EurWORK European Observatory of Working Life

Managing musculoskeletal disorders — Estonia

About

Country: 
Estonia
Author: 
Kaia Philips
Institution: 
University of Tartu


Disclaimer: This information is made available as a service to the public but has not been edited or approved by the European Foundation for the Improvement of Living and Working Conditions. The content is the responsibility of the authors.

This is the Estonian contribution to the topic report on the impact of work changes on the resurgence of work-related musculoskeletal diseases, coordinated via questionnaire by AGFOL for the European Working Conditions Observatory.

1. Definitions

The various terms listed above in describing MSDs all put the accent on repetitive and cumulative motions.

The Eurostat description of EODS methodology provides some useful comparative insight about disease statistics and the general functioning of national work-insurance systems, e.g. who compensate occupational diseases, in particular MSDs included and at what degree of seriousness are listed: only some of the MSDs are recognized as such by National Insurance Agencies (NIAs) and other agencies entitled by government and/or social partners in playing such a role. There are two main obstacles to their recognition: certain activities outside work expose people to similar risks, especially women (see question 3 below); and the nature of the contract does not help to point to the occupational origin of the disease.

1. Please, report the official definition of WR-MSDs, if any, or the most widespread one. Please specify whether it includes backaches.

The main legislative act in this area is the Occupational Health and Safety Act, which provides the occupational health and safety requirements for work performed by persons working on the basis of employment contracts and to public servants, the duties of employers and workers, the organisation of occupational health and safety in enterprises and at state level, the procedure for conduct of challenge proceedings, and liability for violation of the occupational health and safety requirements. This act divides illnesses related to work either as an occupational disease or as an illness caused by work:

  • An occupational disease is a disease, which is brought about by risk factors present in the working environment and included in the list of occupational diseases, or the nature of the work. The Minister of Social Affairs should establish the list of occupational diseases, where diseases are categorised by hazard factor causing an occupational disease.

  • An illness caused by work is an illnesses brought about by a risk factor present in the working environment and which is not deemed to be an occupational disease.

Occupational Health and Safety Act distinguishes physical, chemical, biological, physiological and psychological factors that may harm worker’s health. Act also states, that in order to prevent the physical and mental stress of workers, the employer shall adapt the work to suit the workers as much as possible. Upon the designing of a workplace and organisation of work, the physical, mental, gender and age characteristics of the worker, changes in his or her capacity for work during a working day or shift, and the possibility of working alone for an extended period of time shall be taken into account.

The most widespread definition of musculoskeletal disorders (MSD) is as follows: MSDs are injuries and disorders of the musculoskeletal system where exposure to various risk factors present in the workplace may have either contributed to the disorder’s development, or aggravated a pre-existing condition.

2. Please check whether criteria illustrated in the above EODS paper have been updated in the meantime. Are recognition criteria by NIAs taking into account gender differences? Have there been any changes in last years both in general and wrt to gender issues in particular?

In Estonia, institutions responsible for occupational health and safety issues (see Section 2.1) and NIA do not categorise WR-MSDs neither by the part of the body affected, nor by the gender and other demographic characteristics.

The area of occupational health and safety is developing over the years. In working conditions essential changes and developments occurred during the transitions years 1991-1996 in Estonia. In the sphere of legislation, the Occupational Health and Safety Act entered into force in July 1999 and there are several other regulations and acts in this field adopted during the years 1999-2002. The institutions responsible for occupational health and safety issues are also in the phase of developing.

2. Reporting

Reporting is another key preliminary issue. Two orders of problems can be identified.

Clinical reporting, statistical sources (mainly based on self-reporting), working conditions surveys and administrative sources from NIAs and Health Systems tend to differ. The latter heavily depend on the institutional definitions (both legal and administrative settings) both about their causes and their nature. Figures are often collected and classified according non-homogeneous criteria, and at different analytical level in terms of part of the body affected and causes. For instance, the LFS 1999 additional module reported MSDs in an aggregated way (Q217), while the 2007 LFS ad hoc module questionnaire distinguish (Q215/216) MSDs according three regions affected: neck, shoulder, arms and hands (WR-ULD); hips, legs, feet; back.

