professor, md, phd. matti ylikoski reykjavik 9.11. 2009

Health Promotion and Maintenance of Workability

- National and Local Opportunities in Ensuring Employability of Aging Workforce -

Professor, MD, PhD. Matti YlikoskiReykjavik 9.11. 2009

Prof. M Ylikoski, FIOH / 24.04.23 2

Contents of the presentation

1. The "why" of a National Strategy for "Promotion and Maintenance of Work Ability (PMWA)" – in Finland

2. The PMWA model, definitions and framework3. PMWA in practice4. Summary and conclusions


1. The "why" of a National Strategy for "Promotion and Maintenance of Work Ability (PMWA)" – in Finland


Population changes in Finland 1749 – 2008

Birth – rate Death- r Immigrants Emigration

Future demographic challenge was recognised


0

200000

400000

600000

800000

1000000

1200000

1400000

1865 1878 1891 1904 1917 1930 1943 1956 1969 1982 1995 2008

15-29

45-59

Finnish population by age groups 1865 – 2008(Central Statistical Bureau, Fi)

Future shortage of young workers became critical


1865 1890 1915 1940 1965 1990 2015 20400

20

40

60

80Ikä

Alle 15-v.Yli 65-v.

Väestöllinen huoltosuhde 1865-2050

Lapsia ja eläkeikäisiä 100 työikäistä kohti1912: 70,8 2026: 70,7

1912: 61 lasta, 10 eläkeikäistä2008: 25 lasta, 25 eläkeikäistä2026: 28 lasta, 43 eläkeikäistä

2008: 50,3

Dependency Rate 1865 – 2050Children and retired per 100 people at working age

61 children; 10 retired25 childern; 26 retired28 children; 43 retired

Age> 65 y< 15 y

In 2008 in whole Finnish history the number of 65 years or older was higher than the number of those under 15 years old.


Important reasons for staying at work until statutory old-age retirement

(Statistics Finland 2006)

445353

5660616264

6770

0 10 20 30 40 50 60 70 80 90 100

Sabbatical

Better health care

More flexible working times

More opportunities for education

Higher salary

Improvements in work environment

Better leadership

Better rehabilitation opportunities

More challenges in work content

Decrease in workload and haste

%


> 20 years follow–up research for the why of the strategy - a cohort of 7000 municipal employees since 1981 -

(Tuomi ym. 2005; Ilmarinen 1996)

1. Workplace supports work ability and health (and the business), if:

– well organised, open communication and collaboration– opportunities to develop and influence, – managing over- and underloading – managing conflicts and insecurity at work

2. Mismatch between man and work varies with age and work3. Work ability varies widely between branches and trades

– work should be adjusted with flexibility through the life course– new abilities are needed for info-jobs and new technologies– retired, temporary hindered and unemployed have work ability still– return to work (sick pay; rehabilitation) needs support

4. Problems to appear:– economic depression with restructurings– agriculture and forestry, pulp and paper- and metal industries,

transportation, construction, social services– vulnerable groups: women, handicapped, youngsters, unemployed

aso.

Work ability was seen as the most important asset of employees

in work life, where: health and functional capacity are basic

explanatory variables which influence to – and depend on

- other individual and work related factors,

such as workplace as an organisation and community.

A systemic approach was needed !


Workplace health promotion as a model to maintain and promote work ability

- a systemic approach -

• Health promotion are empowering activities which, aim:– to increase the opportunities and prerequisites of people in

taking care of the health of them, their environment, in their community, and with the support of its social resources (WHO: Ottawa Charter 1986)

• Workplace is ONE of the settings and "social arenas", which offer special opportunities to promote workers´ health an work ability:

– as a community and a decision making system with resources for health and thus, for adjusting work for workers health, and

– as an environment with particular exposures and thus, duties concerning to manage and combat against hazardous loadings.


