Ninth Annual Meeting of the Baltic Sea Network on Occupational Health and Safety
24–25 April 2003
St. Petersburg, Russia

Summary Report

Opening of the Meeting

Professor Tatjana Trofimova, Vice-Rector of the St. Petersburg Medical Academy of Postgraduate studies opened the meeting and wished the participants welcome to St. Petersburg, which is celebrating its 300-year Anniversary. She expressed her pleasure of seeing representatives from different countries around the Baltic Sea gathering together to discuss in open and confidential atmosphere. The Medical Academy and especially the Department of Occupational Health with Director Nikolay Shlyakhetski were very pleased to take part in this important meeting and in the Baltic Sea Network activity. Dr. Ivan Ivanov, WHO European Office, brought his regards to the Meeting. He informed the audience that WHO/EURO is keen to keep occupational health (OH) on the agenda of the office, and that his task is to coordinate the work of the WHO Collaborating Centres in OH in Europe and make OH better visible. Dr. Brigitte Froneberg, ILO, expressed her pleasure of attending the meeting and wished good success to it.

The participants were introduced. The agenda of the Meeting is attached as Annex 1 and the list of participants as Annex 2 to this Summary Report.

Basic Occupational Health

Jorma Rantanen, Finnish Institute of Occupational Health

The concept of Basic OHS was launched in Nancy at the meeting of the WHO Collaborating Centres in OH of Europe. Basic OH refers to a minimum infrastructure for OHS and is not restricting larger OHS programmes, which may exist in a country.

Globally only 15–20% of workers have access to OHS, in the EU the share is about 50%. Commercialisation of the services is a trend, which requires to be analysed. In the EU the coverage of workers by OHS is 100% in big industries but only 10–30% in SMEs and SSEs. Among the farmers the rate is 0–50%. In the world economy the SMEs and SSEs are becoming more and more important.

Exposures to various work environment factors still exist, and a EU study as well as a Finnish study shows that there still is a need for OHS. OH&S problems in Finland can be divided to traditional (occupational accidents 5%, occupational diseases 0.2%, work-related mortality 6.7%, work-related morbidity 10–30% and exposure to unergonomic conditions 30–40%), and new (high pace of work 45%, work stress 36%, chronic lack of sleep 15%, burnout syndrome 7%, inability to regulate the length of the work day 42%, slight possibilities to have an effect on work time 53%, training needed 80%, and learning new things at work 53%). Work-relatedness of some chronic diseases is more common than thought before: asthma 30%, lung cancer 25–30%. Musculoskeletal disorders are getting more and more prevalent.

The working population is healthier than non-working population. This association between employment and health should be paid more attention to. OH is more important for public health than generally understood.

There are several arguments why occupational health should be provided to all:

• Occupational health arguments: 30–75% of workers are exposed to severe health hazards
• Public health reasons: 50–60% of the population belong to workforce
• Socio-economic reasons: still enormous loss of work days and working capacity and high social security costs
• Quality of life: quality and conditions of work are key elements of quality of life of people in any society
• Sustainability: healthy and productive workforce constitutes a key factor for sustainable development and poverty elimination

Basic OH is a special programme element for European WHO CCs in OH. It refers to minimum infrastructure for OHS containing surveillance of work environment, risk assessment, surveillance of health, proposals of preventive and control actions, diagnosis of occupational diseases, provision of first aid, and provision of GP-level health service (where appropriate).

Minimum requirements for basic OHS at the national level are: 1) legislation, 2) competent authority (enforcement), 3) national programme, 4) services infrastructure, 5) human resources (multidisciplinarity), 6) information systems, 7) support and advisory services, 8) training, 9) tripartite collaboration and participation.

The core content of OHS includes several aspects of surveillance and risk assessment, as well as advises on actions for prevention and improvement of workers' health. Good Occupational Health Practice ideas have to be fed to the clients. In making the core OHS activities operational, the leadership of WHO and ILO is very important. A comprehensive OH requires multiprofessional teams. OH is an investment, not only a cost or burden for the society and enterprises; OH is an important production factory.

Actions that could be done by the Baltic Sea Network include:

• Support to the joint ILO/WHO/ICOH and WHO/EURO actions
• Analysing situation in own country and responding to net survey
• Working for the development of OHS infrastructure
• Organizing global campaign events
• Training experts
• Providing good practice guidelines
• Disseminating information
• Carrying out OHS relevant research
• First survey results available in 2005

Summary:

• Work life needs OH&S more than ever
• Full coverage of service infrastructures needs to be organized
• Appropriate content & competence of OHS need to be ensured
• Sufficient number of expert human resources
• New service provision models needed
• Multidiscipl. comprehensive content and approach are inevitable
• OHS have been found productive
• Actions for implementation needed; there are models etc. available

Discussion

Dr. Tor Norseth raised the question how to take actions for improving OHS. Professor Rantanen replied that basically enterprises wish people to be at work and it is not anymore so important for them if the illness causing the absence is work-related or not. Hence, enterprises are interested to eliminate new problems (stress, musculoskeletal disorders etc.). Dr. Axel Wannag stressed the importance of strong political back-up from ILO and WHO. The global and national levels are important since the EU-level is too passive yet. According to Dr. Kari Kurppa, mega studies and wider collaboration is needed instead of fragmented small studies. The marketing of OH and its importance has been failed. More support from the ILO and WHO is needed.

