Health Conditions and Health Care Access Among Filipino Men in the Cruise Line Industry: A Scoping Review

Abstract

Filipino men form a substantial proportion of the global seafaring workforce, particularly in the cruise line industry. The psychosocial, occupational, and environmental conditions influence their health, presenting challenges that are overlooked and unacknowledged and necessitating a systematic mapping of their health conditions and health care access. This scoping review aims to map the literature on the health conditions of Filipino men working in cruise lines to (1) describe prevalent health conditions; (2) identify mental health issues; (3) summarize the psychosocial, occupational, and environmental factors influencing health; (4) explore facilitators and barriers to health care access; and (5) characterize initiatives, interventions, and support systems. The Joanna Briggs Institute (JBI) Scoping Reviews methodology was utilized and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, CINAHL, Embase, Scopus, Web of Science, and relevant maritime health databases were searched from January 2010 to August 2025. In total, 20 publications were included. Filipino men working in cruise lines face a wide range of risk factors for physical and mental health conditions. Occupational hazards, such as noise, vibration, and poor workspace layout, coupled with limited access to fresh food and exercise, aggravate these conditions. While health promotion programs appeared in the literature, onboard health services are often limited, leading to reliance on repatriation and underreporting due to fear of job loss or stigma. A critical need remains for enhanced onboard medical services, culturally sensitive mental health support, robust legal protection, and comprehensive health promotion programs that address the various domains of their profession.

Approximately 400,000 Filipino nationals work on cruise lines (Lopez, 2025), which constitutes a substantial portion of the global maritime workforce. Filipino men play a fundamental role in the worldwide seafarer supply; however, the demanding nature of the job, such as rigorous work schedules, extended periods away from home, and confined environments of cruise ships, presents a distinct impact on their health (Jensen & Oldenburg, 2019; Nielsen et al., 2013). These conditions can impact their physical and mental well-being, often leading to chronic conditions and acute incidents (Huerte et al., 2023b). Despite the recognized importance of seafarer health (Abaya et al., 2023), a comprehensive understanding of the specific health conditions affecting Filipino men in cruise lines and their experiences with accessing health care remains fragmented. While the importance of seafarers’ well-being is increasingly acknowledged, existing studies on the subject often overlook the unique cultural, social, and economic circumstances of Filipino seafarers. This lack of understanding creates gaps in developing culturally relevant and effective health interventions and policy frameworks that benefit Filipino men. This scoping review aims to fill this gap by systematically mapping the existing literature on the health of Filipino men in cruise lines. Specifically, this review (1) describes prevalent health conditions; (2) identifies mental health issues; (3) summarizes the psychosocial, occupational, and environmental factors influencing health; (4) explores facilitators and barriers to health care access; and (5) characterizes initiatives, interventions, and support systems. The review aims to comprehensively search and chart the existing literature, providing a foundational understanding that informs future research, policy development, and targeted interventions for Filipino men working in the cruise line industry.

Review Questions

The primary question for this scoping review is: What is the existing evidence on the health conditions and health care access among Filipino men working in the cruise line industry?

In line with this primary question, the review will address the following specific questions:

1. What are the prevalent physical health conditions reported among Filipino men working in the cruise line industry?

2. What are the prevalent mental health issues experienced by Filipino men working in the cruise line industry?

3. What psychosocial, occupational, and environmental factors influence the health outcomes of Filipino men working in the cruise line industry?

4. What are the reported facilitators and barriers related to accessing and utilizing health care services for Filipino men working in the cruise line industry?

5. What existing health promotion initiatives, interventions, and support systems are documented for Filipino men working in the cruise line industry?

Participants

The participants of interest for this scoping review are Filipino men who work or have worked in the cruise line industry as seafarers or crew members, including individuals across various roles and departments on cruise ships, such as those in deck and engine crew, medical personnel, retail and concession staff, and hotel and hospitality staff such as waiters, cabin stewards, cooks, and entertainers. The focus on Filipino men is due to their significant representation in the cruise line industry and the unique cultural and socio-economic factors that may influence their health conditions and access to health care. Studies will be excluded if data are not disaggregated by nationality and gender, making it impossible to identify the experiences of Filipino men specifically. The review will also exclude studies focused exclusively on non-Filipino cruise line workers or Filipino women in the cruise line industry, as well as those that include Filipino men in the cruise line industry but do not provide sufficient data or analysis relevant to their health conditions or health care access.

