Social determinants of occupational injuries among US-based commercial fishermen: a systematic review.

Abstract

Background: Commercial fishing is a multibillion-dollar industry that supports job growth, small- to large- businesses, and port and city revenue. The commercial fishing industry continues to be one of the most dangerous in the US, with a fatality rate nearly 40 times higher than the national average. Dangers of the fishing industry are multi-faceted and include hazardous working conditions, strenuous labor, long work hours, and harsh weather. Moreover, a vast majority of fishermen suffer from economic insecurity, including safe and affordable housing and food insecurity.

Methods: We followed the recommendations and standards set by the Campbell and Cochrane Equity Methods Group and the Measurement and Evidence Knowledge Network. The review covered 1992-2022 to assess the state of research and to identify new barriers of and facilitators to injury prevention among commercial fishermen using a social determinants of health lens.

Results: Of 292 articles identified, 27 studies met our inclusion criteria. Out of 27 articles reviewed, social determinants of health factors included the built environment, social & community factors, economic stability, health care access, and educational attainment. A major finding was the inability for fishermen to access primary care services, which was often rooted in being a low-wage, im/migrant, or transient worker, and can further escalate injuries. A secondary finding related to injury was a feedback loop where fishermen's unsafe environments led to a culture of accepting risk and downplaying injury, which further created unsafe environments.

Conclusion: Our review shows how injury is connected to social factors, such as a lack of health care access, as well as political-economic factors, such as a lack of sick leave benefits.