According to Eurostat, this make difficulties to collect comprehensive European level data on recognized MSDs. Also in the EU-15, it is not granted that the European standards (EODS in our case) are employed. This causes a further problem of comparability.

Working conditions survey are probably the least dependent on institutional (legal) framework, but cultural/social habits could can affect reporting work related MSDs. However, an UK study shows significant consistencies amongst self-reported and clinical results (see the Foundation report “ Quality of work and employment in Europe. Issues and challenges”.)

This very short overview, far from being complete, outlines some of the main questions related to reporting

3. Please list the main sources of information about WR-MSDs (NIAs and other insurance agencies empowered by government and/or social partners, WCS, public health, statistical bureaux). Please describe the way WR-MSDs are categorized by public authorities and NIAs according to the part of the body affected (upper/lower limb, bone, joint or muscle problem, hips, legs, feet, knees, back, neck, shoulders, arms, etc. ..), causes (repetitive work, vibrations, heavy loads, postures, PCs, etc…..) and occupational and demographic characteristics (labour contracts, occupation, age, gender).

In Estonia, the main governmental institutions dealing with the issues of occupational health and safety are:

  • Ministry of Social Affairs and its Working Environment Unit of Labour Department (established in 2004). Working Environment Unit is responsible for the co-ordination and management of the activities in the field of occupational health and safety.

  • Labour Inspection, which main goal is to arrange the state supervision in the working environment over compliance with the requirements of legislation regulating occupational health and safety and labour relations and to collect statistics of accidents at work and make analysis thereof.

  • Health Insurance Fund (NIA in Estonia, created in 2001) is the only organisation in Estonia dealing with compulsory health insurance. Fund administrates the health insurance database and gathers statistics about overall medical services, insured persons, etc.

Statistics, published by the abovementioned institutions does not present separate statistics about WR-MSDs (there is also no statistics available neither by the part of the body affected nor causes and/or occupational and demographic characteristics).

4. Please describe the number, type and variety of questions advanced in MSDs. Please report the exact formulation of questions advanced in working conditions surveys. What is the evolution over time of question formulation?

General working conditions and employment surveys address occupational health and safety issues in Estonia. There are four nationally representative surveys in Estonia dealing with the issues of occupational health and safety issues, however none of them includes direct questions about MSDs. Unfortunately none of them is up to now continuously investigating occupational disease and therefore the analysis of trends is impossible.

In October 2005 a third working conditions survey together with the 4th European working conditions survey was carried out in Estonia. The publication Tööelu barometer 2005 (480Kb pdf, in Estonian) (WLB 2005) summarises the main findings from these surveys. Questions dealing with occupational health and safety issues are as following:

Q15: “At your principal job, can you according to your needs ... (adjust the temperature, lighting, ventilation, seating, work equipment, choose or change working rhythm, choose or change working methods, choose or change the sequence of performance of work assignments, help from co-workers when necessary)? (yes sufficiently, yes but not sufficiently, not at all, not applicable to respondent)”

Q20: “Is your work such that you are physically exhausted by the end of the work day? (yes frequently, yes rarely, no, hard to say)”

Q21: “What is the reason for your physical exhaustion … (repetitive wrist and forearm motions, regularly working in a standing position, kneeling working position, work position uncomfortable for back, work position uncomfortable for hands, hand motions requiring the use of force, other reason)? (yes, no, hard to say)”

Q25: “Please estimate how great the risk is that your principal job could lead to a chronic disease? (high, medium, low, there is no risk, has already led to one, hard to say)”

Labour force surveys (LFS) are designed to analyse labour market situation and working conditions continuously. Statistical Office of Estonia conducts LFS since 1995 and since 2000 it is a quarterly survey. It covers around 4000 individuals in one quarter and is nationally representative. In 2003, LFS had a supplement (which was included to the questionnaire in two quarters), investigating working conditions of respondents. As this supplement has added to the original questionnaire only once, then trends in working conditions cannot be depicted. Also, the Statistical Office does not publish the results of the data from supplement. The questions related to the occupational health and safety issues are as following:

