REGAZZI, Isabel Cristina Ribeiro. Characteristics of social determinants in health: Truckers on a highway in Brazil. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 05, Ed. 11, Vol. 07, pp. 45-56. November 2020. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/health/characteristics
The present study was directed to answer the following guide question: What are the characteristics of some of the social determinants of the health of truck drivers of a Federal Highway in Brazil? Thus, a survey of the characteristics of some of the social determinants of truckers’ health of a highway in the state of Rio de Janeiro (RJ), Brazil, was carried out. This is a quantitative, exploratory and cross-sectional study. Data were collected through a form containing closed questions about the physical and mental health of truck drivers and analyzed by descriptive statistics techniques. A stand was set up next to the Federal Police station on highway BR 101 in the stretch of Casimiro de Abreu – RJ, where truckers were approached to perform health assessment and complete the research. Twenty-eight truckdrivers participated in the study, in which the total was male, and 89.3% reported not having diabetes mellitus and 86.5% did not present systemic arterial hypertension. It was observed that 78.6% of truck drivers have fixed residence in the state of Rio de Janeiro, 71.4% reported not having health insurance, 50% had a “D” license category and 35.7% had a workload of 8 hours per day. Regarding the type of product transported, 92.8% of these professionals reported not transporting hazardous materials. It is noteworthy that the profession of truckdriver is a career that increases the vulnerability of workers to diseases and health problems, since the specific characteristics of this work exercise and their work environment provide the worker to adopt bad eating and resting habits, besides favoring sedentary lifestyle, stress and reduced demand for a primary health care service.
Keywords: Worker health, vehicle driving, health vulnerability.
Truckers are both salaried and self-employed professionals who provide services to corporations belonging to the logistics and carrier sectors. Among their various functions, truckers squeal, remove and deliver goods. In this profession, according to a study conducted by the National Transportation Confederation, in the capitals of the Brazilian metropolitan regions, male individuals prevail working in cargo transportation, 99.8% of the total (CNT, 2016).
These professionals work driving trucks and, in most cases, perform long routes to deliver orders to customers in order to comply with the period stipulated by the company. Thus, the extensive working day, added to the use of “stimulant” drugs, such as psychoactive substances in order to reach the delivery time, can generate health problems for such working class (ALESSI; ALVES, 2015).
Several studies indicate that, due to the exhaustive work routine, many truckers develop health problems associated with unhealthy lifestyle habits, namely: sedentary lifestyle, sleep disorders, gastrointestinal alterations such as gastroesophageal reflux, ergonomic problems and, in particular, alcohol use, constituting the main element causing traffic accidents among truckdrivers (MASSON; MONTEIRO, 2010). In order to attest to the vulnerability to health problems resulting from this type of professional career, among the occupational fatalities caused by automobile accidents in the United States, 46% of deaths were represented by truckdrivers (CHEN, 2015).
The present study was directed to answer the following guide question: What are the characteristics of some of the social determinants of the health of truck drivers of a Federal Highway in Brazil?
The need for this study is justified due to the data found in the scientific literature that show health risk triggered by the trucker profession. The exercise of this profession requires a few hours of sleep and long periods away from home, being added to the stress and anxiety caused by traffic and bad eating habits. Therefore, these facts increase the vulnerability of these workers to various health problems, highlighting Sexually Transmitted Infections (STIs), predisposition to chronic diseases, traffic accidents and emotional diseases, such as depression (HINO et al 2017).
Thus, the objective was to verify the characteristics of some of the social determinants of the health of truckdrivers of a highway in the state of Rio de Janeiro (RJ), Brazil.
