Norwegian industry and health promotion 1910-1967

No wegian Indus y and IHeal h P omo ion 1910-196'7 HILDE IBSEN (*) SUMMARY In oduc ion. 1.-Occupa ional heal h se ice, i s oo s and mo i a ions. 11.-Heal h, secu i y and well-being. The indi idual heal h con ol a F eia. Indi idual heal h con ol a Ch is iania Po land Cemen Fac o y. Indus ial hygiene and he collec i e wo k en i onmen . Indus y and heal h p omo ion. Conclusion. RESUMEN Se es udia el desa ollo de los se icios de salud ocupacional en No uega a a és de los ejemplos de sendas áb icas de chocola e y cemen o. El es udio mues a cómo los se icios de salud indus ial es u ie on de e minados po di e en es mo i os o posiciones ideológicas. .En e es os des aca on la p esencia de una iloso ía social y polí ica, la del es ado del bienes a como una al e na i a al socialismo, y la de una polí ica es a al p eocupada po la cons ución de una sociedad opulen a y el inc emen o de la p oduc- ción. Todo ello condujo a un in e és c ecien e po la in luencia del ac o humano en la indus ia, en la que al médico empleado le cumplía el debe de con ibui a con o ma un abajado sa is echo, conscien e y p oduc i o en un ambien e de abajo sano. INTROD UCTION In Non ay he his o y o he occupa ional heal h se ice s a s a he end o he 17 h cen u y. The new mining indus y b ough changes in social and hygienic condi ions and engagedl doc o s who mainly wo ked Fecha de acep ación: 21 de sep iemb e de 1992. (*) School o Cul u al and Social S udies, Uni e si y o Oslo, P.O. Box 1056 Blinde n. 0316 Oslo 3. No uega. DYNAMIS Ac a Hispanica ad Medicinae Scien iammque His wiam Zllus aadam. Vol. 13, 1993, pp. 155-172. ISSN: 021 1-9536 156 EIILDE IBSEN l~i h ea men and cu e. They had li le esponsibili y o hygiene and l~ e en ion. Abou 1910 he old wo ks doc o s disapea ed. They we e no longe needed. Acco ding o he Sickness Insu ance Ac (1909) a numbe o wo ke s we e gi en ee medical ea men "and money du ing illness. A he same ime indus y paid mo e a en ion o wo k en i onmen and hygiene. The ime had come o a mode n indus ial heal h o ice (1). 191'7 was a u ning poin . The i s mode n indus ial medical o ice ?was employed a A/S F eia Chocola e Fac o y. In he yea o come Non egian indus y de eloped a ange o olun a y social measu es. The occupa ional heal h se ice was only one amongs a ious measu es as housinig, pensions, p o i -sha ing, wel a e o ice s, e c. Why did Non egian indus y engage medical o ice s? E[ow did he a angemen wo k ou in di e en ac o ies? In wha way did indus y in luence he de elopmen o Non egian heal h policy? In his a icle 1 wan o explo e he de elopmen o occupa .iona1 heal h by making a case s udy o A/S F eia Chocola e Fac o y in Oslo and Ch is iania Po land Cemen Fac o y (CPC) in Slemmes ad, a illage hi y kilome e s sou h o Oslo. A s udy o hese wo ac o ies show how di e en mo i es and ideological posi ions p omo ed he indus ial heal h se ice. 1 will a gue ha he de elopmen a F eia was a esul o he manage s' (Johan Th one Hols ) social and poli ical philosophy. He widened he goals o his business o include no only p o i s and e icency, bu also social and poli ical esponsibili y - noblesse oblzge. He wan ed wel a e capi alism as an al e na i e o socialism and s a e policy in building he a luen socie y (2). (1) NATWG, Haakon; THIISEVENSEN, Ey ind (1983/ 1989). A beidsmie~ og ikke. Y keshygiae og bed i shelseijenes ens emb udd og u ikling i No ge. ( Wo k En i onm.en and Heal h. Indus ial Hygiene and ¿he Founda ion and Deuelopmen o he Occupa ional Heal h Se uice) , Oslo, 1The No wegian Associa ion o Medical O icei:~, p. 74. (2) Occupa ional wel a e and wel a e capi alism is analysed in se