Nellis Oliveira Santos
Universidade de Mogi das Cruzes (UMC), Brazil
E-mail: nellissantos@umc.br
Luiz Teruo Kawamoto Junior
Instituto Federal de Educação, Ciência e Tecnologia de
São Paulo, Campus Suzano, Brazil
E-mail: luizteruo@hotmail.com
Hewely Cardoso
Universidade de Mogi das Cruzes (UMC), Brazil
E-mail: hewely@umc.br
Luci Mendes de Melo Bonini
Universidade de Mogi das Cruzes (UMC), Brazil
E-mail: lucibonini@gmail.com
Submission: 13/09/2018
Revision: 05/10/2018
Accept: 15/10/2018
ABSTRACT
This paper intends to describe the
public health policies and labor conditions of road haulage drivers. In order
to give a brief overview of these policies, it describes some research results,
some indicators pointing to a loss of quality of life of these workers by
virtue of their habits, their physical conditions and labor laws. Finally, the
path indicates some points traced by national policies that seek to preserve
the quality of life of these workers. The method used was literature review
found in scientific bases, pointing data that guide the discussions. Due to the
necessity of road transport in Brazil, truck drivers suffer poor working
conditions to meet the high demand for their services. Seeing that the road
haulage driver is directly involved in the delivery and flow of Brazil's
logistical process of deliveries from the raw materials to the final product to
the consumer, public policies are urgently needed to adjust and improve all the
working and physical conditions to this class of workers in accordance with law
13.103/2015. High rates of traffic accidents with truck drivers were recorded,
however, conditions for good sleep do not favour truck drivers, destabilising
their physical condition, and classifying these professionals as sedentary
because of negative health habits.
Keywords: occupational diseases; working
conditions; occupational health
1. INTRODUCTION
In
Brazil, freight is predominantly carried by trucks and drivers are
professionals with difficulty in caring and their health because they are
always in different places and low income.
Another
difficulty is that many are self-employed professionals, who do not have
programs focused on their health.
The
Universal Declaration of Human Rights, proclaimed on December 10, 1948, states
in its articles 23 and 24 that every human being has the right to work, to free
choice of employment, to just and favorable conditions of work, equal pay for
equal work, as well as the right to rest and leisure, including reasonable
limitation of working hours, as well as other social rights (UNESCO, 1948). In
the same understanding, the International Labor Organization (ILO) at its 155th
Convention, held in Geneva in 1981, adopted several proposals concerning safety,
hygiene and the working environment.
All
workers have the right to physical and mental health and to the balance between
elements that affect their health and are directly related to safety and
hygiene at work and its related environments.
In
Brazil, the Social Rights are set forth in Article 6 of the Constitution
(BRAZIL, 1988), and among these social rights is the right to work, which is in
the same status as the others described in article 6, which are: rights to
education, health, leisure, security, social security, maternity and childhood
protection and assistance to the unaided. Workers’ rights are set forth in
article 7 of the Constitution and it is the responsibility of the Union to
organize, maintain and carry out the labor inspection, as provided in clause
XXIV of article 21 of same Federal Constitution. Also in item XXII, it is
anticipated that the worker will have the right to reduction of risks inherent
to work, through norms of health, hygiene and safety standards and as mentioned
later in item XXVIII, will have insurance guaranteed by the employer against
accidents at work, including the indemnity to which the employer is obliged
when incurring deceit or guilt.
Considering
that workers’ rights are constitutional rights as previously described, any
event that constitutes the violation of these rights is a direct aggression to
the set of basic and elementary rules that socially and politically organize
the Brazilian State.
According
Tavares and Kitamura (2014) workers are the main assets of the organization,
thereby, having a look at some ways that may interfere with their productivity,
represents a strategic move.
This
text aims to evaluate the research results on the working conditions of truck
drivers in Brazil and to evaluate some aspects of Law 13.103 of 2015 that
guarantee more safety to truck drivers working on the books. The goal of this
research was to carry out an exploratory bibliographical research about the
health of the truck driver.
