Gaining health : analysis of policy development in European ...

2.6. Settings
Finland has used the settings approach for many years in
schools, cities and hospitals, strengthened by involvement
in international networks. More recently, certain researchers
have developed standards for health-promoting sports
clubs, since these play a dominant part in leisure activities,
particularly for 10–18-year-olds (46). Economic and legislative
changes have given local communities more flexibility in
allocating their state-provided resources.
2.6.1. The workplace
Health in the workplace is a top priority in Finland, and an
occupational health care system has been in place since
the beginning of industrialization. This was systematically
developed after the Second World War, and particularly
since the 1960s (47) through collective agreements among
the labour market organizations. Legal recognition was
given by the 1978 Occupational Health Care Act, at a time
when consensus politics functioned well, based on collective
income policy agreements. A national development plan for
occupational health was introduced in 1989.
The Finnish Institute of Occupational Health supports these
efforts. The Institute was originally founded with financial
aid from the United States, partly to offset the fact that
Finland was not included in the Marshall Plan. It has become
one of the largest of its kind in Europe, operating
in conjunction with six regional branches. The Institute is
now funded largely by the Government, with about 30%
from external sources. In addition to research on occupational
health, the work environment and work organization,
frequently combined with action programmes, the Institute
offers advisory services and training. Two thirds of the
professional staff in occupational health care have received
specialized training. All five medical schools in the country
have a professorship in occupational health.
According to a guide for planning occupational health services
(47), the goals of the occupational health services are:
• preventing health hazards and protecting employees’
health;
• adapting working conditions to suit the worker;
• rehabilitation;
• health promotion; and
• PHC.
Previously, occupational health care was regarded as a
series of individual actions responding to problems or risk
factors related mainly to safety. Since the major occupational
safety factors are now said to be largely under control,
more attention has been given to health promotion,
supported by important research. For over 20 years, the
Institute has been concerned with the physical and mental
stress encountered by people in the workplace, and by
issues facing an ageing workforce. Musculoskeletal diseases
are still the greatest cause of new work disability pensions
in Finland and in 1994, every fifth employed person suffered
from a chronic disease.
For a number of years, the issue of labour availability has
been on the agenda as labour shortages in some sectors
were combined with long-term unemployment, particularly
among older people. There are therefore, converging interests
between the health and labour sectors.
A long-term study of older workers led to the development
of the concept in Finland of “maintaining work ability”
(48). When the collective incomes agreement was signed
in 1990, and legislation on rehabilitation was completely
overhauled, the major social partners also agreed on action
to maintain work ability. The overhaul of the relevant legislation
obliged employers to take action on the maintenance
of work ability, and was followed by new reimbursement
criteria. The aims can, however, be somewhat conflicting:
on the one hand to protect and promote individual health
at the workplace and, on the other, to reduce the numbers
seeking disability pensions and retiring early.
Chapter 4
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Case studies: policy development in countries for tackling noncommunicable diseases