Occupational health services in Finland

The Ministry of Social Affairs and Health has summarized Finnish social security policy into four main strategies (1):

• promoting health and working capacity
• increasing the attractiveness of work life
• prevention and treatment of social exclusion
• well functioning services and reasonable income security.

The occupational health service system contributes to the implementation of these strategies. Comprehensive occupational health care supports the maintenance of the workers' health and working capacity, promotes safety, improves the quality of work life, and prolongs the full participation of employees in work life.

The Ministry of Social Affairs and Health supervises the occupational health service and safety systems (3, 4). Issues concerning legislation and the development of occupational health services are discussed in the tripartite Advisory Board at the Ministry, represented by the social partners, the government, the providers of services and the Finnish Institute of Occupational Health (2).

According to the Act on Occupational Health Services (2002) employers are required to organize and pay for preventive services for all workers regardless of the size, industrial sector or form of the enterprise (4). Both private and public sectors are covered. Although curative services are voluntary, they are nevertheless included in 80% of the service agreements. Occupational health care is voluntary for self-employed entrepreneurs, e.g. farmers.

Occupational health services can be organized in several ways; through municipal health care centres, private medical centres, or the services may be integrated into the enterprise, or enterprises can organize them jointly. The number of occupational health service units was about 1000 in 2003. These units served some 1.8 million people - 85% of the salaried employees (5). The employer is entitled to reimbursement of the incurred costs from the Social Security Institution. The reimbursement covers 60% of the approved cost of occupational health care and 50% of medical care, up to a prescribed limit. The total cost of occupational health services was 375 million euros in 2003 (6).

The total number of posts in the occupational health service is about 5700; some 1300 physicians and 2200 public health nurses are working along with other experts (physiotherapists, psychologists, opticians, and experts in agriculture, occupational/industrial hygiene, ergonomics, physical activity, technical branches, speech therapy, and nutrition).

The tasks of occupational health professionals include:

1. assessment of the healthiness and safety of the work and working conditions through repeated workplace surveys and other methods, paying attention to exposure to dangerous substances, loading factors in the work, the working arrangements, and the risk of accidents and violence. These factors are taken into account in the planning of the work, working methods and work spaces, and in situations in which the working conditions are changing;
2. investigation, assessment and monitoring of work-related health risks and problems, employees' health, work ability and functional capacity, including any risk of illness caused by the work or the work environment, and undertaking medical examinations deemed necessary as a result of the afore-mentioned points, considering the special characteristics of the individual employee;
3. suggesting measures to improve the healthiness and safety of the work, to adapt the work to the needs and capacity of the employee if necessary, to maintain and promote the employees' work ability and functional capacity, and to monitor the implementation of the proposals for action;
4. providing information, advice and guidance in matters concerning the healthiness and safety of the work, and the health of the employees, including investigation of an employee's workload if requested by the employee on reasonable grounds;
5. monitoring and supporting the ability of a disabled employee to cope at work, considering the health requirements of the employee, giving advice on rehabilitation, and referring an employee for treatment or medical or vocational rehabilitation;
6. cooperating with representatives of other health services, labour authorities, educational authorities, social insurance, social services and the labour protection authority, and when necessary, with different occupational health service providers of the employers in a common workplace;
7. participating in the organizing of first aid readiness;
8. assisting in the planning and organization of measures to maintain and promote work ability as a part of occupational health care, including an investigation of the need for rehabilitation where necessary;
9. assessment and monitoring of the quality and impact of the occupational health services.

The Finnish Institute of Occupational Health (FIOH) is an important asset in the field of occupational health, with its staff of 800 researchers and other experts representing a multitude of fields. The Institute produces evidence-based information, research results, surveys and statistics, recommendations for good practice. The Institute also offers training and other services for occupational health and safety professionals, for workplaces and for the general public. Examples of new publications are the revised edition of the Good Occupational Health Practice guidebook, and the Quality Key for self-assessment of occupational health services, both of which will come out in 2006. The production of evidence-based guidebooks on occupational health practice has also started. The Institute is co-ordinating the Cochrane Occupational Health Field and the production of systematic reviews (7).

Strong political will among social partners, a firm regulatory basis, a well-functioning occupational health service system, and a good knowledge base have enabled the sustainable development of occupational health services in Finland.

Kirjallisuutta

1. Trends in Social Protection in Finland 2003, Ministry of Social Affairs and Health 2003. http://www.stm.fi/Resource.phx/publishing/documents/2993/index.htx
2. Government Resolution on Occupational Health 2015 ? Development strategy for occupational health care, Ministry of Social Affairs and Health 2004:5; http://www.stm.fi/Resource.phx/eng/publc/publs/Julkaisu-2004-short.htx
3. Occupational Health and Safety in Finland 2004, Ministry of Social Affairs and Health 2004:5; http://www.stm.fi/Resource.phx/eng/subjt/safet/index.htx
4. European Agency for Safety and Health at Work - Finland; http://fi.osha.eu.int/index.stm/
5. Occupational Health Services in Finland surveys 1992, 1995, 1997 and 2000, Finnish Institute of Occupational Health
6. The Social Security Institution of Finland; http://www.kela.fi/in/internet/english.nsf
7. Cochrane Occupational Field; http://www.cohf.fi/index.htm