2. RESEARCH METHODOLOGY
This
study consists of a review of narrative literature. The selected studies and
the interpretation of the information are adequate to build a contextualization
for the problem of truck driver health in Brazil. It is understood that the
analysis of the possibilities present in the consulted literature have
contributed to the conception of the theoretical reference of this research.
The
bibliographic survey material collected was carried out in the gateway of
periodicals of CAPES, in the SCIELO articles and in SCIELO books and PUBMED.
3. BIBLIOGRAPHY REVIEW
The
bibliographic review will be presented below.
3.1.
LAW
nº13.103 / 2015 AND THE REGULATIONS OF TRUCK DRIVER ACTIVITY.
Brazil,
which is a peripheral country, has been progressing along the paths of social
protection but still presents some social exclusions and therefore the issue
involving work accidents that results in job loss, most of the time, implies
social exclusion. (POCHMANN; AMORIM, 2004).
Paragraph
3, of Law 8080, 1990, states that health can be determined by certain factors,
which are, among others; food, housing, basic sanitation, environment, labor,
income, education, transportation, leisure and access to essential services.
(BRAZIL, 1990).
A
closer look at the numbers that affect the lives of so many workers leads us to
reflect on the regularization, or a greater supervision of the truck drivers
profession, as affirmed by Silva et al. (2016): "The informality and
precariousness present in this profession, configured by the outsourcing
services, compromise the working and health conditions of workers submitted to
the same context.”.
The
law nº 8.706, of September 14, 1993 in Article 1 states that the National
Transportation Confederation (CNT), in compliance with the provisions of this
Law, is committed to creating, organizing and managing the Social
Transportation Service (SEST) and the National Transportation Learning Service
(SENAT), with legal personality under private law, with no prejudice to the
supervision of the application of its appeals by the Federal Audit Court
(BRASIL, 1993)
One
of the functions of SEST SENAT is to priorities and work on programs of health
and quality of life of truck drivers and public transport. SEST SENAT acts in
the promotion of sports, leisure and the prevention of diseases; aims at the
physical and mental well-being and also to integrate the driver in society. In
addition to education through lectures, seminars, medical examinations and
guidelines in disease prevention. It aims to bring to the truck driver
information on preventive health control, citizenship and environmental
awareness.
SEST
SENAT offers the services of:
i) medical
area: physiotherapy; psychologist; health and nutrition
ii) dental
area: pediatric dentistry; endodontics; surgery; periodontics; orthodontics;
prevention; diagnosis; dentistry and radiology, which led to actions and
programs of health prevention by municipal governments and private
institutions, leading to possible partnerships.
Law
13.103 / 2015, in its article 6, regulates the toxicological tests as follows:
Art. 5 Art. 168 of the Consolidation of Labor Laws -
CLT, approved by Decree-Law Nº 5.452 of May 1943, is now in force with the
following changes:
"Art.
168 .................................................
..................................
§ 6º
- Toxicological tests shall be required, prior to admission and upon dismissal,
in the case of a professional driver, with the right to counter-claim in case
of a positive result and the confidentiality of the results of the respective
tests.
§ 7º
For the purposes of the provisions of § 6º, a toxicological test with a minimum
detection window of 90 (ninety) days, specific for psychoactive substances that
may cause dependence or, demonstrably, impair the steering capacity, may be
used for this purpose the toxicological test provided set forth in Law Nº 9.503
of September 23, 1997 - Brazilian Traffic Code, since it was carried out in the
last 60 (sixty) days." (NR) (BRAZIL, 2015)
The
same law guides drivers for the daily eight-hour journey, which can be extended
for up to two extra hours or, if foreseen in a collective convention or
agreement, for up to four extra hours. These workers shall also rest 30 minutes
every 5 hours and 30 minutes of driving, and shall they also rest for 8
consecutive hours, plus 3 hours during the day regardless of the 30 minutes
mentioned, therefore it will depend on what was agreed between contractor and
worker. (BRAZIL, 2015).
Silva
et al. (2016) refer to the "Law of Truck Drivers" as a document to be
fulfilled by the competent bodies to ensure the quality of life of these
workers, although the neoliberal panorama subjects these workers and other
workers to unilateral interests which oblige them to exercise their productive
activity at the cost of health loss and quality of life loss and even at the
cost of their own lives.
