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Work and health country profiles Country profiles and national surveillance indicators in occupational health and safety Jorma Rantanen Timo Kauppinen Jouni Toikkanen Kari Kurppa Suvi Lehtinen Timo Leino People and Work • Research Reports 44 Finnish Institute of Occupational Health Helsinki 2001

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Work and health country profiles

Country profiles andnational surveillance indicators

in occupational health and safety

Jorma RantanenTimo KauppinenJouni Toikkanen

Kari KurppaSuvi Lehtinen

Timo Leino

People and Work • Research Reports 44

Finnish Institute of Occupational HealthHelsinki 2001

2

Layout of the cover page: Tuula Solasaari-PekkiTechnical editing: Suvi Lehtinen

Printed in Edita Helsinki 2001

ISBN 951-802-443-XISSN 1237-6183

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Preface

Over five years ago the 49th World Health Assembly (WHA) at its plenary meeting on 25May 1996 in Geneva endorsed the WHO Global Strategy on Occupational Health for All.The strategy has been prepared and to a large extent is being implemented by the WHOglobal network of Collaborating Centres in Occupational Health. However, even now it israther difficult to monitor the expected outcome of its implementation due to lack in manycountries of well-structured information systems. The additional stimulus for the develop-ment of a holistic and well-structured information system on the occupational health andsafety management comes from the objectives of WHO, ILO, Member States and the Euro-pean Union health strategies aimed at ensuring the health equity and reducing health gapbetween different countries. The London 1999 Ministerial Declaration on Action in Part-nership recognizes the rights and needs of workers to be informed of occupational and envi-ronmental health hazards in the workplace, and of the public to be informed of hazardsposed to the community by the activities of enterprises. It asks for creation or strengtheningof information systems on health, environment and safety management and performance inenterprises, and for making them accessible to employers and employees as well as to na-tional and foreign investors. The provision of good working conditions, workers’ health andsafety protection and the environmental management in enterprises is an important issue infree trade negotiations within the World Trade Organization. To harmonize the scope of thework and health country profile considerable efforts should be undertaken at an interna-tional level.

The analysis of recent policy documents issued by the international institutions shows thatthe definition of occupational health has broadened considerably and there has been a tran-sition from the strict concept of “prevention of occupational injuries and diseases” to overallprotection and promotion of workers’ general health. The Twelfth Session of the JointILO/WHO Committee on Occupational Health, held in 1995, revised this definition to focuson three different objectives:1. The maintenance and promotion of workers' health and working capacity2. The improvement of work environment and work to become conducive to safety and

health; and3. The development of work organization and working cultures in a direction, which sup-

ports health and safety at work, and in doing so also promotes a positive social climateand smooth operation and may enhance productivity of the undertaking. The concept ofthe working culture is intended, in this context, to mean a reflection of the essentialvalue systems adopted by the undertaking concerned. Such a culture is reflected inpractice in the managerial systems, personnel policies, principles for participation,training policies and quality management of the undertaking.

In line with this definition the holistic concept of good practice in health, environment andsafety management in enterprises (GP HESME), launched in 1999 by the London Ministe-rial Declaration, put emphasis on stakeholders’ partnership. In this concept the responsibil-ity for health at work is not only on occupational health professionals. The employers, butalso employees, make at work a huge number of decisions which have an impact on qualityof living and working environment, work organization and work culture, but also on use ofnatural resources and quality of ambient environment. These decisions have an obvious im-pact on their own health as well as on health and well-being of their families, neighboursand customers. Therefore GP HESME is a process of comprehensive workplace health

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promotion involving all stakeholders inside and outside the enterprise. It takes into accountoccupational, environmental, lifestyle and social health determinants and encourages usinga workplace as setting for health.

GP HESME makes a link between traditional occupational health and implementation ofpublic health and environmental health policies. It aspires to turn enterprises into major set-ting for achieving the WHO objective (WHA, 1977): Attainment by all people of the worldof a level of health that will permit them to lead socially and economically productive lives.

However, indicators used in most of countries for the evaluation of performance in occu-pational health do not reflect the importance of the role and impact of the workplace as asetting for the promotion and protection of health of social partners at work nor do they suf-ficiently reflect the need for change in occupational health practice.

The need to develop the guidelines on the occupational health and safety country profileshas been pointed out in several meetings organized by the WHO Regional Office forEurope. It is believed that the country profiles prepared by the national institutions could bea valuable source of information for different stakeholders inside and outside the country.The concept of occupational health country profiles has been introduced and initially dis-cussed at the meetings of the Baltic Sea Network in Occupational Health and Safety.

The work and health country profile should be designed to serve several levels and bodies,such as decision-makers within government authorities, regional and local authorities, so-cial and health insurers, occupational health services and other enterprise consultants inHES, social partners, training, education and information bodies, research institutions, andthe general public. It is foreseen that in practice such a country profile would be compiledusing data from different national sources. It could be presented and maintained, preferablyon the Internet Website by the WHO Collaborating Centres in Occupational Health. It isassumed that the country profile will be prepared in the national language but be madeavailable in addition also in one of the WHO/EURO official languages.

The document prepared on this topic by the team of experts from the Finnish Institute ofOccupational Health in Helsinki is a first major step to prepare the guidelines on prepara-tion of the health and work country profiles. It is a very comprehensive document present-ing Finnish experience and providing essential data from other countries or internationalorganizations. It will be fully discussed during the Second European Meeting of WHOCollaborating Centres in Occupational Health, to be held in Budapest, 17–18 September2001.

I would like to thank Professor Jorma Rantanen, Director General of the Finnish Institute ofOccupational Health and all his colleagues who have contributed to the preparation of thisdocument. They made a major progress on the way to develop harmonized criteria and indi-cators for developing and auditing the performance of the national workplace health sys-tems.

Boguslaw BaranskiRegional Adviser, Healthy WorkplacesWHO Regional Office for EuropeScherfigsvej 8, 2100 Copenhagen Ø, Denmark

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CONTENTS

PREFACE

FOREWORD ........................................................................................................................................7

1. INTRODUCTION .............................................................................................................................8

1.1 Structure of the document........................................................................................................................................................... 81.2 Aims ................................................................................................................................................................................................... 81.3 Concepts and definitions ...........................................................................................................................................................11

2. INDICATORS AND THEIR SOURCES OF INFORMATION.......................................................14

2.1 Choosing indicators ....................................................................................................................................................................142.1.1 Conceptual model................................................................................................................................................................142.1.2 Validity and comparability.................................................................................................................................................17

2.2 Constructing indicators .............................................................................................................................................................192.2.1 Types of indicators ..............................................................................................................................................................192.2.2 Feasibility..............................................................................................................................................................................21

2.3 Sources of indicator data...........................................................................................................................................................222.3.1 Administrative registers and statistics .............................................................................................................................222.3.2 Questionnaire-based surveys.............................................................................................................................................252.3.3 Expert assessment systems ................................................................................................................................................272.3.4 Observational surveys ........................................................................................................................................................30

3. INDICATORS OF PREREQUISITES OF OCCUPATIONAL HEALTH AND SAFETY...............32

3.1 Occupational health and safety legislation and its coverage ...........................................................................................323.2 Coverage of occupational health service system.................................................................................................................323.3 Performance and resources of the occupational health and safety system..................................................................333.4 Recommended core indicators of an occupational health and safety system..............................................................34

4. INDICATORS OF WORKING CONDITIONS...............................................................................36

4.1 Physicochemical and ergonomic factors ...............................................................................................................................364.2 Psychosocial factors ....................................................................................................................................................................394.3 Working time arrangements ....................................................................................................................................................394.4 Life-style of the employed..........................................................................................................................................................404.5 Recommended core indicators of working conditions ......................................................................................................40

5. INDICATORS OF OCCUPATIONAL HEALTH AND SAFETY OUTCOMES.............................42

5.1 Accidents at work ........................................................................................................................................................................425.2 Occupational diseases ................................................................................................................................................................435.3 Occupational mortality..............................................................................................................................................................445.4 Occupational disability...............................................................................................................................................................445.5 Occupational morbidity.............................................................................................................................................................455.6 Work ability..................................................................................................................................................................................455.7 Work-related health problems and absenteeism due to sickness...................................................................................465.8 Recommended core indicators of occupational health and safety outcomes ..............................................................46

6. PRESENTATION OF INDICATORS.............................................................................................48

7. RECOMMENDATIONS.................................................................................................................51

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7.1 Proposed core set of indicators ................................................................................................................................................517.2 Other proposals............................................................................................................................................................................55

REFERENCES AND INTERNET ADDRESSES................................................................................56

ANNEX 1. COMPILED CONCEPTS AND TERMS...........................................................................60

ANNEX 2. AN EXAMPLE OF A COUNTRY PROFILE: FINLAND (DRAFT).................................68

Basic information on Finland and its health system.................................................................................................................68Area and population......................................................................................................................................................................68Economy ..........................................................................................................................................................................................69Labour force....................................................................................................................................................................................69Public health and health care system..........................................................................................................................................70

Indicators of prerequisites of occupational health and safety................................................................................................72Infrastructure of OH&S ................................................................................................................................................................72Legislation and coverage of OH&S............................................................................................................................................74Human resources in OH&S..........................................................................................................................................................74

Indicators of working conditions ...................................................................................................................................................77Physicochemical exposures .........................................................................................................................................................77Physiological and ergonomic factors .........................................................................................................................................83Psychosocial factors ......................................................................................................................................................................86Working time arrangements ........................................................................................................................................................89Life-style of the employed...........................................................................................................................................................91

Indicators of occupational health and safety outcomes ...........................................................................................................93Accidents at work and occupational diseases ...........................................................................................................................93Work ability....................................................................................................................................................................................95Work-related health problems .....................................................................................................................................................96

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Foreword

This working document of guidance on country profiles in occupational health andsafety (OH&S) has been prepared by the Finnish Institute of Occupational Health(FIOH) on the basis of the initiative of Dr. Baranski of the WHO/EURO. In addition toseveral earlier initiatives of the International Organizations to improve the compilationof OH&S data, the Third Ministerial Conference on Environment and Health, held inJune 1999 in London, also noted a need to strengthen the information systems on safetyand health at work. This Conference supported the implementation of the comprehen-sive concept of good practice in health, environment and safety management in enter-prises (HESME). This prompted WHO/EURO to propose the preparation of two parallelworking documents on preferable indicators of occupational health and safety at theenterprise level, and at the national/regional level.

This document presents a variety of indicators used to describe the status and trends ofOH&S at the national/regional level, and recommends a core set of indicators to be con-sidered predominantly for European use. Although the project is based on a Europeaninitiative, global aspects have influenced the selection of some recommended indicators.

During this work, the WorkSafe Programme of the International Labour Office, ILO,has shown interest in adopting a similar approach to country profiles, including OH&Sindicators at the global level. However, data collection and indicator construction relymainly on work carried out in different projects of the European Foundation for the Im-provement of Living and Working Conditions (in Dublin, Ireland), of the EuropeanAgency for Safety and Health at Work (in Bilbao, Spain), of EUROSTAT, and of re-search institutes and statistical offices in the Nordic countries.

The basic ideas of this document have been introduced at the First European Meeting ofthe WHO Collaborating Centres in Occupational Health, held in Lodz on 11–12 Sep-tember 2000, and a more detailed review is expected to take place in the next meeting ofthe European Network of the WHO Collaborating Centres, planned to be held inSeptember 2001.

We hope that this document can be utilized in the evaluations of national/regionalOH&S situations, and will thus be used as a tool for developing occupational health andsafety in the countries.

The Authors

Helsinki, December 2000

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1. Introduction

1.1 Structure of the document

This document starts by introducing the aims of this exercise and the basic conceptsused in national/regional surveillance of occupational health and safety (OH&S). TheOH&S indicators are then discussed in general terms with illustrative examples from theOH&S domain by type of data source (administrative source, questionnaire-based sur-veys, expert assessment systems and observational surveys). The next chapter deals inmore detail with relevance, validity, comparability and feasibility of indicators in threebasic domains of OH&S (prerequisites of OH&S, working conditions, OH&S out-comes). The technical aspects and presentation of indicators are discussed in the nextchapter. The document ends in a recommendation of a core set of OH&S indicators anda proposal on piloting. A comprehensive annex presents a draft country profile of Fin-land, which serves as example country whose data are used throughout the document todiscuss the pros and cons of different indicators. Finland and Finnish approaches werechosen as examples in this document because comprehensive data on OH&S wereavailable from Finland, and the authors had long experience on the use of these data.

1.2 Aims

The third Ministerial Conference on Environment and Health held in June 1999 in Lon-don recognized the need for developing and strengthening information systems onsafety and health at work. The Conference supported the idea of a comprehensive ap-proach in the development of national indicators for health and safety at work to supportthe design and follow-up of the implementation of appropriate national policies. TheMember States were also encouraged to develop good practices in health, environmentand safety management in enterprises (HESME) for company and workplace level toimplement such policies.

Throughout the industrialized world the basic requirements for health, safety and envi-ronment have been stipulated by legislation, including the Directives on Safety andHealth at Work by the European Union. The further development of policies for occu-pational health and safety and those for environment and health are nevertheless in-creasingly based on information steering. Such a policy is critically dependent on up-to-date information describing the current status of health and safety, the exposures andrisks threatening health, and information on the consequences of such exposures at indi-vidual and population levels. Such information is also of critical importance for settingpriorities for further development, identification of needs for actions, including the de-velopment of capacities and infrastructures, and attracting partners and allies to join theWHO in actions to implement Health for All (HFA) 21 targets of the Regional Strategy.

Appropriate indicator systems can also be used for comparing the needs of policies indifferent parts of the Region, and for the recognition of the impact of actions and pro-grammes undertaken for health and safety.

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The new information-based strategy also requires effective networking of actors at alllevels, i.e., policy, administrative, managerial and practical levels. Such networking canbe effectively stimulated and supported through appropriate, relevant and reliable in-formation.

It is important that the indicator systems which provide an opportunity to build up na-tional profiles are made as descriptive as possible, without rendering them too complex,and kept manageable and feasible for very heterogeneous suppliers of information. It isalso most important to compile even a limited amount of reliable and valid informationrather than to try to establish too heavy, complex and less practical systems with highnumbers of parameters. In such attempts compromises between ideal and feasible sys-tems need to be done. The objective of the present document is to provide suggestionsfor national profiles that describe the most important parameters in occupational healthand safety, starting from a limited number of selected and relevant key parameters, andproviding a possibility for more complex profiles with a growing degree of sophistica-tion, according to the needs and possibilities of the countries.

WHO/Euro has produced a document for indicators on Good Practices in Health, Envi-ronment and Safety Management in Enterprises (HESME) intended to satisfy the infor-mation needs at the company and workplace levels. Our Work and Health Indicator Pro-file (WHIP) approach covers national and regional/provincial levels. These two docu-ments are intended to be complementary, helping to cover all the levels of societalstructures with appropriate indication systems (Figure 1). Plans have been made to ap-ply a similar approach at the global scale in collaboration with the ILO.

Figure 1. Relationships between different indicator systems

International and inter-regional comparisons provide excellent possibilities for bench-marking and for finding common topics for collaboration. Such comparisons, however,require an indicator system for which data are available in as many countries as possi-

Globallevel

Nationallevel

Regional/Provinciallevel

Local level (community)

Enterprise level

Sca

le o

f co

vera

ge

Number of data providers

WHIP

HESME

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ble. Due to the heterogeneity of countries, the parameters which can be compared arevery few. This implies the principle of parsimony (i.e., avoiding too many parameters)particularly in the early stages of indicator development. On the other hand, the indica-tor system is a good stimulus for countries to develop their information systems for theproduction of more detailed profiles with time. Some countries can already do that andare encouraged to draw up more detailed descriptions.

The comparability of data requires the harmonization of concepts, definitions and meth-ods for data compilation. This is a difficult task due to many differences, for example, inthe legal systems of different countries. Therefore, the construction of profiles requiresnot only the mechanical compilation of registered data, but full knowledge and under-standing of the principles on which the data are collected and how they should be inter-preted.

We have two major sources of official information for indicator systems, a) the officialstatistics on registration of data for defined purposes, such as for the follow-up of im-pact of safety and health policies (e.g., official accident statistics) and b) statistics forinsurance and compensation purposes (insurance statistics). Such information systemshave several merits with their wide coverage, stable definitions and usually long history.But even they are vulnerable to poor implementation and variation in practices. Criteria,concepts and definitions are bound to the national laws and practices which may varysubstantially between countries. Differences in the efficiency of registration may lead tounder-registration or registration gaps which may substantially bias the results and in-validate comparisons. Even more they may lead to the so-called registration paradoxshowing a worse situation for countries which very accurately register all the relevantevents, while poor registration may be interpreted as a low level of risk. Official statis-tics are also rigid, and cannot be adjusted to give answers to questions which crop upunexpectedly on issues that are not included in the original registration schemes. Fur-thermore, the delay time in the registries may be substantial. In terms of the rapidchanges in work life, the data need to be collected with short delays and the questions tobe answered need to be flexible according to the context and situation. For this purposesurveys provide a useful tool. But surveys also have their strengths and weaknesses (seesections 2.3.2 and 2.3.4). This report proposes an indicator system that is based on thecombination of registered data and data provided by surveys and expert assessments.

As several types of integration and collaboration processes are ongoing in Europe,where EU integration is proceeding and the interdependence of all the 50 Europeancountries is growing as regards economic and social development, it is important to getreliable and comparable information on the conditions of health and safety in the Mem-ber States. Such information can be used for planning policies and for drawing up pro-grammes for the further advancement of health and safety at work, and thus for the sup-port of balanced socio-economic development of the Region (Figure 2).

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Figure 2. Use of indicators in policy making and implementation

1.3 Concepts and definitions

This document deals with country profiles and national/regional surveillance indicatorsof occupational health and safety.

A country profile on occupational health and safety refers to a combination of (quali-tative) descriptions and (quantitative) data on the state and trends of occupational healthand safety. Quantitative data are presented in the form of indicators. Indicators may inprinciple be also qualitative, but in this document we use only quantitative indicators.One example of a country profile is presented in Annex 2.

An indicator is a device which indicates some quality, change, etc., of a situation orsystem, and draws attention or gives warning. While efforts are normally made to quan-tify indicators, this is not always possible. Moreover, evaluations cannot always bemade by aggregating numerical values alone. Qualitative indicators are therefore oftenused, for example to assess people's involvement and their perception of the healthstatus. WHO has proposed four categories of indicators: health policy indicators ; so-cial and economic indicators ; indicators of health care delivery; and indicators ofhealth status , including quality of life. It should be emphasized that, while indicatorshelp to measure the attainment of targets, they are not in themselves targets. Indicatorshave to be selected carefully to make sure that they are responsive to current trends ofdevelopment and that they are useable for the analysis of ongoing activities. When se-lecting indicators, full account has to be taken of the extent to which they are valid, ob-jective, sensitive and specific. Validity implies that the indicator actually measureswhat it is supposed to measure. Objectivity implies that even if the indicator is used bydifferent people at different times and under different circumstances, the results will bethe same. Sensitivity means that the indicator should be sensitive to changes in thesituation or phenomenon concerned. However, indicators should be sensitive to more

POLICY

STATEOF

OH & SPROGRAMME

ACTION

ACTION

ACTION

ACTION

INDICATORS FOR IMPACT EVALUATION

PERFORMANCE INDICATORS

OH&S

INDICATORS

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than one situation or phenomenon. Specificity means that the indicator reflects changesonly in the situation or phenomenon concerned. Another important attribute of an indi-cator is its availability, namely, that it should be possible to obtain the data requiredwithout undue difficulty (see WHO 1978 in Annex 1).

The indicator systems may address different geographical levels spanning from globalto enterprise levels (see Figure 1). This document covers indicators of national and re-gional/provincial levels. Attention has been paid also to the comparative use of na-tional indicators at the international/global level. We do not consider indicators at theenterprise level (HESME indicators) because they differ from national/regional/provincial indicators as to the type of their reference data. Valid HESME indicators re-quire sector-specific reference data, as it is often reasonable to compare the situation inan enterprise only with that of enterprises in the same sector.

Indicators are an essential tool in occupational health surveillance which includesworkers' health surveillance and work environment surveillance (see ILO 1997 in An-nex 1). It is the ongoing systematic collection, analysis, interpretation, and dissemina-tion of data for the purpose of prevention, improving the health, work ability and well-being of the labour force. Surveillance is essential for the planning, implementation andevaluation of occupational health programmes, and the control of work-related ill healthand injuries, as well as the protection and promotion of the workers' health.

Health surveillance involves producing and examining indicators of mortality, workdisability/ability, occupational diseases and injuries, other work-related diseases, workabsenteeism, occurrence of symptoms, life-style factors, etc. Surveillance of the workenvironment includes the identification and evaluation of environmental factors whichmay affect the workers' health. It covers the assessment of sanitary and occupationalhygiene conditions, factors in the organization of work which may pose health risks,collective and personal protective equipment, exposure of workers to hazardous agents,and control systems designed to eliminate and reduce them. From the standpoint of theworkers' health, the surveillance of the work environment may focus on, but should notbe limited to, ergonomics, accident and disease prevention, occupational hygiene in theworkplace, work organization, and psycho-social factors in the workplace. The sur-veillance system includes the capacity for data collection, analysis and disseminationlinked to occupational health programmes. It refers to all activities at individual, group,enterprise, community, regional and country levels, to detect and assess any significantdeparture from health caused by working conditions, and to monitor the workers' gen-eral health status. Occupational health surveillance programmes record instances of oc-cupational exposures or work-related illness, injury or death, and monitor trends in theiroccurrence across different types of economic activities, over time, and between geo-graphical areas. (see ILO 1997 in Annex 1).

The surveillance process starts with data collection from various sources (registers, ad-ministrative sources, questionnaire-based surveys, expert assessment systems, etc.). Thedata are usually computerized, analysed statistically and displayed in tabular or graphi-cal forms providing distributions, time trends, means, or other statistics.

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Indicators are one method to present the state of OH&S in a country or region. The dataanalysis phase is often followed by the interpretation and evaluation of the significanceof findings carried out by experts familiar with the subject matter. The process shouldcontinue by decision making on direct prevention, dissemination of information, train-ing, research, or other relevant activities. The resources for surveillance are limited ascompared to the extent of the field. The approaches and methods applied should there-fore be regularly assessed and modified before the next data collection. Ideally the sur-veillance process is a loop which moves continuously to a more informative and cost-effective direction (Figure 3, from Tüchsen 1998, modified).

Figure 3. The surveillance process of occupational health and safety

More definitions of concepts and terms related to indicators and surveillance of OH&Sare given in Annex 1 of this document.

Informationresources

KnowledgeResearch results

TheoryMethods

ValuesGoalsCosts

Benefits

Analysis Evaluation

Collection ofInformation

Assessment and modi-fication of the surveil-

lance process

Initiatives andproposals

Measurements Observations Questionnaires Research Education Risk communication

Administrative data Case Reports Prevention Legislation

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2. Indicators and their sources of information

2.1 Choosing indicators

2.1.1 Conceptual model

The aim of this approach is to define a set of OH&S indicators applicable in countrieswith different economic structures, cultures, levels of statistics, etc. The need for wideapplicability might lead us to take feasibility (i.e., availability of data) as the startingpoint. However, such an approach might result in a set of indicators which are not themost relevant and scientifically most valid. An alternative to data-driven indicators is toadopt a concept-driven approach.