M03: “Are you constantly exposed to the following factors at your workplace (noise, vibration, radiation, high/low temperature, insufficient lightening, dampness or smell of mould, gases/smoke, inorganic dust, organic dust, pesticides and mineral fertilizers, synthetic washing and cleaning agents, tobacco smoke, hazardous chemicals, bacteria/viruses/fungi/parasites, other)? (yes, no)”

M04: “To what extent is your work related with the following? (yes often, yes sometimes, seldom or never). Possible answers are as follows:

  • You have to carry heavy objects (over 25 kg) at work,

  • You have to work in an uncomfortable and tiring position (due to wrong layout of the workplace and/or work equipment)

  • Work involves repeated and monotonous movements

  • Work causes you pain resulting from excessive stress of the joints

  • You are unable to rid your mind of work-related thoughts even after work (nervousness, restlessness, sleep disorders due to work worries)

  • You feel neck-shoulder, girdle- or back pains during or after work,

  • During or after work your eyes sometimes burn or are irritated,

  • Due to your work you are mentally exhausted by the end of the working day

  • Due to your work you are physically exhausted by the end of the working day.”

M05: “What is the reason for you being physical exhausted by the end of the end of the working day? Is it repetitious wrist or arm movements, regular working in a standing position, regular working in a sitting position, working in a kneeling position, working position uncomfortable for your back, working position uncomfortable for hands/arms, hand/arm movements requiring force, other reason).”

M06: “At your workplace, can you adjust/regulate temperature, lighting, ventilation, working place, seat, work equipment? (yes, no)”

A survey of the working environment in Estonia (WES 2000) was conducted by the research company EMOR in 2000. The aim of the survey was to assess the quality of the working environment (including issues of occupational health and safety) in Estonian undertakings. The survey consisted of two parts: interviews of employers (top executives of undertakings); and interviews with workers. In total 402 companies’ representatives and 797 employees were interviewed in different areas of Estonia.

Employers’ survey consisted the following questions concerned with work relates health behaviour.

Q14: “Which of the following critical factors based on the working environment, working conditions or the work characteristics, do you estimate as risk factors to your employees’ health? (dust, noise, vibration, bad lightening, lack of ventilation, temperature (high, low), dangerous chemicals, forced position, monotonous, physical load, mental stress, other, don’t have such kind of factors)”

Q15-21: “Giving assessments to different sides of company’s/institution’s working environment on a 10-point scale, where 1 means negative and 10 positive evaluations, then how many points would you give to your company’s/institution’s... (working conditions in general, design/furniture of the workplace, work related daily living conditions, main job – occupation physical difficulties, mental stress caused by the job, job influence to the health, job dangerousness)”.

Employees’ survey included the following questions related to the occupational health and safety issues:

Q5: “Have you had work related health problems in case of your current employer because of ... (work related accident, occupational disease, intense relations at work, or in your opinion due to other work related factor)?”

Q8: “Please evaluate on 10-point scale, how big is in your company, where you work, risk to have occupational diseases or other work related diseases? 10 points means big risk and 1 point, don't have risk at all?”

Q9: “Which of the critical factors based on the working environment, working conditions or the work characteristics, do you consider dangerous to your health? (dust, noise, vibration, bad lightening, lack of ventilation, temperature (high, low), dangerous chemicals, forced positions, monotonous, physical load, mental stress, other, don’t have such kind of factors)”

Q10-16: “Giving assessments to different sides of company’s/institution’s working environment on a 10-point scale, where 1 means completely negative and 10 completely positive, how many points would you give to your company ... (working conditions in general, design/furniture of your workplace, work related daily living conditions, physical difficulties of your work, mental stress caused by your job, job influence to the health, job dangerousness)

In 2005 a survey Health Behaviour among Estonian Adult Population (1.50 Mb pdf, in Estonian and English) (HBS 2004) about the health behaviour among adult population (aged 16-64) was revealed.Estonian Ministry of Social Affairs and conducted by the Department of Epidemiology and Biostatistics of the National Institute for Health Development.