3.2.
SAFETY
AND HEALTH OF THE TRUCK DRIVER
A
statistical survey published by the Ministry of Labor and Social Security on
fatal accidents with road haulers showed that truck drivers die or are injured
due to the use of licit and illicit drugs to stay awake in order to deliver
their loads in continue long distance journeys. With the pressure to make the
deliveries of the goods and the competition of the companies to ensure that
their products are not lacking in places of sale or production inputs in the
industries, these professionals are more likely to be involved in traffic
accidents due to fatigue, many times being the protagonists of the situation
(BRAZIL, 2016).
According
to Sinagawa (2015), fatigue and the use of drugs by truck drivers may be
related to traffic accidents. Penteado et al. (2008), affirms that the working
conditions of the truck drivers affect negatively their quality of life. Masson
et al. (2010) argue that the working model of truck drivers interferes in their
health and consequently causes loss of quality of life throughout the ageing
process.
Yet,
according to Sinagawa (2015), the fatigue of truck drivers leads to the use of
drugs: of the 1.316 urine samples collected, with the help of the Federal
Highway Police between 2008 and 2012, it was identified that 7.8% of the
results were positive for drug use. Marijuana, amphetamine and cocaine have
been identified, which may be related to traffic accidents (TAs).
According
of a research of Bombana et. al. (2017), oral fluid samples were screened for
amphetamine, cocaine, and tetrahydrocannabinol (Δ9-THC) by ELISA and the
confirmation was performed using ultra performance liquid chromatography with
tandem mass spectrometry detection (UPLC–MS/MS). Of the 764 drivers asked to
participate, 762 agreed to participate. The participants were driving an
average of 614km and 9.4h a day. Of the total samples, 5.2% (n=40) tested
positive for drugs. Cocaine was the most frequently found drug (n=21), followed
by amphetamine (n=16) and Δ9-THC (n=8). All drivers were men with an average
age of 42.5 years. With these results it is possible to verify that many truck
drivers were still consuming psychoactive drugs while driving, and cocaine was
the most prevalent one. This reinforces the need for preventive measures aimed
at controlling the use of illicit drugs by truck drivers in Brazil.
Drummer et al. (apud SINAGAWA, 2015,
p.14) state that (…) the licit drugs such as alcohol, medicinal (tranquillizers
and antidepressants) and illicit drugs (amphetamine, cocaine and cannabis) have
a significant role in the occurrence of TA, usually with fatalities. Drummer et
al. (2007) report that drivers who had used psychoactive substances became more
likely to be blamed for collisions than other drivers who had not used drugs.
Other
health problem in truck drivers, according to Freitas et. al. (2010), is hepatitis
C virus (HCV) infection is a global public health problem. Long-distance truck
drivers live apart from their family for long periods of time, a lifestyle that
favors at-risk behaviors such as unprotected sex with multiple partners and
illicit drug use.
3.3.
Truck
Driver Profile
In a
study carried out by Penteado et al. (2008), with 400 truck drivers in the
interior of the State of São Paulo, on the Anhanguera Highway (SP-330), the
following results were obtained:
59,5%
were autonomous.
58,5%
were making short trips, within the state.
They
worked 12,7 hours a day.
They
slept for 5 to 8 hours.
67,75%
complained of constant or sporadic problems with posture.
37,75%
mentioned hearing problems.
57,5%
mentioned about stomach problems.
70%
mentioned about colds/flu.
58,5%
showed negative feelings such as fear, stress and depression.
23%
mentioned dizziness problems.
30,75%
mentioned problems of hoarseness.
36,5%
mentioned throat problems.
53,5%
mentioned cough problems.
87,75%
would ingest coffee.
84,5%
consumed fatty food.
43%
would drink alcohol.
19,5%
use energetic beverages.
32%
smoked.
2%
used other drugs.
As
noticed health loss and the intake of stimulants or other drugs coincides with
the study data. Masson et al. (2010) imply that there will be health losses
caused by unhealthy behaviors such as physical inactivity, a poor diet,
overweight, tobacco use, alcohol, and keeping the truck driver away from home.
