Introduction
Amongst its many profound effects, the COVID-19 pandemic demonstrated the vital role of particular industries and essential workers such as healthcare personnel in maintaining public health, before the development and roll-out of vaccines (Scholz et al Reference Scholz, Schauer and Latzenhofer2022) and especially during the lockdown stage when other activities were curtailed (sometimes severely). In addition to the healthcare system, activities such as transport of goods, food-processing, maintaining utilities (power, water, and sewage treatment), warehousing/logistics, aged and community-care, and retailing, all needed to continue even during lockdowns. Workers in these sectors, particularly before the development of effective vaccines and adequate supplies of effective personal protective equipment (PPE), were exposed to higher risks of infection and experienced significant mental anguish (Cherry et al Reference Cherry, Trish Mhonde, Igor Burstyn, Labrèche and Ruzycki2023; Menezes et al Reference Menezes, Garcia, Maeno, Prearo, Toporcov and Algranti2023; Takala et al Reference Takala, Descatha, Oppliger, Hamzaoui, Bråkenhielm and Neupane2023; Syamlal et al Reference Syamlal, Kurth, Blackley, Dodd and Mazurek2024).
Unlike healthcare, the vast majority of these workers had no training in dealing with infectious diseases or only very restricted training (such as in food hygiene) unsuited to pandemic situations (Persaud et al Reference Persaud, Weinstock and Wright2022). Moreover, in most instances, their workplaces were not designed or managed with infection/pandemic risk in mind (Vecherin et al Reference Vecherin, Chang, Wells, Trump, Meyer, Desmond, Dunn, Kitsak and Linkov2022). Even after the development of vaccines, United Kingdom (UK) evidence indicated vaccination rates were lower amongst workers dealing with the public or vulnerable people (Nafilyan et al Reference Nafilyan, Dolby, Finning, Pawelek, Edge, Morgan, Glickman, Pearce and van Tongeren2022) although this may have been less evident in countries that took a more forceful approach to mandating vaccination, such as Australia.
The challenges of COVID for workers, especially precarious/non-standard workers, across a spectrum of industries, have been made clear in the literature that has relevance for our transport sector focussed study. Precarious workers are less likely to belong to unions or have access to worker representative mechanisms. A large Spanish survey (Ollé-Espluga et al Reference Olle-Espluga, Castiblanque, Llorens-Serrano, Esteve-Matali and Navarro-Gine2024) found that the presence of worker representation was associated with greater workplace protection measures. It is worth adding that precarious workers and female workers (women are over-represented in precarious jobs) not deemed essential, were adversely impacted by the pandemic in ways that affected their health and well-being, including loss of work and income, food security, inadequate government benefits, and violations of labour and OHS standards (Bohorquez et al Reference Uribe Bohorquez and García Sánchez2023; Bosmans et al Reference Bosmans, Vignola, Valentina Álvarez-López, Ahonen, Mireia Bolíbar, Ivarsson, Kvart and Muntaner2023; O’Campo et al Reference O’Campo, Gunn, Perri, Buhariwala, Rasoulain, Daneshvardfard, Ma, Lewchuck, Baron, Bodin and Muntaner2024; Hansson et al Reference Hansson, Ellen MacEachen, Landstad and Tjulin2024). Employment type and duration also affected access to PPE and other COVID-19 protections, further disadvantaging precarious/non-standard workers (Gunn et al Reference Gunn, Vives, Zaupa, Hernando-Rodriguez, Julià, Kvart, Lewchuk, Padrosa, Vos, Ahonen, Baron, Bosmans, Davis, Díaz, Matilla-Santander, Muntaner, O’Campo, Östergren, Vanroelen, Vignola and Bodin2022). Finally, the pandemic exposed serious gaps in occupational health and safety (OHS) and industrial relations legislation, and their intersection with public health, limitations that – with notable exceptions – have not been addressed since the pandemic (Quinlan Reference Quinlan2021; Spieler Reference Spieler2023).
In addition to infection risk itself, changes to work organisation/practices had occupational health and safety (OHS) effects (see for example (Hurd et al Reference Hurd, Ravenswood and Nicholson2022)) as well as the mental anguish associated with awareness of infection risks. A Canadian study (Smith et al Reference Smith, Oudyk, Potter and Mustard2021) found that the mental health of non-healthcare ‘essential’ workers was significantly affected by the adequacy of infection control programs in the workplace. Furthermore, additional quarantining and port controls, along with reduced crew changeovers, increased social isolation, and fatigue, adversely affected the mental health of seafarers. (Kirkby Reference Kirkby2020; Arulanthu Reference Arulanthu2021; Pauksztat et al Reference Pauksztat, Andrei and Grech2022).
During COVID-19, the connections between precarious work and health (both public and occupational) were rediscovered to some degree. In Australia for example, special payments were introduced to cover all temporary workers and contractors who were not entitled to sick leave to cover the period of isolation mandated following infection or close contact with infected persons (Services Australia 2024). This was designed to eliminate a financial pressure to not report disease or isolate – again problems well understood in the 19th century. The then premier of the Australian state of Victoria labelled precarious employment as toxic and promised to do something about it (Quinlan Reference Quinlan2021). Germany introduced new regulations on meatworks that restricted the use of agency-workers/contracting and in Australia a Senate Inquiry into insecure work focused, amongst other things, on lessons to be drawn from the pandemic (Purkayastha et al Reference Purkayastha, Vanroelen, Bircan, Vantyghem and Adsera2021; Security 2022). However, overall, there was surprisingly little learning from the pandemic regarding the greater risks posed by extensive flexible work arrangements.
These increased risks of infection, mental anguish, social isolation, and fatigue were exacerbated by staff shortages and cutbacks in health infrastructure that had occurred in many countries under neoliberal policies over preceding decades, but also by the growth of precarious and informal work arrangements in health/aged care and other industries deemed essential, such as road transport, food processing and retailing (Purkayastha et al Reference Purkayastha, Vanroelen, Bircan, Vantyghem and Adsera2021; Quinlan Reference Quinlan2021).Temporary part time work meant that some aged care workers employed in more than one facility also increased the risks of disease transmission (Henriques et al Reference Henriques, Sousa, Faria, Pinto, Jorge Silva da Costa, Pereira Henriques and Durão2023). Multiple jobholding was also to be found in other industries such as food delivery but in addition to this, these workers were commonly employed on a temporary or even as self-employed contractors which meant any interruption of work (for the disease or quarantine) effectively stopped their income. Low incomes, and concentration of minorities and immigrants in some of these jobs (such as food processing and delivery), meant they were more likely to live in crowded households/communities further exacerbating risks of disease transmission and presenting additional challenges in terms of communicating messages (Côté et al Reference Côté, Ellen MacEachen, Amelia León, Samantha Meyer, Amoako, Jahangir and Dubé2024). The connections between precarious work and increased risks of transmission of infectious disease were not new having been pointed out by The Lancet as early as 1876 (Quinlan Reference Quinlan2021).
