Requirements for lorry drivers are specific in terms of safe working, but also draw on many commonly used occupational health techniques, says Diane Romano-Woodward.
In January this year, the National Institute for Occupational Safety and Health in the US published the findings of a 2011 survey of 1,670 long-haul truckers. Compared with the adult working population, they were found to be twice as likely to be obese (69%) and more likely to smoke (54%).
In terms of the long-term chronic disease risk factors, 88% reported suffering from at least one, such as hypertension, smoking and obesity. Sixty-one per cent reported having two or more of the following risk factors: hypertension; obesity; smoking; high cholesterol; no physical activity; or six or fewer hours of sleep per 24-hour period. (Sieber et al, 2014).
An analysis of 2,000 road accidents involving collapse at the wheel showed that heart disease accounted for 8% and 23% were caused by unexplained blackouts, of which some may have been of cardiovascular origin; 76% of accidents involving drivers with heart disease occurred in those who were already diagnosed, therefore approximately a quarter were due to previously unrecognised heart disease (Petch, 1998). The potentially catastrophic outcome of the collapse at the wheel of a trucker is worthy of prevention activities.
Occupational health (OH) professionals could probably hazard a guess at some of the other health issues of UK lorry drivers from experience or knowledge. These would be identified as musculoskeletal problems from manual handling loads as well as poor ergonomics of the driving position.
Shift work and the difficulties of working away from home may be linked to low mood and other issues of mental wellbeing. Lack of control over food that is available can often lead to obesity and associated problems such as sleep apnoea and diabetes. Static postures while driving for hours at a time and lack of exercise may lead to cardiovascular issues such as high blood pressure and raised cholesterol (Blood Pressure UK, 2008; Davis, 2007).
Assessment is essential
To accurately identify the health issues that may occur, and consider remedial action, it is useful to undertake a Health Needs Assessment (HNA). Health needs are those that can benefit from healthcare or from wider social and environmental changes.
An assessment is a systematic approach to identify the health problems of a population, identifying inequalities in health and access to services (OH and NHS) and to assist in the use of resources to improve the health of the population in the most efficient way.
In order to undertake an HNA, there is a requirement for an understanding of what is involved, as well as the time and resources required to undertake the assessment. Time and effort will also be required to integrate the results and actions into the planning of OH service provision and persuading key stakeholders, such as managers, budget holders, safety colleagues and indeed the workers themselves, that the changes will bring benefits (Wright, 1998). There may be more success in “buy in” from these groups if the outcome is linked to health-and-safety risk assessments and legal requirements or guidance, rather than as general health promotion.
For those new to the subject there is information available from a variety of sources, but it may not be specific to the working population (NICE, 2002; NICE, 2005; WHO, 2001), such as an overview of the process “Summary: the Five Steps of health needs assessment” (NICE, 2005, p5). For working populations, the Department of Health’s East Midlands Public Health Observatory published “Workplace Health Needs Assessment for Employers (2012).
Initially, the health needs assessment can look at existing information sources providing indicators of staff health (NICE, 1999). This might include the following points.
1. Staff profile broken down by age, gender, ethnic group, profession, work location.
This would allow for indentifying age-specific health issues such as benign prostate problems which may lead to urinary issues. There is a campaign for improved toilet facilities for truckers, run by the Irritable Bowel Syndrome Network (IBS, 2014), as well as several Facebook groups (2014).
There is also a two-fold increase risk of coronary heart disease in some South Asian groups in the UK, compared to the general population (British Heart Foundation, 2014).
2. Sickness absence: reasons, numbers, duration. The Health and Safety Executive (HSE) recommends assessment of health after absences of more than one month or after a shorter absence if it is likely that the illness will affect the worker’s fitness to operate machinery, such as workplace transport. If a GP suggests that a worker is fit to return to work, it may not be the same as fitness to operate workplace transport (HSE, 2014 and 2013) (see box 1).
3. Accidents – the accident /incident/near-miss record can be reviewed to identify particular issues such as back problems, knee problems from jumping out of the cab, and immediately engaging in manual handling without warming up. There are also risks such as hand injuries and trapped fingers when moving cages of goods or doing up the clips on the side curtains.
It is possible to gain information from industry-specific research. Two types of accidents were identified as particularly common in the transport of roll cages: the cages falling from delivery vehicles; and drivers falling from the vehicles during loading and unloading (HSE, 2011). The Health and Safety Executive of Northern Ireland has produced useful short videos of safe manual handling in a variety of situations. (HSENI 2012).