Q23: “Have you been diagnosed as having, or been treated for any of the following diseases/symptoms during the last 12 months? (yes/no) (among the other mentioned diagnoses are arthritis, radiculitis and other back problems)”

Q26: Have you had any of the following symptoms or complaints during the last 30 days? (yes 3 or more times, yes 1-2 times, no) (among other symptoms the following were listed: joint pain, back-pain, neck-shoulder pain)”

Q29: “How often have you been overtired on working days during the last 12 months? (almost always, quite often, seldom, never)”

5. Is there any research of analyse of causes available?

There is no research available about causes of WR-MSDs. The main areas of research are the occupational health and safety situation in general and of different economic activities and the occupational hygiene and medicine.

3. Trends of MSDs and their social impact

MSDs complaints show a growth across the editions of the EWCS, supporting the argument of “work densification” and that actual prevention instruments are not fully adequate in order to cope with them. As discussed above, organizational changes, which reflect both changes in competition and HRM practices (see for all Oesterman, 2000), play a key role in such a trend. Such trends can differ significantly across sectors, occupations, firm size and gender.

The increasing participation of women to labour market make the need of engendered prevention policies for the following reasons:

a. According to Pèze (2002), “women are massively hit by MSD not only because of their morphology and hormonal factors, but because work organisation keep them out massively from conception and decision-making”: therefore, workplace design is based on the prevailing occupational group, i.e. men;

b. horizontal and vertical segregation literature show that some industries are significantly engendered (for all Hakim, 1992)

c. women still cope with more domestic tasks than men, facing thus larger risk exposure outside work.

The report “ Work organisation and health at work in the European Union” investigates the relationship between health according three broad classes of organizational factors, an engendered approach from the 3rd EWCS:

- temporal framework, according to the two sub-dimensions of internal flexibility (shifts, long hours, night work, sundays working, no fixed times) and industrial type of the pace of work (depending on the automatic speed of the machine, depending on quantitative standards)

- scope of manoevre, according to the two sub-dimensions of autonomy (no possibility to choose or modify the pace of work; no possibility to choose or modify the methods of work, no possibility to choose or modify the sequence of tasks, not allowed to take a break) and of control (respect of precise quality standards, personal evaluation of the quality of their work);

- social relationships, according to the three sub-dimensions of the commercial constraints (the pace depends on the current demands from customers etc.) discussions (no possibility of discussing work organization when changes occur, no possibility of discussing your working conditions in general) and continuing training.

6. Please report figures on absence days caused by MSDs (from NIAs and other Agencies, or WCS where the former are not available) according to parts of the body affected and causal agent, and their trends over last 10 years, disaggregated by labour contracts, occupation, age, if it were possible in a engendered way, accordingly to the sources available described in Q2. Please report these trends for the following sectors (with the same caveat): manufacturing and mining, health and education, transport and communication.

According to the Labour Inspection statistics, the number of occupational diseases has been relatively small and it is showing a declining tendency since 2000 (see Tables 1-3). In 2005, the most diagnosed occupational diseases and illnesses caused by work were fatigue diseases and these diseases have been leading since 2002. Main reason causing the fatigue disease is physical strain (displacement of weights, physical position and movements in work which cause fatigue, static muscular strain, etc.), which is also accompanied with microclimate of working environment (wind, temperature, etc.).

Table 1. Occupational diseases in Estonia, 1995-2005
Year Number Per 100,000 employees
1995 145 22.1
1996 159 24.6
1997 198 30.5
1998 269 42.0
1999 359 58.5
2000 355 57.1
2001 282 48.8
2002 129 22.0
2003 101 17.0
2004 132 22.2
2005 97 16.2

Source: Occupational accidents and occupational diseases in Estonia in 1995-2005 Labour Inspectorate, 2005.

Table 2. Occupational diseases in Estonia, 1995-2004
  1995 2000 2002 2003 2004
Number of persons diagnosed with occupational diseases for the first time 296 117 95 132
… male (%) 62 49 55
… female (%) 38 51 45
Number of occupational diseases diagnosed for the first time 145 355 129 101 132
First diagnoses of occupational diseases per 100,000 employees 22.1 57.1 22.0 17.0 22.2

Source: Social sector in figures 2005, p. 47, Ministry of Social Affairs, 2005.