According to Penteado et al. (2008, p.41) "working conditions of truck
drivers may have negative impacts on their general health, impairing
communication and the quality of life of these workers".
Research
of Sangaleti et. al. (2014) has the following results: Results Among all of the
subjects, the prevalence of physical inactivity was 72.8%; consumption of
alcoholic beverages, 66.8%; routine use of some type of stimulant during work
activities, 19.2%; and smoking, 29%. Only 20.8% had a healthy weight, and 58.2%
had an abdominal circumference greater than 102 cm. A diagnosis of arterial
hypertension was confirmed in 45.2%, and abnormal glucose levels were detected
in 16.4%. Although some of the truck drivers were aware of these conditions,
most were not taking specific medications.
According
to Codarin et al. (2010) in a survey made with 470 truck drivers covering the
cities of São Paulo, Rio de Janeiro, Belo Horizonte, Vitória, Americana and
Curitiba, realized that:
95%
of the survey samples were men.
49,1%
had only finished or unfinished elementary education.
60,7%
were driving through night shifts.
62,4%
had eutrophic weight.
28,4%
were obese.
53,1%
were classified as insufficiently active or exercised infrequently.
54,2%
were sedentary.
67,1%
consumed alcohol.
According
to Masson et al. (2010) study it is concluded that due to the work model there
is a decrease in health and quality of life, added to this a process of
weakening coming from the use of psychoactive drugs and sexual practices of
risk.
Research
of Hino et. al. (2014), with 37 truck drivers, showed that the majority (54.1%)
reported seeking the health service only in emergency situations and 37.8%
mentioned having sought care for more than a year. The main reason for the low
frequency of services was the incompatibility between work and care hours
(43.2%). The vision of invulnerability of the man contributes so that the truck
driver takes care less of the health.
3.4.
Life
habits of truck drivers
As
Cavagioni (2006) demonstrates in his research carried out on the Régis
Bittencourt Highway (BR-116) within the São Paulo state route, life habits are
not healthy. The 258 participants stated that their habits include:
a)
Life habits
19%
were smokers.
55%
reported using alcohol.
74%
did not exercise.
57%
reported having used sleep-inhibiting drugs.
14%
keep use of the above items.
59%
reported low back pain.
49%
reported stomachache.
b)
Eating habits
43%
consume of processed foods
22%
consumed preferably fried foods
88%
used salt as seasoning
22%
added salt to prepared foods
69%
had their meals in restaurants and 3 to 4 meals a day (57%).
This
author concluded that the interviewees presented risk indicators to
cardiovascular diseases, for the following reasons:
Sedentary
lifestyle
Increased
body mass index abdominal circumference
Hypertension
Hypercholesterolemia
In
others countries like Canada, there are similar problem. Research of Mcdonough et. al.
(2014) showed that predominant themes as stress, work
environment, communication, lifestyle, culture, family, concerns about fatigue.
In terms of the transportation work environment, drivers and managers were
aware of the profession's potential to promote chronic lifestyle-related
illnesses, but they described the challenges to make the profession more
receptive to a healthy lifestyle.
3.5.
Health
problems: most frequent complaints
As
observed by Lemos (2009) in a study among 460 participants, drivers working
with irregular schedules had more complaints about musculoskeletal pain. There
was a high level of complaints about low back pain. The same study showed the
relation between poor quality sleep the lack of discipline to doze with
musculoskeletal pain.
According
to Andrusaitis, et. al. (2006), the occurrence of low back pain in truck
drivers was 59%. The amount of working hours driving the wagon would be the
only indicator associated with low back pain, and for each plus hour worked,
the risk of developing low back pain increased by 7%.
Cavagioni
(2006) found among its participants the index of 59% of drivers complaining of
low back pain, and Lemos (2014) relates the onset of pain with poor sleep
quality as well.
According
to Nunes (1989) a high amount of patients suffering from lower back pain are
classified as professionals in repetitive work and professionals in sedentary
work.
Obesity
is also a factor that acts negatively on the spine, as do pendulous abdomen,
visceroptosis, abnormal foot posture, insufficiently developed muscle masses and
others.