OHS organization in Estonia

Eva Tammaru, Estonian Occupational Health Center

Ms. Tammaru introduced two Twinning projects in the field of occupational health and safety between Estonian Ministry of Social Affairs and the Finnish Institute of Occupational Health. The main results of the first project in 2000–2002 were institutional strengthening of Occupational Health Center (strategy, organizational and staff structure), multidisciplinary training for OHS personnel, increase of awareness and dissemination of information through networks (national OH&S network was established), and preparation of information dissemination strategy.

The second Twinning project "Increase the coverage and effectiveness of occupational health services in Estonia" is currently on approval stage in Brussels. The overall objective of the project is to support in reducing the number of incidences of work-related diseases in Estonia in the long run. This means improving working conditions, ensuring and promoting workers' work ability, improving the efficiency of OH services, and increasing the awareness of employers and employees on OH. The project aims at strengthening the OHS system through expanding the coverage by improving the availability and accessibility of OHS throughout Estonia, improving the development of OHS at policy and administration levels, strengthening the practical implementation of the OHS policy, and training and disseminating good practices. The project supports the implementation of the new "EU Community Strategy for Health and Safety at Work 2002–2006", "National Occupational Health Programme for 2003–2010", "MoSA strategy for OH&S", and preparation of the "Joint Action Plan for OH&S Administration and Public Health Administration for the Years 2003–2005".

The project involves development of sustainable training programme for OH specialists, family physicians, and trainers in OH, and agricultural OH&S. The national Topic Centre on Good Practices will be established. The family doctors' network will be linked to the National OH&S Network and subnetwork on OH&S in agriculture will be established, and the subnetwork on OH&S training institutes will be further developed. Country and community OH&S profiles and indicators will be further developed, information gabs will be identified, and information packages will be made on the basis of the information strategy. Internet will be used for information and training material dissemination. Training curricula on work-related and occupational diseases will be prepared. The project forms a multidisciplinary and integrated approach for developing the OH&S in Estonia.

OHS organization in Lithuania

Remigijus Jankauskas, Occupational Medicine Centre, Institute of Hygiene

Occupational health and safety system in Lithuania is divided between two ministries, Ministry of Health and Ministry of Social Security and Labour. Occupational health services are under the Ministry of Health while the Labour Inspectorate is under the Ministry of Social Security and Labour. There are two models: big enterprises have own in-plant OHS units; SMEs use the services of the state public health centres, which are divided in 10 regions.

The basic legislation concerning OH&S comprises five laws: occupational health care (6/1999), labour codex (7/2002), labour protection (6/2002); public health care (5/2002), and public health monitoring (7/2002). There are several policy documents and action programmes for strengthening of OH&S going on in Lithuania, as well as international projects.

The coverage of OHS among enterprises was 80 % in 1999. The amount of in-plant OHS is decreasing (1977: 795; 1999: 443). The percentage of workers under obligatory medical examinations is around 90%. The enterprises are not very active in conducting risk assessments; in 1999, 48 % of the enterprises were making risk assessments. A policy document concerning risk assessment is under preparation. The amount of OH personnel in Lithuania is decreasing; in 1999 there were 34 occupational physicians in Lithuania (compared to 885 in Finland, 33 in Estonia, and 179 in Latvia).

OHS organization in Norway

Axel Wannag, Directorate of Labour Inspection

The Work Environment Act was issued in Norway in 1977. There are 22 high-risk branches, in which all the enterprises are obliged to engage OHS. Individual enterprises in other branches must also engage OHS if the Labour Inspectorate deems it necessary. Other enterprises are encouraged to engage OHS voluntarily. According to the law the function of the OHS is to assist the enterprises in securing and improving work environment. The OHS helps the enterprise so that the enterprise can fulfil its obligation to create a safe and ideally healthy work environment for the employees. The OHS personnel are in the role of advisers and the sole responsibility for the work conditions rests with the employer and the enterprise. The enterprise also decides in which form it uses the OHS. As a result, a multitude of OHS set-ups and a very heterogeneous situation exists in Norway.

There is no public quality control (or standards) of the personnel delivering OHS. Therefore the quality of OHS varies a lot. Among the enterprises with legal obligation to engage OHS, 84% of enterprises of more than 50 employees has engaged OHS; in smaller enterprises the proportion is less.

The OHS are in an "open market situation", in which, in order to survive in the market, they shall not too strongly promote their preventive services, if the enterprise shows only little interest toward such services.

The OHS is not directly legally regulated, thus, no governmental agency can influence the OHS directly or control its operations. For example, the Directorate of Labour Inspection collaborates only with the enterprise, not directly with the OHS. The governmental aid to OHS comprises a basic course in OH, open to all professionals, and a secretariat of two persons at the National Institute of Occupational Health. The secretariat has built up a registry of the OHS, keeps Internet pages, promotes networking in the field, and has published a Norwegian handbook of good OHS practices.

In the year 1999 there were around 770 OHS units and they covered around 1 143 500 employees (about 50% of Norwegian workforce).

