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Occupational Safety and Health in Finland
Journal of Safety Research, Vol. 31, No. 4, pp. 177–183, 2000 Copyright © 2000 National Safety Council and Elsevier Science Ltd Printed in the USA. All rights reserved 0022–4375/00/$19.00 ⫹ .00
Pergamon
PII S0022-4375(00)00039-6
Special International Report Occupational Safety and Health in Finland Erkki Yränheikki and Heikki Savolainen
In Finland, occupational safety is the responsibility of the employer, while the occupational safety and health laws are enforced by the Labour Inspection Service, an organization of the state. The Labour Inspection is divided in 11 administrative districts, and it employs 360 professionals. They are mandated to carry out site visits without prearranged appointments to inspect safe work situations, working hours, construction safety, or any aspect of accident risks. The inspectors are also mandated to verify the existence of sufficient occupational health services as prescribed by the Occupational Health Services Act for all employees. The occupational health services are typically provided by enterprise-owned medical departments, by mutually owned health care centers, by private practitioners, or by municipal health care centers. The latter are required by law to provide all services as prescribed by the legislation to anyone who comes to the facility. This situation is prevalent in the countryside, where there are very few private caregiving centers. Declaring occupational accidents and disease cases is mandatory, and the Inspection districts examine all accidents to establish causes and consequences, and to initiate prosecution in case of criminal negligence. Labour Inspection Districts are also notified of the new occupational disease cases as they are declared to insurance companies. Insurance for occupational disease, accidents, and death is an obligation of the employer, although they can choose the insurance company. The medical confidentiality between the workers and their occupational health care providers is very strict. Official statistics are maintained by the state Statistics Finland organization, and they may be used, for example, for research purposes by scientific institutes like the Finnish Institute of Occupational Health. Construction industry accounts for 25% of all fatal accidents (120 cases per 1 million working hours), followed by mechanical, wood, metal, machinery, and pulp and paper industry (10% each of fatal accidents) with rates ranging from 100–160 cases per 1 million working hours. There are some 5,000 occupational disease cases per year (rate 22/10,000 employed). The major disease categories include repetitive strain injuries (1,300 cases), respiratory aller-
Erkki Yrjänheikki, PhD, is a qualified occupational hygienist and the Director of the Research and Development Section of the Department of Occupational Safety and Health. He also teaches occupational hygiene at the University of Oulu.
Winter 2000/Volume 31/Number 4
Heikki Savolainen, MD, is a former professor of occupational medicine at the University of Lausanne and currently Chief Medical Officer at the same Section responsible for occupational health.
177
gies (600 cases), occupational skin diseases (1,000 cases), and 900 cases of noisecaused hearing loss. In 1998, 589 cases of asbestos-related diseases were reported. © 2000 National Safety Council and Elsevier Science Ltd. Keywords: Safety, health, occupations, labor, inspection, accidents, diseases, statistics
INTRODUCTION Finland, a member of the European Union (EU), is situated between 60 and 70 degrees N latitude, and thereby one of the northernmost countries in Europe. It covers 130,558 square miles, with 5.1 million inhabitants, which makes it one of the most sparsely populated countries in the continent. Finland is an industrialized country, known for its pulp and paper, metal, and electronics industries. The industries sector employs 470,000 people (21% of all employed), compared to the private services sector, which is the largest with 810,000 employed (over 36% of the total workforce). The public sector is also large (650,000 or 29%), followed by construction (140,000 or 6.3%), and agriculture and forestry (145,000 or 6.6%). The per capita income exceeds $24,000 (USD). Finland is a republic and a parliamentary democracy. The highest legislator is the National Assembly, while the State Council (government) and ministries can issue decrees, ordinances, and resolutions. The National Assembly administers the fundamental laws of occupational safety and health, that is, the Occupational Safety and Health Act (1958) and the Occupational Health Care Act (1978). The latter is currently under review. These are completed by the decrees, ordinances, and other instructions of the executive so that, for example, action programs toward the maintenance of working ability (1994) have been decreed (Ministry of Social Affairs and Health, 1999). The first legislation on occupational safety was given in Finland in 1889, and it was enforced by two labor inspectors. One of them was placed in Helsinki, Capital City, and the other in Tampere, an industrial center some 110 miles north of the capital (Hoskola, 1999). Finland was then still a Grand Duchy under the tutelage of the Russian Empire. It is also of interest to note that similar laws were passed in the United Kingdom, Switzerland, and other European countries in 1870 and later. Industry began to establish dispensaries for medical care after that and increasingly in the 1930s. The Finnish Institute of Occupational Health was established after World War II, and was governed by a private foundation that received annual grants from the government until 178
1978, when it became a governmental organization by a public law. In the same year, the Occupational Health Care Act was issued.
