Occupational health and safety in Finland.

The tradition of Finnish legislation on occupational health and safety began 180 years ago. The renewal cycle of the principal acts has been about 20 to 30 years. At present the Finnish occupational health and safety legislation meets the Scandinavian standard well, though the structure of the Finnish legislation meets the Scandinavian standard well, though the structure of the Finnish legislation is more fragmented. The organization and manpower resources of occupational health and safety comprise more than 100,000 persons (5% of the labor force), and the number of full-time experts is about 3,600. The finances amount to 0.3% of the gross national product. Although intensive reforms for strengthening legislation, research, and practice were carried out during the 1970s, one-third of the labor force still works under daily health and safety risks. Several occupational and nonoccupational risk consequences cummulate into one and the same high risk population. Accident risk still remains the most prevalent and severe type of risk in the Finnish work environment. Three major national programs (National Occupational Health and Safety Program, National Occupational Health Service Program and National Program for Science Policy) were established so that the needs of occupational health and safety can be met. The programs are designed to respond not only to current problems, but also to those which can be expected in the future (caused, eg, by the large-scale implementation of new technology).


Legislation
The first statutory regulation including occupational health statutes was issued in 1805 (13). The first occupational safety regulation came in 1889. Since that time Finnish occupational health and safety legislation has been renewed at intervals of 20 to 30 years. However, during the 1970s, more new legislation was produced for occupational health and safety than during any other previous decade; it included new acts on labor inspection, occupational health and safety administration, occupational health services, the nationalization of the Institute of Occupational Health, job security, study leaves, and the Work Environment Fund.
At present our labor legislation is in many respects comparable with that of the other Scandinavian countries though the Finnish legislation is more fragmented (15). In certain areassuch as the provision of occupational health services (28), the marking and labeling of hazardous chemicals 1 (9), and the registration of carcinogenic exposures -Finland has gone further than its Nordic neighbors (3,14). Right now two comprehensive legislative reforms are being prepared. The first is new legislation on job security. Its intention is to combine the former rather fragmented regulations into one and the same act so that the individual's employment security can be improved and strengthened. The bill on job security is currently being discussed in Parliament. Another extensive reform is the renovation of the comprehensive occupational safety act of 1958. The main issues of this reform will be the promotion of safety activities at the plant level by increasing the statutory power of safety commissions and by granting safety delegates more power to regulate work conditions at the plant level. Although it will be some time before this latter reform is accepted, the practice of occupational health and safety continues, because the present act gives already comparatively strong power to the authorities, especially to labor inspection.
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Organization and manpower resources
The organization of the administration of occupational health and safety is described in fig 1. There are three parallel central organizations reporting directly to the Ministry of Social Affairs and Health. The safety activities are administered by the National Board of Labour Protection; the medical aspects of occupational health are controlled by the National Board of Health; and research, training, and advisory expert services are the responsibility of the Institute of Occupational Health. The regional level comprises 14 labor inspection districts, health administrations in 12 provinces, and six regional institutes of occupational health. The activities at the local level are carried out by munincipal health authorities, munincipal labor inspectors, and plant-level safety commissions, safety delegates and occupational health physicians and nurses, who all are present in the local organizations because of legislation. The total number of personnel in the Finnish occupational health and safety system comprises more than 100,000 persons (about 5 O / o of the labor force) who have received specific training for occupational health and safety functions (1 4-3 weeks). About 3,600 of the 100,000 are full-time occupational health and safety experts.

Occupational health and safety risks
During the 1970s the Institute of Occupational Health and the National Board of Labour Protection both surveyed the risks to health and safety in Finnish industry. Rough approximations of the occurrence of various risk factors are given in table 1. More-detailed calculations indicate that at least a third of the Finnish labor force still works in an environment which involves daily exposure to agents or factors containing health risk (7,10). The consequences of risk are partly registered as occupational diseases (24) and as labor accidents '(8). As seen in fig 2, the number of occupational diseases increased during the 1970s and are again increasing in the early 1980s. These increases reflect the impact of altered registration criteria, improved registration. better diagnostics, and the effect of research in finding new diseases and improved methodologies for the detection of occupational diseases. One of the most important factors has been the expansion of occupational health services. The incidence rate of occupational diseases is 23.7/10,000 of the active working population.
The trends for the total number of labor accidents have not been very positive during the last decade. The number of accidents has been strongly determined by the rate of overall economic activity in the country (20). In 1981 the average rate of workplace accidents causing at least a 3-d absence from work was 620110,000 active workers. As seen in fig 3, the number of fatal accidents at workplaces decreased by 42 O/ o and the corresponding number for accidents on the way to or from work by 49 O/ o between the years 1970 and 1980. The reduction of fatal accident rates was from 1.3/10,000 workers in 1970 to 0.7/10,000 (46 O/ o reduction) in 1980, and the trend toward a decrease is still continuing. However, the success in preventing traffic accidents was better than that of preventing workplace accidents.
Recent studies have found that several nonoccupational risk factors cumulate within that part of the labor force which is also running under the highest occupational accident and hygienic risks. Therefore, these groups should make highly interesting objects for preventive measures (16, 21), not only to regulate the occupational risks, but also for prevention of the overall risk of the population.

Programs
After the recognition of the aforementioned and other risk charts and a consideration of the intensive development of the Finnish economy, the following three national programs have been established in response to the problems already discussed: the National Occupational Health and Safety Program, the National Occupational Health Service Program, and the National Program for Science Policy.

