Summary Report

Opening of the Meeting

1. The Sixth Annual Meeting of the Baltic Sea Network on Occupational Health and Safety was opened by Ms. Inger Ohlsson, Director General of the National Institute for Working Life in Sweden. In welcoming the participants to the Meeting, she also de-scribed the activities of the Swedish National Institute for Working Life, and called upon discussions on the highly actual problems of the working life, e.g. fragmentation and needs for life-long learning in connection with discussions on the training and edu-cation issues in occupational health and safety.

Dr. Boguslaw Baranski welcomed the participants on behalf of the World Health Or-ganization (WHO) and expressed the gratitude of the WHO Regional Office for Europe, to the National Institute for Working Life, for assuming the responsibility to organize the Meeting. He also expressed the gratitude of the WHO to the Finnish Institute of Oc-cupational Health for support and co-operation in the practical arrangements of the Bal-tic Sea Network on Occupational Health and Safety. He welcomed the idea of utilizing the network for discussing topical substance issues, such as training and education, and occupational health and safety indicators.

Ms. Suvi Lehtinen, Co-ordinator, Secretariat of the Baltic Sea Network on Occupational Health and Safety at the Finnish Institute of Occupational Health, welcomed all the par-ticipants to the Meeting. She reminded that the idea of the Network was put forward in November 1995, with the web-page of the telematic Network having been opened in March 1997. In spite of the short history of the Network, many advances have already been achieved thanks to the active efforts and commitments of the Network Members. The network structure is based on an inter-institutional and peer-to-peer activity, and voluntary commitment of the institutions. It aims at the full utilization of various infor-mation sources, both national and international. She also thanked the Swedish National Institute for Working Life, Ms. Inger Ohlsson, Mr. Bo Dahlner and Ms. Gunborg Jungeteg for hosting the Network Meeting, and the WHO/EURO through Dr. Baranski for support in all stages of the Network development.

2. Ms. Suvi Lehtinen, Finland, was elected 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.

3. Mr. Lars Rydén introduced the activities of the Baltic Sea University that was estab-lished to serve the Baltic Sea drainage basin. He stressed the importance of networking in supporting the activities in various countries. He described the staff of the centres in various countries. Some of them comprise the researcher, lecturer, TV-producer, and students. TV is actively used because it is the most widely available channel. Altogether 35 TV programmes have been produced. Also, the units and the University itself pro-duce various course materials, such as sustainable development and industrial produc-tion. One of the topics of the University is environmental management (certification and audit, cleaner production, product design, and inspection and control), another is urban management. Much attention is given to the studies on pollution of the Baltic Sea. In-stead, occupational health is not a subject of the Baltic Sea University, i.e. the contact with the Baltic Sea Network is most useful and interesting.

Scope and purpose of the Meeting

4. The overall purpose of the Sixth Annual Meeting of the Baltic Sea Network on Occu-pational Health and Safety was to review and discuss optimal ways of using education and training for promotion and protection of the health of employees, their work ability and well-being.

Knowledge and information are the growingly important components of social and eco-nomic development in the modern societies. These factors dominate recent changes in production and servicing technologies and organization of work. Professional compe-tence and skills are highly dependent not only on the scope and quality of education re-ceived at school, university and postgraduate studies, but also on the scope and quality of continuous adult education.

The health, work ability and the well-being of employees, as well as their future em-ployability, depends to a large extent not only on their own education, but also on the education and professional skills of their employers, executive and personnel managers, and the various experts comprising the occupational health team. The role of education and training in occupational health and workplace health management seems to have been growing in recent years as a result of rapidly changing working conditions and fragmentation of the work life. Recognition of the role of workplace health management in achieving the overall public health objectives (e.g. reduction of chronic non-commu-nicable diseases of the working-age population, healthy ageing with prolongation of economically and socially productive life) is important.

The scope of the meeting covers education and training of employees, employers, and occupational health professionals, quality assurance in training and education, and the education of employees to enable them to maintain their work ability.

The specific objectives of the meeting were to:

• review the scope, purpose and methodology of education and training, including distance learning, in occupational health and safety, and training in the maintenance of work ability for professionals, employees and employers in countries around the Baltic Sea
• review methods used for quality assurance in training and education, including ac-creditation and certification of courses
• evaluate progress, and plan further development of the Baltic Sea Network.

5. Dr. Boguslaw Baranski described the activities of the WHO/EURO in 2000 within the Healthy Workplace Programme.

The scope and purpose of the European programme on good practice in health, envi-ronment and safety management in enterprises (GP HESME) has been prepared. This was reviewed by the WHO meeting of HESME focal points (nominated by ministries of health, environment and labour and by international organizations) held in Bilthoven on 23-24 March 2000. The meeting recommended the preparation of European criteria and indicators of GP HESME, jointly with ILO, UNEP and other international organiza-tions.

He mentioned that HESME is driven by the current regulatory requirements, voluntary initiatives and agreements, economic appraisal, and effective management procedures. He referred to the decision made by the Fourth Meeting of the Network of WHO Col-laborating Centres, held in Helsinki, on 7-9 June 1999, concerning the guidelines on economic appraisal. It will be published by WHO, Geneva in the near future. The Euro-pean networks supporting HESME are governmental focal points (20 countries), IGOs and NGOs focal points (ILO, UNEP, EC, OECD, CEFIC, ICOH, others) are also util-ized. The WHO Collaborating Centres in Occupational Health are included, as well as Social Insurance Institutions (14 countries), and the Baltic Sea Network on Occupa-tional Health and Safety (10 countries). Several publications have also been published to support the dissemination of information.

