Norway: Status and trends in risk exposures at work and work-related health
A total of 2.7 million people (71% of the working age population) were in work in Norway in 2013. The Norwegian employment rate for women and elderly workers is also high, compared with the EU generally. However, although the working environment for Norwegian employees would appear to be improving, threats to health are still present.
The National Institute of Occupational Health (NIOH) published its third fact book on working environments and health in spring 2015. The book, published every three years, presents and analyses official statistics on the work environment of Norwegian employees. It provides current facts and figures and identifies trends in health hazards. Its results and conclusions are the basis for policy decisions about matters such as which types of working conditions require attention, or what kind of information is needed to initiate campaigns to improve the work environment.
Methods and measures
The fact book’s conclusions are based on data from several sources including the Social Transfer Payment Register, the Patient Discharge Register and the Labour Inspectorate. The most important data, however, come from Statistics Norway, which also publishes its Working environment, survey on living conditions every three years.
Since 2006 it has been based on responses from a panel of interviewees, and the most recent survey was carried out in 2013. Eligible respondents are Norwegian residents aged 18–66. In 2013, a total sample of 21,707 people was randomly drawn from this population. Of these, 10,875 (53.1%) people were interviewed between 15 April 2009 and 25 January 2014.
Occupational health in Norwegian working life – a brief overview
Some 60% of doctor-reported sickness absences are musculoskeletal disorders and mental health complaints. This prevalence has remained steady for the past 20 years. Almost half of all employees who report symptoms of these disorders attribute them fully or partially to their jobs. Both international studies and recently published Norwegian studies show that psychosocial and mechanical factors in the work environment contribute to the development of these complaints.
However, compared with figures from 20 years ago, self-reported work-related respiratory symptoms are less prevalent today, although symptoms in the lungs and airways are still the most common reason for assessment by the occupational medicine departments in Norway. Estimates show that about 20% of all cases of lung cancer among men in Norway and between 10% and 20% of cases of chronic obstructive pulmonary disease are caused by exposure at work. Moreover, skin disorders are reported to be as prevalent today as they were 20 years ago and there is no change in the percentage of workers who report skin contact with oils and lubricants or frequent contact with water. Although exposure to work-related loud noise has significantly declined in recent years, noise damage is still the work-related illness most frequently reported to the Labour Inspectorate. Occupational injuries account for approximately 12% of all injury cases in Norway, and the risk of work-related injuries is particularly high among young men. The number of fatal occupational injuries has decreased over the long-term although this decline seems to have levelled out during the last decade.
Working hours and the psychosocial and organisational working environment
Working hours have an impact on health, work–life balance and well-being. Shift work and long working weeks are important risk factors in the modern working environment, and they are linked to serious health problems. In 2013, almost one in four people reported that they were working shifts or on rotation. The proportion of employees saying they work nights in their main job has fallen slightly in the last 15 years. In total, 17.1% of people in work say they have worked nights during a four-week period in their main or secondary job. This represents around 450,000 people. The percentage of people with long working weeks (45 hours or longer) has fallen somewhat, from just in excess of 14% in 2000 to just under 12% in 2013. However, the number of people with long working weeks has remained relatively stable in the same period at just over 300,000. Figures from the 2013 Survey on Living Conditions show that 340,000 people (13.4%) find that the demands of their jobs quite often, or very often, affect their home life.
Figure 1: Trend in self-reported psychosocial work environment factors 1989–2013 (%)
Norwegian people in work are generally positive about their psychosocial and organisational working environment. As shown in Figure 1, between 1989 and 2013 there was a decrease in the proportion of people experiencing:
- poor relationships between managers and employees;
- few opportunities for professional development or full use of skills;
- job insecurity.
The proportion of workers reporting bullying at the workplace was also stable. However, at the same time there was an increase in monotonous work, sexual harassment, and violence and threats of violence. Although the proportion of workers exposed to violence and threats of violence rose, this may be partly explained by the increase in the number of people working in health, social care and social services. Psychosocial challenges are particularly prevalent in these sectors and in the education and service sectors.
High work pressure, combined with limited opportunities for employees to take control of their working day, has been shown to increase the risk of cardiovascular disease (men) and depression and back and neck pain (men and women). Unfortunately the survey questions measuring those aspects were changed for the 2013 survey and so it is no longer possible to track or analyse trends for these factors.
In 2013, about 400,690 workers (around 16%) were in jobs with a combination of high pressure and low levels of control over decision-making. This combination is more common among women (22%) than men (11%) and is particularly widespread in the health and social care professions, among waiters and other catering staff, and among customer services employees.
A total of 203,000 workers (7.5%) say they have been subjected to violence or threats of violence in the past year – risks, as already mentioned, that are particularly prevalent among occupational therapists, social workers, nurses and health and social care workers, and also police officers and security personnel.
A total of 123,000 people in work (4.7%) say they have been subjected to unwanted sexual attention or comments in the workplace in the past year. Violence and threats of violence, along with sexual harassment are more commonly reported by women than by men. In 2013, 78,300 workers (3%) said they had been bullied in the workplace. The prevalence in Norway of bullying in the workplace remained relatively stable during 1989–2013.
Psychosocial risk factors and mental health
Good mental health is a key factor for participation in working life. In 2012, people with mental health conditions accounted for 28% of all new disability pension recipients in Norway, and 20% of all doctor-reported sickness absences in 2014. However, the prevalence of mental health issues and conditions has remained stable in the last few decades.