In addition to local level of OHS, described above, there is also the other level of OHS, which comprises 6 occupational clinics (under the Ministry of Social Affairs and Health), and National Institute of Occupational Health (under the Ministry of Municipalities and Labour). Additional support for the system are given by the Statistics Norway, Labour Inspectorate, research institutions and universities.

A national campaign has started to get the drop-outs back to work. Governmental task force has been set up to produce up-to-date background documents, evaluations and recommendations for a new "work life law". The task force comprises several sub-groups, from which one is the sub-group on OHS. The topics of the sub-group is to plan a certification of OHS in order to secure the professional quality of OHS, to evaluate the branches obliged to use OHS, and to evaluate the economical aspects of OHS:

ILO considerations on occupational health services

Brigitte Froneberg, ILO

The ILO was constituted in 1919 for three reasons: humanitarian, political, and economic. It is the oldest United Nations organization and the only one with a tripartite structure. The concept of decent work was created in 1999. The concept refers to promotion and realization of standards and fundamental principles and rights at work, creation of employment, right to decent work for all at equal opportunity, safe working conditions and social protection, strengthening of tripartite and social dialogue, and other cross-cutting activities.

The website of ILO (www.ilo.org) has information on labour protection, conditions of work e.g. maternity protection, SAFEWORK policy documents, and areas of action, resources, standards, etc.

ILO strategies comprise ILO standards (conventions, recommendations, etc.), and a management system approach at enterprise and national level (national OSH programme). ILO instruments are 1) conventions, 2) recommendations, 3) codes of practice, and 4) technical assistance. The instruments related to OHS are:

• Convention C155 "Occupational Safety and Health", Recommendation R164 (1981); ratified in 40 countries
• Convention C161 "Occupational Health Services", Recommendation R171 (1985); ratified in 22 countries
• Code of Practice "Protection of workers' personal data", 1997
• Code of Practice "Technical and ethical guidelines for workers' health surveillance, 1998

ILO standards are minimum level standards. When many countries have higher standards they may not have ratified the minimum standard.

Requirements for Basic Occupational Health include overview/statistics (priorities, need), necessary infrastructure elements (e.g. legislation, competent authority, national programme, etc.), and core contents for OHS. The obstacles for implementing OH include lack of knowledge, fear of costs, shortage of human resources, insufficient infrastructure, fragmentation of work, and separation of health and labour sector. The degree of OH implementation varies among countries, hence a stepwise improvement is advocated, in line with national priorities.

Dr. Froneberg finished her presentation by describing the main results of The European Foundation 2002 study on working conditions in candidate countries compared to member states:

• More employment in agriculture, less in service sector
• Higher proportion of self-employed workers
• Lower proportion of workers in skilled job categories
• Gender segregation less prevalent
• Exposure to risk factors higher
• Work less client-oriented, less reliant on computer technology work organization less decentralized, less worker responsibility, more hierachical
• Job demands higher, worker autonomy lower, more co-worker support
• Working hours longer, unsocial working hours more prevalent
• More workers consider their health being at risk
• Work-related health problems reportedly higher

Toward the 4th Ministerial Conference on Environment and Health, Budapest 2004

Ivan D. Ivanov, WHO Regional Office for Europe

The overarching theme of the conference is the future for children. The concept of environmental health includes occupational health and food safety. The following sessions are organized at the Ministerial Conference:

Session I: Progress made in Europe on environment and health aims at ensuring continuity of the environment and health process in Europe and at setting directions for its future. The focus is on the newly independent states.

Session II: Strengthening the policy making base to provide the policy makers with the appropriate tools and evidence based knowledge to facilitate decision making in both the health and environment policies.

Session III: Emerging priority issues; to address emerging issues and provide adequate preventive responses; focusing on health and global change, housing, and health and sustainable development.

Session IV: The way forward; information and effective actions to achieve the protection of children's health from environmental hazards. Outcome: the Children's Environment and Health Action Plan.

In the Budapest conference occupational health will be dealt with as follows:

• Environmental health (EH) situation in Europe incl. occupational exposures and their health effects
• Evaluation of the impact of EH process on key stakeholders, incl. business and industry
• London decisions: health, environment and safety management in enterprises
• Occupational health indicators and reporting
• Precautionary principle in OH
• Sustainable development in OH practice

Children's Environment and Health Action Plan for Europe includes health aspects of child labour and parental occupational exposures. Countries preparations for the conference include an analysis of the implementation of London decisions: HESME; a review of applicability of a core set of environmental health indicators, and a review of national evidence on health effects of child labour and parental occupational exposures.

Training of occupational health and safety personnel

Matti Ylikoski, Finnish Institute of Occupational Health

Professor Ylikoski started his presentation by listing the main challenges for training of the OH&S personnel. They are turbulent global economy, new technology and new production, and the ageing of the work force.

Training of the OH&S personnel has been shown to increase work efficiency. E.g. 27.3 % of the trained OH personnel ordered occupational hygienic measurements compared to 8.7 % of non-trained OH personnel and 73.6 % of trained physicians assessed risks for reproductive toxicity compared to 58.7% of non-trained OH personnel.

