Musculoskeletal disorders in fisheries

The fishing industry has rapidly evolved over the last decades introducing new working methods and techniques. These changes influenced the working conditions of the workers in fisheries but they are still often confronted with musculoskeletal disorders (MSDs). The nature of the work includes several risk factors that contribute to the development of MSDs. Prevention strategies require a comprehensive approach combining measures both on an organisational and individual level.

Definitions

The fishing industry includes all activities related to fishing such as fish catching, transporting and fish processing. Within the Statistical Classification of Economic Activities in the European Community (NACE rev 2) the sector has the code 03 Fishing and aquaculture and is part of section A Agriculture, forestry and fishing ^[1]. Musculoskeletal disorders or MSDs denote health problems of the locomotor apparatus, i.e. muscles, tendons, the skeleton, cartilage, ligaments, nerves or peripheral vascular system. Some MSDs are non-specific because only pain or discomfort exists without evidence of a clear specific disorder. Work-related musculoskeletal disorders (WRMSDs) include all MSDs that are induced or aggravated by work and the circumstances of its performance.

Data on work-related health problems and MSDs in fisheries

Statistical data on work-related health problems and MSDs in fisheries are limited. As stated above, the fishery sector is part of the broad category A Agriculture, forestry and fishing within the Statistical Classification of Economic Activities (NACE rev 2). NACE rev 2 dates from 2008. Before 2008 the fishery sector was considered as a separate category (B Fisheries, NACE rev 1). This change in classification not only means that it is difficult to compare data before and after 2008 but also that recent data on the fishery sector are scarce. Figures and trends on accidents and work-related health problems are presented in Accident prevention in fisheries.

On the Eurostat website statistics on work-related health are derived from the Labour Force Survey. Only the statistics based on LFS 1999 list Fisheries as a separate sector. In the 2007 and 2013 data, fisheries are considered as part of the agriculture, forestry and fisheries sector. As fisheries is a much smaller sector than agriculture, these data only provide a limited insight into the extent of the problem for fisheries. It is therefore still worthwhile to present the data from LFS 1999. Table 1 shows that MSDs are more prevalent in fisheries than in all sectors. 57.5% of all health problems in fisheries are MSDs compared to 49.2% in all sectors. MSDs are also more severe than in other sectors. 75% of the MSDs cases in fisheries bring about more than 14 days loss. In other sectors only 30% of the MSDs result in more than 14 days lost from work.

Table 1: Types of health problem reported in the EU fishing sector (NACE rev 1) and in All NACE activities (standardised prevalence rate) - 1999

Eurostat, LFS 1999, the prevalence rate = (number of people suffering from a work-related health problem / number of persons in employment in the reference population) X 100 000.

Source: Compiled by the author, based on Eurostat ^[2]

Research studies

The high prevalence of MSDs in fisheries is confirmed by several research studies. Studies from different countries reveal that the occurrence of injuries and MSDs among fishermen is generally high although national differences in the working conditions of the fishing industry do exist ^{[3] [4]}. A cohort study of Danish seamen revealed a higher incidence of rotator cuff syndrome and carpal tunnel syndrome. Cohorts of seamen of 1994 and 1999 were compared with the entire Danish workforce. The findings suggest an association between work within fishery and the incidence of shoulder lesions, rotator cuff syndrome and carpal tunnel syndrome. The study suggests that the explanation for the higher incidence of shoulder and wrists problems may be found in the working conditions on fish vessels. Fishermen are known to have repetitive hyperflexing and twisting movements of the wrists in cold surroundings e.g. when tearing fish out of the net and physically demanding repetitive work with elevated shoulders during work with ice in the hold ^[3]. Other studies from other countries such as Sweden, US, UK, Sri Lanka confirm high prevalence rates of fishermen reporting low back pain ranging from 50 to 80% ^[5]. A Danish study looked into the link between the workload of the fishermen and MSDs complaints. The researchers carried out a study among 270 fishermen to determine the predictors of musculoskeletal pain. Low back and shoulder pain were most common and experienced by 4/5 of the fishermen during the last year. Hand and neck pain was secondly most frequent with a pain prevalence of around 2/3. Furthermore, the study showed that the amount of workload was the main predictor of these MSDs complaints. No associations could be found for other possible predictors such as BMI, boat type, time at sea, etc. ^[5]. A phone survey among 832 fishermen carried out in 2014 came to a similar conclusion. The fishermen suffered in comparison with a control population significantly more acute incidents related to musculoskeletal disorders. 33% reported that they had experienced pain in neck/shoulders/arms often or very often during the previous 12 months, and 93% believed this was fully or partly due to their work situation ^[6].

The multifactorial causation of work-related MSDs is commonly acknowledged. Several groups of risk factors including physical and mechanical factors, organisational and psychosocial factors, and individual and personal factors may contribute to the genesis of work-related MSDs. Workers are generally exposed to several factors at the same time and the interaction of these effects may aggravate adverse effects. Figure 1 illustrates the risk factors contributing to MSDs. Working in the fishery sector is considered a hazardous occupation and the workers are confronted with a wide range of risk factors. An overview of risk factors is presented in Accident prevention in fisheries.

