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Medical standards and worldwide
acceptance of seafarer health certificates


                     Tim Carter
       Norwegian Centre for Maritime Medicine
        UK Maritime and Coastguard Agency
      International Maritime Health Association
Who determines seafarer
      medical standards?
 ILO/IMO – international conventions
 National maritime/health authorities

  aligned with national practices/laws
  and international conventions –
  output statutory certificate of fitness.
 Employers/ P&I clubs – non-statutory
  standards as part of selection for
  employment.
Why are there two parallel systems?
What is the purpose of
           standards?
   Statutory – safeguard maritime
    safety and minimise risk to
    individuals. Detail endorsed in
    political process involving social
    partners.
   Employer – as statutory + reducing
    costs of illness at sea, repatriation
    and compensation. Set unilaterally
    by employers,insurers.
What may standards cover?
   The conduct of the examination –
    valid, consistent, fair, ethical,
    economical.
   The criteria for specific impairments
    and medical conditions.
   The process of taking decisions on
    fitness.
   The issue of a certificate of fitness.
   Appeal arrangements.
Perspectives (maritime health)
   Procedures and protocols of International
    Agencies (ILO, IMO,WHO)
   Governments (maritime – national and open register,
    health, social security)
   Employers, agents, insurers etc.(HR, crewing,
    design, supply , P and I)
   Seafarers, trade unions etc.(working conditions,
    equity, members benefits, claims)
   Subject experts (risks, remedies – evidence,
    effectiveness)
   Professional bodies (good practice – jobs,
    income, status)
Drivers for international
               action
   Move from national to global crewing,
    management, sourcing (fitness, repatriation)
   Move from integrated owners/employers to
    contract management (less recruitment for
    defined careers, QA needs)
   Inequities in risk and working conditions
    (‘good and bad’ flags)
   Inefficiencies in current arrangements
    (duplication – certification, costs of poor
    decisions)
   Fairer basis for international competition (
    less variation in crewing costs, social security needs)
Building on the past
   National arrangements – traditional
    maritime nations and newer ones.
    ‘Protected’ and global flags
   Previous ILO, IMO, WHO initiatives
   Attitudes of employers, unions and
    governments to health of seafarers
    and its regulation
   Place of and trust in health advisers
Maritime health - scope
 Fitness to work at sea – maritime
  safety, personal ‘risk’, corporate
  financial risk.
 Managing medical emergencies at sea

 Onshore care, rehabilitation and repatriation
 Health education and promotion – personal,
  environmental
 Safe and healthy working conditions
 Passenger risks
 Infections and spread

At interface of ILO, IMO and WHO
IMO approach
   STCW revisions. Sight and hearing
    +physical capability (1995 on). General
    criteria for fitness added (2012). Reluctance
    to accept mandatory capability criteria,
    acceptance for vision.
   STCW about issue of certificates –
    dominance of these as communication
    mechanism
   Did not wish to be involved in 1997
    ILO/WHO Guidelines on medical
    examinations. Now participating in
    revisions.
IMO key text
STCW 2012 A-1/9
 Vision (standards)

 Physical capability (recommendations)

 Hearing and speech (recommendations)
 No impairing medical condition

 No medical condition aggravated,
  leading to unfitness or risk to others
 No impairing medication

Procedures for examination and
certification
ILO approach
   MLC consolidated many earlier
    conventions. Parallel convention on
    fishing
   Health scattered through MLC:
    certificates, medical care on board, care
    and repatriation, working and living
    conditions (weak on smoking, diet)
   Social security issues: keep the doctors
    out!
   Leading role in supporting guideline
    development 1997 and now.
ILO key text
MLC 1.2 medical certificate procedures
Hearing and sight

No medical condition aggravated,

leading to unfitness or risk to others
MLC 2.5 medical repatriation
MLC 3.1 – 2 accommodation, food
MLC 4.1 – Medical care aboard
MLC 4.3 – occupational health and safety
Developing good practice –
medical examination guidelines
   Text from MLC and STCW 2012 as basis.
   Shortcomings of 1997 Guidelines
   Experience of authorities and others
   IMHA w.g. on medical fitness criteria
   Special Adviser to ILO developed draft text
   Working group to review and modify – 2
    meetings 2010 and 2011.
   Co-ordinated endorsement by ILO and IMO
    now in progress.
Users of Guidelines
 Maritime Authorities in preparing national
  regulations
 Maritime Authorities in adopting text as
  national law.
 Examining doctors as issuers of certificates

Will they make for more acceptance of
  certificates internationally and by
  employers? Text + application in practice.
Supporting initiative – QA of examiners,
  additional professional guidance, training
  for examiners, ethical framework.
Conventions, Guidelines and
   mutual acceptance of
        certificates.
   Anticipate agreed international medical examination
    framework that is detailed enough to be adopted
    unchanged by flag states. National laws that comply with
    conventions are the basis for certificate issue.
   If framework used then barriers to free movement of
    seafarers reduced- provided states, employers and
    seafarers accept the advantages of a common and well
    founded basis for certificate issue.
   Less chance of either unjustified discrimination or of
    preventable illness and accidents at sea.
   Savings in time and cost.
   Better basis for decision-taking by maritime health
    providers.
Barriers to mutual
          acceptance
   Inertia of maritime authorities
   Maintaining advantage for nationals
   Links to national social security
   Lack of interest by ship operators
    who have their own PEME
    arrangements.
   Lack of international quality
    assurance for conduct of
    examinations and certificate issue.
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Carter seahealth 4 12 tim [1]