Concept

The core concept of this review encompasses two main areas: health conditions and health care access among Filipino men working in the cruise line industry. Health conditions include both physical health conditions (prevalence, types, and impact of physical illnesses, injuries, and non-communicable diseases) and mental health issues (mental health disorders, psychological distress, stress, fatigue, and their determinants). This exclusion criterion also encompasses the psychosocial, occupational, and environmental factors that influence these outcomes. Health care access refers to the ease with which Filipino men in the cruise line industry can access and utilize health care services. Health care access involves both formal provisions onboard ships (like ship infirmaries and medical staff) and ashore, as well as informal support systems. The concept also includes the facilitators and barriers to accessing these services. The review will investigate health promotion initiatives and interventions, which involve documented strategies, programs, and support systems aimed at improving the health and well-being of Filipino men working in the cruise line industry.

Context

The context of this scoping review is the global cruise line industry, with a specific focus on the unique onboard and off-board environments in which Filipino male seafarers are employed. The context presents several characteristics: the distinct occupational setting of cruise ships, which entails exposure to various physical and psychological stressors, irregular schedules, extended periods at sea, and confined living and working conditions. The geographic location is global, with cruise ships operating in international waters and docking in various ports worldwide, which can impact health care access and legal frameworks. Furthermore, the review will consider cultural and sub-cultural factors, specifically the background of Filipino men, including their collectivistic values, family obligations (often as primary breadwinners), resilience, and potential reluctance to seek mental health support due to stigma. Finally, the review will acknowledge specific racial and gender-based interests and details by focusing solely on Filipino men, recognizing that their experiences may differ from those of other nationalities or genders due to distinct recruitment practices, contractual agreements, and socio-cultural expectations.

Types of Sources

This scoping review includes a diverse range of primary research studies. The majority of the sources are quantitative studies, with a heavy emphasis on cross-sectional designs (e.g., cross-sectional surveys, descriptive cross-sectional studies, analytical cross-sectional studies) and retrospective studies (e.g., retrospective observational studies, retrospective analyses). Several qualitative studies employ methods such as in-depth interviews and phenomenological research designs. One source is a multi-method study that combines retrospective document analysis with cross-sectional qualitative data. Finally, one review article or critical policy analysis was included, which, while not a primary research study, likely served to provide a broader policy and historical context for the review.

Method

Scoping Framework and Reporting Standards

This scoping review was conducted following the Joanna Briggs Institute (JBI) methodology for scoping reviews (Peters et al., 2020), which provides a structured approach for mapping evidence across various fields. This framework, an evolution of Arksey and O’Malley’s original five-stage scoping framework, emphasizes a rigorous and transparent process. The stages include (1) defining and articulating the review question(s) and objectives; (2) developing a search strategy; (3) searching for and selecting studies; (4) extracting and charting data; and (5) collating, summarizing, and reporting the results. This organized method encompasses all quantitative and qualitative evidence regarding the health of Filipino men in cruise lines, ensuring that the literature is systematically and comprehensively mapped. To ensure reliable and repeatable reporting of methods and findings, adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was maintained.

Search Strategy

To capture the full scope of published literature evidence, we searched five electronic databases: PubMed, CINAHL, Embase, Scopus, and Web of Science. We constructed search strings centered on the core concepts of Filipino nationality and cruise ships or the maritime industry. The search utilized both controlled vocabulary (e.g., MeSH terms) and free-text keywords tailored to each database. Reference lists of all included studies were hand-searched to identify additional sources.

Search Queries

• PubMed: (((cruise or “maritime” or ships[mesh] or “naval medicine”[mesh] or sailor or seafar*[tiab] or “cruise line*”) AND ((“Philippines”[Mesh] or “philippin*”[tiab] or “filipin*”[tiab])))).

• CINAHL: (MH “Philippines” or XB “philippin*” or XB “filipin*”) AND (cruise or “maritime” or MH “Ships” or “naval medicine” or sailor or XB “seafar*” or “cruise line*”).

• Embase: (“cruise” OR “maritime” OR “ship”/exp OR “naval medicine”/exp OR “sailor” OR “seafar*”:ti,ab,kw OR “cruise line*”) AND (“Philippines”/exp OR “philippin*”:ti,ab,kw OR “filipin*”:ti,ab,kw).

