1. © Työterveyslaitos – www.ttl.fi Health surveillance - The role of Occupational Health service and competent person for health at work Timo Leino D.Med.Sci, Adjunct Professor Chief Physician Finnish Institute of Occupational Health Health and Work Ability Research and Development in OHS Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland Tel. +358 30 474 2388 Mobile +358 43 825 1894 timo.leino@ttl.fi www.ttl.fi 1 3.6.2013

2. © Työterveyslaitos – www.ttl.fi 2 Occupational health and safety system in Finland 3.6.2013

3. © Työterveyslaitos – www.ttl.fi 3 Special features of the Finnish OHS Tripartite Advisory board on Occupational Health Care (based on law) Tripartite negotiations at state level  planning and follow-up of OHS Legislation since 1978 Curative services as part of the OH service Since 1990 the concept of Maintenance of Work Ability as part of OH service Finnish Institute of Occupational Health with six Regional Institutes 3.6.2013

4. © Työterveyslaitos – www.ttl.fi 4 Self-employed Enterprise Farmers Enterprise OHS unit Joint model of OHS unit Private medical centre Enterprise Municipal health centre Models for service provision

5. © Työterveyslaitos – www.ttl.fi 5 Content and tasks of occupational health services by law and regulations Content is planned as a cooperative effort at the workplace by the occupational health professionals Occupational health services' tasks are: analysis of working conditions, health hazards and work strains by regular access to places of work evaluate and monitor employees' health status and working ability in pre-employment and periodic medical examinations (approximately 1 million per year) provide employers and employees information, counselling and guidance about the health risks present in the workplace and about how they can be prevented planning and follow-up of measures for maintaining employees' working ability provide rehabilitation counselling and refer employees for further treatment or rehabilitation as needed provide regular medical services on the general practitioner level (voluntary, but about 80% of the OHS service agreements include curative services) 3.6.2013

6. © Työterveyslaitos – www.ttl.fi Health examinations in OHS Pre-employment For workers in hazardous jobs When returning to work after a long period of sick leave For assessment of work ability After especially hazardous jobs even when the person is not any more working in such a job e.g. when exposed to asbestos 6 3.6.2013

7. © Työterveyslaitos – www.ttl.fi 7 Financing The employer is primarily responsible for organizing and financing the OHS for the employees Provided the OHS Act is complied, the employer is entitled to reimbursements from the Social Security Institution (SSI) Reimbursement up to 60% of costs of preventive and 50% of costs of curative services The SSI covers the reimbursements from Sickness Insurance Fund, which is financed by the employers, the employees and the Government. The OHS costs of the SSI are, however, totally covered by the Employer. The total reimbursement costs of the SSI were 285 M€, and the total costs about 626 M€, i.e. on average 342 €/employee and reimbursement costs 156 €/employee. (2010) 3.6.2013

8. © Työterveyslaitos – www.ttl.fi Health surveillance in OH Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of data in order to improve health and safety at the population group; and individual level Two elements can be identified hazard surveillance health surveillance 8 Koh D and Aw T. Surveillance in occupational health Occup Environ Med. 2003 September; 60(9): 705–710. 3.6.2013

9. © Työterveyslaitos – www.ttl.fi Why health surveillance is needed? Guide immediate action for cases of public health importance; measure the burden of a disease (or other health-related event), including changes in related factors, the identification of populations at high risk, and the identification of new or emerging health concerns; monitor trends in the burden of a disease (or other health- related event), including the detection of epidemics (outbreaks) and pandemics; guide the planning, implementation, and evaluation of programs to prevent and control disease, injury, or adverse exposure; evaluate public policy; detect changes in health practices and the effects of these changes; prioritize the allocation of health resources; describe the clinical course of disease; and provide a basis for epidemiologic research. 9 CDC, 2001 3.6.2013

10. © Työterveyslaitos – www.ttl.fi 10 The scope of health surveillance Can be narrow like when the interest is only on exposure-effect-disease- relation or wider like in Finland, where the work ability model is used as a theoretical model in OH 3.6.2013

11. © Työterveyslaitos – www.ttl.fi Health surveillance can include Workers surveys Exposure databases Registers of accidents and diseases Registers of sickness leave or absenteeism Multisource/policy-directed systems Intervention- and OSH management-related systems 11 3.6.2013

12. © Työterveyslaitos – www.ttl.fi Case Finland 12 Work Environment Workers Health OSH Register of Occupational Hygiene Measurements Register of Biological Monitoring Results Register on Employees Exposed to Carcinogens Finnish Work and Health Survey Working Conditions Study Finnish Working Life Barometer Barometer of Maintenance of Work Ability Register of Occupational Accidents Register of Occupational Diseases Finnish Cancer Registry Statistics on Sickness Absences Statistics on Work Inability Pensions Labour Inspectorate’s Workplace Information System Social Security Institute’s OHS Statistics Occupational Health Service Survey https://osha.europa.eu/en/topics/osm/reports/system.stm 3.6.2013

