Fifth Annual Meeting of the Baltic Sea Network on Occupational Health and Safety

18–19 November 1999

Berlin, Germany

1. The Fifth Annual Meeting of the Baltic Sea Network on Occupational Health and Safety was opened by Dr. Fritz Kochan, Director of the Federal Institute of Occupational Safety and Health in Berlin. In welcoming the participants to the Meeting, he emphasized the need for continuous collaboration, in the rapidly changing environment in particular, and pointed out the importance of the four topics of the present Meeting in expanding the data and knowledge base of the participating countries and institutions.

The official welcome address was given by Mr. Andreas Horst, Director, Ministry of Labour. He wished all the participants welcome, and also welcomed the collaboration among the countries of the Baltic Sea. He stressed the importance of monitoring the economic effects of occupational health and safety.

Dr. Boguslaw Baranski welcomed the participants on behalf of the World Health Organization (WHO) and expressed the gratitude of the WHO Regional Office for Europe, to the Ministry of Labour, Germany and the Federal Institute for Occupational Safety and Health in Berlin, for assuming the responsibility to organize the Meeting. He also expressed the gratitude of WHO to the Finnish Institute of Occupational Health for support and co-operation in the practical arrangements of the Baltic Sea Network on Occupational Health and Safety. He mentioned that this Network is important from the point of view of the WHO, as it has facilitated the implementation of the WHO Strategies, improved the information and knowledge about occupational health and safety in the participating countries, and provided a forum for discussing the harmonization of various occupational health and safety indicators.

2. Professor Jorma Rantanen, Finland, was elected Chair, Professor Fritz Kochan, Germany, Co-Chair, and Ms. Suvi Lehtinen, Finland, Rapporteur of the annual follow-up meeting. The Programme of the meeting is attached as Annex 1 and the list of participants as Annex 2 to this Summary Report. On behalf of the Network, Professor Rantanen expressed his warmest thanks to the German Ministry of Labour and the Federal Institute for hosting the Meeting.

Scope and purpose of the Meeting

3. The Fifth Annual Meeting of the Baltic Sea Network on Occupational Health and Safety aimed at monitoring the present stage of development of the Network and at drawing a plan for the further development of the organization and substantive activities of the Network, and at reaching an agreement on the future activities of the Network.

                    The main themes of the Fifth Meeting were:

It is of utmost importance to work together with all the relevant International Organizations, with the ILO and EU in particular, and their programmes in order to ensure the maximum utilization of the existing information, and to avoid the duplication of work.

The national economic, social and legislative framework and policies in each Member State have a dominant impact on the occupational and environmental health practices in most enterprises. In many WHO Member Countries, there is a trend towards reorienting occupational health and safety practices to help reduce the increasing economic and social costs of work-related and non-work-related ill-health and work disability.

The implementation of the WHO Global Strategy on Occupational Health for All, developed by the Collaborating Centres in Occupational Health and endorsed by the 49th World Health Assembly (Resolution WHA49.12) requires innovative approaches and the active participation of the enterprises and other workplaces. The concept of Good Practice in Health, Environment and Safety Management in Enterprises (GP HESME) provides such an opportunity.

There is a need for institutions participating in the network to conduct periodic evaluations of the programme development, methods used to plan future collaboration, including revision of the scope, methods, and the annual as well as long-term programme of collaboration.

Thus, the objectives of the Meeting, as defined by the scope and purpose document, were to:

a) review the role and methodology for economic appraisal in promoting occupational health and safety in the participating countries

b) exchange opinions on methods used to initiate and monitor GPHESM in enterprises

c) evaluate the progress of the Baltic Sea Telematic Network on Occupational Health and Safety.

4. A number of important actions have been taken by the WHO/EURO to develop the countries' abilities to collect and distribute relevant information on occupational health and safety. In November 1995, a WHO Consultation proposed the establishment of a Telematic Information Network on Occupational Health and Safety for the Institutions in the Countries around the Baltic Sea. The Network has now been established, and all the 10 countries have expressed their interest to join, and all have opened their pages in the Network. Three follow-up meetings of the Network have been organized, the first one in Riga in October 1996, the second in Vilnius in September 1997, and the third in Sagadi, Estonia in October 1998. The follow-up meetings have discussed the substantive contents of the information which could be used through the Network. The Riga meeting discussed Occupational Health and Safety Assessment and Future Developments of the Network, the Vilnius Meeting had on its agenda Notification and Registration of Occupational Diseases and Accidents, and Workplace Risk Assessment, and the Estonian meeting focused entirely on the development of the telematic network, both technically and substantively.