Risk factors linked to the physical workload are very common: prolonged standing, working in awkward positions, pushing and pulling and also carrying loads as well as repetitive hand-arm movements.

On fishing vessels the variety of tasks involved with fish catching and manipulating gear, equipment and loads lead to postural deviation, repetition, and forceful exertions. Working on fishing vessels requires frequent manual handling of heavy and awkward loads and often takes place in poorly designed work areas with constricted and awkward work spaces. Also the movement of the vessel is known to contribute to the strain on the workers. The motion of the ship is mainly counteracted by motions in the lower limbs and back, inducing an increased strain on the workers when standing ^{[3] [1]}, ^{[2] [7]}.

In the fish processing industry workers are confronted with ^[8]

• repetitive work e.g. cutting and trimming of fillets;
• forceful motions of upper limbs, constrained neck postures, e.g. sorting;
• prolonged standing e.g. grading, sorting;
• handling of heavy loads.

Both on fishing vessels as in the processing industry environmental factors such as high and especially low temperatures are very common. The low temperatures are due to weather conditions (on fish vessels, in open workplaces in the fish processing) but also linked to working with ice (to preserve the fish), in freezers, etc. Low temperature in combination with the physical workload of the tasks is associated with MSDs among workers ^{[9] [10]}.

Organisational factors such as extended working hours, shift work, limited rest periods, etc. also contributes to MSDs. In the fish processing industry excessive speed on the work line is considered especially harmful ^[8].

Individual characteristics such as age, gender, lifestyle are also known to impact on MSDs. A study on health risk factors among fishermen concluded that the working conditions of fishermen can lead to an increase of health risks. For instance, while at sea, fishermen need a high calorie intake but often dietary habits and the conditions on board of vessels (e.g. lack of storage) lead to an insufficient calorie intake and a poor diet. Poor quality of sleep and irregular working hours only reinforce these negative effects. Data on BMI and mortality show that fishermen are in a special medical and high risk occupational group ^[11].

Legal initiatives have led to the implementation of measurements for preventing MSDs. An effective approach for preventing MSDs relies on measures both on organisational and individual level.

Legislation

At EU level the basic principle on occupational safety and health are laid down in the framework directive (directive 1989/391/EEC^[12]). This directive applies to all sectors and all employers/employees. It stipulates the general principles on risk assessment, the need to take appropriate measures and the principle of workers participation. Several specific directives have been adopted based on the framework directive. Directive 90/269/EEC focuses on the manual handling of loads ^[13]. The directive prescribes that employers have to take appropriate organisational measures, or provide appropriate means, in particular mechanical equipment, in order to avoid the need for the manual handling of loads by workers or to reduce the risks. All workstations have to be organised in such a way as to make manual handling as safe and healthy as possible and assess, in advance if possible the characteristics of loads and the working conditions. Workers have to be informed and trained on the risks of manual handling and how these risks can be avoided.

Directive 93/103/EC lays down minimum safety and health requirements for work on board fishing vessels ^[14]. The directive determines that fishing vessels are used without endangering the safety and health of workers. Also, workers have to be informed and trained about all measures that are taken regarding safety and health on board vessels.

Another important European directive was adopted in 1992 and concerns the medical treatment on board vessels, whereby fishing vessels are specifically addressed ^[15]. The requirements for medical supplies are listed and it is required that every vessel with a crew of 100 or more workers, which is engaged on an international voyage of more than three days has to have a doctor on board.

In 2012 the social partners in the European sea-fisheries sectors signed an agreement concerning the implementation of the ILO Work in fishing Convention (188)^[16]. Among others the agreement sets out minimum age, compulsory medical examinations and certificates for fishermen. It deals with sufficient and qualified manning and specifies the limits on hours of work and rest. This agreement has been laid down in a directive (2017/159/EU). The directive requires that Member states have to comply with the ILO Convention but they may maintain or introduce provisions more favourable to workers in the sea fishing sector ^[17]. This directive is a step forward for improving working conditions in the fisheries sector. Contrary to the directive on OSH in fisheries (93/103/EC), this directive covers in principle all fishing vessels and not only those vessels of 15 meters and over. Nevertheless, the directive contains some provisions that are specifically addressed to vessels of a length of 24 meters or more or normally staying more than three days at sea ^[18].

Risk assessment

The risk assessment process forms the basis for the prevention of MSDs in fisheries. Ergonomic risk assessment is the systematic examination of all aspects of work, considering and evaluating the work-related and individual exposure of workers to risk factors, how these risk factors can be eliminated and, if not, what preventive measures are, or should be, in place to control the risks. Basically any risk assessment includes the following steps:

• identify the risk factors (repetitive movements, excessive force, awkward postures, duration/work environment, organisation, psychosocial aspects/individual characteristics);
• decide who may be harmed and how. Evaluate the risks and options for solving the problems, and decide on action;
• take action;
• review the findings.