Objectives of the OH&S training are to increase the cohesion in "mosaic" work life, to maintain sustainable OH&S competence, to maintain competence level of elderly workers, and to response to changing and new hazards. Key target groups are OH&S and health professionals, OH&S officials, researchers and trade unions, and vulnerable groups.

The recently established Training Centre on Occupational Health Services at the FIOH has the following challenges and demands:

• Predicted lack of OHS professionals, the annual need of OHS physicians is 30–40 more; the annual need of OHS nurses is 55–60 more.
• Need for certification, academic degrees, registration and follow-up of training curricula.
• Maintenance of the appreciation on OHS and assurance of work careers on the branch
• Assurance of high professional ethics and social competence
• Co-ordination and use of FIOH resources in training in general
• Development of multidisciplinary training programmes
• Integration of research results to training and collaboration with universities

The FIOH has a long tradition in training of experts, enterprises and organizations. The training is multidisciplinary itself and based on multidisciplinary research and verified evidence, oriented to continuous development, and problem and target group based. FIOH has a strong position in the training at the universities (year 2001: 6 associate professors).

According to the Occupational Health Act (2001) the OHS professionals must be competent, have necessary knowledge, be trained, be professionally independent from employer and employees, and have enough further training to assure the maintenance of skills and knowledge.

The Training Centre of the FIOH has the following functions:

• To follow and evaluate training needs among specialists in Finland
• To develop examinations and training programmes in collaboration with universities and other training institutes
• To produce further and advanced training
• To conduct research, develop training methods and organize training of trainers
• To follow verified competencies
• To support training in other departments of the FIOH and to co-ordinate the training activities at the FIOH.

The future development of the training include the following aspects:

• Improving learning in organizations and exchange of knowledge between experts and responsible people in enterprises
• Focus on social medicine and health
• Health promotion at the work place.

The FIOH training includes also vulnerable groups like migrant labour. This is an important question, because more and more guest workers are expected due to the shortage of the domestic work force. Migrant workers have higher risks, but are under-users of health services.

The system of occupational health and safety personnel training in Latvia

Maija Eglite, The Institute of Occupational and Environmental Health (IOEH), Riga Stradins University
Tatjana Zabarovska, State Labour Inspectorate

New training system of OHS specialists is being created in Latvia at the moment. The IOEH is the leading institution in Latvia providing education in OHS. The IOEH and the Association of Latvian Occupational Physicians are giving training for occupational physicians already working in the OHS, and for general practitioners. The new postgraduate training system has 4 steps: basics of occupational hygiene, individual work, occupational medicine, and examination. Certificate is given for 5 years period. This system is going to be improved by increasing the training staff, lecture hours and by extension of study topics, etc.

Occupational hygienists are usually physicians as background, thus their knowledge is limited to medical aspects of hygiene. The IOEH has developed a master's level programme for occupational hygienists training, which could be launched in the study year 2003/2004.

There are no official regulations for speciality of occupational nurses in Latvia, nor certification system. At present IOEH is organizing courses on basics of occupational nursing (40 hours) for nurses working in factories. The necessity of OH nurses should be foreseen in the legislation. IOEH should prepare a training programme for OH nurses and an association of OH nurses should be established.

The State Labour Inspectorate has training programmes for occupational safety and health specialists and representatives. A new law on Labour Protection has been enforced on 1.1.2002, but there are no means for implementing it, i.e. Regulations are not accepted yet as concerns competent institutions and specialists. The training programme for basic level of labour protection specialists and safety representatives comprises a total of 160 hours of training (50 training, 110 practical work). Occupational health and safety comprises 19 hours of lectures. The general basic training programme of the SLI for labour inspectors has a total of 220 hours including 28 hours of occupational health training.

Training of occupational health personnel in Russia

Mikhail Mikheev, St. Petersburg Medical Academy of Post-graduate Studies

OHS personnel in Russia comprises occupational hygienists with three years basic training (anatomy, chemistry, etc), after which general hygiene, occupational hygiene, nutrition, food safety, etc., assistants of occupational hygienists, occupational physicians (general physicians with additional training of 6 years after graduation), occupational nurses (general nurses who work with occupational physicians), related medical professionals involved in medical examinations (i.e. examinations provided by a group of specialists), safety engineers, ventilation engineers, and safety technicians. Safety engineers are trained at the technical universities. All engineers can work as safety engineers.

The OHS personnel training has three levels: 1) undergraduate training (diploma), 2) internship, and 3) postgraduate training (e.g. MAPS). Postgraduate training includes courses, ordinatura (2 years specialization) and aspirantura (3 years training). The training does not include ergonomics or health promotion aspects.

Principles of training include prevention, protection, and treatment. In St. Petersburg there are two clinics, which give treatment for occupational diseases. There are two approaches of training: multidisciplinarity and multisectorality. Multidisciplinarity of training should be improved in Russia.

In MAPS, the OHS personnel training is given in the following departments: Department of Medicine of Labour and Occupational Pathology, Department of Radiation Hygiene, Department of Medical Ecology, Department of Toxicology, Department of Rehabilitation, and Department of Informatics.

The cost-benefit of training can be evaluated with economical indicators and health indicators. These indicators are not very much developed, and they should e developed more in Russia.

Among general practitioners also occupational patologists exist (amount 100). They pass theoretical and practical exam.

