The Cracow Seminar, October 2006 A summary of status-quo analysis of WHP in 12 AACs Elżbieta Korzeniowska Jacek Pyżalski The Polish National Centre for Workplace Health Promotion The Nofer Institute of Occupational Medicine in Łódź

1. the formal scope of occupational healthcare  the duties of the employers concerning employees’ health  legislation on WHP and HP  financing of WHP  meaning of the WHP concept (mainly according to the NCOs)  staff training for the implementation of WHP & HP  research on the WHP concept development and its promotion

2. development of structures for the co- operation between the WHP stakeholders in AACs 3. certain specificity of the post- communist countries in their process of assimilating the concept of HP/WHP and adapting its principles to the local conditions

The duties of the employers concerning employees’ health – common issues  The basic duties of employers in relation to the health of their employees are relatively similar in AACs  In general employers have to: ensure healthy and safe working conditions sometimes also assess and manage the risks inform employees about the risks train employees in work safety and hygiene The duties of the employers concerning employees’ health – common issues  The basic duties of employers in relation to the health of their employees are relatively similar in AACs  In general employers have to: ensure healthy and safe working conditions sometimes also assess and manage the risks inform employees about the risks train employees in work safety and hygiene

The duties of the employers concerning employees’ health - differences  Differences are observed in relation to periodical examinations In certain countries these are obligatory for all employees covered by the healthcare system (e.g. in Poland) In other countries there exist some selection criteria (i.e. periodical examinations are obligatory only for people working in hazardous conditions or whose work may influence the safety or health of others)  The consequences of such examinations may vary among AACs  Employers in various countries also have different obligations regarding compensation for sickness absenteeism

Legislation on HP  no AAC has a separate act exclusively devoted to HP  HP is mainly present in documents: concerning public health (Bulgaria, the Czech Republic, Estonia) or concerning health care subsystem, including occupational health care ( e.g. Poland, Slovenia, Hungary) called National Health Programmes (e.g. Poland, Slovakia) or versions thereof related to selected issues such as mental health, nutrition, drugs (Poland, Slovenia)  in most cases HP has been defined (the exceptions being Latvia and Slovenia)

Legislation on WHP  There aren't any AACs where WHP is regulated by a separate legal act  Legal acts mentioning WHP usually refer to: occupational health and safety (Bulgaria, Estonia, Slovenia), tasks of occupational medicine (Poland, Hungary) or specific health problems (e.g. drugs in Slovenia)  WHP is not at all legally regulated in Cyprus, Lithuania, Latvia, Malta and Slovakia

Legislation on WHP  Only Estonian and Slovnian legal acts contain WHP definitions: In Estonia’s Occupational Heath and Safety Act – WHP is defined as the application of work-related organizational and medical measures to prevent damage to the health of employees as well as promotion of their physical, mental and social well-being In Slovenia, in the Resolution on the National Program on Safety and Health at Work, WHP has been defined by its goals: to enable workers to work in a healthy and safe work environment; to preserve work ability and to reduce premature retirement; to reduce excessive sickness absenteeism; to prevent injuries at work, as well as occupational diseases or diseases which are caused by work, environment, lifestyle or social determinants; to enable an optimum balance between the company’s economic profits on one side and work ability of all employees on the other; to enable production of healthy and environmentally-friendly goods for people

Financing of WHP  Unfortuantely, the aforementioned legal acts are generally not accompanied by any financial solutions  In general, in AACs HP is financed ad hoc, on a case-to-case basis, which allows for the occasional carry-out of HP projects but does not give foundations for planning and implementation of a HP strategy

The WHP concept  In certain AACs the WHP concept has been developed in detail by the NCO (e.g. Poland), in others its meaning is not precisely defined, and the parameters refer for instance to the general concept of HP from the Ottawa Charter or the EN WHP documents and tools (e.g. Slovenia, Estonia)  The analysis of activities recognised by 12 NCOs as the most important for WHP indicates that most frequently WHP is understood as occupational heath and safety and/or developing safe behaviour in the work environment plus health education activities (or possibly supporting and facilitating implementation of healthy lifestyles of employees) or non-obligatory improvement of a workplace and employee premises and/or medical examinations.