According
to Lemos (2014), physiotherapeutic intervention helps to reduce musculoskeletal
pain and improves sleep quality in truck drivers working irregular hours, since
he realized that the high prevalence of muscular pain among these subjects is
likely related to poor sleep quality regardless of workload.
In
order to evaluate the sleep disturbance of 206 Brazilian truck drivers and 200
Portuguese truck drivers who worked in irregular shifts, Souza et. al. (2008)
found that both had difficulty in staying active and alert during the day, had
a habit of consuming alcohol, used psychoactive drugs and had been involved in
traffic accidents within the last five years.
A
research of Leyton et. al. (2012) showed that in Brazil, truck drivers report using
amphetamines to maintain their extensive work schedule and stay awake. These
drugs can be obtained without prescription easily on Brazilian roads. In their
research, urine samples were screened for amphetamines, cocaine, and
cannabinoids by immunoassay and the confirmation was performed using gas
chromatography-mass spectrometry (GC-MS). Of the 488 drivers stopped, 456
(93.4%) provided urine samples, and 9.3% of them (n=42) tested positive for
drugs. Amphetamines were the most commonly found (n=26) drug, representing
61.9% of the positive samples. Ten cases tested positive for cocaine (23.8%),
and five for cannabinoids (11.9%). All drivers were male with a mean age of 40
± 10.8 years, and 29.3% of them reported some health problem (diabetes, high
blood pressure and/or stress).
Silva-Júnior
et. al. (2009) concluded in their research that the prevalence of depression
among truck drivers was 13.6%. Multivariate analysis showed that being 45
years or older had a protective effect (OR = 0.19 P = 0.02), whereas low
educational level (OR = 3.03 P = 0.01), use of stimulants (OR = 5.03 P <
0.01) and wage-earning (OR = 2.84 P = 0.01), as opposed to self-employment,
increased the risk for depression. Truck drivers are at increased risk for
depression when compared to the general population.
Research
of Masson and Monteiro (2010) showed
that all truck drivers interviewed were men, the majority were married, had
kids, low study level and more than 30 years old. 54,2% reported abuse
psychoactive drugs. The majority was aware of the importance of using condoms
with casual partners; 47,5% reported relationship with casual partners and 86%
always used condoms.
Pulerwitz
et. al. (2008) in surveys administered to a random sample of 1,775 truck drivers crossing
Southern borders in Brazil indicate that stigma is an important barrier to HIV
testing and disclosure. Learning more about stigma is important given the
growing assertions that testing is a 'critical gateway' to HIV prevention and
treatment. As access to HIV testing and treatment improves, providers
increasingly need to understand and address how stigma acts as a barrier to
services.
3.6.
Sleep
problems
A
survey was conducted by Souza, et. al. (2008), aiming to evaluate the sleep
disturbances of 206 Brazilian truck driver and 200 Portuguese truck drivers,
who worked irregular shifts, such as if they had excessive daytime sleepiness
and quality of life issues.
It
was noticed that both groups had difficulties to stay active and alert during
the day, had a habit of consuming alcohol, used psychoactive drugs and had been
involved in traffic accidents in the last five years.
In a
study carried out by Lemos (2009) in the state of São Paulo with 460 truck
driver over a 12-month period, it was noticed that between drivers working
irregular hours, there was a higher number of complaints of musculoskeletal
pain and prevailing lower back pain complaints. Statistical data within the
study was presented, showing the relation between poor quality sleep, lack of
discipline to doze and musculoskeletal pain in truck driver.
According
to Lemos (2014, p. 07), in his new study on the physiotherapeutic intervention
to reduce musculoskeletal pain and improve sleep quality in truck drivers
working irregular schedules, it was noticed that, "There is a high
prevalence of muscular pain between drivers, regardless of working hours.
However, poor sleep, short sleep and the presence of pain seem to be
associated”.
Research
of Knauth (2012) in the south of Brazil with 854 truck drivers, showed that Amphetamine
use to stay awake was reported by 12.4% of the truck drivers, either in
isolation or in combination with other substances (coffee, guaraná powder,
energy drinks, snorted cocaine). Amphetamine was the most cited substance by
those who consumed something to stay awake. The consumption of alcoholic drinks
was mentioned by more than 70% of the interviewees; among those who drink,
45.1% reported that they use alcohol at least once a week. Amphetamine use was
associated with younger age groups, wage increase, longer trips, and alcohol
use.