Training of occupational health personnel in Sweden

Bo Dahlner, National Institute for Working Life (NIWL)

Sweden has not a legislation on Occupational Health Services. The new trends like globalisation, downsizing, outsourcing etc. are also problems of the Swedish work life. The OHS covers ca 75% of the work places. There are multidisciplinary teams in OH services. The NIWL helps the OHS with providing them with competent personnel trained by NIWL.

Occupational health physicians are trained with one annual course of three terms; 30–40 participants are attending the course. Nine weeks of theoretical studies and fulfilment of a project work are required. Occupational health nurses are trained with one annual course of four terms; 30–35 participants/course. 11 weeks of theoretical studies and 29 weeks of individual studies, including fulfilment of a project work are required. Occupational health physiotherapists are trained with two annual courses for 50 participants. The training includes 6 weeks of theoretical studies and 14 weeks of individual studies and fulfilment of a project work.

Work environment engineers are trained with one course every second year with 30–35 participants. 40 weeks of training and fulfilment of a project work are required. A work environment engineer is a combination of occupational hygienist and a safety engineer.

A work environment for workers' representatives -course is organized every second year with 30–35 participants. 5,5 weeks of theoretical studies and fulfilment of a project work are required.

The psychologists were not trained during the last five years but now a new course has started for behavioural scientists. The course is focusing on preventive aspects and includes five weeks of theoretical studies and a fulfilment of a project work.

Discussion

Further Mr. Dahlner explained that there are 1500 safety engineers trained, of which 700 are active today in OHS, the rest are working as consultants. Dr. Martimo asked if the training is organized separately for various professional groups, or if it is mixed, and Mr. Dahlner replied that some courses the physicians and nurses attend together, and especially shorter courses are open for different professional groups.

Mr. Dahlner also clarified that 500 psychologist have been trained earlier and they all are still active in OHS. Professor Rantanen considered the training of psychologist especially important; the Training Centre at FIOH has a special training line for that. There are 400 occupational phychologist available in OHS in Finland.

The group discussed about the objectives of training. It was mentioned, that it is difficult to train employers and managers to understand the importance of OHS. There is also a need to train the trainers in this matter. Dr. Froneberg mentioned, that the German approach with Berufsgenossenschaften organizing seminars for employers is working quite well.

According to Professor Shlyakhetski the employers in Russia are not very interested to be trained in these problems, but it is necessary to improve their understanding on risks, etc. Dr. Wannag expressed the opinion that training of employers should not be the sole responsibility of the OHS personnel, for example in Germany, the Berufsgenossenschaften have a higher status than the OHS have.

Dr. Lamberg said that several strategies can be used simultaneously; and it is important to co-operate on many levels. The employers should understand the economical benefit of investing in OHS. Dr. Kurppa said that the company should have an OH policy, which could be prepared together with the OHS and the managers.

According to Dr. Jankauskas, the quality of training and the competence of trainers are problems in Lithuania. Occupational Medicine Center is not a training institution, but a research institution, and can not have influence enough for improving the situation. Professor Mikheev mentioned three main factors from which the situation of the working population depends: economy, (healthy) life style and occupational hazards at work places.

Professor Rantanen concluded that big industries are well aware about the OH issues and about their social responsibility. The problem area is the SMEs and self-employed; they are not able to make actions, they are missing practical tools, etc. External interventions are needed: municipal health centres are one tool; in Finland also a national action programme has been launched. It was pretty successful and another one is starting. The FIOH makes strong intervention by disseminating information, giving advice, services, etc. Public sector needs to be pushed to keep their responsibility.

Panel discussion on economic appraisal in OH

Members of the Panel:

Remigijus Jankauskas, Lithuania
Suvi Lehtinen, Finland
Eva Tammaru, Estonia
Axel Wannag, Norway
Chair of the Panel: Jorma Rantanen, Finland

The topic of the panel was to discuss on the position of OH as one of the productive sectors, economic analyses done, and economic impact reached. First, each member of the Panel gave a short introduction to the subject.

Eva Tammaru, Estonia:
Losses and expenses on national level are calculated in Estonia on the basis of the information of sickness fund, statistical office, etc. Factors like sick-leave compensation, number of sick days, sick workers/day, and costs of absenteeism are studied. There is a project with Denmark going on in 2003 concerning improving the methodology of follow-up of occupational accident costs on the company and national levels. Within the project training courses for inspectors are arranged and training material produced. A draft model has been created on costs of occupational accidents at the company level. The model is tested in case studies to create a final model. Absenteeism from work has consequences in the form of lost working time, temporary replacements, reallocation of workers, etc., which again cause more expenses.

Axel Wannag, Norway:
Three Norwegian groups have started economic appraisal in order to identify hidden losses the enterprises have, and to identify possible hidden sources of profit in the production, in order to give a better basis for decision making, and, especially in the longer run, to improve the financial results of the enterprises. The groups are ECONman consultant enterprise, Employers' Confederation of Enterprises in Transportation, and a Research Institute in Rogaland. Dr. Wannag also mentioned a WHO Instrument, the WHO Health and Work Performance Questionnaire (HPQ), which concentrates on the return to work after sickness. The prevention is not handled.

