Jorma Rantanen
A number of challenges are faced by both enterprises and workers as they try to adapt to a new world order and a global economy running 24 hours a day. The factors that will shape working life and associated developments include a new political climate, demographic social change, ecological threats, technological developments, new and rapidly growing economies, and changes in the workforce and the structure of enterprises. Global companies merge and may come to administer larger economies than certain medium-sized countries. National-level enterprises seek survival through outsourcing, subcontracting and networking. The detail of my argument and all the implications are laid out in my paper.
We move into the next millennium in an economic, political and social atmosphere totally different from the situation no more than 10 years ago, and the pace of change is likely to continue. Simultaneously, we have new work organisations, new technologies, new materials and energies and new work practices, associated with new types of diseases and burdens such as musculoskeletal disorders, hypersensitivity and allergies, occupational cancer, and age-related and reproductive disorders.
One of the key processes is the search for flexibility by companies – flexibility in organisation, in working hours and working practices, and in the competence and skill of personnel. Many of these changes are positive, but we have also detected negative aspects, such as more adverse working conditions, lack of learning opportunities at work and lower pay.
Dozens of old occupations have disappeared and yet more will disappear as a result of change.
The working methods and practices in virtually all jobs are changed by new technology. The job content is increasingly becoming mental and social rather than muscular and manual as it was in the past. Just as the human brain is becoming the most important “engine” of the
working world, the conditions of mental work are also becoming more important. How can we optimise the work of the human brain in the new information-rich and highly technical environment?
Information technology (IT) provides excellent opportunities to search for information throughout the world that will facilitate the protection and promotion of health. Many highly hazardous exposures and conditions can be avoided with the help of automation and
mechanisation of dangerous work processes. But IT also makes new demands. There are three main challenges associated with the human–IT interface: visual ergonomics; cognitive
processes in computer–human interaction; and psychomotor and keyboard ergonomics. In addition to the interface problems, information overload and time pressures may occur and seriously affect the productivity and quality of information-intensive work. That is why in Finland we have designed a large research programme on information-intensive work.
It has been calculated that the workforce is renewed at the rate of 2% a year while knowledge is renewed at 7% a year. This implies that in the year 2010 we will have over 80% of the present workforce still employed while over 90% of today’s information and knowledge will have been replaced. Rapid changes at the workplace mean that all people participating in working life need continuous development and life-long learning.
Investing in competence improvement has been found to be profitable, not only economically as an effective way of improving productivity, but also in enhancing subjective wellbeing and prevention of stress. Work-related stress is, without any doubt, one of the new occupational epidemics. It affects health, wellbeing, quality and productivity at work. Many occupational health service units report an increased risk of psychological burn-out.
Several factors cause stress at work. They include time pressure, the competence gap (a major stress factor for many older workers), external pressures and higher performance demands, information overload, understaffing and threat of violence.
Some 30–50% of Finnish and other European Union workers report work-related stress derived from several simultaneous factors involving time pressure, competence problems, job insecurity, high work demands and continuous change. Over 50% of European Union workers suffer from time pressure at work; and in Finland, depending on the economic sector, 50–75%
of workers experience time pressure that makes it difficult to meet quality standards.
Working hours are getting longer, with unconventional working hours and night shifts becoming more common. Over one third of workers in Finland work more than 45 hours a week, and 8% work 65–80 hours. The shortage of personal time will be compensated for by sleeping less, which may lead to lower productivity and risks of errors and accidents. We should be cautious not to exceed the psycho-physiological limits of humans. This is essential for concentration, safety, learning and innovation.
The need to develop health and safety at work is shown by the fact that 5 million occupational accidents with 6000 fatalities occur each year in the European Union, and the fact that
occupational diseases and work-related disorders lead to the loss of between 100–200 million working days annually. Altogether, occupational health reasons lead to the loss of 600 million working days in the European Union each year, corresponding (according to one estimate) to a loss of €60 billion or almost 1% of the total GNP of the European Union. This figure may be
an underestimate, since the total economic loss from occupational accidents and diseases in Finland is estimated at 4–5% of GNP.
