1. Nordic Collaboration on Fishing Safety Workshop in Copenhagen 20-21 Feb 2014 Improvement and Harmonisation on Nordic fishermen´s data on injuries and working time - comparable data to improve safety in fishing by working together Olaf Jensen, Centre for Maritime Health & Society, Southern Danish University Esbjerg, Denmark

2. Contents Why do we need injury incidence data Methods – epidemiological measures Harmonised ”nominator data…” Harmonised ”denominator data” ILO proposals international Proposals for the nordic collaboration Olaf Jensen ocj@sdu.dk

3. A review based on peer-reviewed scientific publications gave the following information: Studies from Poland, UK, Norway, Iceland, USA inclusive Alaska, Canada and Denmark show more or less similar results There has been about 50 % reduction of the fatal injury rates in fishing since the 1970’ies. Olaf Jensen ocj@sdu.dk

4. The relative risk for fatal injuries in fishing compared with other industries varied from about 25 to 50. There is good evidence that around half of the fatal injuries are related to vessel disasters - and that fatigue and lack of good safety culture are main risk factors for the vessel disasters. Olaf Jensen ocj@sdu.dk

5. National rates cannot be compared due to: different methods for denominator time (different calculation of fishermen´s hours or days of work) different criteria for inclusion of accidents (3 days off, 1 day or other) We need comparable count of the accidents We need comparable information about the risk time Olaf Jensen ocj@sdu.dk

6. Epidemiology Epidemiology is the study of the determinants, distribution, and frequency of disease and accidents in human populations 6

7. Epidemiology The development of new cases of an accident that occur during a specified period of time in (“at risk”) individuals = INCIDENCE RATES 7

8. Crude incidence rate: Number of fatal accid. in time period Number at risk of dying in period = 8

9. Counts Proportions Rates Ratios Tools of Measurement

10. Case Counts Measuring disease or health or health care frequency starts with counting cases Simplest and most frequently gathered measure in epidemiology 10

11. Refers to the number of accidents counted i.e.Number of fatal accidents in fishing in Denmark in 2010 = ? Limited usefulness for comparable purposes without knowing size of the source population Counts 11

12. Epidemiologic rates contain the following: Accident number (Numerator) Person-time (De-numerator) Rates 12

13. LocationAccidents YearPopulation Denmark 4 2010 3000 Faroe Islands 3 2010 1000 Annual Rates of Occurrence DK 4/ 3000 = 1,3 per 1000 person-years F3 /1000 = 3,0 per 1000 person-years Rates - example

14. is a fraction between the numerator and denominator Annual Rates of fatal accidents DK 4/ 3000 = 1,3 per 1000 person-years F3/1000 = 3,0 per 1000 person-years RATIO = 3/1,3 = 2,3 = Relative risk Ratio 14

15. Rates are the basic tool for prevention Why are rates important? Because they provide complete information to compare rates: Year by year in the same industry Between countries Between industries 15

16. Comparison Ratios can be seriously biased by: 1) Inequal nominator data: X / Y 2) Inequal denominator data: X / Y 3) Inequal reporting degree: 0-99% 4) Difference in validity – classification bias, 16

17. 17 1) Different inclusion criteria of cases Lost time injury (LTI-1 Day): A work injury that results in an absence from work for at least one full day or shift any time after the day or shift on which the injury occurred Lost time injury (LTI-3 Day): A work injury that results in an absence from work for at least 3 full days or shift any time after the day or shift on which the injury occurred Serious injury: A lost time injury that results in the injured person being disabled for a period of two weeks or more. Minor injury: A lost time injury that results in the injured person being disabled for a period of less than 2 weeks

18. 18 2) Different definition of population risk time 1000 fishermen per year 1000 Full-time equivalent fishermen per year 1000 days at sea 1.000.000 hours work at sea

19. 19 3) Different reporting degree – seriousness ?

20. 20 3) Different reporting degree – Type of ship??

21. 21 3) Different reporting degree – area on the globe

22. 22 4) Definitions and concepts - misunderstandings Duration rate: The average number of workdays lost per injury Injury index: The number of workdays lost per million hours worked Serious injury frequency rate: The number of serious injuries per million hours worked The calculated risk: The number of fatal accidents per 1000 man-labour-years The frequency rate of new cases: Days lost per new case:

23. 23 5) Different definitions - lack of comparability Sound case definitions based on diagnosis, defects, pathology Definition of the population at risk (number of fisheremen registered, full-time equivalent number of fishermen etc)

24. 24 ILO recommendations 1998 and 2012

25. 25 ILO Definition

26. 26 ILO recommendations –sources of data 25. In compiling statistics of occupational injuries, various sources of information should be used in order to provide as full a picture as possible of the situation at a given point in time and to give an estimate of any under-reporting which may occur. For example, consideration could be given to periodically supplementing the information available from systems for the notification of compensation of occupational injuries by adding brief modules of questions to existing survey questionnaires, such as those used for establishment surveys for employment and wages, and for labour force surveys.

27. 27 ILO recommendations –sources of data 26. Where data from different sources are used together, attempts should be made to ensure that the concepts, definitions, coverage and classifications used by the different sources are consistent. To this end, it would be useful to establish a coordinating committee at the national level, comprising representatives of government, other producers of statistics on occupational injuries, and employers’ and workers’ organizations. In addition, efforts should be made to harmonize the statistics compiled from different sources and by different bodies.

28. 28 The nordic collaboration proposal: A permanent national coordinating committee in each of the Nordic countries with representatives of government, other producers of statistics on occupational injuries, and employers’ and workers’ organizations, epidemiological researchers and occupational health services. A permanent nordic collaboration committee to provide technical and epidemiological guidance on the how to use and harmonize data from different sources based on the ILO resolution:

29. 29 The nordic collaboration proposal: A permanent nordic collaboration of the national groups for improving and harmonising data on fishing injuries and the populations at risk: Nordic collaboration group National group in Norway Iceland Danish Faroe islands

30. 30 The nordic collaboration proposal: To use and harmonize valid data among the Nordic countries from different sources based on: Insurance data (inavailable in DK - legal change?) Martime Authorities data Occupational Health Service data National statistics on mortality and discharge register Research: 1. Population register cohorts – validity check of routine data 2. Repeated household surveys with estimation of under- reporting and of costs of occupational injuries.

31. 31 The nordic collaboration proposal: The nordic fishing injury collaboration group elaborates a 5 year working plan on how to harmonise and utilise, analyse and disseminate data (injury and population at risk) from different sources step by step: 2014-15: Data from the insurances 2015-16: Data from the maritime authorities 2016-17: Data from household surveys 2017-18: Data from hospitals and death registers

32. 32 Nordic research collaboration proposal: Establishment of a nordic collaboration research strategy with a 5 year working plan: validation of register data and to validate and use data that yet cannot be included in a regular surveillance. Nordic research strategy DenmarkNorwayIceland Faro Islands

33. 33 Nordic collaboration in the …future: Establisment of a nordic training and education forum by sharing training material etc. Nordic safety and health training collaboration DenmarkNorwayIceland Faro Islands

34. Olaf Jensen ocj@sdu.dk

35. Thank you very much for your attention