The WHP concept  The implementation in enterprises/organisations of cohesive, coherent and comprehensive internal strategies on the health of employees has been assessed as the most important by NCOs from: Bulgaria, Poland and Slovenia. NCOs from the Czech Republic and Lithuania rated it the second most important, and Slovakia - the third  Empowerment of employees was the second most important according to the NCOs from Bulgaria, Lithuania, Poland and Slovenia, while it was positioned fourth in Slovakia and fifth in Latvia

Staff training for WHP & HP implementation  Generally, there are major differences among AACs concerning WHP training no professional group has HP or WHP issues within their vocational training in Cyprus, Estonia and Lithuania there are no special WHP courses in Romania most often - in AACs - HP is in the curricula for medical staff and public health specialists  in Bulgaria, the Czech Republic, Hungary, Latvia, Poland, Slovenia HP is an element of vocational training for occupational physicians  in the Czech Republic, Hungary, Latvia and Poland HP is also an element of vocational training for occupational nurses

Staff training for WHP & HP implementation  There is no AAC where HP constitutes a separate course of studies ending with a degree of Master of Health Promotion

Research on the WHP concept development and its promotion  The state of scientific research possibly supporting WHP development looks promising in all AACs  Interesting data of this sort have been collected in a definite majority of AACs - the studies were focused on: the health behaviours of employees (e.g. Lithuania, Poland) their attitudes towards occupational health and safety (Lithuania, Poland) the state of health and life, and work habits of white-collar workers (the Czech Republic) work conditions and measures aimed at WHP (Bulgaria) the motives and attitudes of the management towards OSH (Bulgaria) risk assessment (e.g. the Czech Republic, Slovakia)

the attitudes towards WHP propagating- these were checked among the following professional groups:  employers (Poland, Slovenia)  experts (Bulgaria)  occupational physicians and nurses (Poland) the state of enterprises’ activities in promoting health (Poland)

Models of good practise in the field of WHP implementation  A number of AACs presented actions which, in their opinion, could serve as MGP these were programmes carried out in specific companies (e.g. Czech Republic, Romania, Slovenia) there were also examples given of broader projects  starting with those which encompassed a few or several companies (e.g. Estonia, Slovakia)  and ending with ones encompassing whole regions, industries or even whole countries (e.g. Bulgaria, Poland)

Development of WHP structures in AACs  There is a visible development of structures and cooperation among social partners for WHP in AACs; obviously, the solutions and levels of progress vary from country to country

 Examples of the main WHP structures in AACs which participated in the ENWHP before the Dragon-fly Project Bulgaria - the “WHSP & NNHSPC” Association; the Bulgarian ”Healthy and Safe Workplace” Forum The Czech Republic - the National Forum of Health Promoting Organisations; the National Program of Health Promotion; the Non-Smoking Organisations; the Healthy Company as a Bonus for Life Hungary - the Hungarian Forum for WHP Poland - the Polish National Network for WHP Romania - the Romanian Network for WHP; the Romanian Forum for WHP Development of WHP structures in AACs

 WHP structures in AACs which became ENWHP members within the framework of the Dragon- fly Project Only in Estonia & Slovenia the process of network building was initiated before the Dragon-fly Project In the remainig countries (namely Cyprus, Latvia, Lithuania, Malta & Slovakia) the Project helped new NCOs:  identify potential social partners who would be interested in propagating the WHP concept  initiate a social dialogue on the existing conditions, objectives and means of carrying out the process of WHP structures building, which created a sound basis for the network building Development of WHP structures in AACs

HP/WHP development in the post- communist countries  The positive aspects of a communist tradition HP activities were present in ideological declarations and as part of the measures (care) undertaken by the state; such declarations have often been reflected in practice  The negative aspects of a communist tradition characteristic for the communist period treating occupational health predominantly as an ideological value led to the paternalistic (if not authoritarian) attitude towards workers in the issues of health (they have become passive recipients, devoid of the power to influence the scope and form of the services provided, sometimes even obliged to use them) neither the health of the labour force was seen as company capital nor were the expenses seen as an investment

HP/WHP development in the post- communist countries a certain lack of economic stability a shortage of public funds an instability of legal systems (frequent changes in the law) problems with creating new systems of social values high levels of unemployment illegal employment the bad financial standing of many companies (particularly the smaller ones) fiscal solutions not employer-friendly when it comes to instituting HP in companies  Exemplary issues observed in the post- communist countries constraining the WHP development

AACs’ capability of WHP development  The main factors supporting further WHP development in AACs the awareness of the political elite or representatives of NGOs and other stakeholders in reference to WHP is growing the cooperation in the field of WHP is possible due to the highly active institutions and persons who have taken on the role of NCOs of ENWHP

Thank you for your attention!