Occupational Health in a Public Health Perspective[1]

Occupational+Health+in+a+Public+Health+Perspective%0d%0aGunnar+%c3%85gren+MD+PhD+Director+General+Swedish+National+Institute+of+Public+Health%0d%0a%0d%0a%0cA+healthy+workforce+always+an+important+objective+in+Swedish+public+health+policy%0d%0a%e2%80%a2+18th+century%2c+a+healthy+population+an+important+resource+for+the+king+and+the+nation+%e2%80%a2+19th+century%2c+struggle+against+alcohol%2c+for+the+freedom+to+organise+labour%2c+shorter+working+hours+%e2%80%a2+20th+century%2c+a+very+succesful+work+for+a+better+physical+workplace+environment+%e2%80%a2+Strong+cooperation+between+employers+and+trade+unions%2c+building+a+strong+occupational+health+organisation%0d%0a%0d%0a%0cOn+the+other+hand%0d%0a%e2%80%a2+Social+inequity+in+health+with+working+life+as+an+important+determinant.+%e2%80%a2+Increasing+inequality+in+health+between+manual+workers+and+professionals+%e2%80%a2+The+psychosocial+working+environment+has+often+been+neglected.%0d%0a%0d%0a%0cThe+crisis+in+the+1990%e2%80%99s%0d%0a%e2%80%a2+Economic+crisis+and+cut+downs+%e2%80%93+a+reduction+of+the+public+sector+%e2%80%a2+Working+conditions+grew+worse+especially+among+women+in+the+health+and+care+sector+%e2%80%a2+Stop+for+state+subsidies+to+workplace+health+facilities+%e2%80%a2+Increase+in+unemployment+rates+and+later+increase+in+sick-leaves%0d%0a%0d%0a%0cHealth-related+absence+from+work%0d%0a%e2%80%a2+Approximately+15+%25+of+the+total+workforce+on+sick-leave+or+early+retirement+for+medical+reasons.+%e2%80%a2+A+more+%e2%80%99narrow%e2%80%99+labour+market+in+relation+to+people%e2%80%99s+working+ability+and+educational+level+%e2%80%a2+Geographical+imbalance+%e2%80%a2+Higher+demands+and+less+control+%e2%80%a2+New+attitudes+towards+the+health+insurance%0d%0a%0d%0a%0cIncrease+in+workrelated+sick-leave+especially+among+women%0d%0aDe+stora+sociala+200+skillnaderna+i+h%c3%a4lsa%0d%0a180+160+140+120+100+Den+kraftigt+%c3%b6kande+80+arbetsrelaterade+oh%c3%a4lsan+60+40+20+0%0d%0a%0d%0aAbsent+from+work+for+more+than+30+days%0d%0a%0d%0aDen+f%c3%b6rs%c3%a4mrade+h%c3%a4lsan+bland+barn+och+ungdomar%0d%0a%0d%0aThousands%0d%0a%0d%0aMales+Brist+p%c3%a5+fysisk+aktivitet+Females%0d%0a%0d%0ai+kombination+med+d%c3%a5lig+kost%0d%0a%0d%0a19+74+19+77+19+80+19+83+19+86+19+89+19+92+19+95+19+98+20+01%0d%0aGunnar+%c3%85gren+2002%0d%0a%0d%0a%c3%96kning+av+alkohol+och+andra+droger%0d%0a%0d%0a%0cRise+in+sickness+benefits+and+early+retirement%0d%0a900000+800000+700000+600000+500000+400000+300000+200000+100000+0+1998+1999+2000+2001+2002+2003+Year%0d%0a%0d%0aNumber+of+persons%0d%0a%0d%0aLongterm+sickness+Early+retirement%0d%0a%0d%0a%0cImportant+to+look+at+the+determinants+%e2%80%93+but+which+are+they%3f%0d%0a%e2%80%a2+Mental+problems+increasing+portion+of+sickleaves+%e2%80%a2+Increase+of+self+experienced+mental+problems+in+the+population+%e2%80%a2+The+labour+market+probably+the+single+most+important+determinant+but+there+are+a+lot+of+others+%e2%80%a2+To+address+the+determinants+of+health+a+task+for+the+public+health+policy%0d%0a%0d%0a%0cThe+Swedish+National