Concept-driven indicators are developed on the basis of a conceptual framework irre-spective of the availability of data. Theory determines an ideal set of indicators whichthen are operationalized and measured. Concept-driven indicators are primarily science-based and valid, whereas data-driven are primarily feasible. An approach of theoreti-cally and methodologically well-grounded indicators was adopted in the development ofEuropean social indicators (EUSI system) (Noll 2000a). Our approach is concept-drivenas far as possible, but also the availability of data and their comparability across coun-tries are taken into account in the selection of core indicators.

Choosing an indicator involves also discussing the policy/normative aims and prioritiesof OH&S. Indicators should address relevant phenomena in OH&S.

WHO has published a list of criteria for checking the relevance of environmental healthindicators (Corvalan et al. 1998). Relevant indicators are

- directly related to a specific question of concern- related to conditions which are amenable to action- easily understood and applicable by potential users- available soon after the event or period to which it relates- based on data that are available at an acceptable cost-benefit ratio- selective, so that they help to prioritize key issues in need of action- acceptable to the stakeholders.

The relevance of various OH&S issues varies by country and period. There is a veryclear difference as to the relevance of OH&S hazards between the industrialized anddeveloping countries. This is evident from the following priority lists generated at ILO(Takala 2000).

Priorities of industrialized countries:

- Stress, overload and pace of work, psychological factors, workplace relations andmanagement

- Problems caused by aging workforce, maintaining ability to work- Right-to-know, right to be informed, hazard communication- Chemical substances, carcinogens, asbestos

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- Ergonomics, repetitive work and musculoskeletal problems- Organizational issues and safety and health (quality) management issues- Preventive occupational health services, health promotion- New technologies.

Priorities of developing countries:

- Agricultural work accounts for 2/3 of manpower and work-related problems- Other hazardous sectors, such as mining, construction, fishery, logging, and par-

ticularly dangerous occupations- Major industrial accidents and fires- Traditional accident and safety problems, housekeeping and productivity- Occupational diseases, Global Programme on the Elimination of Silicosis- Vulnerable groups, in particular, child labour- Transfer of technology.

Most of the indicators described in the present document relate to the priorities of theindustrialized countries, such as psychosocial, ergonomic and chemical factors, as wellas work ability, management issues of OH&S, and occupational health services. Thepriorities of developing countries gave rise to the indicator on the consumption of pesti-cides. Also traditional indicators on work accidents and occupational diseases are in-cluded among the core indicators.

The European Agency for Safety and Health at Work has published a document on pri-orities and strategies in OH&S policy in the EU countries (EASHW, 1998). In this re-port the national authorities in OH&S described their views on the present state and fu-ture plans concerning the following important national issues: legislation, enforce-ment/inspection, campaigns, financial incentives, certification, training, risks and riskgroups, research, management, strategies, and developments in the labour market. Wetried to include most of these areas in our indicators, provided that valid quantitativemeasures were available. Some of these issues are included in the proposed country pro-files as descriptive figures or text. The priority list of hazards by EASHW also influ-enced our selection of specific core indicators among many alternative hazards. At leastfour of the 15 EU countries had paid particular attention to the following occupationalsafety or health hazards:

Physical agents- noise- ionizing radiation- vibrationChemical agents- asbestos- chemical agents (general)- lead- carcinogensSafety- machine safety- risk of falling- electrical risks

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Psychosocial risks- stressErgonomic risks- physical strain/manual handling

Also many national bodies have set priorities for OH&S. One of the largest efforts is theNORA (National Occupational Research Agenda) project in the United States where theexperts of the National Institute for Occupational Safety and Health (NIOSH) with theirpartner organizations prioritized 21 research areas. The results of this on-going projectare well documented and freely available through the Internet (www.cdc.gov/niosh/norhmpg.html).

Conceptual frameworks for environmental indicators have been developed by OECD,UN Environment Programme, US Environmental Protection Agency and WHO(Corvalan et al. 1998). The WHO model which addresses the driving forces, pressures,state of the environment, exposures, effects and actions (DPSEEA), is rather well appli-cable also to the area of OH&S. Driving forces (D) in the DPSEEA model refer todemographic, economic and technological factors which influence the occurrence ofpotential hazards and outcomes. Some examples of them include a decreasing agricul-tural population, economic growth of telecommunication services and the automation ofindustrial processes. The driving forces may increase or decrease pressures (P) onworking conditions, e.g., production and consumption of chemicals, and their waste re-leases change. Pressures influence the state (S) of the work environment, e.g., the occur-rence of air pollutants, or of stress factors at work change. The changes in the state ofthe work environment may increase or decrease occupational exposure (E) or strain,which may be measured or assessed as external or internal dose. Exposure may lead tovarious effects (E) ranging from fatalities to changes in perceived well-being. Action(A) is a wide category of activities which may affect all other parts of the driving force-effect chain. It includes political measures (e.g., banning of asbestos), introduction ofclean technologies (e.g., closed processes), hazard management (e.g., lifting aids),monitoring (e.g., exposure measurements), education (e.g., safety training), awarenessraising (e.g., information campaigns) and treatment of health outcomes (e.g., rehabilita-tion).

For the purposes of our project, we present a more simplified model (Figure 4) whichdescribes the domains of our indicators. We include in the OH&S indicators both indi-cators for known hazardous working conditions and indicators for their known healtheffects. The third group of indicators consists of measures of the state of OH&S legisla-tion and occupational safety and health management systems. Even though we do notinclude socio-economic indicators in our indicator set, we are aware that it is importantto pay attention also to socio-economic factors, such as the proportion of agriculture inthe economy and the degree of automation in industrial processes. Differences as re-gards to these factors may lead to the need to classify countries into groups according totheir socio-economic structure in order to maintain adequacy of the comparisons.

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Health outcomes

Working conditions

Socio-economic structure- demography

- industries- technologies

OH&Spolicy and

infrastructure

Exposure, work load and stress

Figure 4. Conceptual model for OH&S indicators

We call indicators, that describe working conditions, exposure indicators . They refer toworking conditions and cover the major determinants of OH&S outcomes. Indicatorsthat describe health outcomes we call effect indicators . They refer to all OH&S out-comes in the wide sense of the word. Examples of these classes of indicators are givenin Annex 2 of this document. We call indicators that describe OH&S policy and infra-structure prerequisite indicators as they describe the state of the most important fac-tors required for successful performance of national OH&S systems. They concern, e.g.,the quality of legislation, coverage of OH&S, characteristics of the occupational healthservice system and safety inspection system, etc. The state of OH&S policy and infra-structure also has an effect on the availability and quality of exposure indicators and ef-fect indicators.

It is possible to construct also ‘hybrids’, i.e., exposure-effect indicators which combineinformation on the outcomes and their determinants. Examples of such are ‘incidence ofwork accidents due to falling’ and ‘incidence of occupational diseases due to exposureto asbestos’. These kinds of indicators have been proposed in the area of environmentalhealth (Corvalan et al. 1998). The construction of environmental health indicators re-quires that a causal relationship is established between exposure and effect. When thisrelationship is unknown, or one wants to survey all effects of a given exposure or a spe-cific effect of all exposures, ‘pure’ exposure indicators and effect indicators are the onlyoption. The value of exposure-effect indicators is in their ability to indicate also thecausal exposure, if preventive measures are needed to reduce the incidence of a harmfuloutcome. However, ‘pure’ exposure indicators enable also proactive action if the effectsof the exposure are known. Our core set of indicators does not include any exposure-ef-fect indicators, although such indicators are often available in national statistics on workaccidents and occupational disease.

2.1.2 Validity and comparability

Validity refers to the ability of an indicator to describe accurately and precisely the phe-nomena of concern. The validity of an indicator depends on the completeness of thedata and the reliability of its source. Validity aspects of different types of data sources

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are described in more detail in the next chapter on data sources. Briefly, administrativedata may lack validity because of incomplete coverage. Interview surveys produce‘subjective’ data of varying validity depending on the formulation of the questions. Ex-pert assessment systems are often based on measured data and professional judgement.Although the measurements may be accurate and ‘objective’, they may also be selectiveand unrepresentative of the phenomena in question. Professional judgements are always‘subjective’ and of varying validity. Sometimes validity can be tested by contrasting in-formation from different sources, or studying a smaller sample carefully (‘golden stan-dard’). Because of the difficulties of measuring validity in surveillance, it has been de-scribed merely as a goal which should be reached by defining the studied phenomenaand indicators accurately, and by using tested methods whenever possible (Tüchsen1998).

A detailed checklist of validity criteria for environmental health indicators has beenpublished by WHO (Corvalan et al. 1998). The criteria are:

- based on a known linkage between the environment and health- sensitive to changes in the conditions of interest- consistent and comparable over time and space- robust and unaffected by minor changes in methodology/scale- unbiased and representative of the conditions of concern- scientifically credible, not easily challenged- based on data of a known and acceptable quality.

This list is a useful guideline also in the construction of OH&S indicators. Many itemsof the list can be condensed to the requirement that an indicator should be relevant,valid and feasible. Because this document proposes an indicator set for internationaluse, one component of validity, the comparability of data, is of special interest. Threekinds of comparisons are possible:

- between countries (external reference)- between regions within a country (internal reference)- within a country or region over time (country/region itself as a reference).

Comparability is generally poor across countries unless the data collection methodsand definitions used are the same. The most problematic indicators in this respect arethose which are derived by using administrative data, e.g., occupational diseases (seesection 2.3.1). The pilot study on the State of Occupational Safety and Health in theEuropean Union (EASHW 2000) looked for the availability and comparability of na-tional data with jointly collected data from the Second European Survey on WorkingConditions (ESWC)(see section 2.3.2). National data on 21 different OH&S exposuresand outcomes were available in 58% of the cases. National data were in accordancewith ESCW data in 20% of the cases. National data could either not be compared withESWC data (24%), or they were different (14%). This suggests that comparable datafrom national surveys are available only in the minority of cases. The reasons for in-comparability are many. The contents and answering alternatives in two surveys maydiffer. The sample size and structure, as well as the survey methods (telephone inter-view vs. personal interview vs. postal inquiry) may influence the results. If surveys arecarried out in two countries, also language differences may be of concern. Based onthese findings, we consider international surveys preferable to national ones as data

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sources, when the results are compared across countries. National surveys are veryvaluable in the surveillance of the situation and trends within a country, but their resultsare rarely applicable to international comparisons.

Expert assessment systems, such as CAREX (see section 2.3.3), are usually based onsystematic definitions, uniform methodology and standardization by economic struc-ture; this tends to improve comparability across countries. However, also expert as-sessment systems include a ‘subjective’ component: different experts are likely to comeup with different estimates due to varying competence, interpretation of data, andamount of work spent on the assessment.

Comparisons between regions within a country are usually easier than between coun-tries, provided that the same definitions and methodology are used to survey all regions.The reference in regional comparisons may be either the mean of the country, or thebest (benchmark) and worst regions. If the economic structure of a region differs sig-nificantly from that of other regions, the data can usually also be standardized by eco-nomic structure.

Comparisons over time within a country or region are usually quite well comparable,if the definitions and methodology have remained the same over time. The reference inthese comparisons is the country or region itself at an earlier date. The economic struc-ture may have changed, but the change is usually so slow that standardization is notneeded.

2.2 Constructing indicators

Constructing an indicator means operationalizing the indicator, i.e., defining how tomeasure the concept behind the indicator.

2.2.1 Types of indicators

Indicators may be grouped according to several aspects. For example, they differ intheir composition. A simple (non-composite) indicator summarizes information only onone aspect of the phenomena under study. A composite indicator summarizes informa-tion on related simple indicators describing the same phenomena. It is usually presentedas an index by summing over single indicators which may have similar or differentweighting factors (as multipliers). By condensing the data it provides an overall sum-mary of the state of OH&S or one of its sub-areas. The disadvantages of composite in-dicators are that they cannot be calculated if data on one or more of their components(simple indicators) are missing, and that their construction is judgement- and value-de-pendent (Briggs 1998). The construction of a composite indicator requires that some-body selects the components to be included and sets weights to them. Both of these pro-cesses are subjective, making composite indicators debatable. Some composite indica-tors are in limited use in OH&S, e.g., work ability index (WAI). Because of their sub-jective nature, we avoided proposing any composite indicators to be included in ourcore set of OH&S indicators.

Indicators may be divided also by their level of subjectivity into:- objective indicators

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- subjective indicators.

Objective indicators represent facts that are independent of personal evaluations. Sub-jective indicators are based on an individual’s perception and evaluation of conditions(Noll 2000b). According to these definitions, most administrative statistics (e.g., statis-tics on occupational diseases) could be called objective, and data from interview andquestionnaire-based surveys subjective. The borderline between objective and subjec-tive is often not clear. Administrative statistics may be based on information observedand interpreted by an individual. Before being recorded in an administrative register, thedata may be collected and transferred in several phases involving subjective elements,such as decision on inclusion/exclusion and coding. This makes administrative data‘semi-objective’. On the other hand, information from interview surveys, althoughbased on the perception of individuals, may also have ‘semi-objective’ features. This isthe case especially when a question is simple and the response independent of a per-son’s opinion. E.g., Were you at work last Sunday?

If the questions concern concepts which are complex and may be perceived very differ-ently by the respondents, it is advisable to ‘standardize’ the concept by providing a briefdefinition to harmonize the responses. Therefore it is better to avoid asking about expo-sure to noise, cold, vibration, stress, etc., as such, without defining in the question whatis meant by these concepts, and what is the minimum level of exposure to be noted.

In our core set of indicators we have included both objective and subjective indicators.In the selection of subjective indicators, we have preferred ones which define briefly theconcept, if it is suspected to be interpreted variably by the respondents.

The object of interest of an indicator may be the whole population or a specific fractionof it. Therefore indicators may also be classified as

- total population indicators- risk group indicators.

The total population indicators are typically expressed as mean values. They are impor-tant because they indicate the total burden of a disease or of an exposure in the popula-tion. The distribution of exposure or effect in the population is often uneven in the oc-cupational context. The subgroups which have the highest exposure or incidence of aharmful outcome are of special interest from the point of view of prevention. Thereforeindicators may also be tailored to address groups at high risk instead of total population,total employed population, or total exposed population.

Most of our proposed indicators address the total (employed/exposed) population. Theonly exception is the indicator of working hours. Instead of the average working hoursof the employed (in hours/week), we propose using the proportion (%) of the employedwho work for more than 50 hours/week. The reason for this is that the mean workingtime is in most countries about the same, and not predictive of any specific hazard. In-stead, a very long working time is predictive of burnout, which is one of the priorityhazards in post- industrialized countries.

Subgroup-specific indicators are closely related to the previous classification (totalpopulation/risk group). These indicators may also be called stratified indicators. Datamay be stratified, e.g., by industry or occupation, resulting in

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- industry-specific indicators (sector-specific indicators)- occupation-specific indicators- gender-specific indicators- agent-specific indicators, etc.

Subgroup-specific indicators are usually constructed to identify subgroups at high risk.Therefore they are indispensable in all statistics and other surveillance information inthe area of OH&S. They also have another important use: they can be used to standard-ize data to improve comparability across countries/regions (or over time). If the eco-nomic structure of two countries differs greatly, the comparison of indicator data is notinformative. Comparability can be improved by comparing only countries with a rathersimilar economic structure, or by standardizing data by economic structure. One exam-ple of this kind of standardization is the CAREX system (see section 2.3.3), where thepreliminary estimates of the numbers of workers exposed to carcinogens were first stan-dardized by economic structure of the country and then adjusted by national exposurepatterns by experts. It is possible to standardize indicators also in multinational surveys,such as the European Survey of Working Conditions (see section 2.3.2). By first calcu-lating an expected value for a country on the basis of industry-specific mean values ofall participating countries, one can then compare countries and see if the indicator valueis different from the expected value.

We have not included any stratified indicators in our core set. The reason for this is thatour proposal is meant to serve simply as the first approach to evaluate the general stateof OH&S in a country as regards other countries. However, it is evident that stratifiedindicators are a necessity in every serious surveillance system of OH&S.

2.2.2 Feasibility

The construction of OH&S indicators requires good quality data. These data should beavailable from international or national sources, or there should a procedure to obtainmissing data at a reasonable cost. The availability and quality of European OH&S datahave been studied (Nossent et al. 1996). Sixteen countries, including all EU countriesand Norway, provided information on the availability of data and on actual data in 1996.There was more data on OH&S outcomes than on working conditions. Data on workaccidents were best available (15 countries) followed by general mortality and occupa-tional diseases (12 countries). National data were available for physical exposures (10countries) and to lesser extent for other working conditions. The report tabulates figureson the availability of data by sex, age, occupation, economic sectors and some othervariables. The comparability of data was also crudely assessed and discussed. Since thatstudy, several projects have provided data on the working conditions (ESWC 1997),carcinogen exposure (Kauppinen et al. 2000), work accidents (Eurostat 1997) and occu-pational diseases (Karjalainen and Virtanen 1998) of 15 EU countries.

Probably less data for OH&S indicators are available from countries outside the Euro-pean Union. Data on OH&S legislation and work accidents worldwide have been col-lected by ILO (ILO 1999, www.ilo.org). Also WHO has collected information on workaccidents, reported occupational diseases and selected exposures from all Europeancountries in the context of Health for All by the Year 2000 programme (WHO 1994).The United States, Canada and many other non-European countries also have adminis-trative recording systems on accidents, occupational diseases, sickness absenteeism and

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mortality. However, comparability of data with the European sources may be question-able. The same is true also as regards non-European surveys: definitions (questions) andmethodologies (sample, data collection, coding) are different from the European prac-tice.

If OH&S indicator data are missing, there are in principle several ways to try to collectthem. Administrative sources (registers, databases) often have their own history and es-tablished usage. Their modification to produce data in the form required is difficult andmay even require legal changes. Observational surveys on hazards are slow and veryresource-demanding, and carrying out such surveys has turned out to be feasible in onlya few countries.

Questionnaire-based surveys on working conditions have been conducted in most in-dustrialized countries, and they are feasible if the infrastructure of a country allows thesampling of individuals and contacting them personally, by telephone or by mail. Theirfeasibility in developing countries, however, may be lower due to the lack of accuratepopulation registers, limited number of telephones, illiteracy, and other obstacles. Thequestions and survey methods should be as well harmonized with the requirements ofthe indicators as possible.

Another feasible approach to collect missing data is the expert assessment system. If nodata are available, and surveys and other data collection methods are not applicable, ateam of national or international experts could estimate the prevalence of the exposureor burden of the OH&S outcome on the basis of a suitable reference country which hascomplete good quality data available. An industry-specific approach allows also stan-dardization of data according to the economic structure of the country, and this im-proves comparability with other countries. The experts can also modify their estimatesby taking into account specific exposure or disease patterns prevalent in their countries.Although this procedure produces only estimates, their validity and comparability maybe reasonable, especially in regard to the rather limited effort needed to produce them.

2.3 Sources of indicator data

This chapter discusses the major sources of indicator data from the point of view of va-lidity and comparability. Illustrative examples of strengths and weaknesses are pre-sented. The main emphasis is on international data sources and harmonization projects,because our view is that they provide more comparable data than national sources.Readers who are interested in national data sources are referred to the European data-base on OH&S information systems (HASTE 1995, http://www.occuphealth.fi/e/eu/haste).

2.3.1 Administrative registers and statistics

Administrative registers maintained by governmental agencies, insurance companies orresearch institutes typically provide data on the numbers of work accidents and occupa-tional diseases. Their basic purpose is not surveillance. Often they are constructed tosupport compensation and prevention activities stated in the national legislation. Dataon the numbers of accidents or diseases are a by-product of these registers and dependsignificantly on national regulations, their coverage and recording praxis. On rare occa-

23

sions, standard statistics provides also information on production, export and import ofhazardous agents (e.g., asbestos, pesticides) which may be useful in the construction ofcrude national exposure indicators.

Some advantages and disadvantages of administrative registers and other similarsources providing standard statistics:

Advantages Disadvantages• systematic data collection, often nationwide

and based on legal obligation• continuous data collection and production

(continuity and stability)• internal comparisons within data often valid

and informative for preventive purposes

• coverage often incomplete in spite ofobligatory nature of data collection(under-reporting)

• restricted to fixed (case) definitions ofadministrative nature (inflexibility)

• comparability across countries oftenpoor

• data production often slow

An example: Pilot project on European Occupational Disease Statistics (EODS)

A Pilot Project on European Occupational Disease Statistics (EODS) was launched in1991 to assess the comparability of the data drawn from the existing systems (Kar-jalainen and Virtanen 1998). Eurostat collected data on recognized occupational dis-eases in the 15 Member States for 31 selected items of the European Schedule of Occu-pational Disease for the year 1995. The data did not cover the entire working populationfor some member states, and for some member states it did not represent recognizedcases. A questionnaire was used to clarify the inclusion criteria of mild diseases in gen-eral, coding of the medical diagnosis and specific recognition and inclusion criteria ofsix selected items. Labour Force Survey data were used to build reference populationsthat would correspond to the total workforce and the workforce that was covered by therecognition/compensation scheme (filtered workforce). The incidence of occupationaldiseases (31 items) in 1995, as calculated on the basis of total workforce and filteredworkforce is presented in the following figure.

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Figure 5. Incidence of 31 occupational diseases in the member states of the EuropeanUnion in 1995 (Karjalainen and Virtanen 1998)

The main factors restricting comparability were: (1) definition of the reference popula-tion, (2) varying inclusion criteria, (3) the coding of the medical diagnosis, and (4) dif-ferences in the recognition of mild cases.

Definition of the reference population. Self-employed, family workers and workers incertain sectors were not covered or were only partly covered by national recognitionsystems. The proportion of the filtered workforce and the total workforce is a crudemeasure of the coverage of the occupational disease statistics. If the coverage is good,incidence is not affected by the selection of the reference population. However, the ef-fect of coverage is not very dramatic because in all EU countries the recognition systemcovers most of the employed persons.

Inclusion criteria. There was variation in the inclusion of specific diseases in the 31items studied, e.g., the inclusion of asthma, rhinitis and alveolitis in respiratory allergiesor pulmonary fibrosis, and the various pleural abnormalities in asbestosis.

Coding of the medical diagnosis. Coding by diagnosis in the 31 items studied varied bycountry. A draft list was proposed according to the ICD classification of WHO.

Recognition of mild cases. Some countries recognized occupational diseases at an earlystage when they did not yet cause any disability in medical terms, while some memberstates recognized only cases with a certain minimum level of disability. It was not pos-sible to directly compare the total incidence rates for most of the occupational diseases.This concerned, e.g., noise-induced hearing loss.

The authors (Karjalainen and Virtanen 1998) summarize the strengths and weaknessesof the data:

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Strengths of the data. The data on recognized cases of occupational disease represent ahigh degree of causality. They also provide detailed information on exposure and onmedical and social consequences. Such data can be used in the prevention and evalua-tion of the impact of the problem. Finally most systems offer these data on a continuousand more or less nationwide basis. If the effect of the varying inclusion criteria for se-verity and type of disease is eliminated by comparing the industry-specific incidencerates after adjustment for the national incidence rate in the pilot data, one can concludethat the risk industries identified by the national systems and the incidence rate ratiosare similar in the member states for items in which the number of cases allows statisticalcomparison.

Weaknesses of the data. After the above improvements, two general restrictions remain:(A) The data on recognized occupational diseases reflect not only the occurrence ofsuch diseases, but inevitably also the way in which the concept of an occupational dis-ease has been integrated into the social security system. Questionnaire data on the na-tional recognition criteria of specific items proved to be informative in this regard. (B)The EODS pilot data indicate that underreporting is probable even for some classicaloccupational diseases, while it is quite clear that statistics on recognized cases do notrapidly identify new health problems.