A working document on the European criteria and indicators of GP HESME has been prepared. This document has been assessed and amended by the First European Meet-ing of WHO Collaborating Centres in Occupational Health, held in Lodz, Poland, on 11-12 September 2000. A final draft of this document will be presented at the Second meeting of HESME focal points, to be held in Turku, on 22-23 April 2001 jointly or-ganized with the Finnish Ministry of Social Affairs and Health and the Social Insurance Institution, Turku, Finland.

Proposals for comprehensive workplace health policies based on the GP HESME ap-proach have been prepared and presented at international meetings of WHO/EURO, at two sessions of the European Environment and Health Committee, and at various inter-national and national meetings.

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 Fifth Annual Meeting was held in Berlin, Germany, 18-19 November 1999, and the Sixth Annual Meeting in Uppsala, Sweden, on 9-10 November 2000. The Network provides a good model for collaboration for other parts of the European region.

A new network of the European Social and Health Insurance Institutions for Workplace Health Promotion has been established, in collaboration with the Research and Devel-opment Centre, Social Insurance Institution, Turku, Finland. An initial meeting was held in Bilthoven, The Netherlands, on 21-22 October 1999, the first network business meeting on 23-24 May 2000 in Bonn, Germany and the second Network Business meeting is planned to be held in Reykjavik, Iceland, in March 2001.

Education and training in occupational health and safety

The Training Session was chaired by Professor Jorma Rantanen, Finland.

6. Ms. Inger Ohlsson described the needs for training of the experts in the occupational health team in Sweden: occupational health physicians, occupational health nurses, physiotherapists, psychologists, and safety and hygiene engineers. Nowadays, all of these experts work only seldom in a team. However, their expertise is needed as a com-bined entity in solving the problems at the workplace level. The two-year training pe-riod comprises studying, practical work, writing reports, etc. The length of the courses varies from a couple of days to several weeks. In the longer-term training courses all the central areas of expertise in occupational health and safety are covered. The training and education of the occupational health and safety professionals has been taken rela-tively good care of. Instead, the training of employers in occupational health and safety is lagging behind, as in many other countries as well. The nurses' courses are 11-week courses, and physiotherapists have 6 weeks of training. Shorter courses deal with occu-pational toxicology, occupational asthma, career choice and allergies, etc. International courses are running for Africa and Latin America, lasting 2 years. Part of that training is organized in Sweden, but the majority is conducted in their own region and their own countries. Between 1972-1999 altogether the following numbers of professionals have been trained: 1700 occupational health physicians, 3400 occupational health nurses, 1000 physiotherapists, 1600 safety and hygiene engineers, 350 psychologists, 260 qualified safety delegates, and 30 occupational hygienists. She mentioned the need for additional training because of the generation shift due to the approaching retirement age of the large age cohorts. In the discussion, the question was taken up how many of those having been trained will really go to occupational health services, and how many will drop out after the training. At the moment, there are no exact statistics about the situa-tion, but the impression was that many of the trained professionals actually go to practi-cal occupational health services

7. Professor Jorma Rantanen, FIOH, Finland, described the new challenges to training in occupational health and safety. He discussed the quantitative needs, the qualitative needs, and the new training strategies and opportunities. The problem in the occupa-tional health and safety training is monodisciplinarity, even though some countries stipulate the multidisciplinarity and certification. There is a continuous shortage of manpower resources for occupational health and safety. New substance areas needed in training of occupational health professionals were mentioned such as new technology, violence at the workplace, and psychosocial stress to mention but a few. There is a need to move from a risk-factor oriented approach in occupational health and safety to a comprehensive multidisciplinary development orientation. The work life is changing rapidly and hence the speed at which knowledge is being outdated is tremendous. Therefore the life-long learning is badly needed (knowledge renewal rate is 7% a year, while manpower turnover is 2% a year). In meeting the knowledge requirements in oc-cupational health and safety in the modern society, not only the explicit knowledge (the factual knowledge) but also tacit knowledge (silent knowledge, understanding, how-to-do-it knowledge) is needed. Tacit knowledge constitutes a crucial prerequisite for the learning basis in the future. Tacit knowledge comprises the technical part including skills, and the cognitive part. Tacit knowledge includes in addition to individual learn-ing also collective learning. Transferring the tacit knowledge into codified knowledge is needed and methods to carry out this in practice is a challenge also for occupational health and safety expert training. The basis for understanding should be ensured in oc-cupational health and safety training.

8. Professor Boguslaw Kedzia, CIOP, Warsaw, Poland, presented the Polish situation in occupational health and safety expert training. He described the training activities of the CIOP in the field of occupational health and safety. A total of 528 occupational fatali-ties and 1323 serious accidents occur in Poland annually. This will pose certain de-mands for the training of experts. It has been calculated that the total number of em-ployees at risk is 897,000. There is some variation among the branches of industry in the accident risk. The number of registered occupational diseases has increased during the past two decades. The training of trainers has been systematically organized. In Po-land, some institutes (such as the Nofer Institute of Occupational Medicine in Lodz) are concentrating on occupational health training, CIOP deals more with engineering and safety issues. The main target groups are employers, safety personnel, industrial hy-gienists, employees, and supervisors. Model programmes and model materials for training have been provided. Postgraduate studies ar also organized (240 contact hours). In 1997-2000, 330 graduates have been trained. Education packages contain 22 mod-ules covering all aspects of occupational health and hygiene. There is also a lecturer's guide to improve the impact of training. Specialized courses are arranged on topics such as first aid. The certification of the training is done for occupational safety and health lecturers, safety specialists, auditors of safety systems, ergonomists, etc. Distant learn-ing is being developed. New teaching aids, such as video clips in the multimedia pres-entations are utilized and multimedia training materials provided. CD-ROMs are also an effective form of presenting information, and Internet can be better used than previ-ously. Occupational health and safety issues and materials are provided for all levels of the education and training system in Poland.