Remigijus Jankauskas, Lithuania:
There is not much experience in Lithuania on economic appraisal. The FIBELLC Inco-Copernicus -project had some elements close to it. A project has started also in Lithuania concerning the investment of enterprises in health. Especially for SMEs it is considered profitable to invest in occupational health. Two approaches exist: 1) How to calculate possible losses and to measure costs of elimination of risks, and 2) What are the costs of OH service providing?

Suvi Lehtinen, Finland:
Ms. Lehtinen started with reminding that occupational health is a basic right of everybody, which must not be ignored even if not economically profitable on a short term. The projects described as examples from Finland, show only short-term effects, which are easier to be seen.

• Dalbo-project at a metal company (Näsman & Ahonen 1999, Haag Proceedings) showed that the improvement of working conditions caused an increase in the productivity of 8.4% in five years, and a 10-fold benefit-cost ratio. The payback time of the investment was 1.2 months.
• The study at 142 construction sites aimed at finding out whether there is association between working conditions of the work site and productivity (Kemppilä et al. 2002). TR-measurement (systematic measurement of the level of safety at the work site) was used. Costs, time schedule, productivity, and quality were the indicators measured. The results showed that 61% of the construction sites with good work environment reached a profit level higher than 10%, compared to 17% of the construction sites with poor work environment.
• Maintenance of Work Ability at SSEs -project (Bergström et al. 2003) includes 98 company-based development and training projects in ergonomics, safety at work, hygiene at work, work communities, and professional competence. The results showed that the investments on ergonomics give the best profit to the company on short-term productivity, investments on workers' competence give more individual profit.
• In Maintenance of Work Ability -project (MWA Barometer 2001) the managers were interviewed on the cost and benefit ratio of OHS during the previous 12 months. The results showed that 85% of the interviewed considered the ratio very good or fairly good.
• Work environment improvements and productivity -project (Niemelä et al. Am J Ind Med 2002;42:328–55) showed that the increased productivity is most likely related to improved work environment, i.e. better thermal climate, reduced contaminant concentrations, and better lighting conditions.
• Work organization improvements and productivity -project in SMEs included two questionnaire surveys and interventions. Both productivity and profitability were positively associated with the interventions. Job satisfaction was positively related to higher productivity and profitability.

Discussion

Dr. Kurppa suggested that economic appraisal could be a subject area at the BSN website, and studies and information on this theme would be gathered on the pages.

Professor Mikheev informed that in Russia the workers are not active in improving the working conditions, because better salaries are paid for working in poor conditions. In Russia there are very few projects on this theme in practice. The policy of Soviet times prevails. Employers do not pay much attention, and because of the long latency period, occupational diseases will be seen only in the future.

Dr. Martimo took up the association between the economical situation and workers' well-being; economical success of the companies is the best MWA of workers. Dr. Wannag informed that in Norway big firms are paying less insurance fees than small enterprises. This is much discussed at the moment. Professor Rantanen warned of using simplified models. Even Tervus/Potential has serious defects in cost-benefit calculation; for example, the follow-up time is too short. Professor Rantanen also pointed out that instead of the disease oriented burden analysis and burden of the disease -approach the focus should be in preventing the diseases and exposures instead. Dr. Ivanov reminded that the burden of the disease -approach has a broader scope in Europe and attempts to take into consideration the real health effects.

Professor Shlyakhetski informed that there is an obligatory insurance system is Russia. The fields of industry are divided in groups according to risk factors. Factories have to pay insurance fee of 0,2% of paid salaries. Insurance company can increase or decrease this percentage. At the moment there are problems especially in rehabilitation of ill workers.

The Chair concluded the discussion with the following three points:

• Whether OH or not? Yes, in spite of economic costs – OH is a basic human rights
• Fixed sum of money? – How to use this resource best?
• Risk of underestimating the benefit? Post-analysis is needed. Consideration of associated costs, not only direct costs, needed.

The new economic theory has the following components: 1) material capital; 2) financial capital; and 3) two important forms of "new" capital: human (intellectual) and social capital. These two are getting more and more important in modern production life. OH supports a good use of the new capitals.

WHO Task Force web-portal on OH&S profiles and indicators

Kari Kurppa, FIOH

The WHO Task Force 13 activity started among the WHO Collaborating Centres in Occupational Health, with a WHO/EURO initiative to develop indicators. FIOH drafted an indicator system and conducted a survey in 22 European countries. The main problems were comparability (in general the indicators were not comparable between countries) and availability, which varied a lot between countries.

The indicator approach gives a good picture about the situation within a country and some comparisons between the countries can be made. Local indicators, provincial and regional, are a fruitful way to use the approach within a country.

Dr. Kurppa described the structure of the Task Force 13 website: information include background information, definitions of concepts, a background document from the year 2001, results of pilot surveys in different countries, and OH&S profiles of various continents and countries.

Sub-national profiles are local, district and community profiles. It seems that people are very enthusiastic about the sub-national profiles in many countries, because the traditional indicators are often of national level. Local instruments can be put into use on the local level. The local indicators, e.g. on village level, are more qualitative than quantitative.

