Despite huge advances in information and communications technology, UK residents made more than nine million journeys abroad for work last year- up 12% since 2004.

A generation ago, a whiff of glamour surrounded the planes and trains used by the business traveller. But today, corporate travel has less cachet and people recognise it can be an unhealthy, and sometimes downright dangerous, business. Working abroad can expose business travellers to a host of risks they rarely - if ever - face in their UK workplaces. And this poses problems for the health and safety professionals who will almost always have to manage those risks at a distance of hundreds, if not thousands, of miles.

Risks faced by business travellers abroad stem from many sources. As well as health risks and local security issues that may compromise a traveller's safety, the fact that they are likely to be working in an unfamiliar place and facing cultural and language barriers plus poor transport and communication links makes managing their health and safety a complex business.

As with other areas of health and safety management, protecting business travellers relies on appropriate planning, risk assessment and advice.

Personal service

Building a risk profile - an individual risk assessment for an employee travelling abroad - is the best starting point for managing risks to work travellers, according to the Institution of Occupational Safety and Health (IOSH).

"As well as general travel-related elements, [a risk profile] should include specific personal circumstances that could affect their health and safety while abroad, such as disabilities or medical conditions," says IOSH's guidance.
Many business travel risks can be mitigated by proper advance planning. This includes ensuring that employees' vaccinations are up to date, that they take anti-malaria drugs if necessary, and that they carry - and know how to use - insect repellents, mosquito nets and first-aid kits.

Travel medicine is a complex and fast-changing field, and although some GPs will provide a basic range of vaccines, seeking advice from a specialist travel health clinic is sensible. "Some companies understand about the health and safety issues involved, but others don't," says Mary Kedward, managing director of The Travel Clinic in Cambridge. "So many people travel unvaccinated, unaware of malaria risks, and it's a health and safety issue. There is a duty of care to staff whether they are at home or abroad."

Background detail

In line with IOSH's risk profile approach, travel health clinics build up a detailed picture about both the business traveller and the environment they will be working in to minimise the health risks.

"We need to know about their state of health, their previous vaccines and the dates of those vaccines," says Kedward. "We look at their British vaccination schedule - tetanus, diphtheria, polio and  MMR [mumps/measles/rubella]. A lot of people don't realise they are still at risk of measles and mumps, especially when travelling, because children in Asia and Africa aren't vaccinated. Then we start on the ordinary hepatitis A and typhoid vaccinations that you can probably get from your GP, but perhaps not at short notice. We look at what job they are doing - we deal with people doing mine disposal, [but] if you're working in an air-conditioned office, travelling in an air-conditioned car and staying in an air-conditioned hotel, your risks are different."

But, she stresses, good travel health involves not only vaccinating business travellers but educating them too. "Although the cholera vaccine will protect against some types of diarrhoea - a big problem for travellers - a lot is down to the traveller, including hand hygiene, sexual hygiene and hospital hygiene," she says.

Travel health clinics will also provide information and advice about first aid and medical kits, and about the dangers of deep-vein thrombosis (DVT). Periodically in the news, DVT kills between 500 and 1,000 people in Britain each year. A recent study by the World Health Organisation found that, on average, an air passenger who takes a flight lasting more than four hours has around a one in 4,700 chance of suffering DVT. The study also found that being tall, overweight or female or taking the contraceptive pill significantly increases the risk. Kedward says she routinely discusses DVT with businesses travellers and will advise them to exercise, rather than sleep, on a long-haul flight and consider wearing compression stockings.

Eastern exposure

When Simon Latner (not his real name) was asked by his East Anglian employer to travel to their offices in Bangalore at short notice in April 2007, he jumped at the chance. "It was only a one-week trip and we were under pressure to get to India quickly," he explains. "I'd never been there before, had no vaccinations before I went, but thought I'd be OK because I was staying in a good hotel and eating my lunches in the company canteen."
Halfway through his week in India, Latner began suffering from diarrhoea and called a doctor who gave him a course of antibiotics. Feeling a little better, Simon was able to work on Friday and flew back to the UK the following day. Returning to work on Monday, he continued to feel unwell and had a high temperature, as well as bouts of dizziness, sickness and diarrhoea. "I thought I was just getting over a minor food bug, because everyone says that's what happens when you go to India," he says.

After two weeks, his symptoms worsening, he called the accident and emergency department at his local hospital and was told to come in as soon as possible. "I was admitted to the infectious diseases ward and stayed there for 16 days. They thought it was typhoid, but it took a lot of blood tests to find out. Paratyphoid was finally diagnosed after a week in hospital and I ended up suffering liver and lung complications," Latner explains.

By failing to provide him with any health information or advice before he travelled, Latner's employers put him at risk not only of typhoid but also of other infectious diseases. If the company had access to an occupational health service, or had at least advised him to see his GP before travelling, Latner's vaccinations would have been updated and he would have travelled to India far better protected.

"If I had known then what I know now, I would do things differently, because I lost two-and-a-half weeks of my life and could have infected my wife and three-month-old son," he says. "I would get vaccinated next time and I would like my employer to get professional advice for staff on business travel. All I had to rely on were anecdotes from work mates."