5. The main priorities of activities of the European Agency for Safety and Health at Work were outlined by Mr. Finn Sheye. He described the activities of the Bilbao Agency in building the information network and establishing links between the EU Member States and later on also the candidate countries and also other relevant, already existing networks. In addition to building the network, the Agency also has another task: to organize information services to the Member Countries and to communicate the information in electronic form to all those who need it.

He also described various information projects going on in the Agency. The Occupational Safety and Health Monitoring was mentioned as one form of information collaboration in the European Union. Other forms of practical collaboration were the good safety and health practices; also research projects on work and health are surveyed, and there are four topic centres for compiling the information available and dispatching it through the electronic networks. Also, various systems and programmes in occupational safety and health are described and utilized within the Bilbao Agency collaboration.

6. The programme of work for 1999–2001 of the WHO Regional Office for Europe was introduced by Dr. Boguslaw Baranski. The following progress report of the WHO/EURO comprehensive occupational health programme in 1998–1999 was presented.

A series of meetings held in Belgium, France, the Netherlands, Poland, Ukraine, and the United Kingdom was organized (January 1998–May 1999) to formulate a holistic concept of good practice (GP) in health, environment and safety management in enterprises (HESME). It was prepared jointly with governmental and non-governmental experts, and experts from enterprises and academia. The Declaration of Ministers of Health and Ministers of the Environment, as adopted at the Third Ministerial Conference on Environment and Health held in June 1999 in London, emphasizes:

"We will promote good practice in health, environment and safety management in enterprises, in collaboration with stakeholders in our countries such as local authorities, enforcement agencies, business (including small and medium-sized enterprises), trade unions, NGOs, social and private insurance institutions, educational and research institutions, auditing bodies, and providers of prevention services. The current regulatory frameworks and economic appraisal related to health and safety should be, if necessary, strengthened for this purpose and self-regulatory mechanisms (voluntary initiatives and agreements) should be used as complementary measures. We invite WHO and the International Labour Organisation to work together to assist countries in developing processes, involving all stakeholders, for the implementation of environmental practice which also promotes public health, and to develop close co-operation with the European Commission to assist the candidate countries for membership of the European Union to meet their obligations".

The follow-up programme on the implementation of good practice in HESME has been prepared and will be supervised by the European Environment and Health Committee.

The first national meeting with international input was held on 15–17 September 1999 in Ankara to strengthen activities encouraging good practice in HESME in Turkey. The concept of GP HESME has been presented at several national and international meetings of occupational health professionals.

Several activities aimed at the inclusion of workplace health promotion in the comprehensive occupational health programmes. The representatives of CEE countries were invited to the European Conference "Healthy Employees in Healthy Organizations – Workplace Health Promotion in Europe", held in Bonn on 31 May–1 June 1999. The Conference was co-organised by BKK Essen within the European Commission programme on Public health, with a special WHO/EURO session on the "Future of Occupational Health in Europe". At the invitation of the Tacis Russia Preventive Health Care Project 1998–2001 and the Federal Ministry of Health and Medical Industry in Russia, technical support was provided to establish model workplace health promotion programmes in Elektrostal City in the Russian Federation.

The Baltic Sea Telematic Network on Occupational Health and Safety has been further strengthened, and it provides mechanisms for sharing information, capacity building and harmonization of HES management in enterprises. The Fourth Annual Meeting was held in Sagadi, Estonia, 1–3 October 1998, and the Fifth meeting in Berlin, Germany, 18–19 November 1999.

Guidelines on "Quality Assurance in the Management of Multidisciplinary Occupational Health Services" have been prepared and edited for publication by WHO/EURO. The documents "Occupational medicine in Europe: scope and competencies" as well as "Role of the occupational health nurse in workplace health management " have been prepared through broad consultations with respective professionals, and are now in the final stage of editing. A manual for the education of employers and employees on the concept and implementation of GP in HESME is being prepared.

