Emerging Critical Health Issues for Commercial Drivers

ST: Okay, good afternoon everybody. Welcome to the driver safety theatre, an interesting session. Driver health is becoming a really important issue for all companies to manage. There is a lot of new research coming out which indicates a problem far bigger than any of us had ever realized. We have an expert panel, two presentations, and some discussion to follow. I am going to leave you in the hands of my very good friend Dr Grant Charlesworth Jones to introduce the context for the session and our two speakers. Thanks Grant.

GCJ: Super, thanks very much Simon. Just to let you know I have some excellent speakers here, so catch every word they say because it is worth listening to. The reason we are talking about driver health is because the UK’s legislation is so far behind internationally. Almost every other country is ahead of us, and we are now at a situation where something has to be done about it.

I work for D4 Drivers and together with Loughborough University we are doing the world’s largest study into driver health. That will inform how best to future cast what driver health assessments look like, including better medicals and more digital access to health and health data. On the 4th of September we also have the world’s first driver health awareness day, hosted at Loughborough University. That is a world first, and that is when things are going to start to shift in this sector.

On the subject of today’s speakers, I am going to introduce Professor Stacey Clems from Loughborough University. The School of Sport is ranked number one in the world, and Stacey is the foremost author on driver health research in the UK. I am also going to introduce Dr David Garley. Some of you may recognize him from television. Is that right David?

DG: It was true. Yes.

GCJ: There we are. He might not make you laugh like he made Cat laugh, but still enjoy his talk anyway. If we may, we will start with Professor Clems from Loughborough University.

SC: Perfect. Thank you Grant.

Good afternoon everybody. I am going to spend about 10 minutes setting the scene and talking about driver health, and highlighting how poor driver health can have a negative impact on health and safety.

Commercial drivers are an essential occupational group, but they are exposed to many risk factors associated with their occupation. They spend long periods of time sitting. The food options available to them at rest stops tend to be unhealthy. We also see problems with dehydration, which can link to long-term kidney problems. Drivers work shifts, so most of them experience disturbed sleep and sleep deprivation, and David will talk more about that shortly. The job itself is also isolating. Drivers spend long periods on their own, are exposed to pressure around delivery schedules, and the unpredictable behaviour of other road users. All of these factors together can have a major impact on both physical and mental health.

We know from our own research at Loughborough University and from international research that drivers are a high-risk group. They tend to experience higher rates of obesity compared with other occupational groups, and higher rates of many chronic diseases, with some countries reporting reduced life expectancy compared with other occupations. Poor health profiles can also increase the risk of accidents.

We have seen huge advances in vehicle technology over the years, with sophisticated systems improving vehicle safety. However, when we think about drivers themselves, there has been limited investment in their health, arguably the most important component of the vehicle.

Drivers undertake a vehicle check at the beginning of each shift, and it is essential that everything is in the green in terms of status. However, a driver will typically only have their health checked once every five years, and only after they are over 45 as part of the D4 medical process in this country.

As Grant said earlier, we are behind internationally. We recently conducted a review of medical practices for drivers and found that the UK is one of the only countries where drivers are not regularly checked until around age 45, after their initial licensing medical. Other countries, including South Africa, India, European countries, the United States, Canada, and Australia, frequently check the health and wellbeing of their drivers.

Looking at the health profile of drivers in the UK, we see more red and amber than green across health indicators, particularly in poor sleep, low activity levels, high sitting time, blood pressure, and weight status.

We also reviewed D4 medical provision for vocational drivers, including HGV, bus, and coach drivers, and compared this internationally. Not only is the frequency lower in the UK, but the comprehensiveness of checks is also reduced. This is something we are working to improve.

Driver obesity is a major problem in the UK and elsewhere. We have collected new data comparing obesity rates in HGV drivers with men in the general population in similar occupational groups. Obesity rates in drivers are significantly higher across all age groups. What is particularly concerning is the high prevalence among younger drivers, especially those aged 25 to 34, given that they will not typically receive another medical until age 45.

So far this may have felt a bit worrying, so I will briefly finish by introducing a solution we are developing at Loughborough University to improve driver health and wellbeing. This is called the SHIFT programme, the Structured Health Intervention for Transport. It is a multicomponent, theory-based health promotion programme developed in partnership with drivers and industry, supporting changes in lifestyle behaviours.

Before I explain SHIFT further, I would like to play a short game. If you are able, please stand up. I will ask a series of questions. If you answer yes, stay standing. If you answer no, sit down and remain seated.

If you regularly sleep between seven and nine hours a night over the past six to twelve months, stay standing.
If you do not smoke, stay standing.
If you eat at least five portions of fruit and vegetables a day, stay standing.
If you are regularly active and complete 150 minutes of moderate to vigorous activity each week, stay standing.
If you do not exceed 14 units of alcohol per week, stay standing.

Well done. The purpose of that exercise is to show that although we know what healthy behaviours look like, it is very difficult to achieve them consistently because life and work get in the way.