CURRENT ORGANIZATION The Finnish legal framework is based on two fundamental laws—the Occupational Safety and Health Act (1958) and the Occupational Health Care Act (1978). The former regulates the general safety in work as related to accidents, working hours, conditions of employment, exposure to chemicals or energy, and other physical or material aspects. The Act also serves as the legal basis for public control of all workplaces in Finland. It is enforced by the Labour Inspection Service, which is divided in 11 districts with 16–60 inspectors each. Their mandate covers 220,000 workplaces and some two million employees. While autonomous in their actions, the districts are under the coordination of the Department of Occupational Safety and Health, which is one of the departments of the Ministry of Social Affairs and Health. The ministry department is the executive, planning, and coordinating organ for the Council of State in matters under the field of application of the Occupational Safety and Health Act. The Occupational Health Care Act provides basic occupational health services for all employees, as concerns prevention of occupational disease and maintaining the working ability. It is the responsibility of the employer to organize the necessary care through its own medical department, mutual private sector centers, private practitioners, or municipal health care centers. Municipalities are under the legal obligation to furnish the basic preventive services to anyone who wants them. There are over 1,000 identified services providers in Finland, but the municipal centers are usually the only ones available in small rural communities. The application and control of the Act is under the purview of the Department of the Preventive Social and Health Policies of the Ministry of Social Affairs and Health. The department supervises all health care measures through regional government and in municipalities. It is also responsible for the conJournal of Safety Research
tents and substance of preventive care. Occupational health care providers may also offer disease management and treatment services on a voluntary basis. The costs from the latter and from the preventive care are partially reimbursed by the Social Insurance Institution of the state. The coordination of actions of the two departments takes place through the Council of Occupational Health Care and through ad hoc working parties as required and created by the government. The Council members include partners and contractants in the labor market, other government ministries, the Social Insurance Institution, and the Finnish Institute of Occupational Health. The latter is a research institute created originally by a joint action of industry and labor unions after World War II, and subsidized by the state. A specific law changed it to a governmental organization in 1978. It is the principal research arm in matters of occupational health and safety. Another relevant council in occupational safety and health includes one for nuclear safety, among others. All employees are insured for occupational accidents and diseases by an underwriter chosen by the employer. The insurance companies have established among themselves a federation that provides joint statistics and proposes technical guidance and documentation. As for the mandatory guides and inspection, they fall under the aegis of the State Technology Authority of the Ministry of Trade and Industry. Additional technical and research organizations include the Center for Occupational Safety and the Finnish Work Environment Fund, respectively.
WORKING ENVIRONMENT Finland has traditionally comprehensive birth registries, which were first established by church parishes and later expanded to all walks of life. Currently, Statistics Finland provides all official Finnish figures. The data are of obvious interest to the government, while they have also more recently been required by the European Agency for Safety and Health at Work for the EU. A national working party reviewed the situation up through 1997. That database has mainly served for the figures in this article. Physical Exposures Exposure to noise at or above 80 dB(A) is very common. Five percent of all employees are continuously exposed during the 8-hour shift, and Winter 2000/Volume 31/Number 4
20% are exposed to it for more than one-quarter of the shift. It is clear that noise abatement in manufacturing industries, in mining, and in various public services remains a priority. Hearing loss due to noise exposure is a prevalent occupational disease in Finland. Over 100,000 working Finns are exposed to hand/arm and/or whole body vibration. It represents over 10% of the blue collar employees. Professions and trades include transport, construction, manufacturing of machinery and other metal products, and agriculture and forestry. Statistics of occupational disease cases indicate some 20 vibration-induced states annually, which might only be the tip of the iceberg in view of the large exposed population. Sweat-inducing heat exposure is experienced by 17% of employees for at least a quarter of the workshift. The professions and trades exposed include food production, textile industry, pulp and paper industry, glass works, and building trades. Comparable numbers (21% of employees) are exposed to cold in such diverse occupations as refrigerated food production and storage, forestry and sawmill work in winter, construction in winter, and many transport professions in the winter. Postures and Movements Lifting and handling heavy objects is very common in many occupations in Finland. In two separate surveys, 30% and 37% of respondents affirmed that their daily workshifts included repeated lifting and handling using muscle force alone. These occupations are mostly comprised of health care workers, restaurant and hotel workers, builders, and warehouse and packaging workers. The conditions are worse in small firms that cannot invest in extensive work-saving machinery than in larger companies. Correct use and appropriate training are also important issues when machinery is available. Repetitive hand/arm movements have become even more common because of the constant expansion of various service professions (e.g., supermarket cashiers, office work, and semiautomated light industry, like assembly of electronic goods). The repetitive movements are experienced by 30% to 70% of employees, depending on surveys. Occupational injury cases come mainly from the food industry (meat cutters), assembly of electronics appliances, using pressurized air-operated tools, and many health care professions. This exposure category is a large cause of occupational disease in Finland (1,314 cases in 1998, up 2% from 1997). 179