Within these essential sectors, the transport industry played a critical role in maintaining societal function during the pandemic. However, transport workers faced unique challenges, including frequent public interaction, confined working environments, and high mobility, all of which increased their risk of exposure to respiratory diseases (Browne et al Reference Browne, Ahmad, Beck and Nguyen-Van-Tam2016). Moreover, the users of transport services, whether directly or indirectly involved, are an integral part of the transport system, and their interactions with transport workers and environments significantly influence the transmission dynamics of respiratory diseases. Understanding the impact of COVID-19 or other related respiratory diseases on transport users is crucial for a comprehensive assessment of pandemic transmission within the transport system (Guo et al Reference Guo, Xiao, Wang, Li, Du, Dai, Gong and Xiao2023).
This study focusses attention on a particular sector. The transport sector is vast, encompassing subsectors such as long-haul and short-haul trucking, as well as industry-specific transport such as refrigerated and livestock transport (Belzer and Sedo Reference Belzer and Sedo2018). Non-standard employment, including self-employed contractors and casual/temporary employees, is prevalent in this industry, further complicating the health and safety landscape. Ground transport workers, particularly those involved in road transport, represent a critical yet vulnerable segment within the transport industry. In Australia, for example, the road transport sector alone employs around 270,000 workers (Stanford and Grudnoff Reference Stanford and Grudnoff2020). These workers often operate in precarious conditions, with limited access to health protections such as PPE, and inconsistent adherence to public health guidelines (Gunn et al Reference Gunn, Vives, Zaupa, Hernando-Rodriguez, Julià, Kvart, Lewchuk, Padrosa, Vos, Ahonen, Baron, Bosmans, Davis, Díaz, Matilla-Santander, Muntaner, O’Campo, Östergren, Vanroelen, Vignola and Bodin2022). Despite the crucial role they play, there is a significant gap in research focused on understanding the specific risks faced by transport workers during respiratory pandemics. The aim of this study was to understand the current state of research on the impact of respiratory diseases on transport workers and to identify any remedies that could mitigate the risks associated with these diseases in the transport industry.
Methods
This study examines the literature to consolidate research findings and identify the impact of respiratory pandemic diseases (including but not limited to COVID-19) on transport workers. In this study, we employed Levac et al’s five-stage scoping review process (Levac et al Reference Levac, Colquhoun and O’Brien2010). Ethical approval was not required. The scoping review has been registered with the Open Science Framework (https://osf.io/nsey8).
Stage 1: Identifying the research questions
Our intention was to provide a nuanced investigation of the breadth of scholarship on transport and infectious diseases. To achieve that aim, the research team developed the following questions: What is known from the global literature about the reasons for and factors surrounding transport workers getting infected with pandemic respiratory diseases like COVID-19? Given that equity is a key principle of public health, it ought to underpin research, policy, and practice, so, what are the equity implications of respiratory diseases like COVID-19 for diverse groups of transport workers, including the dynamics around the spread of diseases? What is the impact of COVID-19 or related respiratory diseases on those who use transport services directly or indirectly, considering the globally and locally documented measures employed by governments and transport industries?
Stage 2: Identifying relevant studies
Between December 2022 and February 2023, we searched PubMed, Embase, and EBSCO research databases using relevant keywords. The search was guided by a set of descriptive key search terms. Key search terms used were semantically related and grouped into six categories as follows:
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(a) Infection, exposure, detect, transmission.
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(b) COVID-19, respiratory, pandemic, H1N1, SARS-CoV-2, severe acute respiratory syndrome, Middle East respiratory syndrome corona virus, coronavirus.
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(c) Transport, freight, automobile, driver, truck, lorry, bus, train, taxi, rideshare, delivery.
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(d) Work, staff, employee.
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(e) Equity, demographic, social, economic, equality, disadvantage, vulnerable, deprive, gig.
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(f) Plan, strategy, measure, guideline, policy, prevention, governance, legislation, closure, restriction.
Boolean operators were used to combine key terms i.e., AND/OR/*.
Boolean operators were used as follows:
The key terms within each category were combined using the OR operator. For example, “Infection OR exposure OR detect OR transmission”.
The categories themselves were combined using the AND operator. For example, “(Infection OR exposure OR detect OR transmission) AND (COVID-19 OR respiratory OR pandemic OR H1N1 OR SARS-CoV-2 OR severe acute respiratory syndrome OR Middle East respiratory syndrome corona virus OR coronavirus).
Stage 3: Identifying the study selection criteria
Only articles published in English between 2002 through 2022 were included to ensure that the review covered recent literature. To be included, articles had to meet the following inclusion criteria, which were identified based on the research questions in Stage 1:
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(a) Focused on exposure to respiratory infectious disease pandemics, including COVID-19, among transport workers.
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(b) Reported symptomatic respiratory infections amongst and/or exposure to transport workers.
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(c) Included research papers focussed on symptomatic infections and/or exposure to transport workers that are linked to work-related factors and/or from sources other than work-related like household contact.
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(d) Covered equity implications of respiratory disease pandemics for diverse groups of transport workers.
Articles on air pollution and transportation patterns, articles related exclusively to maritime and air transport modes, and articles that primarily focused on theoretical models or strategic frameworks were excluded. Although both maritime and air transport sub-industries are present in the results, we excluded articles that focused exclusively on these modes. That decision was made because our review aimed to concentrate on the broader context of ground-based transport modes, such as freight, automobile, truck, lorry, bus, train, taxi, rideshare, and delivery services. Maritime and air transport modes operate in significantly different environments compared to ground-based transport modes.
The primary focus of this scoping review was to capture a breadth of literature related to the subject matter, rather than evaluate the quality of the studies included (Munn et al Reference Munn, Peters, Stern, Tufanaru, McArthur and Aromataris2018). As such, the inclusion criteria were designed to prioritise the potential information contained within the selected papers, rather than conducting a detailed quality assessment of each paper.
