘vision, principles and goals’ for the human element, as set out in IMO Resolution A.947 (23). This acknowledges ‘the need for increased focus on human-related activities in the safe operation of ships, and the need to achieve and maintain high standards of safety, security and environmental protection for the purpose of significantly reducing maritime casualties.’ [1]

This person-centred approach provides the tools and the means to address the human element and mitigate human-system issues. However, there is an increasing tendency in the maritime industry, and in national legislation, to see the human element as only a matter of competence and leadership. This represents the least effective treatment of hazards. Designing out and protecting against are the preferred hazard treatments and more information on this is available in Ch E2.2. These require consideration of the human component of maritime systems when designing ships and ship systems for resilient performance.

Human-systems issues continually change as technology and operational practices change. Reactive regulations and rules that mitigate particular failures associated with reported incidents will not prevent the next incident. Human hazard identification and near-miss analysis are crucial to effective management of the human contribution to incidents. At present neither of these is routine in the maritime industry.


  1. IMO 2003, Resolution A.947(23) Human Element Vision, Principles and Goals for the Organisation, 2003. International Maritime Organisation, https://wwwcdn.imo.org/localresources/en/OurWork/HumanElement/Documents/A947(23).pdf

F.3 Ergonomics and Health Hazards




Many of the physical health hazards to which seafarers are exposed on board differ little from those to which workers are exposed ashore and include:

  • Biomechanical hazards that put seafarers at risk of musculoskeletal injury:
    • Injuries to the trunk when handling heavy equipment such as pumps and nets, sometimes exacerbated by the necessity to adopt stressful postures in confined spaces below deck.
    • Injuries to the distal extremities caused by vibration, high forces or fast repetition of movement with additional risks due to backlash from winches or pulleys
    • Injuries due to slips, trips and falls or being struck by moving objects
  • Exposure to stressful environmental conditions when working on deck, for example, heat, cold, strong winds, noise.

These hazards are discussed in detail in recent publications and within the textbook in Chapter E2.

Specific hazards

Seafarers are also exposed to additional hazards that are particular to working at sea. These include

  • vessel motion
  • fatigue associated with long voyages
  • sleep disruption/disturbance when working watches
  • psychosocial stressors
  • safety issues introduced or exacerbated by technological changes.


Vessel Motion 

Pisula et al identified vessel motion thresholds for maintaining physical and mental performance in a study of naval personnel at sea[1]. The motions of interest were those arising from the interaction between the vessel and the external environment, including the sea state. Vibration from machinery and equipment was not part of the study. Personnel completed daily diaries while deployed in ships fitted with motion sensors. The physical effects of motion recorded were:

  • Problems carrying and moving things
  • Balance problems
  • Sleep disturbed by motion
  • Physically tired
  • Mentally tired
  • Abandoning tasks because of ship motion

In addition, the cognitive effects of motion were:

  • Problems making decisions
  • Issues with stomach awareness
  • Taking too long to finish tasks
  • Making mistakes

Figures 1 and 2 show the odds ratios (OR) for any physical or cognitive problems with different levels of deck motion. It is clear that a maximal OR of 6 occurs at 0.45 ms-2 rms. That is, physical problems were six times more likely to be reported when the 6-hour rms acceleration was 0.45 ms-2 or greater.

Ship motion amplifies the risks associated with all of the biomechanical hazards listed above and the cut-off value at which the risk increases rapidly is 0.45 ms-2 rms. This information is potentially useful for the designers of smaller vessels and, given suitable instrumentation aboard, might be of use to Masters for scheduling tasks. Over longer periods, motions of this magnitude may cause sleep disruption/deprivation.

Figure 2 shows the threshold for cognitive effects of vessel motion.

When the same analysis is performed for ‘cognitive effects’, an OR of 3.6 at is seen at an az,6h(max) of 0.55 ms-2 or greater. This indicates that the cognitive effects are less sensitive to motion than the physical effects.


Figure 1. Odds ratios for likelihood of any problems being reported with 95% confidence intervals for ‘physical effects’ as a function of the maximum 6-hour rms acceleration in the z-axis over the preceding 24 hours (pooled data from 779 daily diary responses). From: Pisula, P.J., Lewis, C.H. and Bridger, R.S. 2012. Vessel motion thresholds for physical and cognitive performance. A study of naval personnel at sea. Crown Copyright, contains public sector information licensed under the Open Government Licence v2.0.


