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10 carter ncmm international bodies and development of regulations


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The NCMM Sea Health Conference 2011 – MLC 2006

The NCMM Sea Health Conference 2011 – MLC 2006

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  • 1. International bodies and the development of regulations: challenges and results. Case study of medical fitness criteria Tim Carter Norwegian Centre for Maritime Medicine UK Maritime and Coastguard Agency International Maritime Health Association
  • 2. 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)
  • 3. 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)
  • 4. 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
  • 5. Placing maritime health Specifics are a small part of MLC. Whole convention contributes to it Small part of STCW. One element in safety system Small and low priority part of WHO work now. Topic with long and difficult history – blame and gain. Expertise has single profession origin – ‘medical gaze’
  • 6. Baggage! Seafarers: inequity. UK strike, ITF Tom Mann. Employers: free markets – capital and labour, no state supervision. Unseaworthy seamen: alcohol, VD – UK Flag states: merchantilism: old UK, USA. New: India. Social security links and national interest – France, Spain. Welfare – state: Nordic countries, E Europe. Missions: Christian, other faiths. Predictive value of health assessment. Medicalised view of capability Faith in certificates
  • 7. Changes – work at sea Voyage time Job demands Communications Global ownership And crewing
  • 8. UN Agencies, goals and constituents ILO: tripartite with social partners dominant. Decent working conditions. Negotiations IMO: flag states and NGOs. Maritime safety. Power of veto. EU group, open registers, USCG, newer maritime nations. WHO: source of UN health expertise. Not organised by industry. Infection, nutrition, care. Health ministries.Expert evidence based review. Occupational issues low priority unless profitable: IMGS.
  • 9. UN Agencies -outputs Conventions – ratification as basis for national law. (IMO – regulations and mandatory A code) Recommendations – how to meet convention requirements (IMO – non-mandatory B code) Guidelines –official but subsidiary Technical guidance and handbooks – non official. Authorities, other users.
  • 10. Maritime health - scope Fitness to work at sea – maritime safety, personal ‘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 spreadAt interface of ILO, IMO and WHO
  • 11. 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.
  • 12. IMO key textSTCW 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 medicationProcedures for examination andcertification
  • 13. 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.
  • 14. ILO key textMLC 1.2 medical certificate proceduresHearing and sightNo medical condition aggravated,leading to unfitness or risk to othersMLC 2.5 medical repatriationMLC 3.1 – 2 accommodation, foodMLC 4.1 – Medical care aboardMLC 4.3 – occupational health and safety
  • 15. WHO approach Was major player. Maritime now low priority. Active on infection control – International Health Regulations. Profitable publication – IMGS. Fit for what purpose? Should be key to international harmonisation, linked to medical chest requirments and to radiomedical advice Participated in 1997 Guidelines on medical examination, not with current revision. Issues on quality of evidence.
  • 16. Developing good practice – fitness examinations 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.
  • 17. Users of Guidelines Maritime Authorities in preparing national regulations Maritime Authorities in adopting text as national law. Examining doctors as issuers of certificatesWill 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.
  • 18. Progress on guidelines Draft text developed, based on IMHA wg, UK MCA, other administrations. Large measure of agreement at meeting Oct 2010. Issues: - harmonising with MLC and STCW - regulatory pedantics vs. usefulness - national perspectives - seafarers and ‘risk’
  • 19. Next steps Redrafted after meeting Inclusion of fishing? Circulation – any changed positions: states, employers, TUs? Second meeting September 2011 Endorsement up the line in ILO and IMO. Publication!!
  • 20. Related health topicsLessons from joint work on medicalfitnessInternational Medical GuideMedical chestsEmergencies at sea – training,guides, telemedicine, evacuation,treatment, repatriation[Medical aspects of social security]
  • 21. Common features Political interests and rational policies Social partners can influence but maritime authorities have to implement Expertise: not needed, on call, at hand, partisan or neutral, dominant.The human zoo – know the animals before designing the cages!