(Work) Life

Individual witha handicap

Medical invalidity

Individual with limitedabilities in regard of job demands

JobIndividual

Disability

Individual in the work life context and "system"

Organisation

Bio – Psycho – Social"residual" work ability

(Work) Life

From "handicap" orientation - via balance model - towards a multifactorial approach


Widening of the "Well-being at Work" concept (Hämäläinen 2008, Hanson 2007, Ylikoski ym. 2006, Kickbusch 2004, Whitelaw ym. 2001)

1. From pathogenic approach towards "salutogenic" view• what is dangerous to health what is good for health and well-

being– health as a resource in meeting life (conditions/environment)

2. From prevention towards promotion• risk factors health and work ability determinants• protect and avoid strengthen, support• reactive predictive (proactive)

– unemployment research coping with transitions at work life 3. From objects for expert actions towards participation of the

empowered people• individual lifestyle population & organisational (setting)

partnership strategies with empowered actors• general models and Good Practices locally tailored solutions• specialized campaigns continuous strategic integration and

processes with committed actors4. (Re)integration of well-being and productivity


2. The PMWA model, definitions and framework


Work, functional capacity and age are linked- and there is lot to do -

(Ilmarinen 1999)

Age

Job demands

Functional capacity & competence

%

Reserve

Decrease job demands

PROBLEM

SOLUTIONS

Promote and maintain work abilityReserve


PMWA: Rationale

• PMWA operations were based on:– knowledge of aging,– physiological, psychosocial and health changes needing

special emphasis due to aging of the work force and– knowledge for adjustment the work conditions according to the

individual at his/her situation.• However, recently the whole life course and work career are

considered as a challenge for the PMWA activities– qualifications needed at work are changing continuously– life course transitions challenge coping aptitudes regularly– organisational changes evoke individual support and

adjustments


Basic training

Vocationaltraining

Published 2006, disseminating

Published 2002country wide

Countrywide since 1997

TowardsWork life

From Schoolto Work

40+ workers

- transfer to decent job

re-employment

Pilot,to be published2009

To Job

Unemployed andkicked out

- promotionof activelearning career

Prevention of mental depression

-promotion of career-prevention of burn out

Successful Senior

Supporting career through the whole life course(Vuori et al. 2007)


Definition of the PMWA

• Workplace activities aiming at promoting and maintaining the ability to work

– include all measures,– that the employer and the employees as well as – the co-operative organizations at the workplace take in a united

effort– to support the ability to work and to enhance the functional

capacities of all persons active in working life– throughout their working careers

Two-Partite Consensus with recommendation 1990 Obligatory (employers duty) legislation 2001


3. PMWA in practice


PMWA

activitiesWork and work environment:

Work conditionsJob content and demands

Work community and organizationCommunity and organizationManagement and leadership

ParticipationOrganizational learning

Individual:Health and functional capacity

Subjective:Values

Attitudes and motivationCompetence

Professional and social

Target areas and their "weight" in the PMWA measures

(Ilmarinen 2006)

0 %5 %

10 %15 %20 %25 %30 %35 %40 %

Effect on work ability

healthcompetencevaluesworkcommunity

Family

Society


PMWA

activitiesWork and work environment

Work community and organization•empowering self – esteem health

•participation commitment achievements more concrete•co – construction organizational learning social capital

Individual

Values and competence

The organizational development axis in the PMWA "four flies with one hit"

- how to act in practice ? -


From practical experiences, research and corporative collaboration towards legislation,

wide programmes and good practices

Practical experiences • Experts (OS&H)• Workers, managers, HR

Social partners• Policies • Negotiations

Research• Long-term cohort

• Surveys

Good Practices: Experts (OS&H)

Work places

Social partners• Agreements • Recommendations

Legislation

Nation wideProgrammes

• Ministries• Social partners

• Soc Sec Insur Co´s• Regional networks

•Companies• NGO´s

1980 - 1990 - 2001 – 2005 - 1995 -

Main activities in practice

• PMWA in companies nationwide

and obligated for employers (2001 -)

• "Work Ability Index" for assessment (1998 - )

• "Flexible retirement" – legislation (2005 -)

• "Age Management" – training (1999 -)

• "Transition coping" – model (1997 - )


PMWA measures carried out:Training and competence building

35

42

60

58

81

51

55

66

71

91

0 10 20 30 40 50 60 70 80 90 100

Training of planning skills

Training of team skills

Quality training

Training for the use equipment

Supporting competence building

%

Management (n = 882)Personnel (n = 812)