Safe and secure

Beyond bacteria, corporate travellers can face other physical risks when working abroad, ranging from petty street crime to violence and kidnapping. Thorough risk assessments and - if necessary - training will help employees protect themselves. IOSH also recommends that health and safety professionals arrange security briefings for first-time travellers (see box below).

"Briefings should be low-key, balanced and carefully constructed, with an emphasis on avoiding risks," says the guidance. "Training in risk prevention (avoiding being a target and limiting exposure to theft, mugging and con tricks) not only boosts the traveller's confidence, but is essential for minimising risks to your staff while they're abroad."

Communications is the final issue to consider. Although this depends on the nature of the business, IOSH says that "as a minimum you should be able to contact your staff at specific times, and they should be able to communicate with their base when they need to. Arrange a timetable for your staff to contact you to let you know they're OK. Make sure they get in touch even if they have nothing to report."

The level of precaution that needs to be taken obviously depends on the local environment. Paul Greeves, head of occupational risks (journalism) at the BBC, says, "Our approach is graded according to the level of risk. If someone is going to Paris for a meeting, we assume they are able to look after themselves, bar making sure that they are insured."

Weighing the risks

Because its staff routinely travel to parts of the world very few UK civilians would ever venture to, the BBC has robust systems in place to keep them safe. By categorising destinations into two groups, the BBC is able to provide appropriate protection to travelling staff. Known as "travel advisory", the first group includes cities such as Rio and Johannesburg.

"These are slightly more difficult areas," says Greeves. "They need no additional measures but they are places where, if you have not been before, you should take advice about where it's not safe to go."

Highest-risk destinations, termed "hostile environments" by the BBC, are conflict zones or areas with extremes of crime or climate. "For these, we have a separate set of measures, including a separate risk assessment, a six-day training course for staff including first aid, and we give staff proper safety equipment such as helmets, flak jackets and full medical kits. We will also have contingency plans in place," he explains.

Most health and safety professionals will never have to face sending staff into war zones but, Greeves says, the basic principles remain the same: "Other organisations may not put their employees into such extremely risky situations as embedding them with troops in Iraq or travelling into the jungle for weeks like Bruce Parry [for BBC's recent series Tribe]. Crucially, you need a process by which these trips are reviewed at the appropriate management level to assess if the risks are really worth taking."

Stresses and strains

Physical threats, internal or external, are not the only health risks associated with corporate travel. An NOP poll of 200 executives conducted in 2005 revealed that for many, business travel is up there with some of life's most stressful events: more than one in four of the executives polled said they would rather face the stresses of moving house than the regular round of check-in queues, flight delays and lonely nights in unfamiliar hotel rooms.
The results of a more scientific study among employees at the World Bank Group paint a similarly worrying picture. Alarm bells began ringing at the World Bank in the late 1990s when it discovered that staff who travelled for work were far more likely to submit health insurance claims. Compared with their non-travelling colleagues, men who travelled for work filed 80% more health insurance claims and women 18% more.

As a result, the bank surveyed its travelling staff and some of the results came as a major surprise. As well as finding that the more employees travelled, the more they suffered from typical travel-related diseases of the upper respiratory tract, infectious diseases and skin disorders, the survey also uncovered a parallel increase in psychological disorders such as anxiety.
Dr Bernhard Liese, the World Bank's former medical director, says: "What we hadn't expected at all was the dramatic increase in psychological disorders. Psychological disorders increased linearly with the number of missions travelled. While all of them were highly committed to their work and derived satisfaction in their ability to work with clients abroad, nearly everybody complained about the high work pressures. While on mission, travellers work on weekends, they sit at the computers in the evenings and before they fall asleep they worry what happens in the office. Many find on return to the office that everything is waiting on the desk and they find the workload close to unmanageable."

The bank has since reviewed its travel health policy and realised that, though it specified a maximum number of days per year that employees could travel, this limit was being exceeded by at least half of staff.

Whether it is the mental stresses and isolation that can come with regular long-distance travel or the vulnerability to foreign infections, business travellers will always face hazards. Health and safety specialists can seldom follow them to help control these risks, but their duty of care doesn't stop at the airport runway. So it's all down to the planning and preparation and anticipating what faces business voyagers.

Business travel fact file

• Safety in the Global Village - Keeping your Staff Healthy and Safe Abroad: www.iosh.co.uk/files/technical/Safety%20in%20the%20global%20village%2Epdf 
• Travel Health Network and Centre: www.nathnac.org
• Advice for business travellers: www.fitfortravel.scot.nhs.uk/advice/travellers/business.htm
• Department of Health advice for travellers: www.dh.gov.uk/en/Policyandguidance/Healthadvicefortravellers/index.htm
• Foreign & Commonwealth Office travel advice: www.fco.gov.uk/travel
• Business Travel Health Association: www.btha.org

Security briefings - issues to cover

• Security background of the country and immediate neighbourhood.
• Cultural background, including religious customs and standards of social behaviour.
• Crime and the police.
• Personal security awareness and procedures at work, at home and on the move.
• Security resources that residents can call on.

Source: Safety in the Global Village, IOSH