When deciding on actions, the hierarchy of prevention has to be applied favouring technical and organisational measures above personal protection. Selecting and implementing preventive measures always requires the involvement of the workers. The workers of the fisheries sector are a vital source of information about hazards and they can provide a unique insight into the problems that might cause MSDs. Their suggestions for measures are valuable, particularly in such a difficult and complex work environment as a fishing vessel or installation.

Technical interventions

Technical interventions aim to reduce the physical workload and thus also decrease the risk for MSDs in fisheries. These interventions can amongst others focus on the elimination or reduction of risks related to manual handling of loads, working in awkward postures, repetitive work and hand-arm tasks, etc. The following types of technical interventions can be distinguished (based on Strategies to tackle musculoskeletal disorders at work):  

• Automation or mechanisation: decisions to automate certain work processes, to implement powered or mechanical transportation or handling equipment such as conveyor belts, lift trucks, electric hoists, etc.

Special attention must be given to the fact that no new risks are introduced. A study describes the introduction of a new flow line in the fish processing industry ashore and on board larger processing vessels. The flow line consists of a system of conveyor belts transporting the fish through decapitating and filleting machines to the workers who seize each fillet and cut and trim it with a knife. Other conveyor belts transport the fish to the packing station, after which the fish is quick-frozen. The study found that after the introduction of this new flow line the prevalence of musculoskeletal symptoms among women working in fish-filleting plants decreased for the lower limbs but showed an increase for the upper limbs ^[1]. Often automation and mechanisation changes are made not for improving health and safety but for economic (and environmental) reasons.  

• Ergonomic (re)design: design and optimisation of the (physical) work environment to enable working in a comfortable posture. Ergonomic design should amongst others take the principles of anthropometry into account. Examples in for fishery sector include work-bench heights variable for tasks and short/tall users, adapting conveyor belts, grab rails and design of rails, holders for fish on by-catch table, etc. ^[19].  
• Ergonomic work equipment and tools: introduction or redesign of ergonomic work equipment and tools. Examples are supports of standing tasks.

Organisational interventions

Interventions at the organisational level can focus specifically on the improvement of work processes and tasks (e.g. job rotation). In the fishery sector this is often difficult to organise. The processing industry often is organised in a strict manner with limited possibilities for task rotation. However, several tasks have to be executed (packaging, filleting, etc.) and through a careful task design process improvements could be made to reduce the exposure to MSDs risks and introduce a wider variety of tasks. On fishing vessels, deck activities (managing the nets and lines) can be alternated with work in the factory/hold. Factory tasks are repetitive (particularly sorting, head and tail, packing), often in sustained and awkward postures. Also on fishing vessels, special attention must be given to the review of sleep cycles and roster patterns.

Person-oriented interventions

Person-oriented interventions rely on training programmes, information, education, the introduction of exercises, etc. These types of interventions are focused on raising more awareness among workers and attempting to change their working behaviour. Information and training may include topics such as:

• working methods, workstation adjustment, use of equipment;
• postural variation, task variation in procedures for each task;
• manual handling, including training in lifting/handling techniques;
• break practices;
• exercises, fitness, relaxation;
• nutrition/hydration.

Especially the working conditions on fishing vessels, sometimes combined with the low level of education among fishermen, make it difficult to implement information and training programmes. There is need for specific programmes adapted to the specific working environment ^[11] .

Systematic monitoring of the health of workers in fisheries is a person-oriented intervention. Health monitoring identifies workers at risk, ensures the systematic monitoring of their health and investigates work-related causal factors. This should allow early intervention actions and prevent that acute MSDs become chronic.

Guidance

There is little guidance available on MSDs in fisheries. The European handbook for the prevention of accidents at sea and the safety of fishermen was developed by the social partners at EU level. The handbook contains very little information on MSDs or the prevention of MSDs. A short chapter deals with the manual handling of loads ^[20].The website safefishing.eu http://safefishing.eu provides an audio-visual training tool on the prevention of occupational hazards in the trawling fishing sector. The training programme is available in several languages and offers a video and a guide for the trainer.

MSDs are a common work-related health problem within the fishery sector. Data reveal that prevalence is high and that the nature of the work contributes to the development of musculoskeletal disorders. Prevention should be based on a comprehensive approach combining organisational and individual measures. Efforts have been made to issue (soft) law to tackle safety and health risks. However, the focus lies mainly on preventing severe accidents (e.g. avoiding people going over board). Technical innovation, mechanisation and new techniques have been introduced but since these trends tend to focus on economic efficiency and environmental concerns, the health of the workers is often ignored. New risks have arisen and the strain on the workers remains considerable. Key for preventing MSDs is an ergonomic design of working equipment, organisation and environment. There is a need on the one hand for developing strategies for combining efficiency and ergonomics when introducing new techniques and methods in fisheries and on the other hand for raising awareness on the added value of integrating safety and health issues into change processes.