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

Chapter 4
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The employer, in both the public and private sector, is
responsible for health and safety at the workplace and is
required to organize and pay for preventive occupational
health services for all workers regardless of the size, industrial
sector or form of the enterprise. The provision of
curative services is voluntary but is included in 80% of the
service agreements. Some 92% of wage and salary earners
are now covered for such care and about one third of outpatient
medical care for people in employment is provided
by the occupational health services. Joining the occupational
health service system is voluntary for the self-employed,
such as farmers.
Occupational health services may be organized through
municipal health centres or private medical centres or by
the enterprise itself, alone or in collaboration with other
enterprises. The aim is to assess dangers and hazards in
the workplace, prevent problems through early intervention,
promote health and the ability to work and develop
the workplace community and environment. As increasing
numbers of doctors prefer hospital or occupational health
work rather than PHC, there is some danger of a two-track
system, with the employed being well and conveniently
served, even in terms of their transfer to hospital care, and
the PHC centres dealing mainly with children and older
people.
The emphasis in occupational health care is on avoiding
occupational health risks, diseases and accidents and dealing
with problems related to physical and mental health. Nevertheless,
lifestyle issues of importance to NCD are also
addressed. About one third of the workforce eat lunch in a
workplace cafeteria, which has been important in improving
dietary habits. By law, workplaces must have a specific
programme for promoting safety and health.
As seen in the section on tobacco, when smoking was
restricted in the workplace in 1994 it was well accepted by
most workers, including smokers. Anti-smoking regulations
in the workplace appear to have been feasible, well-accepted
and implemented.
Target 4 of Health 2015 states that “Working and functional
capacity among people of working age and workplace conditions
will improve, helping people to cope longer in working
life; retirement will be about three years later than in
2000” (14). Employers are already facing some tightening of
the labour force and have an interest in keeping older workers
for longer. Incentives such as a 4% increase in pension
for every extra year worked, and actions to make working
life more pleasant, increased the average retirement age by
one year between 2000 and 2006.
2.6.2. Schools
The school has long been recognized in Finland as an
important setting for health promotion. Hot school lunches
have been provided in Finnish schools since the 1940s.
Tobacco legislation prohibited smoking in schools in 1977
and tobacco control and other health education issues were
included in the curriculum. Also, a special survey of the
health habits of young people aged 12–18 was initiated in
1977 and has been carried out every two years since then.
Collaboration with England and Norway, initiated in 1982,
led to the WHO project on Health Behaviour in Schoolaged
Children, which now includes 41 countries following
a common research protocol. A school-based monitoring
system of perceived health, health behaviour, opinions on
school health services and related factors was started in
1996. The participation of a municipality is voluntary and
presumes its partial financial support.
Partly based on the experience of the North Karelia Project,
a Healthy Schools programme was started in 1989 and
Finland joined the European Network of Health Promoting
Schools (ENHPS) in 1994. There is an active national
ENHPS network, but the movement for health promotion
in schools is much wider than participation the WHO
project.
Case studies: policy development in countries for tackling noncommunicable diseases