e al wo ks. See o example, BRANDES, S ua (1976). Amen'can Wel a e Capi alism 1880-1 940, Chicago/ London, Chicago Uni e si y P ess, 210 pp.; BRODY, Da id (1968). The Rise and Decline o Wel a e Capi alism. Zn: John B aeman; Robe H. B eme ; Da id B ody (eds.), Change and Con inui y in Twen ie h-Cen uly Ame ica: The 1920's, Ohio, Ohio S a e Uni e si y P ess, pp. 147-178; EDWARDS, Richa d (1979). Con es ed Tmain, New Yo k, Basic Books Inc., 261 pp.; LAZONIC, William (1990). Compe i i e Ad an age on ¿he Shop Floo , Camb idge Mass./London, Ha a d Uni e si y P ess, pp. 240-251; No wegian Indus y and Heal h P omo ion 19 10- 196'7 157 Bu he occupa ional heal h se ice mus also be seen as a means o imp o e he p oduc ion. Cleanliness had high p io i y in a chocola e ac o y we e he p oduc s had o be o he bes quali y. When CPC go a medical o ice hi y yea s la e , no one men ioned wel a e capi alism. The mo i es we e mo e oo ed in he s ong p oduc i i y s a egy which de eloped in Non egian inclus y a e he Second Wo ld Wa . The need o inc eased p oduc ion also esul ed in a g owing in e es in he human ac o in indbs y. E e y wo ke should be accep ed as an indi idual so ha he could eel physical and psychical well-being. The medical o ice should help o shape a sa is ied, a i'onal and p oduc i e wo ke in a heal hy wo k en i onmen . I. OCCUPATIONAL HEALTH SERVICE - A'S ROOTS AMI MOTNATIONS The i s mode n occupa ional heal h sle ice was es ablished on he ini a i e o F eia Chocola e Fac o y. Johan Th one Hols , he manage , wan ed o make F eia a leading ac o y bo h socially and comme cially. He had housing policy e y much a hea and in 1910 he s a ed o build a ga den ci y o his employees. Few yea s la e Th one Hols wan ed o expand his building p ojec , bu he municipali y e used o coope a e. He was e y disappoin ed, bu he didn' s op d eaming o F eia as an ideal ac o y. He ound new solu ions. Th one Hols s b o he , Pe e F. Hols who was a doc o , in oduced him o Ca l Schia z, an ac i e doc o who pu g ea e o s in o p omo ing nu i ion and hygiene. Th one Hols knew abou Schia z' doc o al hesis abou mass-examina ion o Non egian school child en, and he asked him o ca y ou sys ema ic examina ions o his employees (3). Th one Hols s essed ha hygiene was a e y impo an ques ion. In his ideological w i ing om 1914, Indus y and Indus ial A~oblems, he claimed ha ~ he MELLING, Joseph (1991). Indus ial capi alism and he wel a e o he s a e: he ole o employe s in he compa a i e de elopmen o wel a e s a es. A e iew o ecen esea ch. Sociology, 25, 219-239. (3) STRDM, Axel (1975). Bed i shelse jenes en i No ge - bakg unn og p insippe (The Occupa ional Heal h Se ice in No way - Backg ound and P inciples). In: 0i ind La sen (ed.) , Fo ebyggende medisin (P e en i e Medicine), Oslo, pp. 150-157. HILDE IBSEN people who neglec hei hygiene will soone o la e collaps» (4). He linked pe sonal hygiene o na ional economic gues ions. A poo pe sonal hygiene weakend he na ions' heal h and had bad consequences wi h ega d o p oduc ion and compe i i e powe - bo h impo an elemen s in he philosophy o wel a e capi alism. To p omo e occupa ional wel a e he indus y needed p o i . Th one Hols and Schi0 z me in mu ual in e es s. They bo h had ideas which hey wan ed o es .and made F eia a s a ing poin o a social expe imen . Th one Hols wan ed o y ou his social poli ical ideas, while Schio z wo ked ha d o p omo e hygiene and p e en i e medical wo k. A F eia he was gi en ee hands and he ansla ed his ideas in o p ac ice. P o ec ion o he wo ke s had become a main issue in he p e ious yea s. Wo k en i onmen was a c ucial ques ion. Schio z claimed, howe e , ha collec i e public measu es c