The long-time Director General of the Finnish Institute of Occupational Health (FIOH), Professor Jorma Rantanen, retired at the beginning of November 2003 after serving in this position for nearly 30 years. During his tenure, the FIOH grew into a versatile expert research institute with national coverage. To honor his career and life work, the Institute started the tradition of an annual 'Jorma Rantanen Lecture'. The Institute management selects an internationally renowned expert in occupational health and safety and invites him or her to give the Lecture on Research Day. The first 'Jorma Rantanen Lecture' was given in December 2003 by Professor Philip Landrigan, from the USA, President of the Collegium Ramazzini.
Work and Government policy
Globalization of the market and the rapid development of information and communication technology have raised the level of well-being in Finland, as elsewhere. This development has been criticized, however, for insufficient consideration of its social, cultural, work and environmental effects. In 2003, economic growth slowed, and the decreased profitability of the most rapidly growing branches led to the reorganization of activities and reductions in personnel. Services and trade have continued to grow, but the profitability of many previously rapidly growing areas has diminished.
Increased competence and coping at work are successes of the policy of Prime Minister Vanhanen. The goal of the Government is to ensure that all citizens participate fully in work life. The Government also focuses on combining work and family life, on mental and physical well-being at work, promotion of work ability and the special needs of the aging workforce. The aim is to ensure for Finland both international competitiveness and the Finnish welfare state.
Staying on at work
Large age cohorts are approaching retirement age. Already, more than a quarter (27%) of the Finnish workforce have reached the age of 50, and concern is growing about the availability of a sufficient workforce and the financing of pension costs. In the coming years, Finns must be motivated to continue to work for 2–3 years longer than at present. To support this goal, the Finnish Ministry of Social Affairs and Health has launched the nationwide VETO action program for the years 2003–2007, which includes the themes of continuing to work longer, and rehabilitation. The aim is to stretch both ends of the work career.
The work pension system will be renewed in 2005, giving workers an incentive to work longer, by offering them higher pensions if they stay on. Discussions are also under way about reducing the relatively long years of study at universities and other educational institutions in Finland. This would allow young people to start their work careers earlier.
Health and safety in the workplace must be improved further, as a prerequisite for keeping Finnish people at work. As employees have differing age structures and backgrounds, their individual skills and limitations must be considered and the work and working conditions developed accordingly. A poor work climate increases the employees’ symptoms and absences for sickness.
The action program ‘Youth and work’, which has been on-going for 2 years, is designed to improve young peoples’ ability to work and their readiness to start work. The program includes investigations of the factors that affect the work life and functional capacity of young people. On the basis of the results, we will create models to help young people to acquire safe, healthy work habits and sustain their ability to work.
We have developed group intervention methods to control the transitions in work life. A successful ‘Back to work’ method, which helps unemployed persons to find new employment, has been implemented for several years. The method ‘From school to work’ supports young people in their transition from school to work life. A method called ‘Towards working life’, which helps young persons to plan their careers, is now in the testing stage. A method targeted at people on the threshold of retirement is in the planning stage. Its purpose is to boost work ability and well-being in the last stage of a career and support retired workers in running their lives.
The action program ‘Changes, flexible solutions and well-being at work’ was launced at the beginning of 2003. In this program, we analyse the changes that occur during a working life and in the structure of the workforce, and their effects on well-being. The results will be brought to the attention of societal decision-makers, the developers of work safety and occupational health services, as well as organizations.
We are launching the ‘KESTO’ action program to promote work ability and functional capacity and to support the promotion and maintenance of work ability, lengthening of careers and continuing at work. Within the program, we will focus on coping at work and on the causes of reduced work ability. New methods will be developed to support people who decide to continue longer at work.
Another action program, ‘Combining work, family and other spheres of life’, is in the planning stage. Its purpose is to support equality in the work culture and to reconcile work and family life, in order to create a basis for well-being and for coping with work in all stages of a career.
We alone cannot improve coping at work and stimulate people to continue to work. In order to achieve this goal, there will have to be cooperation among research institutes and other actors. But even that may not be enough. People make decisions according to their own situation: people want to look after their children or grandchildren or to care for elderly parents or to study. Many kinds of self-realization affect their decisions and weigh more heavily than the amount of some future pension or opportunities offered at work.