4. Ill-health retirements/early retirements/OH referrals, including number, reasons and cost to the business. One OH adviser tells of other difficulties when the referral is for fatigue but no underlying health issues are found that contribute to this. It is then up to management to assure themselves at the start of each shift that the driver is able to undertake the run safely. This can be by questioning the individual about their current fitness/fatigue, observing them manoeuvring the vehicle in the yard and documenting that they have done this.
5. Staff appraisals: any feedback relevant to health. For example, deliveries to stores may be required at specific timed intervals and there may be financial penalties to the transportation company if the delivery time is missed. This may be reported back to the individual as a performance issue; but may be identified as related to health if, for example, the delay was caused by the requirement for toilet breaks or to get out of the vehicle and stretch.
6. Employee assistance programmes/counselling uptake. Anonymous details of uptake rate and reason for access, the nature of the assistance given and the cost to the business can identify issues such as problem with particular shift patterns and the impact of work on family life. It appears that some workers chose night work so that they can care for children during the day, but may then not get enough sleep.
7. Observation of the working environment, such as the ergonomics of the cab and living facilities if the cab is used for sleeping. Basic hygiene may be a problem if the driver is living in the vehicle, with limited access to showering and hand-washing facilities. The use of portable urinals and hand sanitising gels/sprays may be of benefit. With regards to ergonomics, advice may be available from ergonomic specialists regarding driving position, but this requires that individuals adjust their seats which may not be an established habit. The document produced for the Highways Agency by Loughborough University gives photographic guidance on the subject (Highways Agency, 2007). The vehicle manufacturer may also provide useful information (Scania, 2006).
8. Other sources: complaints, insurance claims and grievance procedure information may all be used to identify health needs in an organisation.
Clearly, if individuals are going to be asked about their health, then representatives from the group will need to be involved in the planning stages. They will need to have a good understanding of why the health needs assessment is being done, how the information will be used (particularly if individuals can be identified as having a health issue) and the likely prospect of activities identified in the assessment that are designed to improve health actually being implemented. As there is likely to be a cost in terms of resources and worker time away from work activity during screening, management will need to be involved and committed to the assessment.
Imperial Health at Work (2014) has identified 10 benefits for organisations that might be used to persuade them of the cost effectiveness of heath assessment in accident prevention.
There should be agreement about what will happen if a person is found to be unfit to drive during the assessment. For example, if hypertension is found, the worker may be temporarily unable to work until seen by his or her GP and a treatment programme put in place. The driver may not have the necessary skills that would allow temporary redeployment into an office environment.
It might be possible to double crew to allow another person to drive, while the affected worker helps with the manual handling; however, this may not be possible and is unlikely to be feasible for extended periods. For this reason, workers may be reluctant to come forward for health assessment, particularly if they feel that the Group Two entitlement (and therefore their job) is at risk. (For details of health requirements for Group One and Group Two drivers see DVLA’s “At a glance guide to the current medical standards of fitness to drive”, updated in 2013).
Self-assessed health status
An anonymous questionnaire may be distributed and returned on a voluntary basis; this may be more acceptable to drivers and will provide some useful data. The basics in preparing such a survey are outlined in the 2012 Department of Health document.
It is important to use a validated questionnaire that can be modified by inserting the appropriate occupational groups. It is important to have some open questions so that the workers can express issues that are of concern to them. The results of the questionnaire can be analysed using a database, and this is covered in Appendix 1 of the 2012 document. See box 2.
Assessed health status
Self assessment of health is useful, but it may be more helpful to have simple health checks by someone skilled in heathcare and with equipment not normally available to workers – for example, blood-pressure measurement, calculation of body mass index (BMI) and blood cholesterol assessment. This is useful as, often, people do not have a real understanding of their own state of health and the implications; it also provides an opportunity for health promotion and education.
Baur et al in 2012 found that a high proportion (68%) of overweight and obese male firefighters underestimated their measured BMI categories. As a result, they were unlikely to fully appreciate the negative health consequences of their excess weight. The results of this study emphasise the importance of objectively measuring BMI and then informing patients of their actual weight status and the associated disease risks.
Although transport drivers are a different occupational group, it is likely that the findings might be similar. Drivers find it difficult to attend a GP surgery during the working day so it may be helpful to have a “Well Man Health”check to assess the risk of cardiovascular disease in the workplace. To comply with DVLA standards (HSE, 2014) those with a Group Two licence must have a health assessment every five years after the age of 45 and annually after the age of 65.