  • 1. Medical standards and worldwide acceptance of seafarer health certificates Tim Carter Norwegian Centre for Maritime Medicine UK Maritime and Coastguard Agency International Maritime Health Association
  • 2. Who determines seafarer medical standards?  ILO/IMO – international conventions  National maritime/health authorities aligned with national practices/laws and international conventions – output statutory certificate of fitness.  Employers/ P&I clubs – non-statutory standards as part of selection for employment. Why are there two parallel systems?
  • 3. What is the purpose of standards?  Statutory – safeguard maritime safety and minimise risk to individuals. Detail endorsed in political process involving social partners.  Employer – as statutory + reducing costs of illness at sea, repatriation and compensation. Set unilaterally by employers,insurers.
  • 4. What may standards cover?  The conduct of the examination – valid, consistent, fair, ethical, economical.  The criteria for specific impairments and medical conditions.  The process of taking decisions on fitness.  The issue of a certificate of fitness.  Appeal arrangements.
  • 5. Perspectives (maritime health)  Procedures and protocols of International Agencies (ILO, IMO,WHO)  Governments (maritime – national and open register, health, social security)  Employers, agents, insurers etc.(HR, crewing, design, supply , P and I)  Seafarers, trade unions etc.(working conditions, equity, members benefits, claims)  Subject experts (risks, remedies – evidence, effectiveness)  Professional bodies (good practice – jobs, income, status)
  • 6. Drivers for international action  Move from national to global crewing, management, sourcing (fitness, repatriation)  Move from integrated owners/employers to contract management (less recruitment for defined careers, QA needs)  Inequities in risk and working conditions (‘good and bad’ flags)  Inefficiencies in current arrangements (duplication – certification, costs of poor decisions)  Fairer basis for international competition ( less variation in crewing costs, social security needs)
  • 7. Building on the past  National arrangements – traditional maritime nations and newer ones. ‘Protected’ and global flags  Previous ILO, IMO, WHO initiatives  Attitudes of employers, unions and governments to health of seafarers and its regulation  Place of and trust in health advisers
  • 8. Maritime health - scope  Fitness to work at sea – maritime safety, personal ‘risk’, corporate financial risk.  Managing medical emergencies at sea  Onshore care, rehabilitation and repatriation  Health education and promotion – personal, environmental  Safe and healthy working conditions  Passenger risks  Infections and spread At interface of ILO, IMO and WHO
  • 9. IMO approach  STCW revisions. Sight and hearing +physical capability (1995 on). General criteria for fitness added (2012). Reluctance to accept mandatory capability criteria, acceptance for vision.  STCW about issue of certificates – dominance of these as communication mechanism  Did not wish to be involved in 1997 ILO/WHO Guidelines on medical examinations. Now participating in revisions.
  • 10. IMO key text STCW 2012 A-1/9  Vision (standards)  Physical capability (recommendations)  Hearing and speech (recommendations)  No impairing medical condition  No medical condition aggravated, leading to unfitness or risk to others  No impairing medication Procedures for examination and certification
  • 11. ILO approach  MLC consolidated many earlier conventions. Parallel convention on fishing  Health scattered through MLC: certificates, medical care on board, care and repatriation, working and living conditions (weak on smoking, diet)  Social security issues: keep the doctors out!  Leading role in supporting guideline development 1997 and now.
  • 12. ILO key text MLC 1.2 medical certificate procedures Hearing and sight No medical condition aggravated, leading to unfitness or risk to others MLC 2.5 medical repatriation MLC 3.1 – 2 accommodation, food MLC 4.1 – Medical care aboard MLC 4.3 – occupational health and safety
  • 13. Developing good practice – medical examination guidelines  Text from MLC and STCW 2012 as basis.  Shortcomings of 1997 Guidelines  Experience of authorities and others  IMHA w.g. on medical fitness criteria  Special Adviser to ILO developed draft text  Working group to review and modify – 2 meetings 2010 and 2011.  Co-ordinated endorsement by ILO and IMO now in progress.
  • 14. Users of Guidelines  Maritime Authorities in preparing national regulations  Maritime Authorities in adopting text as national law.  Examining doctors as issuers of certificates Will they make for more acceptance of certificates internationally and by employers? Text + application in practice. Supporting initiative – QA of examiners, additional professional guidance, training for examiners, ethical framework.
  • 15. Conventions, Guidelines and mutual acceptance of certificates.  Anticipate agreed international medical examination framework that is detailed enough to be adopted unchanged by flag states. National laws that comply with conventions are the basis for certificate issue.  If framework used then barriers to free movement of seafarers reduced- provided states, employers and seafarers accept the advantages of a common and well founded basis for certificate issue.  Less chance of either unjustified discrimination or of preventable illness and accidents at sea.  Savings in time and cost.  Better basis for decision-taking by maritime health providers.
  • 16. Barriers to mutual acceptance  Inertia of maritime authorities  Maintaining advantage for nationals  Links to national social security  Lack of interest by ship operators who have their own PEME arrangements.  Lack of international quality assurance for conduct of examinations and certificate issue.