owded ou he indi idual humane hygiene. Al1 emedies had o be used o make he human being heal hy and o inc ease i s capaci y bo h physically and in ellec ually. Resea ch conce ning p o ec ion alid en i onmen was impo an , bu i had o be done in co- ope a ion wi h clinical-medical examina ions o he indus ial wo ke . Schio z build up he occupa ional heal h se ice acco ding o new p inciples. He used he same me hodes as he had used in examining schoolchild en. His ask was no o cu e bu o do p e en i e and consul a i e medical wo k. He commen ed on he wo ke s heal h and hei abili y o wo k. He wo ked o he imp o emen o wo k condi ions aind he ied o s imula e he wo ke s o a heal hy and hygienic way o li e. The main pu pose was o gi e he ac o y a s ong and heal hy wo ki ig s a . I ook yea s be o e doc o s and manage s became in e es ed in he occupa ional heal h se ice. F eia was alone o nea ly wen y yea s (5). Some o iice s in he S a e Labou Supe ision ied, howe e , o sp ead he gospel o occupa ional heal h. They wan ed he public supe is~o s o p omo e hygiene in he ac o ies. T adi ionally hese supe iso s had been mo e (4) THRONE HOLST, Johan (1914). Zndus i og indus ielle p obleme , K is iania, H. Aschehough & Co., p. 4. (5) BRUUSGAARD, A ne (1943). Bed i shelse jenes en ( he Occupa ional Heal h Se~ce). Li og Helse (Li e and Heal h), 10, 51-52. No wegian Indus y and Heal h P omo ion 1910-1967 159 in e es ed in making echnical imp o emen s han in imp o ing he wo ke s heal h (6). In he ea ly hi ies doc o s ook mo e in e es in he ques ion o occupa ional heal h. Schia z' wo k a F eia and his eaching a he uni e si y ga e esul s. When Schio z died in 1938 ou doc o s who had been Schia z' s uden s, con inued his wo k. Some o hem we e adicals, like A ne B uusgaa d and Axel S om (7), and al1 o hem had go hei educa ion du ing he expansion o social medicine in he hi ies. One o hem, Ey ind Thiis-E ensen, wo ked ou di ec i es o he occupa ional heal h se ice in his lec u e o he doc o al hesis in 1941. He wan ed al1 en e p ises wi h mo e han i y employees o es ablish he a angemen . He p oposed ha al1 di ec i es should be made by he P o esso o hygiene a he Uni e si y o Oslo and he chie o ice s in he S a e Labou Supe ision. In 1943 ele en en e p ises had engaged an indus ial medical o ice - only wo in 1940. The a angemen s di e ed and in se e a1 ac o ies nei he he managmen , wo ke s no he cloc o s we e sa is ied. Du ing 1943 he pe iodical Li og Helse (Li e and Heal h) published a numbe o a icles conce ning indus ial medical o ice s and go posi i e esponse om a numbe o en e p ises. A he end o 1943, i y ou en e p ises had go an occupa ional heal h se ice build on Schio z' model. The need o ind simila di ec i es inc eased dunng 1943, and B uusgaa d, Na ig, S am, Thiis-E ensen and Eile H. Schia z (Ca l Schio z' son) joined oge he in he Associa ion o Indus ial Medical O ice s. They wan ed suppo om he medical es ablishmen bu he Non egian Medical O ice s Associa ion was ou o unc ion because o he wa . Ins ead hey s a ed a co-ope a ion wi h he Non egian Hygiene Associa ion (8). The wa limi ed hei wo k, bu hey managed o publish b ochu es which ga e ad ise o doc o s who wan ed o p ac ice as indus ial medical o ice s. Du ing 1944 he associa ion dis ibu ed wo b ochu es o al1 he membe s (6) NATWG; THIISEVENSEN (1983/1989), op. n (n. l), p. 60. (7) NORDBY, T ond (1989). Ka l Euang. En bzog a i, OOs, H. Aschehough, p. 55 and p. 182. A ne B uusgaa d was one o he commi e membe s o he i s boa d o he Socialis Doc o s Associa ion om 1931. Axel S ~m was a membe o he associa ion. (8) The No wegian Hygiene Associa ion was, howe e , an associa ion wi hin he Non