Table 3. Occupational diseases by disease and occupation, 1998-2004
  1998 2000 2002 2003 2004
Total cases of first diagnosis 269 355 129 101 132
By diseases
Vibration syndrome 109 137 45 15 30
Repetitive strain injuries 72 128 47 54 66
Hearing impairment 37 60 22 21 20
Other occupational diseases 51 30 15 11 16
By occupation
Tractor drivers 90 114 41 28 22
Car and bus drivers 32 50 16 2 4
Farm labourers, stock farmers 26 55 17 21 28
Excavator and crane drivers 16 15 6 3 4
Sewers, weavers 5 12 3 6 2
Joiners 17 6 4 1 0
Processors of fish and meat products 15 8 6 6 5
Forestry workers 4 5 3 3 4
Medical workers 2 2 1 2 0
Confectioners 3 1 3 1 0
Painters 6 9 7 4 1
Timber processors 0 0 1 1 3
Mining workers 2 4 0 1 0
Tool fitters 9 10 1 3 7
Construction workers 2 3 1 0 4
Welders 16 13 2 3 6
Concerting workers 2 1 0 0 0
Ship builders 0 2 0 1 0
Manufacturers of dairy products 0 0 1 1 3
Other fields of occupation 22 44 16 13 39

Source: Social sector in figures 2005, p. 49-50, Ministry of Social Affairs, 2005.

According to the National Policy on Working Environment, the reporting of occupational diseases is increasing thanks to better diagnostic work at the Clinic of Occupational Diseases and the workers’ increasing economic interest. Occupational diseases are not diagnosed by periodical medical examinations, which are formal. Most of the workers apply to the Clinic only when affected with a serious impairment of their health. By that time many of these people are given two or three diagnoses. On the first place are muscular-skeletal disorders, followed by vibration disease, hearing damages and erysipelas in the meat processing. According to the report Social sector in figures 2005 (published by the Ministry of Social Affairs), among the cases diagnosed in recent years, the number of vibration syndromes has decreased and the number of repetitive strain injuries (caused by handling loads, incorrect working posture, and forced posture) has risen. While the vibration syndrome cases formed 39% of all diagnosed occupational diseases in 2000 and 23% in 2004, the proportion of repetitive strain injuries in the same years was 36% and 49% respectively.

Diagnosis of occupational diseases is aggravated by several factors: proving the presence of links between the disease and the risk factors in the working environment is particularly problematic. This indicator is also influenced by the availability of occupational health care services (incl. the presence of an occupational health physician in the county).

7. Please report figures from WCSs on MSDs suffered according to parts of the body affected and causal agent, and their trends over last 10 years, disaggregated by labour contracts, occupation, and age in an engendered way by gender, accordingly to the sources available described in Q2. Please report these trends for the following sectors (with the same caveat): manufacturing and mining, health and education, transport and communication.

The HBS 2004 gives some information about general symptoms and complaints (there is no specification, whether the diseases are work-related or not) (see Table 4). As is seen from table, the share of respondents having backache does not vary remarkably by gender and age. However, middle-aged and elderly people have backache more frequently than young people. Among women, the pains in shoulder and neck areas are more widespread than among men.

Table 4. Distribution of respondents by having some symptoms/complaints during the last 30 days (%)
  16-24 years 25-34 years 35-44 years 45-54 years 55-64 years Total
Males
Chest pain during physical strain 10.4 14.6 10.6 15.4 21.3 14.1
Joint-pain 34.1 30.6 35.2 43.5 54.1 38.6
Back-pain 40.5 47.2 47.7 45.8 44.4 45.1
Neck-shoulder pain 25.4 22.2 26.5 26.5 34.8 26.7
Females
Chest pain during physical strain 13.8 15.0 19.8 19.5 26.6 19.2
Joint-pain 28.9 24.0 33.5 56.4 56.2 40.8
Back-pain 47.2 43.7 50.0 47.4 46.5 47.0
Neck-shoulder pain 42.5 33.3 46.0 44.6 43.3 42.1

Source: Health Behaviour among Estonian Adult Population

According to WLB 2005, the average absent days during the last 12 months because of different health problems was 5.69. Average absenteeism due to occupational diseases or illnesses caused by work was 1.18 days and average absenteeism due to occupational accidents was 0.57 days. WLB 2005 also allows to characterise work related symptoms in more detail. According to survey 44% of workers complain that their work causes muscular pain, 44% complain about overall tiredness and 41% about backache.