2.3.2 Questionnaire-based surveys

Interview surveys and other questionnaire-based surveys on working conditions are car-ried out in many countries and areas. They provide valuable information on the preva-lence of perceived exposure to some physical agents, ergonomic factors, physiologicalfactors, psychosocial factors, life-style factors, on work ability, and on the occurrence ofwork-related symptoms.

Some advantages and disadvantages of questionnaire-based surveys:

Advantages Disadvantages• contents flexible, can be tailored to ad-

dress issues of current interest• based on a representative sample of

population• repeated data collection and production

(rather continuous)• comparability rather good across coun-

tries, if questions and methods similar• sensitive to changes in working condi-

tions• rather rapid and inexpensive to carry out

• based on subjective perception of workingconditions (indirect nature of information)

• validity of questions may be unknown• questions may be imprecise and variably

understood by respondents (imprecision)and results difficult to interpret

• sensitive to context (e.g., economic reces-sion may influence responding)

An example: Second European Survey of Working Conditions (ESWC)

The European Foundation for the Improvement of Living and Working Conditions hasconducted EU-wide surveys on working conditions in 1991 and 1996. These two sur-veys produced harmonized and original data on situations and trends in the EuropeanUnion. The second survey took place in January 1996 and collated the views of 15,800workers from all over the EU. One thousand workers in 15 Member States of the Euro-

26

pean Union were questioned simultaneously about topics relevant to their working con-ditions. The sample was representative of the working population. This questionnaire-based survey involved face-to-face interviews and was conducted outside the work-place. The third survey is in progress.

Although the ESWC survey questions were uniform and the data were collected in asimilar fashion in every country, comparability of the results was not good for eachquestion. Linguistic issues and responding culture may have influenced the comparabil-ity across countries. An illustrative example is exposure to cold (ESWC 1977). Thequestion posed was: How often are you exposed at work to low temperatures either out-doors or indoors. The highest prevalences were reported by Greek (44%) and Portu-guese (33%) respondents, whereas, for example, Finnish (19%), Swedish (22%) andItalian (19%) respondents reported less exposure. The reason for these striking differ-ences against the expected result may be linguistic, or due to a different perception ofcold, different responding culture, or different clothing against cold. The formulation ofthe question is so vague as regards ‘low temperatures’ that it may lead to different inter-pretations of the concept ‘cold’.

The linguistic and interpretative contexts in different countries may also influence theresponding to questions on psychosocial/ work organizational items. The ‘socioeco-nomic’ approach (predominant, e.g., in France) focuses on aspects of work organizationand functioning of enterprises, whereas the ‘psycho-social’ approach (predominant, e.g.,in Scandinavian countries) focuses on the consequences to the workers’ health and well-being. Because varying thinking patterns prevail, the same question may be translatedby researchers and interpreted by respondents in different ways in two countries (Af-fichard et al. 1998).

The questions in ESWC were developed partly on the basis of questions used in Nordicsurveys. The validity of Nordic questions has been comprehensively tested in Sweden(Wikman 1991). The answers of workers to survey questions were compared to the ac-tual conditions at workplaces. The actual conditions were assessed by experts based onmeasurements (e.g., noise, temperature), observations (e.g., ergonomic factors, outdoorwork) and interviews/professional judgements (e.g., psycho-social factors). The ques-tions were divided first into three groups based on their ‘subjectivity’. The first groupincluded questions which were thought to be precise, uniformly interpreted by respon-dents (concrete) and easy to respond to, based on the experience and observations of therespondents. Typical questions in this group concerned outdoor/indoor work, sit-ting/standing work, and well-specified questions on ergonomic and physical factors.The second group included more ‘subjective’ questions which were less precisely speci-fied and utilized more abstract concepts. These questions required more complexevaluation by the respondent, but concerned still the concrete work environment orwork organization. The third group included ‘subjective’ questions on personal experi-ence and reactions. Typical questions in this group concerned harm or inconvenienceperceived by the respondent. The correlation between the answers and actual situation(validation criteria) was higher for the less subjective questions on physical conditionsof work. The correlation coefficients for groups 1, 2 and 3 were 0.75, 0.64 and 0.53, re-spectively. The corresponding correlation coefficients for psychosocial factors were0.54, 0.41 and 0.24. The best accordance was found for simple questions on indoorwork and sitting work, where only 1% of the answers were false positives or negatives.

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Specific questions gave less ‘false’ answers than did the general ones. For example, al-ternative questions on exposure to high level noise specified by examples provided 6–17%, but a general question on noisiness 25% and a subjective question on harm due tonoise 29% of answers which departed from the actual situation assessed by the experts.The conclusion of the study was that valid questions are simple and based on observa-tions on the work environment or on physical reactions. If the question includes con-cepts which can be interpreted in different ways by the respondents, it is advisable toillustrate them with examples (e.g., noise, cold, heat, heavy lifting) or to show pictures(e.g., difficult positions). The response scales should also be as specific as possible. Forexample, it is better to ask for a proportion of time exposed than for a simple answer‘yes/no’, or ‘always/often/rarely/never’.

ESWC data have been used to construct indicators for the work environment in theMember States of EU (Dhondt and Houtman 1997). Most of the EU countries have car-ried out also their own national surveys, but their methodologies differ so much that theresults are not comparable across countries. The long preparatory work on ESWC ques-tions including relevance and validity considerations and the same methods used tocollect data in all countries makes ESWC a preferable source for indicator data. On thebasis of ESWC and other available data, 56 indicators were defined covering physicalexposure, musculoskeletal job demands, information on working conditions, genderequality, and safety and health output. Most of these indicators are based on one or sev-eral questions in ESWC. The state of the work environment is indicated usually by thepercentage of respondents reporting exposure to an agent or factor for at least ¼ or halfof the time. Some indicators are of the sum score type, e.g., percentage of workers ex-posed to at least two musculoskeletal demands. The indicators were constructed usingthe methodology of the social indicators project of the European Union. Indicator dataare proposed to be included in the HASTE database of the European Foundation for theImprovement of Living and Working Conditions.

2.3.3 Expert assessment systems

When administrative sources and questionnaire-based surveys fail to provide reliableinformation on the prevalence of exposure or on the occurrence of a health outcome, anexpert assessment project can be a feasible approach. Such an approach has proven tobe useful when estimating specific chemical exposures, which are too numerous to beinquired in questionnaires and difficult to identify by the respondents. The idea is thatone expert or a team of experts familiar with national exposure patterns and workforcecharacteristics estimates the numbers of exposed persons (and their exposure levels) fora country. If the national data are comprehensive and valid, they can be used as refer-ence data for another country having invalid data or lack of data to generate preliminaryestimates of numbers of the exposed workers in that country. The experts of that coun-try can then refine these preliminary estimates based on their knowledge of differencesbetween exposure patterns in their own country and the reference country. This ap-proach can also be applied to generate alternative estimates for work accidents and oc-cupational diseases if these are reported incompletely to the administrative sources.

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Some advantages and disadvantages of expert assessment systems:

Advantages Disadvantages• based on uniform definitions and method-

ology• definitions may be difficult to follow in

practice• systematic, can be extended to issues and

countries where data are missing or unre-liable

• based partly on degree of knowledgeand subjective views of experts

• validity of results may remain unknown• comparability rather good across countries• rather rapid and inexpensive to carry out

An example: International information system on occupational exposure to car-cinogens (CAREX)

CAREX is an international information system on occupational exposure to known andsuspected carcinogens (Kauppinen et al. 2000). The CAREX (CARcinogen EXposure)database, constructed in the mid-1990s with support from the Europe Against Cancerprogram of the EU, provides selected exposure data and documented estimates on thenumbers of exposed workers by country, carcinogen, and industry. CAREX includesdata on 139 agents evaluated by the International Agency for Research on Cancer (allagents in Groups 1 and 2A, and selected agents in Group 2B), displayed across the 55industrial classes of the United Nations system (ISIC Revision 2). The 1990–93 occupa-tional exposure to these carcinogens was estimated for the 15 countries of the EU in twophases. First, estimates were generated automatically by the CAREX system on the ba-sis of national workforce data and exposure prevalence estimates from two referencecountries (the United States and Finland). These estimates were then refined by nationalexperts in view of similarity/dissimilarity to the perceived exposure patterns in selectedcountries. CAREX was recently extended to include estimates also for exposure in Es-tonia, Latvia, Lithuania and the Czech Republic (see www.occuphealth.fi/list/data/CAREX).

The strengths of the CAREX system are its systematic nature, wide coverage and easeof use. CAREX tries to apply basically the same definitions and procedures to eachcountry, which tends to improve the comparability and consistency of the results acrosscountries. It covers all industries in an international classification of industries, and isable to provide both national and industry-specific estimates. CAREX is easy to use inpersonal computers.

The validity of the CAREX estimates was extensively discussed by the planning teambefore the construction of CAREX, and several measures to improve validity wereadopted. First, all estimates were standardized according to the labour force structure ofthe individual countries. Second, uniform definitions of agents and of occupational ex-posure, with inclusions and exclusions, were used to improve consistency. Third, pre-liminary estimates were checked and modified by national experts familiar with the ex-posure situation in their own country. Fourth, exposures in the reference countries weredocumented and estimated as specifically (at the sub-industrial level) as possible to pro-vide a sufficient knowledge base for the estimations in other countries. Fifth, industrialhygiene data and descriptive information on exposures were included in the database tosupport the estimation efforts. Sixth, estimates suspected to represent a low level of oc-cupational exposure were marked to allow their inclusion or exclusion, since low expo-sures may have a strong effect on the estimated numbers of exposed. Seventh, prelimi-nary estimates for non-reference countries were selected by professional judgement to

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be the most valid out of alternative estimates (alternatives: value based on Finnishprevalence, value based on US prevalence, value based on their mean, own national es-timate, no exposure). In spite of these precautions and the aids included in the CAREXsystem, there were still many validity issues of concern, such as differences in country-specific use patterns for carcinogens, in the concept of exposure, in national surveyprotocols, in time frames, in national industrial coding systems (conversion difficulties),and in the assessment of multiple exposures.

Omission of country-specific exposure patterns may bias results seriously. One suchexample is exposure to radon from the ground which is higher in Finland than in mostEU countries, possibly resulting in overestimation in other countries if not adequatelychecked by national experts. Different legislation may lead to great variation in expo-sure patterns between countries, as in the case of asbestos or passive smoking at work.The adjustment of default estimates to correspond to the national situation turned out tobe problematic. The national adjustment resulted in an increase of the total number ofworkers exposed to CAREX agents in Denmark (+15%) and France (+4%), but a de-crease in Italy (-7%) and the Netherlands (-17%). The impact of the adjustment was alsoagent-specific extending from nil to substantial (e.g., radon). Although national expertswere able to adjust the figures to correspond better to the exposure patterns of theircountries, it is likely that the adjustments were sensitive to the definition of exposure(e.g., inclusion/exclusion of potential and low exposures) in the survey data and otherexposure information used by the experts.

The concept of exposure in the reference countries differed. The Finnish protocol re-quired in most cases that non-occupational exposure, measured as annual dose, had tobe exceeded, whereas the US protocol addressed potential exposure. The Finnish ap-proach sets the minimum exposure generally at a higher level than the US approach, andtherefore results in lower proportions of exposed workers.

The survey protocols varied by country. The US data were based on an observationalfield survey (NOES, see section 2.3.4) and the Finnish data on professional judgement.Both methods have their advantages and disadvantages. The NOES survey was sensitivein identifying exposures, whereas the Finnish procedure often neglected small exposedgroups and atypical exposures. However, sometimes the case was the opposite.

The time frame of the assessments was not the same for all countries. The reference datafrom the United States came from a field survey performed in 1981–83. Exposure pat-terns have probably changed after that in the United States and elsewhere. The Finnishestimates were for the assessment period 1990–93. However, the reference values mayhave been outdated and their application to the present situation in another country istherefore questionable.

Conversions between different industrial coding systems were used in the processing oflabour force statistics and US exposure data. The major part of the labour force statisticscame from OECD directly in the UN ISIC Revision 2 coding system. However, theOECD data are not coded originally according to UN ISIC but according to nationalclassifications, which are then converted to UN ISIC. Conversions, different definitionsof the employed populations included, and estimations of missing values brought someinaccuracy and incomparability to the labour force statistics used in CAREX.

The CAREX system applied Finnish values to other EU countries in estimating the de-gree of multiple exposure. National modifications of multiple exposure multiplierswould have been preferable, especially if the exposure patterns were likely to differ sig-nificantly from the Finnish one.

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Overall, an approach based on expert assessments, is worthwhile if data from othersources are very unreliable. It can generate rather valid preliminary estimates on theprevalence of exposure or on the occurrence of health outcomes across countries withreasonable effort. However, uniform definitions and procedures need to be applied toimprove comparability of data across countries.

2.3.4 Observational surveys

Observational surveys at the national level are rare. They are usually very extensive be-cause the variability of working conditions requires large numbers of workplaces to bestudied to allow generalizations on the whole labour force. Therefore they also require asubstantial amount of organization, expert work and travelling. Their strength is thoughtto be the reliability of the results because they are based on observations and data inter-preted by experts.

Some advantages and disadvantages of observational surveys:

Advantages Disadvantages• based on uniform definitions and methodol-

ogy• conceptual definitions may be diffi-

cult to apply in practice• systematic, based on a representative sample• based on observations of experts and visits

to actual workplaces (reliability)

• based partly on subjective observa-tions

• validity may remain unknown• exposure levels difficult to assess• comparability poor across countries• slow and very expensive to carry out

An example: National Occupational Exposure Survey (NOES)

The National Occupational Exposure Survey (NOES) was conducted by the US Na-tional Institute for Occupational Safety and Health (NIOSH). NOES was a nation-wideobservational survey conducted in a sample of 4,490 establishments in 1981–83. Thetarget population was defined as employees working in establishments or job sites in theUS employing eight or more workers in a defined list of Standard Industrial Classifica-tions. Generally, these classifications emphasized coverage of construction, manufac-turing, transportation, private and business service, and hospital industries. The NOEShad little or no sampling activity in agriculture, mining, wholesale/retail trade, fi-nance/real estate, or government operations. NOES addressed recordable potential ex-posure. A potential exposure had to meet two criteria to be recorded: (1) A chemical,physical or biological agent or a trade name product had to be observed in sufficientproximity to an employee so that one or more physical phases of that agent or productwere likely to enter or contact the body of the employee; and (2) The duration of thepotential exposure had to meet the minimum duration guidelines (at least 30 min-utes/week on an annual average, or at least once per week for 90% of the weeks of thework year). NOES did not address the level of exposure at all. NOES covered about12,000 different hazards in 523 industrial and 410 occupational classes. Field work wascarried out by 15 surveyors between January 1981 and May 1983 (Seta et al. 1988,Greife et al. 1995).

The strength of field surveys is that they are based on representative, stratified samplesof workplaces, and the resulting data can therefore be used to estimate the numbers of

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exposed workers at the national level. A weakness of field studies is that they usuallyprovide no information on exposure levels, which makes risk assessment and targetingof preventive measures difficult. Subjectivity may also be a problem, especially whenlow or infrequent exposures are recorded. Field surveys are also laborious, slow and ex-pensive to carry out (Kauppinen and Toikkanen 1999).

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3. Indicators of prerequisites of occupationalhealth and safety

3.1 Occupational health and safety legislation and its coverage

Determining the quality of national OH&S legislation with indicators is complicated.However, a country profile should at least describe the relevant legislation. Internationalorganizations, such as the ILO and the EU, have set standards for national legislation intheir conventions and directives. The most important ILO standards are ILO ConventionNo. 155 on Occupational Safety and Health (1981) and No. 161 on Occupational HealthServices (1985). In Europe also the implementation of EU Council Directive 89/391/EEC and other related directives could be used as a proxy indicator for the quality andcompleteness of national legislation.

ILO collects information on the ratification of its OH&S conventions in the membercountries. Countries which have ratified most of the about 20 ILO Conventions con-cerning safety and health tend to have the highest legal coverage of OH&S laws andpolicies (Takala 1999b). The coverage influences the performance of enforcement (e.g.,safety inspection system), of the employment injury compensation system (e.g., re-cording of injuries and diseases), of the OH&S activities at workplaces (e.g., safetycommittees), and of the occupational health services. While the enforcement of occupa-tional safety and health legislation covers practically 100% in the Nordic countries, thefigure for many developing countries is close to 10% or less, leaving major hazardoussectors and occupations uncovered, such as agriculture, small-scale enterprises and theinformal sector. The same applies to basic compensation and recording systems in casesof occupational accidents and diseases, and to the coverage of occupational healthservice systems.

3.2 Coverage of occupational health service system

The coverage of occupational health (OH) service may refer to two things: the propor-tion of employed legally covered by OH services and the proportion of employed hav-ing access to the services. Both the extent of the legal coverage of the working popula-tion and the actual accessibility to OH services vary greatly worldwide. Over 80% ofthe workforce in Finland are covered by occupational health services, while 80–90% ofthe countries in the world have neither ratified the ILO Convention on OccupationalHealth Services, nor established other mechanisms to provide such services. The WHOestimates that this inaccessibility can be as high as 50% even in industrialized countries(Takala 1999b).

Information on the legal coverage of compulsory OH services by industrial sectors canbe obtained from the national authorities. This list can be complemented by industrialsectors and occupations, which can obtain voluntary services. It is more difficult to es-timate the accessibility of the services. There are countries in which compulsory OHservices are restricted to companies employing a certain number of employees, e.g. over300. It is also possible to limit compulsory services to particular OH services. An exam-

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ple is the United Kingdom, where health examinations in only specific hazardous jobsare compulsory. These exceptions must be noted. Public statistics, expert panels andsurveys can be used when estimations are made. We prefer to use accessibility insteadof legal coverage as an indicator of the coverage of OH services. Comparable dataacross countries on the accessibility of OH services can be collected by questionnaire-based surveys among the employed. The accessibility, however, does not in itself guar-antee that the OH service efficiently provides the appropriate services needed by thecustomers. Therefore it would be advantageous to have also indicators which describethe performance of OH services, and more widely, the performance of the whole OH&Ssystem.

3.3 Performance and resources of the occupational health andsafety system

The performance of the OH&S system depends on many factors such as legal base, cli-ent needs, adequate financial and human resources, efficient organization and manage-ment of service, competence and quality of the services. Again, the inter-country varia-tion is great. For instance, while in Germany a detailed description of the processes andtasks of OH personnel are included in the regulations, in Sweden, most of the servicesare based on client needs subject to contract negotiations between the OH service pro-viders and the enterprises.

Some of the services are more common than others. In a review of multidiciplinaryhealth services in the EU Member States, the two most commonly performed tasks weremedical health examinations and risk assessment (Reviews of Multidisciplinary Servi-ces in the EU Member States 1996). Curative services that are usually voluntary are in-cluded in the services in most of the EU countries, including France, where the OHservice is by law strictly preventive.

Each service has a different delivery process requiring one or more actors. A list of pro-cesses common in OH&S is given in Table 1. Safety inspections refer to inspections atworkplaces performed by any kind of labour, factory or safety inspectors. Only one in-dicator of the management of OH services is listed in Table 1, i.e., quality assurance.

Table 1. Key processes in OH&S. A model table for the evaluation of the performanceof a national/regional OH&S system. Alternative terms are presented (the most com-monly used in bold).

Process Yes/No

Compulsory/ Voluntary

Actors No. ofactions/actor

No. ofactions /1000 em-ployed

Workplace surveys , workplacevisits, exposure assessment, riskassessment and managementHealth examinations, health sur-veillance (general & risk-based)Workplace health promotion,health education, counselling

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Assessment of work ability, reha-bilitationCurative servicesFirst aid, accident managementEducation, training, informationcampaignsQuality assurance of OH proc-esses, auditsSafety inspectionsInitiatives and advice for man-agement of workplace safety andhealth; safe workplace design

Several problems exist in how the listed processes are understood and who is the princi-pal actor in each process. The problem with terms and definitions is illustrated in thetable by listing several terms with approximately the same meaning and bolding theterms used most in the English literature on the topic. The capacity ratios are suggestedto be used as performance indicators to measure how well employees are actually cov-ered by the services (the number of actions per 1000 employed) and how effectively theservices are functioning (the number of actions per actor). The actual content and rele-vance of actions is not known without further investigation at the national level.

These performance indicators of the OH&S system outlined in the two right-side col-umns of Table 1 are too many to be included in our core set of indicators. The collectionof data for them is also complex and would require unambiguous definitions and proce-dures to guarantee at least reasonable comparability across countries. Instead, it issomewhat easier to indicate the human resources (actors) available to perform thesetasks, although the composition of the team of professionals providing the services var-ies. For example, in the United Kingdom, an occupational health physician or a spe-cialized nurse can act solo. Experts from technical and psychosocial fields are called inwhen needed. In Denmark, the tasks of the OH teams are directed more towards con-sulting and assisting the management on technical and organizational aspects of worksafety and health. Consequently, the number of OH physicians in the team is low. Theservices both in Denmark and UK may be called multidisciplinary. The principal actorswho perform the tasks listed in Table 1 include occupational health physicians, occupa-tional health nurses, safety inspectors and workplace safety personnel (e.g., safety man-agers and safety representatives of workers). It is reasonable to count in also actors whodo this work part-time instead of including only a limited number of specialists workingfull-time. As far as possible, the numbers of actors should be presented as full-timeequivalents (person years) per 1000 employed. These figures may be available from na-tional registers, by using expert panels, or from national surveys. Sectorial analyses arealso possible. The underlining idea and limitation of this approach is that the human re-sources available reflect the level of activities, regardless of what they are.

3.4 Recommended core indicators of an occupational healthand safety system

The definitions of core indicators in the domain of the prerequisites of OH&S and thebasic reasons to include them are summarized in Table 2. This set represents indicators

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which in our opinion are relevant, valid and feasible. They also have potential for cross-country comparisons, although data from most countries are missing, with the exceptionof the ratification of ILO conventions. The sources of data to construct them and meth-ods to generate the missing data are described in section 7 (Recommendations).

Table 2. Recommended core indicators of prerequisites of occupational safety andhealth

Indicator Definition Reason for inclusion,comments

Ratification rate of rele-vant ILO key conven-tions on OH&S (% rati-fied)

Proportion of ILO conventions rele-vant to OH&S (N=20) which acountry has ratified thus far

Indicates the state andcoverage of OH&S legis-lation

Human resources in la-bour safety inspection(inspectors/ 1000 em-ployed)

Number of all types of labour safetyinspectors per 1000 employed work-ers

Indicates the state ofOH&S enforcement

Human resources in la-bour safety at workplaces(safety representativesand managers/ 1000 em-ployed)

Number of safety representatives ofworkers and safety managers atworkplaces per 1000 employedworkers

Indicates the state ofOH&S activities of thepersonnel at workplaces

Human resources in oc-cupational health serv-ices (physicians andnurses/ 1000 employed)

Number of physicians and nurses(full-time equivalents) in occupa-tional health services per 1000 em-ployed workers

Indicates the state of occu-pational health services

Coverage of occupationalhealth services (% of theemployed)

Proportion of employed who haveaccess to occupational health serv-ices based on a questionnaire-basedsurvey

Indicates the accessibilityof occupational healthservices

In addition to these core indicators, there are indicators on, e.g., the coverage of the en-forcement, of the compensation system and of the OH services, as well as the perform-ance indicators in Table 1, which can be used for the surveillance of prerequisites ofOH&S at the national or regional level (see Annex 2).

