HEALTH OF PROFESSIONAL DRIVERS

A Report for

Transport & General Workers Union

by

John Whitelegg
ECO-LOGICA LIMITED

May 1995

Eco-Logica Ltd
White Cross
Lancaster, LA1 4XQ.

Health of Professional Drivers © Eco-Logica Ltd 1995 1

INTRODUCTION
Considerable progress has been made in recent years in improving health and safety at work. For many
people work does not take place in a fixed location but involves a large number of tasks associated with
the control of a vehicle and exposed to all the hazards of a heavily trafficked environment. For those
who drive lorries and buses there has been a deterioration over the last 20 years in work conditions. This
deterioration is largely the result of traffic congestion and its associated air and noise pollution but also
with the pressures of maintaining a demanding schedule in circumstances that make that task almost
impossible. A lorry or bus driver is at the sharp end of the failure of our transport system. Buses find it
almost impossible to maintain schedules and the pressure on lorry drivers to meet demanding schedules is
intense. The driver in both circumstances has to absorb the failures of the transport system in the form of
increased stress levels, conflict with customers and the intensification of a wide range of work pressures in
a hostile environment. These circumstances damage the health of drivers in a way that is unacceptable.
The objectives of this report are to review the evidence on the work related health problems of drivers
and to make recommendations for a significant improvement in the working environment of this neglected
group of professionals.

THE TRAFFIC ENVIRONMENT

The environment in which drivers spend the majority of their time is polluted, noisy and dangerous. It
is an environment over which they have no control whatsoever and is an environment that wrecks their
schedules, disrupts their home life, makes social activities and regular breaks very hard to plan and
supplies constant hassle. To make matters worse drivers frequently bear the brunt of criticism for problems
that crop up whilst driving.
Drivers are exposed to significant amounts of health damaging air pollutants in their work. Diesel
fuels have carcinogenic properties and exhaust emissions from the total vehicle fleet contain pollutants
such as carbon monoxide, nitrogen oxides and sulphur dioxide all of which can damage the respiratory
system and are associated with asthma, bronchitis and a range of other health problems including
headaches, sore eyes and ear problems. Levels of pollution are higher in the cab than at the kerbside
giving workers a level of exposure to air pollutants that would not be tolerated in the workplace.
Drivers are exposed to constant noise and vibration from their own vehicles and their working
environment is dominated by noise from all vehicles. Noise damages hearing and damages health and can
frequently exceed levels set for occupational noise.
The road environment in urban areas and on motorways is a dangerous environment. In urban areas it is
far more dangerous for pedestrians and cyclists than it is for lorry and bus drivers but the risk of accident
and injury for professional drivers is a work related hazard that should be reduced to levels that are no
greater than accident and injury levels in a workplace at a fixed location. In 1993 635 HGV drivers and
passengers were killed or severely injured and 3333 persons injured in total (all severities). The equivalent
figures for LGV (<3.5 tonnes) drivers and passengers were 1082 killed or severely injured and 7417 injuries
of all kinds.
Lorry drivers and bus drivers contribute to the level of danger experienced by the more vulnerable road
users especially pedestrians and cyclists. They do this primarily through the exceedance of speed limits
and as a direct result of time pressures and work intensification that in their turn add to the stresses and
strains of the job. Some indicative information from the 1994 edition of Transport Statistics Great Britain
is summarised in Table 1.

TABLE 1: COMPLIANCE WITH SPEED LIMITS: 1993 (PER CENT OVER LIMIT)
buses and coaches rigid and articulated rigid and articulated
lorries with 4 axles lorries with 5 axles

Motorways 21 32 36

Dual Carriageways 29 70 76

A Roads 14 56 64

Source: Table 4.12, Transport Statistics Great Britain, 1994. HMSO September 1994

Health of Professional Drivers © Eco-Logica Ltd 1995 2

 The high rates of non-compliance add to the stress and danger experienced by drivers and add to the
dangers experienced by vulnerable road users. They also add to operating costs through higher levels of
fuel consumption. Work practices that are designed to eliminate speeding will dramatically improve the
working conditions of drivers. Put simply drivers need more time to do the work that is expected of them
and more time for breaks.

DOES DRIVING MAKE THE DRIVER ILL?