• Scopus: (“Philippines” OR “philippin*” OR “filipin*”) AND (cruise OR “seafar*” OR “cruise line*”).

• Web of Science: (“Philippines” OR “philippin*” OR “filipin*”) AND (cruise OR “seafar*” OR “cruise line*”) (All Fields) AND filipino seafarer (Topic).

Eligibility Criteria

Primary research studies that specifically reported on the health outcomes of Filipino male seafarers working in cruise lines were included. Consistent with JBI methodology, all forms of evidence, including both quantitative and qualitative study designs, were considered. Eligible study designs comprised cross-sectional surveys, retrospective cohort studies, qualitative investigations (e.g., interviews or focus groups), and policy analyses that provided firsthand data on health conditions, influencing factors, health care access, or health promotion.

Reports that examined prevalent physical health conditions (e.g., musculoskeletal disorders, cardiovascular diseases), mental health issues (e.g., stress, depression, anxiety), occupational and environmental factors (e.g., noise, vibration, work hours), psychosocial factors (e.g., isolation, family separation), health care access barriers and facilitators, and documented health promotion initiatives or support systems were selected.

Animal or in vitro experiments, as well as review articles without original patient data, were excluded. Studies focusing on non-Filipino populations or seafarers in non-cruise ship settings (e.g., cargo ships, fishing vessels) were omitted to maintain relevance to the target demographic. Only sources with accessible English abstracts or full texts were considered for final inclusion.

Study Selection

Consistent with JBI guidance, title and abstract screening were performed independently by two reviewers using the predefined eligibility criteria. After removal of duplicates, each reviewer assessed all retrieved records for relevance. Discrepancies at this stage were flagged for discussion and provisional inclusion, rather than immediate exclusion, to ensure that potentially relevant studies were not prematurely discarded.

Full-text articles of all provisionally included titles and abstracts were then retrieved and evaluated in detail by the same pair of reviewers. Each full text was assessed against the inclusion and exclusion criteria. Where disagreements arose, the reviewers first sought resolution through consensus discussion. In the absence of an agreement, a third reviewer was consulted to determine eligibility for the final research. The specific reasons for exclusion at the full-text stage were meticulously documented. Figure 1 presents a PRISMA flow diagram illustrating the number of records identified, screened, assessed for eligibility, and incorporated into the review. The figure illustrates the study selection process, detailing the rationale for excluding some studies at the full-text stage.

Figure 1.

PRISMA Diagram.

Data Charting and Synthesis

A uniform data extraction form was developed in Microsoft Excel and evaluated on a limited selection of the included studies to ensure clarity and consistency. Two reviewers independently collected data regarding the study’s attributes, including the publication year, study design, sample size, and study focus. The reviewers collected extensive data on specific physical health conditions (e.g., musculoskeletal disorders, gastrointestinal complaints, traumatic injuries, cardiovascular risks), mental health issues (e.g., stress, fatigue, depression, anxiety), influencing factors (e.g., work hours, isolation, environment), health care access barriers and facilitators (e.g., onboard services, repatriation, stigma), and documented health promotion initiatives (e.g., education, counseling, digital tools).

Descriptive statistics were used to summarize the quantitative data. For instance, frequencies and percentages were provided for categorical variables, such as types of medical repatriation or the prevalence of mental health symptoms. Tabulated summaries facilitated the comparison of research, highlighting similarities in reported conditions and influencing factors.

A thematic analysis methodology was employed to analyze qualitative data derived from interviews, open-ended survey inquiries, and narrative case studies. Following JBI recommendations for qualitative evidence synthesis in scoping reviews, two analysts independently coded the qualitative material line by line before collaborating to develop an initial coding scheme. Subsequently, the codes were classified into overarching themes through a series of discussions centered on physical health conditions, mental health issues, facilitators and barriers to accessing health care services, and health promotion initiatives and programs. A consensus was reached on resolving discrepancies, leading to an update to the theme definitions.

Finally, quantitative findings and qualitative themes were integrated in a narrative synthesis. This approach enabled the mapping of how the health conditions and health care access of Filipino men in the cruise industry intertwine with their psychosocial, occupational, and environmental factors, providing a comprehensive foundation for identifying gaps and guiding future research.

