Presentation by prof Jorma Rantanen at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012

1. Connecting Health and Labour
Global Conference
Organized by the World Health Organization
in collaboration with TNO Work and Health and the Dutch Government
with support from the World Organization of Family Doctors (Wonca) and the International
Commission on Occupational Health (ICOH)
29 November - 1 December 2011, The Hague, The Netherlands
How to ensure universal
coverage of occupational health
services?
Prof. Jorma Rantanen, MD, PhD
Chairman of the Board, University of Jyväskylä, Finland
Past President of ICOH

2. OPENING THE DOOR TO BETTER
HEALTHCARE ACROSS EUROPE
Proposal for a Directive of the European Parliament
and of the Council on the application of patients’ rights
in cross-border healthcare
Council Conclusions on Common values and
principles in European Union Health Systems
SOCIAL PROTECTION FOR
INCLUSIVE DEVELOPMENT
A NEW PERSPECTIVE IN EU CO-OPERATION W
AFRICA

3. Coverage of OHS in Finland
% of workers+ self-
Number of employees employed covered by OHS
>100 100
100- 50 97
10 – 49 91
1-9 64
Farmers 50
Total 85.1
126 million enterprises in the world. 97% of them are small companies.

4. Informal workers of the world most in need of OHS
Total number ~ 1.6 billion
Region Women Men Self-
employed
North Africa 43 NA 62
SSA 83 63 70
Latin 58 48 60
America
Asia 60 60 59
World 60 ~ 65
(Source: Chen, DESA Working paper No. 46, 2007)

5. Gaps in occupational health
services
• Policy gap
• Regulation gap
• Implementation gap
• Coverage gap
• Risk gap
• Content gap
• Relevance gap
• Resource gap
• Gap in effectiveness and impact
ILO COnvention N0. 161 ratified by 30 Countries.

6. Basic Occupational Health Services,
BOHS
• Full coverage
• Publicly provided
• Primary health care approach
• Still competent OHS
• Supported by expert institutions
• Low-cost solutions
• Adapted to local conditions
• Part of USP

7. BOHS

8. The BOHS cycle
Workers health
Orientation
and planning
Evaluation
Surveillance of WE
Record keeping Surveillance of
Individual worker's health
health record
Worker
General Assessment of WE Risk Assessment
health service individual's
health risk
Emergency
preparedness First aid
Health education
Dg of ODs and health
Accident prevention and WRDs information Information
Prevention of Education
OH hazards
Initiatives
Work environment Work Organization

10. Model Normative basis Source of funding Service Examples of
provision countries/Area
”Public health”, Health care Government health budget Public service Albania
General health legislation provision units, Kosovo
budget model primary health Thailand
care China, India
”Employer” model Legislation or Individual employers pay all the Own OHS or Sweden
voluntary costs of services they use external public or Netherlands
private
Health insurance Legislated health Contributions by employers. The Often public Slovenia
model insurance covers the Fund pools the contributions and Former Croatia
costs pays back on capitation basis before 2008
Special Special law on OH Contributions by the employers Public Croatia since
occupational insurance + solidarity principle 2008
health insurance
Accident Accident insurance or Employers pay a premium which Own or external Austria
insurance model workmen's may be either flat or experience- Germany
compensation law based (reflecting the risk of France
accidents in the company or in the Spain
sector)
Combined Law on income Employer pays primarily the costs Own or external, Finland
“Employer” + insurance + Law on but gets reimbursements under either public or
Public health + occupational health certain conditions private provider
Health insurance services Farmers get the occupational
model hygiene services free of charge
(financed from government budget)
Association or OSH Law just Member fees by Association or Group service Sweden, Finland
Cooperative defining employers Cooperative members model Tanzania,
financing obligations Netherlands

11. Economic appraisal: A SEE Country
(Rantanen 2010)
Total GDP 33 Bill €
Total health expenditure HE 2.70 Bill € 8.2% of GDP
Total loss by occupational 1.32-1.97 4-5.9% of GDP
accidents and diseases Bill € ~ 50-73% of
HE
Total cost by 500 OHPS 4.68 mill € 0.014%
and 500 OHNs + 30% of GDP
driving costs 0.17% of HE

12. Activity ongoing either as pilot
BOSH activities in the World project or permanent activity
Activity planned
Finland
NW Russia
Baltic
Balkan
Turkey
East Africa
Brazil China
Mexico India
Thailand
Vietnam
Indonesia