To ensure the relevance of the selected publications, the screening process was conducted in three steps. In the first step, [Qureshi] independently screened the titles of the publications according to the inclusion criteria. To ensure validity, publications that met the criteria were then reviewed by [Harris and Jegasothy]. Although Levac et al recommend that both title and abstract screenings be conducted by at least two reviewers independently, our approach was tailored to manage the extensive volume of initial search results efficiently. The title screening was performed separately from the abstract screening to manage the large volume of initial search results more efficiently. Given the extensive number of articles retrieved, an initial title screening allowed us to quickly exclude obviously irrelevant studies, thereby streamlining the subsequent abstract screening process. This two-step approach helped ensure that only potentially relevant articles were subjected to more detailed abstract and full-text reviews, improving the efficiency and feasibility of the screening process given our resource constraints. At this stage, only the most apparent aspects of the inclusion criteria, such as focus on transport workers and respiratory diseases, were applied. Any discrepancies were resolved through discussion. In the second step, the abstracts of the shortlisted publications were screened as required by the inclusion criteria by two authors for each of the three scoping review questions. Each question was handled by two reviewers who independently screened the abstracts to ensure thorough and unbiased evaluation. Discrepancies were resolved through discussion. In the third step, the entire article was screened for relevance. The screening process is depicted in Figure 1.
Figure 1. Selection flowchart diagram following PRISMA guidelines.
Stage 4: Charting the data
Three data extraction tools were developed for each of the three research questions to extract key elements. These tools were reviewed and validated by other authors. The key elements included in the data extraction tools were used as a baseline to extract relevant information. That detail included exposure details, outcomes, factors and reason for infection, equity implications, infection control measures, strategy details, implementation, effectiveness, and evaluation of the strategies. For the purposes of this study, the term “strategy” is defined as any guideline, policy, or plan that is implemented by the government or the transportation industry to prevent and/or control the transmission of infections.
As lead author Qureshi then inductively assigned codes to the themes, which were then reviewed and validated by the co-authors (Harris, Jegasothy, Seale, Chughtai, and Quinlan). In addition to the key elements, the team also extracted baseline data related to the title and summaries of the selected studies. This information is presented in Table 1.
Table 1. Baseline details of all selected articles
Stage 5: Summarising results
The results were summarised under four themes (see Figure 2). Themes one, two, and three correspond to questions one, two, and three of the scoping review, respectively.
Figure 2. Graphic Representation of the Key Transport Workforce Risk and Exposure to Respiratory Pandemic Diseases. Themes Identified from the Selected 39 Research Articles.
Results
All the 39 research articles included in the scoping review were focused on COVID-19. Two papers emerged as common sources of information for addressing questions one, two and three (Crizzle et al Reference Crizzle, Malik and Toxopeus2021; Ingram et al Reference Ingram, Archibald, Alvarez and Perrotta2022). One paper was a common source of information for addressing questions one and two (Shan Reference Shan2022). All the texts included in our review met the same overall inclusion criteria outlined in the methods section. However, within this set of included studies, we further shortlisted papers based on their relevance to each specific research question. The main themes and subcategories are depicted in Figure 2. General characteristics of the 39 research articles have been presented in Tables 2–4.
Table 2. Characteristics of Studies Included in the Scoping Review for Question number 1: Study Design, Methodology, Industry Focus, and Demographic Characteristics
Table 3. Characteristics of Studies Included in the Scoping Review for Question number 2: Study Design, Methodology, Industry Focus, and Demographic Characteristics
Table 4. Characteristics of Studies Included in the Scoping Review for Question number 3: Study Design, Methodology, Study time period, Industry Focus, and Spatial distribution
Theme one: Why transport workers are at higher risk of infection from respiratory pandemic diseases: Uncovering the causes
The literature on transport workers and risk of infection is multifaceted. The following sub-sections examine the high risk of exposure and the factors that influence the transmission of respiratory pandemic infections among transport workers and addresses question one of the scoping review.
High risk of exposure to respiratory pandemic diseases among transport workers
Transport workers faced heightened risk of exposure to respiratory pandemic diseases potentially resulting in an increase in mortality rate (Tomasi et al Reference Tomasi, Ramirez‐Cardenas, Thiese, Rinsky, Chiu, Luckhaupt, Bateman and Burrer2021). For example, an observational study (Yasri and Wiwanitkit Reference Yasri and Wiwanitkit2020) about COVID-19 outbreaks and mortality among public transportation workers in California reported the cumulative outbreak incidence for all public transportation industries was 1.4 times as high as that for all industries, and the cumulative crude mortality rate for all public transportation industries was 174 per 100,000 workers, which was 1.5 times as high as the rate across all industries. Among individual public transportation industries, the cumulative outbreak incidence was 5.2 times as high in bus and urban transit (129.1) and 3.6 times as high in air transportation (87.7) as in all industries. Annual outbreak incidence in public transportation industries increased by 68.4%, from 11.7 outbreaks per 1,000 establishments in 2020 to 19.7 in 2021, whereas outbreak incidence across all industries increased by 22.9% (from 8.3 to 10.2) during the same period. Furthermore, the study concludes that these observations underscore the vulnerability of public transport workers, whether exposure occurs from interactions with the public, coworkers, or other sources. Notably, in a case report from Thailand, transport workers who contracted the infection were found to have a higher likelihood of requiring hospitalisation, indicating the severe impact of the disease on this vulnerable group (Yasri and Wiwanitkit Reference Yasri and Wiwanitkit2020).
These findings highlight that transport workers are a vulnerable group who should be prioritised in future pandemic preparedness and response strategies. Such strategies can include targeted vaccination efforts, access to antiviral treatments, public health messaging, and enhanced workplace protection measures. These measures might involve improving ventilation systems and ensuring the use of well-fitted masks or respirators (e.g., N95s) by both workers and the public (Heinzerling Reference Heinzerling, Vergara, Gebreegziabher, Beckman, Wong, Nguyen, Khan, Frederick, Bui, Chan, Gibb, Rodriguez and Jain2022).