Identifying priority areas
When the information has been gathered and the results of questionnaires and health assessments have been analysed it is time for the planning stage and the first thing to do is prioritise. Those health conditions with the most significant size and severity of impact will be identified by the OH professional, who will then suggest suitable interventions and actions, and discuss their acceptability to stakeholders.
Once there is agreement, then specific interventions can be planned. Other health promotion organisations may need to be involved, such as the NHS Smoking cessation programme. It is essential to build in the monitoring and evaluation of the strategy, and finally measure the impact of the activity.
Jane Coombs of Working Well Solutions has identified activities that might be useful for drivers and provides a case study of interventions on the website (Coombs, 2014). This was prompted by an accident investigation and included a review of catering facilities to encourage healthy eating, the provision of an eye-test chart and instructions so that drivers could check their own eyesight, and access to voluntary health checks for diabetes, hypertension, obesity and vision screening.
Assessing the health needs of the driver workforce is an important aspect of health and safety if all drivers are to be, and remain, safe. Driving is a sedentary job requiring the encouragement and education to drivers to eat healthily and to take regular exercise to avoid ill health and injury to others on the road.
Baur D, Chriostophi C, Tsismenakis A, Jahnke S, and Kales S (2012). “Weight perception in male career firefighters and its association with cardiovascular risk factors”. BMC Public Health 2012, 12:480 doi:10.1186/1471-2458-12-480.
Blood Pressure UK (2008). Exercise & activity lower blood pressure. BPUK website.
British Heart Foundation (2014). South Asians and heart disease. BHF website.
Coombs J (2013). How to get drivers more healthy- health promotion in the workplace. Working Well Solutions website.
Davis S (2007). Webmed exercise to lower cholesterol. WebMD website.
Department of Health (2012). Health, work and wellbeing. Defining the priorities: workplace health needs assessment for employers. East Midlands Public Health Observatory.
DVLA (2013). At a glance Drivers medical unit of the Driver and Vehicle Licensing Authority.
Facebook (2014). Truckers’ Toilets – name and shame truckers’ loos.
HSE (2011). Safe transport of roll cages.
HSE (2013). Workplace transport safety: a brief guide. INDG199 (rev2). HSE website.
HSE (2014). Medical standards for drivers.
HSENI (2013). Manual handling videos.
IBS Network (2014). Truckers’ Toilets UK March 2014.
Highways Agency (2007). Vehicle ergonomics: best practice guide”. Highways Agency publication code. PR113/07 Guide Loughborough University.
Imperial Health at Work (2014). Driver medical group 2: overview.
NICE (2005). Health needs assessment: a practical guide. NICE website.
Petch M (1998). “Driving and heart disease”. European Heart Journal 19, pp.1,165-1,177.
Scania (2006). A laboratory vehicle mock-up research work on truck driver’s seat position and posture: a mathematical model approach with respect to anthropometry, body landmark locations and discomfort. Stockholm, Sweden.
Sieber W, Robinson C, Birdsey J, Chen G, et al (2014). “Obesity and other risk factors: The national survey of US long-haul truck driver health and injury”. American Journal of Industrial Medicine 9999.
Wright J,Williamson R, Wilkinson J (1998). “Development and importance of health needs assessment”. British Medical Journal. 25 Apr, 1998; 316 (7140): pp.1,310-1,313.
Box 1: Driving at work – managing work-related road safety
Fitness to operate
A person’s fitness to drive/operate a vehicle should be judged on an individual basis, but the aim is to match the requirements of the task with the fitness and abilities of the driver/operator.
Are you satisfied that your drivers are sufficiently fit and healthy to drive safely and not put themselves or others at risk?
- Do drivers of heavy lorries, for which there are legal requirements for medical examination, have the appropriate medical certificate?
- Although there is no legal requirement, should those at-work drivers who are most at risk also undergo regular medicals?
- Should staff that drive at work be reminded that they must be able satisfy the eyesight requirements set out in the Highway Code1?
- Have you told staff that they should not drive, or undertake other duties while taking a course of medicine that might impair their judgment? In cases of doubt they should seek the view of their GP.
Box 2: Questions covered
- general health
- perceived disability and health problems lasting longer than 12 months
- life satisfaction and anxiety
- healthy eating
- alcohol intake
- physical activity
- work contribution to health
- work affecting health adversely
- list of possible interventions in the workplace so that the individual can identify those of interest, for example: health checks/know your numbers; healthy eating advice; smoking cessation; advice on aches and pains; and emotional resilience.