+Public+Health+Committee%0d%0aIn+1997+a+national+public+health+committee+was+formed+All+main+political+parties+were+represented%2c+a+number+of+experts+Many+important+NGO%e2%80%99s+were+represented+Main+task%3a+to+propose+public+health+goals+and+strategies+The+committee+worked+for+three+years%2c+a+number+of+interim+reports+was+delivered+The+task+of+the+committee+%e2%80%93+to+propose+national+public+health+goals+which+should+guide+all+sectors+of+the+society%0d%0aGunnar+%c3%85gren+2003%0d%0a%0d%0a%0cTo+express+the+goals+in+relation+to+health+determinants+was+an+important+decision%0d%0aThere+is+an+obvious+relation+between+the+goals+and+political+actions+in+order+to+achieve+them+The+main+area+of+public+health+work+becomes+placed+outside+the+health+and+medical+sector+If+the+goals+are+broadly+accepted+they+will+guide+actions+in+many+sectors+of+the+society%0d%0aGunnar+%c3%85gren+2003%0d%0a%0d%0a%0cSome+problems%0d%0aIn+some+instances+it+may+be+hard+to+show+that+the+fulfilment+of+a+goal+leads+to+improved+health.+Economists%2c+administrators+and+others+may+have+difficulties+in+accepting+population+health+as+a+desirable+political+goal+Conclusion+%e2%80%93+you+have+to+provide+good+scientific+evidence+in+order+to+promote+public+health+policy%0d%0a%0d%0aGunnar+%c3%85gren+2003%0d%0a%0d%0a%0cEleven+target+areas+for+public+health%0d%0aSecure+and+favorable%0d%0a%0d%0aParticipation+and+Economic+and+influence+in+social+security+the+society%0d%0atReduce+tobacco%2c+alcohol%2cIlliciit+drugs%2c+doping%2cgambling%0d%0a%0d%0aconditions+during+childhood%0d%0a%0d%0aHealthier+working+life+Healthy+and+safe+environments+and+products%0d%0aHealth+and+medical%0d%0a%0d%0aA+good+health+on+equal+conditions%0d%0aSafe+sexuality%0d%0a%0d%0aGood+eating+habits+and+safe+food%0d%0a%0d%0aEffective+protection+care+that+promotes+good+health%0d%0a%0d%0aIncreased+against+communicable+and+good+reproductive+physical+activity%0d%0ahealth+diseases%0d%0a%0d%0a%0cSwedish+public+health+policy-+main+target+areas%0d%0a1.+2.+3.+4.+5.+6.+7.+8.+9.+Participation+and+influence+in+the+society+Economic+and+social+security+Secure+and+favorable+conditions+during+childhood+and+adolescence+Healthier+working+life+Healthy+and+safe+environments+and+products+Health+and+medical+care+that+more+actively+promotes+good+health+Effective+protection+against+communicable+diseases+Safe+sexuality+and+good+reproductive+health+Increased+physical+activity%0d%0a%0d%0a10.+Good+eating+habits+and+safe+food+11.+Reduced+use+of+tobacco+and+alcohol%2c+a+society+free+from+illicit+drugs+and+doping+and+a+reduction+in+the+harmful+effects+of+excessive+gambling.%0d%0aGunnar+%c3%85gren+2004+13%0d%0a%0d%0a%0c1.+Participation+and+influence+in+the+society%0d%0a%e2%80%a2+Lack+of+participation+and+influence+aggravates+the+effects+of+a+bad+working+environment+%e2%80%a2+Solid+scientific+evidence+for+the+causal+relation+between+high+demands-low+control+and+disease+%e2%80%a2+Decrease+of+influence+in+the+workplace+an+important+factor+in+relation+to+the+increase+in+sick-leave%0d%0a%0d%0a%0c2.