National Occupational Safety and Health Program
On the basis of the surveys already referred to, the National Board of Labour Protection has selected twelve priority areas for a National Occupational Safety and Health Program. When the priorities were set, the following criteria were used (10): (i) the prevalences and the seriousness of the negative health consequences, (ii) the occurrence and intensity of risk factors, (iii) the number of exposed workers, (iv) the qualitative and quantitative perception of risks among employees and employers, (v) the cost-benefit ratio of the preventive measures, (vi) the trends of the  In fact the resources of the occupational safety and health administration are not sufficient for the intensified activity considered necessary in all priority areas. Besides, some of the priority areas need to be investigated before concrete measures can be taken. Therefore the occupational safety and health administration will primarily intensify its activity during the next years, particularly in areas 1, 4, 5 and 6 of the preceding list.
In connection with the decision concerning priority areas, the importance of the priority area "reducing work-induced psychic overstrain," especially in the future, has been pointed out, but the possibilities of the occupational safety and health administration to take practical action in that field are at present very limited.
Practical actions within the priority areas will be undertaken as projects. Three projects were started in 1981, and they may serve as examples of the operational measures of the National Occupational Safety and Health Program. They concern (i) epoxy and polyurethane resins, (ii) internal transport within workplaces, (iii) and preventing the inadvertent starts of machines.

National Occupational Health Service Program
Occupational health services have developed very positively during the 1970s  4). At the moment more than 75 O/o of the active labor force is provided with such services. The areas not covered are small industries and the self-employed, eg, farmers (26,27). The National Occupational Health Service Program, which was partly given in the form of a new Occupational Health Service Act, stipulates the provision of preventive occupational health services for all employees independent of the branch of industry, size of the company, or of whether one is an employee or self-employed (25). Theoretically, then, coverage is 100 O/o. The implementation of the act has taken place in five separate steps according to an order of priority. The last step began 1 August 1982, and the entire act will be in force by 31 March 1983. Numerous problems, concerning the content and methods of occupational health services for farmers and the self-employed, have been met in the stages of implementation. Therefore two major research programs have been started so that more information can be gathered on the most effective methods for providing services in agriculture and to small enterprises. In spite of the difficulties already mentioned the enforcement of the new act has proceeded well. At the end of the third stage of implementation, 89 O/o of the companies controlled by labor inspection were covered by occupational health services, and 96 O/o of the labor force working in the branches of industry of stage 3 were provided with services (11).
An essential part of the National Occupational Health Service Program is the effective training of occupational health personnel (25). Specific training curricula for occupational health physicians and occupational health nurses have been prepared, and a new medical speciality in occupational heslth services has been established (5). The old speciality in occupational medicine, which has existed in Finland for 20 years, was simultaneously transformed to a subspecialty for occupational health services. After full implementation of the program the Finnish occupational health services will employ 1,000 physicians and 2,500 nurses, which makes one physician per 1,800 workers and one nurse per 740 workers (ratios which have already been achieved for 75 O/o of the active labor force). This situation implies that 500 new occupational health physicians and about 1,000 nurses should be trained during the next few years, as some of the presently working occupational health personnel also needs training (27). Since the general primary care services will be given by the municipal health center without charge, the capacity of occupational health physicians can be effectively directed toward preventive work. There are three main research programs which could be mentioned. In the National Program for Science Policy for the 1970s occupational health and safety research was declared one of the five national priority areas for research. Accordingly the Academy of Finland prepared its national medium-term program for occupational health and safety research (1,22). This program was able to increase the funds of the Academy of Finland for occupational health and safety research threefold in three years during the midseventies. The main interest of the program was focused on traditional chemical and physical hazards, on psychosocial factors, and on accidents.
Another important program is the science policy program of the Finnish Fund for Labor Protection Research (23). High priority is given to ergonomic research and to research concerning safety in materials handling in industry. The Fund is intended to respond quickly and effectively to the immediate research needs of practical work life and to problems at the plant level.
The third research program is that of the Institute of Occupational Health, which was revised in 1981 (4). The main emphasis is given to applied research concerning the following priority areas: (i) hazardous exposures (including selected chemical and physical exposures and, especially, their long-term effects and combined effects); (ii) occupational origin of diseases (including new occupational diseases, allergy, genotoxic effects, occupational diseases of the musculoskeletal system, and work-related cardiovascular diseases); {(iii) physical strain (including the adverse effects of physical overload, monotony and static muscular work); (iv) psychosocial problems (including problems of machine-paced work, psychological monotony, inconvenient work shifts and problems derived from the implementation of new technology); (v) industrywide studies on high risk branches, their risk profiles and preventive measures; (vi) hypersensitive groups (pregnant women, the handicapped, young workers and elderly workers) and their special requirements i n the w o r k environment; and ~(vii) labor accidents.
The criteria used f o r the selection of problems f o r research projects are in accordance w i t h those already described as priority criteria f o r the National Occupational Health and Safety Program.
Within the priority areas, the focusing of the scope is done in o r d e r t o obtain the necessary depth in the scientific approach. The most important characteristics of research carried o u t under this program are the following: high applicability, high practical relevance f o r occupational health and safety, multidisciplinarity, and a problem-oriented and problem-solving nature. This emphasis should, however, n o t lead t o the exclusion of basic research w h e n it is found t o be necessary.