Figure 2 Odds ratios for likelihood of any problems being reported with 95% confidence intervals for ‘cognitive effects’ as a function of the maximum 6-hour rms acceleration in the z-axis over the preceding 24 hours (pooled data from 779 daily diary responses). From: Pisula, P.J., Lewis, C.H. and Bridger, R.S. 2012. Vessel motion thresholds for physical and cognitive performance. A study of naval personnel at sea. Crown Copyright, contains public sector information licensed under the Open Government Licence v2.0.

Sleep Deprivation

Sleep deprivation has an indirect effect on the performance of many tasks and deficits are often not observed until an adverse event occurs. The main effect is to increase the effort required to maintain a given level of performance and to reduce the capacity to monitor one’s actions in relation to one’s intentions[2]. In 2009, Gould et al.investigated the effects of 60-hours of sleep deprivation on the high speed navigational performance of offshore patrol craft[3]. There was no effect on performance using either pencil and paper charts or an Electronic Chart Display Information System (ECDIS) although participants experienced more micro-sleeps using ECDIS suggesting lower arousal. Participants compensated for sleep deprivation by reducing speed. More information on sleep deprivation in the maritime environment is available in Ch xx.


Fatigue is not the same as feeling sleepy. The latter is caused by a lack of sleep, sleep disruption or being awake when one is normally asleep. According to Bridger (2018),fatigue is a consequence of work that lowers the capacity for work of the same kind. To impugn a state of fatigue is to imply the accumulation of some kind of deficit in the resources required to maintain performance. Work of the same kind is work that requires the same resources. Fatigue, therefore is specific to an activity whereas sleep deprivation leads to a general deficit that affects the performance of most tasks.  In 2010, Bridger and Brasher investigated fatigue in seafarers on two occasions, either side of a period of 1-2 months at sea[4]. Even in those with physically demanding jobs, the main work factor associated with fatigue was frustration. There was no relationship between age and fatigue, which may be evidence of a survivor effect, but fatigue was greater at the second assessment.

Work Ability

Demographic changes in society are reflected on board ship. In some countries, seafarers are getting older and the prevalence of overweight or obese seafarers is increasing. A study of work ability of the crew of a vessel in the Mediterranean[5] demonstrated that work ability was found to decline with age, as expected, and was lower in obese seafarers than those of a healthy weight. A statistical model found work ability to decline at age 46 years in the obese compared to 56 years in those with a healthy BMI – an accelerated decline of 9 years in the obese.

Ergonomics design principles and processes (Earthy)

Ergonomics is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimise human well-being and overall system performance.

The following list presents the collated requirements of ISO 26800[6] and 9241-210[7]. Together these specify the fundamental principles of ergonomics and ergonomic design, required project activities and required organisational management activities.

  • Identify and describe the environment in which a system, product, service or facility is intended to be used, taking full account of the nature of the task and its implications for the human.
  • Design for the target population and the whole user experience.
  • Drive and refine the design by user-centred evaluation and use of established ergonomic criteria.
  • Include multi-disciplinary skills and perspectives in the design team.
  • Consider human-system issues and the relative importance of ergonomics/human factors early and continuously in the project
  • Identify user needs and specify the user requirements based on an explicit understanding of users, tasks, interactions and environments.
  • Establish ergonomics criteria for the design.
  • Include ergonomics and user requirements in design solutions.
  • Take account of ergonomics criteria in conceptual and detailed design.
  • Prevent negative effects by application of ergonomics principles.
  • Identify appropriate methods and resources for human-centred design activities.
  • Integrate these activities and their outputs with other system development activities.
  • Feedback and communicate on human-centred design activities as they affect other design activities and trade-offs.
  • Include and integrate human-centred design into the overall project plan and all phases of the product life cycle.
  • Integrate milestones for human-centred activities into the overall design and development process.
  • Allocate time for iteration and the incorporation of user feedback, and for evaluating whether the design solution satisfies the user requirements
  • Identify the range of skills and viewpoints required.
  • Involve workers or users (or potential workers or users) in the process
  • Make individuals and organization(s) responsible for the human-centred design activities.