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4. Indicators of working conditions

The text in this section is partly based on a review article by two of the authors (Kaup-pinen and Toikkanen 1999).

4.1 Physicochemical and ergonomic factors

Physicochemical exposures are numerous. Physical agents of occupational importanceinclude noise, hand-arm vibration, whole-body vibration, heat, cold, draught, ionizingradiation and non- ionizing radiation. Thousands of chemical agents may have adversehealth effects. These include inorganic dusts (e.g., asbestos), organic dusts (e.g., flourdust), metals (e.g., lead), organic solvents (e.g., benzene) and other organic agents (e.g.,many pesticides). Examples of indicators of physicochemical exposures are presented inAnnex 2.

Microbiological hazards include viruses, bacteria, spores and other micro-organisms.Their exposure indicators are rare. It is more common to survey them through the inci-dence of infections or communicable diseases.

Ergonomic factors relevant to work include inconvenient and difficult work postures,manual handling of burdens (e.g., lifting), repetitive work movements, sedentary workand standing work. Perceived physical work load and work with video display unitsmay also be included among factors which may have physiological effects on workers.Examples of indicators of ergonomic exposures are presented in Annex 2.

The next sections describe briefly data sources which are used to construct physico-chemical and ergonomic indicators. The major sources are questionnaire-based surveys,occupational hygiene measurement and biomonitoring databases, observational surveys,registers of exposed workers, expert assessment systems, and statistics on consumption.

Questionnaire-based surveys

Questionnaire-based surveys are a rather common way to collect information on physi-cal, chemical and ergonomic factors at work. Examples of these are the NHANES Sur-vey in the USA, the ESWC Survey in the EU, and national surveys in the Nordic coun-tries. One such survey, the Second European Survey on Working Conditions, has beendescribed earlier (see section 2.3.2). They are a valuable source of information for thesurveillance of physical and ergonomic factors, provided that they specify clearly whatis meant by exposure. For chemical exposures, they tend to be unspecific and variablyinterpreted by the respondents by lumping together many chemicals with different ef-fects (e.g., ‘breathing in vapours’ or ‘handling dangerous chemicals’). Some widespreadchemical exposures can, however, be reliably identified by the respondents. These in-clude environmental tobacco smoke, engine exhaust, detergents, welding fumes andsolvents. The level of exposure cannot be reliably reported by the respondents, but theproportion of working time exposed can be used to distinguish those who are exposedcontinuously from those who are exposed temporarily. Indicators of exposure to noise,of handling dangerous chemicals, and of handling heavy loads, are based on interviewsurveys.

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Databases on occupational hygiene measurements and biomonitoring

Occupational hygiene measurement databases are maintained in many countries by re-search institutes, labour safety authorities, or companies (see e.g., Smith and Glass1993). These databases provide an overview of exposure levels and their trends. How-ever, the information is often based on compliance measurements from a selected sam-ple of workplaces which usually varies from year to year, making the results unrepre-sentative and difficult to interpret. Large measurement databases are laborious to main-tain because of their comprehensive coding requirements. The potential of measurementregisters to aid in the identification of work tasks entailing high exposure levels may beinsufficiently utilized. This type of ‘alarm’ information is essential for prevention, andits dissemination to workplaces should be promoted. Workplaces also need informationon feasible preventive measures to control excessive exposures. Although they arevaluable for risk identification and prevention, databases on occupational hygiene andbiomonitoring measurements can rarely be used directly in the construction of nationalexposure indicators. Indicators such as the proportion of measurements exceeding theexposure limit value have been constructed and used, but their interpretation is difficultif the workplace sample is not representative and varies over time. None of theindicators in our proposed core set is based on data from these kinds of registers.

Observational surveys

Examples of observational field surveys on the occurrence of exposure are the US Na-tional Occupational Hazard Survey (NOHS) in 1972–74, the US National OccupationalExposure Survey (NOES) in 1981–83 (Seta et al. 1988, Greife et al. 1995), the SUMERsurvey in France (Heran Le Roy and Sandret 1996), exposure surveys in Denmark(Brandorf et al. 1995, Seedorf and Olsen 1990) and an on-going survey in Israel. TheNOES Survey has been discussed in more detail previously (see section 2.3.4). NOESprovides estimates of the numbers of workers potentially exposed by industry, occupa-tion and gender in the United States in 1981–83. However, these estimates are influ-enced by the definition of potential exposure and its interpretation among field survey-ors. Field surveys also require much expert work, and they are difficult to repeat inother countries according to uniform methodology which would improve comparabilityof the data. The core set of proposed indicators does not include indicators which wouldrequire observational surveys.

Registers of exposed workers

Registers of exposed workers are rare. Some countries have a special register on work-ers exposed to ionizing radiation, but there is a lack of national or international registersof workers exposed to other hazards. One example of such a register is the FinnishRegister on Occupational Exposure to Carcinogens (ASA) (Kauppinen et al. 1992). Theobjectives of ASA were to stimulate identification, assessment and prevention of car-cinogenic exposures at workplaces, to target safety inspections, to enable targetedtraining and dissemination of information, and to enable national follow-up of occupa-tional cancer risks. The employers are obligated to notify exposed workers annually to anational register. ASA does not focus on true high-risk groups, because the minimumlevel of exposure is low and inaccurately defined. It is also likely that all exposed work-ers are not notified. In this sense ASA resembles other administrative registers and

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shares their problems, such as strong dependence on national legislation and notificationpractices, and incomplete coverage (see section 2.3.1).

Expert information systems

One international expert information system (CAREX) has been described previously(see section 2.3.3). CAREX utilized data from questionnaire-based surveys (e.g., envi-ronmental tobacco smoke), observational field surveys (e.g., NOES and SUMER), anexposure register (ASA) and national expert information systems (e.g., FINJEM). Allthese data were reviewed and assessed by a team of experts and modified by nationalexperts to generate carcinogen- and industry-specific exposure estimates for the EUcountries. Selected CAREX data and figures are shown in Annex 2. Our core set of in-dicators includes only one indicator on exposure to carcinogens, i.e. the consumption ofasbestos per capita.

An example of a national expert information system is the Finnish Job-Exposure Matrix(FINJEM Exposure Information System) (Kauppinen et al. 1998). This system providesquantitative information on exposure prevalences, levels, and numbers of exposedworkers by period, agent and occupation. FINJEM covers the major chemical, physical,microbiological, ergonomic and psychosocial factors occurring in Finland. It was con-structed with the help of about 20 experts who entered relevant background data on thelabour force and on exposures to a database, and assessed accurately defined exposuresaccording to a uniform procedure. This database has been used for surveillance pur-poses, in large epidemiological studies (e.g., in register-linkage studies) and as a generalmultipurpose databank on exposures.

Consumption statistics

Statistics on production and trade (export, import) statistics can in some cases providedata for indirect exposure indicators. If annual production, export and import figures areknown, domestic consumption can be estimated. One example is the use of asbestos. In1996 asbestos was produced in more than 16 countries and the production of the 8 mainproducers varied between 57,000 and 700,000 tons, and asbestos was consumed inabout 100 countries (Tossavainen and Takahashi 2000). The annual consumption percapita ranged from zero to 3.4 kg. This indicator has been shown to predict rather wellthe incidence of asbestos-induced mesothelioma 20–30 years after the consumption(Takahashi et al. 1999).

Another example is the annual consumption of pesticides which is a relevant surrogateexposure indicator, especially for developing countries where pesticide poisonings arecommon. The Food and Agriculture Organization of the United Nations (FAO) collectsnational data on pesticide use annually by a questionnaire. The data are maintained in adatabase, but there are some limitations, such as the high rate of non-response (only 50–60 countries provide data) and unknown comparability (some countries may report theweight of the formulation instead of the active ingredient) (www.fao.org/waicent/FAOINFO/economic/pesticid.htm). In spite of these limitations we propose the indica-tor ‘annual pesticide consumption per agricultural worker’ to be included for the mo-ment in the core indicator set. An alternative would be to use an effect indicator insteadof exposure indicator. However, official statistics on fatalities and poisonings due to ex-posure to pesticides are known to be unreliable due to notorious underreporting. Agri-

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cultural workers in many countries are not covered by any employment injury benefit orinsurance schemes. The World Health Organization (WHO) has estimated that the totalnumber of cases of pesticide poisonings is 2–5 million, out of which 40,000 are fatal(Forastieri 1999).

4.2 Psychosocial factors

Stress and other psychosocial factors are one of the top priorities of OH&S in industri-alized countries. They cover, e.g., challenges, social climate, control possibilities, socialdemands and supervisor support at work. Questionnaire-based surveys are the majorsource of information on psychosocial factors. The Second European Survey on Work-ing Conditions has been described in the previous chapters (see section 2.3.2). Data forFinland from the EU survey and from national surveys are presented in Annex 2.

Psychosocial factors are a challenging area of surveillance where indicators, surveymethods and interpretation of results still require research to provide more practical andvalid information. The theories and concepts in this area are not yet established, al-though the validity of different questions has been studied. Psychosocial factors can beclassified into two mutually overlapping classes (Tüchsen 1998):

1) workload factors, such as haste at work, difficult decisions, and threat of violence2) factors which modify the relationship between workload and health outcomes, such

as control possibilities and social support at work.

Modifying factors may weaken or strengthen the effect of workload factors. The effectsof psychosocial stress at work, such as burnout and psychosomatic symptoms, are clas-sified as outcome indicators, and are therefore not covered in this section.

We selected ‘working at very high speed’ as the indicator of psychosocial stress atwork. This indicator can be derived from one question in the ESWC Survey. Data inAnnex 2 suggest that it correlates strongly, e.g., with ‘working to tight deadlines’. Anadditional advantage of this question is that it is measured as a proportion of workingtime, which is more uniformly understood by respondents than less specific categories,such as often, sometimes, etc. (see e.g., Wikman 1991).

4.3 Working time arrangements

Also working time arrangements (total working time, shift-work, work at night, work onSundays, flexitime, etc.) may influence the health or social relationships of employees.Data on working time arrangements are usually collected in questionnaire-based surveyson working conditions or in labour force surveys. The general issues related to the va-lidity of one survey, the Second European Survey on Working Conditions, have beendiscussed previously (see section 2.3.2). Example definitions and data on working timearrangements are presented in Annex 2.

We propose one indicator on working arrangements to be included in the core set ofOH&S indicators: proportion of the employed working regularly over 50 h/week. Thereis evidence that regular long workdays increase the risk of exhaustion and burnout (Ka-limo and Toppinen 1997) which is one of the OH&S priorities in industrialized coun-

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tries. Especially if a high value for this indicator is combined with a high value for theindicator ‘high-speed work’, burnout may be expected to be a serious problem.

4.4 Life-style of the employed

A holistic view of OH&S considers the health of employees to be determined not onlyby their working conditions, but also by life-style factors. The most relevant lifestylefactors with health effects are tobacco smoking, alcohol consumption, diet and physicalactivity. Data on these factors usually come from questionnaire-based surveys. Exampledata for Finnish workers are presented in Annex 2. Some internationally comparabledata are also available, but they are not presented in this document (EC 2000).

Although life-style factors are relevant to health, we considered them to be outside thescope of the present document. Life-style factors are more important as public healthindicators than as OH&S indicators, and we preferred indicators which address directlyoccupational issues.

4.5 Recommended core indicators of working conditions

The definitions of core indicators in the domain of working conditions and the basicreason to include them are summarized in Table 3. This set represents indicators whichin our opinion are relevant, valid and feasible. They also have sufficient potential forcross-country comparisons. The sources of data to construct them and the methods togenerate missing data are described in section 7 (Recommendations).

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Table 3. Recommended core indicators of working conditions

Indicator Definition Reason for inclu-sion, comments

High levelnoise (% ofemployed)

Question in survey:How often are you exposed at work to each of the fol-lowing? (all of the time, almost all of the time, around ¾of the time, around half of the time, around 1/4 of thetime, almost never, never, don't know)

• Noise so loud that you would have to raise yourvoice to talk to people

Included if at least around ¼ of the time

Important physicalhazard

Handlingdangeroussubstances(% of em-ployed)

Question in survey:How often are you exposed at work to each of the fol-lowing? (all of the time, almost all of the time, around ¾of the time, around half of the time, around 1/4 of thetime, almost never, never, don't know)

• Handling or touching dangerous products or sub-stances

Included if at least around ¼ of the time

Indicates overallchemical exposure

Asbestosconsumption(kg/capita/y)

Reported consumption of asbestos in 1996 per capita Important carcino-gen

Pesticideconsumption(kg/agricul-turalworker/y)

Consumption of pesticides in 1998 per agriculturalworker as reported to FAO

Important toxicgroup of agents

Heavy loads(% of em-ployed)

Question in survey:How often does your main paid job involve each of thefollowing? (all of the time, almost all of the time, around¾ of the time, around half of the time, around 1/4 of thetime, almost never, never, don't know)

• Carrying or moving heavy loadsIncluded if at least around ¼ of the time

Important ergo-nomic factor

Working atvery highspeed (% ofemployed)

Question in survey:How often does your main paid job involve each of thefollowing? (all of the time, almost all of the time, around¾ of the time, around half of the time, around 1/4 of thetime, almost never, never, don't know)

• Working at very high speedIncluded if at least ¼ of the time

Importantpsychosocialfactor

Working atleast50h/week (%of employed)

Question in survey:How many hours do you usually work per week, in yourmain job?Included if at least 50 h/week

Indicates burnoutand workload

In addition to these core indicators, there are many other indicators in this domainwhich can be used for the surveillance of working conditions at the national or regionallevel (see Annex 2).

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5. Indicators of occupational health and safetyoutcomes

The text in this section is partly based on a review article by two of the authors (Kaup-pinen and Toikkanen 1999).

5.1 Accidents at work

Accidents at work receive a high priority worldwide, but especially in developingcountries. Statistics on occupational injuries and accidents are collected in almost allcountries for purposes of worker compensation and prevention. Definitions and notifi-cation practices are often based on regulations, and statistics are published annually.The coverage of statistics may be a problem especially when an accident causes only aminor injury leading to a short absence from work or no absence.

ILO collects information on fatal and non-fatal work accidents worldwide. A resolutionon statistics of occupational injuries was adopted at the 13th International Conference ofLabour Statisticians in Geneva in 1982. It defines work accidents as accidents occurringat or in the course of work which may result in death, personal injury or disease (ILO1999). However, the national definitions may vary. The numbers of work accidents mayrepresent reported or compensated accidents depending on the source of data. The num-bers may include also commuting accidents (on the way to or from work), and even oc-cupational diseases. The coverage of data may be limited to certain types of workers(employees, insured persons, full-time workers, etc.), or specific economic activities.The numbers are very much affected by the minimum number of days of absence fromwork (3 days vs. 1 day vs. no limit).

Cross-country comparisons require calculation of incidences (accident rates). They areusually expressed as rates per 1000 or 100 000 employees or persons insured, but theymay also be given as rates per million hours worked or per 1000 years of 300 days each.The most commonly available incidence rates are expressed as accidents per 100 000employees.

Fatal accidents are not reported to ILO from all countries of the world. Global figuresand rates for fatal accidents have been estimated by ILO (Takala 1999a). In 1994, theestimated total number of fatal occupational accidents was 335,000 and the average in-cidence was 14.0/100,000 workers. These figures include fatal accidents and traffic ac-cidents at work, but not commuting accidents or fatal health problems at work (e.g., as-bestos-induced deaths). The annual incidences ranged between 1 and 44 per 100,000employees. We propose this indicator to be included in the core set, although compara-bility across countries is slightly hampered by national differences in definitions, cover-age and reporting.

Comparability problems of non-fatal accidents are partly the same as for fatal accidents,but an additional problem is related to the seriousness of the accident. It is usuallymeasured as the number of days of absence from work. ILO collects global statistics on

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work accidents, but as for fatal accidents, national definitions and practices vary, re-sulting in questionable comparability (ILO 1999). The EU has prompted a project whichaims at harmonizing European statistics on accidents at work (ESAW)(Eurostat 1997).An accident at work is defined in this project as such that the person is unfit for workfor more than 3 calendar days apart from the day of the accident. An accident shouldoccur in the course of work. This includes road traffic accidents at work but not acci-dents when commuting to or from work. Also deliberate self-inflicted injuries and inju-ries emanating from strictly natural causes are excluded. Data for ESAW came from in-surance-based systems with 100% reporting of compensated cases (except in one coun-try), or from compulsory notification systems with varying reporting levels of notifiedcases. In some EU countries the reporting systems did not cover some types of profes-sional status (e.g., self-employed, working family members), some branches (e.g., thepublic sector, parts of the transport sector), or road traffic accidents during work. TheESAW project has produced national incidence rates of accidents at work with morethan 3 days of absence per 100,000 employees in 8–9 branches in 15 EU countries in1994–96. The incidence ranged from 1200 to 7200 per 100,000 employed in 1996 (Eu-rostat 1997). In spite of limitations and comparability problems, we propose for themoment that the incidence of work accidents as defined by the ESAW project will beincluded in the core set of OH&S outcome indicators. It is evident that such data are notdirectly available outside the EU countries, and require an expert estimation approach orstandardized data collection effort.

An alternative to the collection of harmonized statistics on occupational injuries is tocollect questionnaire-based survey data. The Labour Force Survey of the European Un-ion included in 1999 an ad hoc module on accidents at work and occupational diseases.The questions on accidents refer to accidents which caused injuries during the past 12months at work or in the course of work. Also the type of injury and the time elapsedfrom the accident to restarting of work are inquired. The results of this study are ex-pected to be published in 2001, and they may provide data for the construction of avalid indicator on work accidents which would be comparable across countries.

5.2 Occupational diseases

Occupational diseases are usually regulated in the same way as occupational injuries,and statistics are produced annually in most countries. National legislation, diagnosticpractices and notification procedures strongly influence the statistics. Comparability ofdata across countries is often very poor (Laursen et al. 1992). This was clearly revealedin the pilot project aiming at standardized European Occupational Disease Statistics (seesection 2.3.1). The incomparability of data across EU countries was obvious. It is likelythat these pilot statistics measure more the coverage of compensation and notificationsystems than the true incidence of occupational diseases. The value of this kind of com-parative statistics is in its ability to reveal gaps in the identification of occupational dis-eases and to stimulate discussion on the appropriateness of national legislation andpractices.

Although very difficult to compare across countries, statistics on occupational diseasesare important at the national level. Annex 2 provides data on occupational diseases inFinland. Data can be compared between regions within a country, or over time quite ac-curately, provided that the national system is the same in all regions and remains the

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same over time. Because the risk of occupational diseases varies greatly by industry andoccupation, more specific statistics identifying groups at high risk are essential for thiskind of statistics.

Because occupational diseases are traditionally a high priority outcome in OH&S, wepropose including an indicator in our core set. As incidence figures cannot be comparedat all across countries, we mention this fact in parentheses in the title of indicator to re-mind the users of the data. The proposed indicator is the annual incidence of 31 occupa-tional diseases per 100 000 employed. It is evident that such data are not directly avail-able outside the EU, and thus require an expert estimation approach (also within EUcountries) or a standardized data collection effort.

An alternative to an expert assessment project on occupational diseases would be tocollect questionnaire-based survey data. The Labour Force Survey of the EuropeanUnion in 1999 included an ad hoc module on accidents at work and occupational dis-eases. The questions on occupational diseases refer to illnesses, disabilities or otherphysical or mental health problems of the person during the past 12 months, which werecaused or aggravated by the work. This definition is wider than the traditional definitionof occupational disease which varies considerably by countries. Also the type of healthproblem, length of the sick leave and some characteristics of work are inquired. It is notyet possible to evaluate whether these questions in the survey could provide data for theconstruction of a valid indicator of occupational diseases which would be comparableacross countries.

5.3 Occupational mortality

The statistics on causes of death have been analysed by occupational title at least in theUK, USA, and the Nordic countries. Mortality patterns in different occupations are de-termined both by occupational and life-style factors. Only in rather rare cases are spe-cific occupational risks so strong that they influence significantly the mortality of anoccupational group. An example of such an occupation are insulators whose mortality tomesothelioma is substantially influenced by heavy exposure to asbestos. We do not pro-pose any mortality indicators (except fatal work accidents) to be included in our core setof indicators.

5.4 Occupational disability

Pension statistics have been analysed by occupation and diagnosis at least in the Nordiccountries (Tüchsen 1998). The work-relatedness of back pain, mental disorders andheart diseases may be studied through work disability data. As with occupational dis-eases, the state and trends of work disability depend significantly on the national legis-lation and practices. Because the etiology of work disability is often multifactorial, withboth non-occupational and work-related factors contributing to it, work disability ad-dresses only indirectly the effects of work. We do not propose any indicators on workdisability because of incomparability problems and the multifactorial nature of the out-comes.

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5.5 Occupational morbidity

The concept of work-related diseases includes occupational diseases that are predomi-nantly caused by occupational exposure, and other diseases to whose etiology or devel-opment work contributes. Such diseases include musculoskeletal diseases, mental disor-ders, cardiovascular diseases, respiratory diseases and cancer. The occurrence of work-related diseases and their determinants (age, gender, occupation, etc.) can be studied byquestionnaire-based surveys or from registers (disease-specific registers, hospital dis-charge registers). Particularly surveillance methods for musculoskeletal symptoms anddiseases have been developed during the 1990s (Kuorinka and Forcier 1995). Work-re-lated and occupational diseases may be surveyed in the same way as communicable dis-eases, through a network of individual health care providers. A system called SentinelEvent Notification System for Occupational Risks (SENSOR) was launched in the1980s in some states of the USA (Baker 1989). Case reports of work-related conditionsare analysed by a central state agency, which also coordinates follow-up and interven-tion activities to prevent occupational diseases. This approach has been applied, e.g., tosilicosis, asthma, pesticide poisoning (Maizlich et al. 1995a), lead poisoning and carpaltunnel syndrome (Maizlish et al. 1995b). The SENSOR approach is an alternative andcomplementary method to study work-related and occupational diseases if registers andsurveys are unsatisfactory. We considered that work-related diseases and occupationalmorbidity are issues which are still in the research mode, and not directly measurablewith established methods to allow indicators to be constructed. Although the SENSORapproach and national register-linkage approaches are able to provide interesting infor-mation on work-related morbidity, these systems are at the moment applicable only in afew countries, and they cannot form a basis for indicator data which would be compa-rable across countries.

5.6 Work ability

The mean age of the labour force is increasing in most industrialized countries, andtherefore problems caused by aging of the workforce and activities to maintain workers’ability to work have become a priority in OH&S. Work ability has become an importantsummarizing concept in the efforts to avoid early retirement of the aging labour force.Work ability may be considered to include not only physical health, psychosocial well-being and professional competence of individuals, but also an appropriate work envi-ronment and work organization which improve the performance of individuals at work(Ilmarinen 1997). The Work Ability Index (WAI), which is based on a person’s ownopinion of his/her work ability, diseases diagnosed by a physician, and sick leave duringthe past year, has been found to predict future work disability and early retirement(Tuomi et al. 1998, Eskelinen et al. 1991). Work ability can be measured by severalquestions in surveys (see Annex 2). However, the validity of WAI has not been suffi-ciently tested yet. There may also be other measures of work ability in preparation.