Factors influencing the transmission of infections among transport workers
The implementation of preventive measures, such as the provision of PPE and passenger restrictions, was a crucial step towards mitigating the risk of respiratory pandemic diseases among transport workers (De Matteis et al Reference De Matteis, Cencedda, Pilia and Cocco2022; Harris and Kirkham Reference Harris and Kirkham2021). However, these measures were generally found to be inadequate. Several key factors contributed to the continued high risk of infection among transport workers:
Public Contact and Material Handling: A high percentage of transport workers were involved in positions that required frequent contact with the public and the handling of materials, which increased the risk of infection (De Matteis et al Reference De Matteis, Cencedda, Pilia and Cocco2022; Harris and Kirkham Reference Harris and Kirkham2021;Öngel et al Reference Öngel, Gülenç, Gürcanli and Arbak2022; Pongpirul et al Reference Pongpirul, Pongpirul, Ratnarathon and Prasithsirikul2020; Ingram et al Reference Ingram, Archibald, Alvarez and Perrotta2022).
Air-Conditioned Vehicles: A study on aerosol transmission of COVID-19 in different commuter microenvironments found that air-conditioned vehicles increased risk of transmission (Das and Ramachandran Reference Das and Ramachandran2021). Relatedly, the highest number of outbreak-associated cases occurred in the air transportation sector (Heinzerling Reference Heinzerling, Vergara, Gebreegziabher, Beckman, Wong, Nguyen, Khan, Frederick, Bui, Chan, Gibb, Rodriguez and Jain2022).
Inconsistent Use of PPE: In response to the elevated risk of respiratory pandemic diseases among transport workers, several preventive measures were introduced, including the provision and compulsory use of PPE (Harris and Kirkham Reference Harris and Kirkham2021; De Matteis et al Reference De Matteis, Cencedda, Pilia and Cocco2022; Pongpirul et al Reference Pongpirul, Pongpirul, Ratnarathon and Prasithsirikul2020; James et al Reference James, Thompson, Chin-Bailey, Donaldson Davis, Walters and Holder Nevins2022). Although these measures aimed to minimise the risk of infection, the adherence to PPE usage among transport workers was inconsistent (James et al Reference James, Thompson, Chin-Bailey, Donaldson Davis, Walters and Holder Nevins2022; Harris and Kirkham Reference Harris and Kirkham2021) with a significant association between the relative change in income and reduced mask-wearing practice (James et al Reference James, Thompson, Chin-Bailey, Donaldson Davis, Walters and Holder Nevins2022).
Ethnicity: Ethnicity was identified as a significant risk factor across the literature, with black or Hispanic populations disproportionately affected by the COVID-19 pandemic reporting higher infection rates in the transport industry (Faberman and Hartley Reference Faberman and Hartley2022).
Underlying Health Conditions: The literature also indicated a higher risk of infection among transport workers due to underlying health conditions, including hypertension, type 2 diabetes, sleep apnoea, high cholesterol, and depression (Crizzle et al Reference Crizzle, Malik and Toxopeus2021).
Theme two: Equity implications of respiratory pandemic diseases for transport workers
This section explores the equity implications identified in the literature concerning transport workers and the transmission and control of respiratory diseases, including COVID-19. The primary equity issues highlighted relate to the distribution of impacts, notably in terms of employment precarity and the lack of agency and control among transport workers.
The main pathways to impact were physical and psychosocial, increased exposure to infection, increased susceptibility to disease, financial precarity, and uncertainty regarding policies and responsibilities for protection from the virus. The following sub-sections examine the equity implications of respiratory diseases like COVID-19 for diverse groups of transport workers across structural conditions and systematic disparities.
Structural inequalities: Longer working hours, larger geographic coverage, overcrowded spaces
Structural inequalities concerned the institutional barriers faced by transport workers that caused them to be at higher risk of poor outcomes. Workers who faced inadequate infection control measures, longer working hours, and larger geographic coverage for deliveries were affected in their ability to take health and safety measures; they also limited time and resources to prioritise their own well-being (Ingram et al Reference Ingram, Archibald, Alvarez and Perrotta2022; Tran et al Reference Tran, Nguyen, Nguyen, Nguyen, Huynh, Pojani, Nguyen Thi and Nguyen2022). Poor socio-economic situations, longer working hours, broader geographic coverage, and operating in closed environments significantly increase the risk of exposure and transmission of respiratory diseases among transport workers (Ingram et al Reference Ingram, Archibald, Alvarez and Perrotta2022). Additionally, the inability to avoid crowded spaces increased the risk of virus exposure (Baygi et al Reference Baygi, Mohammadian Khonsari, Agoushi, Hassani Gelsefid, Mahdavi Gorabi and Qorbani2021). Cyclist delivery workers faced increased risks due to the absence of road safety infrastructure, such as bike paths and parking, as well as limited options to avoid crowded spaces, leading to higher chances of virus exposure (da Lage and Rodrigues Reference da Lage and Rodrigues2021). Accessing medical care posed a significant challenge for transport workers due to the unprecedented nature of the pandemic and the nature of their work (Shan Reference Shan2022).
Systematic inequalities: Ethnic and racial disparities, unemployment
Systematic inequalities concerned the increased risk of disadvantage for particularly vulnerable workers. The impact of the pandemic was not equally distributed among all workers. The pandemic significantly influenced employment in the transportation sector, with higher rates of unemployment observed compared to non-transportation industries groups (Mack et al Reference Mack, Agrawal and Wang2021). Racial disparities were apparent among some transport workers during the pandemic. Workers from minority groups, including non-White, Hispanic, and non-citizens, were disproportionately affected compared to their counterparts. Additionally, intersectional factors played a significant role; for example, a study conducted in the US demonstrated that non-White and Hispanic females faced an even greater impact. Transport workers as a whole faced a 20.6% increased likelihood of unemployment due to the pandemic, with non-White and Hispanic females encountering an alarming 29.5% higher probability of unemployment during this challenging period (Mack et al Reference Mack, Agrawal and Wang2021; Baygi et al Reference Baygi, Mohammadian Khonsari, Agoushi, Hassani Gelsefid, Mahdavi Gorabi and Qorbani2021). In Brazil, companies were also shown to have profited from hiring marginalised groups, such as black delivery workers, due to their low wages and working conditions. Thus, black men were at a high risk of contracting respiratory diseases, including COVID-19, due to their history of social vulnerability (da Lage and Rodrigues Reference da Lage and Rodrigues2021). This lack of protections for minority groups and marginalised workers further emphasised systematic inequality.
Additionally, education was shown to matter. University-educated riders displayed greater awareness of the risks associated with COVID-19 infections and traffic infractions. In contrast, transport workers with lower educational levels, particularly older riders, displayed reduced propensity to sanitise their hands or use a shield (Tran et al Reference Tran, Nguyen, Nguyen, Nguyen, Huynh, Pojani, Nguyen Thi and Nguyen2022).
