Constraints to healthcare access amongst commercial fishers
Constraints to healthcare access amongst commercial fishers
Rachel Turner, Lucy Szaboova, Gwynedd Williams, Environment and Sustainability Institute.
Key findings:
- Social and cultural norms, organisational constraints and personal concerns all affect how readily fishers access healthcare.
- Healthcare providers need to offer more flexible service provision if they are to be able to be compatible with the working practices of fishers.
- There also needs to be work done which can address the attitudes and norms which may lead to a reluctance amongst fishers to seek help.
Summary
This study set out to examine the health issues faced by commercial fishers in Cornwall, and to identify the constraints that influence fishers’ access to healthcare. The findings highlight the particular importance of organisational constraints and personal concerns, which differed among fishers, and constraints related to social and cultural norms, which applied widely across the sample of fishers. These findings underscore the need for a holistic concept of access to understand demand-side as well as supply-side constraints, and can inform future policy and practice in two key ways.
First, the findings have important implications for healthcare providers in delivering services to fishers. These include the need for supply-side interventions that provide more flexible service provision compatible with the working practices of fishers, and targeted approaches to service provision that recognise the heterogeneity of commercial fishers and their health needs. While such initiatives are emerging in a UK context (for example, provision of tailored physiotherapy services, quayside health checks and lifestyle support), the range of symptoms experienced by fishers highlights the need for additional health promotion services that target common risk factors (e.g. smoking cessation), mental health, stress and fatigue, as well as common physical health problems (e.g. manual handling) across a wider range of fishers. Lessons could be learnt from previous public health initiatives that have sought to address health inequalities in UK farming communities by improving awareness about preventative measures and access to healthcare.
Second, reducing demand-side barriers to healthcare access requires interventions to address attitudes and norms that may lead to reluctance to seek help. In other resource dependent communities such as farming, industry bodies play an important role in providing ‘soft entry points’ to health services, bridging the gap between farmers and healthcare providers by integrating health advice and resources with wider industry information. The development of new initiatives targeting fishers may be informed by activities seeking to address health issues in other male-dominated industries such as seafaring and construction. The input of family members, and particularly women, is also widely recognised in convincing men to seek healthcare. This was confirmed by the focus group findings, which illustrated that women often encourage arrangements such as booking appointments. In general, emotional support and active coping assistance from social networks are important factors in reducing the effects of stressors on individual wellbeing, and there is a need to identify and share best practices. However, placing emphasis on family members can create increased stress related to fishing, and may unintentionally reinforce the message that men should not be concerned about their health.
Although fishers share similarities with other male-dominated occupations, this study also highlights specific needs and challenges in relation to accessing healthcare. These require solutions from healthcare providers that address both supply- and demand-side access constraints. The design of interventions targeting fishers will need to consider the unique needs, circumstances and heterogeneous characteristics of fishers through a holistic understanding of access.