Pain or fatigue-causing postures are indicated by over 30% of Finnish employees. The number of this type of complaint has increased since the late 1970s, probably due to improper application of ergonomic principles and organization of work. Typical situations include welding of metal frames in construction and ship building, painting and fishing, and agriculture, while also frequent tasks in health and child care are problematic. Bad postures cause workers 60–64 years of age to leave or change occupations. It induces, therefore, an age bias on surveys. Exposure to Carcinogens After the ban on technical and industrial use of asbestos, the number exposed has diminished from its peak, and now it remains at little more than 5,000 people, mostly in the building industry. Crystalline silica exposure is widely spread in construction, where it concerns some 70,000 people. Diesel engine exhaust gases cause exposure to some 3,000 employees in the same branch, and to 24,000 in all forms of land transport. Other important occupational carcinogens include radon gas (49,000 exposed in buildings with the specific indoor air contamination), Chromium (VI) compounds (7,000), and hardwood dust particles (65,000). The carcinogen with the highest number of occupational exposures is the UV irradiation in outdoor jobs, with 180,000 exposed employees according to the Finnish CAREX database (Vincent, Kauppinen, Toikkanen, Pedersen, Young, & Kogevinas, 1999). Exposure to Neurotoxic Chemicals All exposure to chemicals in Finland is assessed at one million employees, whereas the numbers concerning the five most frequent neurotoxicants (aromatic and chlorohydrocarbon solvents, lead, arsenic, carbon monoxide, and aliphatic hydrocarbon solvents) are estimated at 35,000. Perhaps more important than the raw figures is the mode of exposure in chemical mixtures (paints, glues, polymers) and by noninhalation portals of entry (skin, gastrointestinal). Severe intoxications are infrequent, while programs of biological monitoring for exposure (e.g., to lead) show that vigilance is still necessary. It seems that the biological monitoring programs should be maintained at least in their current volume, and clinical monitoring techniques should be refined even further. 180
Psychosocial Factors One-third of the employees feel that they are very busy in their work and 40% to 55% of all employees estimate that their time schedules are too tight in branches such as general offices, hotels and restaurants, land transport, health care, and food industries. Repeated surveys have shown an increasing trend from the 1970s onwards. Young employees (⬍25-year-old) feel consistently that they are not as much concerned as their older peers. Violence and threat of violence episodes are experienced twice a month by more than 21% of guardians and safety officers, by 7% of health care professionals, by 6% of social workers, and 2.4% of waiters. Less frequent episodes are experienced by 25% to 39% of the same respondents. Harassing by colleagues and chiefs is experienced currently by 6% of employees in hotels and restaurants, by 7% in retail jobs, and by 6.7% of teachers. A history of harassment in the same categories varies from 6% to 12.5% as told by the same respondents. Women are more often victims (19%) than men (13%). Monotonous work is still very common. Onethird of textile and garment workers report this complaint, which is even more prevalent in food processing (41%) and in wood-working jobs (48%). It seems, though, that monotonous work is diminishing through a better process organization and automation and by application of teamwork methods. Accidents There were over 53,000 accidents that caused an absence from work for more than 3 days in Finland in 1996. The leading causes included solid objects or articles, working environment and structures, tools, machinery, and conveying or lifting gear. One-quarter of fatal accidents occur in the construction industry (120 cases per 1 million working hours), and the wood working industry, metal manufacturing industry, machinery and related equipment production, and paper and pulp industry account for 10% each, of all fatal accidents. Workers aged 45 to 54 years have a 20% higher risk of a fatal accident than average, while males are victims in 96% of all cases. Falling or collapsing objects were implicated in 30%, entanglement or entrapment in 20%, falling or leaping from a platform in 15%, striking against objects in 15%, and falling, slipping, or stumbling in 10% of all fatal accidents. The accident rates have remained stable during recent years. Journal of Safety Research
Occupational Diseases The greatest risk of an occupational disease is in agriculture and forestry, followed by food, drink, and tobacco production, wood-working jobs, metal and metal-working industries, and the construction industry. Diseases caused by farm work and forestry include respiratory allergies, repetitive strain injuries, and skin diseases. Flour asthma is an important risk in the food industry, and skin ailments are the most frequent diseases. Over half of all repetitive strain injuries are caused by work in the food production industry. Ninety-eight cases of occupational cancer have been reported in Finland in 1998. Asbestos exposure is the leading identified cause. It is obvious that exposure to complex mixtures, like polycyclic aromatic hydrocarbons in tar or in foundry smoke are an important risk of lung cancer, while their etiological roles in individual cases are much harder to prove. As for the chemical causes of noncancerous diseases, nickel, cobalt, and chromium are important causes of skin hypersensitivity as are the organic diisocyanate hardeners in respiratory diseases. Natural latex is the emerging etiology of respiratory ailments in health care workers. In general, the incidence of major occupational diseases (Table 1) is similar to that reported for other comparable European countries (Boillat, Guillemin, & Savolainen, 1997). Analogously, there is the tendency that more and more cases are found in small workplaces where reactive chemicals are handled without respiratory or other protective devices.
DISCUSSION Finland has had laws on labor protection for 110 years. Obviously, the focus of preventive policies and measures taken have changed over time. The Table 1. Notification of Occupational Disease Cases in Finland Repetitive strain injuries Skin disease Hearing loss Respiratory allergies Diseases caused by asbestos Others Total
1314 972 930 613 589 398 4816
*Data for 1998 from Finnish Institute of Occupational Health.