The answer to this question for both bus and lorry drivers is an unequivocal "yes". The weight of
accumulated epidemiological evidence and occupational health surveys could not be clearer. Bus and lorry
drivers are more likely to experience a range of respiratory, gastrointestinal, musculoskeletal disorders
than a population matched for age and social class that does not drive professionally. Drivers can also
expect a higher incidence of cancers particularly lung and bowel than a matched population.
Professional drivers have a lifestyle that is not conducive to good health. In addition to their exposure
to noise and air pollution the job does not provide the same opportunities for social contact as many other
jobs, and shift work, unsocial hours etc can disrupt both home life and social activity. Home life and social
contacts provide a powerful source of support for those experiencing stress and an absence of this support
compounds an already difficult problem. Drivers are more likely to have a diet that is not conducive to
health than those groups of workers who can return home for an evening meal on a regular basis and take
regular meal breaks in a staff canteen. A diet high in fats and carbohydrates and low in fresh fruit, salads
and fibre will add to the level of poor health. The incidence of smoking and drinking can also create
health problems and most surveys of the health of drivers that form the basis of this review have gone to
considerable lengths to "control" for this aspect of lifestyle. If we are to be accurate in an assessment of the
health risks of professional driving it is important to filter out other factors such as smoking and diet. It is
of little help to conclude that drivers are ill because they smoke a lot when a "driving effect" can be
identified even when smoking is taken into account in the statistical analysis.
Drivers are exposed to a number of health problems as a direct result of the posture adopted in driving.
Sitting in the driving position exerts considerable forces on the spine and can cause a number of problems
with the musculoskeletal system in particular backaches, neck problems, pulled muscles, and general
stiffness. The driving posture also causes problems for the digestive system.
The evidence on health effects of driving has been collected together under four headings:
1 cancers
2 gastro intestinal and musculoskeletal disorders
3 fatigue
4 noise and health

1. Cancers
There is a long standing concern for the effects of exposure to diesel exhaust and the risks of lung and
bladder cancer. This concern is wider than bus and lorry drivers and covers air quality in bus garages,
warehouses etc where inadequate ventilation can lead to significant concentrations of pollutants. If
drivers spend time in the cab, in filling stations, on motorway service areas and truck stops, on the road
and in polluted depots their accumulated exposure would give rise to serious concerns. Total exposure to all
sources of cancer causing chemicals is very important indeed and goes unrecorded.
A large study of cancers and exhaust and combustion products was undertaken in Montreal in the
1980s(1). Interviews were carried out for 3726 cancer patients, 20 sites of cancer were examined and
information obtained for exposure to about 300 substances. Detailed job histories were collected and a
number of associations detected. Gasoline exhaust was associated with rectal cancer and diesel exhaust
with colon cancer. An increased lung cancer risk was associated with both diesel and gasoline exhausts.
The study identified the occupational group "motor transport operating" as the dominant group exposed to
diesel and gasoline emissions.
Studies going back to the 1950s have arrived at similar conclusions. A review of this field by the
American Health Foundation(2) confirms the existence of a high death rate from lung cancer in
transportation workers from a variety of sources including "exhaust from diesel and gasoline engines,
Health of Professional Drivers © Eco-Logica Ltd 1995 3
petroleum lubricants and dust from asphalt roads". Truck drivers, auto repair workers and transportation
workers exhibited high standard mortality ratios (SMRs) from lung cancer. Associations between exposure
to diesel exhaust emissions and elevated rates of cancer incidence have been identified for railroad
workers and for those working with heavy construction equipment. Evidence is also presented in this
review of the relationship between smoking and exposure to exhaust emissions. A two fold increase in risk
of cancer was observed in the group exposed to diesel exhaust emissions even when smoking was controlled.
Elevated rates of bladder cancer are also reported for gas station workers, fuel oil dealers, garage owner,
auto mechanic, taxi driver, truck driver, bus driver and deliveryman. These risks persisted after allowing
for smoking. The cancer rates amongst lorry and bus drivers were higher than control groups having taken
into account the effects of smoking. A study in Detroit reported an increased risk of lower urinary tract
cancer in truck drivers and once again the raised risks persisted after allowance was made for smoking.
A study of 2,465 male urban bus drivers in three major cities in Denmark(3) reported "significantly
elevated" SMRs for bladder and skin cancers. Interestingly this study identified the air intake for bus
defroster systems as a problem. These are located at the front of the bus 1.0-1.5m above the street "where
the concentration of air pollutants is the highest". The study implicates carcinogens in the driver's cab as
the source of the problem particularly polycyclic aromatic hydrocarbons (PAHs). Concurrence with other
Danish studies (lorry drivers and taxi drivers) is also reported. Elevated rates of cancer were reported
even when smoking was controlled for.
A study of professional drivers in London(4) found fewer deaths from all causes than expected. Lorry
drivers showed excess deaths from stomach cancer and lung cancer and taxi drivers experienced raised
mortality rates from bladder cancer, leukaemia and other lymphatic cancers (though these raised
incidences did not reach statistical significance). Bus, coach and lorry drivers mortality patterns were
similar but the all driver data was strongly influenced by lorry drivers who contributed to over 75% of the
deaths in the study.
In 1989 the International Agency for Research on Cancer (IARC) in Lyon, France classified diesel engine
exhaust as a "probable human carcinogen". This view is shared by the UK Department of Health
Committee on Carcinogens and the US National Institute of Occupational Safety and Health. In 1990 the
US Environmental Protection Agency classified the compound as a probable human carcinogen.
More recent research has identified a statistically significant association between particulates and
excess mortality in the general population(5). Particulates are an important constituent of diesel exhaust
emissions and are associated with deaths from lung cancer and cardiopulmonary disease. An estimate for
Britain(6) puts excess mortality from this cause at approximately 10,000. Whilst these studies and
estimates are based on air quality data and careful collection of mortality data in the general population
they have already identified a major area of health concern not hitherto recognised. The implications of
particulates for the health of lorry and bus drivers has not yet been evaluated particularly the links with
cardiopulmonary disease.
The existence of a literature going back over 40 years and demonstrating that bus and lorry drivers are
exposed to proven cancer causing agents is a public health issue of some importance. The likelihood that
there are additional deaths arising particularly from particulates and associated with heart disease
merits close scrutiny. The need for intervention in this area of work to reduce exposure to cancer causing
chemicals is long overdue.