Results

Study Characteristics

Twenty studies, published between 2011 and 2025, underwent a thorough analysis of the health and well-being of Filipino seafarers, which displayed varied research focuses and methodologies. The most significant number of investigations, five in total, focused on medical repatriation and epidemiology. Three studies focused on cardiovascular and metabolic risks, as well as the classification of health risks. The remaining studies spread equally across several important topics, as pairs of investigations addressed mental health and psychosocial issues, sexual health, but also sexually transmitted infection (STIs), occupational injuries, as well as trauma, nutrition and weight management, work environment, plus team culture, as well as policy and legal analysis. The methods used differed among the investigations, with cross-sectional designs being the most common, employed in nine studies. Seven studies employed retrospective designs, while qualitative methods, policy/legal analysis, and multi-method approaches were each used in two studies. Sample sizes ranged considerably, with 10 studies utilizing medium-sized samples of 100–999 participants. Six studies featured large samples of 1,000 or more participants, while three studies had small samples of fewer than 100 participants. One study did not report its sample size. Table 1 presents a summary of the reviewed articles, organized by study focus, population size, study design, and key findings.

Table 1.

Summary of Findings.

Study	Study focus	Population size	Study design	Key findings
Abaya et al. (2015)	Medical repatriation epidemiology	6,759	Retrospective	Injuries, musculoskeletal, gastrointestinal, and genitourinary illnesses are most common; psychiatric/psychological disorders are present.
Abaya et al. (2018)	Repatriation rates after long-term stay	51,830	Retrospective	Higher repatriation after >200 days; gastrointestinal (GI) and musculoskeletal complaints common; psychiatric repatriation in cargo ships.
Abaya et al. (2023)	Medical repatriation	6,526	Retrospective	Musculoskeletal, gastrointestinal, and traumatic injuries are the top causes; anxiety, depression, and insomnia are among the psychiatric cases.
Abaya et al. (2025)	Ten-year repatriation trends, Maritime Labour Convention 2006 impact	>13,000	Retrospective	Decreased repatriation post-Maritime Labour Convention 2006; musculoskeletal, gastrointestinal, and psychiatric causes increased; and trauma decreased.
Gregorio et al. (2016)	Cardiovascular disease (CVD) knowledge, attitudes, and practices among Filipino seafarers	136	Cross-sectional	High prevalence of cardiovascular disease risk factors (diet, smoking, inactivity); knowledge gaps; risk-taking behaviors persist.
Guevara et al. (2010)	Sexual health knowledge, attitudes, and practices among male Filipino seafarers	100	Cross-sectional survey	Limited sexually transmitted infection (STI) prevention knowledge; high-risk sexual behaviors; routine STI/human immunodeficiency virus (HIV) screening; double standards in sexual attitudes.
Guillot-Wright (2017)	Policy review: seafarers’ health care rights	N/A	Critical policy analysis	Laws exist, but limited resources at sea; neoliberal policies and open registries undermine protections.
Hansen & Canlas (2019)	Health profile: Filipino vs. Danish seafarers	9,654 (each cohort)	Retrospective cross-sectional cohort	Filipinos are younger, with less extreme obesity, similar smoking, and stricter health standards in the Philippines.
Harry et al. (2023)	Ethical dilemmas among Filipino cruise line seafarers	10	Phenomenological qualitative	Family ties, health concerns, faith/temptation, work problems, stress, depression, and anxiety are prevalent.
Huerte et al. (2023a)	Repatriation trends in the Philippine shipping company	924	Retrospective	Injury/trauma, musculoskeletal, gastrointestinal, cardiovascular disease, infectious, and genitourinary conditions; declining cardiovascular, gastrointestinal, and genitourinary trends.
Huerte et al. (2023b)	Health risk classification in Filipino seafarers	11,831	Retrospective observational	High prevalence of risk class C; older, male, married, and higher-ranking individuals are at higher risk; there is a need for tailored screening.
Jensen & Oldenburg (2019)	Traumatic experiences among seafarers	323	Cross-sectional	High rates of trauma (accidents, piracy, stowaways); psychological after-effects; Filipino crews need pastoral support.
Lu et al. (2012)	National culture and human failures in shipping	608	Cross-sectional	Filipino seafarers have the highest collectivism, lower power distance, and higher collectivism/uncertainty avoidance, which reduces human failures.
Neumann et al. (2024)	Nutrition attitudes (Europeans/Southeast Asians)	810 seafarers, 62 cooks	Cross-sectional	Most value a healthy diet; Europeans are less willing to change habits; cooks are open to digital support.
Neumann et al. (2021)	Eating behavior and weight (Europeans/Asians)	64 (study I), 820 (study II)	Cross-sectional	Overweight/obesity is higher in Europeans; Filipinos gain more weight on board; diet differs at home vs. ship.
Nielsen et al. (2013)	Work environment and well-being (Filipino/European)	541	Cross-sectional	Safety, job demands, and team cohesion are key to satisfaction; Filipinos report a more negative environment but stronger team cohesion.
Pia et al. (2024)	Legal/policy analysis of the Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC)	48	Multi-method (legal, qualitative)	The POEA-SEC is inadequate in terms of health/safety, failing to address issues such as fatigue, stress, and tenure, which leaves the government unable to protect seafarers fully.
Radic (2018)	Occupational injuries among cruise ship crew	39	Qualitative	Slipping, falling, body movement, contact injuries, psychological stress from isolation, and long hours.
Saniel & De los Reyes (2010)	Risky sexual behaviors among male Filipino seafarers	501	Cross-sectional	Unmarried, alcohol-drinking, young, and low HIV knowledge linked to multiple partners; need for targeted HIV prevention.
Sarinas et al. (2022)	Mental health factors and coping among Filipino seafarers	100	Cross-sectional	Stress, fatigue, and separation from family are the top mental health issues, coping via positivity, socializing, and family contact.