Winter 2000/Volume 31/Number 4
idea of a field organization in the form of the Labour Inspection districts has well resisted the times, and has been well appreciated by all concerned. Its authority and expertise is mostly considered up to date and neutral by its customer. In previous years, the individual inspectors emphasized their controller’s role, whereas now they have included technical counseling in the workplace. From early on, only technically qualified people have been recruited as inspectors, although with emerging concern of chronic health risks and psychosocial factors the need has shifted to health and human science professionals. This has been reflected in recent recruiting policies as, for example, occupational health nurses, and sociologists have been engaged as inspectors. No medically qualified persons have yet served as an inspector, as is the case in Ireland or in the United Kingdom. The lack of medically qualified inspectors in districts hinders somewhat the collaboration between the Labour Inspection and occupational health care providers. Much of this is caused by the circumstance that all personal data of employees is of medical privilege, which cannot be divulged. Another aspect is that Labour Inspection cannot report on the adequacy of occupational health care services and their plans at workplaces. It can only ascertain that such services, as required by the law, exist. Finland is one of the EU countries that emphasizes working ability and tries to prevent early retirement and exclusion of employees over 45–50 years. Special government programs have been conceived to these ends to counteract the effect of retirement of the large generations born after World War II, now in their 50s, in 2010 and onwards. This is somewhat against the modern business management techniques that strive toward the mean age of 38.5 years for personnel. However, it is believed that the factual retirement age for Finnish men of 58 years should be pushed over 60 to obtain a financial viability of the pension systems. The life expectancy of both sexes increases constantly, so that a youth born in the 1980s can expect to live over 18 years after retirement at the age 65. The option of a flexible retirement age, perhaps indexed to the remaining life expectancy, should be considered. Finland was also severely hit by an economic recession in the early 1990s, which left large segments of the population unemployed, and reduced the tax revenues. It caused cut-backs of state and municipal services, especially in social and health care branches and in education, with 181
increased redundancy of trained people. This circumstance is one of the factors in perceived stress and increased overtime work by the employees who have been retained for the absolute core services. As these employees retire, it creates recruiting problems because the trained unemployed reserves have not necessarily been able to maintain their skills. Some of the expertise and talent have also been lost to other EU countries and beyond because of the free labor market and globalization. A generation gap may also exist in the form of basic and technical education received by younger generations, much more conversant with information technology and in foreign language skills. They are easier to retrain in new operation procedures and probably require less direct management on the job. Although temporary, such circumstances demand good managerial skills and flexible personnel policies in the firms. Much of this is reflected in the labor inspectors, who have to deal with all complaints according to their brief. The Department of the Occupational Safety and Health in its national coordinator’s role stipulates jointly with the districts national action projects for 3–4-year periods. The current special actions include reduction of accident rates, prevention of locomotor diseases, and counteracting violence. Some 30% of inspector’s resources are required to be used toward these national goals. It is obvious that campaigns cannot reach all workplaces by personal contact or visits, so information and education become very important. Working ability and aging worker programs have benefited from television programs and advertisements, and from local meetings and briefings by trade associations and unions. Much of the contents have been jointly approved by the Council of Occupational Health Care and other learned or professional parties. Evidence-based development requires strong research input. Finland has a large research institute in the form of the Finnish Institute of Occupational Health. Its main office is situated in Helsinki, with six regional institutes in major economic regions with the goal to serve local research and development needs. Some regional outlets also have national responsibilities, like marine occupational health, agriculture and forestry, or woodworking industries. The state maintains the institute largely from its annual budget, while the institute also generates considerable revenue from its own service laboratories. Several other independent institutes and university departments com182
pete for grants by the Finnish Work Environment Fund, which has a council to evaluate the scientific merits and desirability of the proposed projects. Therefore, the possibility of a national coordination of research in occupational safety and health exists. The EU is a new factor in stimulating and funding research and development. Many of the European initiatives have been eagerly taken up by small and medium-size Finnish enterprises in the hope to gain a competitive edge. Their impact is yet to be evaluated, although it is already evident that their administration has remained uncomplicated, and that most results are thoroughly practical, with the idea that these new operating procedures and organization of work will remain even after the end of external European funding. It is clear that the European dimension will increasingly have a positive impact on the Finnish occupational health and safety. Finnish occupational safety and health has a need to further modernize its functioning. It has to offer its services in all corners of the geographically large country, which may mean that new devices based on information technology have to be adopted and exploited more fully. Their use should be increasingly encouraged by small firms as to the autoevaluation of risks, of product safety, or of environmental impact. It may be that occupational safety and health services have to learn to collaborate more closely with the environmental health authority, and there is no reason that such a collaboration would not be beneficial to both. In conclusion, the Finnish occupational safety and health scene is undergoing a rapid change as it has to adapt in the situation of a diminishing and aging workforce, of European collaboration, of globalizing markets, and of accelerating introduction of new technologies.
ACKNOWLEDGMENT The Finnish occupational safety and health server can be found at the internet address: www.fi.osha.eu.int.
REFERENCES Boillat, M.-A., Guillemin, M.P., & Savolainen, H. (1997). The present state and practice of occupational health in
Journal of Safety Research
Switzerland. International Archives of Occupational Environmental Health, 70, 361–364. Hoskola, H. (1999). Safety at Work. Labour Inspection in Häme 110 years (1889–1999). (pp. 1–116) (in Finnish). Turenki: Author. Ministry of Social Affairs and Health (1999). Occupational
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Health Care. Guides and Instructions 6 (pp. 1–12). Tampere: Author. Vincent, R., Kauppinen, T., Toikkanen, J., Pedersen, D., Young, R., & Kogevinas, M. (1999). CAREX: International information system on occupational exposure to carcinogenic agents in Europe. Cahiers de Notes Documentaires, 176, 49–50.