Because of its high priority in OH&S, we propose for the moment that one simple sur-vey question (the most predictive component question) of WAI would be used to indi-cate the state of the work ability of the employed. Data are probably available only froma limited number of countries which have used the WAI approach or have included thisspecific question in their national surveys on working conditions. This question is, how-ever, simple and easy to include in questionnaire-based surveys.

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5.7 Work-related health problems and absenteeism due to sick-ness

Work-related symptoms and health problems cover such outcomes as perceived stress,backache, overall fatigue, headache, muscular pain, sleeping disorders, and irritability.Absenteeism from work due to health problems may also be work-related, althoughnon-occupational reasons usually dominate.

The Second European Survey on Working Conditions includes a set of questions onwork-related health problems and absenteeism (see Annex 2). Analysis of the symptomsreported in questionnaire-based surveys may reveal new or existing risks at work. How-ever, because also non-occupational symptoms are common, attention needs to be givento the collection of precise information on symptom frequency and severity to identifywork-related symptoms (Wegman 1994). Due to this confounding by non-occupationalfactors, the indicators of work-related symptoms at the national level do not address di-rectly OH&S hazards. Absenteeism depends both on work and on other factors, such asage, gender and life-style. Although work-related problems are a useful outcome to fol-low at the workplace level, we do not recommend any indicators to be included in thecore set due to the complex relationship between work and these outcomes.

5.8 Recommended core indicators of occupational health andsafety outcomes

The definitions of core indicators in the domain of OH&S outcomes and the basic rea-son to include them are summarized in Table 4. This set represents indicators which inour opinion are relevant, valid and feasible. They also have sufficient potential forcross-country comparisons. The sources of data to construct them and methods to gen-erate missing data are described in section 7 (Recommendations).

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Table 4. Recommended core indicators on occupational health and safety outcomes

Indicator Definition Reason for inclusion,comments

Fatal workaccidents

Cases of fatal accidents and traffic accidents atwork per 100,000 employees; does not includecommuting accidents and fatal health problemsat work

High priority outcome

Work acci-dents

Cases of accidents and traffic accidents atwork with more than 3 days absence per100,000 employees; does not include com-muting accidents, deliberate self-inflicted inju-ries or injuries emanating from strictly naturalcauses

High priority outcome,data not comparableacross countries outsideEU

Occupationaldiseases (in-comparableacross coun-tries)

Cases of 31 occupational diseases as definedby EU per 100,000 employees

High priority outcome,data not comparableacross countries

Perceivedwork ability(0–10 scale)

Question in survey:Assuming that your work ability at its best isworth 10 points, how many points would yougive to your current work ability (scale 0–10)?0 means that you are not able to work at all.

Basis for a Work AbilityIndex

In addition to these core indicators, there are many other indicators on this domainwhich can be used for the surveillance of working conditions at the national or regionallevel (see Annex 2).

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6. Presentation of indicators

The advisory committee of WHO recommended in 1997 a method to visualize the gen-eral health status of a population. The method was called the Visual Health InformationProfile (VHIP) method (WHO 1997). The core of the method is a multi-dimensionalcircular radar figure where each dimension represents one indicator. The scale of eachdimension ranges from 1 to 10. Value 1 is in the outer circle and represents a situationwhere urgent improvements are needed. Value 10 is in the centre and represents a goodsituation. The values representing the health status of a population (national or regional)form a profile within the radar. There may be several profiles within the circle repre-senting the situations between countries, between regions, between two dates, or be-tween a specific region and the country. These profiles allow visual comparisons andevaluations to be made, and a database provides additional information if needed.

We adopted the basic idea of the VHIP method, and applied it to the field of occupa-tional safety and health. We call the resulting profiles Work and Health InformationProfiles (WHIP). WHIP data can be compared between countries, between the regionswithin one country, and over time within a country or region. Examples of radar figureswhich compare the index country (Finland) with other countries, or two periods withinthe index country, are presented in Annex 2. In cross-country comparisons we haveadopted the benchmarking approach so that the best country (benchmark) is closest tothe centre of the figure and the worst country closest to the circle. The ‘best’ and ‘worst’countries vary by indicator and are based only on countries for which indicator datawere available. The index country (=country of interest) is shown in the figures betweenthe best and worst country. A commonly available spreadsheet programme (MS Excel)was used to generate figures.

Several technical problems were encountered while constructing their visual presenta-tions:

- directionality of indicators- scaling of indicator values- visualization of great differences between indicators- visualization of small temporal changes of an indicator- comparing indicators from different dates- standardization of values by economic structure- presenting missing information- presenting incomparable information.

A high value of an indicator may represent a good or a bad state of affairs, depending onthe indicator. A high value is good if the prerequisites of OH&S (coverage, resources,etc.) are considered, but bad if hazards or adverse health outcomes are considered. Thisdirectionality of indicators means that the benchmark would be variably close to thecentre or outer circle of the radar figure if the figure includes indicators whose direc-tionality is different. This would complicate the interpretation of the figure. In order toavoid this we turned the scale around. The visual message is now correct. The turning ofthe scale is indicated in parentheses in the title of the indicator (e.g., scale 100–0%).

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The scales of indicators may be absolute or proportional. Absolute scales have the ad-vantage of providing information in easily comprehensible terms. For example, theprevalence of hazard in a population is expressed in terms of % of workers exposed. Ifall prevalences are, say between 5% and 10%, an absolute scale of 0–100% forces thefigure close to the very centre of the radar figure, making visual comparisons difficult.If a proportional scale, e.g. 5–10% is used, the values of the best country, index country,and worst country are well spread between the centre and circle, but the values are nolonger directly absolute prevalences. A further complication with scaling is that differ-ent indicators are expressed in variable units (%, hours per week, cases per 1000, 10,000or 100,000 employed, or per million, etc.). We therefore compromised between absoluteand proportional scales. We used absolute scales (0–100%) when the variability be-tween countries was sufficient (see e.g., Annex 2, Figure on the prevalence of workingtime arrangements). If the variability was small, a proportional scale was used, as forthe average working time, which was scaled between 30 and 50 h/week in the same fig-ure. It was also convenient to cut the upper end of the scale if all indicator values weresmall. For example, if all figures were below 50%, we set the maximum to 50% to in-crease the visual spread between the best, index and worst countries (see e.g. Annex 2,Figure on prevalence of exposure to physical and chemical agents). In the incidence fig-ures we also modified the units (e.g., from cases/million hours to cases/10 millionhours) in order to have the values in the same absolute scale (see e.g. Annex 2, Figureon incidence of work accidents and occupational diseases). When the unit of the indi-cator is not %, it is shown in parentheses in the title of the indicator.

A special case of scaling concerned situations where the prevalences of related indica-tors were widely distributed between high and low values (see e.g. Annex 2, Figure onexposure to carcinogens). A radar figure is not very informative in such cases becausemost values are too close to the centre. For these kinds of cases we recommend usingalternative figures. The same information is more clearly presented as vertical (or hori-zontal) lines where the best and worst countries are at the lower and upper end of theline, and the position of the index country is marked on the line (see the alternative fig-ure on exposure to carcinogens in Annex 2). This presentation visualizes better largedifferences between related indicators.

Figures which describe changes over time (trends) within a country are sometimes alsodifficult to visualize in radar figures. This is the case when the changes are small butstill significant (see e.g. Annex 2, Figure on changes in work ability). The small im-provement in the mean value of perceived work ability of the employed is hardly visiblein the Figure, even though it is significant. Temporal changes are often better presentedby line diagrams. We have included as an example one line diagram on changes in theincidence of major types of occupational diseases over time.

Another minor problem with radar figures on temporal trends is that data on differentindicators may come from different years. In the figures we have simply omitted theseslight inconsistencies of years and referred only to ‘earlier year’ and ‘later year’. An-other alternative would have been to give the years in parentheses in the title of the indi-cator.

The indicator figures presented in this document are not standardized by economicstructure of the country. Therefore many differences between countries may have natu-ral explanations. For example, the consumption of pesticides per capita is probably low

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if agriculture is only a minor sector in a country. Sector differences in the risk can bepresented, e.g., as horizontal bar figures (see Annex 2, Figure on allergic respiratory dis-eases by sector). When comparing countries, one could improve comparability by usingas reference countries only such countries which have a rather similar economic struc-ture. For example, comparing industrialized countries with developing countries may beinappropriate due to their different economic structure. The World Bank has classifiedcountries to 6 groups by area and to 4 groups by income (gross national product, GNP)which may improve comparability of data when an indicator is significantly correlatedwith area or income of the country (for the classifications, see www.worldbank.org/data/databytopic/class.htm).

Another option to improve comparability is to standardize indicator values by the eco-nomic structure of the employed. For example, the prevalence of high-level noise in theEU countries may be standardized by economic structure, and the observed prevalencecan be compared with the prevalence expected on the basis of the economic structure ofthe country (see Annex 2, Figure on exposure to noise by country, from Marklund2000).

When data on an indicator of the index country is missing, we indicate this in parenthe-ses in the title of the indicator. If reference data are missing, the index country is simul-taneously the best and worst country.

If the current data are essential but incomparable across countries, as for occupationaldiseases, the incomparability is indicated in parentheses in the title.

For the core set of indicators we have presented two different profile figures: a multi-dimensional radar figure, and a proportional vertical bar figure. In the bar figure zerorepresents the worst country and 100 the best country.

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7. Recommendations

7.1 Proposed core set of indicators

The criteria of a good core set of indicators to describe the state of OH&S in a countryor region are the following (Noll 2000b, modified):

- consistency (indicators well-defined, valid and comparable)- non-redundancy (each indicator addresses a different issue)- comprehensiveness (indicators cover all relevant areas of OH&S)- parsimoniousness (indicators are as simple as possible, and not too

many).

Our selection of proposed core indicators is presented in Table 5. The reasons for inclu-sion of the indicator and its definition are described in the preceding, domain-specificchapters. We consider all proposed indicators as relevant for OH&S, and many of themaddress high priority issues predominantly in industrialized countries. Their validity isgenerally good in the defined form, and most of them provide rather comparable dataacross countries. Comparability is a serious problem for the indicator on occupationaldiseases, and problematic for indicators on prerequisites of OH&S (except ILO ratifica-tions), pesticide consumption and work accidents. Our set was also planned to be non-redundant and parsimonious. The set contains only simple (non-composite) indicatorsand is limited to 16 key indicators. We decided to avoid composite indicators becausethey require complete data on component indicators which are usually not available, andjudgment on the weights of component indicators which is subjective and therefore de-batable. Our set therefore became incomprehensive. By selecting only the most relevantsimple indicator from one area (e.g., high level noise to represent physical agents), ourapproach omits other indicators of the area which may be significant at the nationallevel (e.g., cold, heat, etc.). Another implication of this approach is that countries cannotbe directly ranked by the overall state and performance of the OH&S system accordingto this set of indicators. The ranking would require construction of an algorithm whichsummarizes information (and lack of information) from different indicators into one in-dex.

The core set proposed in this document is just a crude comparative tool to evaluate thestate of OH&S in a country/region in regard to other countries/regions. Therefore moredetailed indicator sets and surveillance methods should be used at the national/regional/provincial level to identify risks and problems in OH&S aiming at effective preventionof adverse health outcomes and improvement of the health of workers. Therefore alsothe construction of more comprehensive country profiles including essential descrip-tions and indicator data is highly recommended.

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Table 5. Recommended core indicators on occupational health and safety

DOMAIN/indicator Source of infor-mation

Availabilityof data

Collection ofmissing data

OH&S SYSTEMRatification of ILO OH&S con-ventions (% of conventions)

ILO most ILOcountries

by ILO

Human resources in laboursafety inspection (inspectors/1000 employed)

national statistics orestimates

limited by expert as-sessment

Human resources in laboursafety at workplaces (safety rep-resentatives and managers/ 1000employed)

national statistics orestimates

limited by expert as-sessment

Human resources in occupa-tional health services (physiciansand nurses/ 1000 employed)

national statistics orestimates

limited by expert as-sessment

Coverage of occupational healthservices (% of the employed)

nationalquestionnaire-basedsurveys

limited by expert as-sessment orquestionnaire-based survey

WORKING CONDITIONSHigh-level noise (% of em-ployed)

EU surveys 15 EUcountries

by question-naire-basedsurveys

Handling dangerous substances(% of employed)

EU surveys 15 EUcountries

by question-naire-basedsurveys

Asbestos consumption(kg/capita/y)

national statistics orestimates

most coun-tries

by expert as-sessment

Pesticide consumption(kg/agricultural worker/y)

national statistics orestimates

around 60FAO coun-tries

by FAO, or byexpert assess-ment

Heavy loads (% of employed) EU surveys 15 EUcountries

by question-naire-basedsurveys

Working at very high speed (%of employed)

EU surveys 15 EUcountries

by question-naire-basedsurveys

Working at least 50h/week (% ofemployed)

EU surveys 15 EUcountries

by question-naire-basedsurveys

OH&S OUTCOMESFatal work accidents national statistics most coun-

triesby ILO

Work accidents national statistics orestimates

EU countries by ILO, byexpert assess-ment, or byquestionnaire-based surveys

Occupational diseases (incompa-rable across countries)

national statistics orestimates

most coun-tries

by expert as-sessment, orby question-naire-based

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surveysPerceived work ability (0–10scale)

national surveys very limited by question-naire-basedsurveys

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Table 6. Data for recommended core indicators on occupational health and safety,Finland as an example country

DOMAIN/indicator Bestcoun-try

Indexcoun-try

Worstcoun-try

Referencecountries

Remarks

OH&S SYSTEMRatification of ILO OH&S con-ventions (% of conventions)

90 80 0 ILO memberstates (ca.180)

scale 100–0 %

Human resources in laboursafety inspection (inspectors/1000 employed)

0.20 0.16 0.05 7 Europeancountries

scale 0.2–0

Human resources in laboursafety at workplaces (safety rep-resentatives and safety manag-ers/ 1000 employed)

- 11 0 Finland only scale 15–0

Human resources in occupa-tional health services (physi-cians and nurses/ 1000 em-ployed)

1.2 1.2 0.1 7 Europeancountries

scale 1.5–0

Coverage of occupational healthservices (% of the employed)

87 87 10 7 Europeancountries

scale 100–0 %

WORKING CONDITIONSHigh-level noise (% of em-ployed)

21 39 39 EU memberstates (N=15)

scale 0–50 %

Handling dangerous substances(% of employed)

10 18 32 EU memberstates (N=15)

scale 0–50 %

Asbestos consumption(kg/capita/y)

0 0 3.4 all countries(over 200)

scale 0–4 kg

Pesticide consumption(kg/agricultural worker/y)

0 12 181 FAO (N=54) scale 0–200 kg

Heavy loads (% of employed) 24 38 40 EU memberstates (N=15)

scale 0–50 %

Working at very high speed (%of employed)

37 71 71 EU memberstates (N=15)

scale 0–100 %

Working at least 50h/week (%of employed)

8 13 38 EU memberstates (N=15)

scale 0–40 %

OH&S OUTCOMESFatal work accidents (/100,000employed)

1.4 3.2 43.7 ILO memberstates (ca.180)

scale 0–50/100,000

Work accidents (/1000 employ-ees)

13 35 73 EU memberstates (N=15)

scale 0–100/1000

Occupational diseases (/1000employees, incomparable acrosscountries)

0.02 1.7 1.7 EU memberstates (N=15)

scale 0–2/1000

Perceived work ability (0–10scale)

- 8.0 - Finland only scale 9–7

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Two alternative WHIP figures based on the above data are shown on the followingpages. Note that data are very scarce for some of the indicators (Table 6); these figuresare shown only as illustrative examples of the core indicators of OH&S.

7.2 Other proposals

Our analysis and proposal on core indicators is preliminary by nature. The feasibility ofthis indicator set and approach is unknown apart from Finland which was used as a testcountry in the preparation of this document. The process of constructing OH&S indica-tors and related data collection can be outlined to proceed through the following stages:

1) Preliminary analysis of sources of data for national OH&S indicators and countryprofiles (included in this document)

2) Preliminary proposal on national core OH&S indicators (included in this document)3) Piloting of national core OH&S indicators in selected countries (test of feasibility)4) Evaluation of national core OH&S indicators (relevance, validity) and of data col-

lection procedures (feasibility) by group(s) of experts5) Proposal on final national core OH&S indicators, and on data collection procedures

by group(s) of experts.

The proposed set of key indicators should first be discussed and, if appropriate, modi-fied by interested parties. The next step could be testing of the feasibility of the core setof OH&S indicators in some countries. The piloting could take place, for example, inone EU country, in one EU candidate country, in one newly industrialized country, andpossibly in one developing country.

It is already known that the availability of indicator data varies from very good to verylimited (see Table 5). Our aim was to include relevant and valid indicators, for whichdata are either available, or can be made available with reasonable effort. A substantialpart of the missing data can be collected by adding a simple question (as defined in thisdocument) in national questionnaire-based surveys. This may be rather easy in countrieswhere questionnaire-based surveys are established, but difficult in countries without atradition and sufficient infrastructure for carrying out such surveys. Another major ap-proach to collect missing data is expert assessment (see section 2.3.3). This method re-quires a team of experts which plans a suitable estimation procedure and contacts na-tional focal points which can provide national information needed in the estimation.National experts can also check the results of the estimation, modify them, and interpretthem together with the international expert team. Expert assessment projects could beorganized, e.g., by WHO/EURO, EU/Bilbao, EU/Dublin, WHO or ILO which all havenetworks of national focal points.

If piloting and evaluation suggest that this kind of an indicator set is useful and feasible,the project could continue by construction of an international database, data collectionfor indicators from focal points, expert assessment efforts to generate missing data, or-ganization of questionnaire-based surveys in selected countries, and reporting and dis-semination of information through the Internet.

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Maizlish N, Rudolph L, Dervin K. The surveillance of work-related pesticide illness: an appli-cation of the Sentinel Event Notification System for Occupational Risks (SENSOR). Am J PublHealth 1995a;85:806–11.

Marklund S (ed). Arbetsliv och hälsa 2000. Arbetslivsinstitut/Arbetarskyddsstyrelsen 2000.

Noll H. Social indicators and social reporting: The international experience.(www.ccsd.ca/noll1.htm). 2000b

Noll H. The European System of Social Indicators (unpublished paper). 2000a (www.zuma-mannheim.de/data/social-indicators).

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Piirainen H, ym. Työ ja Terveys -haastattelututkimus v.1997. Taulukkoraportti, Työterveys-laitos, Helsinki 1997.

Piirainen H, ym. Työ ja Terveys -haastattelututkimus v.2000. Taulukkoraportti, Työterveys-laitos, Helsinki 2000.

Rantanen J. Role of occupational health services in the improvement of workers' health.Presentation made in New Trends and Developments in OHS, 3–6 October 1989, Helsinki,Finland.

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Reviews of Multidisciplinary Services in the EU Member States. CASA. October 1996. Centrefor Alternative Social Analysis, Copenhagen, Denmark.

Seedorf L, Olsen E. Exposure to organic solvents I. A survey on the use of solvents. Ann OccupHyg 1990;34: 371–8.

Seta J, Sundin D, Pedersen D. National Occupational Exposure Survey. Volume I. Survey man-ual. Cincinnati: National Institute for Occupational Safety and Health, 1988.

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Takala J. Indicators of death, disability and disease at work. Asian-Pacific Newsletter on Occu-pational Health and Safety 2000;7:4.8.(www.ilo.org/public/english/protection/safework/accidis/index.htm).

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WHO. World Health Organization (WHO), Regional Office for Europe. Printout of HFA data-base and some other data available in the WHO Regional Office for Europe. Copenhagen:WHO Regional Office for Europe, 1994.

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ANNEX 1. Compiled concepts and terms

coverage: A measure of the extent to which the services rendered covered the potentialneed for these services in a community. It is expressed as a proportion in which the nu-merator is the number of services rendered, and the denominator is the number of in-stances in which the service should have been rendered. (see Last 1988)

criterion: A criterion is a standard by which something is judged, and may be technicalor social. A technical criterion for the safety of drinking-water would be a certain tech-nical standard for water purity; a social criterion for the suitability of drinking-waterwould be the acceptance of its taste by the people for whom it is intended. (WHO 1984)

demography: The study of populations, especially with reference to size and density,fertility, mortality, growth, age distribution, migration, and vital statistics, and the inter-action of all these with social and economic conditions. (see Last 1988)

health: Is defined in the Preamble of the Constitution of the WHO as a state of com-plete physical, mental and social well-being and not merely the absence of disease orinfirmity. In 1978, WHO-EURO referred to health as a dynamic process which dependslargely on the individual capacity to adapt to the environment; to be healthy means tomaintain an intellectual and social activity despite any disorders or handicaps. (see ILO1997)

health care: Those services provided to individuals or communities by agents of thehealth services or professions, for the purpose of promoting, maintaining, monitoring, orrestoring health. Health care is broader than, and not limited to medical care, which im-plies therapeutic action by or under the supervision of a physician. The term is some-times extended to include self-care. (see Last 1988)

health indicator: A variable, susceptible to direct measurement, that reflects the stateof health of persons in a community. Examples include infant mortality rates, incidencerates based on notified cases of disease, disability days, etc. These measures may beused as components in the calculation of a health index. (see Last 1988)

health services: Services that are performed by health care professionals, or by othersunder their direction, for the purpose of promoting, maintaining, or restoring health. Inaddition to personal health care, health services include measures for health protectionand health education. (see Last 1988)

health statistics : Aggregated data describing and enumerating attributes, events, be-haviours, services, resources, outcomes, or costs related to health, disease, and healthservices. The data may be derived from survey instruments, medical records, and ad-ministrative documents. Vital statistics are a subset of health statistics. (see Last 1988)

indicator: A thing that serves to give an indication or suggestion of something else; Adevice which indicates the condition of a machine etc.; which draws attention or giveswarning, Something used in a scientific experiment to indicate some quality, change,etc. (see Oxford 1993)

61

If the aim of the programme is to train a number of auxiliary workers annually, thenumber of workers trained each year is a direct – or output – indicator. If the aim is toimprove child health, several indicators could be used, such as nutritional status, psy-chosocial development, the immunization rate, or the morbidity and mortality rates.While efforts are normally made to quantify indicators , this is not always possible.Moreover, evaluations cannot always be made by aggregating numerical values alone.Qualitative indicators are therefore often used, for example, to assess people's in-volvement and their perception of their health status.

WHO has proposed four categories of indicators: health policy indicators ; social andeconomic indicators ; indicators of health care delivery; and indicators of healthstatus , including quality of life. It should be emphasized that, while indicators help tomeasure the attainment of targets, they are not in themselves targets. Indicators have tobe selected carefully to make sure that they are responsive to current trends of develop-ment and that they are useable for the analysis of ongoing activities. When selecting in-dicators, full account has to be taken of the extent to which they are valid, objective,sensitive and specific.