Data from the 2013 Survey on Living Conditions shows that around 15% of the working population had reported mental health issues in the previous month. Just under half said their problems were work-related. The proportion of people in work suffering from significant mental health issues stands at 10%, equivalent to just over 250,000 people. Around 11% reported sleeping problems entirely or partially caused by their work, while one in five said they felt mentally exhausted after work at least once a week. New Norwegian research has found that around one quarter of all cases of mental problems in the working population can be attributed to psychosocial and organisational risk factors such as low levels of co-determination in the workplace, role conflicts, high emotional pressure, bullying/harassment and lack of job security. The 2013 Survey on Living Conditions found that people especially likely to say they are exposed to psychosocial risk factors in their working environment are those working in primary and lower secondary education, as well as health, social care and social services. The same group also report a high prevalence of mental health issues.
Figure 2: Trend in self-reported mechanical exposures 1989–2013 (%)
Exposure to certain mechanical factors, such as lifting in awkward positions and having to work with one’s hands at shoulder height, has fallen over the past 20 years (Figure 2). The number of people working while crouching or kneeling has remained relatively stable over the same period.
The most common mechanical factors are repetitive and monotonous hand or arm movements, and working while standing up, but the percentage of people exposed to these factors has remained relatively stable over the past 20 years. More young workers (aged 17–24) are exposed to these factors than older ones. There is a clear link between levels of education and mechanical exposure. With the exception of work involving computer screens and keyboards, workers with lower secondary education as their highest qualification report the greatest frequency of mechanical exposure. Workers with a lower level of education are more often employed in manual or blue-collar occupations where mechanical exposure is more prevalent.
However, the difference in exposure between men and women is less marked.
Musculoskeletal disorders are about as common today as they were 20 years ago. Around seven in ten people in work report aches and pains during any one month. As for the more serious conditions, 27% of the working population report being somewhat, or very much, affected by aches and pains during any one month, and around half say these complaints are entirely or partially caused by their work. Research shows that both mechanical and psychosocial factors have an impact on the extent and intensity of such health complaints.
Figure 3: Trend in self-reported chemical and physical exposures 1989–2013 (%)
The proportion of people reporting exposure to dust/smoke/gas/fumes in the workplace has decreased over the past 20 years (Figure 3). Younger workers and those with the lowest levels of education are generally more likely to report exposure. Exposure to dust, smoke, exhaust, gas, steam and chemicals is widespread in the building and construction industry and among industrial workers, and is three to five times more common among men than women.
Although passive smoking has fallen due to the introduction of an indoor smoking ban, around 220,000 people continue to be exposed to secondary tobacco smoke every day at work. This particularly affects building and construction workers, health and social care workers, and security guards and police officers.
There is no change in the proportion of people reporting skin contact with oils and lubricants or frequent contact with water. There is a slight decline in contact with cleaning/degreasing agents. Women are slightly more likely to report exposure to cleaning/disinfecting agents and twice as likely to report skin contact with water for a quarter of the working day or longer. Men report four times as much skin contact with solvents/degreasers as women and almost seven times more contact with oils and lubricants. Generally speaking, exposure to risk factors declines with age and higher levels of education. Occupations that present most risk are those from which workers are most likely to report work-related skin complaints and disorders.
A key indicator of risk levels in the workplace is occupational injuries that lead to death. There was a marked decline in these up to the turn of the millennium; since then, the rate has fluctuated. However, there is some uncertainty associated with the recording of deaths caused by occupational injury. The average risk in all sectors is estimated at 1.5 deaths per 100 million hours worked. The risk in the fishing industry is more than 15 times higher than the average. It is also high in agriculture and forestry, and next highest in shipping and transport/warehousing. Between 2009 and 2014, women accounted for only 9% of deaths in industries under the Labour Inspection Authority’s jurisdiction (onshore industries).
The figures in Statistics Norway’s Labour Force Survey appendix from 2013 estimate that around 84,000 people suffered occupational injury in 2013. Taking into account the fact that some may suffer more than one injury, the annual number of occupational injuries can be estimated at around 105,000. Most prone to injury are police officers and security guards, with an annual injury risk of more than 11%. Some building and construction professions have an injury risk of around 10%, while the primary sector (industries engaged in production or extraction of natural resources such as crops, oil and ores) has an average annual risk of 7%. There is also a relatively high risk of injury among chefs and kitchen assistants, in manufacturing, and among health and social care workers. There is a clear over-representation of foreign workers in the injury statistics.
Improving the work environment has been a priority in Norway for many years, and the country has long promoted occupational health and safety and employee participation in the prevention of risk. As a result, the overall picture of working conditions is positive.
Exposure to physical and mechanical risk factors has decreased in the last 20 years, although some of the psychosocial risk factors, especially those related to patient care, have increased. This can be seen as a result of more individuals working in the health, social care and service sector, and fewer individuals working in industry.
The Statistics Norway survey covers only people included in the national population registry. As a result, migrant workers on short-term contracts are not included in the analyses. Most migrant workers are employed in blue-collar occupations where exposure to both physical and mechanical factors is greater. However, migrant workers constitute about 3% of the working population in Norway, and would therefore be unlikely to affect trends in exposures at a national level. Overall, changes in recent years have advanced in the right direction.
Although the results regarding the overall work environment in Norway are positive, it should be noted that working conditions vary considerably across occupations and sectors.
Within certain professions, self-reported health complaints are growing. These can be broadly divided into two groups: female-dominated professions in the health and social care sector such as healthcare workers, nurses and kindergarten/classroom assistants; and male-dominated skilled and unskilled manual jobs in building and construction, manufacturing, transport and warehousing.
Therefore, it is important to recognise the different needs of occupational groups and to support them by developing targeted preventive measures at the workplace.