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Pergamon
PII S0022-4375(00)00039-6
Special International Report Occupational Safety and Health in Finland Erkki Yränheikki and Heikki Savolainen
In Finland, occupational safety is the responsibility of the employer, while the occupational safety and health laws are enforced by the Labour Inspection Service, an organization of the state. The Labour Inspection is divided in 11 administrative districts, and it employs 360 professionals. They are mandated to carry out site visits without prearranged appointments to inspect safe work situations, working hours, construction safety, or any aspect of accident risks. The inspectors are also mandated to verify the existence of sufficient occupational health services as prescribed by the Occupational Health Services Act for all employees. The occupational health services are typically provided by enterprise-owned medical departments, by mutually owned health care centers, by private practitioners, or by municipal health care centers. The latter are required by law to provide all services as prescribed by the legislation to anyone who comes to the facility. This situation is prevalent in the countryside, where there are very few private caregiving centers. Declaring occupational accidents and disease cases is mandatory, and the Inspection districts examine all accidents to establish causes and consequences, and to initiate prosecution in case of criminal negligence. Labour Inspection Districts are also notified of the new occupational disease cases as they are declared to insurance companies. Insurance for occupational disease, accidents, and death is an obligation of the employer, although they can choose the insurance company. The medical confidentiality between the workers and their occupational health care providers is very strict. Official statistics are maintained by the state Statistics Finland organization, and they may be used, for example, for research purposes by scientific institutes like the Finnish Institute of Occupational Health. Construction industry accounts for 25% of all fatal accidents (120 cases per 1 million working hours), followed by mechanical, wood, metal, machinery, and pulp and paper industry (10% each of fatal accidents) with rates ranging from 100–160 cases per 1 million working hours. There are some 5,000 occupational disease cases per year (rate 22/10,000 employed). The major disease categories include repetitive strain injuries (1,300 cases), respiratory aller-
Erkki Yrjänheikki, PhD, is a qualified occupational hygienist and the Director of the Research and Development Section of the Department of Occupational Safety and Health. He also teaches occupational hygiene at the University of Oulu.
Winter 2000/Volume 31/Number 4
Heikki Savolainen, MD, is a former professor of occupational medicine at the University of Lausanne and currently Chief Medical Officer at the same Section responsible for occupational health.
177
gies (600 cases), occupational skin diseases (1,000 cases), and 900 cases of noisecaused hearing loss. In 1998, 589 cases of asbestos-related diseases were reported. © 2000 National Safety Council and Elsevier Science Ltd. Keywords: Safety, health, occupations, labor, inspection, accidents, diseases, statistics
INTRODUCTION Finland, a member of the European Union (EU), is situated between 60 and 70 degrees N latitude, and thereby one of the northernmost countries in Europe. It covers 130,558 square miles, with 5.1 million inhabitants, which makes it one of the most sparsely populated countries in the continent. Finland is an industrialized country, known for its pulp and paper, metal, and electronics industries. The industries sector employs 470,000 people (21% of all employed), compared to the private services sector, which is the largest with 810,000 employed (over 36% of the total workforce). The public sector is also large (650,000 or 29%), followed by construction (140,000 or 6.3%), and agriculture and forestry (145,000 or 6.6%). The per capita income exceeds $24,000 (USD). Finland is a republic and a parliamentary democracy. The highest legislator is the National Assembly, while the State Council (government) and ministries can issue decrees, ordinances, and resolutions. The National Assembly administers the fundamental laws of occupational safety and health, that is, the Occupational Safety and Health Act (1958) and the Occupational Health Care Act (1978). The latter is currently under review. These are completed by the decrees, ordinances, and other instructions of the executive so that, for example, action programs toward the maintenance of working ability (1994) have been decreed (Ministry of Social Affairs and Health, 1999). The first legislation on occupational safety was given in Finland in 1889, and it was enforced by two labor inspectors. One of them was placed in Helsinki, Capital City, and the other in Tampere, an industrial center some 110 miles north of the capital (Hoskola, 1999). Finland was then still a Grand Duchy under the tutelage of the Russian Empire. It is also of interest to note that similar laws were passed in the United Kingdom, Switzerland, and other European countries in 1870 and later. Industry began to establish dispensaries for medical care after that and increasingly in the 1930s. The Finnish Institute of Occupational Health was established after World War II, and was governed by a private foundation that received annual grants from the government until 178
1978, when it became a governmental organization by a public law. In the same year, the Occupational Health Care Act was issued.