You know, just standing in front of someone telling them that is probably not going to change their behaviour because they already know it. So what we have adopted with SHIFT is a slightly different approach. It is very much a discussion-based approach. It is not someone standing there saying you should do this, this and this. It is a discussion with drivers to say, okay, these are the challenges that you face as part of your job. So how could you embed a bit more movement into your day? You do not have to start running or go to the gym, but how can you just walk a bit more? And then how can you maybe make slightly healthier food choices within the restrictions you face? Drivers themselves come up with solutions that they can actually adopt.

This programme has been found to be quite effective in a robust trial, and it supported drivers to be more active relative to controls after six months. We have seen some clinically meaningful increases in activity as a result of the programme.

The programme is now available as a driver CPC module and is gradually being adopted by a number of different operators. We are monitoring feedback and seeing some really positive results from drivers being able to make lifestyle changes. We have seen some quite substantial weight loss, for example, in some of our drivers, and they really like this new style of driver CPC.

So that is just one example of some of the work we are doing to try and find solutions to improve driver health and wellbeing. We are doing a lot more at Loughborough, and I would be very happy to chat to anyone afterwards about this work, or if you are interested in learning more about SHIFT.

We have lots of partners that we are working with on this and lots of companies adopting our programmes. We are really keen to make a positive difference to driver health and wellbeing and improve road safety in this country. For now, thank you very much for listening, and I will pass back to Grant. Yes.

GCJ: Thank you very much Stacey. We are going to be taking some questions from the audience. We have got a roving mic, so we will take some questions at the end if that is okay. I would next like to introduce, and he will do autographs at the end, Dr David Garley from the Better Sleep Clinic.

DG: Just got an electric shock off the podium. It feels wrong at a health and safety event.

Good afternoon everyone. My name is David. I am a GP and director of the Better Sleep Clinic, and I am here to talk about sleep and driver health and safety. My talk is based on three core points. Number one, poor sleep is really common. Number two, poor sleep makes a significant impact on workplace fatigue and accident risk. And number three, crucially, poor sleep can be fixed.

To understand the importance of sleep, you only really have to think back to the last time you did not sleep well and reflect on how you felt. You probably felt awful. You were physically fatigued, you could not think, concentrate, or remember anything. And if you are being honest, you were probably quite cranky. That can happen after one night of poor sleep.

But if you sleep badly for a week, a month, a year, or five years, the impact on your health is much more sinister. It affects both physical and mental health in a range of ways. I do not want to overwhelm you with statistics, but there is an ocean of very robust research linking poor sleep with a wide range of poor health outcomes, both physical and mental, and with issues at work.

When we think about driver health, cardiovascular disease, risk of diabetes, and mental health are at the top of the list, and sleep underpins all of these in a very significant way. In terms of workplace safety, it is not just about small mistakes. There is a 75 percent increased risk of a workplace accident resulting in permanent disability. One of the most striking statistics is that around 20 percent of road traffic accidents are associated with poor sleep, which is one in five.

What is most striking is that there is really no part of your life that is not impacted by poor sleep.

So what stops us from sleeping?

There is the background population risk. Around 10 percent of the adult population have insomnia, which is more than many people think. Insomnia is difficulty falling asleep, staying asleep, and it has a significant impact on you during the day.

Within different occupations, there are two additional sleep problems that stand out. The first is shift work. There is an increasing expectation that industries run 24 hours a day, and around 20 percent of EU employees now work shifts.

The third condition is obstructive sleep apnoea. Anyone can get it, but the main risk factors are being male, being older, and carrying extra weight. In some industries this can push prevalence to around 30 percent, which is enormous.

The bottom line is that sleep disorders in workplace settings are extremely common.

You might be thinking that you do not see many cases coming through in your workforce. That is probably true because people do not call in sick saying they could not sleep. They will say it is a bad back, an MSK issue, a cold, or a stomach problem. But we know from research that insomnia is associated with almost 15 additional days off work, which is nearly three working weeks.

When I worked in hospitals, I only remember one case where someone actually called in because they were too sleepy, and they still had to come in at the end of the day.

I will spend a bit of time on obstructive sleep apnoea because it is common but slightly unusual. It is a sleep disorder usually associated with snoring, where the upper airway repeatedly closes during sleep. The airway is made of hard structures, like the bony palate, and soft structures, like the back of the throat and base of the tongue.

Hard structures stay in place, but soft structures are held by muscles. As you fall asleep, these muscles relax and the airway narrows. This causes turbulent airflow, which makes the soft structures vibrate, which is what we hear as snoring. In obstructive sleep apnoea, the airway can fully close, causing a pause in breathing.

The body can tolerate this for a short time, but eventually it triggers an alarm and wakes you up to reopen the airway. This leads to fragmented sleep, where you are repeatedly pulled out of deep sleep into lighter sleep or wakefulness. When the airway reopens, you may gasp or choke.

At night this causes loud snoring, pauses in breathing, choking and gasping. During the day, people feel extremely sleepy, fall asleep in inappropriate situations, and may struggle with memory and concentration. In about 20 percent of cases, it can also lead to depression.

