Surveillance of occupational disease and injury in Finland
This section summarises the key components of surveillance systems in Finland. Full details of each system are contained within the International Review of Methods and Systems used to Measure and Monitor Occupational Disease and Injury: NOHSAC Technical Report 35.
Finland has a population of just over 5 million people. The Finnish workforce is about 2.5 million. Occupational safety and health matters are primarily the responsibility of the Ministry of Social Affairs and Health7. Additionally, the Federation of Accident Insurance Institutions is also important, as employers are obliged to take out statutory workers’ compensation insurance.
The Finnish Institute of Occupational Health is funded by the Ministry of Social Affairs and Health and governed by a board of directors responsible to the Minister. It was founded in 1945 and has approximately 600 permanent staff and about 300 project contractors. There is a surveillance division, headed by Dr Timo Kauppinen.
The Occupational Safety and Health Inspectorates and the Occupational Safety and Health Department of the Ministry of Social Affairs and Health are the enforcement authorities of occupational safety and health legislation concerning workplaces. Control of products used at work is also exercised by these authorities, in response to Finnish membership of the EU. The Occupational Safety and Health Department and the Occupational Safety and Health Inspectorates supervise the conformity of machines, equipment, chemical substances, and personal protective equipment used at work by means of market surveillance, in order to ensure that only safe and conforming products are used at workplaces.
Institutions responsible for occupational safety and health in Finland:
- Centre for Occupational Safety
- Consumer Agency
- Federation of Accident Insurance Institutions (FAII/VAKES)
- Finnish Institute of Occupational Health
- Finnish Work Environment Fund
- Ministry of Labour
- Ministry of Social Affairs and Health
- National Product Control Agency for Welfare and Health (SSTV)
- Occupational Safety and Health Inspectorates
- Radiation and Nuclear Safety Authority
- Safety Technology Authority (TUKES)
- Technical Research Centre of Finland (VTT)
There are several Finnish surveillance systems, registers, and related surveys in operation. These include the following:
Information on occupational diseases is held in a number of databases. The principal one is the Finnish Register of Occupational Diseases (FROD), and this is supplemented by other important registers e.g. the Finnish Cancer Registry. All occupational diseases are required to be reported to FROD8.
The aim of the FROD system is to provide statistical information on occupational diseases for labour protection, occupational healthcare, and research. Intended users include administrative and field personnel in labour protection and healthcare organisations and researchers of occupational health.
|FIGURE 1||Data flows into the Finnish Register of Occupational Diseases|
The detailed classification of information in FROD makes the Register potentially very useful for the prevention of occupational diseases. The major limitation to the data set is the lack of any information on costs of claims or cases. Coverage of the Register is “incomplete” due to issues regarding diagnostic clarity, causal certainty, and an unknown degree of under-reporting.
Surveillance of occupational injuries is provided by the insurers providing compulsory cover for workers.
The principal database is the Database of Occupational Injuries (FINOCCINJB). All accidents that result in three or more days off work are included. Insurers are obliged to provide the Register with data on every case reported to them, regardless of compensation decisions.
The aim of the FINOCCINJB system is to provide statistical information on occupational injuries for labour protection, occupational healthcare, and research. Intended users include administrative and field personnel in labour protection and healthcare organisations and researchers of occupational injury. Each year, there are approximately 120,000 occupational injuries recorded. The number of fatalities is in the range of about 50 cases.
A supplementary source of information is the Database of Descriptions of Severe Occupational Injuries (FININJDESC). This is designed to capture information on all severe accidents that are examined by statutory inspectors.
Statistics are made available regularly. Access to the database is restricted. The quality of data is not measured. The FIOH are open in suggesting that there are reasons to believe it is not of high quality. The codes that are used to categorise accidents are not considered good.
Nearly all accidents that result in three or more days off work are likely to be included in the system. The system can be used to measure how many accidents occur in different industries and occupations. However, it provides little information about how the accidents happened and the probable causes.
The exceptions to this are the serious injuries that are attended by labour inspectors, but the quality of this data is dependent on the ability of the inspectors to make useful analyses of the accidents.
The Register of Occupational Injuries and Diseases in Finland (Tyotapaturna – ja ammattitautirekisteri, TPSR) is a combined register that is designed to capture data on all accidents at work or occupational disease in Finland. This system is run by the Federation of Accident Insurance Institutions and contains information on all injuries and diseases that have been compensated on the basis of statutory workers’ compensation. All insurance companies practising statutory accident insurance in Finland are under an obligation by law to deliver this data.
The general aim of the TPSR is to provide statistics of accidents at work and occupational diseases over a long period of time. Statistics can then be provided on the basis of numerous variables. These include:
- the injured body part
- means of transport (if the accident happened while commuting)
- primary cause of the disease and its medical diagnosis
- the amount of compensation paid.
The system does not contain text fields so its main use is in the creation of numeric statistical information, on the basis of which conclusions can be made and appropriate actions taken. The intended users are government officials, insurance companies, the FIOH, and other interested parties. The information is considered reliable, since the database has a long continuous history and a relatively high capture rate.
The Finnish model of occupational disease and injury surveillance provides a template for developing an effective integrated system for the surveillance of occupational disease and injury in New Zealand. The Finnish system for the surveillance of occupational disease and injury is not without flaws and suffers from some data quality issues, but crucially the Finnish system:
- is concept driven
- is led by a dedicated surveillance unit that includes appropriately qualified and experienced personnel
- collects data from a variety of sources including, where appropriate, unique identifiers that enable data and cases to be matched
- is adequately resourced.