CURRENT ORGANIZATION The Finnish legal framework is based on two fundamental laws—the Occupational Safety and Health Act (1958) and the Occupational Health Care Act (1978). The former regulates the general safety in work as related to accidents, working hours, conditions of employment, exposure to chemicals or energy, and other physical or material aspects. The Act also serves as the legal basis for public control of all workplaces in Finland. It is enforced by the Labour Inspection Service, which is divided in 11 districts with 16–60 inspectors each. Their mandate covers 220,000 workplaces and some two million employees. While autonomous in their actions, the districts are under the coordination of the Department of Occupational Safety and Health, which is one of the departments of the Ministry of Social Affairs and Health. The ministry department is the executive, planning, and coordinating organ for the Council of State in matters under the field of application of the Occupational Safety and Health Act. The Occupational Health Care Act provides basic occupational health services for all employees, as concerns prevention of occupational disease and maintaining the working ability. It is the responsibility of the employer to organize the necessary care through its own medical department, mutual private sector centers, private practitioners, or municipal health care centers. Municipalities are under the legal obligation to furnish the basic preventive services to anyone who wants them. There are over 1,000 identified services providers in Finland, but the municipal centers are usually the only ones available in small rural communities. The application and control of the Act is under the purview of the Department of the Preventive Social and Health Policies of the Ministry of Social Affairs and Health. The department supervises all health care measures through regional government and in municipalities. It is also responsible for the conJournal of Safety Research
tents and substance of preventive care. Occupational health care providers may also offer disease management and treatment services on a voluntary basis. The costs from the latter and from the preventive care are partially reimbursed by the Social Insurance Institution of the state. The coordination of actions of the two departments takes place through the Council of Occupational Health Care and through ad hoc working parties as required and created by the government. The Council members include partners and contractants in the labor market, other government ministries, the Social Insurance Institution, and the Finnish Institute of Occupational Health. The latter is a research institute created originally by a joint action of industry and labor unions after World War II, and subsidized by the state. A specific law changed it to a governmental organization in 1978. It is the principal research arm in matters of occupational health and safety. Another relevant council in occupational safety and health includes one for nuclear safety, among others. All employees are insured for occupational accidents and diseases by an underwriter chosen by the employer. The insurance companies have established among themselves a federation that provides joint statistics and proposes technical guidance and documentation. As for the mandatory guides and inspection, they fall under the aegis of the State Technology Authority of the Ministry of Trade and Industry. Additional technical and research organizations include the Center for Occupational Safety and the Finnish Work Environment Fund, respectively.
WORKING ENVIRONMENT Finland has traditionally comprehensive birth registries, which were first established by church parishes and later expanded to all walks of life. Currently, Statistics Finland provides all official Finnish figures. The data are of obvious interest to the government, while they have also more recently been required by the European Agency for Safety and Health at Work for the EU. A national working party reviewed the situation up through 1997. That database has mainly served for the figures in this article. Physical Exposures Exposure to noise at or above 80 dB(A) is very common. Five percent of all employees are continuously exposed during the 8-hour shift, and Winter 2000/Volume 31/Number 4
20% are exposed to it for more than one-quarter of the shift. It is clear that noise abatement in manufacturing industries, in mining, and in various public services remains a priority. Hearing loss due to noise exposure is a prevalent occupational disease in Finland. Over 100,000 working Finns are exposed to hand/arm and/or whole body vibration. It represents over 10% of the blue collar employees. Professions and trades include transport, construction, manufacturing of machinery and other metal products, and agriculture and forestry. Statistics of occupational disease cases indicate some 20 vibration-induced states annually, which might only be the tip of the iceberg in view of the large exposed population. Sweat-inducing heat exposure is experienced by 17% of employees for at least a quarter of the workshift. The professions and trades exposed include food production, textile industry, pulp and paper industry, glass works, and building trades. Comparable numbers (21% of employees) are exposed to cold in such diverse occupations as refrigerated food production and storage, forestry and sawmill work in winter, construction in winter, and many transport professions in the winter. Postures and Movements Lifting and handling heavy objects is very common in many occupations in Finland. In two separate surveys, 30% and 37% of respondents affirmed that their daily workshifts included repeated lifting and handling using muscle force alone. These occupations are mostly comprised of health care workers, restaurant and hotel workers, builders, and warehouse and packaging workers. The conditions are worse in small firms that cannot invest in extensive work-saving machinery than in larger companies. Correct use and appropriate training are also important issues when machinery is available. Repetitive hand/arm movements have become even more common because of the constant expansion of various service professions (e.g., supermarket cashiers, office work, and semiautomated light industry, like assembly of electronic goods). The repetitive movements are experienced by 30% to 70% of employees, depending on surveys. Occupational injury cases come mainly from the food industry (meat cutters), assembly of electronics appliances, using pressurized air-operated tools, and many health care professions. This exposure category is a large cause of occupational disease in Finland (1,314 cases in 1998, up 2% from 1997). 179
