A national industrial health service on a voluntary basis

摘要

In Norway—a country with a population of about 3.2 million—the largest occupational group is employed in manufacturing and trade, which accounted for a total of 480 000 individuals in 1946. Most industries are small, only about 100 firms having more than 500 workers. As industry developed, there arose an increasing need for organizing a special plant health service, with the aim of protecting and promoting the health of the workers.Certain regulations were worked out, and in 1945 a general agreement was made between the Norwegian Medical Association, the Norwegian Employers' Association, and the Norwegian Federation of Labour; a tripartite body was then formed, the Board of Industrial Health Service, to give information and advice to industries. This plant health service is based on voluntary mutual agreement and not on legislation.All expenses for the plant health service are met by the industry itself. In firms with no special occupational health problems, the physician works one hour per week per 100 workers; in firms with special problems, two hours. The duties of the plant physician consist in giving the employees pre-employment and periodical health examinations, and health guidance, and carrying out other preventive measures. First aid, treatment for occupational diseases not requiring absence from work, and treatment of certain minor ailments are the only forms of therapy given at the plant. Workers in need of further medical treatment are referred to general practitioners or hospitals. Absenteeism is recorded in a uniform way in all industries that have joined this industrial health service. The plant physician has to submit an annual report on his work to the Board of Industrial Health Service.This system of industrial health service has given very good results. In 1953, 653 plants were participating with about 186 000 workers. About 260 active plant physicians are to be found in Norway at present, most of them working on a part-time basis. The cost of this service is about 20-30 Norwegian kroner (3-4 US dollars) per worker per year.There is co-operation and co-ordination between the industrial health services and the public health services. Many local public health officers work as part-time industrial physicians, and many industrial physicians co-operate closely with the local boards of health, especially in the field of tuberculosis control.The special form of industrial health service adopted in Norway has sprung out of the particular situation there, which made possible the establishment of an industrial health service without danger of weakening the medical services as a whole. Any lack of physicians would have prevented the creation of this service, and the system is therefore not to be recommended for a country with a shortage of physicians. The geographical extent of Norway and the difficult communications in many places have necessitated the delegation of preventive health work mainly to the private physicians, the health centres and institutes playing but a small part in such work.