Moreover, profound impacts on gig workers – those without formal worker status - also emerged from the literature. One study (Apouey et al Reference Apouey, Roulet, Solal and Stabile2020) revealed how gig workers were impacted in terms of financial precarity, anxiety about the future, and perceptions of risk of infection. There was variation in requirements for personal/workplace infection control for gig workers. Equity impacts varied in terms of the level of reliance on gig work and the ability to continue gig work through the lockdown.
Higher-income gig workers were more likely to transition to remote work, while those with lower incomes faced greater obstacles making that transition (Apouey et al Reference Apouey, Roulet, Solal and Stabile2020). Other behavioural challenges were also documented for gig workers, including the relationship between stress and coping mechanisms such as increased smoking (Crizzle et al Reference Crizzle, Malik and Toxopeus2021).
Financial burdens
The financial situation of transport workers played a significant role in shaping their health and safety behaviours. Those who suffered substantial income loss during the lockdown were particularly burdened with rent payments and demonstrated increased risky behaviours, such as less adherence to safety measures, compared to homeowners who had more financial stability. In contrast, transport workers who were the sole source of household income or those living with older adults at higher risk of COVID-19 complications, showed a greater tendency to use additional protective measures, such as face shields (Tran et al Reference Tran, Nguyen, Nguyen, Nguyen, Huynh, Pojani, Nguyen Thi and Nguyen2022).
Theme three: The impact of respiratory pandemic disease measures on transport services: Strategies to mitigate risks, costs, and outcomes
The following sub-sections of theme three examines the impact of infection control measures employed by governments and transport industries (see Table 5). This includes analysis of risky behaviours exhibited by transport workers and users of transport workers.
Table 5. Strategies Implemented During COVID-19 Pandemic to Control Spread of Infections in the Transport Industry
Scope of strategies used and their perceived impact
Various infection control measures were implemented by governments and transport industries to prevent the spread of respiratory pandemic diseases; however, these measures could not fully protect transport workers. Infection control measures, such as lockdowns, use of PPE, social distancing, and increased hygiene practices, were the main non-pharmaceutical measures employed to control the transmission of respiratory pandemic diseases (Chand et al Reference Chand, Yee, Alsultan and Dixit2021; Dzisi and Dei Reference Dzisi and Dei2020; Karam et al Reference Karam, Eltoukhy, Shaban and Attia2022). Several other interventions were implemented to improve the travel experience for passengers and working conditions for transport workers. These measures included controlling loading rates, temperature screening, decentralised staff distribution, suspending ticket checking, encouraging remote communication, and enhancing work flexibility (Yin et al Reference Yin, Li, Zhang and Wu2021). Measures, such as investigating qualifications, reporting suspected cases, and recording and tracing close contacts, were also employed (Yin et al Reference Yin, Li, Zhang and Wu2021).
Numerous challenges arose when it came to ensuring full compliance with infection control measures for the transport industry. This was particularly significant in the context of public transport, where strict adherence is essential to minimise the risk of transmission. Although the literature indicated a positive compliance rate with social distancing guidelines in buses, partial adherence to the policy on wearing face masks in most types of vehicles was highlighted (Dzisi and Dei Reference Dzisi and Dei2020). Also, another study reported that the low percentage of guidelines and contingency plans in the transport sector was problematic (Zhang et al Reference Zhang, Hayashi and Frank2021).
The effectiveness of measures implemented by governments and transport industries was significantly influenced by how well these measures were communicated to the public. Effective dissemination of information about these measures, often through the internet and television, was crucial in promoting compliance. While dissemination is indeed a part of the implementation process, it plays a distinct role in ensuring that the intended audience understands and adheres to the control measures. (Yin et al Reference Yin, Li, Zhang and Wu2021).
While the implementation of infection control measures by governments and transport industries demonstrated positive significance in curbing transmission, the literature nevertheless highlights how these efforts came with additional costs and challenges especially in global south countries (Yin et al Reference Yin, Li, Zhang and Wu2021). Economic measures to alleviate those negative impacts were reported to be less sufficient in these settings (Zhang et al Reference Zhang, Hayashi and Frank2021).
Outcome of infection control measures: Reduction in spread of disease, remote working, change in consumer preferences for using transport services and bankruptcy
Most studies included in this review suggested that measures generally helped to reduce the spread of pandemic infectious diseases while also resulting in reduced vehicle capacity and increased waiting times for passengers (Karam et al Reference Karam, Eltoukhy, Shaban and Attia2022; Yin et al Reference Yin, Li, Zhang and Wu2021). Inequity also resulted, as reduced public transport services disproportionately impacted low-income communities and essential workers who relied on those services (Thomas et al Reference Thomas, Jana and Bandyopadhyay2022).
On the other hand, infection control measures increased the significance of remote working while reducing demand for travel, particularly in urban areas (Thomas et al Reference Thomas, Jana and Bandyopadhyay2022). This shift in work dynamics decreases in demand for certain transport services amongst those who can afford to work from home, such as public transport and ride-hailing services, while simultaneously leading to an increase in demand for delivery services (Rothengatter et al Reference Rothengatter, Zhang, Hayashi, Nosach, Wang and Oum2021). Limiting demand for transport had broader economic impacts on the industry, particularly airlines, with many companies facing bankruptcy and staff lay-offs. In turn, those changes reduced transport options and increased ticket prices (Karam et al Reference Karam, Eltoukhy, Shaban and Attia2022; Calderón Peralvo et al Reference Calderón Peralvo, Cazorla Vanegas and Avila-Ordóñez2022). Increased car dependence resulted, as well as changes in walking and cycling patterns (Zhang et al Reference Zhang, Hayashi and Frank2021; Christidis et al Reference Christidis, Navajas Cawood and Fiorello2022; Nguyen and Pojani Reference Nguyen and Pojani2021).
During the COVID-19 pandemic, truck drivers faced increasing challenges finding adequate parking at truck stops and rest areas. This scarcity of parking spaces not only disrupted their regular rest schedules but also contributed to heightened levels of fatigue among these essential workers. Almost a fifth (18.5%) reported being more fatigued, and more than 50% of 146 reported feeling drowsy while driving with 12% nodding off or falling asleep at the wheel while driving (Crizzle et al Reference Crizzle, Malik and Toxopeus2021).