egian Medical O ice s Associa ion. 160 HILDE IBSEN o he No wegian Hygiene Associa ion. They also made a s anda d con ac o indus ial medical o ice s. When he wa was o e B uusgaa d discusseíl he u u e o he occupa ional heal h se ice wi h one o he Wo ke s' Associa ions on a con e ence in sp ing 1945. The wo ke s had wo main objec ions. They ea ed ha wo ke s would be declea ed disabled o medical easons and hey ea ed ha he indus ial medical o ice s would se e he employe s in e es s mo e han he wo ke s (9). The Associa ion o Indus ial Medical O ice s ound he objec ions legi ima e and sugges ed he es ablishmen o a sec e a ia wi h ep ese* a i es om he T ades Union Cong ess and hle No wegian Employe 's Fede a ion. B uusgaa d claimed ha i was impossible o secu e he a angemen wi hou suppo om he wo o ganisa ions. Du ing ha summe B uusgaa d go in ouch wi h he sec e a y o he T ades Union Cong ess, Kon ad No dahl. He showed some in e es bu dicln' sugges a co-ope a ion. The o ice manage in he Employe 's Fede a ion was ese ed. The ques ion o co-ope a ion was allowed o es . Ins ead he Associa ion o Indus ial Medical O ice s concen a ed on ge ing suppo om he Medical O ice s Associa ion. In sep embe 1945 he subjec was pu on he agenda o he associa ion's yea ly con e ence and i was in p inciple app o ed. In Feb ua y 1946 he Associa ion o Indus ial Medical O ice s ied once again o es ablish a co-ope a ion wi h he T ades Union Cong ess and he Employe 's Fede a ion. In he mean ime bo h o ganisa ions had made a close examina ion in en e p ises which had engaged indus ial medical o ice s. The expe iences we e posi i e, and he Boa d o Indus ial Medical O ice s was es ablished on May 22 1946 wi h ep esen a i es o he T ades Union Cong ess, he No wegian Employe 's Fede a ion and lie Associa ion o Medical O ice s (10). Haakon Na ig was elec ed p esideni o he boa d. Why was he e an inc eased in e es in he ques ion o he occupa ional heal h se ice om 1943? How was i possible a e such a sho ime o es ablish a new boa d comp ising adi ionaly c'on ending pa ies? Haakon Na~ig has claimed ha he ime o i had come (1 1 ). Expe iences om di e en en e p ises showed ha he occupa ional heal h se ice was a p ac ica1 and economical solu ion o he ques ion o bo h heal h and (9) NATVIG; THIIS-EVENSEN (1983/1989), op. ci . (n. l), p. 90. (10) Ibidem, p. 106. (1 1) NATVIG, Haakon (1953). Bedn shelse jenes ens em id (The u u e o he Occupa ional Heal h Se ice), Lz og Helse, 19, 104107. No wegian Indus y and Heal h P omo ion 19 10- 1967 161 wo k en i onmen (12). The indus y had o show he way oge he wi h doc o s. «We canno wai ha he S a e in nea u u e will be able o a ange such a heal h con ol» (13). The inc eased in e es in he ques ion nqus also be seen in conec ion wi h he employe s' wish o educe he sick.ness a e by s onge con ol. The sickness a e was inc easing and some en e p ises used he medical o ice as a 'policeman'. O he ac o ies had p oblems wi h ce ain diseases like ube culosis, silicosis and lead poisoning. By es ablishing a pe manen heal h supe ision he manage s wan ed o make an e ec i e campaign agains diseases. Bu in many cases employe s had acknowledged a wide social esponsibili y o hei employe s dui-ing he wa . ~Since we ha e been poo in o he espec s, i seems ha he in e es in good heal h and wo king powe has inc easedu (14). F om he doc o s poin o iew he wo k as indus ial medical o ice was well paid and ga e in e es ing wo k. The Boa d o Indus ial Medical O ice s was ounded in a ime when e e ybody wan ed o econs uc he damages o he wa . Bo h he boa d and he ag eemen on P oduc ion Commi ees was «a p omising e idence ha he will o co-ope a e was s onge