Occupational Safety and Health in Estonia

Part IV: Occupational health services

As for monitoring, occupational health services are important, not to determine disease or injury in a worker and to arrange appropriate treatment, or to select for particular work activities, but to verify that controls are in place and working. If controls are adequate the workforce will not be in ill-health because of its work. Occupational safety and health services range from the simple to the complex. At a minimum they usually address the immediate needs of injured or ill employees by providing first aid and response to accidents. More elaborate services may include medical surveillance programmes and provision for in-house medical capability. In addition, some companies are focussing on off-the-job safety and health through employee wellness or employee assistance programmes, especially for alcohol and drug abuse. There are different types of health examinations and different means of ensuring that workers do have health check ups. The aim of this section is to determine what is available in the way of occupational health services at the workplace in Estonia now.

Occupational health examinations are common practice in Estonia, being carried out in 81.5% of the workplaces surveyed. They were most common in the primary production sector, with 100% of workplaces carrying out health examinations for employees and least common in the manufacturing sector (See figure 17). However, the manufacturing workplaces in this survey formed a very heterogenous group and health examinations were carried out in only 25% of the textile, clothing and leather workplaces and in all of the metal and chemical manufacturing workplaces (although it must be pointed out that there was only one workplace representing the chemical industry and two workplaces representing the metal industry).

Figure 17. Workplaces of different industries where health examinations were carried out

Energy means energy, electricity, gas and water supply

The size of the workplace had a distinct effect on whether health examinations were common practice or not. All workplaces with more than 500 employees carried out health examinations, whereas this figure goes down to 89.7% for those workplaces with 100-500 persons, and to 72.7% for those workplaces that employed less than 50 persons.

In 65.9% of those workplaces where health examinations were carried out, these included a pre-employment check up. Checkups on leaving the company, however, were not included in any of the health examinations - a case of relinquishing responsibility once a worker leaves a company? Continuing periodic health examinations are advisable for some work-related diseases and injuries and exposures known to be associated with disease, including those with long latency periods.

Usually, health examinations were carried out by a private health professional (in 70.7% of cases). Health examinations conducted by a company doctor or nurse or by an occupational health services for a group of undertakings were much less common (25.6%). In none of the workplaces surveyed were health examinations carried out by a union doctor or nurse.

Although private health professionals are the major providers of occupational health examinations, they are less likely to check the general hygiene of the workplace or advise workers on health issues than do company doctors or nurses or occupational health services for a group of undertakings. Only 33% of the private health professionals who conducted health examinations also checked the general hygiene of the workplace compared with over 80% of company doctors or nurses (See figure 18).

Only 38.1%% of the respondents said that improvements were made to the workplace after the results of health examinations. 45.2% said that improvements were not made and 16.7% did not know if improvements were made or not. Transferring a worker to another job after a health examination was very common, 75% of the respondents saying that individual workers were sometimes transferred, and 32.6% that they were sometimes fired.

Figure 18. Workplaces where certain occupational health measures were conducted when the health examination was carried out by different health professionals

Transferring workers to other jobs or firing them was more common in public-owned enterprises than in privatised enterprises. In fully 95% of the public-owned enterprises, workers were sometimes transferred to other jobs and in 47.4% sometimes fired after health examinations. Firing of workers because of health-related problems was much more common in primary production workplaces and in the service sector. This was the practice in 50% of the primary production workplaces surveyed and in 45% of the service industry workplaces.

Results of the health examinations were given to the worker concerned in 90.9% of the workplaces and to the union in 39% of the workplaces.

In 50% of the workplaces, workers were tested for alcohol and in 7.7% for illegal drugs. Alcohol and substance abuse is a safety, health and productivity issue and as such should be an important part of trade union concerns.

56.4% of the companies kept health records, but only 7.5% of the unions did. This percentage for union record-keeping is surprisingly low considering that the results of health examinations were given to the union in 39% of the workplaces surveyed, and the results of workplace monitoring in 55.8% of the workplaces. Record keeping by companies was below average in the service industries (45.5%) and was less common in privatised than in public-owned enterprises. (The questionnaire did not distinguish between those injuries and diseases which had to be reported and other injuries and diseases.)

According to the respondents, 72.7% of the workplaces reported work-related injuries and 34.5% reported work-related illnesses to the authorities at the national level. 80.5% of the respondents said that their union has access to this information.


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