Occupational health services (OHS) are one of the most relevant ways of responding to the health problems of the working populations in modern society. It is a common observation of all European Union member states that the implementation of Framework Directive 89/391 on Safety and Health at Work has provided a stimulus for the development of preventive and occupational health services. This is the experience both of countries with a high level of OHS development and those whose level of OHS still lies below the European average.
The new needs brought about by rapid developments in working life are not necessarily covered by the Framework Directive, particularly problems of a psychological and psychosocial character, fragmentation of working life, the growing numbers of self-employed, short-term and casual workers, and the needs of groups such as older workers. We need both to:
●prevent and control the current and traditional hazards such as “old” chemicals, including lead, solvents, mineral dusts, heavy physical work and noise (the Framework Directive and the daughter directives provide strong support to this); and
●meet the new challenges (new technologies, new radiological, chemical and biological factors, allergens, “new” musculoskeletal disorders, psychological and psychosocial problems, violence at work, and problems of working ability in older workers).
The changes in the nature of the problems require changes in the content of the services.
Advice and consultations on complex problems of psychological and psychosocial stress, social life in the workplace, motivation and working ability will be increasingly needed.
New training requirements need changes in strategies and methods, including the use of guidelines on good practice and supervised work on site, and distance learning through the use of telematic training systems and multimedia. The latter provides several new possibilities for practitioners who cannot be released to attend courses.
With a few remarkable exceptions, the human resources of OHS are still predominantly monodisciplinary – medical in most cases and sometimes technical. Roughly speaking, there are some 100,000 people (including physicians, nurses, other experts and support personnel) working in OHS in the countries of the European Union and the European Economic Area. If the 140 million working people in the European Union were to be adequately served by multidisciplinary services, the need would be as many as 250,000–280,000.
There is a need to revise and harmonise the curricula and the principles of formal recognition of experts throughout the European Union, although to what extent harmonisation can be realised in practice remains to be seen. The training curricula for physicians, nurses,
occupational hygienists and safety engineers are well developed in some countries, but there is a lack of systematic training for all others in the multidisciplinary team.
Some countries are adopting new development- and promotion-oriented approaches that deal with workers, the work environment and the work community together. Inevitably this leads to the use of multidisciplinary teams and a change from a limited, predetermined service content to a flexible, comprehensive content corresponding to the needs of the enterprise, its management and its personnel.
In addition, this new approach is likely to lead to much richer contacts, collaboration and networking of OHS with other related activities. Thus OHS, which has sometimes been an isolated activity, is combining with other related activities within and outside the company. In addition to preventing risks to health at work and the promotion of health, one of the
objectives of OHS will be to support the overall development of the company.
In Finland, we have developed a strategy of “maintaining work ability” as a comprehensive approach in OHS, linked to the development of the enterprise as a whole. The strategy integrates earlier efforts in occupational health and safety, organisational development, development of competence and even the development of an organisational culture. Some enterprises have successful1y combined this strategy with their quality management systems.
The key is the comprehensive, integrated approach instead of running health and safety, organisational development and training activities separately.
Europe has been described by many as a continent lagging behind technically and
economically. It is nevertheless likely that final success in global competition will be won not by technical innovations, but by combining the social with the technical and economic dimensions.
The importance of the social dimension is seen very clearly in the attitude towards the employment of the older worker. Most industrialised countries will experience a relatively rapid aging of the workforce. While younger individuals are strong in so-called “liquid intelligence”, which is based on a good short-term memory, the “crystallised intelligence” and
“silent knowledge” of older individuals can be a most valuable asset to an enterprise, and not least in times of rapid change and turbulence. Older people should be seen as stabilising forces in the management of change. They represent longer-term organisational memory, which industry finds of utmost value when hit by external or internal crisis.