Theme four: Lessons learned for sustainable and resilient policies and interventions
The studies included in this scoping review provided recommendations for reassessing and analysing current transport systems and policy governance, considering pandemic situations. Some studies emphasised the significance of education, collaboration, and screening in mitigating transmission (Malinga et al Reference Malinga, Wiysonge, Ndwandwe, Okeibunor and Talisuna2021; Ingram et al Reference Ingram, Archibald, Alvarez and Perrotta2022) Others emphasised the need for accessible data to enable workers to evaluate their risk of exposure (Harris and Kirkham Reference Harris and Kirkham2021; Shan Reference Shan2022). New transport policies and decision-making frameworks were proposed with the aim of building a less-risky and environmentally sustainable public transport system during the pandemic and into the post-pandemic era (Karam et al Reference Karam, Eltoukhy, Shaban and Attia2022; Calderón Peralvo et al Reference Calderón Peralvo, Cazorla Vanegas and Avila-Ordóñez2022; Rothengatter et al Reference Rothengatter, Zhang, Hayashi, Nosach, Wang and Oum2021; Thomas et al Reference Thomas, Jana and Bandyopadhyay2022). Recommendations from one study included implementing stringent sustainability policies, investing in zero-carbon transportation technologies, and monitoring individuals’ and companies’ behaviours to understand the long-term impacts of the pandemic on transportation (Rothengatter et al Reference Rothengatter, Zhang, Hayashi, Nosach, Wang and Oum2021). Other studies suggested long-term interventions such as remote work and staggered work hours was suggested to reduce peak hour demand, over-crowding, and traffic congestion in the post-pandemic period (Calderón Peralvo et al Reference Calderón Peralvo, Cazorla Vanegas and Avila-Ordóñez2022; Thomas et al Reference Thomas, Jana and Bandyopadhyay2022). Foreseen changes to public transport use in the post-pandemic era led to recommendations to evaluate long-term effects of these shifts (Kutela et al Reference Kutela, Combs, John Mwekh’iga and Langa2022). Transportation planners and decision-makers, another study suggested, should focus on promoting the use of public transport by rebuilding riders’ confidence in services and discouraging excessive car usage. (Tarasi et al Reference Tarasi, Daras, Tournaki and Tsoutsos2021). Another argued for prioritising the implementation of dedicated cycling lanes and infrastructure to safeguard cyclists during and after lockdown periods.
The ongoing production and distribution of masks was highlighted as necessary to address the continuing challenges of COVID-19 transmission on public transportation, especially targeting low-income communities, given their vulnerability to the virus and cost of masks at market rates (Dzisi and Dei Reference Dzisi and Dei2020).
Different modes across the industry were highlighted for recommendations. Another study reinforced the crucial role in society and the economy played by long haul truck drivers (LHTDs) and the unique challenges they faced during the pandemic, with recommendations ranging from improving rest area and washroom access to transport workers (Crizzle et al Reference Crizzle, Malik and Toxopeus2021).
Expanding the focus of research was recommended. One study (Thomas et al Reference Thomas, Jana and Bandyopadhyay2022) pressed for researching the impacts of the pandemic on the transport sector specifically in developing countries. Others highlighted the importance of ongoing research for innovation to effectively tackle the challenges faced by the transportation industry in the face of the pandemic profit reduction (Karam et al Reference Karam, Eltoukhy, Shaban and Attia2022; Calderón Peralvo et al Reference Calderón Peralvo, Cazorla Vanegas and Avila-Ordóñez2022; Rothengatter et al Reference Rothengatter, Zhang, Hayashi, Nosach, Wang and Oum2021; Thomas et al Reference Thomas, Jana and Bandyopadhyay2022).
Discussion
Pandemics are a fact of human existence, and preparation based on evidence and experience is fundamental if future pandemics are to be managed better, and so less damaging (Maccaro et al Reference Maccaro, Audia, Stokes, Masud, Sekalala, Pecchia and Piaggio2023). This comprehensive scoping review has demonstrated the vulnerability and consequences of respiratory pandemics for the transport industry workforce globally. Transport workers were placed at the front line of infections and bore the consequences of non-pharmaceutical interventions. These interventions not only disrupted standard ways of working in the transport industry but also changed the role of transport in everyday life (Browne et al Reference Browne, Ahmad, Beck and Nguyen-Van-Tam2016; Fielbaum et al Reference Fielbaum, Felipe Ruiz, Rubio, Tirachini and Rosales-Salas2023). Other high-interaction industries, including healthcare (Qureshi Chughtai and Seale Reference Qureshi, Chughtai and Seale2022), have seen proactive steps introduced to maintain the well-being of healthcare workers and the communities they serve. This review suggests a similar urgency was, and indeed will be, required to address risks and hazards faced by transport workers. (Maccaro et al Reference Maccaro, Audia, Stokes, Masud, Sekalala, Pecchia and Piaggio2023) The literature suggests lessons for targeted solutions and preventive measures that can both improve the safety and well-being of transport workers and contribute to a more sustainable transport sector. Certainly, the evidence from the literature reviewed indicates that transport workers face more elevated risk from respiratory pandemic diseases than people who work in other industries (Heinzerling Reference Heinzerling, Vergara, Gebreegziabher, Beckman, Wong, Nguyen, Khan, Frederick, Bui, Chan, Gibb, Rodriguez and Jain2022). This heightened vulnerability can be attributed to the nature of their work, which involves frequent interactions with the public as well as movement of people and goods (Öngel et al Reference Öngel, Gülenç, Gürcanli and Arbak2022). The range of challenges identified in the literature as those faced by transport workers during a pandemic supports the importance of comprehensive universal interventions across society as well as tailored targeted measures that address the specific risks and demands of the transportation industry (Fisher et al Reference Fisher, Patrick Harris, George and Baum2023). These risks are related to different pathways that impact the holistic wellbeing of transport workers, particularly those who are more vulnerable than others due to the nature of their work (Apouey et al Reference Apouey, Roulet, Solal and Stabile2020; Tran et al Reference Tran, Nguyen, Nguyen, Nguyen, Huynh, Pojani, Nguyen Thi and Nguyen2022; da Lage and Rodrigues Reference da Lage and Rodrigues2021; Mack et al Reference Mack, Agrawal and Wang2021). (Fisher et al Reference Fisher, Patrick Harris, George and Baum2023; Agarwal et al Reference Agarwal, Agarwal and Motiani2020; Ming et al Reference Ming, Ray and Bandari2020) One reason that societal measures were not effective for transport workers was because a high percentage of workers were involved in close