A systematic review on occupational hazards, injuries and diseases among police officers worldwide: Policy implications for the South African Police Service

Exposure to occupational hazards can lead to work-related injuries or diseases [1]. The International Labour Organization (ILO) revealed that every 15 s, 153 employees experience work-related accidents, worldwide. Furthermore, every year 6300 deaths occur due to occupational accidents and 2.3 million deaths occur due to occupational diseases. Apart from death, occupational hazards can lead to prolonged absence from work if not prevented [2]. Annually, a global estimate of 4 % of the Gross Domestic Product (GDP) is lost as a result of occupational injuries and diseases [3]. Since 2001, there has been an increase in the number of reported cases worldwide [4]. In addition, the increase in exposure to air pollution, toxic chemicals and strenuous work activities have negative implications on the health and wellbeing of employees [5]. These observed impacts pose serious health and safety problems. Hence, there is need for inculcating a safety culture in the workplace [6].

The occupational health and safety (OHS) of police officers including in Sub-Saharan Africa is a major public health concern [7]. The ILO expects countries to improve OHS management by creating universal awareness on OHS. However, most developing countries do not have sufficient evidence on the rates or economic costs associated with OHS. Few studies have provided fragmented evidence that requires enormous assumptions to permit simplification and extrapolation [8]. There are limitations with regard to research in the area of OHS, which affects policy development and program management in South Africa. Studies conducted from other countries such as Romania revealed that time spent in attending to occupational injuries and diseases could have been used to combat crime [9]. This has far-reaching consequences in terms of managing crime, whereas in the interest of public health and safety, there is a need to protect police officers. Thus, it is essential to draw lessons from other countries.

In South Africa, the OHS of police officers needs to be seriously considered because the South African Police Service (SAPS) plays a critical role in crime prevention [10]. There is a need to understand how occupational hazards affect the workforce, in order to provide well-planned OHS interventions and a conducive working environment. It can also help address public health concerns and enhance the effectiveness of police officers while on duty [11]. Hence, the objective of this review was to describe the occupational hazards, injuries and diseases affecting police officers worldwide, in order to benchmark the policy implications for the SAPS.

The ILO categorizes hazards that affect police officers as accident, physical, chemical, biological, ergonomic, psychological and organizational [33]. From the 36 studies in this review, we identified the occupational hazards, injuries and diseases affecting police officers in the workplace. The papers included in this review are highlighted in Fig. 5 and Table 1.

This review provided detailed information regarding the occupational hazards, injuries and diseases that affect police officers while on duty. Most of the studies reviewed were conducted in the USA [40, 41, 44, 48‐50, 53, 58, 67, 63], Australia [37, 38, 68, 65], India [39, 69, 60, 70], Brazil [54, 71] and China [34, 66]. We also found studies from Brunei [43], Canada [36], France [42], Germany [46], Israel [61], Italy [56], Korea [51], Mexico [47], Norway [35], Poland [59], Portugal [62], Taiwan [34] and the UK [11]. From these studies, it was clear that occupational hazards can result in various injuries and disease [40]. In the police department, affected police officers are off work for a considerable number of days or months, which leads to loses in working hours. Hence, it is essential for the SAPS to develop guidelines to effectively manage related occupational exposures.

This review has shown that police officers are at a higher risk of accident related hazards, which lead to injury, compared to non-police officers who work for the same department [36‐41]. This review also identified the common causes of work related injuries and diseases, as well as how it compromise effectiveness of police officers in discharging their duties [33]. For example, a well experienced police officer who sustains a fracture from a fall, may struggle to pursue criminals in the future. Thus, it is important to promote safe driving and conduct regular in-service training on the prevention of accident hazards [72].

Physical hazards such as increased noise levels from the firing range or emergency horn cannot be completely avoided by police officers; this is because such duties are part of their routine work [64]. However, given the potential of long-term hearing impairment, there is need to introduce and implement noise control measures. The SAPS requires guidelines that will address NIHL, including annual hearing exams for monitoring the hearing of police officers, as well as ear protection when at the firing range. It is also key to address other physical hazards that can occur due to exposure to ambient environmental factors, such as adverse weather conditions. There should be good provision of personal protective clothing and equipment for officers who work in harsh weather conditions.

From our findings, it is evident that exposure to chemical hazards can lead to cancer, which is a major concern among police officers [42]. Furthermore, exposure to CN has been shown to result in occupational dermatitis [54]. Therefore, it is important for police officers to be screened for cancer annually. In addition, the SAPS need to educate police officers about skincare and provide sunscreen cream. Such efforts can help prevent, identify and manage the risk of cancer in the police force.