3.1 Please provide some crosstables of MSDs according to part of the body affected and, if possible, causal agent, with the following organizational factors in an engendered way, showing trends from the 90s and taking into account the questions included in WCS for each country:

- pace of work (speed or repetitiveness, tight deadlines)

- autonomy (in general and wher possible breaks opportunities , scope on pace of work, scope on methods);

- use of PCs and other ICTs devices;

- scope of discussion over work organization and/or organizational changes;

No information available .

4. Trends of MSDs and their economic impact

MSD has consequences both on health and work efficiency. This latter can be accounted in lower productivity of both the affected worker and his/her substitute.

Lower work efficiency is just part of the costs. They are both direct (compensation, treatment, medical care) and indirect (production lost, loss of quality in production, errors/mistakes in production, absenteism, replacement). As we have seen in the introduction, estimates produced by some countries differ in included costs.

Just from these few cases, their amount is undoubtedly huge and calls for prevention policies and a careful evaluation of their impact in terms of costs and benefits.

8. Are there estimates of MSDs costs? If any, which direct and indirect costs are included? Who carry them? If not, what indicators are monitored by policy makers and Agencies in order to propose/draw new policies, esp. in prevention?

According to statistics from Health Insurance Fund, Estonian National Social Insurance Board, Statistical Office of Estonia, there have been some calculation done by Ministry of Social Affairs about social and economic losses in Estonia (see Table 5). There are no separate estimations available about the economic impact of MSDs.

Table 5. Social and economic losses, 2000-2003
  2000 2001 2002 2003
Sick leave compensations (thousand EEK) 516,497 513,164 545,236 604,160
Sick days per year 5083,041 4658,517 4523,188 4732,493
Medical care costs (thousand EEK) 1392,370 1600,056 1650,489 1728,231
Number of workers 572,500 577,700 585,600 594,300
Sick workers per year 22,005 20,167 19,581 20,487
GNP (thousand EEK) 84000,000 95000,000 107000,000 117000,000
GNP per worker per day (EEK) 635 712 791 852
GNP loss per all workers per day (thousand EEK) 13,976 14,356 15,488 17,460
GNP loss per all workers per year (thousand EEK) 3228,681 3316,366 3577,812 4033,281
All costs of absenteeism (thousand EEK) 5137,549 5429,587 5773,537 6365,672
All costs of absenteeism (% of GNP) 6.12 5.72 5.40 5.44

Source: Social and economic losses 2000-2003, Ministry of Social Affairs.

Working environment survey (WES) conducted in 2000, summarises that 90% of all enterprises interviewed, do not estimate economic losses of diseases at all.

4.1 Are there “return to work policies” (by whom/ on what level/ whose initiative/ involvement of the actors) developed and implemented (in general and specifically for MSDs)?

Such information are collected just in order to have a flavour of the shared awareness of their social and economic impact, and as such we deal with them. Please do not devote more than 300 words.

There is no specific “return to work policies” developed and implemented in Estonia. However, the occupational health service providers (occupational health doctors, nurses, etc.) should also be involved with rehabilitation activities. According to Occupational Health and Safety Act occupational health specialists should provide the following occupational health services:

  • conduct of risk assessments of the working environment, including the measurement of the parameters of risk factors;

  • medical examination of workers and evaluation of their state of health;

  • organisation of medical rehabilitation for workers;

  • provision of advice to employers on the adaptation of work to the abilities and state of health of workers;

  • provision of advice to employers on selection and use of work equipment and personal protective equipment, and on improvement of working conditions;

  • psychological counselling of employers and workers.

The main attention in the area of occupational health and safety is concerned to the prevention policies (see Section 5).