In collaboration with the Research and Development Centre, Social Insurance Institution, Turku, Finland the network of social and health insurance institutions involved in the strengthening of comprehensive occupational health has been initiated at the meeting in Bilthoven, the Netherlands, on 21–22 October 1999.

Technical support was provided to the development of the new WHO/HQ occupational health programme and the WHO Global Network of Collaborating Centres in Occupational Health.

7. The new ILO Programme on SafeWork was presented by Mr. Pavan Baichoo. He emphasized the need for urgent measures in global work life, because still every year, more than 1.2 million people die of work-related accidents and diseases, and more than 160 million workers fall ill each year due to workplace hazards. Furthermore, the poorest, least protected – often women, children and migrants – are also among the most affected. He also pointed out that micro- and small enterprises account for over 90 per cent of enterprises; the conditions in these are often very poor and the workers are often excluded from all labour protection.

The ILO sees occupational safety and health as a basic human right, and therefore actions need to be taken to ensure that this basic right is respected in all countries and in all workplaces. The ILO Conventions and Recommendations provide the basic minimum standards for working conditions and occupational safety and health in the globalizing world of work. The goals of the ILO SafeWork Programme focus on protecting workers in hazardous occupations, on expanding protection especially to vulnerable groups of workers, on the promotion of workers' health and well-being, and on demonstrating the social and economic impact of improving workers' well-being, showing that protection pays. Several new approaches are being developed in addition to the more traditional ones to be used in the implementation of the Programme worldwide.

8. Four presentations were given on the topic of Economic appraisal and incentives in occupational health and safety, namely by Mr. Jos Mossink, The Netherlands, Mr. Jan Rzepecki, Poland, Dr. Axel Wannag, Norway, and Dr. Karsten Stegemann, Germany. In addition, brief statements were heard from Ms. Tatjana Zabarowska, Latvia, Dr. Mikhail Mikheev, Russia, Dr. Remigius Jankauskas, Lithuania, and Dr. Matti Lamberg, Finland.

9. Economic appraisal

Economic appraisal (EA) was found to be an important new approach in the evaluation of occupational health and safety and in providing arguments for the development of occupational health and safety systems. EA can also be used as a tool for benchmarking of the performance of various programmes. It was found essential to improve the data and information systems needed for the economic appraisal. The data needed are very versatile (see Working Group reports) and originate from numerous sources. The correct compilation, analysis and interpretation of such data necessitates collaboration with the owners of the data sources.

Numerous pitfalls and problems are inherent in the use of data in economic appraisal. The choice of parameters and the analytical model chosen may have a substantial impact on the ultimate result of the analysis. The quality of data used also has a major impact (e.g. the degree of coverage of the registration system). Therefore, the data should always be interpreted by experts who govern the methodology and who are aware of the pitfalls, problems and deficiencies of the data and methodology, but who also understand the aspects of occupational health and safety. There are also substantial ethical aspects associated in the economic appraisal, particularly in setting the monetary value for human health, well-being and life.

Without prejudicing the value of economic appraisal as one tool for the evaluation of occupational health and safety activities, it should be emphasized that the ultimate justification of occupational health and safety is drawn from the need to protect the health and safety of people at work. Thus, occupational health and safety activities need to be prioritized and implemented even when the outcome of the economic appraisal is not favourable. If the occupational health and safety activities, in addition to their health impact, also show a positive economic impact – as in many cases they have – it should not be considered as a precondition, but as a further stimulus for the development of occupational health and safety.

10. Incentives

A number of economic incentive systems were described and analysed in the Meeting. Both the positive and negative incentives were discussed. The incentives can be roughly divided into normative (legislative), economic, or informative.

The normative incentives function mainly on the steering and obligation side, enabling the right to operate the activity if the standards are complied with, and bringing punitive action in case of non-compliance. Modern global competition brings new aspects to the incentives, for example, the possibility of getting unjustified competition benefit through non-compliance, and by damage to the enterprise image through poor and illegal performance. It was concluded that nobody should receive economic benefit from non-compliance to standards and from compromising the health and safety of workers. It is the duty of government authorities to ensure stringent enough enforcement of the legislation.

