Physical and Mental Health

Given the working and living conditions and numerous stress factors discussed above, it is not difficult to see that life at sea is harsh, both physically and mentally. Consequently, seafarers’ physical and mental health is a concern in the industry (Bloor et al. 2000). For example, fatigue is reported to have chronic negative effects, such as disorders related to sleep, metabolism, and the cardiovascular and gastrointestinal systems, among others (Jepsen et al. 2015).

In terms of the most serious problem, fatality, a piece of research suggested that Danish fleet seafarers were about six times more likely to die from occupational accidents compared with Danish workers ashore in modern days (Borch et al. 2012; Hansen 1996). Robert and Marlow’s (2005) research suggests that, during the period from 1976 to 2005, the fatal accident rate in the British merchant fleet was double that of Royal Fleet Auxiliary

• 102 Working at sea and the challenges
• (RFA) shipping, and that the fatal work-related accident rate in the British merchant fleet was about four times that of the RFA rate. Based on official statistics during the period of 2003-2012, a more recent study (Robert et al. 2014) shows that the rate of mortality due to accidents in the British merchant fleet was 14.5 per 100,000 - 21 times of that in the general workforce,
• 4.7 times of that in the construction industry, and 13 times of that in the manufacturing sector.

Regarding serious injuries and illnesses, Abaya et al. (2015) examined the repatriation data from 12 manning agencies in the Philippines. In total, their data consisted of 6,759 medically repatriated cases out of 338,963 deployments recorded between 2009 and 2014. These cases were from 2,256 vessels of 174 different shipping companies globally. The data showed that

1.7 percent of Filipino seafarers were repatriated due to medical reasons (see Table 6.4).

Among these, the top five causes were injuries (21.4 percent), musculoskeletal problems (19.4 percent), gastrointestinal problems (17.1 percent), genitourinary issues (8.9 percent), and cardiovascular concerns (8.1 percent).

Needless to say, repatriation is associated with severe health problems. To include more general health issues, Lefkowitz et al. (2015) examined the four-year record of reported injuries and illnesses on a sample of 1,322 ships (during the period from 2008 to 2011). The data showed that illness cases (n = 2,764, 70.5 percent) were more common than injury cases (« = 1,157,29.5 percent). Ratings had a significantly higher overall injury rate than officers (see Table 6.5). By contrast, the difference between the two groups regarding the rate of illness was much smaller.

Table 6.4 Medical repatriation cases and rates of Filipino seafarers

Source: Abaya et al. (2015).

Table 6.5 Rate of reported incidents (per 100 person-years)

Lefkowitz et al. (2018) further examined the reported injuries and illnesses from a sample of American seafarers from January 2014 to July 2016. The results similarly showed that illnesses were more frequently reported than injuries. While the overall injury rate was 113 per 1,000 person-years, the overall illness rate was 211 per 1,000 person-years. Compared with their previous study (Lefkowitz et al. 2015), the rates of reported injuries and illnesses among American seafarers were higher than those of the global seafarers.

According to Lefkowitz et al. (2018), the injury rate in the shipping industry was higher than that in other transport sectors. In terms of illness, a large body of literature on occupational health of seafarers from the Nordic countries (Norway, Finland, Denmark, and Sweden) has indicated that, compared with the general population, seafarers are more susceptible to work-related cancer, chronic diseases such as ischemic heart disease, hepatitis, diabetes, and musculoskeletal problems due to their working conditions; they were also more likely to contract infectious and sexually transmitted diseases such as malaria and HIV (for a review, see Bhattacharya 2009).

More recently, the mental health of seafarers has been thrust into the spotlight. More often than not, mental health problems are not reported, as explained by the UK Chamber of Shipping:

It’s difficult to know how many people have been affected by mental health issues while working at sea - it’s still an issue ‘hidden’ behind stigma. This might be explained by a certain culture of ‘machismo’ among seafarers, where any form of illness is perceived as weakness.³