Additional information

Further, general information about ergonomics and the Human Machine Interface (HMI) can be found at:

Ergonomics risks associated with operations (Earthy and Vu)

ISO 6385:2016[8]Ergonomics principles in the design of work systems considers human beings as the main factor and an integral part of the system of work to be designed, including the work process, and the work environment. It sets principles and recommendations for the management of ergonomics risks. These principles should be used to ensure that ergonomics is considered in the design and operation of safety and other management systems in order to ensure understandable and workable procedures, checklists, permits, planning, reporting, means of managing problems and selection and use of tools and equipment.


Consider major interactions between one or more people and the components of the work system, such as tasks, equipment, workspace and environment. These interactions create demands on the worker collectively described as the external workload. This results in reactions, called work strain, within the worker that will vary depending on individual characteristics such as size, age, capacities, abilities, skills, etc. Work strain has impairing effects, for example, fatigue generated by work, repetitive strain injury (RSI) and work related upper limb injuries (WRULDs), and facilitating effects such as skill development, that further affect the individual characteristics of the worker in a feedback loop. Ergonomic design optimises work strain by avoiding impairing and promoting facilitating effects. Unimpaired human performance improves system effectiveness and efficiency.


Employ Ergonomics as a preventive function throughout the lifecycle rather than to solve problems after design is complete. The most important decisions that have consequences in the design are made at the beginning of the design process, for example, minimisation of high-risk activities such as working at height or in confined spaces, so particular attention should be paid to the application of ergonomics principles in the earliest stage of work system design. Although Ergonomics fits well into project risk assessment it can also be successfully employed in the redesign of an existing, unsatisfactory work system such as optimising heavy and awkward lifting or movement, adequate illumination, more usable equipment, re-design of information.

Involvement of workers

Involve workers in a participatory manner at all stages. The experience of workers provides an indispensable knowledge base. Work to construct, maintain, operate, and supervise each requires different considerations. In accordance with a human-centred approach, workers should be involved and should participate in the design and operation of work systems. This includes toolbox talks, allocation of sufficient people for a task and cross checking as work is carried out.

Target population.

The need for the development of special solutions for individual workers can be minimized, and the accessibility of the work system improved, by considering the needs of people with the widest expected range of abilities and in the range of foreseeable operating situations.  and applying ergonomic principles to ensure that work systems are accessible to them. Such operating situations include normal, disturbed and degraded functioning. At the same time solutions should meet the range of size and strength required, particularly for PPE and access openings.  Good luck and superhuman performance should never be expected, while fatigue, distraction and misunderstanding must be taken as everyday events. 

Operating conditions.

The variety of operating conditions encountered includes but is not limited to:

  • repetitive actions,
  • time pressure,
  • multiple, conflicting demands,
  • enclosed space entry,
  • effects of low manning,
  • lone working,
  • availability in emergencies,
  • dealing with consequential injuries,
  • use of PPE and dealing with PPE failures.

The exacerbation of effects by delay, lack of fitness and stress should also be considered.

On a day-to-day basis toolbox talks should address practical issues such as

  • what's broken,
  • people's experience and worries,
  • are they fatigued, preoccupied or carrying injuries,
  • the language(s) of the team,
  • what needs checking,
  • expected workload from tasks,
  • other tasks that have to be done at the same time, and
  • what to do if something goes wrong.

The National Institute for Operational Safety and Health (NIOSH) hierarchy of controls[9] criticises the use of administrative controls and PPE when hazards are not well controlled and proposes the removal of hazards as the best solution.

The UK P&I Club's Consolidated Risk Focus publication presents an analysis of major risks at sea and recommendations for mitigation[10]. Many of these hazards are related to procedural human factors.

Many aspects mentioned here are covered in greater depth in other chapters of the Textbook.

Ergonomics risks associated with the design of the ship (Vu)

The consideration of physical capabilities and limitations of the crew as part of the design of a ship is rarely addressed in the training and education of naval architects and marine engineers. The design and construction of ships and marine equipment still aims primarily to comply with existing regulations which, in turn, were established because of frequent and serious injury or long-term incapacity such as falls from height or hearing loss. This lack of a pre-active approach in design practice is evidenced in several ship designs that do not address key areas.

