ALF MAGNE HORNELAND
The probably oldest trace of statutory medical standards for seafarers in Norwegian seafaring history can be found in “Magnus Lagabøtes Landslov”[1] (AD 1276) where it was required that men capable of standing a beacon watch are those with healthy eyes, ears, feet, men that are free and of age, able for military service, domiciled and not a foreigner[2].
Requirements for sailors’ ability to work, to see and to hear, came earlier in the military navies than in the merchant navy. Already during the 17th century, one can find traces of such requirements in naval history[3].
In the late 1800s, the Norwegian maritime authority became concerned about merchant seafarers’ health condition[4]. They did not issue requirements for pre-employment medical examinations at this time, but focused on first aid, equipment for treatment of illnesses and dietary requirements.
Norway introduced mandatory pre-employment medical examinations from 1903[5], probably among the earliest requirements for any merchant navy. The requirements were simple: There were demands regarding visual acuity and colour vision, and the seafarer should provide a declaration that he did not present symptoms of malignancy and contagious diseases, including contagious tuberculosis[6].
C.8.2.1 Development by the UN Agencies
During the 20th century, several steps were taken regarding improvement of the regulations on medical examinations. The international process of development was initiated by the ILO shortly after its establishment in 1919[7], with the “Medical Examination of Young Persons (Sea) Convention, 1921 (No. 16), followed by the “Medical Examination (Seafarers) Convention, 1946 (No. 73). These instruments are now incorporated in the Maritime Labour Convention, 2006 (MLC, 2006).
The present Norwegian regulations from 2014 are based on the International Guidelines on the medical examination of seafarers of 2013 from ILO[8] and IMO[9], and the fitness criteria are identical to those of the International Guidelines.
After the International Maritime Organisation was established in 1958, the organisation started to develop qualification requirements. The qualification requirements also included health requirements in the STCW Convention, 1978, with later amendments. These standards focused on eyesight and hearing, as well as recommendations for physical fitness, although not specified in much detail.
Attempts to harmonize the requirements resulted firstly in the Guidelines for conducting Pre-sea and Periodic Medical Fitness Examinations for Seafarers[10] published jointly by the WHO[11] and the ILO. It was, however, not until 2013, that ILO and IMO jointly issued the “Guidelines on the Medical Examination of Seafarers” [12], based on MLC 2006[13] and the STCW Convention[14].
These guidelines have been used by some countries as minimum requirements in the development of national regulations, by other nations directly as they are, without further alteration.
The focus has gradually shifted from being solely concerned about working ability, avoidance of threats to ship operations and other crewmembers, to also including the aspects of advice on medical care and prevention of illness of the seafarer.
C.8.2.2 Regional development: the EU
In parallel to the work in the UN agencies, national and regional authorities started similar processes. The EU introduced statutory standards for medical fitness examination from 31 December 1995[15], based on the qualification requirements of the STCW Convention[16]. The regulations were more of a formal character, making medical fitness a legal requirement of the EU, albeit referring to the requirements of the ‘administration’ (national requirements of a member state). The present legal framework in the EU is the Directive 2008/106/EC[17], still not describing detailed standards, rather referring to member states requirements.
C.8.2.3 Development in seafaring countries
Seafaring countries are, almost without exception, members of the IMO and ILO. Membership responsibilities include implementation of the medical fitness requirements of the MLC 2006 and STCW conventions and, as a consequence, adoption of the International guidelines on medical examination of seafarers. The interpretation of these conventions and guidelines varies somewhat between member states regarding training of approved doctors and quality assurance systems. Some countries refer directly to the international guidelines as mandatory without making national arrangements; others develop complicated systems with national details, guidance and training for doctors, quality systems[18], and measures to prevent forgery of medical certificates[19].
Some countries have approved doctors outside their own borders, e.g. the UK, the Netherlands, Germany and Norway. Other countries rely on the national certificate of the seafarer’s home country.