The present study has a quantitative, exploratory approach and was cross-sectional. It evaluated truckers who transited the BR-101 Highway, in the municipality of Casimiro de Abreu, located in the State of Rio de Janeiro, Brazil. Data collection occurred during a health promotion action for truck drivers, held on July 14, 2018. This action was promoted by the Fluminense Federal University (UFF) of the Rio das Ostras Campus, in partnership with the city of Casimiro de Abreu, and had the support of the Federal Highway Police (PRF). A stand was set up next to the federal police station, in which blood pressure assessment, haircut, and defensive driving guidance were offered.
Data collection was based on interviews conducted through a form containing closed questions about the socioeconomic, demographic and physical and mental health of truck drivers. The instrument was previously elaborated based on existing questions in the form provided by the Brazilian Institute of Geography and Statistics (IBGE) and specific questions for this population, in which it was pre-tested. Under the guidance of the teachers organizing the action, undergraduate nursing students applied the questionnaires on the day of the action. For each participating truckdriver, the free and informed consent form (TCLE) was applied. The inclusion criteria were truckers (autonomous and fleet) who transited the BR 101 in the stretch in Casimiro de Abreu. The research sample was characterized as convenience, and truckers were recruited who reduced the speed of the vehicle to see the Federal Police, stopping at the side of the highway and who at the time showed interest in participating in the action. Convenience sampling is adequate when used mainly in exploratory research, aiming to obtain a response quickly and inexpensively and to generate ideas (OLIVEIRA, 2001).
The collected data were entered in a spreadsheet and analyzed by means of measures of central tendency and proportion. The data was processed in the R Program, which is free and available for download. The results were represented in graphs and tables.
The present study is part of the project submitted and approved to the Ethics and Research Committee (CEP) of the Antônio Pedro University Hospital (HUAP). Being the researcher committed to follow all the principles and norms pre-established by Resolution No. 466/2012 of the National Health Council (CNS), which regulates research involving human beings (BRASIL, 2012). Approved by the Research Ethics Committee (CEP HUAP/UFF), CAAE: 73671617.5.0000.5243 Opinion Number: 2.384.79.
The sample of the research was 28 truckers. The main sociodemographic characteristics of the participants were male (100%) and the median age of 46 years, with the lowest age observed at 23 years and the age of 64 years (Figure 1). The average monthly income found was R$2,000.00, with the minimum value of the observed income of R$1,000.00 and the maximum of R$10,000.00. The place of residence with the highest predominance was the state of Rio de Janeiro, where 78.6% of truckdrivers have fixed housing (Table 1). It was found that the most prevalent work regime was the 8-hour daily workload, representing 35.7% of the participating truck drivers, and that 50% of truckers are qualified as category “D” (Table 2 and Figure 2).
Figure 1 – Boxplot of the distribution of the age of truckers in BR 101 – Casimiro de Abreu, 2018.
Table 1 – Distribution of variables related to the place of residence of truck drivers, 2018.
|Place of residence||Percentage (N= 28)|
|Espírito Santo||3,6 %|
|Minas Gerais||3,6 %|
|Rio de Janeiro||78,6 %|
|São Paulo||10,7 %|
Source: personal archive
Table 2 – Distribution of variables related to workload and the category of truckers’ qualification, 2018.
|Qualification categories||Percentage (N=28)|
|5 to 6 hours||14,3 %|
|7 o’clock||14,3 %|
|8 o’clock||35,7 %|
|8.1 to 10 hours||17,9 %|
|11 to 12 hours||14,3 %|
|3:00 p.m.||3,6 %|
Source: personal archive
Figure 2 – Boxplot of the distribution of the daily workload of truckdrivers in BR 101 – Casimiro de Abreu, 2018.
Regarding traffic accidents that occur during the work journey, the majority of truck drivers who participated in the study reported not having suffered accidents on highways. Regarding the transportation of dangerous products, almost 100% of truckers did not perform this type of transport (Table 4).
