The cornerstone of unity

53 OCCUPATIONAL SAFETY AND HEALTH
An early example of an occupational safety and health (OSH) measure in Finland under Swedish rule is that 
work by children under the age of 14 was forbidden in the guilds in 1770. Eventually the concept of humane 
work however deteriorated both in farming and in early industries. One attempt to correct this was the Swedish 
royal decree of 1805 that made farmers responsible for taking care of their servants. And in 1889 decrees were 
enacted requiring occupational safety for all workers, especially women and children.
The workforce began to be seen as a valuable national resource, as described in the following statement by 
Prof. E. G. Palmén, member of the Diet of Finland: “A national asset, even the most valuable national asset is 
the physical and financial a
dvancement of the working class.” Indeed, Finland’s first constitution from 1919 
decrees that “the citizens’ ability to work enjoys the special protection of the state”, and all subsequent versions 
of the constitution have provided such protection in the same spirit.

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The young independent republic actively developed legislation in the 1920s and 30s on occupational 
inspections, accident insurance, employment contracts, and occupational diseases. Occupational safety and 
health were also seen as important means of achieving gender equality. Employment has played an important 
role in enabling women to become self-sufficient and independent. It has also improved the health of pregnant 
women and their fetuses and resulted in OSH for nursing mothers in Finland as one of the first countries 
worldwide. 
The Finnish Occupational Safety and Health Act and relevant monitoring provisions have been reformed 
every 20 to 25 years to keep up with changes in working life. The most far-reaching reform happened in the 
1970s, when the entire OSH administration and OSH monitoring and OSH workplace activities were reformed 
through two OSH laws. Their implementation at the workplace was coupled with the principles of participation 
and codetermination required by law. Simultaneously the tenacious attitude of blaming supposedly careless 
employees was finally abandoned. Accidents began to be seen first as caused by work environment risks and 
later as safety management failures. In 1978, Finland adopted the world’s so far only independent occupational 
healthcare act.
Finland’s density of OSH inspectors is Europe’s highest, and it functions very well. More than 60,000 OSH 
managers, representatives and deputies, and committee members are active at the workplace level. OSH work 
is supported by research and by providing an amount of training to everyone involved that is among the highest 
in Europe. 
Accident statistics are the traditional and most important 
– but not the only – criterion for judging the 
effectiveness of OSH. Since the OSH reform in the 1970s, Finland has been able to reduce the rate of fatal 
accidents by 85%, and it is now in fifth place in the EU or perhaps even better if differences in the compilation of 
statistics are taken into account. Malta, Luxembourg, the UK, and the Netherlands are ahead.
The Finnish Occupational Safety and Health Act and relevant monitoring provisions have been reformed 
every 20 to 25 years to keep up with changes in working life. The most far-reaching reform happened in the 
1970s, when the entire OSH administration and OSH monitoring and OSH workplace activities were reformed 
through two OSH laws. Their implementation at the workplace was coupled with the principles of participation 
and codetermination required by law. Simultaneously the tenacious attitude of blaming supposedly careless 
employees was finally abandoned. Accidents began to be seen first as caused by work environment risks and 
later as safety management failures. In 1978, Finland adopted the world’s so far only independent occupational 
healthcare act.
Finland’s density of OSH inspectors is Europe’s highest, and it functions very well. More than 60,000 OSH 
managers, representatives and deputies, and committee members are active at the workplace level. OSH work 
is supported by research and by providing an amount of training to everyone involved that is among the highest 
in Europe. 
Accident statistics are the traditional and most important 
– but not the only – criterion for judging the 
effectiveness of OSH. Since the OSH reform in the 1970s, Finland has been able to reduce the rate of fatal 
accidents by 85%, and it is now in fifth place in the EU or perhaps even better if differences in the compilation of 
statistics are taken into account. Malta, Luxembourg, the UK, and the Netherlands are ahead.
Occupational healthcare has existed in Finland since the 16th century, when the army and navy hired barber 
surgeons to take care of their soldiers’ injuries and diseases. An 1805 Swedish royal decree required farmers to 
provide good nutrition for their servants and to pay the costs of care for diseases caused by their work (except if 
caused by the worker). The state was a pioneer in the development of real occupational healthcare. The army 
and navy hired doctors and medics to take care of fortress builders in the middle of the 18th century and the 
workers constructing the Saimaa Canal in the middle of the 19th century.
As the Industrial Revolution progressed, early industrial companies organised already in the 1850s 
occupational healthcare for their workers that included both preventive care and disease treatment. In this way, 
the model and practice of Finnish OSH developed step by step, and it was in fact called the “Kymiyhtiö Model” 
after a company that showed the way. 
That model spread to essentially all large industrial companies and also the public sector and to 
thecooperative movement after WWII, when Finland’s agrarian society became industrial at the fastest rate in 
Europe. The 1963 Health Insurance Act also included coverage of occupational healthcare services from the 
health insurance funds. At about the same time, the main trade unions and employers’ organisations negotiated 
an occupational healthcare agreement that became part of the national income policy agreements for dozens of 

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years.
The most significant reform of occupational healthcare was the Occupational Healthcare Act of 1978. It was 
the world’s most progressive OSH legislation, and it aroused a lot of international interest. It made employers 
responsible for organising and paying for occupational healthcare for all employees, regardless of the industry, 
occupation, employment contract, or the size or location of the workplace. In addition, self-employed people and 
independent entrepreneurs were given the right to get occupational healthcare from the municipal health centres. 
Occupational healthcare was defined very broadly 
– including prevention of work-related health problems and 
hazards; protection and promotion of the health, working capacity, and safety of employees; medical treatment 
and first aid as well as referral to rehabilitation 
– which now has proved to have been very wise, for example for 
supporting employees that are older or have a reduced work capacity.
To control the costs and simultaneously control the content of occupational healthcare, a compensation 
system was set up that was managed by Finland’s Social Insurance Institution but financed by employees and 
employers. This simultaneously became an incentive for employers. The new legislation put Finland’s 
occupational healthcare in first place in the world; coverage topped 90% of wage earners and 50% of self-
employed people, especially farmers.
The services were provided as stipulated by the legislation, and the costs stayed well under control. More 
content has since been added to the relevant decree and the compensation criteria, e.g. following good 
occupational healthcare practices, carrying out activities that maintain work capacity, supporting employees 
coming back to work, and helping those adjust to work whose work capacity is reduced. 
Finland’s occupational healthcare has served as a model in many countries and international organisations. 
The International Labour Organisation’s occupational healthcare agreement was drafted to a large degree 
according to the Finnish law. The World Healt
h Organisation’s occupational healthcare strategies and guidelines 
have received many stimuli from Finland. The occupational healthcare of the staff of all UN organisations largely 
follows Finland’s model. Unfortunately EU directives have not been of help in developing Finland’s occupational 
healthcare; Finland has indeed several times suggested the drafting of an occupational healthcare directive, but 
this hasn’t received the endorsement of all the member states.
New challenges facing OSH and occupational healthcare include globalisation and internationalisation, the 
fragmentation of companies, work, and employment, new health hazards and health risks, for example new 
materials and techniques and new work schedules, the growing heterogeneity of the workforce, ageing 
employees, employees with reduced work capacity, and structural reforms of the Finnish system of public 
services.
Jorma Rantanen 
– former director general of
the Finnish Institute of Occupational Health