Validity implies that the indicator actually measures what it is supposed to measure.Objectivity implies that even if the indicator is used by different people at differenttimes and under different circumstances, the results will be the same. Sensitivity meansthat the indicator should be sensitive to changes in the situation or phenomenon con-cerned. However, indicators should be sensitive to more than one situation or phenome-non. Specificity means that the indicator reflects changes only in the situation or phe-nomenon concerned. Another important attribute of an indicator is its availability,namely that it should be possible to obtain the data required without undue difficulty.(see WHO 1978)

medical data: Are those data collected for medical purposes, i.e., for the purpose ofpractising medicine; such data are those collected by a physician or by a health profes-sional (for instance, a nurse or a paramedic) working under a physician's responsibilityand should only be used for medical purposes. (see ILO 1997)

monitor: Something that serves to remind or give warning; to oversee, supervise, orregulate; to watch closely for purposes of control, surveillance, etc.; keep track of;check continually. (see Webster 1996)

notifiable disease: A disease that, by statutory requirements, must be reported to thepublic health authority in the pertinent jurisdiction when the diagnosis is made. (seeLast 1988)

occupational health: Since 1950, the ILO and WHO have had a common definition ofoccupational health, revised in 1995: Occupational health should aim at: the promotionand maintenance of the highest degree of physical, mental and social well-being ofworkers in all occupations; the prevention amongst workers of departures from healthcaused by their working conditions; the protection of workers in their employment fromrisks resulting from factors adverse to health; the placing and maintenance of the workerin an occupational environment adapted to his physiological and psychological capa-bilities; and, to summarize, the adaptation of work to man and of each man to his job.

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The main focus in occupational health is on three different objectives: (i) the mainte-nance and promotion of workers' health and working capacity; (ii) the improvement ofworking environment and work to become conducive to safety and health; and (iii) de-velopment of work organizations and working cultures in a direction which supportshealth and safety at work and in doing so also promotes a positive social climate andsmooth operation and may enhance productivity of the undertakings. The concept ofworking culture is intended in this context to mean a reflection of the essential valuesystems adopted by the undertaking concerned. Such a culture is reflected in practice inthe managerial systems, personnel policy, principles for participation, training policiesand quality management of the undertaking. (see ILO 1997)

occupational health care: Refers to the care of the health of workers. It includes pre-ventive health care, health promotion, curative health care, first aid, rehabilitation andcompensation, where appropriate, as well as strategies for prompt recovery and return towork. (see ILO 1997)

occupational health data: Are those data collected for occupational health purposes;such data are collected by an occupational health professional. Minimum requirementsshould be established with regard to sensitive health data which should be covered bymedical confidentiality. (see ILO 1997)

occupational health professionals: Are persons who have been accredited through ap-propriate procedures to practise a profession related to occupational health or who pro-vide occupational health services according to the provisions of relevant regulations.Occupational health professionals include all those who by profession carry out occu-pational safety and health activities, provide occupational health services or who are in-volved in occupational health practice, even if only occasionally. They may be occupa-tional health physicians, nurses, occupational safety and health inspectors, occupationalhygienists, occupational psychologists and specialists involved in ergonomics, accidentprevention and the improvement of the working environment, as well as in occupationalhealth and safety research. Many others, in addition to occupational health and safetyprofessionals, are involved in the protection and promotion of the health of workers, e.g.management and workers' representatives. (see ILO 1997)

occupational health services: services entrusted with essentially preventive functionsand responsible for advising the employer, the workers and their representatives in theundertaking on the requirements for establishing and maintaining a safe and healthyworking environment which will facilitate optimal physical and mental health in rela-tion to work and the adaptation of work to the capabilities of workers in the light oftheir state of physical and mental health. (ILO Convention No. 161, see Rantanen & Fe-dotov 1998)

occupational health services, functions of: The ILO Convention No. 161 specifies thatoccupational health services should include those of the following functions that areadequate and appropriate to the occupational risks at the worksite:- identification and assessment of the risks from health hazards in the workplace;- surveillance of the factors in the working environment and working practices which

may affect workers’ health, including sanitary installations, canteens and housingwhere these facilities are provided by the employer;

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- advice on planning and organization of work, including the design of workplaces, onthe choice, maintenance and condition of machinery and other equipment and onsubstances used in work;

- participation in the development of programmes for the improvement of workingpractices, as well as testing and evaluation of health aspects of new equipment;

- advice on occupational health, safety and hygiene and on ergonomics and individualand collective protective equipment;

- surveillance of workers’ health in relation to work;- promoting the adaptation of work to the worker;- contributing to measures of vocational rehabilitation;- collaborating in providing information, training and education in the fields of occu-

pational health and hygiene and ergonomics;- organizing first aid and emergency treatment;- participating in analysis of occupational accidents and occupational diseases. (see

Coppée 1998).

occupational health practice: Consists not only of the activities performed by the oc-cupational health service. It is multidisciplinary and multisectoral activity involving inaddition to occupational health and safety professionals other specialists both in the en-terprise and outside, as well as competent authorities, the employers, workers and theirrepresentatives. Such involvement requires a well-developed and well- coordinated sys-tem at the workplace. The necessary infrastructure should comprise all the administra-tive, organizational and operative systems that are needed to conduct the occupationalhealth practice successfully and ensure its systematic development and continuous im-provement. (see Rantanen & Fedotov 1998)

occupational health surveillance: Is the ongoing systematic collection, analysis, inter-pretation, and dissemination of data for the purpose of prevention. Surveillance is es-sential to the planning, implementation and evaluation of occupational health pro-grammes and control of work-related ill health and injuries and the protection and pro-motion of workers' health. Occupational health surveillance includes workers' healthsurveillance and working environment surveillance. (see ILO 1997)

occupational health surveillance system: Is a system which includes a functional ca-pacity for data collection, analysis and dissemination linked to occupational health pro-grammes. It refers to all activities at individual, group, enterprise, community, regionaland country levels to detect and assess any significant departure from health caused byworking conditions and to monitor workers' general health. Occupational health sur-veillance programmes record instances of occupational exposures or work-related ill-ness, injury or death and monitor trends in their occurrences across different types ofeconomic activities, over time, and between geographical areas. (see ILO 1997)

occupational health and safety: (Syn: occupational safety and health) Is the disciplinedealing with the prevention of work-related injuries and diseases as well as the protec-tion and promotion of the health of workers. It aims at the improvement of workingconditions and environment. Members of many different professions (e.g., engineers,physicians, hygienists, nurses) contribute to occupational safety, occupational health,occupational hygiene and improvement of the working environment. (see ILO 1997)

64

parameter: In mathematics, a constant in a formula or model; in statistics and epide-miology, a measureable characteristic of a population. (see Last 1988)

periodic medical examinations : Assessment of health status conducted at predeter-mined intervals, e.g., annually or at specified milestones in life such as preemployment,or preretirement. This form of medical examination generally follows a formal protocol,e.g., employing a set of structured questions and/or a predetermined set of laboratorytests. (see Last 1988)

primary health care: Health care that begins at the time of first encounter between apatient and a provider of health care; An alternative terms is primary medical care.The WHO definition of primary health care includes much more: Primary health care isessential health care made accessible at a cost the country and the community can af-ford, with methods that are practical, scientifically sound, and socially acceptable. Eve-ryone in the community should have access to it, and everyone should be involved in it.Related sectors should also be involved in it in addition to the health sector. At the veryleast is should include education of the community on the health problems prevalent andon methods of preventing health problems from arising or of controlling them; the pro-motion of adequate supplies of food and of proper nutrition; sufficient safe water andbasic sanitation; maternal and child health care including family planning; the preven-tion and control of locally endemic diseases; immunization against the main infectiousdiseases; appropriate treatment of common diseases and injuries; and the provision ofessential drugs. (see Last 1988)

profile: A verbal, arithmetical, or graphic summary or analysis of the history, status,etc., of a process, activity, relationship, or set of characteristics: a biochemical profile ofa patient's blood; a profile of national consumer spending; a set of characteristics orqualities that identify a type or category of person or thing (see Webster 1996)

public health: Public health is one of the efforts organized by society to protect, pro-mote, and restore the people's health. It is the combination of sciences, skills, and be-liefs that is directed to the maintenance and improvement of the health of all the peoplethrough collective or social actions. The programmes, services, and institutions involvedemphasize the prevention of disease and the health needs of the population as a whole.Public health activities change with changing technology and social values, but thegoals remain the same; to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population. Public health is thus a social in-stitution, a discipline, and a practice. (see Last 1988)

qualitative data: Observations or information characterized by measurement on a cate-gorical scale, i.e., a dichotomous or nominal scale, or, if the categories are ordered, asordinal scale. Examples are sex, hair colour, death or survival, and nationality. (see Last1988)

register, registry: In epidemiology the term "register" is applied to the file of data con-cerning all cases of a particular disease or other health-relevant condition in a definedpopulation such that the cases can be related to a population base. With this informationincidence rates can be calculated. If the cases are regularly followed up, information onremission, exacerbation, prevalence, and survival can also be obtained. The register is

65

the actual document, and the registry is the system of ongoing registration. (see Last1988)

risk: The probability that an event will occur, e.g., that an individual will become ill ordie within a stated period of time or age. Also, a non technical term encompassing a va-riety of measures of the probability of a (generally) unfavourable outcome. (see Last1988) Exposure to the chance of injury or loss. (see Webster 1996) risk assessment:The qualitative or quantitative estimation of the likelihood of adverse effects that mayresult from exposure to specified health hazards or from the absence of beneficial influ-ences. (see Last 1988) risk factor: An aspect of personal behaviour or lifestyle, an envi-ronmental exposure, or an inborn or inherited characteristic, which on the basis of epi-demiological evidence is known to be associated with health-related condition(s) con-sidered important to prevent. (see Last 1988) risk indicator: An attribute that is associ-ated with an increased probability of occurrence of a disease or other specified outcomeand that can be used as an indicator of this increased risk. Not necessarily a causal fac-tor. (see Last 1988) risk management: The steps taken to alter, i.e., reduce, the levelsof risk to which an individual or a population is subject. (see Last 1988)

safety: The state of being safe; freedom from the occurrence of risk or injury, danger, orloss; the quality of averting or not causing injury, danger, or loss. (see Webster 1996)

standard: Something that serves as a basis for comparison; a technical specification orwritten report drawn up by experts based on the consolidated results of scientific study,technology, and experience, aimed at optimum benefits and approved by a recognizedand representative body. (see Last 1988)

standardization: A set of techniques used to remove as far as possible the effects ofdifferences in age or other confounding variables, when comparing two or more popu-lations. (see Last 1988)

survey: An investigation in which information is systematically collected but in whichthe experimental method is not used. (see Last 1988)

surveillance of the working environment: A generic term which includes the identifi-cation and evaluation of environmental factors which may affect workers' health. It cov-ers assessments of sanitary and occupational hygiene conditions, factors in the organi-zation of work which may pose risks to the health of workers, collective and personalprotective equipment, exposure of workers to hazardous agents and control systems de-signed to eliminate and reduce them. From the standpoint of workers' health, the sur-veillance of the working environment may focus on, but not be limited to, ergonomics,accident and disease prevention, occupational hygiene in the workplace, work organiza-tion, and psycho-social factors in the workplace. (see ILO 1997)

validity: The property of being genuine, a true reflection of attitudes, behaviour, orcharacteristics. A measure (such as a question, series of questions, or test) is consideredvalid if it is thought to measure the concept or property which it claims to measure.(There are many different definitions of validity in the available literature. (see Marshall1998)

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variable: Any attribute, phenomenon, or event that can have different values. (see Last1988)

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List of sources:

Coppée G. Occupational health services and practice. In: Encyclopaedia of Occupational Healthand Safety. Fourth edition. Volume I. Ed. Jeanne Mager Stellman. International Labour Office,Geneva 1998:16.18–16.22.

Development of health programme evaluation: Report by the Director-General. Geneva, WorldHealth Organization, 1978 (document A31/10).

Glossary of Terms used in the "Health for All" Series No. 1–8. Health for All Series, No. 9,World Health Organization, Geneva 1984, 36 p.

Last John M (ed). A Dictionary of Epidemiology. Second edition. Oxford University Press,New York 1988, p. 141.

Marshall, Gordon (ed). A Dictionary of Sociology. Oxford University Press, Oxford 1998.

Rantanen J, Fedotov I. Standards, principles and approaches in occupational health services. In:Encyclopaedia of Occupational Health and Safety. Fourth edition. Volume I. Ed. Jeanne MagerStellman. International Labour Office, Geneva 1998:16.2–16.18.

Technical and Ethical Guidelines for Workers' Health Surveillance Report. International LabourOrganisation, Geneva, 2–9 September 1997. http://www.ilo.org/public/english/protection/ safe-work/health/whsguide.htm.

The New Shorter Oxford English Dictionary. Volumes 1–2. Brown, Lesley (ed). ClarendonPress, Oxford 1993, p. 3801.

Webster's Third New International Dictionary: Unabridged. Gove, Philip Babcock (ed). Mer-riam-Webster Inc., Springfield 1986, p. 2662.

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ANNEX 2. An example of a country profile: Finland(draft)

Basic information on Finland and its health systemThe basic country information of this annex is mainly from Leino et al. 2000.

Area and population

Finland has been an independent republic since 6 December 1917. The population of Finland is5.1 million and the area 338 000 km2 (population density 15 per km2). 63% of the populationlive in urban areas. The capital city is Helsinki (540 000 habitants), and the official languagesare Finnish (spoken by 93% of the population) and Swedish (6%). The country is divided intofive provinces and 455 municipalities.

Table 1. Population statistics of Finland in 1998

Population (million) 5.160 Men (%) 2.516 Women (%) 2.644Labour force (million) 2.507 Employed (million) 2.222 Men (%) 52.8 Women (%) 47.2 Unemployed (million) 0.285 Unemployment (%) 11.4Live births per 1000 population 11.1Deaths per 1000 population 9.6

SOURCE: Labour force survey 1998. Population statistics. Statistics Finland, Helsinki, 1999.

69

Economy

Table 2. Selected economic indicators of Finland

FIN EUR-15Gross national product (GNP) per capita (in USD) 1996 23240 NAGross domestic product (GDP) per capita (purchasing power parity inUSD) 1994

17417 NA

GDP produced by agriculture, hunting, forestry and fishing (%) 4.4 2.3GDP produced by industry and construction (%) 35.4 30.7GDP produced by services (%) 60.2 67Export as % of GDP 37.7 29.8Import as % of GDP 29.7 27.6Inflation rate (%) 1.2 1.7

SOURCES:Health in Europe 1997, WHO Regional Publications, European Series, No 83, annex 1.FINLAND: GDP (%) figures from Statistical Yearbook of Finland, Helsinki 1998REMARKS: NA = data not available

The Finnish economy has improved continuously after an economic recession in the early1990s. In 1997, Finland imported mainly mechanical appliances (15%), electrical machineryand equipment (14%), mineral fuels and oils (10%) and automobiles and bicycles (8%). Themajor export commodities were paper and paperboard (21%), electrical machinery and equip-ment (18%), mechanical appliances (14%) and wood and wood articles (6%).

Labour force

Table 3. The employed by industry in Finland in 1997

Industry N(1000)

%

Agriculture, hunting and forestry 150 7Fishing 2 0.1Mining and quarrying 6 0.3Manufacturing 436 20Electricity, gas and water supply 22 1Construction 130 6Wholesale and retail trade; repair of motor vehicles, motorcycles andpersonal and household goods

263 12

Hotels and restaurants 66 3Transport, storage and communication 164 7Financial intermediation 48 2Real estate, renting and business activities 192 9Public administration 133 6Education 146 7Health and social work 310 14Other community, social and personal service activities 116 5Private households with employed persons 4 0.2Extra-territorial organizations and bodies 7 0.3Not classifiable 0 0TOTAL 2195

SOURCES: ILO Yearbook of Labour Statistics 1998. REMARKS: NA = data not available

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According to the labour force data, forestry and logging, paper industry, recreational and cul-tural services, wood industry, water transport, manufacture of petroleum and coal products, wel-fare institutions, petroleum refineries and metal ore mining employed proportionally at least50% more workers in Finland than in the EU on average. On the other hand, coal mining, pro-duction of petroleum and natural gas, pottery industry, footwear industry, leather industry, rub-ber industry, wearing apparel industry, textile industry, personal and household services andfishing employed only 50% or less of the mean in the EU. The average hourly labour costs inindustry were ECU 20.3 million and indirect costs as % of total labour costs 26%.

Public health and health care system

Table 4. Health statistics

Life expectancy (years) at birth (1997) Men Women

73.480.5

Infant mortality per 1000 live births, 1996 or latest available 4.0Maternal deaths per 100,000 live births (1993) 4.1Standardised death rate (SDR), cardiovascular diseases, 0–64 years /100,000(1993)

81.7

Standardised death rate (SDR), cancer, 0–64 years / 100,000 (1993) 66.8Standardised death rate (SDR), external causes of injury and poisoning, 0–64years /100,000 (1993)

79.3

Standardised death rate (SDR), suicide and self-inflicted injury, 0–64 years/100,000 (1993)

26.5

Human development index, 1994 0.94Total health expenditure (% of gross domestic product), 1996 7.5Physicians per 1000 population 3.0Dentists per 1000 population 1.0Nurses per 1000 population 10.6

SOURCES:Health in Europe 1997, WHO Regional Publications, European Series, No 83, annex 1. EurostatLife expectancy (1997) and numbers of registered physicians, dentists and nurses (1997) from StatisticalYearbook of Finland 1998, Helsinki 1998.REMARKS:The human development index measures the average achievements in a country in three basic dimensionsof human development: longevity, knowledge, and a decent standard of living.

Table 5. Indicators of health system attainment and performance in WHO MemberStates in 1997

Measure Indicator Definition ofindicator

Unit

Health level(DALE)

Attainment of health level goals (rank among191 WHO countries in 1997)

see source -

Health distribu-tion

Attainment of health distribution goals (rankamong 191 WHO countries in 1997)

see source -

Level of respon-siveness

Attainment of goals on level of responsive-ness (rank among 191 WHO countries in1997)

see source -

Distribution ofresponsiveness

Attainment of goals on distribution of re-sponsiveness (rank among 191 WHO coun-

see source -

71

tries in 1997)Fairness in fi-nancial contri-bution

Attainment of goals on fairness in financialcontribution (rank among 191 WHO coun-tries in 1997)

see source -

Overall goalattainment

Overall goal attainment (rank among 191WHO countries in 1997)

see source -

Health expen-diture

Health expenditure per capita in internationaldollars (rank among 191 WHO countries in1997)

see source -

Health systemperformance onlevel of health

Health system performance on level of health(rank among 191 WHO countries in 1997)

see source -

Overall healthsystem perform-ance

Overall health system performance (rankamong 191 WHO countries in 1997)

see source -

SOURCE:World Health Report 2000 (www.who.int/whr/2000/en/report.htm)

Table 6. Data for health system attainment and performance in WHO Member States in1997

Measure Country RankHealth level (DALE) Index country: Finland 20

Best WHO country: Japan 1Worst WHO country: Sierra Leone 191

Health distribution Index country: Finland 27Best WHO country: Chile 1Worst WHO country: Liberia 191

Level of responsiveness Index country: Finland 19Best WHO country: United States of America 1Worst WHO country: Somalia 191

Distribution of respon-siveness

Index country: Finland 20.5

Best WHO country: United Arab Emirates 1Worst WHO country: Central African Republic 191

Fairness in financialcontribution

Index country: Finland 9.5

Best WHO country: Colombia 1Worst WHO country: Sierra Leone 191

Overall goal attainment Index country: Finland 22Best WHO country: Japan 1Worst WHO country: Sierra Leone 191

Health expenditure Index country: Finland 18Best WHO country: United States of America 1Worst WHO country: Somalia 191

Health system perform-ance on level of health

Index country: Finland 44

Best WHO country: Oman 1Worst WHO country: Zimbabwe 191

Overall health systemperformance

Index country: Finland 31

Best WHO country: France 1Worst WHO country: Sierra Leone 191

SOURCE: World Health Report 2000 (www.who.int/whr/2000/en/report.htm)

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Indicators of prerequisites of occupational health and safety

The information in this section of the annex is mainly from Leino et al. 2000. FIBELLC refersto the countries studied in the project (Finland, Italy, Belgium, Estonia, Latvia, Lithuania, theCzech Republic).

Infrastructure of OH&S

OH&S system

Reference: Occupational health and safety organization of Finland (leaflet)

* Regulations* Enforcement* Inspection* Directions

* Guidelines* Statements* Consultations* Monitoring

OTHER AUTHORITIES

Safety Technology AuthorityFinnish Centre for Radiation and Nuclear SafetyNational Public Health InstituteNational Research and Development Centre for Welfare and HealthNational Product Control Agency for Welfare

* Training* Information* Registers* Funding

Occupational health care personnel Occupational safety superviser

WORKPLACE

EmployerEmployee

* Consultations* Training* Information* Register of occupational safety personnel

* Research grants* Grant for applied research* Scholarships* State grant for occupational safety (State administration)* Agreements (State administration)

RESEARCH AND SERVICE UNITS

Finnish Institute ofOccupational Health- 6 regional institutes

Technical Research Centre of Finland

Institutions of higher education

Universities

Private researchinstitutes

Federation of Accident InsuranceInstitutions

* Research* Expert services* Measurements* Statements

* Education* Information* Statistics

LABOUR MARKET ACTIVITIES

Labour market organisations

Centre for Occupational Safety The Finnish WorkEnvironment Fund

State advisorycommitteeon occupational healthand safety matters

Safety delegates Safety representatives Occupational safety committee

OCCUPATIONAL HEALTH AND SAFETY AUTHORITIES

Dept. for promotion of health and welfare

Dept. for occupationalsafety and health

Ministry of Social Affairs and Health

Municipal boards of labourprotection - Permit section

Occupational safety andhealth inspectorates- 11 districts

Social Insurance InstituteAdvisory committee onlabour protection

Advisory committeeon occupational healthservices

73

OH service models

The following five models were used for occupational health (OH) services until January 1996:(1) the municipal health care centre model, (2) companies’ in-plant services (integrated model),(3) group services for several small or medium-sized enterprises (joint model), (4) regionalservice units of the state (structure similar to that of group services), and (5) private medicalcentre model.

Municipal healthcare centre

Self-employed

Farmers

Enterprise

Enterprise

Enterprise

Enterprise

OHSunit

Enterprises 65%Employees 40%OHS units 29%

Enterprises 2%Employees 28%OHS units 43%

Enterprise

Joint model OHS unit

Enterprises 4%Employees 6%OHS units 6%

Enterprise

Enterprise

Enterprise

Private medicalcentre

EnterpriseEnterprise

Enterprise

Enterprises 29%Employees 26%OHS units 22%

Reference: Rantanen J. Role of occupational health services in the improvement of workers'health. Presentation held in New Trends and Developments in OHS, 3–6 October 1989. Also in:Rantanen J, Hyvä työterveyshuoltokäytäntö. Finnish Institute of Occupational Health, Helsinki1997, and Räsänen K, et al. In Kauppinen et al. (Ed) Work and Health in Finland in 2000 (InFinnish), Finnish Institute of Occupational Health, Helsinki 2000.

74

Legislation and coverage of OH&S

Table 7. Indicators of legislation and coverage of OH&S

Factor Indicator Definition of indicator UnitILOratification

Proportion of ILOconventions onOH&S ratified

Proportion of ILO conventions relevant toOH&S (N=20) which a country has rati-fied until present (scale 0–1 where 1 cor-responds to 100%)

-

Coverage ofaccidentinsurance

Proportion of the em-ployed covered byaccident insurance

Proportion of the employed covered bycompulsory or voluntary accident insur-ance including insurance against occupa-tional diseases (scale 0–1 where 1 corre-sponds to 100%)

-

Coverage ofoccupationalhealth care

Proportion of the em-ployed covered byoccupational healthservices

Proportion of the employed covered bycompulsory or voluntary occupationalhealth services (scale 0–1 where 1 corre-sponds to 100%)

-

Table 8. Statistics on legislation and coverage of OH&S (Takala 2000, Leino et al.2000)

Country Year N Value ofindicator

Unit

ILO ratification Index country: Finland 1999 16 0.8 -Best ILO country: Sweden 18 0.9 -Worst ILO country: many 0 0 -

Coverage of acci-dent insurance

Index country: Finland 1998 0.905 -

Best FIBELLC country: -Worst FIBELLC country: -

Coverage of occu-pational health care

Index country: Finland 1997 0.87 -

Best FIBELLC country:Finland

0.87 -

Worst FIBELLC country:Estonia, Latvia and Lithuania

0.1 -

REMARKS: FIBELLC refers to Finland, Italy, Belgium, Estonia, Latvia, Lithuania, the Czech Republic.