But the really challenging statistic is that 85% of people with this condition are undiagnosed. Part of the reason for that is that so many of the symptoms happen when you are asleep. Unless you have a bed partner who is up and taking notes, they are not necessarily going to know that this is happening.

As the symptoms creep on so gradually, you just think that this is what life is like, that you are knackered all the time, that you are sleepy, and that you have poor memory. But it is actually a diagnosable sleep condition, and as well as being diagnosable, it is also very treatable.

The main treatment that we look at, particularly with drivers if there are a lot of daytime symptoms, is CPAP, which is the mask that blows air at a low pressure and gently holds your airway open from the inside. So as you fall asleep and your airway muscles relax and your airway closes, that air pressure holds it open so that you can continue breathing freely as you sleep and get into these deep stages.

I would love to talk more about CPAP. I have actually brought one in, so I have left it on the table at the back in the Driving for Better Business area. If you are bored later, come and find me and I will talk your ear off about CPAP.

One of the massive obstacles in engaging with sleep, particularly sleep apnoea, is concerns about losing a driving licence, which you can understand. If you operate a fleet, organisationally you are going to be worried that suddenly your entire workforce is going to be unable to drive.

The overarching law is that if you feel excessively sleepy, you should not drive regardless of the reason, whether it is late nights, young children, or a sleep disorder. But it is actually very rare that you have to surrender your licence. For perspective, at our sleep clinic we do these tests all the time and we have never stopped anyone driving permanently. This fear is out of proportion to the reality.

You might have to stop driving while you are on treatment until you get better, but this is usually about two weeks. It is not a lifelong ban at all. The DVLA will ask you three questions: do you have sleep apnoea, are you on treatment, and are you feeling better? If the answer is yes, there are no restrictions at all on your driving.

But actually trying to communicate this means people do come forwards for diagnosis and treatment, and they end up as healthier, happier, and safer drivers.

So I just wanted to come back to those last three points. Poor sleep really is extraordinarily common in the workplace. It makes a huge impact on your ability to work, but it is absolutely treatable. If you would like to know more, I am around at the stand later and would be happy to chat through some of the approaches.

This brings us to the end, and I will hand back to Grant.

GCJ: Now, does anybody have any questions for either Professor Clems or Dr Garley at all?

You are brave enough, are you? We did have a… hang on a second, somebody is jumping in.

The gentleman is bringing the microphone.

Audience: Thank you very much. Very interesting. My name is Tom, from a company called Back in Action. We are specialist MSK physiotherapists in occupational health. One thing I noticed that was not mentioned much, I know you touched on MSK and MSDs in terms of driving, commercial drivers stationary for long periods of time. Has there been any research at Loughborough in terms of MSK risk and causes in commercial drivers? If that made any sense whatsoever.

SC: Good question. Can you hear me okay?

I guess it is something we are really interested in and have been looking at. We have not done a specific study on MSK and drivers, but in many of our studies we ask drivers about MSK symptoms, so we are measuring it. We have had conversations with companies who say it is a really big problem and have asked if we can work on a solution.

We have lots of data on it and we see very high prevalence of back pain and knee problems in drivers. We have not yet worked specifically in that area, but we hope that programmes like SHIFT, which encourage more movement where feasible, may also improve MSK-related issues.

We are always open to discussions about further research.

Just to add on the sleep aspect as well, MSK issues can massively impact sleep, so it is a bit of a vicious cycle.

GCJ: Thank you so much for that.

Good. Anyone else got a question?

Audience: So I could ask one for Dr Garley if we have a minute. We are seeing obesity rates in younger drivers aged 25 to 34 more than double compared with matched populations. How does that translate into risk profiling for sleep conditions?

DG: Yeah, obesity is most closely linked to obstructive sleep apnoea. There is a large dataset called the Wisconsin Sleep Cohort that shows how BMI, age, and sex relate to prevalence. You can estimate how many workers are likely to have sleep apnoea based on those factors.

The challenge is that sleep apnoea is already present and increasing. The real challenge is finding a practical way to engage with it that addresses fears from both drivers and employers, including concerns about cost and losing drivers from the workforce.

So the prevalence is increasing, but there is currently very little provision to diagnose and treat it at scale. If you consider the size of the problem, there is nowhere near enough provision.

So we are at the back of the list again for that?

We are, sadly.

GCJ: Does anyone have more questions?

Audience: Thanks. I work in the rail industry, so we deal with shifts and fatigue. One issue is availability of decent food and drink at rest stops. There are slightly healthier options now, but they are few, expensive, and inconsistent. Is there any initiative to improve this?

That is a really good point. It is something we are very interested in and actively researching. In our SHIFT programme, drivers said they knew what they should be doing but could not find healthy food.

We are doing a new study using a photovoice app where drivers take photographs of rest stop environments, good and bad. We have a lot of images of poor toilets and potholes so far.

The aim is to use this evidence to influence planners, government, and rest stop design. I am speaking with National Highways, the Department for Transport, and planning consultants about redesigning rest stops.

There is also an app that helps drivers find better rest stops, so there is some movement in this area.

If anyone here employs drivers and wants to take part in the study, come and speak to me afterwards.

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