According to the report of Ministry of Social Affairs Social sector in figures 2005, from 2000 to 2004, i.e. after the entry into force of the Occupational Health and Safety Act and its implementing acts, 28,063 inspections have been conducted, of which 6,833 inspections were focused on evaluating the condition of the working environment as a whole on the basis of the methods developed by the Labour Inspectorate. This includes 8,289 inspections in 2004, which covered 2,626 enterprises (with the working environment as a whole evaluated in 1,243 enterprises). On the basis of the inspection of the fulfilment of precepts it can be concluded that the working environment has improved in the majority of previously inspected enterprises (see also Tables 6 and 7). A serious problem is the knowledge of managers and employees about occupational safety and health matters. Only a few managers have had appropriate health and safety training.

Table 6. Evaluation of working environment, 2004 (number of enterprises inspected was 1,243)
Condition of the working environment (% of enterprises)
  Low Medium High
Risks arising from technical risk factors 31.2 66.9 1.9
Risks arising from physical, chemical, biological and physiological risk factors 31.9 64.2 3.9
  Satisfactory Deficiencies found Unsatisfactory
Employer’s activities in fulfilling legal requirements 22.5 61.1 16.4
Workers’ common environment 72.4 23.7 3.9
Working environment on the whole 16.9 81.6 1.5

Source: Social sector in figures 2005, p. 46, Ministry of Social Affairs, 2005.

Table 7. Fulfilment of requirements established by the Occupational Health and Safety Act (% of enterprises, where requirements are not met)
Activity or situation inspected or evaluated %
Existing and active working environment council (enterprises over 50 workers) 10.5
Training of members of the working environment council 15.0
Election of working environment representatives 34.5
Training of working environment representatives 46.7
Working environment risk assessment plan for reducing health risks 54.4
Organisation of internal control 38.4
Health care service agreement 60.7
Medical examination of workers 38.2
First aid training 29.0
Instruction of workers in the sphere of occupational health and safety 12.3
Provision with personal protection equipment 1.9
Investigation of occupational accidents and cases of occupational disease 57.7
Application of measures intended for the prevention of occupational accidents and diseases 3.8

Source: Social sector in figures 2005, p. 47, Ministry of Social Affairs, 2005.

5. Prevention policies and room to manoeuvre

The figures/data so far available seem to suggest that we are not sure the EU is already the downward part of the slope of the reported graph form Brenner et al. (2002). The 2002 Scoreboard on implementing the Social Policy Agenda statement about the “insufficiency of current occupational health and safety practices and hence the cost of non-social policy to businesses and workers” could be applied to MSDs. As the Community strategy on health and safety at work (2002 – 06) points out, “the preventive approach set out in Community directives has not yet been fully understood”.

According to various studies, such as those summarized in Bourgeois et al. (2000) both MSDs and stress-related disorders arises out of work situations which limit workers’ discretion. Along these lines Coutarel (2003) suggests preventive strategies based on the notion of room to manoeuvre (“marge de manoeuvre”). i.e. the means and opportunities of action an employee has in a given production situation to influence and correct the work process. This gives the possibility for the individual to have control over the work situation and to use personal capacities.

According to Douillet, Schweitzer, 2002, “expanding workers’ discretion (…) becomes a key prevention priority: not just to reduce the physical and psychological stressors, but also as a way of recognizing the individual’s creativity at work”. The organizational changes in order to prevent MSDs must therefore include all the concerned stakeholders (Daniellou, 2005).

Therefore, the room to manoeuvre approach calls for prevention strategies based on interventions at an early stage at the design of the workplace according a participative method, which can be different labelled and stylized across countries. This calls for the opportunity in developing some quality indictors in order to set benchmarking policies, such as:

  • Good quality working conditions;

  • Possibilities of cooperation;

  • Mobility;

  • Rotation;

  • Organisation of work which allows to make maximum of benefit out of the workforce

  • Training

  • Stability in the workforce/low staff turnover

Limits of such a prevention approach are economic constraints (productivity/overall performance maintainance, further investments) and social constraints (population characteristics, level of experience, training, levels of exposure).

9. In general, plant-level prevention policies are “risk elimination oriented” or centered around “risk information”? What the role of social partners?