contact with customers and materials, making them more likely to become infected during their work (De Matteis et al Reference De Matteis, Cencedda, Pilia and Cocco2022; Harris and Kirkham Reference Harris and Kirkham2021;Öngel et al Reference Öngel, Gülenç, Gürcanli and Arbak2022; Pongpirul et al Reference Pongpirul, Pongpirul, Ratnarathon and Prasithsirikul2020; Ingram et al Reference Ingram, Archibald, Alvarez and Perrotta2022). For example, specific transport modes, like air-conditioned vehicles, were found to increase the chance of transmission of pandemic respiratory diseases (Das and Ramachandran Reference Das and Ramachandran2021). This demonstrates the importance of considering sll modes of transport and their associated risks when implementing preventive strategies (Cahill et al Reference Cahill, Kay, Howard, Mulcahy, Forde, George, Ziampra, Duffy, Lacey and Fitzpatrick2022; Qureshi et al Reference Qureshi, Chughtai, Islam, Tuckerman and Seale2022). As has been highlighted by studies from other sectors (Meng et al Reference Meng, Wolff, Mattick, DeJoy, Wilson and Smith2017; van Heijster et al Reference van Heijster, van Berkel, Boot, Abma and de Vet2022; Babaei et al Reference Babaei, Avazeh and Doshmangir2022), the transportation industry should prioritise targeted interventions, especially for vulnerable groups of workers who have underlying health issues, as these individuals are susceptible to infectious diseases. Effective communication strategies can be used to deliver information regarding these solutions, ensuring the safety of these transport workers during respiratory pandemics (Ingram et al Reference Ingram, Archibald, Alvarez and Perrotta2022; Silva et al Reference Silva, Galvao, Chapman, da Silva and Barreto2021). In addition, the reviewed literature found inconsistencies in adherence to PPE usage emphasising the need for improved training programs to ensure proper utilisation (Cahill et al Reference Cahill, Kay, Howard, Mulcahy, Forde, George, Ziampra, Duffy, Lacey and Fitzpatrick2022; Qureshi et al Reference Qureshi, Chughtai, Islam, Tuckerman and Seale2022). Effective risk communication is necessary, and guidelines and contingency plans in the transport sector should be mandatory. (Zhang et al Reference Zhang, Hayashi and Frank2021; Das and Ramachandran Reference Das and Ramachandran2021; Yasri and Wiwanitkit Reference Yasri and Wiwanitkit2020; Aung et al Reference Aung, Kuroda and Hinoura2022; Tran et al Reference Tran, Nguyen, Nguyen, Nguyen, Huynh, Pojani, Nguyen Thi and Nguyen2022; Thomas et al Reference Thomas, Jana and Bandyopadhyay2022) The equity implications identified in the literature related primarily to the distribution of impacts in terms of precarity of employment, and lack of agency and control amongst the workforce. Equity was revealed as having structural and systematic dimensions. The review revealed structural inequities among transport workers including lower-income gig workers during respiratory pandemics, in line with other literature (Crizzle et al Reference Crizzle, Malik and Toxopeus2021; Shen et al Reference Shen, Li, Dong, Wang, Martinez, Sun, Handel, Chen, Chen, Ebell, Wang, Yi, Wang, Wang, Wang, Chen, Qi, Liang, Li, Ling, Chen and Xu2020; Apouey et al Reference Apouey, Roulet, Solal and Stabile2020). Additionally, limited access to medical care further exacerbates the challenges faced by transport workers, hindering their ability to seek timely healthcare interventions (Aguilar-Palacio et al Reference Aguilar-Palacio, Maldonado, Malo, Sánchez-Recio, Marcos-Campos, Magallón-Botaya and Rabanaque2021).
Addressing these structural dynamics requires government agencies, employers, unions, and industry groups collaborate to create a fair and inclusive environment within the transportation industry (Ingram et al Reference Ingram, Archibald, Alvarez and Perrotta2022; Aung et al Reference Aung, Kuroda and Hinoura2022; Rice et al Reference Rice, Greenspan, Bauer, Rimby, Bodner and Olson2022). One of the challenges reviewed, for instance, was that on line platform work – such as online deliveries – operated on a business model which, categorise workers as ‘self-employed’ rather than employees. That categorisation effectively side-stepped regulatory protections on wages, hours, other working conditions, and access to such transport workers’ compensation after suffering a work-related injury or illness (Wething Reference Wething2022).
Improved/universal work protection and targeted educational initiatives are all required (Mack et al Reference Mack, Agrawal and Wang2021). By resolving systematic inequalities, the industry can nurture a more resilient workforce and be better prepared for future pandemics. In a number of countries/jurisdictions, efforts have recently been made to address these gaps, most notably by deeming gig-workers to be employees, and so, covered by labour protections relating to minimum wages and the like (for a review see (Munton and Rawling Reference Munton and Rawling2023)). A potentially more far-reaching setting of reforms was recently enacted in Australia in the ‘closing the loopholes’ industrial relations legislation. This empowered the Fair Work Commission – Australia’s federal industrial relations tribunal – to set minimum wages/payment and conditions for platform/gig-workers (such as those doing food delivery) and contract truck drivers (Underhill and Quinlan Reference Underhill and Quinlan2024). For industry practice, improving compliance with infection control measures is crucial for ensuring the safety and well-being of both transport workers and the general population during a respiratory pandemic. However, the literature reviewed here demonstrated some of the challenges in ensuring full compliance (Zhang et al Reference Zhang, Hayashi and Frank2021).
The measures implemented by governments routinely failed to consider the complexities of the transport industry, impacting negatively on the workforce, which in turn risked the effectiveness of the pandemic response (Dzisi and Dei Reference Dzisi and Dei2020; Yin et al Reference Yin, Li, Zhang and Wu2021). The transport industry also fell short in fulfilling its responsibility to curb the transmission of infections during the COVID-19 pandemic due to a lack of preparedness. It needs to be acknowledged that some countries were more active than others. Early in the pandemic Australia, like several other countries, closed not only its international borders to people movement for a prolonged period – a centuries old response to pandemics – but most of its state borders as well (Spennemann Reference Spennemann2021). To minimise the infection risks associated with trucks moving both interstate and over short distances special protocols were implemented to deal with interstate and intrastate/urban road transport including mandatory-testing and screening (and evidence of this), isolation controls, PPE requirements, and infection control training. While some companies maintained training in infection controls after the mandatory protocols were lifted, there was no effort by government to ensure these measures were maintained (Stobart and Duckett Reference Stobart and Duckett2022).