Haste, psychological loading and mental health
Every third year, we carry out an interview survey ‘Work and health in Finland’, which provides extensive information about the working conditions and well-being of Finns. According to the survey, haste and mental strain at work have decreased somewhat over the past 3 years. Nevertheless, 43% of the employed workforce experience haste at work. Those in social and health care services experience the most mental stress.
The increased demands of work, the quickened work pace, insecurity, competitiveness and fixed-term work contracts cause mental strain and excessive loading. Disturbances in mental health, especially depression, are common in the population of working age. Depression often impairs concentration, learning capacity, memory and decision-making and slows psychomotor performance. For these reasons, even mild symptoms of depression can decrease working ability and functional capacity. Mental disturbance is the most prevalent cause of premature retirement in Finland, constituting 40% of all causes of retirement. The number of days of sick leave due to mental problems has also increased. In 2002, the Social Insurance Institution paid over EUR 127 million in compensation for the costs of mental and behavioral disturbances.
The association between mental health and work is nevertheless still unclear. What are the effects of the requirements of professional competence and the demands of work on mental health? Can psychological overloading be recognized early enough, and how can it best be prevented? What is the best way of supporting people who are returning to work after recovering from a mental disorder? We can help people to cope with work and to continue in their jobs by investigating the association between mental disturbance and work life, by improving working conditions and by systematically training occupational health professionals. One of our aims is to tackle this challenge.
Brain@work
‘Human aspects of work in the information society’ is an action program behind the national spearhead program ‘Information-intensive work’. In the action program, we study how information-intensive work affects health and seek methods to lessen loading in this type of work. In the Brain@work Laboratory, we are developing new research methods in brain and sensory system physiology, psychophysiology, perception psychology and neuropsychology. We simulate and model information-intensive work tasks, conduct research on sleep and alertness and design methods to measure stress objectively.
We disseminate information on the health effects of information-intensive work and on how to prevent excessive loading to Finnish workplaces. In spring, we opened a databank on our website, which contains practical knowledge about information-intensive work, e.g. on planning work schedules, ergonomics, electromagnetic fields and ways of promoting the well-being of the brain in information-intensive work. We draw up guidelines for workplace design, taking into account the effects of information-intensive work on the musculoskeletal organs, the upper limbs and sensory organs.
Work-related asthma
Of the 4,807 cases of occupational disease or suspected occupational disease reported to our Register of Occupational Diseases in 2002, the most prevalent were strain injuries due to repetitive work tasks (28% of all cases), but 518 (11% of all cases) were allergic respiratory diseases. As irritant-induced asthma is now an accepted occupational disease, asthma research, which was previously considered to be the domain of clinical medicine, is more often studied by epidemiological methods. The risk for respiratory allergy is greatest in the food-processing industry, where workers can be exposed to flour dust and bread-altering enzymes, and in cattle farming, where exposure to moldy hay, cow dander, storage mites and fodder dust is common, although molds are not sensitizers in the traditional sense. The 304 cases of respiratory diseases that were diagnosed as occupational asthma was 10% more than in 2001.
We have studied the prevalence of work-related symptoms among persons with asthma, and the associated risk factors, and found that the work environment is strongly implicated: the dusts encountered at work are the most important risk factor for asthma. Extremes of temperature, poor indoor air quality, chemical agents and physical loading factors also aggravate the symptoms. Improving the work environment can therefore help prevent asthma symptoms at work. Psychological loading at work did not appear to increase work-related asthma symptoms.
Biological hazards
Considerable attention has been paid recently to the biological hazards in living and working environments. In spring, the SARS epidemic spread to many parts of the world, and the threat of bioterrorism has aroused worldwide concern. Many Finns are exposed to mold spores in moisture-damaged, mold-infected buildings. Serious infections have been acquired in Finnish hospitals, and in neighboring regions cases of drug-resistant tuberculosis are on the rise. Health care personnel and workers in waste disposal, security, food processing and agriculture are exposed in particular to biological hazards. The health effects due to molds can be a problem in any occupational group, and exposure to rare microbes is possible; special expertise is therefore needed to detect the source and agent and in diagnosing and controlling the disease.