han con lic on in e es s. (15). To imp o e he popula heal h and he wo ke s social ci cums ances i was necessa y o comba illness and o imp o e he hygienic condi ions in indus y. While in an wel a e clinics and heal h con ol o schoolchild en was a good se ice o child en, adul s had inex o no hing. The heal h se ice was causal (16). Mos o he popula ion had ee heal h examina ion and ea nen , bu he e we e no good p e en i e se ices. Regula exa nina ion o appa en ly heal hy people was one o he main pu poses in p e en i e medical se ices. These se ices had o be expanded and be o e ed o he majo i y o he wo king popula ion. The occupa ional heal h se ice expanded be ween 1947 and 1949. No o he social heal h se ice had any simila de elopmen in such a sho ime. In 1952 abou 500 en e p ises had an indus ial medical o ice , ha is 7,7% o indus ial en e p ises wi h mo e han i e employees (1'7). The (12) Ibzdem. (13) BRUUSGAARD (1943); op. ci . (n. 5), p. 51. (14) Ibzdem, p. 52. (15) I,z og Hehe, 13 (1946), 153. (16) BRUUSGAARD (1943), op. ci . (n. 5), p. 51. (17) NATViG (1953), op. ci . (n. ll), p. 104. 162 HILDE IBSEN pe cen age a ied be ween 1,8% i11 16,9% in di e en pa s o No way. The a angemen was mos common in coun ies a ound Oslo. A ound 1965 aboui 1.500 en e p ises we e coVe ed by he occupa ional heal h se ice (18). This de elopmen co esponded wi h" g ea e in e es in he human ac o in indus y. In addi ion mo e and mo e manage s ealiised ha hey had social esponsibili y. Howe e , he main eason o he expansion mus be seen in connec ion wi h he g ow h o he a ional and p oduc i e socie y. The employe s had o inc ease p oduc i i y by ge ing a s ong and heal hy wo k o ce. No only echnical means o p oduc ion had o unde go a ionalisa ion, bu he wo ke s oo. In his wo k he indus ial medical o ice had o make a ~heal hy and p ope a ionalisa ion o he main means o p oduc ion - he human beeing~ (19). II. HEALTH, SECURITY AND WLL-BEING The indi idual heal h con ol a F eia When Schia z s a ed o wo k a F eia he o ganized he heal h se ice acco ding o his own ideas and p inciples. The lines he layed down we e la e ollowed by he Boa d o Indus ial Medical O ice s. New me hods we e d awn up: indi idual heal h con ol, egis a ion o absence and hygienic wo k. Fo se e al yea s he mode n ac o y doc o' concen a ed on he indi idual heal h con ol (20). I was necessa y o examine he human being be o e u he con ol o he hygienic condi ions. When he doc o had analysed l:e wo ke s and hei diseases i was easie o ind connec ions be ween illness and wo k en i onmen . Schia z wo ked as a pa ime doc o wi h wo wo king hou s a week. Al1 employees we e examined once a yea . Schio z called o six o eigh wo ke s e e y ime. Bo h men and women we e s ipped o he wais , bu he women kep he b a. The wo ke s ga e i.n o ma ion abou p e ious (18) NATVIG; THIIS-EVENSEN (1983/1989), op. ci . (n. 1) p. 145. (19) 12i og Helse, 13 (1946), p. 153. (20) STRaM, Axel (1957). F a ae e ed en no sk be l i i e e k igsWa ene (Abscence wi hin a No wegian ac o y in he a e wa pe iod). Sosial A beid (Social Wo k), 10, 209-220. No wegian Indus y and Heal h P omo ion 19 10- 19617 163 wo k and illness. Schio z examined hands and ee h. F eia was a nu ien ac o y and Schi~ z paied g ea a en ion o pe sonal hygiene. Fu he mo e he examined he skele on and ee s. He sou ided hea and lungs, measu ed heigh and weigh . I a wo ke was ill he was sen o a gene al p ac i ione o a specialis . Schio z had made an ag ee nen wi h he Boa d o Heal h in Oslo in case o ube culosis. The examina ion me hod was e y simple. Few me hods exis ed which we e usable o mass-examina ions. Schi~ z based his diagnosis on «a p ac