According to the Occupational Health and Safety Act, an employer shall ensure compliance with the occupational health and safety requirements in every aspect related to the work. Among other obligations an employer is required to:

  • conduct regular internal controls of the working environment in the process of which the employer plans, organises and monitors the occupational health and safety situation in the enterprise;

  • review the organisation of internal control of the working environment annually and analyse its results and, if necessary, adjust measures to the changed situation;

  • conduct risk assessment of the working environment to ascertain the risk factors present in the working environment, measure their parameters as necessary and assess the possible effect of the risk factors on the health of workers, taking into account the gender and age characteristics of the workers;

  • based on the risk assessment of the working environment, prepare a written action plan designating the measures to prevent or reduce health risks; and conduct a new risk assessment of the working environment if the working conditions have changed and the work equipment or technology has been upgraded;

  • notify the workers of the risk factors, the results of risk assessments of the working environment and of the measures to be implemented in order to prevent damage to health, through working environment representatives, members of the working environment council and workers’ representatives;

  • organise the provision of medical examinations for workers whose health may be affected, in the course of the work process, by risk factors present in the working environment or the nature of work;

  • at the request of a worker and on the decision of a doctor, transfer the worker to another position temporarily or permanently or ease his or her working conditions temporarily.

Employers and workers are required to co-operate in the creation of a safe working environment and for this purpose, employers shall consult workers or their representatives, and working environment representatives in any issue relating to the working environment, take into account their proposals in planning for measures to improve the working environment and invite them to participate in the implementation of such plans.

According to the Occupational Health and Safety Act, the organisation of occupational health and safety is consisting of the following specialists:

  • A working environment specialist is an engineer competent in the sphere of working environment or any other specialist in an enterprise who has received training concerning the working environment An employer shall appoint a working environment specialist from among the employer’s workers or, in the absence of a competent person, hire a working environment specialist from outside the enterprise.

  • A working environment representative is a representative elected by workers in occupational health and safety issues. In an enterprise with ten workers or more, the workers shall elect one working environment representative from among themselves.

  • A working environment council is a body for co-operation between an employer and the workers’ representatives which resolves occupational health and safety issues in the enterprise. In an enterprise with at least fifty workers, a working environment council shall be set up at the initiative of the employer and shall comprise an equal number of representatives designated by the employer and representatives elected by the workers. The Labour Inspectorate has the right to demand that a working environment council be set up in an enterprise with less than fifty workers depending on the risk factors present and the number of occupational accidents and cases of occupational disease in the enterprise.

The obligations of working environment institution in an enterprise is to monitor, regularly analyse the working conditions, examine the results of internal controls of the working environment, participate in the preparation of occupational health and safety strategies of the enterprise, notify the workers and the employer of dangerous situation or deficiencies discovered in the working environment, assist in the creation of suitable and safe working conditions and working organisations, etc. As is seen from the list of obligations, the plant-level prevention policies should be both “risk elimination oriented” and also “risk information oriented”.

5.1 Please illustrate some plant-level good practices (at least one in manufacturing and one in services) following (or showing significant similarities with) the “room to manoeuvre” approach above skecthed, showing in particular the adopted approaches and the impact both in working conditions and firm performance. Is there any specific strategy of the kind towards small and medium enterprises?

No information is available.

10. Have been developed any quality indicators measuring “room to manoeuvre” preventive strategies?

No, there have been no developments of quality indicators measuring “room to manoeuvre” preventive strategies.

References

Health Behaviour among Estonian Adult Population, 2004, National Institute of Health Development, Tallinn, 2005.

Occupational Health and Safety Act (RT I 1999, 60, 616), entered into force 26 July 1999, last amendments (RT I 2000, 55, 362).

Rahu, M., Tekkel, M., Veideman, T., Health Behaviour among Estonian Adult Population, 2004, National Institute of Health Development, Tallinn, 2005.

Social sector in figures 2005, Ministry of Social Affairs, Tallinn, 2005.

Tööelu barometer 2005. Sotsiaalministeerium, Saar Poll, Tallinn, 2006.

Working environment survey. Ministry of Foreign Affairs, Ministry of Social Affairs, EMOR, Tallinn 2000.