Finland and Brazil exchange occupational health service insights

Occupational health services

Occupational health care in Brazil is well-developed, with highly skilled professionals specializing in occupational medicine. Laws guarantee private companies employees' access to these services. The coverage of occupational health services remains inadequate, as nearly half of the workforce is employed in the informal sector and public sector does not have access to occupational health services.

Occupational health services offer both curative and preventive care, consistent with practices in Finland. The expenses associated with occupational health care are the responsibility of the employer.

In Brazil, occupational health services (OHS) are provided through a multi-tiered system combining universal public healthcare, mandatory social security, and employer-led specialized services.

The unified health system (SUS)

All individuals employed in Brazil, including those within the informal sector, are guaranteed constitutional access to health services through the Sistema Único de Saúde (SUS). Worker's Health Reference Centers (CEREST), as specialized units within SUS, offer comprehensive services such as diagnosis, surveillance, and rehabilitation for occupational health conditions. The e-SUS Linha da Vida program, introduced in late 2022, seeks to integrate national notification systems to improve the quality of data on work-related diseases.

While the 2025 landscape shows advanced legislative frameworks, actual OHS coverage for the total workforce remains relatively low, estimated at approximately 26% as of recent assessments.

Mandatory employer services

In accordance with Regulatory Standard No. 4 (NR-4), organizations are required to maintain Specialized Services in Occupational Health and Safety (SESMT). The law guarantees access to occupational health services for private companies' employees. There, multiprofessional occupational health services are well-developed, with highly skilled professionals specialized in occupational medicine. The private sector occupational health services offer both curative and preventive services, consistent with practices in Finland. According to law, the expenses associated with occupational health services are the responsibility of the employer. Staffing levels for these units are determined by the number of employees and the organization's risk classification, with the mandate to employ occupational physicians, nurses, and safety engineers as appropriate. Regarding Risk Management (GRO), employers must identify and evaluate all workplace risks. May 2025 onwards, updated regulations necessitate also the assessment of psychosocial risks, such as occupational mental health considerations. Parallelly the official list of occupational diseases was completed with a high number of new outcomes, including psychological burnout.

Social security and insurance

Formal employees in Brazil are protected with the National Social Security Institute (INSS) in cases of occupational accidents and disability.

• GILRAT/RAT Contribution: Employers are required to pay a tax ranging from 1% to 3% of their payroll, with rates determined by the risk level associated with their activities, to support disability benefits. In Brazil, RAT stands for Riscos Ambientais do Trabalho (Environmental Work Risks), and GILRAT is the acronym for Grau de Incidência de Incapacidade Laborativa Decorrente dos Riscos Ambientais do Trabalho (Degree of Occupational Disability Due to Environmental Work Risks).
• Accident Prevention Factor (FAP): This factor serves to adjust an employer's tax obligations upward or downward based on their actual incidence of workplace accidents.

Wicked problems

Brazil faces similar work-life challenges to those encountered in Finland. More than 470,000 workers have left the workforce due to mental health concerns. Musculoskeletal disorders also highlight the need for preventative strategies, and proactive measures are essential to prevent occupational accidents.

Additionally, the workforce is aging due to increasing life expectancy, requiring occupational health to address both the diagnosis and treatment of chronic conditions such as work-related cardiovascular diseases and cancer.

Despite the existence of a comprehensive legal framework, considerable OHS coverage gaps remain as challenges:

• Informality: An estimated 40 per cent of the workforce is engaged in the informal sector, without access to social security-based compensation or formal occupational health and safety (OHS) initiatives.
• Underreporting: Occupational diseases are often underreported, with fewer than 6 per cent of recorded workplace injuries officially classified as "diseases."
• Regional Disparities: Notification systems, such as SINAN, are not uniformly applied across all regions, resulting in fragmented data collection.

Many of the wicked problems have been effectively responded by the Government policies but considering the size and the economic structure of the country, the universal implementation takes time.

Association activities are vivid

The Brazilian Association of Occupational Health Physicians (ANAMT) is founded in 1968. ANAMT is a non-profit, scientific and professional non-governmental organization. It is the largest association of occupational health physicians in Latin America, dedicated to uniting and coordinating the activities of professionals interested in promoting workers' health.

ANAMT's fundamental pillars are the protection of workers' health, scientific research and dissemination of evidence-based information, protection, recognition and development of occupational medicine professionals' continuous education. The Association organizes events to discuss the most important issues related to the specialty, such as the ANAMT Presence Forum, the ANAMT National Congress, regional seminars and distance learning courses.

Brazil is divided in 26 States and 1 Federal District, totaling 27 federative units. They collaborate with ANAMT to disseminate best practices in occupational medicine and for professional development. The regional entities organize training events, such as refresher courses, congresses, and seminars, and disseminate the issues addressed by ANAMT throughout Brazil.

To increase the visibility of work promoting worker health and safety at the international level, ANAMT maintains partnerships with leading universities, public bodies and civil society organizations worldwide.

ANAMT's mission is to unite occupational health physicians by providing excellent training in occupational health care, occupational rehabilitation, and professional advocacy. The vision is to be a pioneer in the development of occupational health and safety through a strong and representative association of occupational health physicians with a national and international dimension.

Conclusion

Brazilian legislation provides a framework for occupational health and occupational medicine activities. Effective legislation provides a framework for activities, and effective legislation is fundamental to achieving high standards in occupational health service. OHS systems in Brazil and Finland exhibit many similarities, resulting in both countries encountering common challenges such as globalization and digitalization. However, a notable distinction lies in demographic trends; specifically, the aging population presents a more pronounced issue in Finland.

Summary

One key takeaway for me is that Finland's occupational health service system closely resembles the Brazilian and is governed by similar laws. The atmosphere at the ANAMT congress reminded a lot of STLY's spring and autumn seminars. The congress itself was themed around the poetry of Cora Coralina, a poet from Goiânia.

"Happy is the one who shares their knowledge and learns what they teach."

– Cora Coralina