Discussion

Dr. Ivanov asked which indicators are comparable in European countries and Dr. Kurppa replied that mostly those that rely on ILO ratifications. Dr. Froneberg clarified that in the ILO the same kind of indicators are used, and the comparability within a country is more important than between the countries.

Dr. Kurppa concluded that the indicator approach is very important to continue, but the difficulties of it have to be understood in order not to make wrong conclusions and use for indicators and profiles.

Progress in networking – country reports

Sweden/Bo Dahlner
There are over 200 links at the BSN website. At the moment there are some problems depending on the changes at the National Institute for Working Life. Links were broken because researchers moved out from the Institute. The new web-pages are not built yet. Institute changed the old domain niwl.se to arbetslivsinstitutet.se. BSN links were broken but they are fixed now.

Russia/Mikhail Mikheev
The website address of English pages of the Department of Occupational Health of the MAPS is www.health.maps.spb.ru. Main page includes basic information and needs some updating at the moment. Future prospects include updating, and building up the pages with links to documents (e.g. guide to medical examinations). Especially the training centres under the Ministry of Labour (25 in St. Petersburg) are going to be linked. There are also plans to disseminate information on BSN in the form of articles in professional journals.

Norway/Tor Norseth
Stami pages are linked to BSN, but they are not very extensive in English at the moment. There are plans to increase the English edition of the pages.

Latvia/Maija Eglite
BSN website management is working well and there are no difficulties in updating. At the moment most of the old pages have been updated to new pages. The IOEH web-pages are in the address www.rsu.lv/dvvi. Other activities of the IOEH include setting up of the new equipment in connection with a Phare project, and a new state investment project for development of the IOEH. The training activities and development of new training programmes of the IOEH are extensive. New strategy in OH&S was developed in autumn 2002 (available in BSN website under information sources. A large number of translations and adaptations of training materials, and information material is being published. A book on environmental health (incl. work environment) is going to be published in autumn 2003. IOEH participates in the development of the Bilbao network pages of Latvia.

Finland/Suvi Lehtinen
At the national level there are two new legislations in the implementation phase: Act on OHS, and Act on Occupational Safety. Ministry of Social Affairs and Health has launched two new programmes: VETO-programme and OHS programme. FIOH is contributing to both programmes. At the Finnish Institute there are two action programmes launched: Support to OSH Activities, and Promotion of Work Ability and Functional Capacity. The new Twinning-project with Estonia is starting. WHO programmes are well underway both with the Headquarters and EURO Office. TF 13 profiles are being put in the web, and ICOH activities are being developed.

Estonia/Ester Rünkla
There are four websites in OH&S at the moment in Estonia:

1. Estonian OH network. The network was established in connection with the Estonian-Finnish Twinning Project 2000–2002. It includes a network policy statement and information dissemination strategy of the Estonian OH&S, and a directory of the Estonian OH&S Network.
2. Estonian national network infoserver. The aim is to provide an intranet for OH specialists in Estonia and to increase interactivity. There are 10 persons who can update the pages (several institutions).
3. Bilbao Agency's Network. Estonia joined 2002. The pages are updated in Estonian and in English.
4. BSN. The network is serving OH experts. New updating in OH profiles: Pärnu county profile; two community profiles, Harku and Ylenurme. Estonian OHS system is presented.

Lithuania/Remigijus Jankauskas
Lack of resources has prevented the updating for a long time, but now the pages have finally been updated. In February a meeting for potential users in Lithuania has been held; all institutions expressed the need for information also in English. Under news & activities there is a sociological survey described. National funding will be distributed especially for development of telematic services, and if received, much progress will be made in the near future.

Discussion

Professor Rantanen concluded that the progress with the website is very rewarding. Also Dr. Ivanov greeted the network for the good results. Dr. Ivanov took up a positive attitude towards Professor Rantanen's question whether Baltic Sea Network could be considered as a WHO network. Dr. Wannag reminded that the development could not have been possible without the support of the Finnish Institute of Occupational Health.

Glossary on Work Environment

Bo Dahlner, Sweden and Remigijus Jankauskas, Lithuania

Mr. Dahlner gave a status report on the BSN glossary-project. The glossary has three parts: 1) A list of words, abbreviations and general explanations, 2) Comments to the lists, and 3) A waiting list (words that may be discussed).

Some problems may occur with abbreviations. For example OHP can mean occupational health physician or occupational health psychology/ist. Therefore the abbreviations must be explained.

Several definitions were discussed, e.g. occupational health services, ergonomics, occupational health, occupational health psychology, occupational hygiene, occupational medicine, occupational safety and health, public health, and work environment. Occupational health services have been defined in ILO Convention 16. Ergonomics, however, has different definitions. Dr. Kurppa pointed out that concepts are a very important issue to discuss, because even in Finland there are different definitions for ergonomics and no consensus at the moment exists. Therefore it would be good if international organizations could agree on one definition. The concepts could be distributed within a country between specialists and compare the results in the next meeting. ILO and WHO could also give their opinion. Professor Mikheev suggested that IEA's (International Ergonomics Association) opinion should be checked.

All participants agreed on the importance of harmonization of basic concepts. Mr. Dahlner suggested that the discussion forum under the Swedish pages could be used for discussing the definitions (log in: bsn, password: 007).

