Historical aspects from Norway
Since this course content comes from a Norwegian University, it might be of interest to read about some historical aspects of the development of occupational health services in Norway. This might be of interest for a developing country which is about to establish their own OHS units.
An occupational nurse taking care of a worker who has cut himself. This is a typical type of curative work in occupational health units © Ø. Larsen
First, the work at companies was purely curative
The first physicians working in something that resembles occupational health services in Norway were employed at silver mines during the eighteenth century, treating a variety of diseases among mine workers. The curative work was in focus, and both lung disorders due to the dust exposure and tuberculosis were common. Later, this type of work was developed to take place also in factories, and physicians in Norway were employed at diferent types of industrial plants. They were doing mainly curative work until about 1917. In the period 1917-1977, these physicians were mainly concerned about the health of the individual and how to promote the health for each individual worker. Surveys of the workers included for instance an evaluation of the nutritional status; to be strong and well nourished was for instance a good protection against tuberculosis.
When occupational physicians started to perform preventive work, not only health aspects related to the work situation was in focus. Some factories had programs to improve the general health of the workers. Low weight posed an extra risk of developing tuberculosis, and therefore, checking the weight of the workers was important, like you see on this photo. © Ø. Larsen
From curative work to preventive work
A few physicians started to work on preventive issues in the factories. In the early 20th century, an agreement about the company doctors work was signed by the Norwegian Medical Association and organizations for employees and employers in 1946. Occupational health services were later specifically regulated in the Norwegian Work Environment Act of 1977. This act emphasized that the primary task of company physicians was to address preventive issues at the workplace. The physician worked at first together with nurses, in the last part of the period they also included physiotherapists in their teams.
The first Norwegian occupational physicians were particularly interested in work-related diseases, such as lung diseases and hearing deficits. Here, the physician to the left is working with an x-ray machine to examine the lungs, and the one to the right is cleaning the ears of a worker before testing the hearing © Ø. Larsen
Supplementing physicians, new occupational groups were included in the occupational health services in addition to the physicians in the 1970-ties, and many new types of occupational health services were established. Larger, multidisiplinary team work was established in the new occupational health services. In additon to the physician, nurse and physiotherapist, occupational hygienists and safety engineers were included in the teams.
Physiotherapists had sessions with physical exercise for the workers in some factories, to reduce the risk of developing musculoskeletal diseases. Such programs were developed in the multidisciplinary teams in the occupational health units. © Ø. Larsen
Industries were forced to have OHS by regulations
In 1990, twenty different trades and industries in Norway were legally required to ensure access to occupational health services. This requirement developed over some years. Subsequently, the number of regulated trades and industries has increased. About half of the current Norwegian workforce has access to occupational health services, and all expenses related to these services are paid by the companies themselves. Occupational health services are not formally affiliated with public health services, and the most relevant public regulations, including official approval of the occupational health services given, are supervised by the Ministry of Labour and Social Services. The legislation has clearly been an important factor to establish OHS in Norway. However, there is a distance between the OHS and other parts of the health system, and this is a disadvantage. The OHS and different actors in the Norwegian public health system do not co-operate much, reducing the impact of the work.
OHS needs to be certified
IN 2010 new regulations for OHS in Norway were developed. Now an OHS needs to be certified by a special unit at the Labour Inspectorate to be allowed to give services to the companies. There are requirement about for instance types of professions who should form the OHS, their competence and work plan. The requirements related to the physicians in the OHS have been unclear, and some OHS have reduced the position of the physician to a minimum. This seems to be negative for the OHS. The number of competent physicians in the OHS is decreasing. Rules of this type can be an advantage to reduce unserious activities within the field, but it seems like too many regulations also can have disadvantages. We do not think that this certification has been completely successful. It is important to make useful regulations of OHS in a country, regulations which inspire to further work and which includes so many groups of health personnel as possible. The OHS units are important tools in the battle against occupational injuries and diseases.
© University of Bergen/Author: B.E. Moen