- Observatory: EurWORK
- Labour market policies,
- Work organisation,
- Disability and chronic disease,
- Public services,
- Working conditions,
- Social policies,
- Published on: 14 Kasım 2014
Disclaimer: This information is made available as a service to the public but has not been edited by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.
According to the Finnish National Work and Health survey, 70% of currently working Finns had no chronic disease diagnosed by doctor, 20% had chronic disease which did not interfere with work and 11% had chronic disease diagnosed by doctor interfering with work in 2012. Chronic disease diagnosed by doctor interfering with work was most common among farmers (17%). The corresponding percent among upper white-collar workers was 10%, lower white-collar workers (13%), self-employed 14% and blue-collar workers 15%. The survey showed a decreasing trend in prevalence of self-reported chronic disease. Another survey, Health 2011, showed that the prevalence of self-reported chronic diseases has reduced in the population of working age since the previous survey in 2000.
Block 1: Concept, definitions, sources of information and methodological issues on chronic diseases and work from the national perspective
1.1. National definition of chronic disease
The definitions of “chronic diseases” are arbitrary although the term “chronic disease” is used in various context. “Long lasting” disease, defect, or impairment affecting the activities of daily living or work is the prerequisite for legally based benefits and support like a disability pension or rehabilitation.
An extensive medical statement on a person's state of health is needed when applying the benefits. Clear rules on the medical conditions are given for the rating of the permanent disability after an accidental injury (Act No 1639 on the injury insurance). The Social Insurance Institution of Finland (Kansaneläkelaitos, Kela) also gives clear rules for the diseases entitling patients to reimbursement of medication due to chronic diseases (about 35 diseases e.g. hypertension, asthma, heart diseases, diabetes, glaucoma, etc. http://www.kela.fi/laakkeet-ja-laakekorvaukset_erityiskorvaus).
The Occupational disability is dependent on the occupation and not fully determined by the chronic medical conditions, which complicates the comparison of diseases in different statistics. There are 11 slightly different legal definitions for the occupational disability depending on the insurance system and working sector (e.g. public or private sector). In the general social security the disability is related to the worker’s usual or similar work, but in the public sector the reference is the employee’s ordinary work. For the occupational pension the ability to work has to be reduced by 3/5 of the full ability or by 2/5 for the part time pension. In addition, for the workers older than 60 years some pensions can be allowed by socioeconomic reasons in addition to the health status.
Generally, allowance of the pension requires at least one year occupational disability due to disease, defect, or impairment.
For any work absenteeism the definition of the disease relies on the definition of individual medical practitioner until 90 days, after which the Social Insurance Institution (Kela) demands for an extensive medical statement.
1.2. Information on national sources of statistical information dealing with the issue of chronic diseases and their relation to employment and working conditions
The Social Insurance Institution (Kela, http://www.kela.fi/web/en) keeps register on the compensated sick leaves that are longer than 10 working days. The register contains information on sick leaves, age, gender, and living area. Occupation is coded only for a sample of all persons (6.6%) according to the standard occupational classification for statistics. In reports the figures are estimated by the weights computed of this sample. Kela has published yearly statistics on sick leaves since 2003. Public statistical tables with diseases (by ICD classification) have included information on gender, age, duration of sick leaves, occupation, and geographical area. Separated public tables contain mostly two or three variables; e.g. diseases are given separately by duration of sick leave and occupation. Therefore information on long lasting (chronic) diseases by occupation can be received from the register database only by request for a specific new study. The maximum duration of compensation is 300 working days, after which the disabled person can apply for the pension.
The Finnish Centre for Pensions (Eläketurvakeskus, ETK, http://www.etk.fi/en/service/home/770) keeps register on all disability pensions and receives the information from the insurance companies. Since 2003 publically are available yearly statistics including ICD main classification of diseases by age and gender.
The Finnish National Work and Health surveys 1997-2012 (FIOH)(www.ttl.fi/tyojaterveys). The surveys represent currently occupationally active Finnish speaking employees aged 25-64 (population sample). The data is collected via computer-assisted telephone interviews (1997, n=2136; 2000, n=2013; 2003, n=2326; 2006, n=2229; 2009, n=2377; 2012, n=1827). In this report we used data from 2006-2012. The questions about chronic diseases are:
- Do you have a long-term, at least 3 months, illness or injury diagnosed by a doctor? 1 No, 2 Yes, 8 Cannot say, 9 No answer
- Do these long-term sicknesses or injuries as diagnosed by a doctor interfere with your current work? 1 No; 2 Yes, 8 Cannot say, 9 No answer
- Which of your long term sicknesses or injuries as diagnosed by a doctor interfere in your current work?