To enhance compliance, our review highlighted various strategies that could be employed to protect transport workers in future pandemics. First, transport workers should be provided with thorough infection control education and training. Second, effective communication and engagement channels should be established to regularly disseminate information regarding infection control measures. Transport workers should be involved in making decisions. This would give them a sense of ownership and responsibility. Third, providing adequate resources. This will involve providing adequate PPE, hygiene supplies, and training. Additionally access to regular testing and healthcare services should be facilitated to promptly manage any potential infections. Fourth, effective monitoring is crucial. Regular audits and feedback loops can identify areas of improvement and address non-compliance effectively. Lastly, fostering collaboration among transport industry stakeholders and public health authorities is vital. Sharing best practices, coordinating efforts, and standardising methods will help improve compliance and create a unified approach to infection control.
While comprehensive, scoping reviews such as this contain inherent limitations (Arksey and O’Malley Reference Arksey and O’Malley2005). The review was based solely on the findings and interpretations reported in the included studies; the accuracy of the results depends on the methodology of the original studies.
This review included studies from various countries with differing transportation industries and healthcare policies, limiting the generalisability of the findings across different contexts. English-only articles may have missed relevant studies in other languages, omitting valuable data. The wide range of the studies included, in terms of methodology, population, and outcomes, presents a challenge in reaching conclusive findings. Future research should examine specific regional contexts and include studies in multiple languages for a more inclusive understanding.
Conclusion
The pandemic highlighted both the importance of industries like transport to maintaining public health but also the challenges to safeguarding workers and the community particularly where the workforce is vulnerable/precarious. What we found regarding road transport is mirrored in findings from other industries like maritime transport, food processing, health, and aged care. These risks are not new and require amongst other things changes to how work is regulated. Seeking to regulate all workers in ‘employee-like’ arrangements provides the potential for building a more sustainable workforce and industry. There is also a need for industry-specific training in infection control and other measures OHS legislation and relevant policy instruments (like the Fair Work Commission in Australia).
However, a one-size-fits-all strategy for combating global pandemics should be avoided. Rather, some control measures need to be shaped around the circumstances of particular industries and subsectors. The transport sector is not only fundamental to the maintenance of the global economy through the transport of goods, but it also provides critical public services, such as public transit, taxis, ridesharing, and delivery services. Accepting the distinct dangers encountered by various subsets of the labour force is imperative if effective pandemic prevention measures are to be developed while also ensuring a core sector of the global economy is maintained safely for its workers, for the public, and broader society. The risks of new pandemics are ever present and increasing. Lessons from previous pandemics must guide the institutionalising of both comprehensive and targeted preventive measures in critical economic sectors, such as transport.
Data availability statement
The author confirms that all data generated or analysed during this study are included in this published article. Furthermore, primary and secondary sources and data supporting the findings of this study were all publicly available at the time of submission.
Funding statement
This work was supported by Transport Education Audit Compliance Health Organisation (TEACHO) Limited. TEACHO Limited was not involved in study design, the collection, analysis and interpretation of the data, the writing of the report, and the decision to submit the paper for publication.
During the preparation of this work the author (s) used CHATGPT to identify and correct grammatical mistakes. After using this tool/service, the author (s) reviewed and edited the content as needed and take (s) full responsibility for the content of the publication.
Competing of interests
The author (s) declare none. Author 6 (MQ) is associated with TEACHO and gave expert input into the manuscript.
Ethical standards
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Dr Mohammed Owais Qureshi is a Postdoctoral Research Fellow at the Black Dog Institute, University of New South Wales. He previously worked as a Research Associate at Centre for Health Equity Training, Research and Evaluation, University of New South Wales. He is a public health researcher dedicated to improving health equity and population health. He employs mixed methods research to explore topics and is interested in conducting qualitative studies to gain a deeper understanding of public health challenges. He has worked as an academic and researcher in various educational and corporate institutions globally. Research interests include suicide prevention; infection prevention and control; and health equity.
Dr. Patrick Harris is a senior research fellow and acting director at the Centre for Health Equity Training, Research and Evaluation. He is an applied public health social scientist who is interested in complex real world policy issues. His broad interest is addressing health equity through public policy. His main areas of expertise are the intersections of health and equity with infrastructure and urban planning, and climate adaptation for health with a policy lens.
Dr. Edward Jegasothy is an epidemiologist and senior lecturer at the Sydney School of Public Health. He has previously worked with NSW Health as a biostatistician. He completed a Master of International Public Health in 2013, Master of Biostatistics in 2018 and a PhD in environmental epidemiology in 2020. His interests are in inequality, health inequity and the political economy of public health.
Dr. Holly Seale is a social scientist and associate professor at the School of Population Health, Faculty of Medicine and Health, University of New South Wales. Holly leads a program of research focused on the social and behavioural factors impacting engagement with infectious disease prevention strategies. Her work encompasses vaccination, pandemic preparedness, antibiotic resistance and stewardship and healthcare infection prevention and control.
Dr. Abrar Chughtai is a medical epidemiologist, having more than 20 years’ experience in the health sector with governmental, non-governmental and international health organizations. He has substantial experience of public health programs and infectious diseases research, having worked in the World Health Organization (WHO) for many years. Currently he is working as a Senior Lecturer in the School of Population Health, University of New South Wales Australia. He is also the director of the Master of Infectious Diseases Intelligence (MIDI) Program at School. His research interests include epidemiology and control of infectious diseases, focusing on emerging and re-emerging infections.
Dr. Michael Quinlan is emeritus professor in the School of Management and Governance, University of New South Wales Australia and Director of the Industrial Relations Research Centre. His major expertise is the field of occupational health and safety (OHS) and risk, particularly aspects related to work organisation, management and regulation. In addition to publishing widely on OHS he has undertaken inquiries, investigations and audits for governments in Australia and New Zealand on safety in the trucking industry, mining and OHS regulatory regimes. He has also served as an expert on a number of government advisory bodies in Australia and New Zealand as well as helping to prepare reports on OHS for the World Health Organisation, European Commission, European Agency on Safety and Health at Work and International Labour Organisation. He currently serves on the editorial board of six academic journals based in Australia and the UK.