2 Gastrointestinal disorders and musculoskeletal disorders

A wide ranging review of city bus drivers(7) has identified occupational stress as a primary causal
factor in a number of diseases. These include gastrointestinal diseases, heart disease and musculoskeletal
disorders. The review quotes information on absenteeism and early retirement in support of its findings.
Absenteeism for bus drivers is double the rate for other public sector employees and more than half of the
bus drivers will retire prematurely, typically from stress related illness or musculoskeletal dysfunction. A
study of peptic ulcers among urban bus drivers in Denmark(8) showed a prevalence of abdominal pain
alleviated by food intake of 12% among bus drivers and 6% among the general population. The incidence of
hospital discharge with duodenal ulcer among young bus drivers was twice the incidence among Danish
men as a whole. 33% of Copenhagen bus drivers over the age of 50 had left their jobs for health reasons
and peptic ulcers were an important factor in the profile of health reasons. The causes of these health

Health of Professional Drivers © Eco-Logica Ltd 1995 4

problems were described as "psychosocial" and relate to stress, shift work and very difficult time
schedules.
A study of low back trouble among urban bus drivers in Denmark(9) demonstrated that 57% of the 2045
bus drivers studied suffered from this health problem. The sitting position and exposure to vibration were
identified as the most likely causal factors associated with this high proportion of back trouble. The
differences between bus drivers and a control group were statistically significant. In a US study focusing on
reasons for early retirement(7) musculoskeletal problems accounted for 35% of the cases and psychiatric
problems 35% of the cases. Only 12% of the drivers worked to the official retirement age.
Musculoskeletal disorders have been observed in lorry drivers particularly those involved in the
distribution of goods. A Swedish investigation(10) of 460 professional drivers showed that the prevalence
of musculoskeletal complaints was highest for lower back, shoulders and knees. Drivers engaged in local
deliveries had the highest prevalence of complaints. They showed a higher relative frequency of
complaints in hands, lower back, hips and knees in comparison to the whole group studies. More than half
the drivers interviewed in this study expressed the view that their job involved physical strain and
mental stress.
A Dutch study of 439 lorry drivers(11) found an association between work demands and musculoskeletal
complaints and work demands and psychosomatic complaints. The study is interesting because of the way
it relates the musculoskeletal complaints to psychological aspects of the work environment. The study
suggests a link between what the authors call "decision latitude" and a number of commonly occurring
muscular and related complaints. The complaints include pain or stiffness in the neck and upper limbs,
pain or stiffness in the back and perceived difficulty with standing, sitting, walking and stair climbing. In
more simple language the study is suggesting that where drivers have very little control over their
working environment and have to take what it throws at them they respond with physical illnesses of
the kind described.
It is very important in understanding the demanding working environment of drivers that there will be
a complex interaction between the physical aspects of that environment (eg posture, ventilation, noise)
and the psychological stresses that will work to initiate or amplify physical ailments. One study has
referred to the incidence of psychological disturbance in urban bus drivers(7). In this study 13% of the
sample of drivers scored "in the range equivalent to hospitalised psychiatric patients" and that this was
the result of the amount of hassle involved in the job of driving a bus. The existence of highly stressed and
ill bus drivers has been noted in another study(12). Stressful factors identified for bus drivers include time
pressures, traffic noise, congestion, equipment vibration, air pollution, lack of control over working
conditions and social isolation of the drivers from co-workers. It is not surprising therefore that many bus
drivers seek early retirement and many more suffer hypertension and a predisposition to cardiovascular
diseases(7).