13. © Työterveyslaitos – www.ttl.fi System requirements for setting up health surveillance Usefulness Simplicity Flexibility Data quality Acceptability Sensitivity Predictive value positive Representativeness Timeliness Stability Feed back for action 13 3.6.2013

14. © Työterveyslaitos – www.ttl.fi Conducting surveillance Engage the stakeholders in the evaluation Describe parameters for follow-up e.g. frequency, severity, costs, preventability Describe the surveillance system draw a flow chart and name the actors and beneficiaries Consider needed resources and costs to run the system Evaluate the surveillance system regularly 14 3.6.2013

15. © Työterveyslaitos – www.ttl.fi Actors in health surveillance Authorized national organisations collecting statistics labour statistics health statistics OSH administration Research institutes niosh, public health institute Regional and local governments Private organisations Employers 15 3.6.2013

16. © Työterveyslaitos – www.ttl.fi A typical flow chart of a health surveillance system 16 CDC,2001 3.6.2013

17. © Työterveyslaitos – www.ttl.fi Describe the components of the system What is the population under surveillance? What is the period of time of the data collection? What data are collected and how are they collected? What are the reporting sources of data for the system? How are the system's data managed (e.g., the transfer, entry, editing, storage, and back up of data)? Does the system comply with applicable standards for data formats and coding schemes? If not, why? How are the system's data analyzed and disseminated? What policies and procedures are in place to ensure patient privacy, data confidentiality, and system security? What is the policy and procedure for releasing data? Do these procedures comply with applicable regulations? If not, why? Does the system comply with an applicable records management program? For example, are the system's records properly archived and/or disposed of? 17 3.6.2013

18. © Työterveyslaitos – www.ttl.fi Standardizing data EU: EODS methodolgy for standardized recording of occupational diseases Pascalicchio R. C/O World Systems Ltd & Eurostat - Unit E3, November 2000, document available at Eurostat E3 secretariat http://ec.europa.eu/social/BlobServlet?docId=3153&langId=en http://ec.europa.eu/social/BlobServlet?docId=3153&langId=en ILO: List of occupational diseases (revised 2010) http://www.ilo.org/safework/info/publications/WCMS_125137/lang-- en/index.htm 18 3.6.2013

19. © Työterveyslaitos – www.ttl.fi Quality assessment and quality improvement of national registries of occupational diseases ODIT tool the completeness of the notification form coverage of registration guidelines or criteria for notification education and training of reporting physicians completeness of registration statistical methods used investigation of special cases presentation of monitor information presentation of alert information 19 Spreeuwers D, de Boer AG, Verbeek JH, van Dijk FJ. Characteristics of national registries for occupational diseases: international development and validation of an audit tool (ODIT). BMC Health Serv Res. 2009; 9: 194. 3.6.2013

20. © Työterveyslaitos – www.ttl.fi Audit of OD surveillance in six EU countries: Austria, Belgium, the Czech Republic, France, Finland and the UK The average quality was rated 3.2 (SD 2.2) out of 10 for monitoring occupational diseases and 5.3 (SD 1.4) out of 10 for alerting to new risks Two main reasons for low scores: inadequate education and training of physicians poor participation of notifying physicians 20 Spreeuwers D, de Boer AG, Verbeek JH, van Dijk FJ. Evaluation of occupational disease surveillance in six EU countries. Occup Med (Lond). 2010 Oct;60(7):509-16. 3.6.2013

21. © Työterveyslaitos – www.ttl.fi E-health and health surveillance Many countries are developing internet based health monitoring and support systems Canada: www.infoway-inforoute.cawww.infoway-inforoute.ca Finland: National Archive for Health Information Great Britain: www.nhsdirect.nhs.uk/www.nhsdirect.nhs.uk/ The Netherlands: AORTA - national e-health infrastructure Typical components interconnected systems using standards (HL7 v3, SSL) individual health records/accounts health profiles health checkers e-prescriptions Costs have been substantial Sir Edward Leigh said in 2007 evaluation report after the costs had risen 20 billion pounds in six years: "This is the biggest IT project in the world and it is turning into the biggest disaster" 21 3.6.2013

22. © Työterveyslaitos – www.ttl.fi Inspite of all the problems we are facing interconnected health and safety systems are emerging improved health surveillance quicker responses (policies, programs, workplaces, individuals) better, tailor-maid-services cost savings 22 3.6.2013