The methods needed to recognize biological hazards, especially genetic and immunological methods, are undergoing rapid development. We are in a good position to develop expertise in the assessment and control of ‘biorisks’, as hygienic know-how and risk assessment are our strengths. We are increasing cooperation with other research units in the field to broaden our competence further.
Occupational health services
The Occupational Health Services Act was amended in 2002. Its aims are to support work ability and to recognize the hazards that reduce it. Early prevention is the key to the maintenance of work ability. The Act obligates employers to provide occupational health services to their employees, although the organization of such services to agricultural and other entrepreneurs is voluntary. According to the ‘Work and health in Finland’ survey, nearly all employees in the public sector and in enterprises with over 10 employees have access to occupational health services; however, nearly one-half of agricultural entrepreneurs and as many as two-thirds of other entrepreneurs are not covered. Provision of these services to small enterprises and entrepreneurs is still a challenge.
In the past few years, there has been increasing talk about good practice in occupational services. Methods that have been found to be effective are applied. The FIOH is collaborating with the University of Amsterdam in designing a so-called Cochrane method for systematic surveys of occupational health services.
The prevailing manner of the organization of occupational health services is changing. Some large organizations that previously had their own health service units have outsourced their occupational health services to private medical centers or municipal health care centers. These new service provision models presuppose the development of new approaches.
Occupational safety and labor protection
The amended Occupational Safety Act, which came into force at the beginning of 2003, emphasizes the psychosocial aspects of occupational safety. It now obligates employers to monitor the work loading of their employees more closely than before, and workplaces, service systems and authorities need new activity models to comply with the requirements. In the action program ‘Support for occupational safety and health activities’, which was launched a year ago, we are designing and evaluating means for improving safety in workplaces. We are also intensifying our cooperation with the labor safety authorities.
The chemical strategy of the European Union is being renewed and will require evaluation over the next few years of the health effects of nearly all chemicals used in industry. The responsibility for the evaluations rests with the industries themselves. This will lead to an increased demand for risk assessment and risk management expertise, which will impose new demands on experts in toxicology and risk assessment. The future location of the Chemical Agency of the European Union in Helsinki will place further pressure on the experts in the FIOH.
Training of professionals
As the present educational system cannot produce enough personnel to replace those who are retiring, it will be necessary to accelerate the training of occupational health and safety professionals. The Training Centre, which started its activity in 2002, plans, follows up and evaluates the training of occupational health and safety professionals and experts. It also develops competence training in collaboration with universities and other bodies responsible for training in the field. The specialties of the Training Centre are the work environment, occupational health, and management of change.
Net services and publications
In June 2003, we introduced our updated website, which provides information about occupational health and safety matters in Finnish, Swedish and English. Each day, about 3,000 visits are made to the website. The most popular topics are ergonomics and chemical safety, occupational health services, psychological well-being and the Information Service Centre.
We produce and sell textbooks, manuals, guidelines, training material, journals, posters, computer programs and databases on the interaction between work and health. The publications are targeted at both specialists and the general public. Recent popular themes have been occupational safety and the maintenance and promotion of work ability and well-being at work.
Competence and well-being of FIOH personnel
The new challenges in work life demand new competence from the FIOH staff. For instance, internal cooperation will be an imperative; vacancies must be filled by persons with novel areas of competence; when necessary, we must seek partners from other institutes in Finland or from the international research community. The generation changeover of FIOH personnel offers possibilities for renewal, but at the same time we must retain our traditional competence in strategically important areas. In the midst of these changes, we must take care of our own health and well-being at work and of our ability to innovate.
Success at work is grounded in good leadership. Our training program for supervisors was launched at the end of the year, and, during the first phase, about 80 supervisors will be trained. The training topics include leadership, management, cooperation, teamwork, quality of service and management of resources.
Collaboration with other research institutes
The challenges related to ensuring health and well-being are versatile and complex and demand collaboration with other institutions. In spring, we joined with other research institutes under the jurisdiction of the Ministry of Social Affairs and Health (National Public Health Institute, National Research and Development Centre for Welfare and Health, Radiation and Nuclear Safety Authority of Finland) to write a report about our joint collaboration. We concluded that the promotion of the health and well-being of the population is a mutual endeavor of all the institutes, each having its own role. We also agreed to a general policy of developing the collaboration. A joint collaboration forum composed of the management of the institutes was set up to ensure continuous cooperation, starting in 2004.