3. Fatigue
Fatigue is a manifestation of stress and a symptom of a number of physical health problems. It
certainly indicates the existence of a problem and in the case of bus and lorry drivers is a very serious
matter indeed with implications for their own safety and that of others. The discussion of fatigue is
inextricably bound up with discussions about driving hours, rest hours, road traffic accidents and safety.
Fatigue is a consequence of too much work in too little time, with too many hassles and too little scope
to intervene and correct the situation. The driver is the victim of a number of circumstances, the majority of
which are outside his or her control and this itself adds to the problem. One study(7) has referred to the
incessant pressure on bus drivers to stay on time. Approximately one third of drivers reported they
frequently had no time for any scheduled rest breaks except for a meal respite. The same study has
referred to an association between drowsiness and low-frequency noise levels and observed that tiredness
gets more severe as the driver grows older. Bus drivers find it very difficult to relax at home after a shift
and this contributes to fatigue.
A Japanese study(13) has reported greater levels of fatigue in staff operating one person buses compared
with two person buses. Greater mental fatigue and stress was found in the one person bus and more cases of
near accident were observed in the one person bus.
Fatigue in lorry drivers has been associated with an increase in the likelihood of becoming involved in
Health of Professional Drivers © Eco-Logica Ltd 1995 5
a road traffic accident(14). The accident rate in the second half of a driving trip is approximately twice as
high as in the first half. Numerous other factors influence the accident rate but fatigue is sufficiently
important to warrant close attention. Not surprisingly extremely long working days and short sleeping
periods results in a serious state of fatigue(14). A relatively high risk of becoming involved in a road
traffic accident prevails when drivers are on the road during "abnormal working hours" and/or when a
substantial work load (> 11 hours) has been demonstrated.
A study carried out in the Netherlands for the International Transport Workers Federation(15) has
identified the root cause of the problem: professional drivers do too much work to the detriment of their
health and to the detriment of the road safety environment. This study concludes:
Most research on the relationship between working and driving hours and rest periods on the one hand
and accidents on the other has concentrated on truck drivers. Harris et al (1972) and Mackie and Miller
(1978) investigated this relationship for bus drivers too, but compared to the truck drivers the bus
drivers' samples were small. No specific conclusions about bus drivers will be drawn.
Truck drivers do not comply fully with the regulations that are supposed to govern their working
activities. They work very long days resulting in weeks of more than 60 hours. Averages of 62.5 hours
were found in France by Hamelin (1981) and 75 hours for European drivers of several nationalities by
Van Ouwerkerk et al (1986). A truck driver spends about 60% of this time driving.
Long distance truck drivers who are away from home for several days work irregularly because their
work-rest cycle deviates from the normal cycle of 24 hours and the number of working hours differs from
day to day. As a consequence of this irregularity a working day may start at any time of the day.
Driving between 24:00 and 8:00 is hazardous for the professional driver; the possibility of being
involved in an accident is twice as high as between 8:00 and 24:00. Driving between 3:00 and 6:00 is even
worse, with the possibility of being involved in an accident due to falling asleep at the wheel being 71
times higher than during the period 18:00 to 21:00.
Research on the involvement of trucks in road accidents has not produced consistent results. The only
firm statement about the relationship between driving time and road accidents has been made by
Mackie and Miller (1978). They found that a driver was more likely to be involved in an accident after
5 hours of driving than after less than 5 hours. Working time appears to be a better predictor for road
accident occurrence. Hamelin (1981) found that the accident risk was 2.5 times higher when a driver
worked over 13 hours than when he worked less than 10 hours.
Indications were found that about 7% of road accidents involving a truck are the result of the driver
falling asleep at the wheel because of fatigue. There is also a suggestion that short rest periods, say
less than 6.5 hours, are related to falling asleep while driving. A substantial proportion of drivers take
rest periods shorter than this.
No hard evidence was found concerning the relationship between long working and driving hours and
health problems of professional road transport drivers. However, several studies indicated that
chronic pain in the neck, shoulders and back as well as hernia were serious health problems for the
driver. Almost half of the drivers in two studies, OIBF (1985) and Van Ouwerkerk et al (1986),
reported suffering from some health problem. Many drivers complained about noise, vibrations and
heat at work, but no firm relationship between long exposure to these factors and health could be found
in the literature.