PMWA in operation: Improvements in team function and organization

31

35

36

49

46

52

53

60

54

54

62

69

47

40

51

63

75

79

67

80

75

75

80

82

0 10 20 30 40 50 60 70 80 90

Dimishing of hurrying and time-pressure

Increasing flexibility in working time

Strengthening the skills to control change and crisis

Improvements in organisation and division of work tasks

Improving the appreciation of personnel

Increase of feedback and support

Increase in independence and responsibilities in work

Development of leadership and supervisory skills

Improvement in communication

Clarification of the goals of work processes

Increase in cooperation and participation

Improvent in planning and quality control

%Management (n = 882)Personnel (n = 812)


Positive effects achieved

8 8

14 13

29

17

26

1310

7 85

26

1613

10

4

13 116

25

16 15

8

0

10

20

30

40

Nothing at all Less sicknessabsence

Well-being atwork improved

O rganisationalclimate

improved

%

Management 2001 (n = 882) Personnel 2001 (n = 813)O HS 2001 (n = 743)

Work environment improved

Motivation to work higher

Physical fitness increased

Cooperation improved


The benefits of PMWA is equivalent to it's costs (employers 1999 & 2005)

21

63

50

10

28

62

3 06

010203040506070

Very good Fairly good Fairly bad Very bad Can't say

%

(Work Ability Barometer 2005)


Expected effective retirement age for 50-year-oldsNordic countries in 1996–2007


Expected effective retirement age for 30-year-oldsNordic countries in 1996–2007


Expected effective retirement age for 30-year-oldsNordic countries 1996–2007, females


69,4

59,5

52,7 51,6 50,5

43,137,9

31,8 31,8 31,7 31,4

56,9

41,645,446,144,1

0

10

20

30

40

50

60

70

80

SE DK UK FI IE PT NL DE ES EL FR BE AT LU IT

Employment rates of the 55+ in the EU-15, 2005

Source: Employment in Europe 2006

Stockholm- target EU-15 average


Finland: Increase in the employment rate of ageing workers has been most prominent in the EU during the

latest 15 years (18 % - units !!)

Statistics Finland 2006

Employment rate

Age group


PMWA Activities in Finland- evaluative summary

• Amount of PMWA quite high with many positive effects• Versatile content of PMWA• High confidence to economical benefits:

– good cost and benefit ratio,– follow – up of the cost – efficiency has increased

• The role of OHS significant• SMEs need more support


Thank You for Your Attention !Thank You for Your Attention !


Further readings

• Ministry of Social Affairs and Health & Finnish Institute of Occupational Health (2004): Good occupational health practice. A guide for planning and follow - up of occupational health services. Ministry of Social Affairs and Health & Finnish Institute of Occupational Health. Helsinki. ISBN 951-802-566-5

• Ilmarinen J. Towards a Longer Worklife ! Ageing and the quality of worklife in the European Union. Finnish Institute of Occupational Health, Helsinki 2005.

• ILO: Tackling Global Crisis. Recovery through decent work policies. RepI(A) 2009• Vahtera J, Kivimäki M, Pentti J, Linna A, Virtanen M, Virtanen P, Ferrie JE.

Organisational downsizing, sickness absence and mortality: the 10-Town prospective cohort study. British Medical Journal 2004; 328:555-557

• Tuomi K, Ilmarinen J, Martikainen R et al.: Aging, work, life-style and work ability among Finnish municipal workers in 1981-1992. Scand J Work Environ Health 23 (1997): suppl 1, 58-65.

• Vuori, J., Koivisto, P., Mutanen, P., Jokisaari, M., & Salmela-Aro, K. (2008). Towards Working Life: Effects of an intervention on mental health and transition to post-basic education. Journal of Vocational Behavior, 72, 67-80.

• Ylikoski M, et al. Health in the World of Work: workplace health promotion as a tool for improving and extending work life. Helsinki, Finnish Institute of Occupational Health, 2006. (Reports of the Ministry of Social Affairs and Health 2006:62)

• Ylikoski M, Rantanen, J: The development of modern work organisations: a challenge to occupational safety and health. In Wirtschaftverlag NW (Ed): The future of working conditions: Tb / Bundesanstalt für Arbeitsschutz und Arbeitsmedizin, 102: 289-297, Bremerhaven, 2000.

professor, md, phd. matti ylikoski reykjavik 9.11. 2009

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