+Economic+and+social+security%0d%0a%e2%80%a2+Loss+of+security+causes+economic+stress+%e2%80%a2+Poverty+forces+people+to+take+dangerous+jobs+with+bad+working+conditions+and+long+working+hours+%e2%80%a2+The+poverty+trap%3a+Poverty+%3e+disease+%3e+high+costs+for+medical+care+%3e+increased+poverty%0d%0a%0d%0a%0c3.+Secure+and+favorable+conditions+during+childhood+and+adolescence%0d%0a%e2%80%a2+Cut-downs+in+child+care+and+school+creates+bad+working+conditions+and+affects+children%e2%80%99s+health+negatively+%e2%80%a2+Long+working+hours+and+double+workload+harmful+for+the+relation+between+parents+and+children+%e2%80%a2+Child+labour+and+unemployment+among+young+people+a+very+significant+health+risk%0d%0a%0d%0a%0c4.+Healthier+working+life%0d%0a%e2%80%a2+Taking+good+care+of+the+workforce+an+important+factor+for+social+and+economic+developement+%e2%80%a2+A+strong+organisation+for+the+protection+of+workers+and+a+strong+occupational+health+organisation+important+for+public+health%0d%0a%0d%0a%0c5.+Healthy+and+safe+environments+and+products%0d%0a%e2%80%a2+The+environment+at+the+workplace+important+for+the+environment+in+general+%e2%80%a2+Injury+protection+must+follow+the+same+general+principles+in+the+whole+society%0d%0a%0d%0a%0c6.+Health+and+medical+care+that+more+actively+promotes+good+health%0d%0a%e2%80%a2+A+well+devoloped+primary+care+important+for+occupational+health+%e2%80%93+the+main+part+of+the+working+force+cannot+be+reached+by+specialised+occupational+medicine+%e2%80%a2+Health+promotion+and+disease+prevention+important+for+the+entire+health+sector.%0d%0a%0d%0a%0c7.+Effective+protection+against+communicable+diseases%0d%0a%e2%80%a2+HIV%2fAIDS%2c+Malaria+och+TBC+important+threats+to+the+entire+work-force+i+many+countries+%e2%80%a2+Relation+between+bad+working+environment+and+foodborne+infections%0d%0a%0d%0a%0c8.+Safe+sexuality+and+good+reproductive+health%0d%0a%e2%80%a2+Trafficing+an+important+health+risk+%e2%80%a2+A+number+of+environmental+toxic+substances+reduce+the+reproductive+capacity%0d%0a%0d%0a%0c9.Increased+physical+activity%0d%0a%e2%80%a2+A+healthful+physical+activity+is+often+restricted+by+working+conditions+%e2%80%a2+A+sedentary+life-style+impairs+the+working+capacity%0d%0a%0d%0a%0c10.Good+eating+habits+and+safe+food%0d%0a%e2%80%a2+Unsafe+food+production+often+related+to+unsafe+working+conditions+%e2%80%a2+The+present+agricultural+policy+leads+to+production+of+unhealthy+food+and+disrupts+local+production+and+local+labour+market+%e2%80%a2+Work+stress+predisposes+for+unhealthy+consumption+of+fat+and+sugar+%e2%80%a2+Undernourishmet+impairs+working+capacity%0d%0a%0d%0a%0c11.+Reduced+use+of+tobacco+and+alcohol%2c+a+society+free+from+illicit+drugs+and+doping+and+a+reduction+in+the+harmful+effects+of+excessive+gambling%0d%0a%e2%80%a2+Alcohol+and+illicit+drug+endanger+workplace+safety+%e2%80%a2+Second+hand+smoking+a+workplace+hazard%2c+especially+in+the+hospitality+sector%0d%0a%0d%0a%0cConclusions%0d%0a%e2%80%a2+What+happens+in+the+work-place+strongly+affects+public+health+%e2%80%a2+Public+health+policy+strongly+affects+work-place+conditions%0d%0a%0d%0a%0c