References quoted in above text:

Hamelin, P. (1981) Les conditions temporelles de travail des conducteurs routiers et la securite routiere.
Travail Humain, 44, 5-21
Harris, W. et al (1972) A study of the relationships among fatigue, hours of service and safety of
operations of truck and bus drivers. Santa Barbara Research Park: Human Factors Research Inc.
Mackie, R.R. and Miller, J.C. (1978) Effects of hours of service, regularity of schedules and cargo
loading on truck and bus driver fatigue. Santa Barbara Research Park: Human Factors Research Inc.
OIBF (1985) Analyse der Berufs- und Lebenssituation von Berufskraftfahren. Wien.
Van Ouwerkerk, F. et al (1986) Arbeidsomstandigheden van internationale vrachtwagenchauffeurs.
VK 86-04. Haren: Verkeerskundig Studiecentrum.
Health of Professional Drivers © Eco-Logica Ltd 1995 6
 The author of the report of the International Transport Workers Federation has carried out an original
empirical study of international truck drivers(16) showing the prevalence of fatigue and the links with
road traffic accidents and safety problems. The study involved interviews with 650 truck drivers and has
made available important insights into fatigue and accidents. Table 2 summarise the results of the survey
in terms of falling asleep whilst driving a truck and Table 3 summaries the information on whether or not
an accident resulted from falling asleep.

TABLE 2: ANSWERS TO THE QUESTION OF ALMOST AND ACTUALLY

FALLING ASLEEP IN THE MOVING TRUCK

Categories Almost fallen asleep Actually fallen asleep

f % f %

many times 88 14 16 4

sometimes 301 46 92 24

never 261 40 281 72

Total 650 100 389 100

Reference 16

TABLE 3: INCIDENCE OF AN ACCIDENT AS A CAUSE OF FALLING ASLEEP

BEHIND THE WHEEL OF THE MOVING VEHICLE

f % % of the total group

yes 47 44 7

no 59 56 9

Total 106(*) 100 16

(*) the answer of 2 drivers of the 108 is unknown

Reference 16

A result which shows that 28% of truck drivers have actually fallen asleep at the wheel and 60%
have almost fallen asleep reveals a serious cause for concern and intervention. It is in the interests of both
driver and the general public to take make sure this does not happen. The message is made particularly
clear in the statistic in Table 3 showing that 44% of those drivers who did fall asleep actually had an
accident.

4. Noise and health

Noise is a cause of poor health. It can damage hearing and is associated with a number of
psychological problems that can contribute to stress. As noise is usually experienced at the same time as
vibration there is a combined assault on the lorry and bus driver from both sources. Noise contributes to
disorders of the cardiovascular, nervous and digestive system and reduces worker productivity(17). Noise
has an adverse effect on the nervous system leading to stress and increased blood pressure. This is
particularly worrying for bus and lorry drivers who already experience elevated stress levels from the
traffic environment and time pressures of the work.
One study in India(18) has identified noise levels in bus cabs of 89-106dB(A) and observed that 89% of
the bus drivers had abnormal audiograms ie they had impaired hearing. A control group not exposed to
noise levels in this range showed 19% with abnormal audiograms. 65 dB(A) is normally taken as an
acceptable level(17) so levels above 80dB(A) give serious cause for concern. A loss of hearing is typically
the result of continuous exposure to high noise levels of 85 dB(A) and above for a number of years
The Noise at Work Regulations (1989) require personal hearing protection to be provided where noise
levels reach 85 dB(A) or more. Personal hearing protectors must not only be maintained and used correctly
but must also be worn for the entire period of exposure to the noise to be effective. Failure to wear the

