American Crisis – Health of our Nation’s Truck Drivers
In America, nearly 1 of every 15 people in the workforce is employed in the trucking industry, including over 7 million truck drivers on our roads. Due to an unhealthy lifestyle and lack of good nutritional options while traveling, truck drivers are categorically one of the unhealthiest populations in our country. Indicative of the challenges facing this population, the average life expectancy of drivers is 61 years (Global Insight May 2005). Statistics from the National Institute of Health show that more than 50 percent of truck drivers are obese, compared to the national rate of 26.7 percent. Compared to the general population, the prevalence of diabetes is 50 percent higher and 87 percent of truck drivers have hypertension or pre-hypertension, compared to the national average of 58.3 percent (JOEM 2009). These health issues place a toll on families, impose a financial burden on employers and have created regulatory challenges for the federal government due to the related safety issues on our roads.
The most important aspect of these statistics is that these conditions are preventable through modifying risk factors. Among the general adult population, 21 percent smoke, and 49 percent exercise regularly, while 54 percent of commercial drivers smoke cigarettes and only 8 percent exercise. With the proper lifestyle choices, these drivers can reduce their disease risk and increase their life expectancy and quality of life.
Existing Regulatory Safeguards
DOT Exam – To obtain a certified drivers license, commercial drivers must pass a biannual Department of Transportation (DOT) Examination, which consists of a comprehensive physical including assessment of medical history and biometrics. To qualify for their license, drivers must meet a number of baseline measures. The truck driver’s blood pressure must be 140/90 or below. If the driver is diabetic, the disease must be well controlled generally without insulin. The driver’s respiratory functions cannot interfere with sleep. In addition, the Federal Motor Carrier Safety Administration (FMCSA) is beginning to require fleets to document their employees’ health due to related safety issues.
Compliance Safety and Accountability Act of 2010 addresses roadside safety violations. The CSA has added Behavior Analysis and Safety Improvement Category (BASIC) that addresses FMCSA requirements. The Driver Fitness BASIC will require fleets to adhere to documenting drivers who are unfit to operate a CMV due to a lack of training, experience, or medical qualifications. To be in compliance with the Fitness BASIC, drivers must be able to prove that they are physical and medically qualified through holding of a medical certification card.
National Provider Registry – Beginning in 2014 the government will require registration of DOT examiners to ensure quality certification of a driver’s health. The National Registry of Certified Medical Examiners (NRCME) program would require medical examiners receive training and pass a certification test before being listed on the Registry. The program addresses the range of knowledge, skills and abilities needed to adequately perform physical examinations of CMV drivers.
Improving driver’s health does not go without challenges. Commercial Drivers work extremely long days, in a high stress environment. Their job requires them to meet tight schedules and stay alert for up to 14 hours a day. Drivers remain sedentary for long periods of time and lack of quality food options provide for poor nutrition and diet. Over 80 percent of drivers report unhealthy eating habits, which consist of fast food, high sodium content, and no fruits or vegetables (Brewster June 2007). Uncomfortable living conditions and working schedules are a recipe for unhealthy, irregular sleeping patterns. These behaviors and their implications for chronic disease have become a growing concern for the government as it relates to safety. This is especially in regards to the high prevalence of sleep apnea, blood pressure, and uncontrolled diabetes.
It’s not a matter of adopting a wellness program to address chronic disease, but more importantly the challenge of getting the drivers to participate in the programs in order to raise awareness. Only 30 percent of drivers self report that they have a primary care physician, which may be due to the transient nature of the job and psycho-social issues regarding drivers’ health. With little access to primary care, healthy food, opportunity to exercise, and a compromised overall social wellbeing on the road, drivers encounter tremendous barriers to change, and demonstrate a tremendous health education gap as it relates to nutrition, exercise and healthy habits.
Support for Trucking Fleets and Drivers
Though not all wellness interventions have proven to be successful, health coaching has been implemented at trucking companies such as J.B. Hunt Transport, one of the largest transportation logistics companies. In support of the company’s strong commitment to healthier lifestyles, J.B. Hunt along with Aetna provided online wellness programs and health coaching to employees and their families. At the end of the program, 68 percent reported improvement in body-mass index (BMI) and the number of people saying they eat more fruits and vegetables increased 29 percent (Aetna 2007.) Health coaching, provided a scalable model across the country, can have great influence on the turn around these drivers and companies need to achieve.
In response to the new demands, fleet terminals are now beginning to offer health screenings, workshops, kiosks, and building fitness centers. Truck stops such as Flying J and TA Petro offers programs called StayFit, which are programs designed to address making better choices at truck stops. These programs offer mapped out walking trails, fitness centers, and shelf signs identifying healthier options.
New Opportunities to Improve Driver’s Health
Convenient Care Clinics have created a national network of DOT clinics, and have launched a new initiative focused on the health and wellness of truck drivers across America. Leading organizations such as CVS / Minute Clinic, Little Clinic, RediClinic and Walmart, offer DOT exams and ongoing wellness services for truck drivers in over 600 of their member clinics. These providers are educated on the DOT exams and are trained according to FMCSA regulations. In addition to the DOT medical examination, retail clinics offer wellness services such as biometric screenings, disease management programs, smoking cessation, weight loss programs and nutrition counseling.
Convenient care clinics have been shown to provide improved access to care as well as quality and affordability as compared to urgent care and emergency rooms. They are currently located in 35 states and employ approximately 8,000 nurse practitioners and physician assistants.
Along with the existing health technology and web-based management, retail health clinics can prove to be outstanding options as a “medical home” for those drivers without primary care and traveling on the road. With the use of electronic medical records, these clinics have the capabilities of linking patient records to primary care physicians, insurance companies, hospitals, and other clinics across the country. These systems provide a means to ensure continuity of care no matter the driver’s location. Along with wellness programs, the use of technology is essentially the bridge to providing quality and effective care for this population.
The retail clinics have begun to foster relationships with trucking organizations including the Truckload Carriers Association, State Associations, and Independent Drivers Groups to promote the opportunity for drivers to utilize the clinics for DOT exams, acute and chronic care needs.
Making an Impact on Driver’s Health
The need to improve the health of our nation’s truck drivers is no longer an option. It requires immediate attention and will involve "disruptive changes" in the working environment and within our healthcare delivery model. The environment for drivers must be conducive to good health. Truck stops and fleet terminals must begin to offer healthy food products and make fitness equipment available. Drivers’ also need to have improved access to health education resources and technology such as health kiosks.
Fleet programs should include workshops on wellness with professional staff and health screenings similar to their existing workshops on safety. Also, new and improved healthcare delivery models, such as convenient care clinics, can be offered to drivers for DOT exams and health and wellness programs for themselves and their families. Finally, implementing a successful health coaching model has the ability to improve the prevalence of chronic diseases and could be an important wellness resource for the trucking industry. There are opportunities for organizations focused on health and wellness products and solutions to support these efforts. With the commitment of drivers, employers, and health and wellness professionals, we can provide the resources and means to increase the quality of life and highly impact safety on our nation’s roads.
About the Author
Steward Levy is the President and Founder of Health Promotion Solutions. Health Promotion Solutions provides consulting, biometrics, health coaching, and lifestyle management programs to impact chronic diseases for employers nationwide. Our expertise is providing evidenced-based assessment tools which provide meaningful outcomes, creates employee engagement and measurement of ROI. To learn more about our work with trucking fleets, retail clinics, and how your organization can benefit, please contact info@Healthpromosolutions.com.