Physical Health Conditions and Occupational Factors

Filipino men working in the cruise line industry frequently experience a range of physical health issues, which are significantly shaped by their unique occupational and environmental conditions. Musculoskeletal disorders, gastrointestinal problems, and traumatic injuries are consistently identified as the most prevalent physical health conditions, often leading to medical repatriation (Abaya et al., 2015, 2018, 2023; Huerte et al., 2023b), with musculoskeletal issues being prevalent in manual labor-intensive roles within the deck and engine departments (Radic, 2018). While cardiovascular diseases (Gregorio et al., 2016), dermatological, genitourinary, and infectious diseases (Guevara et al., 2010; Saniel & De los Reyes, 2010) are also reported, their prevalence is comparatively lower. Although overweight and obesity are present, Filipino seafarers show lower rates than their European counterparts, yet studies indicate a tendency for them to gain weight during onboard deployment (Neumann et al., 2021). Environmental factors, including noise, vibration, heat, adverse weather conditions, and poorly designed workspaces (Nielsen et al., 2013), contribute significantly to these physical health risks. Furthermore, limited access to fresh food and opportunities for exercise onboard are associated with an increased risk of weight gain and related health complications (Neumann et al., 2024). To mitigate these risks, preventive measures such as pre-employment medical examinations (PEMEs; Huerte et al., 2023a), regular health screenings, and safety training are implemented. However, the effectiveness of these measures varies, and work-related injuries remain a significant concern (Abaya et al., 2015; Radic, 2018).

Mental Health and Psychosocial Well-Being

The research reveals significant mental health and psychosocial challenges among Filipino seafarers, with stress, fatigue, and separation from family being the most prominently reported issues. In a survey of 100 seafarers by Sarinas et al. (2022), 78% (n = 78) of respondents experienced stress, 64% (n = 64) reported fatigue, and 58% (n = 58) struggled with separation from families and friends. Additional concerns included insufficient sleep (57%; n = 57), prolonged periods at sea (55%; n = 55), and extended working hours (54%; n = 54).

Depression and anxiety emerged as significant mental health challenges (Harry et al., 2023). Contributing factors to poor mental health included long working hours, shift work, sleep deprivation, and social isolation (Abaya et al., 2018). The closed social system on board ships, combined with cultural stressors such as the fear of blacklisting and potential loss of income, further impacted the psychological well-being of seafarers (Harry et al., 2023). Trauma-related mental health issues were also documented, particularly among seafarers who experienced accidents, piracy, or encounters with stowaways. In a study of 323 seafarers, Jensen and Oldenburg (2019) reported that 35.9% (n = 116) of seafarers experienced shipwrecks or severe accidents, 17.0% (n = 55) encountered piracy, and 39.0% (n = 136) dealt with stowaways, leading to recurring unintentional thoughts about these traumatic events.