Human resources in OH&S

Table 9. Indicators of occupational health and safety personnel

Occupationalhealth physi-cians

Occupationalhealth physicians/ 1000 employed

Occupational health physicians (full-timeequivalents) per 1000 employed

/1000employed

Occupationalhealth nurses

Occupationalhealth nurses /1000 employed

Occupational health nurses (full-timeequivalents) per 1000 employed

/1000employed

Occupationalphysiothera-pists

Occupationalphysiotherapists /1000 employed

Occupational physiotherapists (full-timeequivalents) per 1000 employed

/1000employed

75

Occupationalhygienistsand hygieneassistants

Occupational hy-gienists and hy-giene assistants /1000 employed

Occupational hygienists and hygiene assis-tants (full-time equivalents) per 1000 em-ployed

/1000employed

Laboursafety in-spectors

Labour safetyinspectors / 1000employed

Labour safety inspectors (full-time equiva-lents) per 1000 employed

/1000employed

Enterprisesafety man-agers

Enterprise safetymanagers / 1000employed

Enterprise safety managers (full-timeequivalents) per 1000 employed

/100 em-ployed

Safety repre-sentatives ofemployees

Safety represen-tatives of employ-ees / 1000 em-ployed

Safety representatives of employees (full-time equivalents) per 1000 employed

/100employed

Table 10. Statistics on occupational health and safety personnel

Occupational healthphysicians

Index country: Finland 1998 8851 0.40 /1000employed

Best FIBELLC country:Italy

90001 0.45 /1000employed

Worst FIBELLC country:Lithuania

34 0.02 /1000employed

Occupational healthnurses

Index country: Finland 1998 16921 0.76 /1000employed

Best FIBELLC country:Finland

16921 0.76 /1000employed

Worst FIBELLC country:The Czech Republic

1173 0.02 /1000employed

Occupationalphysiotherapists

Index country: Finland 1998 2991 0.13 /1000employed

Best FIBELLC country: - - /1000employed

Worst FIBELLC country: - - /1000employed

Occupational hy-gienists and hy-giene assistants

Index country: Finland 1998 1502 0.07 /1000employed

Best FIBELLC country:Lithuania

378 0.22 /1000employed

Worst FIBELLC country:Latvia

312 0.03 /1000employed

Labour safety in-spectors

Index country: Finland 1998 3603 0.16 /1000employed

Best FIBELLC country:Latvia

162 0.2 /1000employed

Worst FIBELLC country:Belgium and The CzechRepublic

180 0.05 /1000employed

Enterprise safetymanagers

Index country: Finland 1998 102084 0.46 /100employed

Best FIBELLC country:Latvia

84001 0.81 /100employed

76

Worst FIBELLC country:Lithuania

44176 0.26 /100employed

Safety representa-tives of employees

Index country: Finland 1998 135694 0.61 /100employed

Best FIBELLC country: - - /100employed

Worst FIBELLC country: - - /100employed

SOURCES: Occupational health services in Finland 1997. Institute of Occupational Health. Ministry ofSocial Affairs and Health. Helsinki 1998. Annual report of the Occupational Safety and Health Admini-stration 1998.REMARKS: NA = data not available(1) Full-time equivalents; The number of posts in occupational health services in 1998 was 1799 for oc-cupational health physicians, 1930 for occupational health nurses, 589 for physiotherapists, 198 for psy-chologists and 849 for assisting personnel. (2) The figures for occupational hygienists and occupationalhygiene technicians are estimates based on membership in the Finnish Occupational Hygiene Association.Safety engineers and technicians are not included. (3) Those directly involved in workplace safety in-spections; Occupational Safety and Health Administration (OSHA) employs 540 persons, of whom 460work in inspectorates. Some 90 experts work in the central administration. (4) The figures are from thestatistics of the Register of Occupational Safety Personnel 1998. Registration is obligatory for privateenterprises and for municipalities, but excludes public (state) administration. Data were not availablefrom other FIBELLC countries.FIBELLC refers to Finland, Italy, Belgium, Estonia, Latvia, Lithuania, the Czech Republic.

77

Indicators of working conditions

Physicochemical exposures

Table 11. Indicators of physicochemical exposures (Second European Working Condi-tions Survey 1997)

Agent Indicator Definition of indicator UnitHigh-levelnoise

Prevalence of expo-sure to high levelnoise among theemployed

Question in survey:How often are you exposed at work to each ofthe following? (all of the time, almost all of thetime, around ¾ of the time, around half of thetime, around 1/4 of the time, almost never,never, don't know)

• Noise so loud that you would have toraise your voice to talk to people

Included if at least around ¼ of the time

%

Vibration Prevalence of expo-sure to vibrationamong the em-ployed

Question in survey:How often are you exposed at work to each ofthe following? (all of the time, almost all of thetime, around ¾ of the time, around half of thetime, around ¼ of the time, almost never,never, don't know)

• Vibration from hand tools, machinery,etc.

Included if at least around ¼ of the time

%

Radiation Prevalence of expo-sure to radiationamong the em-ployed

Question in survey:How often are you exposed at work to each ofthe following? (all of the time, almost all of thetime, around ¾ of the time, around half of thetime, around 1/4 of the time, almost never,never, don't know)

• Radiation such as X rays, radioactiveradiation, welding light, laser beams

Included if at least around ¼ of the time

%

High tem-peratures

Prevalence of expo-sure to high tem-peratures among theemployed

Question in survey:How often are you exposed at work to each ofthe following? (all of the time, almost all of thetime, around ¾ of the time, around half of thetime, around 1/4 of the time, almost never,never, don't know)

• High temperature which makes you per-spire even when not working

Included if at least around ¼ of the time

%

Low tem-peratures

Prevalence of expo-sure to low tem-peratures among theemployed

Question in survey:How often are you exposed at work to each ofthe following? (all of the time, almost all of thetime, around ¾ of the time, around half of thetime, around 1/4 of the time, almost never,never, don't know)

• Low temperatures whether indoors or

%

78

outdoorsIncluded if at least around ¼ of the time

Breathing invapours

Prevalence ofbreathing in vapoursamong the em-ployed

Question in survey:How often are you exposed at work to each ofthe following? (all of the time, almost all of thetime, around ¾ of the time, around half of thetime, around 1/4 of the time, almost never,never, don't know)

• Breathing in vapours, fumes, dust, ordangerous substances such as chemi-cals, infectious materials, etc.

Included if at least around ¼ of the time

%

Handlingdangeroussubstances

Prevalence of han-dling dangerousgoods among theemployed

Question in survey:How often are you exposed at work to each ofthe following? (all of the time, almost all of thetime, around ¾ of the time, around half of thetime, around ¼ of the time, almost never,never, don't know)

• Handling or touching dangerous prod-ucts or substances

Included if at least around ¼ of the time

%

Table 12. Data for indicators of physicochemical exposures (Second European WorkingConditions Survey 1997)

Agent Country Value of indica-tor

Unit

High-level noise Index country: Finland 39 %Best EU country: Italy 21 %Worst EU country: Finland 39 %

Vibration Index country: Finland 26 %Best EU country: The Netherlands 13 %Worst EU country: Greece 37 %

Radiation Index country: Finland 8 %Best EU country: Portugal 3 %Worst EU country: Austria 9 %

High temperatures Index country: Finland 20 %Best EU country: Sweden 14 %Worst EU country: Greece 40 %

Low temperatures Index country: Finland 19 %Best EU country: Germany, West 17 %Worst EU country: Greece 44 %

Breathing in vapours Index country: Finland 34 %Best EU country: Denmark 15 %Worst EU country: Greece 47 %

Handling dangeroussubstances

Index country: Finland 18 %

Best EU country: Germany, East 10 %Worst EU country: Greece 32 %

79

Table 13. Indicators of use of asbestos (Tossavainen and Takahashi 2000) and pesti-cides at work (FAO database on pesticide consumption)

Agent Indicator Definition of indicator UnitAsbestos Consumption of as-

bestos per capita peryear

Reported consumption of as-bestos in 1996 per capita

kg/capita/y

Pesticides Consumption of pesti-cides per agriculturalworker per year

Consumption of pesticides in1998 per agricultural workeras reported to FAO

kg/agriculturalworkers/y

Table 14. Data for indicators of use of asbestos (Tossavainen and Takahashi 2000) andof pesticides at work (FAO database on pesticide consumption)

Agent Country Value ofindicator

Unit

Asbestos Index country: Finland 0 kg/capita/yBest country: many 0 kg/capita/yWorst country: Russia 3.4 kg/capita/y

Pesticides Index country: Finland 12 kg/agr worker/yBest country: Laos? 0 kg/agr worker/yWorst country: Belgium-Lux 181 kg/agr worker/y

Table 15. Indicators of harm due to physicochemical exposures (Finnish Work andHealth Surveys 1997 and 2000, Piirainen et al. 1997 and 2000)

Agent Indicator Definition of indicator UnitNoise Prevalence of

harm due to ex-posure to noiseamong the em-ployed

Question in survey:Does noise occur in your work? (yes, no) Is noiseharmful in your work (no, to some extent, ratherharmful, very harmful)Included if rather or very harmful

%

Vibration Prevalence ofharm due to ex-posure to vibra-tion among theemployed

Question in survey:Does vibration occur in your work? (yes, no) Is vi-bration harmful in your work (no, to some extent,rather harmful, very harmful)Included if rather or very harmful

%

Dust Prevalence ofharm due to ex-posure to dustamong the em-ployed

Question in survey:Does dust occur in your work? (yes, no) Is dustharmful in your work (no, to some extent, ratherharmful, very harmful)Included if rather or very harmful

%

Solvents Prevalence ofharm due to ex-posure to sol-vents among theemployed

Question in survey:Do solvents occur in your work? (yes, no) Are sol-vents harmful in your work (no, to some extent,rather harmful, very harmful)Included if rather or very harmful

%

80

Detergents etc. Prevalence ofharm due to ex-posure to deter-gents etc. amongthe employed

Question in survey:Do detergents etc. occur in your work? (yes, no)Are detergents etc. harmful in your work (no, tosome extent, rather harmful, very harmful)Included if rather or very harmful

%

Gases, ex-hausts

Prevalence ofharm due to ex-posure to gases,exhausts amongthe employed

Question in survey:Do gases, exhausts occur in your work? (yes, no)Are gases, exhausts harmful in your work (no, tosome extent, rather harmful, very harmful)Included if rather or very harmful

%

Environmentaltobacco smoke

Prevalence ofharm due to ex-posure to envi-ronmental to-bacco smokeamong the em-ployed

Question in survey:Does environmental tobacco smoke occur in yourwork? (yes, no) Is environmental tobacco smokeharmful in your work (no, to some extent, ratherharmful, very harmful)

Included if rather or very harmful

%

Cold, heat ordraught

Prevalence ofharm due to ex-posure to cold,heat or draughtamong the em-ployed

Question in survey:Does cold, heat or draught occur in your work?(yes, no) Is cold, heat or draught harmful in yourwork (no, to some extent, rather harmful, veryharmful)Included if rather or very harmful

%

Inadequatelighting

Prevalence ofharm due to inade-quate lightingamong the em-ployed

Question in survey:Does inadequate lighting occur in your work? (yes,no) Is inadequate lighting harmful in your work(no, to some extent, rather harmful, very harmful)Included if rather or very harmful

%

Mouldy smell Prevalence ofharm due to ex-posure tomouldy smellamong the em-ployed

Question in survey:Does mouldy smell occur in your work? (yes, no)Is mouldy smell harmful in your work (no, to someextent, rather harmful, very harmful)Included if rather or very harmful

%

Table 16. Data for indicators of harm due to physicochemical exposures in Finland(Finnish Work and Health Surveys 1997 and 2000, Piirainen et al. 1997 and 2000)

Agent 1997 2000 UnitNoise 8.6 10.4 %Vibration 1.7 2.1 %Dust 8.1 10.4 %Solvents 1.6 2.3 %Detergents, etc. 2.6 2.6 %Gases, exhausts 2.4 2.2 %Environmental tobacco smoke 2.2 2 %Cold, heat or draught 12.5 16 %Inadequate lighting 4 4.5 %Mouldy smell 11.9 10.8 %

81

Table 17. Indicators of occupational exposure to carcinogens (CAREX database ofFIOH)

Agent Indicator Definition UnitSolar radiation Estimated prevalence

of regular exposure tosolar radiation amongthe employed

Regular outdoor work (>75% of annualworking time) is considered to entail ex-posure. The figures are not comparablefrom the point of view of UV radiationdose, because the intensity of radiationvaries by country.

%

Tobacco smoke(environmental)

Estimated prevalenceof regular exposure toenvironmental tobaccosmoke among the em-ployed

Inhalatory exposure at work to environ-mental tobacco smoke (ETS) due tosmoking of customers or coworkers. In-haling ETS (as smoke or 'smell') at least75% of working time is considered to en-tail exposure.

%

Silica, crystal-line

Estimated prevalenceof exposure to crystal-line silica among theemployed

Inhalatory exposure at work to crystallinesilica (mainly as quartz, cristobalite,tridymite or tripoli) or minerals containingcrystalline silica probably exceeding non-occupational exposure originating fromroad dust, beach sand, etc. (long-term ex-posure level to respirable dust usually<0.01 mg/m3) . Excludes amorphous sil-ica and clay.

%

Diesel engineexhaust

Estimated prevalenceof exposure to dieselengine exhaust amongthe employed

Inhalatory exposure at work to diesel en-gine exhaust likely to exceed significantlythe nonoccupational background level inurban air (usually <0.6 mg/m3, often <0.1mg/m3, measured as nitrogen dioxide).

%

Radon and itsdecay products

Estimated prevalenceof exposure to radonand its decay productsamong the employed

Inhalatory exposure at work to radon-222and its decay products (e.g., radioactivepolonium, lead and bismuth) resulting indoubling of nonoccupational dose whichvaries by country. Also office work in-doors where radon level is high is consid-ered to entail exposure.

%

Wood dust Estimated prevalenceof exposure to wooddust among the em-ployed

Inhalatory exposure at work to hardwooddust (e.g., oak, beech, elm, ash, birch,most tropical woods), softwood dust (e.g.,pine, spruce, larch), woodbark dust anddusts containing wood (e.g., plywood orparticleboard dust) probably exceedingnonoccupational exposure from leasure-time woodworking (long-term exposurelevel usually <0.1 mg/m3). Excludes ex-posure to pulp and paper dust.

%

Lead and leadcompounds, in-organic

Estimated prevalenceof exposure to leadand inorganic leadcompounds among theemployed

Inhalatory exposure at work to lead, leadalloys and lead compounds (e.g., leadchromate, lead oxide, lead acetate, leadnaphthenate, lead tetroxide) likely to ex-ceed the nonoccupational backgroundlevel (often <0.1ug/m3 or <0.3 umol/lblood).

%

82

Benzene Estimated prevalenceof exposure to benzeneamong the employed

Inhalatory or dermal exposure at work tobenzene likely to exceed significantly thenonoccupational exposure due to inhalingurban air or due to filling in gasoline sta-tions (long-term exposure usually below0.01 ppm).

%

Asbestos Estimated prevalenceof exposure to asbestosamong the employed

Inhalatory exposure at work to any formof asbestos (e.g., chrysotile, crocidolite,tremolite, anthophyllite, actinolite,amosite) likely to exceed significantly thenonoccupational background level indwellings or urban air (usually below0.001 f/cm3).

%

Table 18. Data for indicators of occupational exposure to carcinogens (CAREX data-base of FIOH)

Agent Country Year N exposed Value ofindicator

Unit

Solar radiation Index country: Finland 1990–93 180000 8.6 %Best EU country: Italy 1990–93 560000 3.3 %Worst EU country: Greece 1990–93 460000 13.7 %

Tobacco smoke(environmental)

Index country: Finlanda 2000 30000 1.3 %

Best EU country: Finlanda 2000 30000 1.3 %Worst EU country: Lux-embourg

1990–93 11000 6 %

Silica, crystal-line

Index country: Finlanda 1998–2000 60000 2.6 %

Best EU country: France 1990–93 110000 0.5 %Worst EU country: Lux-embourg

1990–93 7400 4 %

Diesel engineexhaust

Index country: Finlanda 1998–2000 36000 1.6 %

Best EU country: Finlanda 1998 36000 1.6 %Worst EU country: Italy 1990–93 550000 3.2 %

Radon and itsdecay products

Index country: Finland 1990–93 49000 2.3 %

Best EU country: TheNetherlands

1990–93 0 0 %

Worst EU country: Swe-den

1990–93 99000 2.5 %

Wood dust Index country: Finlanda 1998–2000 52000 2.3 %Best EU country: France 1990–93 180000 0.8 %Worst EU country: Spain 1990–93 400000 3.3 %

Lead and leadcompounds, in-organic

Index country: Finland 1990–93 13000 0.6 %

Best EU country: Finland 1990–93 13000 0.6 %Worst EU country: Italy 1990–93 290000 1.7 %

Benzene Index country: Finlandb 1998 1600 0.1 %Best EU country: Finlandb 1998 1600 0.1 %Worst EU country: Den- 1990–93 49000 1.8 %

83

markAsbestos Index country: Finlandb 1998 2000 0.1 %

Best EU country: Finlandb 1998 2000 0.1 %Worst EU country: Italy 1990–93 680000 4 %

a Reference: FINJEM database of FIOH, June 2000b Reference: ASA database of FIOH, June 2000

Physiological and ergonomic factors

Table19. Indicators of physical and ergonomic factors (Second European WorkingConditions Survey 1997)

Agent Indicator Definition of indicator UnitPainful po-sitions

Prevalence of painfulor tiring positionsamong the employed

Question in survey:How often does your main paid job involveeach of the following? (all of the time, almostall of the time, around 3/4 of the time, aroundhalf of the time, around 1/4 of the time, almostnever, never, don't know)• Painful or tiring positions

Included if at least around ¼ of the time

%

Heavy loads Prevalence of carry-ing or moving heavyloads among the em-ployed

Question in survey:How often does your main paid job involveeach of the following? (all of the time, almostall of the time, around 3/4 of the time, aroundhalf of the time, around 1/4 of the time, almostnever, never, don't know)• Carrying or moving heavy loads

Included if at least around ¼ of the time

%

Repetitivehand/armmovements

Prevalence of repeti-tive hand or armmovements amongthe employed

Question in survey:How often does your main paid job involveeach of the following? (all of the time, almostall of the time, around 3/4 of the time, aroundhalf of the time, around 1/4 of the time, almostnever, never, don't know)• Repetitive hand or arm movements

Included if at least around ¼ of the time

%

Temperaturenot adjust-able

Prevalence of nonad-justable temperatureamong the employed

Question in survey:Which, if any, of the following working condi-tions can you adjust personally to your owncomfort ?• The temperature

Included if not adjustable

%

Lighting notadjustable

Prevalence of nonad-justable lightingamong the employed

Question in survey:hich, if any, of the following working condi-tions can you adjust personally to your owncomfort ?• The lighting

Included if not adjustable

%

Ventilationnot adjust-able

Prevalence of nonad-justable ventilationamong the employed

Question in survey:Which, if any, of the following working condi-tions can you adjust personally to your own

%

84

comfort ?• The ventilation

Included if not adjustableWork sta-tion not ad-justable

Prevalence of nonad-justable position ofdesk, bench or workstation among theemployed

Question in survey:Which, if any, of the following working condi-tions can you adjust personally to your owncomfort ?• The position of your desk, bench or work

stationIncluded if not adjustable

%

Seat notadjustable

Prevalence of nonad-justable seat amongthe employed

Question in survey:Which, if any, of the following working condi-tions can you adjust personally to your owncomfort ?• The position of your seat

Included if not adjustable

%

Equipmentnot adjust-able

Prevalence of nonad-justable equipmentamong the employed

Question in survey:Which, if any, of the following working condi-tions can you adjust personally to your owncomfort ?• The instrument(s) or equipment you use

Included if not adjustable

%

Table 20. Data for indicators of physical and ergonomic factors (Second EuropeanWorking Conditions Survey 1997)

Agent Country Value ofindicator

Unit

Painful positions Index country: Finland 45 %Best EU country: The Netherlands 28 %Worst EU country: Greece 68 %

Heavy loads Index country: Finland 38 %Best EU country: Luxembourg 24 %Worst EU country: Greece 40 %

Repetitive hand/armmovements

Index country: Finland 79 %

Best EU country: Sweden 43 %Worst EU country: Finland 79 %

Temperature not adjustable Index country: Finland 61 %Best EU country: United Kingdom 49 %Worst EU country: Italy 70 %

Lighting not adjustable Index country: Finland 40 %Best EU country: Sweden 27 %Worst EU country: Italy 69 %

Ventilation not adjustable Index country: Finland 62 %Best EU country: Germany, East 43 %Worst EU country: Italy 78 %

Work station not adjustable Index country: Finland 53 %Best EU country: Sweden 45 %Worst EU country: Portugal 79 %

Seat not adjustable Index country: Finland 39 %Best EU country: Sweden 31 %

85

Worst EU country: Portugal 78 %Equipment not adjustable Index country: Finland 43 %

Best EU country: Sweden 38 %Worst EU country: Portugal 75 %

Table 21. Indicators of harm due to physical and ergonomic factors (Finnish Work andHealth Surveys 1997 and 2000, Piirainen et al. 1997 and 2000)

Agent Indicator Definition of indicator UnitHeavywork

Prevalence ofphysicallyheavy workamong theemployed

Question in survey:Is your work physically light, rather light, to some ex-tent heavy, rather heavy, heavy?Included if rather or very heavy

%

Lifting Prevalence oflifting amongthe employed

Question in survey:Does your work contain lifting, carrying, manual hold-ing up? (not at all, occasionally, every day or almosteveryday, many times daily, many times in an hour)Included if many times in an hour

%

Difficultpositions ofback

Prevalence ofdifficult posi-tions of backamong theemployed

Question in survey:Do you work in a slouched position or otherwise withback in a difficult position? (not at all, over 4 h daily, 1–4 h daily, less than 1 h daily, almost every day, occa-sionally)Included if at least 1 h daily

%

Difficultpositions ofhands

Prevalence ofdifficult posi-tions of handsamong theemployed

Question in survey:Do you work one or both hands above shoulder level orotherwise in a position where you have to hold up yourhands? (not at all, over 4 h daily, 1–4 h daily, less than 1h daily, almost every day, occasionally)Included if at least 1 h daily

%

Kneelingpositions

Prevalence ofkneeling posi-tions amongthe employed

Question in survey:Do you work in kneeling positions? (not at all, over 4 hdaily, 1–4 h daily, less than 1 h daily, almost every day,occasionally)Included if at least 1 h daily