C.8.2.4 The development of enhanced PEME
The P&I insurers[21] (see Ch. 3.8 and 5.13) had rising concerns regarding the health of seafarers in major manning countries during the last decade of the 20th century[22]. Several of the P&I Clubs carried out projects regarding loss prevention by means of more detailed and so-called ‘enhanced’ programmes for medical examination. Today most P&I Clubs implement such programmes[23].
Contrary to some statutory programmes that require laboratory tests on indication only, the majority of these enhanced PEME programmes include a list of mandatory laboratory tests. Such laboratory tests when used in hospitals or general practices are developed for diagnostic purposes in a clinical setting where there is an indication and a certain pre-test probability. Such tests are not designed for screening a healthy population for possible medical conditions. Despite of this fact, some enhanced medical schemes include many of those tests as mandatory. (See later for a more detailed discussion on the use of such tests.)
In addition to sharing the concerns about safety for ship, crew and the seafarer, the enhanced programmes also include objectives like loss prevention and regularity of operations. As can be expected, they are not congruent with the statutory schemes.
[1] Magnus Lagabøte (Magnus the Lawmender, or Magnus Haakonsson or Magnus VI of Norway) promulgated the national law, “Magnus Lagabøtes Landslov”, a unified code of laws to apply for the whole country, including the Faroe Islands and Shetland.
[2] Kjelstadli, 2003, I; 137
[3] Andersen P 1909 Bidrag til søartilleriets historie. København, Cohen forlag s. 8
[4] Koren E S. Helse til sjøs og i fremmed havn. Tidsskr Nor Legeforen 2007; 127:3259-63. Article in Norwegian.
[5] Koren E S. Helse til sjøs og i fremmed havn. Tidsskr Nor Legeforen 2007; 127:3259-63. Article in Norwegian.
[6] Melbye 1964; 1275
[7] The Labour Provisions of the Peace Treaties (as a part of the Treaty of Versailles)
[8] International Labour Organisation
[9] International Maritime Organisation
[10] Guidelines for Conducting Pre-sea and Periodic Medical Fitness Examinations for Seafarers, published jointly by the ILO and the WHO, 1997
[11] World Health Organisation
[12] ILO/IMO: Guidelines on the medical examination of seafarers; Preface. ISBN: 978-92-2-125097-5 (Web pdf)
[13] Maritime Labour Convention 2006 (MLC 2006) (ILO)
[14] International convention on Standards of Training, Certification and Watchkeeping for Seafarers, 1978 as amended (IMO)
[15] Council Directive 94/58/EC of 22 November 1994 on the minimum level of training of seafarers
[16] International Convention on Training, Certification and Watchkeeping for seafarers 1978, 1995 revision (IMO)
[17] DIRECTIVE 2008/106/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 19 November 2008 on the minimum level of training of seafarers (recast)
[18] Quality system for seafarers’ doctors. Circular series V. RSV 12-2014 of 22/10/2014. Norwegian Maritime Authority
[19] New Regulations on the medical examination of employees on Norwegian Ships and mobile offshore unites. Circular – Series R. RSR 02-2014 of 05/06/2014. Norwegian Maritime Authority.
[20] PEME = Pre-Employment Medical Examination. The term is used to describe the mandatory medical examination prior to being employed for work, or periodically during employment for work.
[21] Protection and indemnity insurance or «P&I insurance» is a form of mutual maritime insurance, provided by a P&I Club covering loss of life and personal injury to crew, passengers and others on board, cargo loss and damage, pollution by oil and other hazardous substances, wreck removal, collision and damage to property. P&I insurance is different from “marine insurance” (H&M – hull and machinery) offering cover for shipowners and cargo owners. The International Group of P&I Clubs website: https://www.igpandi.org/about accessed 2019-04-23
[22] Gard Enhanced PEME programme for Filipino Seafarers is expanding, 2016-07-13. Gard Website.
[23] Gard’s pre-employment medical examination scheme. Insight 178, 2005, 01. May 2005.