Occupational health services function in line with the occupational safety organization as regards the division of work and co-operation in the ways of informing and guidance in order, to avoid overlapping activity. The su- pervisors must also be familiar with the prevention of health hazards. Information is needed on
w work processes
w anticipated hazards and risks
w how risks can be anticipated
w how to avoid hazards and risks, for example guidance in the use of personal protective equipment
w individual health restrictions
w behaviour that increases the risk of hazards.
The chosen strategies vary depending on the situation. Technical solutions that eliminate the possibility of human error are the surest way to prevent hazardous situations. Ergonomic solutions can make safe working meth- ods easier. Instead of rewards and punishment, employees should be moti- vated to act safely, for instance, by informing, training and increasing their participation in the planning of their own work. The employees’ own anal- yses of their working habits and a search for safer alternatives are good methods, if the management is genuinely interested in the promotion of safety.
A prerequisite for safe working is that the organization allows, supports and demands it. Behaviour can be channelled either in a safe or a risk- taking direction, through guidance in work methods, the attitudes of super- visors, and basis for payment.
Increased participation and multidisciplinarity are effective strategies of health promotion in occupational health services. There are many ways of encouraging participation, for example, arranging work-place exercises or work-place lunches.
The possibilities people have for promoting their health are diverse, de- pending on their life situation, education, attitude toward health risks, or
out fragmented pieces of health information. People must be offered tools, which can help them to put matters in their right perspective. A very low risk level has already been achieved for many individual risk factors in work life, compared to the risks that people face outside work life. The standard may be different in work life than in private life and the occupa- tional health personnel should take this into account when giving advice. People tend to tolerate greater risks in their private life than at work. The possibilities of people to influence their own work are an important part of their possibilities to promote their health. The occupational health services must also take into account the individual ability of people to cope with problems, also those related to health. Many health habits are a means of coping, and the circumstances affect how these habits are formed. Ex- amples of these habits are, for instance, smoking, excessive use of alcohol, and eating habits.
From the point of view of the occupational health personnel, pre-employ- ment health check-ups, instruction on work tasks, safety instructions, work place surveys, and individual guidance to work groups and employees are important in promoting the employees’ health. The quantity and quality of these activities are crucial factors in successful health promotion, as is the trust built between the health personnel and the employees.
Follow-up, evaluation and development of activity
It is often difficult to measure the effectiveness of the information given, and thus it is difficult to measure efficacy. The impact of information can be, for example, changes in working methods and protection, changes in the work environment, safety policy, health behaviour, state of health, sub- jective well-being or the ability to work. A variety of methods should be used in the evaluation of health-promoting activities. It is often necessary to concentrate on the intervention process itself, in other words, to analyze how easy it has been to implement a certain activity, and what has hap- pened in the process. At least in the case of long-term employment, it is possible to help an employee feel that he is in charge of his own life. This happens best through feedback on the work, self-esteem, and the possibil- ity to participate in the planning of one’s own work.
Along with the tendency of employment to change from permanent to short- term contracts,new health promotion tasks are surfacing. The way people
will change. In good occupational health practice, the problems caused, for instance, by competition and the ageing of workers, are noted, and solu- tions for them are sought. The solutions take into account the health pro- motion of both the work community and the individual, as well as the en- terprise management, supervisors, and the people in charge of designing for creating a health-promoting and safe work environment and of ensuring the prerequisites for health.
Bibliography in English
Bracht N. (ed.) Health promotion at the community level. SAGE source books for the human services series 15. Sage publications 1990.
Sundström-Frisk C. Compelling or participation? Strategies for influenc- ing risk behaviour. Työterveyslääkäri (Occupational physician; Finland, in English) 1/1998:52-59.
Sundström-Frisk C. Promoting safe behaviour. Key-note address. ICOH 25th International Congress on Occupational Health, Stockholm 15–20 Sept. 1996. National Institute for Working Life, Solna, 13–181.
14
Health examinations
Mari Antti-Poika
Introduction
The employees’ health is followed mainly by health examinations. In occu- pational health services, a health examination means a planned meeting between an employee and an occupational health professional, and the pur- pose of the meeting is the assessment, and follow-up of the health and functional capacity of the individual. Examinations targeted at work groups or units are discussed in Chapter 16 Occupational health support for work communities, and health counselling in association with health examina- tions is discussed in Chapter 13 Information and guidance. Health exami- nations provide information also for the planning of activities to promote work ability (see Chapters 12 Maintenance of work ability and 15 Assess- ment of work ability). Figure 13 p.126 illustrates the health examination process.
The target groups and the content of health examinations are planned in accordance to the objectives of the work place. The final objectives may be connected with promoting the employee’s work capacity, preventing work- related diseases and symptoms, or promoting a well-functioning work com- munity and a healthy and safe work environment. Health examinations can also support the prevention and handling of addiction problems, their early recognition and referral to treatment. A health examination is not a sepa- rate procedure, it is part of the comprehensive occupational health servic- es, and helps in the recognition of the need for corrective measures and in the follow-up of their effects.
In order to follow up the workers’ health, a health plan may be drawn up during the health examination. The employee makes the health plan for him/herself together with an occupational health professional. A written summary of the examination can function as the health plan, if it includes the plan, intended actions and the follow-up of the implementation of the plan.
Figure 13.
Flow-chart of a health examination
Group examinations can be used in solving special problems. For example, in examinations carried out after water damage has occurred, in the case of a ‘sick building’, or when assessing the consequences of gas leaks, etc., it is usually feasible to examine employee groups. In these instances, the health examinations complement work place surveys. The methods are chosen carefully according to each case. Often, reference groups are also needed.
Need Definition goals Planning contents according to goals Planning implementation Planning follow-up Implementation Assessment of results Issuing statements and recommendations Output Follow-up ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