Table 3- Distribution of variables related to accident and type of material transported by truckdrivers, 2018.
|Road accidents||Percentage (N= 28)|
|Transport of hazardous materials||(N=28)|
Source: personal archive
Regarding the health of the participating truckdrivers, the issue of coverage by health plan, chronic diseases and use of licit substances was investigated. In the context of health insurance coverage, the highest proportion of truckdrivers did not have health insurance, representing 71.4% participants. In the variables of chronic diseases, 89.3% of the participants reported not having diabetes and 85.7% reported not being hypertensive. Regarding the use of licit substances, 89.3% participants indicated that they did not practice smoking (Table 4).
Table 4 – Distribution of variables related to truckers’ health, 2018.
|Has health insurance||Percentage (N= 28)|
|Did not report||3,6%|
|Did not report||3,6%|
Source: personal archive
The profile of the truckers surveyed does not seem to differ from other national studies, with the vast majority of truckers with monthly income slightly above 1 minimum wage (R$ 998.00 until the publication of the present study) and with a workload of 8 hours of work. It is worth mentioning that in most cases, transport drivers form their monthly income by a combination of salary and commission, which characterizes the reason that many workers choose to drive trucks. However, this economic model directly affects their working conditions, which is why many truckdrivers report in studies found in the literature the wear and tear suffered by long working hours (CNT, 2016; TRILICO, 2015; DELFINO, 2015).
However, truck drivers who work with a daily workload above that established by law, in the present study, represented 17.9% of the participants, which was an interesting observation, as it suggests the adoption of the logic of “profitability” by the workers. In other words, the faster you get to the delivery points and dispatch the goods assigned to the owner, the higher your billing at work, as you will make a greater number of deliveries. However, this attitude may require an increase in weekly workload through shorter rest time and the shorter occurrence of interruption over long distances traveled, generating a higher risk of having drowsiness and providing the consumption of stimulants, whether legal or illegal (THOMPSON; STEVENSON, 2014).
In this context, according to the research conducted by Hino et al (2017), most truck drivers participating in their study reported seeking the health system, in urgent and emergency care, in situations of intense and acute pain. This scenario strengthens the biomedical health model, focused on healing, which added to the fact that possibly working on the logic of profitability can generate several damages to the health of truckdrivers.
Also citing the findings of Hino et al (2017), regarding health care, their findings are in agreement with the data observed in this article, because a portion of the truckers evaluated reported not having health insurance, which makes access to prevention methods even more difficult. On the other hand, a comparative analysis of the data from the current study with the results presented by Ramos et al (2018), observing health from another approach, allows us to analyze that, in both studies, a reduced percentage of truck drivers diagnosed with systemic arterial hypertension and diabetes mellitus was observed. Even Ramos et al (2018) detected in the truckdrivers participating in their study a diagnosis percentage of 17.84% for systemic arterial hypertension and 9.73% for diabetes mellitus, obtaining higher values of hypertensive patients and an approximate value of diabetics when compared to the results found in the present study.
The research conducted by Angeles et al (2014) on the lack of primary care and the health of truck drivers reveals that, although a small percentage of truckdrivers participating in the study pointed out a certain history of diseases, such as diabetes mellitus, heart and lung diseases, a high prevalence of risk factors for chronic and cardiovascular diseases was detected. Among the risk factors that were found the daily salt intake above the recommended average and a nutrient-poor diet, received greater highlights. Therefore, even if truck drivers participating in the current study do not present a significantly high prevalence of history of chronic diseases, this fact should not rule out a high risk for future conditions. Therefore, it is essential that truck drivers receive health follow-up, especially from the Unified Health System, given that in our study 71.4% of truck drivers did not have health insurance.
Another point to be highlighted is that the fact that the truckdrivers studied do not have chronic diseases, such as diabetes mellitus and systemic arterial hypertension, may be related to the lack of medical follow-up, which hinders a possible diagnosis. Several truckers do not seek the health system for consultations and this situation is associated with the exhaustive routine of work along with the social standards related to masculinity. This attitude is corroborated by a research conducted in a Health Center in the interior of São Paulo, in which the care of men was linked to the treatment of chronic diseases, such as diabetes mellitus, systemic arterial hypertension and respiratory tract diseases. However, the methods of disease prevention, both primary and secondary, were adopted by less than half of the men treated, revealing that the approach to health care for the male public is more focused on curing illness than the use of disease prevention methods (BERTOLONI; SIMNETTI, 2014).