iced eye», which was e icien acco ding o he clinical pic u e o he ime. The mos common illnesses we e eczema and de ma i is, angina, diph he ia, b onchi is, consump i es and heuma ism. Ca ies was also a se ious p oblem. In spi e o a simple and maybe impe ec ~examina ion Schio z' me hods ep esen ed some hing new. Schio z, c ea ed he basis o a sys ema ic heal h con ol o g own up people (21). When Axel S 0m ollowed Schi0 z in 1938 he de eloped he examina ion me hods u he . The wo ke s und essed and S om used hal an hou on e e y wo ke . He made an u inalysis and he ook a blood es and a Pi que - es . He measu ed he blood p essii e. E e y employee go hei own book whe e S 0m ma ked in o ma ion abou illness and esul s o he examina ion. Did he doc o s' wo k gi e esul s? How we e he heal h . condi ions a F eia? In spi e o he indus ial medical o ice and o he wel a e measu es he sickness a e a F eia was e y high. In es iga ions o abscence and su eys on diseases go high p io i y. S 0m plannecl a su ey on he sickness a e when he s a ed his wo k in 1938. Because c) he wa i was impossible o b ing i abou in he way he had wan ed. Howe e , he egis ed he abscence and he p esen ed he esul s in he pe iodical Sosial A beid (Social Wo k) ,in 1949. Few yea s la e he imade a new su ey which he p esen ed in he same pe iodical in 195'7. A ha ime abscence in indus y had become a se ious social and economical p oblem. 1 The abscence a F eia inc eased d ama icaly be ween 1940 and 194'7. E e y yea he sickness a e was highe o women han o men. In a e age (21) In e~ew Haakon Nabig 27.2.1991. See also NA'I'VIG; THIISEVENSEN (19831984), op.ci . (n. l), p. 78 and NATVIG, Haakon (197:!). Den no ske ~ed i slegeo iningen - i o id og em id (The Non epan Occupa ional He al h Se oice - he Pas and he Fu u e), Oslo, p. 5. 170 EIILDE IBSEN As we ha e seen, he sickness a e a F eia inc eased a e he second wo ld wa . A ha ime he e had been a medical o ice a he ac o y o nea ly hi y yea s. Based on his own expe iences S 0m could no ind a good answe , and in gene al i was oo ea ly o s udy he connec ion be ween he occupa ional heal h se ice and he sickness a e. The a angemen had, howe e , c ea ed an unde s anding o a heal hy way o Xi e (33). In he i ies and six ies he clinical pic u e changed. Ch onic diseases like ca dio ascula diseases, malignan umo s and myalgies domina ed. Men al diseases and di icul ies o adjus men also inc eased (34). The demand o a heal hy wo k en i onmen was s eng hend. The en i onmen had o be s imula ing and pleasan . Did he indus ial medical o ice s adjus o his de elopmen ? A s udy o F eia and CPC shows ha he medical' o ice and he managemen ied o ollow he social de elopmen . When he claim o s imulan and well-being inc eased, S em and Engeb ig sen co-ope a ed wi h he managemen , o exemple, in ying o p omo e ehabili a ion wi hin he ac o y. CONCLUSION In my analysis o he occupa ional heal h se ice 1 ha e ocused on he mo i es behind he a angemen , how i was o ganized andl in wha way indus y in luenced Non egian heal h policy. My case s udy has shown ha he occupa ional heal h se ice - like o he indus ial wel a e measu es - has many-sided explana~ ions (35). In he i s place i was a pa o he wel a e capi alis mo emen which also ook place in o he wes e n eu opean coun ies and he USA. The wel a e philosophy which de eloped a F eia was o iginally ideological and isiona y. Th one Hols was adical in his you h, bu wen conse a i e a e some (33) Zbidem. (34) STR0M (1975), op. ci . (n. 3), p. 154. (35) Some iewpoin s a e ha occupa ional wel a e de eloped as a new s a egy in he anci ion om pa e nalis o co po a e managemen , ha occupa ional wel a e was a