Health of Professional Drivers © Eco-Logica Ltd 1995 7

protection for only 15% of the time renders it virtually useless(19).
Noise protection is not an easy matter for drivers. Drivers need to be in aural contact with the outside
world and need to be protected from the health damaging consequences of noise. Resolving this dilemma
through cab design and more fundamental solutions for the general traffic environment will be a high
priority.

THE COMBINED EFFECT OF WORK PRESSURES AND ENVIRONMENTAL ASSAULTS ON THE

HEALTH OF DRIVERS
A driver is not exposed to serious assaults on his or her health. In any one working period a driver will
experience all the stress and strains of getting the job done to a very tight schedule. This will be
accompanied by exposure to air and noise pollution with proven health damaging consequences in
situations where shifts and sleep patterns have produced fatigue. Drivers cannot intervene to reduce these
negative impacts and this lack of control together with daily hassles produces a powerful cocktail of
impacts that make the job of a driver very difficult indeed.
It is acknowledged in the epidemiological literature that multiple assaults on health can have a
bigger effect on total health than the sum of all the individual effects might suggest. Put simply a driver
who is tiered and stressed will be more susceptible to infections and a driver with back trouble and hearing
problems will be more stressed. The combination of factors works to amplify the effects of those factors
causing poor health.
Drivers are not uniquely exposed to occupational hazards that are far worse than any other group of
workers. They are, however, very exposed indeed to those sources of poor health that we know are
growing in importance. Noise, air pollution, congestion and hassle in an environment where there is not
enough time to do the job well are exactly those factors where the trend is in the direction of making the
pressures worse. Drivers are very susceptible to health related problems and this situation will
deteriorate over the next few years. It is this deterioration that is as important as the observation of
current levels of poor health.