In the discussion, the question of funding of training was taken up. The balance be-tween the regulatory and voluntary training should also be defined. It seems that the market-based economy does not allow the time for transforming the tacit knowledge to codified knowledge and vice versa. This is, however, important for the implementation of knowledge. It should be ensured in order to enable the occupational health and safety expertise to develop.

9. Professor Peter Westerholm, National Institute for Working Life (NIWL), Sweden, described in his presentation the development of occupational health services - compe-tencies and visions. He continued with describing the project carried out, having sent a questionnaire to 1000 companies/enterprises, employers, safety delegates. A similar questionnaire was sent to all occupational health specialists trained by NIWL after 1993. The smallest companies were excluded because it was the aim to pick up those companies that really use occupational health services. The smallest firms do not. The trainees had found the NIWL courses highly useful. It was also found out that there is a need for further training. Lack of time to attend courses and/or access or availability of the training programmes was found to be a reason for not participating in the training organized by NIWL, more so than the economical questions. Ergonomics and organiza-tional management courses are asked for, as well as quality assurance, and chemical risk assessment. He concluded that pedagogics and the contents need to be adapted to the new demands and needs of occupational health.

The issue of decentralization and centralization in organizing occupational health and safety in the country was touched upon, and the need for competent partners in case of decentralization was stressed. Integration of curricula with the university training was also recommended. Quality management and evaluation are very important topics for the new occupational health, and training in these areas is needed. Distant learning methods should be developed to allow learning regardless of the time and place.

10. Dr. Jan Nosko described the activities of the School of Public Health established by the Nofer Institute of Occupational Medicine, Lodz, Poland. Two degrees of training are conducted, one for 3 years, and the second for 2 years. There is a renewal of physi-cians' specializing training from 1999 on. He described the entry requirements to that training. The specialization training can be given in a limited number of institutions in different disciplines. Occupational medicine has been defined as one of the main spe-cialties with 5 years of training. He emphasized the wide variety of knowledge and skills needed in occupational medicine because of the need for multidisciplinarity. Theoretical instruction, development of practical skills as well as hands-on-training all are needed. It was also mentioned that there are several forms of evaluation during the whole training period in addition to oral exams, such as practical and theoretical exams.

11. Dr. Arve Lie, National Institute of Occupational Health (NIOH), Oslo, Norway, de-scribed the training of occupational health personnel in Norway. Norway has 1.15 mill. workers with 60% coverage of occupational health services. There are 2,550 full-time employed occupational health experts. Basic training course in occupational health services (OHS) is organized by the National Institute, lasting 1 year, with 4 weeks at the NIOH. A small research project carried out in the company of the participant is also in-cluded. The course is multidisciplinary. Advanced training course for OHS is a 2-year programme, with 8x3 days are provided at NIOH. It aims at the development of profes-sional skills, OHS leadership and a Health, Environment and Safety (HES) project. Specialty in Occupational Medicine covers a 4-year postgraduate training, 1 year in OHS and 1 year in a hospital occupational health unit, 300 hours of courses, and 2 years participation in a supervision group. The aim is to have 190 specialists trained (out of 500) by the year 2000. Speciality in Occupational Health Nursing is 5 years postgradu-ate training in OHS, with supervision by a specialist. Approximately 50 specialists will be trained by 2000 (out of 800). The same programme for physiotherapists comprises 5.5 years postgraduate training, a specified curriculum, supervision by a specialist, ap-prox. 50 specialists to be trained by 2000 (out of 400). For occupational hygienists 3-5 years postgraduate training is given, no specified curriculum, individual judgement in a panel, and supervision by a specialist is organized. Approximately 70 specialists are produced by the year 2000 (out of 500). The evaluation of occupational health services was carried out in Norway, indicating that the occupational health services have a posi-tive impact even though more customer orientation communication skills are needed.

In the discussion, the competence of the trainers was taken up. The evaluation proce-dures were mentioned as one form of quality assurance, but in general the quality assur-ance of trainers could be organized more efficiently.

12. Dr. Brigitte Froneberg, Federal Institute of Occupational Health, Germany, described the training of occupational health personnel in Germany. She mentioned that 99.9% of people in Germany are insured within the general health system. Occupational health service is a separate service system. Training in occupational health is organized for employers and employees and for the multidisciplinary occupational health team. Ger-many provides occupational health and safety to 36 mill. employees, there are 12,800 occupational health physicians (OHPs) (1/2796) and 70,000 safety specialists (1/514), labour inspectors number 1/716 enterprises, and technical inspectors 1/965 enterprises. She also described the new demands set by the changing working life. 97.4% are small enterprises employing less than 50 employees, and 86.4 employing less than 10 em-ployees. Noise, heavy lifting, and psychosocial problems are on the top of the com-plaints of workers according to various surveys. 20,734 cases of occupational diseases have been recognized. The quality assurance of occupational health services has been developed. OHPs have a 4-year training with certification. Assistant personnel have 160 hours of training, and they also have an examination. Management skills and learning in customer-oriented services are needed in the training of occupational health profession-als. She concluded that there will also be a change in the understanding of the company management systems to meet the demands of the 21st century to a more systematic and thinking direction. Also the self-employment and atypical work will put more pressure to find new ways for occupational health services to act, providing a proper flow of in-formation. The so-called employer model developed in Germany consists of training and information support to employers of small enterprises, 16 hours in 4 weekends, with a refresher course every 4 years, since it is difficult to cover the small-scale enter-prises with occupational health services. The idea was to find a way to train the manag-ers of small enterprises, and motivate and encourage them to use appropriate and com-petent advice of OHS when needed.