pa o e hical o philan opic managemen and a weapon agains ade unions. C : no e 2. No wegian Indus y and Heal h P omo ion 1910- 1967 171 yea s as F eias' manage . Bu he was s ill ideological and as a s uggle agains socialism he wan ed o build a socie y wi hou a p ole a ia . In ha wo ld, howe e , he wo king class cul u e was los . An impo an elemen in he wel a e capi alis ideology was p o i . I: should no only en ich he ac o y owne , bu be used as a means o se e he na ion. Heal hy and s ong wo ke s we e p oduc i e and necessa y o he compe i i e powe . In he second place he occupa ional heíil h se ice was a pa o he s a egy o inc ease p oduc ion and o ise he popula wel a e. Wo ke s who el sa e and well-being we e e ec i e and! loyal. A g ea many ac o ies build up occupa ional wel a e measu es a e he Second Wo ld Wa - ,CPC is jus one exemple. Du ing he i ies and six ies he occupa ional heal h se ice became he mos common wel a e measu e in addi ion o pension sys ems. In he way he occupa ional heal h sys em was p ac ised we can ollow he p inciples om 1917 up o hese days. The a angmen has ocused on collec i e and indi idual hygiene and p e en i e medical wo k. Bu a subjec o deba e among medical o ice s has always been we he he occupa ional heal h con ol has been no hing else han ~nnea inspec ion». I is di icul o make a comp ehensi e e alua ion o indus y as heal h p omo e . Bu he analysis o F eia and CPC shows ha he occupa ional heal h se ice was impo an in he de elopmen o indus ial hygiene. The a angemen o ced be e sani a y condi ions, well-being and secu i y. I is, howe e , mo e di icul o asses he ex en o which he occupa ional heal h se ice has educed illness. Bu he indus ial medical o ice has p obably con ibu ed o educe occupa ional cliseases and inju ies. Se ious diseases ha e been disco e ed ea ly. The wo ke s ha e go ee egula y heal h con ol and oppo uni ies o ask o ad ice. Wi h he occupa ional heal h se ice, indus y ook an ini ia i e which has bene i ed mos wo king people. Axel S om claimed in 1975 ha he occupa ional heal h se ie would ne e ha e de eloped i indus y had no lead he way (36). Nei he he Public Heal h Adininis a ion no he Medical O ice s Associa ion showed in e es in he li angemen . The pos -wa Heal h Minis e , Ka l E ang, ne e ga e he indus ial medical o ice s any s a us. Thiis-E ensen claimed ha he e en p e en ed an adequa e de elopmen (36) STR0M (1975), op. ci . (n. 3), p. 157. 172 !HILDE IBSEN o he occupa ionai heal h se ice (37). He, like he Medicai O ice s Associa ion, migh ha e ea ed compe i ion in ela ion o he gene al p acei ione s aod hei economic basis. When he Repo om Pa liamen on he P ima y Heal h Se ice was p esen ed in 1971 he occupa ional heal li se ice was sca cely men ioned. Bu he Boa d o Indus ial Medical O ice s ook ac ion and he a angemen was gi en mo e a en ion. The T ades Union has, howe e , been posi i e. In he se en ies i wan ed he a angemen o expand. The Employe s' Fede a ion also ag eed on he impo an e o he occupa ional heal h se ice. When Thiis-E ensen w o e his a icle in 1975 he hoped ha he Medical O ice s Associa ion would gi e mo e a en ion o he a angemen in he u u e. He was su e he occupa ional heal h se ice would con inue o expand, and he hoped ha he public heal h would ake o e he adminis a ion when he au ho i hies we e eady. I would, howe e , no happen in he nea u u e (38). In he lmean ime doc o s wi h pa icula social in e es had an impo an ask: o p omo e p e en i e medicine oge he wi h he indus y. - (37) THIIS-EVENSEN, Ey ind (1975). The Iildus ial Medical O ice -- an Ou side in No wegian Public Heal h?, On: La sen (ed.), @. ci . (n. 3) p. 159. (38) Ibidem, p. 163.