Regarding road accidents and their relationship with workload, it was observed that more than half of the truckers who compose the study reported not having suffered any type of traffic accident during the work hours. This result may be related to the fact that almost half of the participating truckers work 8 hours a day, not exceeding the limit required by law. According to Fragosso et al (2019), among the factors that predispose the occurrence of work accidents with truck drivers who travel long distances, are highlighted the high working hours and lack of rest experienced by these professionals.
5. FINAL CONSIDERATIONS
The profession of trucker is a career that increases the vulnerability of workers to diseases and other injuries, since the specific characteristics of this work exercise and their work environment provide the worker to adopt bad eating and resting habits, besides favoring sedentary lifestyle, stress and reduced demand for a primary health care service. In part, the evidence presented in this study corroborates the information found in the literature to the extent that the daily workload and the occurrence of traffic accidents during the craft were observed, two extremely relevant situations to trace the profile of the truck drivers’ work vulnerability. In theory, what is one has is that the lower the daily workload, the lower the risk for the occurrence of accidents and vice versa.
Another relevant point raised in the present study was the low detection of diagnoses of chronic diseases. However, this finding does not translate into a healthy lifestyle of the truckers interviewed, which is supposedly covered by a small demand for health services for diagnosis and a prognosis of health problems generated by an unhealthy lifestyle promoted by this profession. Therefore, it is suggested that more studies be conducted involving these workers to present new actions to promote the health and well-being of truck drivers, with a view to reducing the social vulnerabilities triggered by the profession with support in scientific evidence.
ALESSI, Angélica; ALVES, Márcia. Keller. Hábitos de vida e condições de saúde dos caminhoneiros do Brasil: uma revisão da literatura. Revista Ciência e Saúde, v. 8. n. 3, p. 129-136, 2015. Disponível em: <https://www.researchgate.net/publication/292076975_Habitos_de_vida_e_condicoes_de_saude_dos_caminhoneiros_do_Brasil_uma_revisao_da_literatura>. Acesso em: 27/07/2020.
ANGELES, Ricardo et al. Primary health care needs for a priority population: a survey of professional truck drivers. Work, v. 49, p. 175–181, 2014. Disponível em: <https://www.researchgate.net/publication/242332741_Primary_health_care_needs_for_a_priority_population_A_survey_of_professional_truck_drivers>. Acesso em: 27/07/2020.
BETOLLINI, Daniele Natália Pacharone; SIMONETTI, Janete Pessuto. O gênero masculino e os cuidados de saúde: a experiência de homens de um centro de saúde. Revista Anna Nery, v. 18, n. 4, p. 722-727, 2014. Disponível em: <https://www.scielo.br/pdf/ean/v18n4/1414-8145-ean-18-04-0722.pdf>. Acesso em: 27/07/2020.
CNT. Confederação Nacional de Transporte. Pesquisa CNT de perfil dos caminhoneiros 2016. Brasília: CNT, 2016. 98 p. Disponível em: <http://cms.cnt.org.br/Imagens%20CNT/PDFs%20CNT/Pesquisa%20de%20Perfil%20dos%20Caminhoneiros/Pesquisa_CNT_de_Perfil_dos_Caminhoneiros_2016_Completo.pdf>. Acesso em: 27/07/2020.
CHEN, Guang. X. et al. Vital signs: seat belt use among long-haul truck drivers – united states, 2010. Morbidity and Mortality Weekly Report, v. 64, n. 8, p. 217-221, 2015. Disponível em: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4584718/pdf/217-221.pdf>. Acesso em: 27/07/2020.