Discussion

13. The quantitative need for occupational health and safety professionals was discussed. The capacity of the expert communities for training should be improved. Distant learn-ing can be a good answer in some areas, but in many new competence areas it is not a proper solution. The authorities and the state should take care of the infrastructures needed for training of occupational health and safety experts. Also, the demand for training in occupational health and safety was questioned. Occupational health authori-ties need to create the pressure and demand for trained occupational health and safety experts. Also, if the resources are scanty various alternative ways to improve occupa-tional health and safety at the workplace level need to be considered (e.g. internal con-trol). It was found that the numbers vary from country to country but there is a rough understanding how much occupational health service manpower is needed in the im-plementation of good occupational health practice. The number of occupational health personnel sufficient for the needs of the modern work life was discussed.

14. The Chair summarized that the work life is changing, with the old problems remaining and new problems emerging. Expertise is needed for both. Expertise and resources should be primarily allocated to prevention and promotion. The curative care that is at risk to become an endless need is also important to consider for example, in the issues of work ability. The volume of curative services, however, needs to be limited to the level relevant for the overall objectives of occupational health services.

Making allies, using competent mediators and doing as much as collaboration as possi-ble were called for. Self-steering models should also be investigated. Mental models are often developed on the basis of large enterprises, whereas the reality in most countries lies on the vast majority of small enterprises. Various models for providing occupa-tional health services to small enterprises should be innovated, such as improving advo-cacy and communication programmes, showing economic appraisal results, developing self-steering models, etc.

Working Group Reports

The questions for Group Work 1 are attached as Annex 3.

15. Report from Group 1 (Rapporteur: Gunborg Jungeteg, Sweden)

Before summarising answers to the questions which had been disseminated the group thought about the general conditions of a presumed occupational health service that should be the basis for the discussion. It was agreed that the most common situation is the so-called free market where the occupational health services act as a supplier and the enterprise as a customer.

In order to eliminate presumed risk factors the following process was suggested: An analysis and action process should be anchored

• by opening a dialogue with relevant people in the enterprise, like the employer and employee representatives
• the dialogue should have the aim to identify indicators for the analysis of the risk, specify objectives for measures and establish the internal and external resources that can be activated in the process of eliminating the risk.
• A risk assessment on the basis of the agreed indicators and objectives should be carried out.

On basis of the result of the risk assessment the process can go into a second phase starting with a new goal setting dialogue with the company management and workers in which the implementation of the measures agreed upon should be the main topic.

Regarding necessary experts in a presumed OH Service the group was in agreement that it depends on the demands of the customer and the needs of the separate situation. A general attitude was that every occupational health service unit should be able to supply access to all sorts of experts like occupational health physicians, occupational health nurse, physiotherapist/ergonomist, occupational hygienist, safety engineers and even occupational health educators. The OH Services of today may also need marketing spe-cialists to be able to reach even the small and medium-sized enterprises as customers.

Regarding training of OH experts the group found that the following areas should be covered:

• High quality basic training
• Interdisciplinary training
• Training in team skills
• Training in evaluation of own and customers' actions
• Tacit knowledge
• Ability/understanding how to maintain knowledge
• Understanding and training of proactive actions in the contact with the enterprises
• Training in negotiation skills.

The education of occupational health experts could be carried out in a country, regard-ing very specialised areas, by a national training centre. There should, however, be re-gional possibilities for training of basic occupational health skills.

As pedagogical methods the group suggested that a high degree of experiential tech-niques should be used and that multidisciplinary group activities could give valuable training for the future professions. Research methods and assessment/evaluation tech-niques are necessary for the experts of OH Services as well as ICT-skills. Multi-facto-rial etiology was agreed to be the focus in the education of occupational health experts.

An additional question about the number of occupational health experts needed was an-swered with the following statement: some countries have knowledge about the num-bers needed, others may not. The conclusions were left to the 7th Meeting in Norway in 2001.

16. Report from Group 2 (Rapporteur Brigitte Froneberg, Germany)

Group 2 identified the list of important actions, such as risk assessment, health surveil-lance, priority setting, and all this needs to be communicated in the company. Compe-tencies needed in occupational health services are determined by the tasks to be done, taking into consideration the changing work life, the competence area of the experts is wide. Health professionals, safety professionals, psychologists, hygienists, nurses should all preferably be trained in managerial tasks as health and safety managers. Spe-cific skills and specialized knowledge of the experts need to be defined. In addition, special topics such as economics, customer orientation and ethics should be included in the curricula. Concerning the needed training capacity, it is important to improve knowledge and raise awareness. Use of Internet should be made more efficient, as well as networking.

17. Report from Group 3 (Rapporteur Trygve Eklund, Norway)

The Group found the following skills important for the occupational health specialists: More communication among those concerned (not only experts) is needed, because em-ployers need to be convinced about the priority value of occupational health and em-ployees must be informed about occupational risks. Concerning the professionalism, the OHS should have the professional skills needed to handle the problems of the firm, they must employ multidisciplinary teams and economic analyses in companies are needed to convince employers about the occupational health needs. The OHS need to take part in the action planning of preventive measures, and at the company level economic ef-fects (or appraisals of them) should be reported for OHS actions.

Concerning the question on the expertise needed in occupational health services, the Group concluded that it depends on several factors, such as kind of firm/company, ex-posures, ergonomic situation, organisation and psychosocial factors - different experts are needed for different problems. Experts need to adapt themselves in the future to the Internet services, and their role may even be to supplement the Internet services. Con-cerning the leadership of an occupational health team, the Group had two various ap-proaches: either the team manager should be an occupational health expert, or the team manager must be a good manager, not necessarily an occupational health expert but in that case an occupational health expert must be included in the team.