Areas to be considered

  • easy movement around the ship,
  • layout of work areas to suit the work,
  • adequate ventilation,
  • obtrusive noise,
  • suitability of lighting,
  • quality of accommodation,
  • provision of recreation facilities,
  • number and design of confined spaces,
  • signs and markings,
  • access and egress arrangements,
  • size and strength of seafarers (anthropometrics),
  • ease of cleaning and maintenance.

In addition there are specific concerns regarding the:

  • location of sanitation,
  • access to potable water in accommodation,
  • quality of accommodation and recreational areas,
  • transient noise,
  • hazardous manual handing,
  • fall protection arrangements,
  • position of valves and maintenance access in engine rooms,
  • size and location of manholes.


The lack of consideration for ergonomics in ship design can cause negative consequences, inducing:

  • slips, trips and falls,
  • pinching/trapping (especially of hands),
  • work-related back and upper limb disorders,
  • fatigue/disturbed sleep,
  • poisoning,
  • asphyxiation,
  • long-term medical effects,
  • motion sickness,
  • vibration,
  • noise,
  • head trauma,
  • kidney stones,
  • low fitness levels and
  • reduced morale brought about by a perception of lack of concern for seafarers evidenced by the quality of both accommodation and the working environment.

Many of these topics are discussed elsewhere in the Textbook.

Future Trends in ergonomics

Increased automation on board will reduce or eliminate many of the traditional health hazards of working aboard ship. New hazards may emerge such as social isolation on board very lean-manned vessels and boredom amongst Masters of highly automated or remote operated vessels. Fully remote-operated ships will introduce new issues that may or may not represent health hazards. These include determining optimal work roles and work loading and finding flexible and appropriate ways of allocating functions to automation or operators. See section C.7.1 and Chapter F.4.9 for a summary of issues 

[1] PJ Pisula. CH Lewis & RS Bridger. 2012. Vessel motion thresholds for maintaining physical and cognitive performance: a study of naval personnel at sea, Ergonomics, 55: 636-649.

[2] Bridger RS. 2018. Introduction to Human Factors and Ergonomics, 4th Edition. CRC Press, Boca Raton, Fl, pp 729

[3] Gould KS. Hirvonen K. Koefoed VF. Roed RK. Salinen M. Holm A.  Bridger RS. Moen BE. 2009. Effects of 60-hours of total sleep deprivation on two methods of high speed ship navigation. Ergonomics, 52:1469-1486.

[4] Bridger RS  Brasher K Dew S. 2010. Work Demands and Need for Recovery From Work in Ageing Seafarers. Ergonomics, 53:1006-1015.

[5] Bridger RS. Bennett AI. 2011. Body mass index interacts with age to determine work ability in seafarers. Occupational Medicine, 61(3): 157-162

[8] ISO 6385:2016 Ergonomics principles in the design of work systems. https://www.iso.org/obp/ui/#iso:std:iso:6385:ed-3:v1:en

[9] https://www.cdc.gov/niosh/topics/hierarchy/default.html

[10] https://www.ukpandi.com/knowledge-publications/publications/article/risk-focus-consolidated-2016-134790/

F.1 Introduction



Ergonomics, medical, psychological and behavioural science perspectives on seafaring align with each other, as all are person-centred. They are concerned with enhancing interfaces with task-based aspects of work, with threats from disease or distress and with interactions with other people respectively.  

This volume brings together a series of contributions, which consider key aspects of person-centred ergonomics, psychological and behavioural sciences approaches to some current concerns in maritime health. It also includes a section on health promotion, as this is heavily dependent on insights from the behavioural sciences.

The management of ships is a very old skill. There is an almost unique management structure.  Traditions relating to work at sea are very strong and they define the knowledge, responsibility and authority required. New systems and ways of working have to be introduced carefully and, in many cases, this is not done in a sympathetic way, leading to inefficiencies or sources of error.

The seafaring culture is complex involving maritime traditions, complex personal motivations, and multilingual, multi-cultural crews. National culture has a strong influence, especially in senior operational and engineering roles. Problem solving, conformance to procedures, perception of risk and response to emergencies are all influenced by cultural and psychological issues. More information on these topics is available in Ch. F.4. However, both onshore support for ships, their design and on-board equipment rarely takes account of these issues. Therefore, risks are built into maritime operations. Application of ergonomic principles at the design stage can remedy these shortcomings as outlined in the checklist later in this chapter.