The text of this paper is based on a presentation at the First International Congress of Maritime, Tropical, and Hyperbaric Medicine, 4th July 2009, Gdynia, Poland. The assessment of fitness to work at sea is an important aspect of maritime risk management. The risks in the industry, the approaches used for assessment, and the evidence on which they are based have changed over time. The transition from an industry in which the nationality of seafarers and the ships on which they worked were the same to one in which ownership and crewing have become global means that, as is true for most other aspects of maritime risk management, compatible international criteria for decisions regarding fitness to work are required.
Many parties, including flag states, employers and their insurers, and seafarers and their trade unions, are involved in agreeing international medical fitness criteria. While all have a common interest in improved health and safety at sea, each has their own more detailed agenda of sectional interests. The scope for development of agreed standards and the role of the parties involved is reviewed, and the current arrangements for taking this process forward are discussed.
Contributions from maritime health professionals and other medical and scientific experts are essential to the development of rational and valid criteria, but the decisions on the level of authority to be given to these and the means adopted for ensuring compliance with them are essentially political issues where the voice of those with subject knowledge is only one among many in the processes for adoption and implementation of any new arrangements.