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Seminar on Health Issues 5 September 2014

On September 5th, 2014 a seminar on health issues was organised in the Ministry of Welfare of Latvia within the project "Latvia: Developing a Comprehensive Active Ageing Strategy for Longer and Better Working Lives". The seminar was attended by an experts from the World Bank, partners from Austria, Poland and Estonia as well as representatives from the Ministry of Welfare of Latvia and other Latvian institutions. Expert of the World Bank introduced participants with overall health and work situation in ageing context identifying main challenges as well as providing possible solutions for further discussion. Partners from Austria, Poland and Estonia gave an insight in their countries’ situation, while representatives of the Ministry of Health of Latvia and Institute of Occupational Safety and Environmental Health concluded with situation analysis concerning health of ageing workers in Latvia.

Still Able and Willing: Health and Work in a Population Ageing Context, presented by Roberta Gatti, World Bank

  • In Latvia, old age, especially men, is less healthy than elsewhere in the EU.
  • Excess mortality for middle-aged men is a challenge, and it is mostly related to cardiovascular problems and unhealthy lifestyles including heavy alcohol consumption and smoking.
  • Health concerns is an important barrier in the labour market as employment is correlated with better self-perceived health status and lower probability of functional limitations among middle-aged and older Latvians. The prevalence of inactivity due to health reasons is higher in Latvia than in the EU-15.
  • In Latvia working conditions do not seem to contribute significantly to employees’ poor health, however, it appears that work-related health problems are more likely to result in severe health limitations than on average in the EU.
  • There is an evidence of continued improvements in intellectual functioning across cohorts due to better education, nutrition, hygiene, smaller families and more stimulating work.
  • Current health challenges can be managed in Latvia by learning from older European countries and adapting interventions that have been proved to work, which among others are:
  • Changing individual health behaviour to reduce cardiovascular disease incidence;
  • Strengthening management of chronic diseases;
  • Developing a robust long-term care sector;
  • Promoting maintenance of cognitive plasticity through physical exercise and workplace mental stimulation;
  • Encouraging employers to adapt workplaces for older workers and promote good health behaviours;
  • Supporting labour force participation of people with disabilities.

Health and Work, presented by Stefan Potmesil, the Austrian Federal Ministry for Labour, Social Affairs and Consumer Protection

  • In Austria the overall strategy is to maintain the capacity for work and employability, especially for older workers; improve health state of the labour force and to foster health-friendly work environments. This entails economic benefits, such as higher tax revenue and higher contributions to social insurance.  
  • In order to reduce invalidity, to prevent unemployment on health reasons at an early stage, to reintegrate workers into the labour market after longer periods of sick leave for health reasons and to preserve their capacity for work on a long-term basis by preventive measures the reform of the Invalidity/Incapacity Pension System was realized.
  • Every request for invalidity/incapacity pension is viewed as request for rehabilitation and therefore individualised support and case management, including psychological and psychotherapeutic care, is provided by coordination of medical and professional rehabilitation and LMP measures.
  • In order to ensure sufficient means of subsistence temporary invalidity pensions are replaced by means of rehabilitation benefit and re-training benefit during the involvement in support measures and activities.
  • According to Austrian calculation about financial added value, each 1 euro invested in preventative measures brings at least 3 euros in contributions to social insurance and taxes as well as reductions in transfers, services and benefits and higher productivity.

Medical Certification in Polish Social Insurance Institution presented by Piotr Winciunas, Polish Social Insurance Institution

  • The main tasks of the Polish Social Insurance Institution are to carry out medical examinations for the purposes of social insurance benefits and control sick leave certificates, establish entitlement to and pay social insurance benefits, establish social insurance obligations, collect social insurance contributions and perform prevention tasks, including medical rehabilitation and prevention of accidents at work and occupational diseases.
  • Polish Social Insurance Institution’s certifying doctors and medical boards evaluate incapacity for work, its degree and expected period. They issue medical certificates on a basis of medical documentation attached to the application and on direct examination of an applicant’s health conditions.
  • The Polish Social Insurance Institution also carries out prevention activities including medical rehabilitation of insured clients to help them return to work or to enable them to continue working as well as prevention of accidents at work and occupational diseases.
  • After medical rehabilitation situation of insured persons is analysed paying attention to received benefits. Rehabilitation is considered as effective if benefits from the Polish Social Insurance Institution is not received during the following year. Statistics show that in 2011 50 % of people who finished rehabilitation did not receive benefits the following year.