Filipino seafarers employed various strategies to maintain their mental well-being. These included maintaining a positive outlook, socializing with crewmates, and maintaining communication with family (Sarinas et al., 2022). Family support was identified as particularly crucial for Filipino seafarers, reflecting their strong collectivist and sociocentric values (Harry et al., 2023). Support systems included emergency counseling through Seafarers’ Missions and some organizational support programs (Jensen & Oldenburg, 2019). However, studies indicated that current legal and policy frameworks, such as the Philippine Overseas Employment Administration Standard Employment Contract (POEA-SEC), were often inadequate in addressing fatigue, stress, and tenure-related issues (Pia et al., 2024).

Health Care Access and Utilization

Access to and utilization of health care services present challenges for Filipino men on board cruise ships. Barriers to health care include limited access to comprehensive medical care onboard, particularly on non-passenger vessels (Guillot-Wright, 2017), leading to a reliance on repatriation for severe conditions, which reflects a reactive rather than preventive approach (Abaya et al., 2015, 2018, 2023, 2025; Huerte et al., 2023b). Underreporting health issues and a reluctance to seek care due to fear of job loss or stigma further impedes timely intervention (Harry et al., 2023). Despite these barriers, available services include preventive care through PEME (Huerte et al., 2023a) and periodic health screenings (Gregorio et al., 2016). Onboard medical support is often restricted to basic first aid or care provided by designated crew members (Radic, 2018), while emergency counseling and crisis intervention for mental health are typically available through seafarer missions. Regarding treatment-seeking behaviors, seafarers may resort to self-medication or delay seeking professional care due to the limited resources available onboard (Sarinas et al., 2022). Although the utilization of available health facilities is high when they are accessible, significant barriers persist, particularly concerning mental health services.

Support Systems and Interventions

Support systems and interventions for Filipino men working in the cruise line industry are documented, although their consistency and comprehensiveness vary significantly. Shipping companies and clinics provide organizational support, which encompasses health care programs that address all aspects of health, including health applications, educational materials, and health talks (Harry et al., 2023). This support is often inconsistent. For example, legal and policy frameworks, such as the Philippine Overseas Employment Administration’s Standard Employment Contract (POEA-SEC), often fail to meet the requirements (Guillot-Wright, 2017; Pia et al., 2024). Regarding health promotion, records indicate that initiatives encompass health education, including HIV prevention and cardiovascular disease risk reduction (Gregorio et al., 2016; Guevara et al., 2010), nutrition interventions, and digital platforms that facilitate menu planning (Neumann et al., 2024). Due to these factors, recommendations emerge for targeted instruction of ship cooks, as well as for developing health promotion plans tailored to their specific needs (Neumann et al., 2024). Cultural factors are important, as family and peer support stand at the core of how Filipino seafarers manage difficulties and make decisions (Lu et al., 2012; Sarinas et al., 2022). The collectivist values and religious beliefs held by them greatly affect their health behaviors as well as how they react to trauma (Lu et al., 2012).

Discussion

Principal Findings

This review of 20 studies stresses a consistent pattern of prevalent health issues among Filipino men working in cruise lines. The high rates of musculoskeletal disorders, gastrointestinal complaints, and traumatic injuries are a direct reflection of the physical demands and inherent risks of seafaring work (Abaya et al., 2015; Radic, 2018). These conditions are not merely discomforts but are significant drivers of medical repatriation, indicating a substantial impact on both individual health and industry operations. For instance, retrospective data involving tens of thousands of cases consistently show that these conditions are leading causes for seafarers being sent home for medical reasons (Abaya et al., 2018, 2015, 2023, 2025; Huerte et al., 2023b). In addition, cardiovascular and metabolic risk factors are evident in several surveys (Gregorio et al., 2016; Guevara et al., 2010), with concerns about weight gain during deployment, despite overall obesity rates being lower than those of some other seafarer populations (Neumann et al., 2021).