The leaders in implementing IT systematically are predominantly the countries with high social capital, and with social policy objectives to ensure universal service provision. In a study of how Finnish enterprises managed economic crisis and survival in a recession, the
characteristics that were found to be of high importance could all be counted as factors in social capital. This was true not only of managing in a crisis but also in the management of rapid growth and development after recovery. Such characteristics include: a competent, open-minded, human and client-oriented leadership; a tolerant and encouraging culture; an
ambitious, development-oriented strategy implemented by dedicated management; competent staff; a flexible organisation; and active participation by staff in decisions and actions related to change.
Countries with a one-sided technical or economic dimension seem to be concerned only with the positive impact of IT on the elite rather than the whole population. In this respect Europe, with its strong social dimension, is likely to be the winner. We have good reasons to expect that with its social dimension, Europe will remain a good place in which to live and work.
Morton Warner
Jorma Rantanen looked at the structure of economies as they have changed over time, and now we are moving into an information-based society. So, in essence, whatever the continuing traditional occupational health problems, there will be a whole new range of health issues for a group of workers we might refer to as the new information “managers”.
I visited a British Steel plant recently, where I discovered that 100 tonnes or more of steel is made in one day by one man, one woman and two people on the floor. They are able to do this through complete information management. I must admit, I was full of admiration for these people and their ability to use the information they had.
In respect of the new information management, we should be linking education and training with health. If people are not well prepared, then we will be encouraging high-level stress, with all its consequences in terms of the increasing needs for health and social care services.
One point that struck me in the area of cognitive functioning relates to an article in The Lancet last week by two scientists from the National Institutes of Health, which talks about the importance of deficits in executive functions. There is a reduction in executive functions within the brain as part of the normal aging process.
There is also, of course, a progression by age in relation to role, so that you go from a junior professional to master to coach to ambassador to storyteller. And yet what we are asking people to do, for longer and longer in their working lives, is to be handlers of information and to be involved in the executive function. So there are quite serious health-related questions about how people are helped to adapt by being retrained or “reconditioned” in some way; if nothing is done we will see a very large increase in stress-related conditions. How long is this going to go on for? Probably for the next 20–30 years until we get that group of informatics literates, who are our children and grandchildren, fully engaged in the workforce.
We have already talked about networks, and in the information society we are starting to deal with networks of people and networks of information. The old characteristics of work – going to a job in a building and being enclosed by the security of four walls – start to disappear.
How do people adapt psychologically when they are forced into network-type behaviour?
There are some people who take easily to it – it is a relief, a new freedom – but there are others who are deeply stressed And there is a third group who will start working in isolation, cutting themselves off rather than being able to join in.
Next there is the burden of disease. If one looks at the work on gender and disability-adjusted life-years (DALYs) in the year 2020, the top item for women is mental illness. When these data first came out there was a lot of discussion as to why this was so. One reason put forward was the multiple roles and functions that women are required to play, both at home with their children and at work and elsewhere. In terms of possible policies for giving them support, so far there seems to be no relief in sight.
Jorma Rantanen offers what I see as a rather classical provider model in his paper, one of training more occupational health physicians, more occupational health nurses and various others. This does not seem to fit well with people being able to empower themselves through information, through forming various psychological and other alliances and networks.
My final point is that we should not forget the needs of what we might call “occupationless”
health, the health of the large number of long-term unemployed in Europe. The potential consequences of long-term unemployment were outlined at a WHO futures consultation in Bratislava in 1995.8In South Wales a lot of new employees are women working part-time
8.Third Consultation on Future Trends and the European HFA Strategy. Report on a meeting, Bratislava, Slovak Republic, 26–27 October 1995. Copenhagen, WHO Regional Office for Europe, 1996 (document EUR/ICP/EHFA 94 01/MT01).
and we still have extremely high levels of unemployment, a picture found elsewhere in Europe.
Ilona Kickbusch
The issue in women’s mental health is not the plurality of roles; there is research evidence that shows that women cope much better after mental illness because they have multiple roles, in contrast with unemployed men who have been thrown out of their only role. The issue is that of multiple roles and identities without the power, autonomy and choice to go with them.