Concerning the training needed for the occupational health experts, the Groups con-cluded that "competence to get things done" should be given a priority, skills in psy-chology and human relationships, salesmanship skills, as well as traditional professional skills were assessed crucial after having completed the basic training

Speaking about the needed training capacity, the Group concluded that a system is needed to map the needs and assess the current training capacity (and future capacity needs). In addition, more professionals are needed in several countries; many experts are close to the retirement age. Team training is also needed, trainers must be trained, and employers should be trained as (occupational health could be included in all basic school curricula).

As to the pedagogical models, the group divided the methods according to the type of knowledge to be transferred: Mainly tacit or mainly explicit knowledge. In the transfer of tacit knowledge: Master/apprentice model is the most effective, learning by peers and learning by role model inspiration (imitating good/skilful persons) can also be used. In the transfer of explicit knowledge: Information technology could be utilized to a great extent. In addition, problem-based learning should be used when it is feasible

As an answer to the question concerning the numbers of experts needed, the Group concluded: How can the desirable number of experts in relation to the number of work-ers be determined? The types and numbers of experts must depend on the types of workers, legislation may govern the types and numbers of experts, market economy alone may not support a high number of experts. Also, many experts are approaching the retirement age: If the number of experts shall be maintained, they must be replaced.

Education and training of employees and employers

The Training Session was chaired by Professor Bengt Knave, Sweden.

18. Ms. Eivor Nilsson, Sweden, described the goals of the Joint Industrial Safety Council (Prevent) of Sweden. It produces training materials in the field of occupational health and safety. The materials have been translated into many languages, e.g. Polish, Rus-sian, Chinese, Japanese, Swahili, etc. in collaboration with the ILO. Problem areas dealt with are ergonomic hazards, knowledge concerning economics and work environment, as well as stress, organization and burnout. The Council organizes annually numerous training courses in Sweden.

Every worker at the workplace needs to think about health and safety, regardless of the task and position. The courses are tailor-made so that they allow dealing with the own questions of the workplace in concern and problems of each trainee. The whole training starts with the analysis of the needs of the company, what is really needed. The activi-ties of the Joint Industrial Safety Council are funded by selling materials and training courses, and through various grants for projects.

19. Dr. Gun Nise, NIWL, Sweden representing International Occupational Hygiene Asso-ciation (IOHA), introduced the activities of the IOHA from the viewpoint of certifica-tion of occupational hygienists. For the IOHA Blackpool workshop in 1995, an inven-tory was made of existing certification systems for occupational hygienists. She de-scribed the IOHA International Certification whose aim is to facilitate the comparison of education and competence, avoid unnecessary restriction, to share technical informa-tion, and to develop quality assurance to education and training and competence of oc-cupational hygienists. Norway and Switzerland have implemented the certification sys-tem since 1995 and several countries are preparing a similar scheme. The aim of the later IOHA Workshop in 1999 was to ensure the quality assurance in occupational hy-giene. The workshop recommended a model certification programme with minimum requirements, the establishment of the IOHA Recognized Certification Board, request-ing IOHA to explore methods for assuring 'mutual recognition' of certification between national boards.

20. Dr. Elena Miloutka, Medical Academy of Postgraduate Studies, St Petersburg, Russia, described occupational medicine in Russia. Occupational medicine is directed by two ministries, Ministry of Public Health and Ministry of Labour. Occupational hygienists work as independent experts. Experts in occupational safety are engineers and educated in technical universities. Two types of medical specialists are trained, one for preven-tive occupational hygiene and one for occupational medicine. Occupational hygienists in Russia are medical doctors by educational background, but they do not have the right to treat patients. She described the hours of training for various specialities. Occupa-tional health and safety are regulated by a number of laws. Training courses in occupa-tional diseases cover 144-216 hours. Certification of health care services is used to stimulate the quality of the services. The transition process in Russia has had an influ-ence on the flexibility of the postgraduate training. Various new methods are taken into use, but the distant learning meets some difficulties because of the lacking equipment. Training of employees is insufficient, and radio and TV programmes and discussions are also used to increase awareness.

21. Dr Axel Wannag, Arbejdstilsynet, Norway, introduced to the workers' and employers' education in Norway. The Workers' Educational Association in Norway provides an extensive training programme for employees. Trade unions and branches of trades or-ganize various training for workers. The '40-hour course' is a basic course in which both line managers and workers are expected to participate. Several organizations run these courses, but they need to be approved by the Labour Union Organization. Several thematic courses are also organized, e.g. on chemical safety. Employers' Federation or-ganizes training for safety leaders, with a very different professional background.

The School for Safety Engineers is run by the Norwegian Institute of Technology, and it is a fairly comprehensive training. Federation of the Norwegian Process Industries or-ganizes also a 40-hour course. Federation of the Norwegian Transport Companies is starting up a middle management training course (most of the middle managers are bus drivers). Norwegian Hospitality Association has an extensive programme of managers, including some HES elements. Employers' Confederation has collaboration with the Business Schools to survey the attitudes of managers towards HES. They aim to estab-lish programmes on HES in the training programmes in the Business Schools. This may improve the situation on health and safety in enterprises a lot in the long run. In Norway there is a negotiation going on to make an agreement on the further education of em-ployees to ensure the employability.

