The Europeanisation of occupational health services : A study of the impact of EU policies

This study concerns Framework Directive 89/391/EEC on health and safety at work, which encouraged improvements in occupational health services (OHS) for workers in EU member states. Framework Directive 89/391/EEC originally aimed at bringing the same level of occupational health and safety to employees in both the public and private sectors in EU member states. However, the implementation of the framework directive and OHS varies widely among EU member states. Occupational health services have generally been considered an important work-related welfare benefit in EU member states. The purpose of this study was to analyse OHS within the EU context and then analyse the impact of EU policies on OHS implementation as part of the welfare state benefit. The focus is on social, health, and industrial policies within welfare state regimes as well as EU policy-making processes affecting these policies in EU member states. The research tasks were divided into four groups related to the policy, functions, targets,and actors of OHS. The questions related to policy tried to discover the role of OHS in other policies, such as health, social, and labour market policies within the EU. The questions about functions sought to describe the changes, as well as the path dependence, of OHS in EU member states after the framework directive. The questions about targets were based on the general aims of WHO and the ILO in relation to equity, solidarity, universality, and access to OHS. The questions on actors were designed to understand the variety of stakeholders interested in OHS. The actors were supranational (EU, ILO, and WHO), national (ministries, institutes, and professional organisations), and social partners (trade unions and employers organisations). The study data were collected by interviewing 92 people in 15 EU member states, including representatives of ministries, institutions, research,trade unions, employers organisations, and occupational health organisations. Other documents were collected from the Internet,databases, libraries, and conference materials for a systematic review of the policies, strategies, organisation, financing, and monitoring of OHS in EU member states. Different analytical methods were used in the data analysis. The main findings of the study can be summarised as follows. First, occupational health services is a context-dependent phenomenon, which therefore varies according to the development of the welfare state in general, and depends on each country s culture, history, economy, and politics. The views of different stakeholders in EU member states concerning the impact and possibilities of OHS to improve health vary from evidence-based opinions to the sporadic impact of OHS on occupational health. OHS as a concept is vaguely defined by the EU, whereas the ILO defines OHS content. The tasks of OHS began as preventive and protective services for workers. However, they have moved towards multidisciplinary and organisational development as well as the workplace health promotion sphere.Since 1989 OHS has developed differently in different EU member states depending on the starting position of those states, but planning and implementation are crucial phases in the process toward better OHS coverage, equity, and access. Nevertheless, the data used for the planning and legitimisation of OHS activities are mainly based on occupational health data rather than on OHS data. This makes decisions on political or policy grounds inaccurate. OHS is still an evolving concept and benefit for workers, but the Europeanisation of OHS reflects contextual changes, such as the impact of the internal market, competition, and commercialisation on OHS. Stronger cooperation and integration with health, social, and employment services would be an asset for workers, because of new epidemics, an epidemiological shift towards new risks, an ageing labour market, and changes in the labour market. Different methods and approaches are needed in order to study the results of integrated services. In the future, more detailed information will be needed about the actual impact of EU policies on OHS and decision-making processes in order to get OHS into different policies in the EU and its member states. Further results and effects of OHS processes on occupational health need to be analysed more carefully. The adoption of a variety of research strategies and a multidisciplinary approach to understand the influence of different policies on OHS in the EU and its member states would highlight the options and opportunities to improve workers occupational health. Key subject headings: Occupational health services, EU policy, policymaking,framework directive 89/391/EECTyöterveyshuollon tehtävänä on edistää hyviä toimintatapoja työpaikan terveyden, ympäristön ja turvallisuuden hallinnassa ja johtamisessa. EU:n puitedirektiivi 391/89/EEC työntekijöiden turvallisuuden ja terveyden parantamisen edistämiseksi työssä loi monille jäsenmaille velvollisuuden esittää uudistuksia ja muutoksia kansalliseen lainsäädäntöön. Merkittävin uudistuksista oli työnantajan velvollisuus kehittää työturvallisuutta ja terveyttä. Puitedirektiivi velvoittaa jäsenmaan toteuttamaan työterveyshuoltoa, mutta puitedirektiivi ei anna perusteita tai ohjeita konkreettisesti työterveyshuollon järjestämisestä. Uusi työterveyden ja -turvallisuuden strategia pyrkii lähentämään työterveysasioita muihin EU:n toimintaohjelmiin, esim. terveys- ja sosiaalipolitiikkaan. Toisaalta työterveyshuolto on osa terveydenhuoltoa, joka ei kuulu EU:n suoraan toimivaltaan, vaikkakin monet eri EU:n politiikat työterveyshuollon toimintaympäristöön epäsuorasti vaikuttavatkin. Tutkimus on vertailevaa terveyspolitiikan tutkimusta EU:n puitedirektiivin vaikutuksista työterveyshuollon kehittymiseen jäsenmaissa 1990-luvulla. Päätavoitteen on vertailla EU:n puitedirektiivin 391/89/EEC vaikutuksia kansalliseen lainsäädäntöön ja normeihin sekä työterveyshuollon rooliin ja tehtäviin viidessätoista EU:n jäsenmaassa. Tutkimuksessa vertaillaan työterveyshuollon organisoinnin eri malleja sekä ammatillisia resursseja sekä laadunhallinnan menetelmiä. Työterveyshuoltoa tarkastellaan kansainvälisten sopimusten ja suositusten (ILO, WHO) kautta sekä EU:n monikansallisen lainsäädännön näkökulmasta harmonisoinnin, lähentymisen ja eurooppalaistumisen kautta. Työterveyshuollon kehityksen eri vaiheita selitetään maiden erilaisesta lähihistoriasta sekä kulttuurin, yhteiskunnallisen kehityksen, teollistumisen, poliittisen liikehdinnän ja työväenliikkeen vaikutuksella. Väitöstutkimus on monografia. Tutkimuksen pääaineisto muodostuu virallisista avoimista asiakirjoista ja politiikan linjauksista sekä haastatteluista, joissa haastateltiin eri maiden työterveyshuollon päätöksentekijöitä ministeriöissä ja laitoksissa eri, keskeisiä virkamiehiä sekä yliopistojen ja tutkimuslaitosten johtavia tutkijoita