TIM CARTER

A.1.4.1 Introduction

There has only been a limited amount of investigation into the health of merchant seafarers and those who work in fishing. This contrasts with the long history of investigations into the health of those serving in the navies of the world.

A.1.4.2 Incentives for health investigations

There are four main groups with some shared and some conflicting interests in the health of non-military seafarers:

Employers of seafarers and their insurers.

Here the priorities are for competent and reliable crewmembers, with minimum health care costs or disruptions to ship operations. Employers are often only interested in short term health problems as employment is frequently for a single period of sea service. They are particularly concerned about medical conditions and injuries that could lay them open to liability claims, either for direct costs or because of health related failures in performance that put the ship and other crewmembers at risk. They may resist studies that they consider are likely to lead to imposed costs or to define new liabilities.

Seafarers themselves and their trade unions.

Their priority is to prevent harm to members, avoid discrimination in employment and ensure effective rehabilitation and return to work after illness or injury. They also aim to secure compensation for those who have been harmed by their work or been ineffectively treated while under contract.

Governmental and international agencies.

Here the prime concern is for maritime safety and for minimising the effects of health problems on this. They may also want to ensure that seafarers on ships of their flag, or covered by relevant international conventions, receive a good standard of care in the event of illness or injury while under contract.

NGOs concerned with the health and welfare of seafarers.

Such organisations are funded by other interest groups or the public, and aim to improve the health and wellbeing of seafarers. Welfare organisations do this by the provision of facilities on board or in ports. Health practitioners prioritise improvements to the evidence base on risks and interventions, while often also providing preventative or treatment services.

These differences in perspective and the associated lack of funding for investigations have inhibited the development of an improved knowledge base on seafarer health. They can also make the planning of any agreed study complex as each group seeks to protect its own interests.

A.1.4.3 The influence of interested parties on the knowledge base

There are a number of ways in which interested parties can improve the knowledge base in maritime health. These include the following.

Information collected but not analysed.  

From the late nineteenth century, most national maritime authorities recorded the deaths of seafarers, mainly for legal reasons. Until more recent times, these records were rarely analysed to look at seafarer risks. The focus of maritime authorities was on maritime disasters and the loss of life associated with them rather than on patterns of illness and injury to individuals. This lack of analysis on personal injuries and diseases does not appear to be deliberate neglect as there were few public demands for such information. However, it certainly avoided both the need to fund studies and the subsequent need to take action on any notable findings.

Evidence needed to make the case for action.

Seafarers encountered medical services in port and clinicians collected a number of case series of illnesses treated. Here there were clear patterns of preventable illness, for instance the continuing prevalence of scurvy in merchant seamen in the 1860s. This information was needed to make the case for quality assurance of the lemon juice supplied to ships as a preventative.

Costly remedial measures inhibited  investigations.

Employers and government were reluctant to investigate the frequency of tuberculosis in British seamen in the 1920s. Eventually pressure by seafarer organisations and the persistence of a few health professionals led to studies that showed a big excess, but these were largely restricted to those who had recently stopped working at sea because of early signs of the disease. The unwillingness to acknowledge this problem was almost certainly because of the cost implications of providing more spacious and better-ventilated crew accommodation.

Short windows of opportunity for investigation.

There were periods where, for political or strategic reasons, the health of seafarers became more highly valued. Norwegian seafarers were the one group of Norwegians who lost their lives in great numbers during the First World War, despite national neutrality. After the end of the war, the Norwegian Red Cross and other agencies took steps to improve the provisions for seafarer welfare and healthcare, while at the same time investigating the nature and scale of need. Further information on this is available in Ch 2.3.2.3.
During the Second World War, there were shortages of seafarers to crew Allied merchant ships and this threatened the supply of food and war materials. New employment arrangements were put in place, with improved port welfare. Data on the causes of unfitness was collected and targeted strategies were developed to reduce the frequency of illness. These focused on specific disabling conditions such as malaria, venereal diseases and tuberculosis.

Employers and their insurers keep information secret.

Both are keen to reduce the frequency of illness in their crewmembers. They have used information on the illnesses leading to repatriation to shape programmes for the selection of crew, however they have failed to make the findings from these publically available and have often built a framework of restrictions on employment based on their unverified findings. Further information on the medical selection of seafarers is available in Ch 4.8.

Occasionally employers or states have funded investigations or reviews that aim to reduce risk. In 1911 the British maritime authority funded experimental investigations to determine the best means of identifying those seafarers who could endanger ships because colour vision deficiencies prevented them recognising red and green navigation lights. The findings from this study led to improved methods of testing that reduced risk, while minimising unjustified discrimination and loss of job opportunities.