Road traffic injury remains a leading cause of preventable death globally, yet Thailand ranks among the world’s highest road traffic mortality nations—without any systematic Medical Fitness to Drive (MFD) programme for licensed occupational drivers. This cross-sectional study examined 2085 public transport and for-hire drivers attending Thailand’s first prototype MFD Clinic at the Institute for Urban Disease Control and Prevention, Bangkok (2020-2024), using a comprehensive six-domain assessment encompassing body composition, blood pressure, pulmonary function, vision, hearing, drug screening, sleep risk, and mental health. Findings revealed a substantial, multidimensional burden of safety-relevant conditions—each detectable through systematic screening, treatable through existing clinical pathways, and regulatable through the commercial driver licensing framework. OSA risk was identified in 44.5%, overweight or obesity in 59.6%, elevated blood pressure in 22.0%, chronic sleep insufficiency in 55.3%, and visual abnormalities in 19.6%. Depression was clinically identified in 4.9% of participants against a self-declaration rate of just 0.2%—a 25-fold disparity that illustrates why voluntary disclosure cannot substitute for structured assessment—and current suicide risk in 2.0%. Almost half (47.7%) reported a prior road crash history. None of these conditions is captured under Thailand’s existing certification framework. The prototype program demonstrates operational feasibility through a tiered service delivery model, inter-ministerial governance architecture, and nationally contextualized clinical guidelines. It offers a replicable, evidence-based framework for low- and middle-income countries seeking to integrate systematic occupational driver health assessment into road safety policy—reframing MFD screening from a bureaucratic formality into a targeted public health intervention with quantifiable potential to prevent deaths at scale.
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