Implementation of the framework agreement on work

related stress

ETUC project - Estonian case

Eda Merisalu, Dr.Med.Sci.

ETUC-UNICE/UEAPME_CEEP autonomous framework agreementon work-related stressRiga, 11-12.10.2005

Work stress as a world wide problem

WHO Health Raport 2001

Mental Health: New Understanding. New Public Health191 countries: global/regional problems of mental health (MH)

Purpose: creating and mapping of profiles and data bases on MH185 WHO have own MH data bases (Estonia -ESA)

Resourses, programs and MH politics 41% of countries MHP doesn’t exist 25% lack of regulatory acts28% lack of finances for MH41% lack of curare of severe cases of MH37% low level of primary health care65% stationary beds in psychiatric hospitals/departments

Influencing factors

• increase of amonts of mental work • increase of importance of private sector• more intensive work• work overload• not official work and pay• increase of employment & unstability• at the same time working on the different posts• increase of work violence

Factors that Endanger Employees´ Health, % of all respondents (N=402)

Mental health statistics in Estonia 2000

94 228 psychiatric consultations per year80 837 of those patients get diagnose9 914 healthy persons

Statistics of behavioral & psychic disorders 2000

Neurosis

0

200

400

600

800

1000

1200

15-19 20-24 25-34 35-44 45-54 55-64 65-74

Nu

mb

er o

f ca

ses

Naised Mehed

Estonian health survey (Leinsalu, Grintšak, Noorkõiv, 1999)

workload >40 hrs per week

0

10

20

30

40

50

Serious healthproblems

Serious distress Negative healthbehavior

%

female

male

Health behaviour survey of Estonian adult population, 2000

Chronic exhaustion

0

10

20

30

40

50

60

16-24 25-34 35-44 45-54 55-64

% Naised Mehed

thinking about suicide

02468

10

16-24 25-34 35-44 45-54 55-64

% Naised Mehed

Health behaviour survey of Estonian adult population, 2000

male

0%

20%

40%

60%

80%

100%

0-4

10-1

4

20-2

4

30-3

4

40-4

4

50-5

4

60-6

4

70-7

4

80-8

4

age

Other

Violent deaths

Cancer

Cardiovasculardiseases

Structure of death causes in Estonia

Structure of death causes

women

0%

20%

40%

60%

80%

100%

0-4

10-1

4

20-2

4

30-3

4

40-4

4

50-5

4

60-6

4

70-7

4

80-8

4age

Other

ViolentdeathsCancer

Cardiovascular

Study of living and working conditions’ in EU countries 1990-2000

Studies in 1990 (EU12), 1995 (EU15), 2000 (EU20), 2005 (EU25)21 500 workers interviewed

Main health complaints: Lower back pain 33%; Stress 28% Shoulder-neck pain 23%; burnout 23%

Main causes• Exposition to physical stress (noise, vibration, cold, warm; lifting heavyweights; constraint position, high work intensity)• Lack of control• New infotechnology• Shift work, part time work• Organisation (multidimensional work, need for teamwork, additional pay)• Use of temporary work force

• work intensity 54%

• repetitive work 50%

• monotonous work 44%

• lack of autonomy 35%

• lack of control over work temp 28%

Causes of work stress in EU countries(Paoli 1996)

• low back pain 30%

• stress 28%

• exhaustion 20%

• musculo-skeletal pains 17%

• headache 13%

Consequenses of work stress, (Paoli 1996)

Agreements on work stress in EU member states EU member

state Dir 89/391EEC; OH&S Act Agreement

1. UK 1974 1995 responsibility of employer for safety and health on the work place / court cases

2. Denmark - No agreements 3. Creece 1985 1996 Presidental Decree, Civil Code on the

Safety of Work Places 4. Finland 1987, 2001 OH&S Act,

2002 TTHOS The preventing of sick leave

5. Sweden Work Env Act, Regulations of Working Time, OH Insur Act

Need for health service at the work place

6. Ireland 1989, 1993 1989 OH&S Act& Well-being Act ie prebvention of work stress and violence /cc

7. Italy 1989, 1990 Work overload and occ accidents /court cases 8. Portugal 1991, 1994 2001 tööõnnetuste vältimine 9. Belgium 1992, 1996 Royal Decree 1998 workers’ well-being and risk assessment 10. Austria 1994 2001 assessment of psycol risk 11. Luxemburg 1994 Stress prevention programs financed by the

employer 12. Spain 1995, 1996 Risk assesment ie psychol. factors 13. Germany 1996, 2001 No agreements 14. Netherland 1998, 1997 OH&H Act Prevention of overload 15. Norway 2002/2003 No agreements 16. France 2002 2000 OH&S Act, 35 h working week 17. Estonia 1999,2001, 2003, 2005 No agreements

Estonian OH&S Law 1999, RT I, 1999, 60, 616

II pt §3. Whatever risk factor at work (Phys,Chem, Biol, Physiol, Psych) can’t cause negative effect on health of worker§ 9. Physiological and psychological risk factors  (1) Physiological factors are severuty of physical work, repetitive work externous positions and -movements ect which may cause health complaints or work related disease.   (2) Psychological factors are monotonous work, not adapted work, bad work organisation, long lasting work alone ect ning muud samalaadsed tegurid, which may cause health complaints or work related disease.   (3) That to prevent mental and psysical overload employer must adapt the work, taking into account physical, mental differences, gender and age. Also changes of work ability during the working day or one shift and possible work alone during long time

III pt §13 Obligations of employer 1) internal control of work enironment, controlling occupational health and safety at the work places, accompaying employees and carrying out risk analysis in the enteprise (RK s 29.01.2003 /01.07.2003 - RT I  2003, 20, 120)

2) To analyse the results of inernal control and to adapt work conditions under the new situation;3) To carry out risk analysis explaining the all risk factors and measuring all the parametres; to assess their effect on workers’ health, accordingly of their sex and age. To archive all the results of risk analysis during 55 years.

OH&S Law 1999, RT I, 1999, 60, 616

Social and economical costs caused by work related accidents and OD in 2000-2003

Disease compensation (EEK) Occupational disease compensation (EEK/GNP%)

Management of work stress 1.    Primary interventionIdentification of psychosocial and organisational risks, risk analysis, risk management, improvement of work culture

2.    Secondary interventionTeaching, training, health promotion programs, good health behaviour. 3.    Tertiary interventionPsychological advisoring, Individual and collective stress management.

Organisational prevention in hospitals (Schaufeli 2002)1$ costs 5-16 $ back

Total costs (533 000 EUR)22 000 EUR technical measurements263 000 EUR training248 000 EUR organisational changes Kasum (741 800 EUR)1,2 milj EUR lost working days 448 200 EUR adaptation to work

Total effectiveness of intervention 208 800 EUR

Case study (1992-1994)