1. Implementation of the framework agreement on work related stress ETUC project - Estonian case Eda Merisalu, Dr.Med.Sci. ETUC-UNICE/UEAPME_CEEP autonomous framework agreement on work-related stress Riga, 11-12.10.2005

2. Work stress as a world wide problem WHO Health Raport 2001 Mental Health: New Understanding. New Public Health 191 countries: global/regional problems of mental health (MH) Purpose: creating and mapping of profiles and data bases on MH 185 WHO have own MH data bases (Estonia -ESA) Resourses, programs and MH politics 41% of countries MHP doesn’t exist 25% lack of regulatory acts 28% lack of finances for MH 41% lack of curare of severe cases of MH 37% low level of primary health care 65% stationary beds in psychiatric hospitals/departments

3. Influencing factors increase of amonts of mental work increase of importance of private sector more intensive work work overload not official work and pay increase of employment & unstability at the same time working on the different posts increase of work violence

4. Factors that Endanger Employees´ Health, % of all respondents (N=402)

5. Mental health statistics in Estonia 2000 94 228 psychiatric consultations per year 80 837 of those patients get diagnose 9 914 healthy persons

6. Statistics of behavioral & psychic disorders 2000

7. Estonian health survey (Leinsalu, Grintšak, Noorkõiv, 1999)

8. Health behaviour survey of Estonian adult population, 2000

9. Health behaviour survey of Estonian adult population, 2000

10. Structure of death causes in Estonia

11. Structure of death causes

12. Study of living and working conditions’ in EU countries 1990-2000 Studies in 1990 (EU12), 1995 (EU15), 2000 (EU20), 2005 (EU25) 21 500 workers interviewed Main health complaints: Lower back pain 33%; Stress 28% Shoulder-neck pain 23%; burnout 23% Main causes Exposition to physical stress (noise, vibration, cold, warm; lifting heavy weights; constraint position, high work intensity) Lack of control New infotechnology Shift work, part time work Organisation (multidimensional work, need for teamwork, additional pay) Use of temporary work force

13. work intensity 54% repetitive work 50% monotonous work 44% lack of autonomy 35% lack of control over work temp 28% Causes of work stress in EU countries (Paoli 1996)

14. low back pain 30% stress 28% exhaustion 20% musculo-skeletal pains 17% headache 13% Consequenses of work stress, (Paoli 1996)

16. Estonian OH&S Law 1999, RT I, 1999, 60, 616 II pt §3. Whatever risk factor at work (Phys,Chem, Biol, Physiol, Psych) can’t cause negative effect on health of worker § 9. Physiological and psychological risk factors (1) Physiological factors are severuty of physical work, repetitive work externous positions and -movements ect which may cause health complaints or work related disease. (2) Psychological factors are monotonous work, not adapted work, bad work organisation, long lasting work alone ect ning muud samalaadsed tegurid, which may cause health complaints or work related disease. (3) That to prevent mental and psysical overload employer must adapt the work, taking into account physical, mental differences, gender and age. Also changes of work ability during the working day or one shift and possible work alone during long time

17. III pt §13 Obligations of employer 1) internal control of work enironment, controlling occupational health and safety at the work places, accompaying employees and carrying out risk analysis in the enteprise (RK s 29.01.2003 /01.07.2003 - RT I 2003, 20, 120) RT I 2003, 20, 120 2) To analyse the results of inernal control and to adapt work conditions under the new situation; 3) To carry out risk analysis explaining the all risk factors and measuring all the parametres; to assess their effect on workers’ health, accordingly of their sex and age. To archive all the results of risk analysis during 55 years. OH&S Law 1999, RT I, 1999, 60, 616

18. Social and economical costs caused by work related accidents and OD in 2000-2003 Disease compensation (EEK) Occupational disease compensation (EEK/GNP%)

20. Management of work stress 1. Primary intervention Identification of psychosocial and organisational risks, risk analysis, risk management, improvement of work culture 2. Secondary intervention Teaching, training, health promotion programs, good health behaviour. 3. Tertiary intervention Psychological advisoring, Individual and collective stress management.

21. Organisational prevention in hospitals (Schaufeli 2002) 1$ costs  5-16 $ back Total costs(533 000 EUR) 22 000 EUR technical measurements 263 000 EUR training 248 000 EUR organisational changes Kasum (741 800 EUR) 1,2 milj EUR lost working days  448 200 EUR adaptation to work Total effectiveness of intervention 208 800 EUR Case study (1992-1994)