The presented definition for occupational health was a WHO definition, the definition of occupational health psychology has been taken from NIOSH. The definition of occupational medicine should concern not only the science but also application.

It was agreed to continue the discussion for definitions. It was also agreed to send the definitions to a round in BSN focal points for comments with an inquiry on national definitions.

Discussion

There are two approaches to continue the glossary-project. The other one is to collect and describe the existing definitions and concepts and not to try to get any consensus. The other one is to get the international consensus for concepts with the aid of ILO and WHO and receive an international policy level agreement on definitions. It was concluded that the Network can not make an international agreement, which is more a political question. Dr. Jankauskas pointed out that national official definitions would be most important to be provided. Also Professor Shlyakhetski considered the glossary-project important and practical for Russian OH experts.

General discussion on networking and BSN development

Dr. Ivanov stated that the Network is important to WHO. Issues agreed within the network can be brought to pan-European level for discussion. Network can spread it's experience to e.g. former Soviet Union countries. Professor Rantanen suggested that Dr. Ivanov would find out if a poster of BSN could be presented at the Budapest Ministerial Conference. Examples of actions of the Network could be presented.

In this connection Professor Rantanen took up Dr. Jacek Michalak's, Poland, proposal concerning a contribution to the EU Public Health programme. Because the time is too short for making a proposal for the open call in Public Health Programme, Professor Rantanen suggested that countries present at the meeting could decide to analyse their core competencies and training activities, trainers, training networks, etc., and this could be done also without EU funding.

Dr. Kurppa mentioned, that the glossary-project is a step to the direction of common activities. Axel Wannag took up the importance to get touch with the German and Danish counterparts as it concerns the mutual collaboration. Jorma Rantanen replied that Professor Kochan has informed that the Federal Institute for Occupational Safety and Health in Germany was not able to attend this time, but that they are interested to join the network activities as soon as they have reorganized their international affairs activity, whereas the Danish colleagues may have the understanding that BSN is not needed as we have the Bilbao network.

Professor Rantanen reminded the participants that in the last Annual Meeting different profiles were identified for the BSN and the Bilbao Network. Participation in the BSN activity has increased the readiness to participate in the Bilbao collaboration, as the Estonian example shows.

The next BSN Annual Meeting will be the tenth meeting. Dr. Ivanov informed that even if the BSN activity should not be an activity organized by the WHO, the next meeting could be hosted by the WHO in Copenhagen. Dr. Ivanov will explore this possibility further.

Conclusions and recommendations

1. The Ninth Meeting was as all the others – successful, enthusiastic and productive

• Warm thanks to Russian colleagues, the Finnish Ministry of Social Affairs and Health, the Finnish organizers, WHO/EURO and ILO, and all participants.

2. Policy: strong international and national leadership is needed as OH still has a too low priority. WHO/ILO policy umbrella is needed.

• Policy actions towards World Health Assembly; support to Dr. Ivanov's efforts at the Budapest Meeting 2004; ILO Conference forthcoming, in which OH&S will be discussed.

3. Basic Occupational Health Services is being lifted to priority issue in WHO/EURO and WHO/HQ, ILO and ICOH. Information and networking are crucial elements in that development.

• International Basic Occupational Health Services programme needed (Global, European)

4. The need for infrastructures is universal. We need to pay more attention to infrastructures as they are the way from research and expert knowledge to action.

• Basic Occupational Health Services -infrastructure for all BSN countries
• Guideline for policy at the national level can be an activity for BSN

5. Training and education at all levels, and life long, is getting more important.

• OHS programmes
• Multidisciplinarity
• Managers
• Workers
• D-Ms
• Training of trainers (training website)
• Special web locus for training
• Trainers' network

6. National OH&S programmes are important for longer-term development. The existing programmes could be collected to the website.

• Model national policy programme

7. Economic appraisal is still in the infancy but some examples of methods and analysis, which have been made, are available.

• Cautious use!
• Methodological development – long-term, post hoc analysis needed
• Methods collected to BSN website
• Examples and research reports to the BSN website

8. The country website reports were very positive and the 2nd–3rd generation in technical development is emerging. Intra-national networking is developed in some countries utilizing web-connections.

• More substance to be fed in; full documents feeded instead of only lists of references, would be an asset
• English material
• User-friendliness

9. Indicators and profiles well on the way. We have some 30 national profiles (22 Europeans) and a number of local and provincial profiles.

• Materials for indicators & profiles to be collected
• Putting profiles to web

10. Glossary of definitions and concepts well on the way

• Contributing to the BSN exercise
• Proposal to joint ILO/WHO Committee
• Collect the definitions and terms from the focal points
• Agreement on what terms will be used

11. WHO/EURO was present again and showed a living interest to the BSN as a sub-regional network and as a good example of well-working network. BSN will be considered as an element in the WHO/EURO OH-programme. Closer linkage and emblem issues will be agreed upon.

• Closer link to WHO/EURO
• Connection to WHO/EURO website
• Budapest meeting OH-substance
• Document on BSN for WHO purposes will be provided

12. The next BSN Annual Meeting in 2004 will be organized in Copenhagen, Denmark, in the premises of the WHO/EURO office.

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Last Modified: 12/31/2002