Ongoing development and evaluation of occupational health services for farmers in Finland

In Finland, occupational health services have been developed based on the 1979 law that was updated in 2002. Cooperation among OH specialists, researchers, authorities, OH-units, interest groups and clients is characteristic of the development of farmers' occupational health services (FOHS). The systematic planning and development of FOHS have been conducted since 1979 by the Finnish Institute of Occupational Health in collaboration with the Social Insurance Institution (SII) and the Farmers' Social Insurance Institution (FSII). In 1985, the National Board of Health issued an ordinance initiating FOHS in municipal health care centres according to the proposals of the research team. Thereafter, FOHS have been continually evaluated and developed. In addition, farmers' health hazards at work and their work related diseases, mortality and accidents have been studied in follow-up surveys in 1979, 1982, 1986, 1992 and 2004. A training program for FOHS personnel started in 1981. The functional adequacy and productivity of FOHS was studied in the surveys of 1989, 1995, 2000 and 2004. A recommendation for applying Good Occupational Health Practice-ordinance (GOHP) in FOHS was issued in 2000. Experiences, needs and expectations of farmers in relation to FOHS were studied in 1992, 2001 and 2004.The results of the survey of the year 2004 and the statistics of the SII an FSII show that functional adequacy of FOHS had improved from the level observed in 1996. The coverage of FOHS has increased from 32% in 1999 to 41% in 2004 of all insured farmers. According to the statistics of the SII the functional adequacy of FOHS has increased. The checking of working conditions is something that has increased in particular. Coverage of FOHS has also increased in some regions. The main limitations for GOHP in FOHS are still the lack of resources and training of OH personnel in many OHS units and the inactivity of farmers as well as local FOHS advisory boards. The most important challenges are to improve the effectiveness and coverage of FOHS.