COSER, Janaina et al. Triagem dos perfis lipídico de glicídico em caminhoneiros que trafegam no centro unificado de fronteira, entre Brasil e Argentina. Revista Brasileira de Analises Clinicas, v. 41, n. 3, p. 223-228, 2009.
DELFINO Livia Guimarães; MORAES, Thiago Drumond. Percepções sobre adoecimento para caminhoneiros afastados pelo sistema de previdência social. Revista Estudos Interdisciplinares em Psicologia, Londrina, v. 6, n. 2, p. 113-143, 2015. Disponível em: <http://www.uel.br/revistas/uel/index.php/eip/article/view/23932/17866>. Acesso em: 27/07/2020.
FRAGOSO JUNIOR, Ademar; GARCIA, Eduardo Garcia. Transporte rodoviário de carga: acidentes de trabalho fatais e fiscalização trabalhistas. Revista Brasileira de Saúde Ocupacional, v. 44, n. 3, p. 1-12, 2019. Disponível em: <https://www.scielo.br/pdf/rbso/v44/2317-6369-rbso-44-e3.pdf>. Acesso em: 27/07/2020.
HINO, Paula et al. Análise dos cuidados à saúde dos caminhoneiros. Revista de Enfermagem UFPE online, Recife, v. 11, n. 11, p. 4741-4748, novembro, 2017. Disponível em<https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/231217/25231>. Acesso em: 27/07/2020.
MASSON, Valéria Aparecida; MONTEIRO, Maria Inês. Estilo de vida, aspectos de saúde e trabalho de motoristas de caminhão. Revista Brasileira de Enfermagem, Brasília, v. 63, n. 4, p. 533-540, 2010. Disponível em: <https://www.scielo.br/pdf/reben/v63n4/06.pdf>. Acesso em: 27/07/2020.
RAMOS, Bruna Helena et al. Condições de vida, trabalho e saúde de motoristas de transporte de cargas. Revista de Enfermagem UFPE online, Recife, v. 12, n. 1, p. 150-159, 2018. Disponível em: <https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/22922/25967>. Acesso em: 27/07/2020.
OLIVEIRA, Tânia Modesto Veludo de. Amostragem não probabilística: adequação de situações para uso e limitações de amostras por conveniência, julgamento e quotas. Revista de Administração Online, v. 2, n. 3, p. 1-13, 2001. Disponível em: <https://pesquisa-eaesp.fgv.br/sites/gvpesquisa.fgv.br/files/arquivos/veludo_-_amostragem_nao_probabilistica_adequacao_de_situacoes_para_uso_e_limitacoes_de_amostras_por_conveniencia.pdf>. Acesso em: 27/07/2020.
THOMPSON, Jason; STEVENSON, Mark. Associations between heavy-vehicle driver compensation Methods, fatigue-related driving behavior, and sleepiness. Traffic Injury Prevention, v. 15, p. 10-14, 2014. Disponível em: <https://www.researchgate.net/publication/266797765_Associations_Between_Heavy-Vehicle_Driver_Compensation_Methods_Fatigue-Related_Driving_Behavior_and_Sleepiness>. Acesso em: 27/07/2020.
TRILICO, Matheus Luis Castelan. et al. Discursos masculinos sobre a prevenção e promoção da saúde do homem. Revista Trabalho e Educação em Saúde, Rio de Janeiro, v. 13, n. 2, p. 381-395, 2015. Disponível em: <https://www.scielo.br/pdf/tes/v13n2/1981-7746-tes-sip00015.pdf>. Acesso em: 27/07/2020.
 PhD in health sciences, Associate Professor Fluminense Federal University (UFF).
 Nursing undergraduate.
 Graduated in Nursing.
 PhD in Health Sciences – UNIRIO
 Doctor of Public Health.
Submitted: August, 2020.
Approved: November, 2020.