CONCLUSIONS AND RECOMMENDATIONS

The health of drivers is an important issue in public health, occupational health, transport policy and
employment conditions. There has not been a concerted assault on those factors that cause poor health and
this is an area of neglect that needs urgent attention.
Measures to protect and improve the health of drivers should be pursued in a way that maximises gains
to all sectors of society. Lorries are perceived as noisy and dangerous and are certainly unwelcome in many
city centres and residential areas. It is in he interest of lorry drivers as well as members of the public that
lorries are made much quieter, much less polluting and much less intrusive. If lorries are managed as part
of a wider strategy to handle freight by all modes of transport then congestion problems could be reduced,
time pressures eliminated and more jobs created in the multi-modal, transhipment activities that would
result. It is important in lorry discussions to have a strategic view of the role and future development of
lorry transport as well as a very practical view of how to improve conditions for drivers and members of
the public now.
Similar arguments can be made for buses. Public transport in many parts of Europe is receiving
investment at a rate many times greater than in Britain. Investments in the Netherlands, Germany, France
and Denmark in new buses, new tram systems, bus lanes and traffic management systems that support buses
will improve life for the driver and the general public. A driver behind the wheel of a new bus with
excellent facilities for the disabled, state of the art communication technology, direct control over
signalling at intersections, excellent linkage possibilities with all other modes and ticketing systems that
almost eliminate taking fares on the bus will be a much happier and healthier bus driver than the UK
version of this situation. When buses have preferential treatment in cities and cars are restrained then the
job of a bus driver can refocus on high quality service to the customer in a safe well regulated environment.
The advantages for bus drivers and passengers of a move in this direction are enormous.
At the practical level of contemporary bus and lorry driving there are a number of policies that should
be implemented on a short time scale whilst the more strategic and longer term arguments about
employment, the environment and investment are developed and pressed home. The main areas for
Health of Professional Drivers © Eco-Logica Ltd 1995 8
immediate action for both bus and lorry drivers can be summarised as follows:
1 Attention to cab design and ventilation to ensure that air quality is the highest attainable standard
and noise levels are reduced to below 70 dB(A). Air in the cab should not be fed directly from the street
and there should be no possibility of evaporative emissions entering the cab from fuel lines, fuel tanks
etc.
2 Continuing progress with detailed attention to design matters to ensure that posture is correct and all
tasks associated with driving can be accomplished with no strain on eyes, hearing, motor functions,
reach etc.
3 The introduction of realistic work schedules that fully reflect the realities of traffic congestion,
keeping to speed limits, the need for breaks and rest periods. This should be kept under constant review
to ensure that drivers do not become the principal victims in absorbing the failures of the transport
system and the workers that bear the brunt of cost cutting. If more time is needed to accomplish the
tasks that have to be accomplished then the health of drivers and the safety of the public require that
this be provided. Drivers should be given longer breaks and wherever possible breaks that facilitate
interaction with other drivers.
4 The design and implementation of shift patterns and working practices that maximise the time than
can be spent at home and/or the time that can be spent with co-workers
5 Install state of the art communications technology in all vehicles. Communications are important for
work efficiency, for the safety of the driver and for eliminating the feelings of isolation.
6 Drivers should become more involved with management decision making about schedules, routes,
timings and organisation. They have considerable experience of these matters which are of value to
the overall commercial success of the organisation and studies(7) have shown that stress can be reduced
and health improved by greater levels of involvement in the management process.
7 For lorry drivers change in working practices and drivers pay (by agreement with workers) to reward
adherence to speed limits. Schneider in the US pays bonuses to truckers on the basis of observance of the
55mph speed limit. This reduces hassle for the trucker and saves the company money in fuel costs(20).
8 For lorry drivers install state of the art scheduling and rostering computer software to maximise use of
vehicles, maximise the number of trips involving a return home in the evening or weekend and minimise
mileages. A system of this kind would improve the health of drivers, improve the safety of the
general public and reduce costs for the organisation.
9 For bus drivers pay particular attention to safety and security of the driver and where circumstances
are particularly difficult use two person operated buses.
10 For bus drivers ensure that bus stations and bus stops are well lit, well located, adequately supervised,
easily accessed, fully equipped with state of the art information technology and where possible
involve immediate and unimpeded access back into the traffic flow. Bus stops can be located on
extensions to the pavement into the street so that when the bus stops all the other traffic stops behind
it and cannot pass. When the bus moves off the normal flow of traffic resumes and cars can overtake
where it is safe to do so. Buses are far more important than cars in urban areas and giving them
physical priority in this way will improve timings, increase passenger satisfaction and reduce the
hassle of driving a bus in congested streets.

REFERENCES

1. Siemiatycki, J. et al (1988) "Associations between several sites of cancer and ten types of exhaust and
combustion products" in Scandinavian Journal Work Environmental Health, 14, pp 79-90.
2. Wynder, E.L. and Higgins, I.T.T. (undated) "Exposure to Diesel Exhaust Emissions and the Risk of Lung
and Bladder Cancer" American Health Foundation, New York.
3. Netterstrom, B. (1988) "Cancer Incidence Amongst Urban Bus Drivers in Denmark", in Int Arch Occup
Environ Health, vol. 61, part 3, 217-22.
4. Balrajan, R and McDowall, M.E. (1988) "Professional Drivers in London: a mortality study" in British
Journal of Industrial Medicine, vol 45, part 7, 483-6.
5. Dockery, D.W. and Pope, C.A. et al (1993) "An Association Between Air Pollution and Mortality in Six
Health of Professional Drivers © Eco-Logica Ltd 1995 9
 US Cities" in The New England Journal of Medicine, Massachusetts Medical Society.
6. Brown, W. (1994) "Dying from too much Dust", New Scientist, 12 March 1994, pp 12-13.
7. Evans, G.W. (1994) "Working in the Hot Seas: Urban bus operators" in Accident Analysis and
Prevention, vol. 26, no.2, 181-93.
8. Netterstrom, B, and Juel, K. (1990) "Peptic Ulcers Among Urban Bus Drivers in Denmark" in
Scandinavian Journal of Social Medicine, vol. 18, part 2, 92-102.
9. Netterstrom, B. and Knud, J. (1989) "Low Back Trouble among Urban Bus Drivers in Denmark" in
Scandinavian Journal of Medicine, vol. 17, part 2, 203-6.
10. Hedberg, G.E. (1985) "Physical Strain in Swedish Lorry Drivers", in Journal Human Ergol (Tokyo), vol.
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