Biological hazards can affect police officers due to contact with human beings, as part of routine work. The reports of NSIs while on duty, demonstrated how important it is to manage biological hazards in the police force [50]. There should be guidance on how police officers can deal with such hazards. It is often difficult to prove the association between biological hazards and medical conditions contracted while on duty [47]. Hence, the policies should indicate how to report NSIs and other work-related incidents when they arise. Furthermore, police officers should be encouraged to report incidents early, in order to obtain PEP.

Ergonomic hazards arising from prolonged driving or lifting of heavy items in the police force requires careful consideration. Moreover, the impact of ergonomic hazards on the musculoskeletal system of the affected police officers cannot be overlooked [73]. The SAPS need to alleviate frequent job pressures by hiring more police officers where there are shortages [35]. When the police officers work in teams, they can take turns to drive, to reduce the effect of fatigue. Training regarding correct lifting techniques should be provided, in order to ensure compliance.

The findings on psychological hazards such as PTSD and stress can affect the mental and physical health of police officers [11, 35, 56‐60, 67, 69, 71, 74, 75]. It is evident that police officers who suffer from stress, are more likely to suffer emotional exhaustion [62]. Police work is structured to show less emotion hence, it is difficult for them to seek medical attention when they experience psychological problems [76]. There is a need for effective post traumatic counselling and stress management in the SAPS [62]. There should be a consideration for daily routine work and operational duties, when assessing the health of police officers [35]. Moreover, there should be education provided on steps to be taken during traumatic situations in the workplace, to boost the morale of police officers.

Organizational hazards can affect the physical and mental health of police officers. Poor mental health is a serious social and public health burden that requires management [77]. If not addressed, mental health problems in the police force can lead to a serious public health crisis [78]. Therefore, it is important to develop and reinforce a policy that creates enabling environments, to reduce poor health outcomes, which could result from organizational hazards.

From the studies in this review, we identified different hazards which police officers are exposed to. We also classified them according to ILO classification of hazards [33]. Most of the identified studies reported on occupational hazards, injuries and diseases that are relevant to the South African context as an upper middle-income country, thus creating a good basis for benchmarking OHS policies. The review also highlights the need for improved knowledge, control measures, management and stakeholder participation [20]. Based on the findings of this study, we recommend that the SAPS develop an overarching OHS policy, to address each hazard identified in this study. Where there are existing policies, it is key to reinforce those through communication and training of the police officers.

Furthermore, the SAPS should utilize evidence-based solutions to manage occupational hazards. There is a need for detailed data with emphasis on the classification of occupational injuries and diseases according to the ILO categories. Moreover, the SAPS can draw lessons from other countries on strategies to improve the OHS. There is a good example on strategies to monitor injuries on duty of police officers from Australia that can help serve as a guide. Moreover, when managing OHS, there is a need for changing the safety culture, in order to have successful OHS programs in the workplace. Safety culture comprises of attitudes, norms, beliefs and practices which minimize exposure of individuals to hazardous conditions related to work [79]. For example, in workplaces where safety culture is part of the organizational culture, it becomes easy for employees to report potential work hazards, without any fear of being victimized [80].

It is imperative to utilize a safety model that is cost effective and user friendly, in order to promote the health and safety of police officers [81]. Based on our findings, the SAPS requires commitment to undertake further research studies on OHS and implement recommendations, in order to manage occupational hazards, injuries and diseases which affect police officers.

The initial aim of the study was to target occupational hazards, injuries and diseases that affect the South African police officers. However, despite the comprehensive search, there was limited literature on the subject for the South African setting, even from the Sub-Saharan Africa. For South Africa, the majority of OHS studies found were in the mining sector and not in the police force. Hence, we reviewed global literature, in order to understand the policy implications for the SAPS.

This review showed that occupational hazards, injuries and diseases can affect the health and safety of police officers. Thus, there is a need for preventative measures such as educating police officers to reduce occupational injuries and fatalities resulting from accident hazards. Similarly, physical hazards like high noise levels, requires police officers to ensure ear protection. Chemical hazards can be related to high concentration of air pollution exposure that can lead to cancer, hence there is need for police rotation. Biological hazards such as NSIs can lead to diseases such as HIV. Therefore, police officers should be encouraged to report when exposed to NSIs. In addition, ergonomic hazards can be prevented by avoiding prolonged driving to reduce musculoskeletal problems. The SAPS seems to have improved the reporting systems on occupational injuries. However, there should be a comprehensive model for management to identify and analyze the factors contributing to the observed increase in OHS cases. Given the scarcity of information on the OHS of police officers in Southern Africa, more studies in the region are needed. Such studies will inform policy as well as management principles and interventions. When a strategy on the OHS of police officers is well developed and implemented, there will be effectiveness on how the SAPS manages crime in South Africa.