The economic incentives can be made available through several mechanisms, through accident insurance premiums, subsidies for specific activities, reimbursement of the costs of activity if standrads are complied with, special services systems or subsidized training. Such incentives are needed particularly for the development of occupational health and safety in small-scale enterprises, among the self-employed, and for specially vulnerable groups.

When economic appraisal show a positive economic impact of occupational health and safety, it functions as an economic incentive with highest relevance to the company in concern. The optimal economic incentive system was described and found to contain several elements, e.g. it demonstrates the external incentive effect, it is based on the participation of workers, it is associated with the improvement of working conditions, it is economical and feasible, and brings short-term benefits.

Information incentives comprise positive public (psychological) feedback by rewarding exceptionally good performance in occupational health and safety. The most typical forms of such incentives are public awards, recognition or labels which support building of a positive image for the operator, and bring to light good examples in occupational health and safety.

11. When concluding the Session on Economic appraisal and incentives in occupational health and safety, Prof. Jorma Rantanen mentioned the need for emphasizing the role of the government in finding an acceptable balance between the economic gains of risk-taking and risk-creating behaviour in the society, and the losses of the victims of risks and accidents. He also referred to the research results showing that productivity can be better increased through investments in training of the personnel rather than by increasing capital investments or work time in the enterprise. This demonstrates the growing importance of human resources in modern economics and emphasizes the importance of occupational health and safety.

12. Three Working Groups discussed three questions concerning the economic appraisal in occupational health and safety. The reports of the Working Groups are attached as Annex 3 to this Summary Report.

It was concluded that there is a need to include some additional information in the country profiles on the Baltic Sea Network webpages covering also aspects of economic appraisal of occupational health and safety activities in the countries. It was also concluded that the coordinator meetings of the Baltic Sea Telematic Network will advance this issue further on their next meeting agenda.

13. Several presentations were made in the Session on Good practice in health, environment and safety management in enterprises, by Dr. Boguslaw Baranski, Dr. Brigitte Froneberg, Dr. Arve Lie, Ms. Riitta Viinanen, Dr. Gregor Breuckner (presented by Dr. Baranski), Dr. Jacek Michalak, and Dr. Mikhail Mikheev.

Dr Boguslaw Baranski presented the concept of GP in HESME as prepared for the Third Ministerial Conference on Environment and Health, held in June 1999 in London. Good practice in HESME has been defined as a process aiming at continuous improvement of enterprise performance in health, environment and safety management involving all stakeholders inside and outside enterprises. It is mainly an initiative for the SMEs, since large companies have already implemented this idea. He emphasized that HESME can only be implemented if existing occupational health services will support the implementation of this holistic approach, and if enterprises will adopt one comprehensive workplace health policy covering occupational, environmental, social and life-style health determinants. HESME aims at the maintenance of the health and work ability of employees through their active participation in the prevention of occupational, work-related and non-occupational, but workplace preventable, diseases. Thus, through the involvement of employers and employees supported by occupational health infrastructure, HESME has great potential to achieve most of the targets specified in the WHO HFA21 public health strategy. It aspires to turn enterprises into a major setting for achieving the main aims of HFA21:

•                     To promote and protect people’s health throughout their lives
•                     To reduce the incidence of the main diseases and injuries and alleviate the suffering caused by these diseases and injuries through activities undertaken by working communities and their partners.

The HESME programme, calling for the holistic enterprise health policy, will contribute to achieving the European Community objectives indicated in the following articles of the Amsterdam Treaty:

Article 137: Improvement of the work environment to protect workers’ health and safety

Article 152: Improvement of public health, preventing human illness and diseases, and obviating sources of danger to human health

Article 174: Preserving, protecting and improving the quality of the environment; and

Article 153: Protecting the health, safety and economic interests of consumers

By promoting the maintenance of the work ability of employees, HESME will have an impact on the improvement of their professional skills and their ability to cope with ever-changing demands of the work life and living in general. It will increase employability of employees in case they have to change their present jobs.