Pain or fatigue-causing postures are indicated by over 30% of Finnish employees. The number of this type of complaint has increased since the late 1970s, probably due to improper application of ergonomic principles and organization of work. Typical situations include welding of metal frames in construction and ship building, painting and fishing, and agriculture, while also frequent tasks in health and child care are problematic. Bad postures cause workers 60–64 years of age to leave or change occupations. It induces, therefore, an age bias on surveys. Exposure to Carcinogens After the ban on technical and industrial use of asbestos, the number exposed has diminished from its peak, and now it remains at little more than 5,000 people, mostly in the building industry. Crystalline silica exposure is widely spread in construction, where it concerns some 70,000 people. Diesel engine exhaust gases cause exposure to some 3,000 employees in the same branch, and to 24,000 in all forms of land transport. Other important occupational carcinogens include radon gas (49,000 exposed in buildings with the specific indoor air contamination), Chromium (VI) compounds (7,000), and hardwood dust particles (65,000). The carcinogen with the highest number of occupational exposures is the UV irradiation in outdoor jobs, with 180,000 exposed employees according to the Finnish CAREX database (Vincent, Kauppinen, Toikkanen, Pedersen, Young, & Kogevinas, 1999). Exposure to Neurotoxic Chemicals All exposure to chemicals in Finland is assessed at one million employees, whereas the numbers concerning the five most frequent neurotoxicants (aromatic and chlorohydrocarbon solvents, lead, arsenic, carbon monoxide, and aliphatic hydrocarbon solvents) are estimated at 35,000. Perhaps more important than the raw figures is the mode of exposure in chemical mixtures (paints, glues, polymers) and by noninhalation portals of entry (skin, gastrointestinal). Severe intoxications are infrequent, while programs of biological monitoring for exposure (e.g., to lead) show that vigilance is still necessary. It seems that the biological monitoring programs should be maintained at least in their current volume, and clinical monitoring techniques should be refined even further. 180
Psychosocial Factors One-third of the employees feel that they are very busy in their work and 40% to 55% of all employees estimate that their time schedules are too tight in branches such as general offices, hotels and restaurants, land transport, health care, and food industries. Repeated surveys have shown an increasing trend from the 1970s onwards. Young employees (⬍25-year-old) feel consistently that they are not as much concerned as their older peers. Violence and threat of violence episodes are experienced twice a month by more than 21% of guardians and safety officers, by 7% of health care professionals, by 6% of social workers, and 2.4% of waiters. Less frequent episodes are experienced by 25% to 39% of the same respondents. Harassing by colleagues and chiefs is experienced currently by 6% of employees in hotels and restaurants, by 7% in retail jobs, and by 6.7% of teachers. A history of harassment in the same categories varies from 6% to 12.5% as told by the same respondents. Women are more often victims (19%) than men (13%). Monotonous work is still very common. Onethird of textile and garment workers report this complaint, which is even more prevalent in food processing (41%) and in wood-working jobs (48%). It seems, though, that monotonous work is diminishing through a better process organization and automation and by application of teamwork methods. Accidents There were over 53,000 accidents that caused an absence from work for more than 3 days in Finland in 1996. The leading causes included solid objects or articles, working environment and structures, tools, machinery, and conveying or lifting gear. One-quarter of fatal accidents occur in the construction industry (120 cases per 1 million working hours), and the wood working industry, metal manufacturing industry, machinery and related equipment production, and paper and pulp industry account for 10% each, of all fatal accidents. Workers aged 45 to 54 years have a 20% higher risk of a fatal accident than average, while males are victims in 96% of all cases. Falling or collapsing objects were implicated in 30%, entanglement or entrapment in 20%, falling or leaping from a platform in 15%, striking against objects in 15%, and falling, slipping, or stumbling in 10% of all fatal accidents. The accident rates have remained stable during recent years. Journal of Safety Research
Occupational Diseases The greatest risk of an occupational disease is in agriculture and forestry, followed by food, drink, and tobacco production, wood-working jobs, metal and metal-working industries, and the construction industry. Diseases caused by farm work and forestry include respiratory allergies, repetitive strain injuries, and skin diseases. Flour asthma is an important risk in the food industry, and skin ailments are the most frequent diseases. Over half of all repetitive strain injuries are caused by work in the food production industry. Ninety-eight cases of occupational cancer have been reported in Finland in 1998. Asbestos exposure is the leading identified cause. It is obvious that exposure to complex mixtures, like polycyclic aromatic hydrocarbons in tar or in foundry smoke are an important risk of lung cancer, while their etiological roles in individual cases are much harder to prove. As for the chemical causes of noncancerous diseases, nickel, cobalt, and chromium are important causes of skin hypersensitivity as are the organic diisocyanate hardeners in respiratory diseases. Natural latex is the emerging etiology of respiratory ailments in health care workers. In general, the incidence of major occupational diseases (Table 1) is similar to that reported for other comparable European countries (Boillat, Guillemin, & Savolainen, 1997). Analogously, there is the tendency that more and more cases are found in small workplaces where reactive chemicals are handled without respiratory or other protective devices.
DISCUSSION Finland has had laws on labor protection for 110 years. Obviously, the focus of preventive policies and measures taken have changed over time. The Table 1. Notification of Occupational Disease Cases in Finland Repetitive strain injuries Skin disease Hearing loss Respiratory allergies Diseases caused by asbestos Others Total
1314 972 930 613 589 398 4816
*Data for 1998 from Finnish Institute of Occupational Health.