The questions in relation to employment concerns current occupation, field of industry, sector of employer, permanent/fixed term/irregular contract, working time and flexibility of it, risk of unemployment and financial situation of the company. Working conditions concern physical, ergonomic, chemical and psychosocial factors and safety at work, reconciliation of working and non-working life, skills development and gender and age equality.
“Health 2000” (http://www.terveys2000.fi/indexe.html) was a health survey carried out in Finland from fall 2000 to spring 2001. The sample (n=6,354) was representative for the adults over 30 years. The survey was partly repeated in 2011 (http://www.terveys2011.info/). Prevalence of common chronic diseases was estimated by history of medical diagnosis listed (“Has a doctor ever detected one of the following diseases?”). In addition symptoms were asked and medical doctors made a standardized physical examination. For most chronic diseases the criteria were symptoms lasting at least 3 months and clinical findings in the examination. [The National Institute for Health and Welfare (THL)]
Statistics Finland (http://www.stat.fi) coordinates several statistics. The National Institute for Health and Welfare (http://www.thl.fi/en_US/web/en) has several health registers based on medical diagnosis made in the health care system and coded according to the ICD-10.
Block 2: Prevalence, recent evolution and effects of the problem of chronic diseases among workers and companies
2.1. People affected by chronic diseases and employment
Due to the lack of definition of chronicity or to the different definitions, the available public sources give different figures.
The Social Insurance Institution (Kela) reported 330,000 compensated episodes of sick leave in 2011. Of them 19% had a duration longer than 60 days and 14% longer than 90 days. Of the spells longer than 90 days 34% were due to musculoskeletal disorders (low back diseases and pain 21% of all, osteoarthritis 7%, and neck-shoulder disorders 6%). Next in the order of magnitude were mental diseases (27%; depression 18%), neoplasms (7%, breast cancer 3%), and cardio-vascular diseases (6%).
According to the public statistics of the Finnish Centre for Pensions (ETK) the total number of disability pensions was 20,000 in year 2012. The greatest diagnostic groups were musculoskeletal diseases (7,100 cases; 35% of all), mental diseases (5,700 cases; 28%), and cardiovascular and neurological diseases and neoplasms (all 1,500 cases; 7%).
Total number of disability pensions has reduced by 20% from about 25,000 in 2008. The greatest reduction occurred in the groups of musculoskeletal and mental diseases. However, these numbers are not related to the total working population; so it is not clear if the figures reflect changes in the rate of diseases or in the demographic distribution, changes in the working conditions, or changes in the pension policy of the insurance companies.
Use of medication
The register on medication due to chronic diseases (Social Insurance Institution, Kela) shows the number of people with medications for some chronic diseases. In 2012 the figures for the people in working age (15 to 64 years) showed that over 717,000 people received full compensation and 414,000 partial reimbursement. The biggest groups were hypertension (0.5 % of the estimated Finnish population in the same age), pulmonary diseases (0.4%) and diabetes (0.3%).
In the Health 2011 survey (http://www.terveys2011.info/) the preliminary results have been compared to those of Health 2000. The prevalence of self-reported chronic diseases was reduced in the population of working age. The self-reported prevalence of coronary heart diseases has clearly reduced in the age group of 55-65 years. Still the prevalence of diabetes was slightly increased. The further analysis of other chronic diseases is going on. The Finnish National Health and Work survey shows decreasing trend in prevalence of self-reported chronic disease.
2.2. Working conditions of employed people affected by chronic diseases
In Finland part-time pension can be granted if the work capacity has been reduced by 2/5 but the worker is still able to work some. The amount of the partial disability pension is half of a full disability pension.
The Finnish National Work and Health survey (www.ttl.fi/tyojaterveys)
According The Finnish National Work and Health survey 70% of currently working Finns had no chronic disease diagnosed by doctor, 20% had chronic disease which did not interfere with work and 11% had chronic disease diagnosed by doctor interfering with work. The corresponding figures in 2006 and 2009 were: 62%, 24% and 14%. The musculoskeletal disorders were most prevalent chronic diseases interfering with work (6-8%). In following inspections we used combined data from years 2006, 2009 and 2012. Analysis were done with cross tabulation.
Chronic disease diagnosed by doctor interfering with work was most common among farmers (17%). The corresponding percent among upper white-collar workers was 10%, lower white-collar workers (13%), self-employed 14% and blue-collar workers 15%.
When considering occupation (ISCO-08 categories), skilled agricultural, forestry and fishery workers had most often (17%) chronic disease diagnosed by doctor interfering with work, followed by service and sales workers (16%), elementary occupations (16%) and craft and related trades workers (14%).
Chronic diseases diagnosed by doctor interfering with work was most prevalent in following sectors (NACE Rev.2 in 10 categories, see 5th European Working Condition Survey, http://www.eurofound.europa.eu/pubdocs/2011/82/en/1/EF1182EN.pdf, on page 5): agriculture (15%), health (15%), public administration and defence (15%) and education (15%).
