Road transport workers in Bangladesh most of whom are truck and bus drivers along with their helpers are at risk of developing a wide variety of health conditions because of their demanding and strenuous job nature. The road transport sector in Bangladesh is run almost exclusively informally: these workers typically do not have a job contract, do not receive a fixed salary and other standard benefits offered and available for many formal sector workers, have unpredictable, undefined, inflexible work hours, and duties. They often work for abnormally long hours for the horrific and omnipresent traffic gridlock across the whole country. Truck and bus drivers and helpers are usually remunerated for trips completed, passengers carried, distance traveled, the quantity of goods shipped, or profits generated. With a "no work no pay" system, they suffer from harsh job and income insecurity during their whole career tenure and they do not receive any paid leave that is legally mandated and implemented by the government in most formal sectors. For any health issue, medical illness, or injury, they remain at the clemency of their employers (i.e., the vehicle owners) and for accidental death, their family members and dependents become destitute.
Globally, transport workers bear a high health burden; previous research studies conducted mostly in the industrialised countries have catalogued the following prevalent health conditions among them: sexually transmitted infections (STI), back and shoulder pain, leg pains, respiratory diseases, cancer, cardiovascular diseases, obesity, diabetes, and a range of mental health conditions including depression, anxiety, chronic insomnia, personality disorders, and post-traumatic stress disorder. In absence of valid and reliable research on a large number of workers in Bangladesh, it can be only presumed that this working population segment - who are exclusively adult males- face comparable health issues. The family members and dependents of these workers are not likely living a healthy life either since transportation workers afflicted with so many health conditions are creating high emotional, behavioural, and economic burdens on their family members. In fact, they may spread some of these contagious health conditions to their spouses or other sex partners through intimacy. The high out-of-pocket costs associated with treating these health conditions must deplete thin family resources that if saved could help the family to spend on education or other wealth-generating schemes to live a somewhat better and comfortable life.
Occupational risk factors of the transport workers include inactive lifestyle due to very long hours of driving or sitting still inside the vehicles, musculoskeletal type injuries during packing and delivery of consignment, goods and passengers, irregular work schedules, experiencing frequent road accidents and deaths, traveling through notoriously congested traffic conditions, spending long hours close to the engines on heated driving seats. In addition, they go through prolonged periods of family and social isolation, are used to intake unhealthy or unclean food on the road, and access untimely or inadequate healthcare because of their transitory and unplanned work nature.
A brief and quick review of existing research evidence reports an array of health risks and morbidities among them. The work-related stressors including long work hours and fatigue, shift work and sleep deprivation, postural fatigue and exposure to noise and vibration, exposure to diesel exhaust fumes were categorised previously into six categories of morbidities for them: (1) mental health disorders; (2) disrupted biological cycles; (3) musculoskeletal disorders; (4) cancer and respiratory illnesses; (5) cardiovascular disease; and (6) substance abuse use and unsafe sexual practices.
Studies have also found that transport workers have higher rates of heart disease, diabetes, lung cancer, obesity, and there was documented evidence of sedentary lifestyles, higher tobacco consumption, and use of stimulants. Although some of these disorders have multiple origins, characteristic occupational exposure in transport drivers (awkward sitting postures, exposure to high noise level, stress, long work shift, sleep deprivation and disorders, environmental pollutants, inadequate exercise, and whole-body vibration for being inside the vehicles) may have a role for the onset, development or exacerbation of many these disorders. Concurrent risk factors such as inappropriate, limited, or unhealthy diet, alcohol addiction, and smoking habits certainly add to their existing risk profile of adverse health effects.
The life expectancy of male truck drivers was reported to be considerably lower than the general men according to one research study conducted in the United States. High job demands (because of increased pressures to reach the destination or meet delivery timetables and no time for recreational activity) along with low autonomy on decision making have been associated with an increased risk of myocardial infarction among the drivers.
In Bangladesh, the road transport system is fundamental for the country's economic activities as waterways and rail services have limited and shrinking coverage with diminishing passenger interest and popularity. Sadly, road transport workers have low income, low literacy, are considered to be unruly, ill-tempered, and are generally disliked or looked down upon by society. No evidence is out there to show there is any attempt to develop strategic plans to address their income insecurity, job stress, or how to offer them low-cost health services.
The road transport industry in Bangladesh is predominantly privately-run. In some countries, healthcare programs have been offered to increase awareness among transport workers, particularly on communicable diseases (STI, HIV, tuberculosis). But before planning health programs, implementation, scale-up, and sustainability, the existing knowledge gaps and healthcare needs of this population have to be studied and reported. Their current ways of accessing healthcare services and the impact of such existing services on their health outcomes are not known either. Given the mobility associated with this population's occupation, inter-district collaboration is vital to assist health service delivery and ensure continuity of care.
The predisposition of transport workers to poor health status is somewhat known by all. Despite making a vital contribution to the economy, the transport workers get no mercy from any corner.
Hasnat M Alamgir is a Professor of Public Health.
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