1. Effectiveness of Health Examinations Kari-Pekka Martimo Pre-Accession Advisor

2. INPUT PROCESSOUTPUT OUTCOME Needs of the work place Costs to the employer Loss of work time Skills of OH personnel Health examination Number of - examined persons - tests - recommendations - interventions Improved health, collaboration; succesful employment; decreased number of OD, WA, risk factors, early retirement,

3. Process model of health examination 1)Identifying the needs 2)Setting the objectives 3)Intervention 4)Immediate results 5)Long-term results

4. 1. Identifying the needs What are the main targets of the health examination (table)? How the needs for actions will be identified? What is the reliability and acceptability of the chosen methods?

5. Classification of health examinations Work-relatedNot work-related Primary prevention Category 1: Recognition of work-related risks (e.g. biological monitoring), assessment of suitability to work Category 4: Assessment of lifestyle risks Secondary prevention Category 2: Early detection of work-related symptoms and signs Category 5: Early diagnostics of diseases, screening Tertiary prevention Category 3: Diminishing the handicap caused by work-related diseases Category 6: Diminishing the handicap caused by diseases

6. 2. Setting the objectives How the objectives will be set? How the objectives will be documented? How the patient’s/customer’s opinions will be observed? How the objectives are understood by the employer and employees?

7. 3. Intervention What kind of interventions will be used? How work-related issues will be included in addition to individual issues? Are the interventions based on evidence?

8. 4. Immediate results How the follow-up will be organized and documented? Has patient/customer satisfaction been measured? Are the results applicable to actions at the work place level?

9. 5. Long-term results How the long-term effects of the applied interventions have been proven scientifically?

10. Summary Why? What? When? Who should be informed and how? And then?

11. Ethical considerations Kari-Pekka Martimo Pre-Accession Advisor

12. Basic ethical requirements 1)Avoiding harm 2)Promoting autonomy 3)Promoting justice (equality/equity)

13. Avoiding harm Curative and preventive services Are the methods relevant to the risks? Reassurance by normal values in unacceptable situations? Consequences to the individual and to the work place? Benefits of screening?

14. Autonomy Compulsory or voluntary? Who makes the decisions based on the results? Right to informed consent? Right to refuse screening? Rights of the service provider? Rights of the employer?

15. Justice Discrimination by the results of health examination? Primarily actions directed at the individual or the work environment? Occupational health services for all? Employer’s duty to cover expenses caused by work-related ill-health?

16. Who wants which? Early detection of work-related health effects Early initiation of preventive measures Early detection of deteriorating work capacity Early initiation of rehabilitating and work-related activities

17. Who wants which? Health counselling Medical rehabilitation Something else?