In
other countries, there are the same problem, a research of Bobko, Chernyuk, and
Gadayeva (2017) in Ukraine, showed that increased workload results in increased
need for sleep in truck drivers that takes place during days off. Night work
decreases sleep duration on days off which may reflect the reduction in the
recovery capabilities of a human body. The deterioration of sleep quality both
on weekdays and on days off is associated with increased health complaints.
In
others business areas the problem is the same, the research of Tavares and
Kitamura (2014) was conducted in a manufacturing industry located in the Valley
of Paraiba, and the results were that among the factors surveyed, sleep is what
most affects employees’ productivity.
3.7.
Accidents
at work
The
Statistical Yearbook of the National Department of Transport Infrastructure
(DNIT) of 2010 showed an increase of 6.946 to 8.616 fatalities in truck
accidents in the road network monitored by federal highway police between 2008
and 2010, throughout the national territory. (BRAZIL, 2010).
This
document points out that of 317.711 thousand of the vehicles involved in
accidents on federal highways, 79.374 thousand were cargo vehicles. (BRAZIL,
2010).
According
to the Statistical Annual of Work Accidents (AEAT) of 2014 and also to data
from the Institute of Social Security (INSS), there is a growing increase in
accidents in the National Classification of Economic Activities (CNAE) - 4930. Which are i) 4930-2/01 for municipal road
transport of cargo, except dangerous goods and removal services; ii) 4930-2/02
for cargo transportation, except for dangerous products and removal services,
inter-municipal, interstate and international; 4930-2 / 03 for road transport
of dangerous goods and 4930-2/04 for road transport of removal services.
Accidents
are thus distributed, showed in Chart 1 in absolute numbers.
Chart 1. Works accidents in
category 4930: total and with CAT (Accidents with Work Accident Communication)
in the period of 2011 to 2013.
Table 1: Accidents with Work Accident
Communication (CAT) in the period of 2011 to 2013
|
Year |
Work
Accidents |
Accidents
with Work Accident Communication (CAT) |
|
2011 |
17.121 |
12.621 |
|
2012 |
17.443 |
13.007 |
|
2013 |
17.590 |
13.432 |
Source: INSS (Institute of Social
Security), adapted by the authors.
According
to data released by the Ministry of Labor and Social Security (MTPS), the
accidents involving truck drivers throughout Brazil in 2014 are that 15% of the
deaths due to accidents at work were drivers of trucks, which leads one to
think that it is necessary to idealize policies that can prevent such losses.
A
research of Girotto et. al. (2016) with 665 male truck drivers in Paranaguá
Brazil, with an average age of 42.2 (±11.1) years, showed that 41.7% of the
drivers reported involvement in accidents and near-miss accidents,
respectively. In fully adjusted analysis, the 3rd tertile of professional
experience (>22years) was shown to be inversely associated with involvement
in accidents (odds ratio [OR] 0.29; 95% confidence interval [CI] 0.16-0.52) and
near-miss accidents (OR 0.17; 95% CI 0.05-0.53). The 2nd tertile of
professional experience (11–22 years) was inversely associated with involvement
in accidents (OR 0.63; 95% CI 0.40-0.98).
4. CONCLUSIONS
Seeing
that the road haulage driver is directly involved in the delivery and flow of
Brazil's logistical process of deliveries from the raw materials to the final
product to the consumer, public policies are urgently needed to adjust and
improve all the working and physical conditions to this class of workers in
accordance with law 13.103/2015.
High
rates of traffic accidents with truck drivers were recorded, however,
conditions for good sleep do not favor truck drivers, destabilizing their
physical condition, and classifying these professionals as sedentary because of
negative health habits.
The
current economic scenario demands higher productivity to the detriment of the
worker. In this sense, the State must guide the creation of public policies
that can guarantee a quality of life for all workers.
As a
suggestion of future research, research policy suggestions for improving the
health of truck drivers.
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