The unemployed too need occupational health care

"We have research findings that show that the health of the unemployed is worse than among people in work and that there are many untreated illnesses among the unemployed. But we do not know what the interaction between unemployment and health is. Does health deteriorate during unemployment or is it that people with health problems more easily become unemployed? There is still more research needed on this", says Ritva Partinen.

Partinen has been the chairperson of the management group of the MSAH project on the health care of the long-term unemployed, which was started in 2007. She is also involved in the sub-working group that followed on from the working group on the reform of working life, known as the Ahtela group, which dealt with proposals on how to prolong working life by improving occupational health care, work-place wellbeing and assessment and health services concerning working capacity for the unemployed.

"Though the cause-effect relationship of unemployment and health is not clear, we know that the unemployed lack preventive occupational health services, which could be used to intervene in health problems straightaway in their initial phase. We are currently rectifying this deficiency", says Partinen.

The health care bill before parliament states that municipalities must organise health counselling and examinations for youth and people of working age who do not fall within student and occupational health care services.

Partinen points out that the bill realises the requirement, which was also expressed in the questionnaire of the MSAH project on the health care of the long-term unemployed. Municipal respondents considered it important that the entitlement of the unemployed to preventive health services be laid down in law.

There already is funding for this. Since 2006, municipalities have received €2 million a year from the central government transfers to local government for health examinations for the unemployed. Support was given to those municipalities involved in the project on the health care of the long-term unemployed for them to develop health examination services for the unemployed. In addition, it will be possible in future to support the development of health services for the unemployed using funding from the National Development Programme for Social Welfare and Health Care (known as the Kaste Programme). The main focus of this programme is on the development of health and social welfare services by municipalities throughout Finland.

Municipalities are not required to start to develop health services for the unemployed from scratch. The MSAH project on the health care of the long-term unemployed created "occupational health care" models in 18 sub-projects conducted in different parts of Finland.

The starting point for the development of the models was centred on local needs and on the objective of having comprehensive and systematic services for health promotion for the unemployed. In some cases, municipalities have arranged health examinations for the unemployed within primary health care, while in others they have been arranged within Labour Service Centres.

In Partinen's view it would be good if primary health care could benefit from occupational health care skills. Cooperation with occupational health care would also be necessary when, for instance, hundreds of people are made unemployed at the same time in the same locality. Primary health care would be unable to cope with such numbers without additional resources. Funding may turn out to be one of the obstacles to such cooperation, as employers finance occupational health care and municipalities finance primary health care.

Partinen emphasises that health examinations for the unemployed are not valuable in themselves, but rather through them people who are unemployed get their working capacity assessed, and access treatment, rehabilitation and re-training.

The MSAH project on the health care of the long-term unemployed revealed that the unemployed are best steered to health services via Employment and Economic Development Offices (EEDOs). Health care does not reach the unemployed without the assistance of EEDOs. The Ministry of Employment and the Economy is currently working out how this collaboration can best be arranged. Could EEDOs act as an employer for occupational health care?

"In planning health services for the unemployed, we should consider which services work place occupational health care could provide already before the onset of unemployment, and how EEDOs would continue with directing people to services", says Partinen.

"It is especially important that EEDOs guide young people who are left without training and jobs towards the spheres of services that they need. They do not yet receive occupational health care and they no longer have the support of student health care.

In the project on the health care of the long-term unemployed 2010 has been a stage in which new models of health care for the unemployed have been disseminated and have taken root. Regional conferences and peer learning days for municipal employees have been held, and study modules constructed for polytechnics.

A guidebook on health during unemployment has been published for unemployed people, and is being distributed by the Finnish Social Insurance Institution and online by the Ministry of Employment and the Economy. The guide is designed to support people's working capacity, wellbeing and health while they are unemployed, and it contains an appendix with details on social security for the unemployed.

"In compiling this appendix we noticed just how multigenerational and abstruse the Finnish social and health system is", says Partinen.

"And because it was difficult simply to put this together, it must also be difficult to exist in the labyrinth of social and unemployment security. This, together with job seeking, requires real strength and health on the part of someone who's unemployed."

Merja Moilanen