Age Management in Poland, presented by Katarzyna Hildt-Ciupinska, Central Institute for Labour Protection – National Research Institute

  • Employment rate for older workers in Poland has been steadily growing since 2005 and in 2013 was 40.6% (31% for women and 51.3% for men).
  • In order to evaluate activities undertaken in Polish enterprises in relation to age management and to assess how older workers (50+) evaluate activities undertaken on their behalf by their companies a study „Evaluation of activities undertaken in Polish enterprises in relation to maintaining older workers (50+) employment” was carried out.
  • Main rain results of the study are following:
  • In the total number of persons employed in 200 surveyed companies,     23% were older workers;
  • Special programmes aimed at employing people aged over 50 were implemented in less than 10% of the enterprises;
  • Less than half of older workers (45%) declared that they had a possibility to work flexible hours;
  • Only 25% of the 50+ workers confirmed that their companies offered special trainings addressed to them;
  • More than 46% were involved in mentoring and nearly 38% declared they were trained by younger workers;
  • The smallest number of activities was undertaken in health care and health promotion. Less than a quarter of respondents had trainings on healthy lifestyle, and only 14% underwent trainings on ageing and the possibility of delaying it;
  • About one fifth of employees confirmed the need for activities targeted at older workers;
  • Respondents confirmed the need for more information about health issues.
  • In order to evaluate ability to work in Poland there is developed a workability index, which is determined on the basis of the answers to a series of questions taking into consideration the demands of work, the workers’ health status and resources. Additionally to assessment by occupational health professionals worker also answers to questions about their health depicting their own concept of work ability.

Health Issues and Active Ageing in Estonia, presented by Siiri Aulik, Ministry of Social Affairs of the Republic of Estonia

  • Currently 50+ population constitutes 38.2% of the total population of Estonia; the number is expected to grow to 43% in 2045.
  • In 2013, employment rate of elderly workers aged 55-74 was 52.8%, while unemployment rate for this age group was 6.8%. 90% of elderly workers in Estonia are full-time employed.
  • Work-related and occupational illnesses are the most common for workers aged 45-64.
  • Work (dis)ability reform targeting persons aged 16-63 years old aims to promote paradigm shift assessing work ability and not incapacity based on diagnosis and to ensure inclusive and individual approach.
  • In Estonia there are 96 800 work incapacity pensioners in Estonia and 63% of them would like to work.  
  • Under the current system, work incapable individuals do not have reduction of benefits if they are unemployed and hence there is no incentive to be active. However, under the reformed system persons with partial workability will be required to fulfil activity requirement (work, care, study).
  • Additionally to support persons without workability or partial workability, there are also measures for employers including training, work experience and wage support, adaptation of work spaces and equipment, disability equipment and support persons.
  • In Estonia following tax incentives are implemented: no minimum monthly social tax requirement for employees with reduced work ability and/or of pensionable age; minimum monthly social tax contribution paid by the state; tax-free compensation for use of personal care or public transportation from home to work.
  • Improving the Quality of Life Programme 2009-2015 – raising awareness of healthy work environments and ensuring flexible and secure working conditions with the goal of maintaining health and improving the quality of working life, labour supply and productivity.
  • Healthy and Active Ageing Policy in Latvia, presented by Sanita Kukliča, Ministry of Health of Latvia
  • The aim of public health policy is to prolong the healthy life years of the Latvian population and to prevent untimely deaths, while maintaining, improving and restoring health.
  • In order to decrease the morbidity and mortality of heart and cardiovascular diseases and to decrease their risk factors negative impact on the public health Action Plan to Prevent Heart and Cardiovascular diseases for 2013-2015 was developed.
  • With the aim to improve quality of primary health care, make it the most accessible, effective and comprehensive level of health care and increase its role in prevention, diagnostics and treatment the Primary Health Care Development Plan for 2014-2016 was developed.
  • Currently the draft of the Public Health Strategy for 2014-2020 is developed with the aim to increase by 3 years the healthy life of individuals and to decrease by 11% the potential years of life lost.
  • As the priority areas of investment are set following areas - cardiovascular diseases, oncology, perinatal and neonatal period care, mental health care.
  • Elderly people are among population groups, which are set as priority in terms of health care access.
  • 9% of seniors in Latvia rate their health as good or very good; 45.5% - as average; while 46% of seniors as bad or very bad.
  • Several health promotion interventions are implemented in order to improve the situation of older people, among others are Healthy Nutrition Guidelines for Elderly People, health promotion in municipalities to improve development of healthy behaviours and lifestyle of local population and awareness raising activities.

Working Condition in Latvia and their Effects on Health of Ageing Workers, presented by Ivars Vanadzins, Insitute of Occupational Safety and Occupation Health, Riga Stradins University

  • By far the most popular reason for long-term health effects among all age groups except of 15-24 years old are working conditions (source: Population survey, Work conditions and risks in Latvia, 2013).
  • From 2009 until 2013 number of workers who have suffered in workplace accidents has been steadily growing in Latvia, 50+ workers form about 33-36% of them.
  • Main causes of severe and fatal accidents at work among 50+ employees are following - worker did not fulfil safety instructions, improper training of worker done by employee, insufficient attention.
  • The most common occupational diseases in 2013 were backbone disorders, connecting tissue diseases, carpal tunnel syndrome.
  • Most workers, who are suffering from pain, claim that it is due to working conditions, have had heavy overload at work, worked overtime and did not use annual holidays.
  • Even though older workers are often associated with health problems, statistics show that number of lost days due to sickness in last year is less widespread among older workers – 52.9% of workers aged 45 and older did not have any lost day due to health problems.
  • Rapid increase of occupational diseases incidence is caused by both the working conditions and improvements in diagnostics and coverage of health surveillance.
  • With increased aging population, occupation diseases will be become a more significant problem because elderly workers are more likely to be affected by occupational diseases that may cause early retirement.

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