Setting occupational standards for insulin‐treated diabetes at sea, on land and in the air

Abstract

Diabetes, particularly treatment with insulin, has proved a longstanding and frustrating barrier to employment in certain occupations where public safety has been deemed to be potentially at risk. Historically, health and safety issues within the work environment have dictated employment policy, precluding people with diabetes who would otherwise be entirely capable of undertaking required responsible and skilled activities. Such considerations have been especially evident for professional occupations involving both commercial and public transport on land, by sea and in the air. This situation is changing. With the combination of individualised diabetes management and implementation of the Disability Discrimination Act, it is no longer appropriate to apply a 'blanket ban' restriction to employment irrespective of circumstances.The UK Maritime and Coastguard Agency (MCA), the Driving and Vehicle Licensing Agency (DVLA) and the Civil Aviation Authority (CAA) have each accepted the principle that insulin-treated diabetes should no longer be an absolute contraindication to occupational employment, but to be potentially permissable subject to strict, robust individual assessment. Each transport agency has established regulatory standards and operational protocols appropriate for their respective domains with a prime emphasis on minimising hypoglycaemia risk. Ensuring public safety remains paramount, but, with these protocol surveillance and assessment processes in place, it has proved possible for individuals with insulin-treated diabetes to achieve fitness certification and gain employment previously excluded to them. Over the last few years, despite having diabetes and being treated with insulin, many merchant seafarers, drivers of heavy goods vehicles and commercial airline pilots have successfully achieved fitness accreditation to work safely and reliably within these special occupational situations. IntroductionAs any person with diabetes will be well aware, the issue of employment and perceived occupational risk has been a longstanding controversy but one that now engages a more liberal attitude. Not that long ago, treatment with insulin would be regarded by many employers as potentially compromising to safety and effectiveness at work. Many people with diabetes found that they were prevented from obtaining gainful employment for which they were otherwise entirely suited. Reversing this situation has been a long and challenging process, involving determination and a championing of the way forward. As modern treatment and management of diabetes have advanced in so many ways with a crucial emphasis on personalised care, so it has become inappropriate to simply apply a 'blanket ban' irrespective of individual circumstances and capabilities. The Disability Discrimination Act of 1995, and more recent amendments, finally legislated that it was no longer lawful to discriminate against a person because of their condition, and this applies to insulin-treated diabetes. However, the Disability Discrimination Act d...

Enabling equality of employment with insulin treated diabetes in safety‐critical occupations

“…Setting occupational standards for insulin treated diabetes in safety‐critical employments is now an achievable reality 15 . Overall, this evaluation of the safety of pilots with insulin treated diabetes, flying commercial and non‐commercial aircraft, has set a standard for equivalent occupations to consider and follow.…”