Dr. Baranski then presented the main steps in developing a national HESME programme:

1. Nominate the national Task Force responsible for the preparation of a national policy encouraging good practice in HESME, and for identifying country funds for the programme. The Task Force should be composed of representatives of the concerned governmental agencies (Ministries of Health, Labour and Environment) and representatives of the employers' and employees’ organizations and other stakeholders.

2. Organize national workshops to review and assess the effectiveness of national and local intersectoral policies, make economic appraisal, estimate a burden of occupational and workplace preventable ill-health, and to initiate national action encouraging enterprises to implement good practice in HESME.

3. Develop criteria and indicators of good performance in HESME at the national, local and enterprise levels, carry out surveys and performance reviews.

4. Develop economic incentives for good practice in HESME motivating for future action, more than being based solely on past experience and a past safety rating system.

5. Prepare educational and training materials for employers and employees and for health, environment and safety professionals, to facilitate their involvement in good practice in HESME.

6. Initiate pilot projects and collect and disseminate examples of good practice in HESME.

7. Involve businesses in their community’s environment and health policy development, including encouraging networks between enterprises committed to improving their performance in HES.

8. Prepare a national report on the progress of HESME performance for the preparation of the European report for the Fourth Ministerial Conference on Environment and Health, scheduled to be held in Budapest in 2004.

WHO intends to launch jointly with ILO, UNEP, Industry and Environment and with the European Commission, an international programme with the following objectives:

• to support national action undertaken in countries to improve health, environment and safety management in enterprises
• to initiate and support the voluntary movement of enterprises and local communities to improve health and work ability and to increase their self-regulatory contribution towards sustainable development
• to support national action undertaken in countries to improve economic incentives for good practice.

Additional aspects that were pointed out in the other prresentations were that HESME, in order to be comprehensive, should be composed of four complementary approaches, namely occupational health and safety, workplace health promotion, environmental management, and social capital and community development. HESME will be driven by current regulatory frameworks, economical appraisal, and voluntary initiatives and agreements related to health and safety.

Also, it was concluded that as the resources of occupational safety and health are scarce, efficient and economic procedures in all actions will be sought. Networking and benchmarking were deemed as such tools, because they are relatively easy to implement at the enterprise level, they have little inbuilt bureaucracy, they are economically feasible, and they bring along positive examples (and perhaps also negative ones from which one can learn). Networking and benchmarking are valuable practical tools in good practice in health, environment and safety management in enterprises.

14. The reports of the three Working Groups on good practice in health, environment and safety management are attached as Annex 4 to this Report.

15. The Session on the Telematic Information Network did a situation analysis of the participating countries and described future perspectives for the Network development. Ms. Suvi Lehtinen gave a brief overview of the present situation, and each country described its own situation and perspectives for the development of the Network pages. It was concluded that the progress in developing the Telematic network has been positive, and the countries have perceived the Network activities as worthwhile. The idea of organizing the coordinator meetings twice a year was deemed useful, both from the point of view of the exchange of actual and topical information, but also for planning the contents of the pages on a more concrete level.

Conclusions and recommendations

1. It was concluded that the WHO/EURO HFA 21 objective on the protection and promotion of health in all stages of human life cannot be achieved without the development of occupational health. Joint efforts should be made to support the idea of giving occupational health a higher priority and a more concise content on the agenda of the WHO HFA21. This can best be achieved through the comprehensive occupational health service approach.

2. Definite progress was recorded in the programmes of the ILO after launching of the Global SafeWork Programme which focuses efforts to increase awareness globally, places emphasis on high-risk and vulnerable groups, and adopts an integrated approach and utilizes the economic appraisal to show that protection pays. The countries should utilize the projects and results of this ILO Programme.

3. The EU Amsterdam Treaty Article 137 emphasizes the protection of the health of working people through the improvement of the work environment. In addition, the new President of the European Commission has declared before the European Parliament that the policy of the new Commission will be strict in the implementation of the basic European legislation on health and safety, particularly in the case of severe hazards at work. This implies a high priority for health and safety in the European Union policy.