In this context, questionnaire studies of active seafarers may capture some of the unreported health problems. The international maritime charity Sailors’ Society and Yale University conducted a questionnaire study of more than 1,000 seafarers. Over a quarter of the respondents stated that they felt ‘down, depressed, or hopeless’ on several days over the previous two weeks; and about half of those who reported symptoms of depression said they had not asked anybody for help. Sampson et al. (2017) conducted two surveys of seafarers’ health, one in 2011 with a sample of 1,026 active seafarers and more recently in 2016 with 1,523 seafarers. In the 2011 survey, 28 percent of the respondents indicated the presence of a ‘psychiatric disorder,’ while in 2016, 37 percent of the respondents did so. Andrei et al. (2018) conducted a survey with 1,026 seafarers from a sample of ships regularly visiting Australian ports. In this survey, about 40 percent of the respondents reported experiencing mental health problems (depression and anxiety) at least sometimes, and around 10 percent of them reported experiencing these problems often. Furthermore, this survey found that seafarers were more likely to experience mental health problems when they were suffering from chronic fatigue and sleep problems and working in demanding roles; conversely, they were less likely to experience mental health problems in the presence of a stable crew (regularly working with the same crew members). The more recent Seafarer Mental Health Study (Lefkowitz & Slade 2019) shows that mental health problems were associated with an increased likelihood of injury and illness while working at sea as well as with an increased likelihood of planning to leave work as a seafarer in the next six months.

In extreme cases, depression leads to suicide. The UK P&I Club announced in 2017 that ‘suicide rates among seafarers suffering from poor mental health have more than tripled since 2014 according to figures from the UK P&I Club’s internal claims system.’ (Laursen 2018). The data collected by Sampson and Ellis (2019) from five P&I Clubs and the HR managers of 43 shipping companies did not agree with the trend identified by the UK P&I Club, however. According to this data, the numbers of reported mental health cases and suicide cases has remained stable and low over the past ten years or so, and mental health problems accounted for between three and 5 percent of medical repatriations. As such, Sampson and Ellis (2019) noted that ship management companies were, in general, not particularly concerned about mental health problems, and that 55 percent of the HR managers stated that their company had not introduced any new policies or practices relating to seafarers’ mental health in the past ten years.

Nevertheless, even if the situation remains the same, poor mental health and its consequences still deserve serious attention. Therefore, stakeholders in the industry, such as seafarers’ charities, the media, and the research community, have become increasingly concerned with mental health problems at sea. It has been identified that the factors discussed in this chapter - such as separation from family, family related problems, lack of shore leave, fatigue, fear of criminalisation and pirate attacks, and bad relationships with colleagues - contribute to poor mental health (Iverson 2012; Melbye & Carter 2017; Sampson & Ellis 2019). Based on a questionnaire study of 1,507 seafarers, Sampson and Ellis (2019) also explored factors that made seafarers happy on board. According to the data, social activities on board such as parties, team sports, barbecues, karaoke, and social drinking together were identified by 1,327 respondents; individual activities, such as going to the gym, reading, listening to music, and so forth, were reported by 490 respondents; and other factors included general working conditions such as salary and weather (466 respondents), shore leave (133 respondents), good relationships on board (129 correspondents), and the ability to communicate with the outside world (100 respondents). In line with these findings, Sampson and Ellis (2019) call on shipping companies to take care of seafarers’ mental health and wellbeing at sea by adopting measures to improve the factors that make them happy.

The Implications of Working and Living Conditions

This chapter has presented and discussed a number of issues related to working and living conditions on ships. Due to these issues, seafarers are likely to feel lonely, socially isolated, stressed, fatigued, threatened, and like they are being blamed. Understandably, they have health and safety implications, as discussed in this chapter; compared with shore-based occupational groups, occupational health and safety records of seafarers are poorer. Furthermore, these issues also likely discourage people from entering into the profession and push some to leave sea at an early stage of their careers (European Commission 2020; Gekara 2009; Papachristou et al. 2015; Tang & Zhang 2019). In other words, they pose challenges to recruitment and retention in the industry. The next chapter will explore the recruitment and retention challenges further, and will also examine and discuss the strategies shipping companies have been taking to manage them.

Notes

• 1 A shore pass is valid for 29 days. If a ship has stayed in the US for more than 29 days, shore passes issued to the seafarers on this ship expire and a new one can be issued only when the ship sails to a foreign country and comes back again.
• 2 When seafarers join vessels in US ports, they enter the US on transit visas. Once they arrive at their vessels, their transit visas fulfil their purpose and are no longer deemed valid.
• 3 See https://www.ukchamberofshipping.com/latest/online-mental-health-support- helping-uk-seafarers/.