When comparing those workers who had chronic diseases diagnosed by doctor interfering with work to those who had no chronic disease and those who had had chronic diseases diagnosed by doctor, which did not interfere with work, we find following:
- those who had chronic disease diagnosed by doctor interfering with work had less influence on amount of work (44% answered little compared to others 36%), length of working day (little influence 44%/37%) and as hole decisions relative to work (little influence 19%/12%) (p<0.001).
- they considered their work more often (p<0.001) mentally (42%/30%) and physically (39%/24%) quite or very strenuous
- they perceived more often (p<0.001) harming noise (50%/34%) and dust (46%/31%) in their working environment and they used chemicals or substances that are hazardous for health more often 31%/21%, p<0.001)(
- their working space was less often functional and practical (57%/68%, p<0.001)
- they got less support and help when needed from manager (20% answered little, others 12%) and colleagues (little 8%/5%)(p<0.001)
- they considered less frequently that manager deal with employees fairly and equally at least very often (50%/62%) and that men and women (43%/48%) and different aged people (45%/56%) are treated completely equally at workplace (p<0.001)
- 22% answered that they had weak opportunities to professional development in current job, which was less (p<0.001) than others (16%)
- atmosphere in work place was tense and tight (26%/15%) and insular (41%/34%) more often (p<0.001)they were more often dissatisfied with work (9%/4%) and life (4%/2%)(p<0.001)
- their life situation outside the work was more strenuous (strenuous 8%/3%, p<0.001)
- they had more problems in work-life balance, 4% neglected often work because of things at home, compared to others 2 % and 18% neglected often things at home because of work, others 11% (p<0.001)
- their work-ability on scale 0-10 was lower (an average 7.1, others 8.5, p<0.001)
- their work-ability in relation to physical demands was lower (14% answered bad/1%) and work-ability in relation to mental demands was lower (bad 7%/2%) (p<0.001)
- they assessed more often (23%/7%, p<0.001) that they were not able to continue working in current job until old-age retirement because of health
- they had more often thoughts of early retirement (29% had thought it often/11%, p<0.001)
- they had more days of illness (an average 3.9 days) during last six months than others (1.9 days, p<0.001)
- those who had chronic disease diagnosed by doctor interfering work considered more often that perceived health was bad (14%) than those who had no chronic disease diagnosed by doctor or who had chronic disease which did not interfere with work (1%, p<0.001)
Block 3: Policies and measures adopted by public and private agents to favour the employment situation and working conditions of people with chronic diseases
3.1. Description of main policy measures/initiatives developed by public authorities or social partners
The Ministry of Social Affairs and Health has started a program for persons with partial work capacity. The concept is aimed at ensuring that there is a seamless chain of services for people with partial work ability that helps them to continue working or to find employment. Work ability coordinator will have a key role in advising and supporting co-operation for all actors (i.e. the worker, workplace, occupational health, social security and insurance, and employment services). Responsibility for adopting the range of tools included in the concept rests with the employer or the local Employment and Economic Development Office. http://www.stm.fi/en/ministry/strategies_and_programmes/people_with_partial_work_ability
In 2012 the legislation on sick-leaves was changed so that every employer has to inform the occupational health (OH) services on the workers who have been on sick-leave for longer than 30 days. In addition, the Social Insurance Institution (Kela) demands for a specific medical statement from the OH for all sick-leaves longer than 90 days. The aim is that the OH and employer shall negotiate on the options allowing return to work by adapting the working condition and so preventing chronicity of the disability.
The European Network for Workplace Health promotion (ENWHP) campaign “Work. Adapted for all. Move Europe” has been implemented by disseminating information material (advice and recommendations for workplaces, examples of good practices). http://www.ttl.fi/partner/enwhp/kampanjat/phwork/Sivut/default.aspx
3.2. Examples of enterprises and/or collective agreements implementing initiatives or establishing clauses to support people with chronic diseases
Several employers have developed their systems to avoid consequences of chronic diseases. One example is an in-house company in a Finnish city that developed their processes (e.g. individual adaptations of work tasks and time schedules of workers) and co-operation within the company, occupational health, and the city human resources organisation. The analysis showed that this co-operative case management activity reduced sick-leaves and disability pensions, and was economically cost-effective. http://www.ttl.fi/fi/verkkokirjat/Documents/Tyokykyjohtaminen.pdf
Due to the lack of definition of chronicity or to the different definitions, the available public sources give different figures. Reporting has been done by sick leaves, disability pensions, use of medication and surveys. Anyhow it seems that there is a decreasing trend in prevalence of self-reported chronic disease. The Ministry of Social Affairs and Health has started a program for persons with partial work capacity. The concept is aimed at ensuring that there is a seamless chain of services for people with partial work ability that helps them to continue working or to find employment.