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idea of a field organization in the form of the Labour Inspection districts has well resisted the times, and has been well appreciated by all concerned. Its authority and expertise is mostly considered up to date and neutral by its customer. In previous years, the individual inspectors emphasized their controller’s role, whereas now they have included technical counseling in the workplace. From early on, only technically qualified people have been recruited as inspectors, although with emerging concern of chronic health risks and psychosocial factors the need has shifted to health and human science professionals. This has been reflected in recent recruiting policies as, for example, occupational health nurses, and sociologists have been engaged as inspectors. No medically qualified persons have yet served as an inspector, as is the case in Ireland or in the United Kingdom. The lack of medically qualified inspectors in districts hinders somewhat the collaboration between the Labour Inspection and occupational health care providers. Much of this is caused by the circumstance that all personal data of employees is of medical privilege, which cannot be divulged. Another aspect is that Labour Inspection cannot report on the adequacy of occupational health care services and their plans at workplaces. It can only ascertain that such services, as required by the law, exist. Finland is one of the EU countries that emphasizes working ability and tries to prevent early retirement and exclusion of employees over 45–50 years. Special government programs have been conceived to these ends to counteract the effect of retirement of the large generations born after World War II, now in their 50s, in 2010 and onwards. This is somewhat against the modern business management techniques that strive toward the mean age of 38.5 years for personnel. However, it is believed that the factual retirement age for Finnish men of 58 years should be pushed over 60 to obtain a financial viability of the pension systems. The life expectancy of both sexes increases constantly, so that a youth born in the 1980s can expect to live over 18 years after retirement at the age 65. The option of a flexible retirement age, perhaps indexed to the remaining life expectancy, should be considered. Finland was also severely hit by an economic recession in the early 1990s, which left large segments of the population unemployed, and reduced the tax revenues. It caused cut-backs of state and municipal services, especially in social and health care branches and in education, with 181
increased redundancy of trained people. This circumstance is one of the factors in perceived stress and increased overtime work by the employees who have been retained for the absolute core services. As these employees retire, it creates recruiting problems because the trained unemployed reserves have not necessarily been able to maintain their skills. Some of the expertise and talent have also been lost to other EU countries and beyond because of the free labor market and globalization. A generation gap may also exist in the form of basic and technical education received by younger generations, much more conversant with information technology and in foreign language skills. They are easier to retrain in new operation procedures and probably require less direct management on the job. Although temporary, such circumstances demand good managerial skills and flexible personnel policies in the firms. Much of this is reflected in the labor inspectors, who have to deal with all complaints according to their brief. The Department of the Occupational Safety and Health in its national coordinator’s role stipulates jointly with the districts national action projects for 3–4-year periods. The current special actions include reduction of accident rates, prevention of locomotor diseases, and counteracting violence. Some 30% of inspector’s resources are required to be used toward these national goals. It is obvious that campaigns cannot reach all workplaces by personal contact or visits, so information and education become very important. Working ability and aging worker programs have benefited from television programs and advertisements, and from local meetings and briefings by trade associations and unions. Much of the contents have been jointly approved by the Council of Occupational Health Care and other learned or professional parties. Evidence-based development requires strong research input. Finland has a large research institute in the form of the Finnish Institute of Occupational Health. Its main office is situated in Helsinki, with six regional institutes in major economic regions with the goal to serve local research and development needs. Some regional outlets also have national responsibilities, like marine occupational health, agriculture and forestry, or woodworking industries. The state maintains the institute largely from its annual budget, while the institute also generates considerable revenue from its own service laboratories. Several other independent institutes and university departments com182
pete for grants by the Finnish Work Environment Fund, which has a council to evaluate the scientific merits and desirability of the proposed projects. Therefore, the possibility of a national coordination of research in occupational safety and health exists. The EU is a new factor in stimulating and funding research and development. Many of the European initiatives have been eagerly taken up by small and medium-size Finnish enterprises in the hope to gain a competitive edge. Their impact is yet to be evaluated, although it is already evident that their administration has remained uncomplicated, and that most results are thoroughly practical, with the idea that these new operating procedures and organization of work will remain even after the end of external European funding. It is clear that the European dimension will increasingly have a positive impact on the Finnish occupational health and safety. Finnish occupational safety and health has a need to further modernize its functioning. It has to offer its services in all corners of the geographically large country, which may mean that new devices based on information technology have to be adopted and exploited more fully. Their use should be increasingly encouraged by small firms as to the autoevaluation of risks, of product safety, or of environmental impact. It may be that occupational safety and health services have to learn to collaborate more closely with the environmental health authority, and there is no reason that such a collaboration would not be beneficial to both. In conclusion, the Finnish occupational safety and health scene is undergoing a rapid change as it has to adapt in the situation of a diminishing and aging workforce, of European collaboration, of globalizing markets, and of accelerating introduction of new technologies.
ACKNOWLEDGMENT The Finnish occupational safety and health server can be found at the internet address: www.fi.osha.eu.int.
REFERENCES Boillat, M.-A., Guillemin, M.P., & Savolainen, H. (1997). The present state and practice of occupational health in
Journal of Safety Research
Switzerland. International Archives of Occupational Environmental Health, 70, 361–364. Hoskola, H. (1999). Safety at Work. Labour Inspection in Häme 110 years (1889–1999). (pp. 1–116) (in Finnish). Turenki: Author. Ministry of Social Affairs and Health (1999). Occupational
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Health Care. Guides and Instructions 6 (pp. 1–12). Tampere: Author. Vincent, R., Kauppinen, T., Toikkanen, J., Pedersen, D., Young, R., & Kogevinas, M. (1999). CAREX: International information system on occupational exposure to carcinogenic agents in Europe. Cahiers de Notes Documentaires, 176, 49–50.
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