In addition to bodily illnesses, mental health problems afflict broad groups, because stress, fatigue, depression, anxiety, and trauma appear frequently (Abila & Acejo, 2021; Jensen & Oldenburg, 2019; Sarinas et al., 2022). These issues are deeply intertwined with the prolonged work hours, social isolation, and extended separation from families that characterize cruise line employment (Banta & Pratt, 2022; Nielsen et al., 2013; Sarinas et al., 2022). The occupational environment, characterized by factors such as noise, vibration, and suboptimal workspace design, further exacerbates both physical and mental strain (Nielsen et al., 2013). Even with PEMEs (Huerte et al., 2023a) plus safety training, which serve as initial protective steps, the availability of health care services that address all needs on the ship remains a significant limitation (Guillot-Wright, 2017). This often leads to a reliance on medical repatriation as the primary solution for severe conditions, indicating a reactive rather than truly preventive health care system (Abaya et al., 2018, 2015, 2023, 2025; Huerte et al., 2023b). A significant barrier identified is the underreporting of health conditions due to fear of job loss or social stigma, particularly for mental health issues (Abila & Acejo, 2021; Banta & Pratt, 2022; Harry et al., 2023). This fear generates a negative loop, hindering prompt action and potentially leading to worse consequences. The review presents a diverse range of health promotion initiatives and support programs. These include targeted health education initiatives (e.g., on sexual health and cardiovascular risk; Gregorio et al., 2016; Guevara et al., 2010), digital support for nourishment (Neumann et al., 2024), and guidance and counseling services often facilitated by seafarers’ missions. The emphasis on culturally sensitive approaches that leverage family and peer support is particularly relevant for Filipino seafarers, given their strong collectivist values (Lu et al., 2012; Sarinas et al., 2022). Figure 2 illustrates the mapping of themes, key challenges, facilitators, and recommendations from the existing evidence among Filipino men working in the cruise line industry.

Figure 2.

Themes, Key Challenges, Facilitators, and Recommendations.

Comparison With Other Populations

Physical and mental health challenges affect more than Filipino seafarers, yet specific features demand comparison against seafarers globally and the public. For example, musculoskeletal disorders occur widely in occupations that require physical strain. The restricted, often repetitive movements aboard cruise ships cause more specific injuries for seafarers than for those working on land (Radic, 2018). Similarly, gastrointestinal complaints could be linked to onboard dietary patterns and stress levels (Neumann et al., 2024).

Many reports describe mental health concerns for seafarers across the globe because of loneliness, lengthy work periods, and little contact with others (Jensen & Oldenburg, 2019; Nielsen et al., 2013). Filipino seafarers, however, feel the weight of lengthy separation from their close-knit family structures, which stems from deep family bonds and financial reasons. This can intensify feelings of loneliness and stress, potentially distinguishing their psychosocial burden from that of seafarers from more individualistic cultures (Banta & Pratt, 2022; Lu et al., 2012; Sarinas et al., 2022). Studies on Western seafarers might highlight different coping mechanisms or a higher reliance on formal mental health services, whereas Filipino seafarers often lean on family and community support (Abila & Acejo, 2021).

The issue of health care access and underreporting is a universal challenge in the maritime industry due to the remote and often isolated work environment (Guillot-Wright, 2017). Filipino seafarers fear being blacklisted or losing their posts. The fierce competition for shipboard work from the Philippines drives this, as they tend to conceal health problems more than seafarers from countries with better worker safeguards or public support systems (Banta & Pratt, 2022; Harry et al., 2023; Pia et al., 2024).

Implications for Practice and Policy

Insights from this review have several important implications for both practice and policy. First, there is a pressing need to enhance onboard health care by expanding the scope and accessibility of medical services. The services must be developed and made more accessible. Such a shift requires providing full primary care and mental health support, moving beyond simple first aid. Attaining this goal means increasing the number of medical staff who possess proper training, improving medical equipment, and also connecting distant care through telehealth options (International Maritime Health Association, 2020; Rachiotis et al., 2010). Mental health support and services must be culturally sensitive, incorporating psychoeducation and counseling programs that leverage Filipino cultural strengths such as family and peer networks while actively addressing stigma surrounding mental health conditions (American Psychological Association, 2017; Tang et al., 2022). Besides reactive care, health promotion programs that cover diet, exercise, and stress management are also important. Such programs require tailoring to the specific environment aboard vessels, as well as the cultural preferences of Filipino seafarers. Digital tools and mobile applications can act as delivery platforms for them (Tang et al., 2022). The review highlights the need to strengthen legal and policy frameworks, particularly the POEA-SEC, which currently falls short in safeguarding seafarers’ health rights. Policy reforms should aim to enhance medical coverage, establish robust reporting systems for health incidents, and protect against discrimination based on health status (International Labour Organization, 2017; Philippine Overseas Employment Administration, 2016). Finally, setting up standardized data collection and monitoring systems can inform policy decisions and direct resource allocation with greater effectiveness (International Transport Workers’ Federation, 2021; World Health Organization, 2019).