22. Professor Jorma Rantanen, FIOH, Finland, described the training of workers and em-ployers in occupational health and safety in Finland. Principally this training is based on occupational safety and health legislation and nowadays on the EU Framework Direc-tive. There is also a collective agreement between the social partners on occupational safety and health training on which, for example, the Occupational Safety Centre (OSC) and Trade unions' (TUC) training activities are based. He mentioned the four main or-ganizations working in the field: Occupational Safety Centre, Employers' Institute for Management (JTO), Trade unions' training organizations, and Finnish Institute of Oc-cupational Health. FIOH training is mainly directed to occupational health and safety experts, but a minor part is also directed to safety representatives and safety officers. FIOH also organizes special training for safety chiefs and safety officers who work as employer's staff members. The total volume of the training of FIOH is 20,000 training days, 300 courses annually. Occupational Safety Centre trains primarily safety repre-sentatives and members of the Safety Committees. The Employers' Training Centre for Management mainly provides training for the managers, and to some extent to safety officers.

The changes in the work life have led to declining training volumes because of the fragmentation, short-term contracts and outsourcing, etc. He described the future per-spectives to increase and intensify occupational health and safety training. This element should be integrated to the training programmes in vocational and even in secondary schools. Financing training in the fragmented work life, motivating target groups to participate in the training and training of trainers are highly actual issues. Life-long learning and maintenance of competence are also crucial issues in the forthcoming years because of the changes in the work life, but also because of the generation shift of occupational health and safety personnel ahead.

Working Group Reports

The questions for Group Work 2 dealing with training of employers and employees in occupational health and safety are attached as Annex 4.

23. Report from Group 1 (Rapporteur: Gunborg Jungeteg, Sweden)

Training of employees and employers in occupational health and safety

The task given to the group had two alternatives; to describe already existing training or to describe ideal training of employees and employers in OH&S. The Group chose to combine the two alternatives into describing the ideal training based on experiences gained from existing training sessions in the countries of the participants.

It was agreed that general issues should comprise the primary content of the training of employers and employees. Such issues are

• - national OH&S legislation
  - employer and employee responsibilities in maintaining and improving their mutual work environment
  - systems for the implementation of knowledge and measures to support/improve the work environment
  - follow-up and evaluation of measures taken
  - supportive resources in the improvement of the work environment
  - methods of risk assessment.

When discussing the question of how many employees and employers should be trained per year, the group found it difficult to define a certain percentage. In large enterprises plans could be made for the whole staff and management. It was, however, a joint view that when talking about employees and the management of small and medium-sized enterprises such estimates are difficult to make. The problem with small and medium-sized enterprises (SMEs) is to reach them and secure their interest in participating in training in OH&S. All types of methods may be used to create contact with the man-agement of the SMEs. There are the various branch organisations, local and national. The records of the Labour Inspectorate can be used to identify the companies. The training programmes need to be tailor-made to be as effective as possible. An example was described where information about a course in preventing violence in small shops was spread by young police trainees "knocking doors" at shopkeepers at the end of work hours. Contact with local trade union offices was also pointed out as a way to reach people employed in SMEs with invitations to participate in OH&S training courses.

Many types of methods were mentioned as an answer to the question "What pedagogi-cal means do you want to use in the training activities?". Traditional seminars and study circles can be used, but also role-plays and ICT-based lectures and materials like distant learning-platforms via Internet, CDs and email-networks. The choice of methods should also be adapted to the "consumer's" need of OH&S training depending on the location and working conditions of the people interested in participating in the training.

The discussion about how long the courses should be got a clear answer: "As short as possible, but as long as necessary!". The duration of effective training depends on the working conditions of the people involved. In high risk work environment adequate time must be used to study legislation and methods for risk assessment. The training methods should also allocate special time to secure proper understanding of the condi-tions. There may be different needs in that respect for employers and employees. A very important part of an OH&S training course was therefore agreed to be the studies of the impact of the training.

As organizers of OH&S training courses the Group saw many different suppliers. The occupational health services were seen as natural trainers, but also trade unions and lo-cal and regional branch organizations. There are public health organizations as well as private training units that can offer occupational health and safety training courses for both employees and employers.

For achieving the long-term impact, occupational health and safety training as a part of the educational system integrated with education in external environment issues was considered the most effective method. Examples of such development at the university level were described. Of special interest for such development are the university busi-ness and technological schools where the future enterprise management people are trained.

24. Report from Group 2 (Rapporteur Boguslaw Kedzia, Poland)

Group 2 discussed the questions on the basis of the experiences from those countries that were represented in the Group, i.e. Poland, Norway, Russia and Estonia. The num-ber of employers and employees trained in occupational health and safety in the coun-tries was relatively well known by all countries. However, more statistical data is needed to focus the training to those most in need. Also, the duration of the training was relatively well covered. The basic training varied from 24 hrs to 40 hrs. It was reported that thematic and specific courses were also organized for employers and employees in Norway and in Estonia.

Group 2 also discussed the contents of a basic course in occupational health and safety. Group agreed that the following topics should be covered during the course, and there should be an exam after the course:

• legal rights and obligations
• reporting of accidents and occupational diseases
• risk assessment covering different factors of the work environment
• risk management
• occupational safety and health management both at the national and enterprise levelsfirst aid.

Also, the question concerning the organizing body of the training courses was dealt with by Group 2. It was reported that in Estonia, the basic courses are commissioned by the Ministry and certified by private training units. In Poland, the courses are commis-sioned by the employers and the training is organized by private training units. The em-ployers ensure the quality control of training provided. In Norway, the training is or-ganized through 'agreement' between the social partners. The quality control of the training provided is also supposed to be carried out the social partners.

In comparison to the ideal training of employers and employees, it was noted that the training should be more tailor-made to suit to the needs of the specific enterprises. Group 2 concluded that the body which licences the training courses in occupational health and safety should pay special attention to the training plans and programmes of the course provider. Also, the lecturers and their competencies should be looked into, as well as the materials for the courses and also the technical facilities where the training is organized.