%

Handmovementrequiringpower

Prevalence ofhand move-ments requir-ing poweramong theemployed

Question in survey:Does your work contain hand movements requiringpower, like screwing, carving, cutting, twisting ofcleaning cloth or milking? (not at all, over 4 h daily, 1–4h daily, less than 1 h daily, almost every day, occasion-ally)Included if at least 1 h daily

%

Repetitivehandmovements

Prevalence ofrepetitive handmovementsexcept typingamong theemployed

Question in survey:Does your work contain repeating similar movements ofhands many times per minute? These occur in e.g. pro-duction line and assembly work, pricing or when mov-ing things from an assembly line. Typing with type-writer or computer is not meant in this question. (not atall, over 4 h daily, 1–4 h daily, less than 1 h daily, al-most every day, occasionally)Included if at least 1 h daily

%

Regular Prevalence of Question in survey: %

86

standingwork

regular stand-ing workamong theemployed

Is your work mainly walking, standing, sitting or someof these? (sitting / walking, sitting / walking, standing,sitting / standing / walking / standing, sitting / other)Included if standing

Regularsittingwork

Prevalence ofregular sittingwork amongthe employed

Question in survey:Is your work mainly walking, standing, sitting or someof these? (sitting / walking, sitting / walking, standing,sitting / standing / walking / standing, sitting / other)Included if sitting

%

Table 22. Data for indicators of harm due to physical and ergonomic factors in Finland(Finnish Work and Health Surveys 1997 and 2000, Piirainen et al. 1997 and 2000)

Agent 1997 2000 UnitHeavy work 26.3 24.6 %Lifting 14.1 13.4 %Difficult positions of back 26.4 23.1 %Difficult positions of hands 17.4 11.7 %Kneeling positions 11.6 13.4 %Hand movements requiring power 17.9 17.2 %Repetitive hand movements 21.9 23 %Regular standing work 5.9 6.7 %Regular sitting work 31.1 30.4 %

Psychosocial factors

Table 23. Indicators of psychosocial factors (Second European Working ConditionsSurvey 1997)

Agent Indicator Definition of indicator UnitWorking atvery highspeed

Prevalence ofworking at veryhigh speedamong the em-ployed

Question in survey:How often does your main paid job involve each ofthe following? (all of the time, almost all of thetime, around 3/4 of the time, around half of the time,around 1/4 of the time, almost never, never, don'tknow)

• Working at very high speedIncluded if at least around ¼ of the time

%

Working totight dead-lines

Prevalence ofworking to tightdeadlines amongthe employed

Question in survey:How often does your main paid job involve each ofthe following? (all of the time, almost all of thetime, around 3/4 of the time, around half of the time,around 1/4 of the time, almost never, never, don'tknow)

• Working to tight deadlinesIncluded if at least around ¼ of the time

%

Not enoughtime to dothe job

Prevalence oflack of time to dothe job among theemployed

Question in survey:For each of the following statements please answerYes or No

• You have enough time to get the job done

%

Rate ofwork notchangeable

Prevalence ofnonchangeablerate of work

Question in survey:Are you able, or not, to choose or change? (yes, no)

• Your speed or rate of work

%

87

among the em-ployed

Methods ofwork notchangeable

Prevalence ofnonchangeablemethods of workamong the em-ployed

Question in survey:Are you able, or not, to choose or change? (yes, no)

• Your methods of work

%

Order oftasks notchangeable

Prevalence ofnonchangeableorder of tasksamong the em-ployed

Question in survey:Are you able, or not, to choose or change? (yes, no)

• Your order of tasks

%

Monoto-nous tasks

Prevalence ofmonotonous tasksamong the em-ployed

Question in survey:Does your main paid job involve, or not (yes, no)

• Monotonous tasks

%

No assis-tance fromcolleagues

Prevalence oflack of assistancefrom colleaguesamong the em-ployed

Question in survey:For each of the following statements please answerYes or No

• You can get assistance from colleagues if re-quired

%

Table 24. Data for indicators of psychosocial factors (Second European Working Con-ditions Survey 1997)

Agent Country Value ofindicator

Unit

Working at very high speed Index country: Finland 71 %Best EU country: Luxembourg 37 %Worst EU country: Finland 71 %

Working to tight deadlines Index country: Finland 72 %Best EU country: Italy 34 %Worst EU country: Austria 76 %

Not enough time to do the job Index country: Finland 32 %Best EU country: Italy 12 %Worst EU country: Finland 32 %

Rate of work not changeable Index country: Finland 28 %Best EU country: Denmark 18 %Worst EU country: Germany, East 37 %

Methods of work not changeable Index country: Finland 26 %Best EU country: Sweden 14 %Worst EU country: Austria 37 %

Order of tasks not changeable Index country: Finland 22 %Best EU country: Sweden 17 %Worst EU country: Germany, East 45 %

Monotonous tasks Index country: Finland 47 %Best EU country: Germany, East 22 %Worst EU country: United Kingdom 67 %

No assistance from colleagues Index country: Finland 10 %Best EU country: United Kingdom 6 %Worst EU country: Greece 32 %

88

Table 25. Indicators of harm due to psychosocial factors (Finnish Work and HealthSurveys 1997 and 2000, Piirainen 1997 and 2000)

Agent Indicator Definition of indicator UnitConstrain-ed atmos-phere

Prevalence ofconstrained at-mosphereamong the em-ployed

Question in survey:What kind of atmosphere do you have in yourwork? Is it more constrained or unconstrained andcomfortable? (constrained, unconstrained and com-fortable)Included if constrained

%

Little sup-port fromcolleagues

Prevalence oflittle supportfrom colleaguesamong the em-ployed

Question in survey:Can you get support and help from your colleagueswhen needed? (very much, rather much, to someextent, rather little, very little)Included if rather or very little

%

Little sup-port fromboss

Prevalence oflittle supportfrom bossamong the em-ployed

Question in survey:Can you get support and help from your boss whenneeded? (very much, rather much, to some extent,rather little, very little)Included if rather or very little

%

Stressfulwork

Prevalence ofstressful workamong the em-ployed

Question in survey:Stress means a situation, when you feel nervous oruneasy or have sleeping difficulties because ofthings bothering you all the time. Do you feelstressed at present? (not at all, little, to some extent,rather much, very much)Included if rather or very much

%

Hasty work Prevalence ofhasty workamong the em-ployed

Question in survey:How often do you have to hurry to get your workdone? (never, rather seldom, every now and then,rather often, very often)Included if rather or very often

%

Mentallyheavy work

Prevalence ofmentally heavywork among theemployed

Question in survey:Is your work mentally light, rather light, to someextent heavy, rather heavy, heavy?Included if rather or very heavy

%

Monoto-nous work

Prevalence ofmonotonouswork among theemployed

Question in survey:Is your work very variable, rather variable, notrather variable but not monotonous, rather monoto-nous, very monotonousIncluded if rather or very monotonous

%

Mentalviolence atwork

Prevalence ofmental violenceat work amongthe employed

Question in survey:Mental violence means constant, repetitive bullying,oppressing or derogatory treatment. Have you beenbefore or are you at present an object of mentalviolence at work? (no, yes at present, yes before notat present)Included if yes

%

89

Table 26. Data for indicators of harm due to psychosocial factors in Finland (FinnishWork and Health Surveys 1997 and 2000, Piirainen 1997 and 2000)

Agent 1997 2000 UnitConstrained atmosphere 22.3 20.5 %Little support from colleagues 5.6 4.5 %Little support from boss 13.8 15.2 %Stressful work 14.3 13.5 %Hasty work 51.7 44.8 %Mentally heavy work 39.6 34.6 %Monotonous work 5.4 7.1 %Mental violence at work 3.6 4.3 %

Working time arrangements

Table 27. Indicators of working time arrangements (Second European Working Condi-tions Survey 1997)

Agent Indicator Definition of indicator UnitAverageworkingtime

Average weekly work-ing time in the main jobamong the employed

Question in survey:How many hours do you usually workper week, in your main job?

h/week

Shiftwork Prevalence of shiftworkamong the employed

Question in survey:Do you work shifts (that is, sometimesworking mornings, sometimes afternoonsor sometimes nights) or irregular hours,or not? (If YES) How many shifts? (no,not working shifts or irregular hours;yes, I work irregular hours, but not in ashift; yes, 2 shifts; yes, 3 shifts; yes, 4shifts; yes, 5 shifts and over; don't know)Included if 2 or more shifts

%

Working atnight

Prevalence of working atnight among the em-ployed

Question in survey:Normally, how many times a month doyou typically work at night, say for atleast 2 hours between 10.00 pm and05.00 am?Included if at least once a month

%

WorkingSundays

Prevalence of workingSundays among the em-ployed

Question in survey:How many times a month do you typi-cally work on Sundays? (1, 2, 3, 4, none)Included if at least once a month

%

WorkingSaturdays

Prevalence of workingSaturdays among theemployed

Question in survey:And on Saturdays? (1, 2, 3, 4, none)Included if at least once a month

%

Averagecommutingtime

Average daily commut-ing time among the em-ployed

Question in survey:How many minutes per day do you nor-mally spend traveling from home towork and back in total?

min/day

Not onflexitime

Prevalence of lack offlexitime among the em-ployed

Question in survey:For each of the following statementsplease answer Yes or No

• You have fixed starting and fin-

%

90

ishing times every dayIncluded if yes

Working atleast50h/week(% of em-ployed)

Proportion of the em-ployed who work at least50 h a week

Question in survey:How many hours do you usually workper week, in your main job?Included if at least 50 h/week

%

Table 28. Data for indicators of working time arrangements (Second European Work-ing Conditions Survey 1997)

Agent Country Value ofindicator

Unit

Average working time Index country: Finland 40 h/weekBest EU country: The Nether-lands

36 h/week

Worst EU country: Greece 46 h/weekShiftwork Index country: Finland 19 %

Best EU country: Portugal 6 %Worst EU country: Finland 19 %

Working at night Index country: Finland 33 %Best EU country: Italy 17 %Worst EU country: Finland 33 %

Working Saturdays Index country: Finland 50 %Best EU country: Sweden 40 %Worst EU country: Greece 73 %

Working Sundays Index country: Finland 43 %Best EU country: Germany,West

22 %

Worst EU country: Greece 52 %Average commuting time Index country: Finland 41 min/day

Best EU country: Italy 23 min/dayWorst EU country: Germany,East

53 min/day

Not on flexitime Index country: Finland 71 %Best EU country: Greece 58 %Worst EU country: Luxembourg 79 %

Working at least 50h/week (%of employed)

Index country: Finland 13 %

Best EU country: Denmark 8 %Worst EU country: Greece 38 %

91

Life-style of the employed

Table 29. Life-style indicators of the employed (Finnish Work and Health Surveys 1997and 2000, Piirainen et al. 1997 and 2000)

Agent Indicator Definition of indicator UnitSmokingdaily

Prevalence of smokingdaily among the em-ployed

Question in survey:Do you smoke or have you smoked ear-lier?(has never smoked, smokes daily (or hasquit smoking less then 6 months ago),smokes but not daily, has quit smokingmore than 6 months ago)

Included if smokes daily

%

Drinking al-cohol at leastonce a week

Prevalence of drinkingalcohol at least once aweek among the em-ployed

Question in survey:How often do you drink alcohol on theaverage? Include also the times whenyou drank small amounts of alcohol, forexample less than a bottle of beer or aglass of wine (daily, 3 times a week ormore often, 2 times a week, weekly, atleast once in a month, at most few timesper year, never)Included if at least once a week

%

Drinking al-cohol untildrunk at leastonce a week

Prevalence of drinkingalcohol until drunk atleast once a weekamong the employed

Question in survey:How often do you drink alcohol untildrunk? (daily, 3 times a week or moreoften, 2 times a week, weekly, at leastonce in a month, at most few times peryear, never)Included if at least once a week

%

Light physi-cal training atleast 3times/week

Prevalence of lightphysical training atleast 3 times/weekamong the employed

Question in survey:How often do you take on average lightexercise, such as walking, cycling orother practical exercise, during your lei-sure time at least half an hour which mayconsist of several periods? (3 or moretimes a week, 1–2 times a week, 1–3times a month, few times per year orless, cannot say)Included if 3 or more times a week

%

Heavy physi-cal training atleast 3times/week

Prevalence of heavyphysical training atleast 3 times/weekamong the employed

Question in survey:How often do you take on average dur-ing your leisure time at least half an hoursuch exercise that you become breathlessor you sweat? (3 or more times a week,1–2 times a week, 1–3 times a month,few times per year or less, cannot say)Included if 3 or more times a week

%

No mealsduring work-

Prevalence of no mealsduring workday among

Question in survey:Where do you normally eat during the

%

92

day the employed work day? (at home, in a restaurant or abar, in the staff canteen, own lunch,other, don’t eat at all)Included if don’t eat at all

Table 30. Data on life-style of the employed in Finland (Finnish Work and Health Sur-veys 1997 and 2000, Piirainen 1997 and 2000)

Agent 1997 2000 UnitSmoking daily 24.1 24.5 %Drinking alcohol at least once a week 50.3 50.7 %Drinking alcohol until drunk at least once a week 6.7 7.8 %Light physical training at least 3 times/week 43.4 50.6 %Heavy physical training at least 3 times/week 35.1 41.6 %No meals during workday 4.9 3.8 %

93

Indicators of occupational health and safety outcomes

Accidents at work and occupational diseases

Table 31. Indicators of work accidents and occupational diseases in Finland

Agent Indicator Definition of indicator UnitFatal workaccidents

Annual incidence offatal accident or trafficaccident at work

Cases of fatal accidents and trafficaccidents at work per 100,000 em-ployees; does not include commutingaccidents and fatal health problems atwork

Cases per100,000employees

Injury atwork or whencommuting

Annual incidence ofinjury at work or whencommuting among theemployed

Question in survey:Have you been injured at work orwhen commuting during the last 12months?Included if yes

%

Injury caus-ing disabilityof at least 3days

Annual incidence ofinjury at work or whencommuting causingdisability of at least 3days among the em-ployed

Question in survey:Have you been injured at work orwhen commuting during the last 12months? Did the (latest) injury causedisability? If yes, how many workdays did you have to be absent? (noinjury during the last 12 months, nodisability, less than 3 days, 3-30 days,over 30 days)Included if at least 3 days

%

Compensatedworkplaceaccidents

Annual incidence ofaccidents at workplacecompensated by insur-ance companies

Accidents of salaried workers atworkplace, or in work site outsideworkplace (accident insurance com-pulsory for all salaried workers, vol-untary for the self-employed)

Cases per10 millionhours

Commutingaccidents

Annual incidence ofcommuting accidentscompensated by insur-ance companies

Accidents of salaried workers whencommuting between the residence andworkplace

Cases permillionhours

Serious workaccidentscausing dis-ability ofover 30 days

Annual incidence ofserious work accidentscompensated by insur-ance companies

Serious accident refers to work dis-ability of at least 30 days or fatality

Cases permillionhours

Notified oc-cupationaldiseases

Annual incidence ofoccupational diseasesnotified by physiciansto Register of Occupa-tional Diseases ofFIOH

Diseases predominantly caused byoccupational exposure to physical,chemical, microbiological or ergo-nomic factors (defined on anAct, insurance compulsory for sala-ried workers, voluntary for the self-employed)

Cases per10,000 em-ployed

Repetitivestress injuries

Annual incidence ofrepetitive stress injuriesnotified by physiciansto Register of Occupa-

Includes mainly cases of epicondylitisand tenosynovitis

Cases per10,000 em-ployed

94

tional Diseases ofFIOH

Noise-in-duced hear-ing losses

Annual incidence ofnoise-induced hearinglosses notified by phy-sicians to Register ofOccupational Diseasesof FIOH

Includes mainly noise-induced hear-ing loss found in audiometric tests

Cases per10,000 em-ployed

Respiratoryallergies

Annual incidence ofrespiratory allergiesnotified by physiciansto Register of Occupa-tional Diseases ofFIOH

Includes mainly cases of asthma, al-lergic rhinitis and allergic alveolitis

Cases per10,000 em-ployed

Skin diseases Annual incidence ofskin diseases notifiedby physicians to Reg-ister of OccupationalDiseases of FIOH

Includes mainly cases of toxic or al-lergic eczema

Cases per10,000 em-ployed

Table 32. Data on indicators of accidents at work and occupational diseases in Finland(Finnish Work and Health Surveys 1997 and 2000, Piirainen et al. 1997 and 2000,Accidents at work 1997, Karjalainen et al. 2000)

Agent 1995 1996 1997 1998 1999 2000 UnitInjury at work or whencommuting (%)

9.7 9.1 %

Injury causing disability of atleast 3 days (%)

4.2 4.3 %

Compensated workplace ac-cidents (/10 million hours)

3.3 3 Cases per 10million hours

Commuting accidents(/million hours)

4.5 4.5 Cases per mil-lion hours

Serious work accidentscausing disability of over 30days (/million hours)

3.6 3.2 Cases per mil-lion hours

Notified occupational dis-eases (/10000 employed)

2.8 2.3 Cases per10000 em-ployed

Repetitive stress injuries(/10000 employed)

8.3 5.9 Cases per10000 em-ployed

Noise-induced hearing losses(/10000 employed)

5.6 4.3 Cases per10000 em-ployed

Respiratory allergies (/10000employed)

4.1 3.3 Cases per10000 em-ployed

Skin diseases (/10000 em-ployed)

5.4 4.4 Cases per10000 em-ployed

95

Work ability

Table 33. Indicators of work ability (Finnish Work and Health Surveys 1997 and 2000,Piirainen et al. 1997 and 2000)

Agent Indicator Definition of indicator UnitPerceivedwork ability(scale 0–100)

Perceived work abil-ity among the em-ployed

Question in survey:Assuming that your work ability at the besthas got 10 points, how many points do yougive to your current work ability (scale 0-10)? 0 means that you are not able to workat all.Mean value x 10 (=scale 0–100)

-

Very goodphysicalwork ability

Prevalence of re-spondents with verygood physical workability

Question in survey:Is your current work ability compared to thephysical requirements of your current (lat-est) work very good, rather good, to someextent good, rather bad, very bad?Included if very good

%

Very goodmental workability

Prevalence of re-spondents with verygood mental workability

Question in survey:Is your current work ability compared to themental requirements of your current (latest)work very good, rather good, to some ex-tent good, rather bad, very bad?Included if very good

%

Definitelyable to workuntil retire-ment age

Prevalence respon-dents who believethey are definitelyable to work untilretirement age

Question in survey:Do you think that as regards to your healthyou are able to work in your current (latest)occupation until retirement age? (no,probably no, probably yes, yes)Included if yes

%

Employersupportsphysical ac-tivity

Prevalence of re-spondents whoseemployer supportsphysical activity

Question in survey:Does your employer/enterprise supportphysical activity for example by providingfacilities for physical activity, giving youtickets for physical activity or participatingin arranging physical activity? (yes, no)Included if yes

%

Occupationalhealth servicesupportswork ability

Prevalence of re-spondents whoseoccupational healthservice supports suf-ficiently work ability

Question in survey:Has the occupational health service sup-ported you in maintaining your work abil-ity? (not needed, sufficiently, too little, notat all)Included if sufficiently

%

Activities toimprovework atmos-phere

Prevalence of re-spondents in whosework places activi-ties to improve workatmosphere havebeen arranged

Question in survey:Has the work atmosphere been surveyed atyour workplace, have events dealing withmental atmosphere of your workplace beenarranged, has there been other activities fordeveloping the work organization. (yes, no)Included if yes

%

Trainingrather or verywell arranged

Prevalence of re-spondents whosetraining has beenrather or very well

Question in survey:How well has training of employees beenarranged at your workplace? (poorly, ratherpoorly, on average way, rather well, very

%

96

arranged at work-place

well)Included if rather or very well

Table 34. Data for indicators of work ability in Finland (Finnish Work and Health Sur-veys 1997 and 2000, Piirainen et al. 1997 and 2000)

Agent 1997 2000 UnitPerceived work ability (scale 0-100) 79 80 %Very good physical work ability 34.3 33.7 %Very good mental work ability 27.9 28.8 %Definitely able to work until retirement age 39 51.4 %Employer supports physical activity 60.1 66.2 %Occupational health service supports suffi-ciently work ability

38.3 38.3 %

Activities to improve work atmosphere 51.8 54.1 %Training rather or very well arranged 48.5 42.7 %

Work-related health problems

Table 35. Indicators of work-related health problems (Second European Working Con-ditions Survey 1997)

Agent Indicator Definition of indicator UnitStress Prevalence of stress

among the employedQuestion in survey:Does your work affect your health, or not? (IFYES) how does it affect your health?

• Yes, stress

%

Backache Prevalence of back-ache among the em-ployed

Question in survey:Does your work affect your health, or not? (IFYES) how does it affect your health?

• Yes, backache

%

Overallfatigue

Prevalence of overallfatigue among theemployed

Question in survey:Does your work affect your health, or not? (IFYES) how does it affect your health?

• Yes, overall fatigue

%

Headache Prevalence of head-ache among the em-ployed

Question in survey:Does your work affect your health, or not? (IFYES) how does it affect your health?

• Yes, headache

%

Muscularpain inarms orlegs

Prevalence of mus-cular pain in arms orlegs among the em-ployed

Question in survey:Does your work affect your health, or not? (IFYES) how does it affect your health?

• Yes, muscular pain in arms or legs

%

Sleepingproblems

Prevalence of sleep-ing problems amongthe employed

Question in survey:Does your work affect your health, or not? (IFYES) how does it affect your health?

• Yes, sleeping problems

%

Irritability Prevalence of irrita-bility among the em-ployed

Question in survey:Does your work affect your health, or not? (IFYES) how does it affect your health?

• Yes, irritability

%

97

Job more dif-ficult becauseof healthproblems

Prevalence of per-sons whose healthproblems maketheir job more dif-ficult

Question in survey:Is your job more difficult for you because ofchronic or permanent health problems? (no,never; yes, all the time; yes, almost all of thetime; yes, around 3/4 of the time; yes, aroundhalf of the time; yes, around 1/4 of the time; yes,but hardly ever; don't know)Included if at least around ¼ of the time (?)

%

Absenteeismdue to occu-pationalhealth prob-lems

Prevalence of ab-senteeism due tooccupational healthproblems amongthe employed

Question in survey:Over the past 12 months, how many days, ifany, were you absent due to health problemscaused by your main job?Included if at least one day

%

Table 36. Data on indicators of work-related health problems (Second EuropeanWorking Conditions Survey 1997)

Agent Country Value ofindicator

Unit

Stress Index country: Finland 34 %Best EU country: Ireland 12 %Worst EU country: Greece 50 %

Backache Index country: Finland 33 %Best EU country: Ireland 13 %Worst EU country: Greece 44 %

Overall fatigue Index country: Finland 20 %Best EU country: Austria 5 %Worst EU country: Greece 57 %

Headache Index country: Finland 20 %Best EU country: Ireland 5 %Worst EU country: Greece 24 %

Muscular pain in arms or legs Index country: Finland 29 %Best EU country: Ireland 6 %Worst EU country: Greece 37 %

Sleeping problems Index country: Finland 11 %Best EU country: Ireland 3 %Worst EU country: Finland 11 %

Irritability Index country: Finland 16 %Best EU country: Ireland 5 %Worst EU country: Sweden 18 %

Job more difficult because ofhealth problems

Index country: Finland 14 %

Best EU country: Spain 4 %Worst EU country: Austria 17 %

Absenteeism due to occupationalhealth problems

Index country: Finland 30 %

Best EU country: Sweden 13 %Worst EU country: Austria 36 %