4. Better information on the current status and trends of occupational health and safety in all Member States is needed. All international organizations put a lot of effort in compiling various statistical and other data from the countries. The quality and comparability of the data needs, however, further development. Efforts should be directed at providing the country-information with such reference and background data that the user of the information will be sufficiently informed in order to make comparisons on a relevant basis.

5. The Baltic Sea Network in its present form, and with the planned developments, provides an excellent instrument for transmitting data on occupational health and safety in a flexible manner. In addition to firmly codified information it also provides a forum for the transmission of the most recent research findings, case reports, and news in the advancement of occupational health and safety for expert communities and practitioners.

6. The added value of the Baltic Sea Network can be further increased by the development of the user networks within the countries and by linking with other relevant networks and data systems in the Region and worldwide. The key actors in the Baltic Sea Network are the occupational health and safety experts in research institutions, practical services and government and other bodies throughout the Region. The key providers of the information are the institutions and professionals active in research, training and information on occupational health and safety. Thus no overlapping, but rather, high synergy with the administrative information provided by the Bilbao Agency of the EU was evident.

7. The importance of economic appraisal in occupational health and safety was agreed upon. It was, however, deemed necessary to choose the parameters and indicators for analysis with great caution. Due to the insufficiency of the present economic theories in the quantification of the value of social and health aspects of work, the development of new economic theories with more versatile parameters and higher sensitivity to the social dimension was called for.

8. Since well functioning and fully covering national data systems are the key issue for the economic appraisal, more efforts should be taken to develop such systems. It was also concluded that the data systems on safety and health at work, on health of the working people, on social and economic consequences of occupational accidents, diseases and work incapacity, as well as for the economic appraisal of occupational health and safety activities need to be established in all countries. A prerequisite for this is a proper information collection system. The harmonization of such systems should be strengthened in order to ensure the comparability of data.

9. Guidelines for good occupational health practices have been produced and implemented in some Member Countries, and instruments for the evaluation and auditing of the performance under such guidance have been developed. Further development of auditing and evaluation systems and the expansion of audit matrices to cover the most relevant aspects and prerequisites for the implementation of the good occupational health practice is encouraged. Simpler and feasible guidelines should also be produced for use in the assessment of occupational health services for small-scale enterprises and for the self-employed.

10. Occupational health and safety management systems have been developed by the ILO and some individual countries. The Declaration of the WHO European Ministerial Conference on Health and Environment, held in London in June 1999, adopted a statement on Good Practice in Health, Environment and Safety Management in Enterprises. Practical ways to implement such systems at the national and company level are being developed with the parallel generation of appropriate indicator and validation systems. Practices feasible in different conditions and different environments such as companies of different sizes and various sectors of economy (industry, services, public sector) are sought.

GPHESM (Good Practice in Health, Environment and Safety Management) in industrial and other enterprises is a multidisciplinary approach to promoting health and safety at work and minimizing the harmful effects of the workplace on the environment. GPHESM also deals with the impact of the workplace on the health of the neighbourhood, on the health effects and environmental impact of its products, and on preservation of the general environment. The integration of HESM functions into the overall management system of an enterprise should result in the effective and efficient promotion of GPHESM. It is the outcome of national and individual enterprise policies in the areas of health protection, promotion and surveillance at work, promotion of a good working culture, and of a work organization conducive to safety and health, and provision of a healthy and safe work and ambient environments.

11. The Meeting discussed the new developments in health promotion in relation to occupational health and safety. It was emphasized that the basic needs and obligations in occupational health and safety should be taken care of as a first priority, while health promotion can be carried out parallel with these basic occupational health and safety activities. Health promotion should, however, never be a substitute for basic occupational health and safety activities. The trend for a comprehensive content and growing collaboration between occupational health services and health promotion was welcomed and encouraged, aiming ultimately at the comprehensive development-oriented occupational health services covering all the relevant aspects, prevention, promotion and development of a healthy company and a healthy workplace. Intersectorial collaboration between the responsible Ministries is also needed.

12. When focusing on the prevention of hazards in high-risk groups and branches of industry, it should be borne in mind that there are some high-risk occupations and activities which are not easily visible because of the latency of adverse health outcomes, such as occupational cancer and other chronic outcomes. Methods should be developed to weigh the priority targets in a balanced and effective way from the point of view of the total health of the working populations. Methods should also be developed to recognize the work-related but invisible or hidden health outcomes, such as stress-related somatic disorders, and mental health problems related to work.