25. In the discussion, it was concluded that every worker and manager should know some basic things about the relation between work and health. Integrating elements of occu-pational health and safety into secondary school training programmes would be one way to ensure this. The government role was also emphasized. Higher educational in-stitutions which train managers should be included. Postgraduate training should also be strengthened and developed further. The role of trade unions was also discussed and it was concluded that it will be important to work closely with them.

Baltic Sea Network on Occupational Health and Safety

The Session was chaired by Dr. Boguslaw Baranski, WHO/EURO.

26. The current state and further development of the Baltic Sea Network (BSN) was dis-cussed. A number of important actions have been taken by the WHO/EURO to improve the countries' abilities to develop 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. Four follow-up meetings of the Network have been organized, the first one in Riga in October 1996, the second in Vilnius in September 1997, the third in Sagadi, Estonia in October 1998, and the fourth in Berlin, Germany in November 1999. The follow-up meetings have dis-cussed the substantive contents of the information that could be used through the Net-work. The Riga meeting discussed Occupational health and safety assessment and fu-ture developments of the Network, the Vilnius Meeting had on its agenda Notification and registration of occupational diseases and accidents, and workplace risk assessment, the Estonian meeting focused entirely on the development of the telematic network, both technically and substantively, the Berlin meeting on Economic appraisal of occu-pational health and safety, and Good practice in health, environment and safety man-agement in enterprises, and the Uppsala meeting on Training in occupational health and safety.

The Session on the Baltic Sea Telematic Information Network on Occupational Health and Safety made a situation analysis of the participating countries and described future perspectives for the Network development. Dr. Kari Kurppa, FIOH, gave a brief over-view of the present situation of the Network. He concluded that the work since the Ber-lin Meeting in 1999, comprised two coordinator meetings, one in Vilnius in March 2000 and the other in Helsinki in September 2000. Ethical issues in occupational health and safety were discussed, as well as the frequency of the coordinator meetings. Also, the possibility of expanding the number of participants in the coordinator meetings was dis-cussed and it was concluded that the organizing institution can invite some representa-tives of the academia related to the agenda. The information about the starting and on-going twinning projects was shared in the coordinator meeting, and the idea of ap-proaching various international organizations and funding agencies, such as PHARE was proposed in order to increase awareness about the Baltic Sea Network on Occupa-tional Health and Safety. The preparation of country descriptions concerning occupa-tional health services was decided to be done. The layout of the pages will be renewed and the new page layout will still be discussed with the WHO/EURO.

Each country described its own situation and perspectives for the development of the Network web-pages.

Country Situation
Denmark The pages have been opened. Denmark was not represented in the Meeting.
Estonia The Estonian country pages had been further developed since the Berlin meeting. Survey results concerning the working conditions in Estonia can also be found on the pages. The pages are updated con-tinuously.
Finland The list of ongoing projects of the FIOH in the Baltic countries has been updated. Most of the work input had been allocated to the re-newal of the page layout of the BSN.
Germany The pages have been stepwise developed, and the contribution of the German Institute in the interactive technical development of the pages was acknowledged.
Latvia Some new contents and information on subject areas had been added to the pages since the Berlin meeting.
Lithuania The pages had been developed further and more information sources had been included.
Norway The work had been well started. Some materials in English are miss-ing. The work is well underway.
Poland The new contents had been added mainly to the Polish language pages of the Network.
Russian Federation The pages of the Medical Academy in St. Petersburg have been well developed with a lot of information. The Training Centre was en-couraged to send a representative to the Co-ordinator Meetings in order to keep informed of the advancements in the Network.
Sweden Sweden had developed a lot of the contents of its pages especially with numerous links to other information sources.

27. Dr. Boguslaw Baranski took up the question concerning the role of the Baltic Sea Net-work in the WHO Strategy. He wished to discuss about the funding systems and lob-bying of occupational health programmes. The European Health 21 strategy defines two main objectives to promote and protect people's health throughout their lives. He also referred to the decision of the London Ministerial Meeting in 1999 concerning the HESME concept. Healthy enterprises concept was also described, consisting of the good practice in HESME and the demonstration of the HESME system to the employ-ees of the company.

28. Professor Jorma Rantanen took up the question of relevance of the burden of disease approach of the WHO. He mentioned that occupational health works at a totally different level far from clinical disease-oriented approach. The modern society should look at the early conditions leading to disease and preventive actions rather than disease burden. The work life, work ability of people and smooth operation of enterprises are affected besides the diseases also to a great extent by stress, time pressure, poor organization of work, poor or outdated competence and poor management, which are not at all reflected in the burden of disease but which still are important and call for prevention. According to Professor Rantanen, occupational health services should not be masked behind other sectors like environment, but it should be discussed on its own as an important area for providing health and safety to the 400 million working Europeans. He encouraged the new lines for thinking when selecting WHO priorities for occupational health and safety in particular.

Conclusions and recommendations

Education and training in occupational health and safety

1. Needs for training in occupational health and safety are growing for several reasons, traditional and new safety and health needs of the 400 million working Europeans, ag-ing of the existing occupational health and safety experts, the rapid structural changes in the work life, introduction of new technologies and new opportunities provided by in-formation technologies. Simultaneously the traditional hazards and exposures, risks of accidents, overloads and diseases still continue to be met at work.

Well-trained, competent experts in occupational health, occupational health nursing, occupational hygiene, psychology, physiotherapy/ergonomics and safety are needed. Curricula for each category should be generated and the competencies achieved should be proven by exams and certification. It was recommended that more experts need to be trained and the competence of the existing experts should be ensured by complementary training.

2. The changing work life calls for new contents and methods to be trained in occupational health, including the training of new skills in practices which are needed for the man-agement of new occupational health problems in new environments.