Research Gaps and Future Directions

The review offered valuable insights, but research gaps persist. Longitudinal studies are scarce because most research currently reports cross-sectional or retrospective data. Investigators should conduct prospective studies to track health trajectories, understand how diseases progress, and evaluate the effectiveness and success of interventions for Filipino men working on cruise lines (Lucas et al., 2022). Some health promotion efforts are documented, but rigorous evaluations of their effectiveness and cost-effectiveness remain scarce. Research should prioritize randomized controlled trials or quasi-experimental designs to determine the impact of interventions on outcomes (Bandura, 2004). Researchers should also adapt interventions to the culture, values, and coping methods of Filipino seafarers. This is particularly relevant to mental health, where family and community factors can be effectively integrated (Tang et al., 2022). The capacity of digital health technologies and telemedicine to improve health care access and provision deserves further investigation. This is because remote and unstable internet connections create difficulties (Mohammadzadeh & Gholamzadeh, 2023; World Health Organization, 2019). Beyond that, researchers must examine particular groups among Filipino male cruise line workers, for instance, those whose jobs demand physical exertion or those who have pre-existing health issues. That examination would help comprehend their varying health requirements. Extensive qualitative research is necessary to record the actual experiences of seafarers. Finally, more in-depth qualitative research is essential to capture the lived experiences of seafarers, including their health challenges, encounters with stigma, and interactions with the health care system (De Castro et al., 2008).

Strengths and Limitations

The scoping review’s approach encompasses all aspects, including peer-reviewed articles and gray literature, providing a comprehensive description of Filipino men’s health conditions aboard cruise lines across clinical, psychosocial, and care aspects. Two independent reviewers screened and extracted data, which reduced selection bias—a principle central to sound review methods. The review included both quantitative data on health frequency and qualitative insights into lived experiences, providing a holistic understanding.

Nevertheless, several limitations should be acknowledged. Studies presented different designs, measured varying outcomes, and reported findings in distinct ways, which prevented a formal meta-analysis and obscured direct comparisons of results. Published literature tends to focus on studies from urban tertiary centers or those with more accessible data. This skewed representation means that seafarers in remote areas or those at smaller companies often have their experiences overlooked. Because the review relied solely on published literature, it overlooked informal support systems and specific company programs. Accessing some gray literature, such as internal company reports or unpublished theses, proved difficult, which narrowed the scope of the review. Subsequent evaluations must employ standardized reporting checklists (such as PRISMA-ScR), proactively seek unpublished datasets from maritime health organizations, and incorporate rigorous evaluation methodologies for gray literature. These enhancements will establish the evidentiary foundation necessary to transform research findings into equitable, community-focused seafarer health care throughout the Philippines and globally.

Conclusion

Filipino men working in the cruise lines encounter difficulty with health conditions, showing frequent musculoskeletal, gastrointestinal, and traumatic injuries; they also face considerable mental health challenges, such as stress, fatigue, depression, and anxiety. Strenuous occupational conditions, isolation, and long periods away from kin worsen the problems. Despite the presence of pre-employment screenings and some health promotion initiatives, access to comprehensive onboard health care is often limited, leading to a reliance on medical repatriation and widespread underreporting, as workers fear losing their position or stigma. A fundamental re-evaluation of how seafarer health is managed is critically needed. The cruise industry should expand comprehensive onboard medical services, develop culturally sensitive mental health support programs that leverage family and peer networks, and implement proactive digital health promotion initiatives. Furthermore, reforming legal and policy frameworks, such as the POEA-SEC, is essential to ensure robust health protection and address systemic barriers. By establishing standardized health reporting and investing in longitudinal research, stakeholders can build equitable and person-centered models of care, ultimately enhancing the well-being of this indispensable workforce.