13. The changing work life needs different competencies and expertise in occupational health and safety so that the new risks can be identified and recognized, and new problems, such as stress-related disorders and work ability problems of aging workers, can be tackled. This is a challenge for the training institutions and programmes targeted at occupational health and safety experts. Training a multidisciplinary team with up-to-date competence requires collaboration between various types of training institutions and disciplines. Efforts towards the harmonization of training curricula and the assurance of the competence of experts were encouraged.

14. There is a need for the involvement of both employers and employees in order to increase the awareness of the new developments and new risks in the changing work environments. The participatory approach should be used to help employers and employees set health and safety targets in their enterprises and discuss them in collaboration with the occupational health service personnel. These target groups, together with those experts who prefer self-studying, will have growing opportunities to utilize the self-learning services of telematic information networks, such as the Baltic Sea Network.

In addition to the training at the workplace level, special elements should be added also to vocational training in order to ensure and improve the work ability of the future workers.

15. The Baltic Sea Network can provide substantial support in strengthening collaboration between the training institutions and in providing substantive information to support the content of the training programmes. The telematic network can also be utilized to inform about the available training events.

16. The Baltic Sea Network, established over four years ago, was one of the first of its kind in Europe. The Network has developed positively covering the ten countries around the Baltic Sea and cumulating continuously relevant and up-to-date information from the member institutions. Such information – being both general and highly specific in character – is actively transmitted and used by the expert communities around the Baltic Sea, and it provides growing support for action at the national level in their everyday practices. Being principally professional and scientific by nature, the mission of the Baltic Sea Network does not overlap with other networks, such as that of the Bilbao Agency, but rather complements and supports it.

17. The practice of using the Annual Meetings of the network, organized by the WHO and the Member Countries, for the follow-up of the recent developments and for long-term strategic planning of the Network activities was deemed useful, while the technical aspects of the implementation are dealt with in the Coordinator Meetings arranged by the Finnish Institute of Occupational Health, organized twice a year.

18. The implementation of the recommendations of the Sagadi Annual Meeting in 1998 for the years 1999–2000 is well on the way. In addition, the two Coordinator Meetings (March 1999 and September 1999) have presented proposals for further development of the Network activities. The Meeting found them all appropriate and endorsed the proposals.

Special attention was paid to the following issues:

• projects carried out at the country level for the development of occupational health and safety data systems and development of registers on health and safety outcomes (in order to know what is going on and who is doing what)
• survey on the needs and feasibility of occupational health and safety information systems
• further development of the contents of the web-pages in order to meet the users' growing needs of substantive information
• support through information and telematic services to the training and education programmes and information on forthcoming and available training opportunities
• expansion of the network within the countries for users in research institutions, government bodies, expert communities, academia, practices, and NGOs.

The Meeting recognized with great satisfaction that the Baltic Sea Network had been linked operationally with a high number of relevant networks, such as the European Network on Safety and Health at Work (Bilbao Agency), ILO, WHO, and others. The Meeting encouraged to continue such linking of the Baltic Sea Network, where appropriate, with other relevant networks in the field of public health, environmental health, occupational health and safety, etc.

The members of the Network were encouraged to apply for funds from the EU TACIS and PHARE or other respective programmes for establishing the national networks. This would be reasonable as the Network strongly facilitates the pre-accession and transition processes going on in Central and Eastern European countries.

19. The Meeting expressed its gratitude to the National Institute for Working Life, Sweden, which had invited the Sixth Annual Meeting in 2000 to be organized in Sweden. A topic proposed for the Stockholm meeting agenda was training in occupational health and safety. The Norwegian participants were asked to consider the possibility of arranging the Annual Meeting in 2001 in Norway.

20. It was agreed that the presentations of the Fifth Meeting will be published by the Federal Institute for Occupational Safety and Health, Berlin; they will also be published on the Internet. It was agreed that the papers be submitted to the Berlin Institute by 15 December 1999.

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