New qualitative needs for training curricula are recognized. First, the scope of training should be broader, including modern aspects of the work life, and at least a part of it should be joint training for various experts in occupational health and safety in order to support multidisciplinarity. Both the sound theoretical basis (explicit knowledge) and the practical implementation of knowledge (tacit knowledge, experience and skills to be transferred from senior experts to younger colleagues) need to be trained. Topics such as identification of hazards at work, and needs of occupational health, prevention and control of hazards, as well as promotion of health and work ability, and the evaluation of occupational health performance should be included in the training programmes.

Elements of occupational health and safety should be integrated into the training pro-grammes of vocational schools, high schools and universities, and for those providing training for forthcoming managers in particular.

3. Precise measures for the need of occupational health personnel are difficult to give due to variation in context, content of services, legal requirements, variation in target groups and clients, sector of economy, size of the enterprise, etc. Some guiding principles would be needed to make the resourcing appropriate and to enable the proper imple-mentation of occupational health programmes.

Analysis of the occupational health and safety resource allocation in countries where data are available is recommended and the results to be reported to the next Network meeting in 2001.

4. While several new problems and challenges need to be met by occupational health ac-tivities also the traditional problems such as occupational accidents, diseases, and expo-sures to heavy physical work, physical, chemical and ergonomic hazards need to be managed. This expands the scope of occupational health substantially and may further aggravate the shortage of experts. While working for better resourcing of occupational health and safety activities, new strategies should be drawn up for more effective use of limited resources which are available.

Better prioritization, collaboration with other actors in occupational health, delegation of some of the tasks from experts to the workplace level actors, effective use of new in-formation technologies and networking should be used as methods to meet the problems of growing needs of experts and constricting resources available.

5. A broad spectrum of methods for adult training are available and are continuously de-veloped by education scientists. The introduction of new technologies provide new op-portunities for distant learning, for network learning and for learning of occupational health practices. Opportunities for the production of training materials and training packages have substantially improved and have been made qualitatively more effective with the help of e.g. multimedia. In addition to the theoretical knowledge basis, also the skills for practical implementation need to be trained.

Full use of modern information technologies in both the production of training materi-als, their distribution, and in distant learning should be encouraged. Collaboration within the Baltic Sea Network in the production and dissemination of such materials and methods is recommended. Due consideration should also be given to training by doing under tutoring of senior experts (tacit knowledge). Methods and their efficiency in this field should also be researched in order to learn more about the critical factors in the implementation of knowledge.

Training of employers and employees

6. Great variation in practices, institutional arrangements, financing and volumes of train-ing of workers and employers is seen among the Baltic Sea countries. It is important to ensure certain basic training in occupational health and safety for each worker and more comprehensive training for those active in occupational health and safety. It is also es-sential that the managers, foremen and other representatives of the employer have suffi-cient knowledge and competence on occupational health and safety. The solutions to meet these requests vary widely between the countries. Due to the EU Framework Di-rective on Occupational Safety and Health (89/391) requirements certain harmonization in this type of training is foreseen.

Training of workers and employers in occupational health and safety is an essential prerequisite for practical actions for health and safety at the workplace level. Such training should be included in the basic curricula of each profession. Continuous up-dating of complementary training should also be ensured.

Mechanisms for collection of data and information on training needs, content of train-ing and ongoing training activities should be organized by the competent authorities in concern. There is also a need to find new mechanisms for the provision and funding of training in occupational health and safety for workers in small-scale enterprises and for the self-employed.

Special efforts should be undertaken to meet the training needs and to cover with training programmes the fragmented target groups in the modern work life.

Baltic Sea Network

7. The progress in developing the Telematic Network (BSN) has been positive, and the countries have perceived the Network activities as worthwhile. The idea of organizing the co-ordinator 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. The more strategic level discussions in connection with the Annual Meetings were also deemed appropriate.

The Baltic Sea Telematic Network can provide substantial support in strengthening collaboration between the institutions in occupational health and safety in carrying out training and other activities and in providing substantive information to support the content of the various programmes. The telematic network can also be utilized to inform about the available training events.

It was recommended that more substance-based information packages be included on the web-pages to provide information and also to contribute to training programmes through dissemination of training materials.

8. During the co-ordinator meetings, the topic of occupational stress was deemed impor-tant by the majority of the participating Baltic Sea countries.

It was recommended that the need for occupational stress information be analysed in the next co-ordinator meeting and then it be decided how to proceed with the develop-ment of a project on occupational stress.

9. For the time being, the costs of maintaining and developing the Baltic Sea Network have been divided so that each participating institution has covered the costs of work, WHO/EURO has partly co-sponsored the Annual Meetings, and the FIOH has covered the costs of the Co-ordinator Meetings (Nordic countries and Germany have covered travels and accommodation themselves). Some funds would be needed for more exten-sive development of various substance entities.

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. Close col-laboration between the BSN and the three PHARE Twinning projects on occupational health and safety ongoing in the Baltic countries was strongly recommended.

Other issues

10. The Meeting expressed its gratitude to the National Institute of Occupational Health, Norway, which had invited the Seventh Annual Meeting in 2001 to be organized in Norway. A topic proposed for the Oslo meeting agenda was Occupational health coun-try profiles.

11. It was agreed that the presentations of the Sixth Meeting will be published by the Na-tional Institute for Working Life, Sweden; they will also be published on the Internet. It was agreed that the papers be submitted to the Swedish Institute by 30 November 2000.

12. Poland invited the Annual Meeting in 2002 to be convened in Poland.

13. St. Petersburg will look into the possibility to invite the Annual Meeting in 2003 to St. Petersburg.

14. The participants expressed their gratitude to the NIWL for hosting the Sixth Baltic Sea Network Meeting.

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