![Page 1: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/1.jpg)
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
![Page 2: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/2.jpg)
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)
![Page 3: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/3.jpg)
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)
![Page 4: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/4.jpg)
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
![Page 5: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/5.jpg)
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’
![Page 6: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/6.jpg)
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
![Page 7: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/7.jpg)
Changes – work at sea
Voyage time Job demands Communications Global ownership And crewing
![Page 8: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/8.jpg)
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.
![Page 9: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/9.jpg)
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.
![Page 10: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/10.jpg)
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 spread
At interface of ILO, IMO and WHO
![Page 11: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/11.jpg)
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.
![Page 12: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/12.jpg)
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
![Page 13: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/13.jpg)
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.
![Page 14: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/14.jpg)
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
![Page 15: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/15.jpg)
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.
![Page 16: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/16.jpg)
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.
![Page 17: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/17.jpg)
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.
![Page 18: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/18.jpg)
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’
![Page 19: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/19.jpg)
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!!
![Page 20: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/20.jpg)
Related health topics
Lessons from joint work on medical fitness
International Medical Guide
Medical chests
Emergencies at sea – training, guides, telemedicine, evacuation, treatment, repatriation
[Medical aspects of social security]
![Page 21: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/21.jpg)
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!
![Page 22: 10 carter ncmm international bodies and development of regulations](https://reader033.vdocuments.site/reader033/viewer/2022052523/55633227d8b42a57348b56ac/html5/thumbnails/22.jpg)