S. Lehtinen Situation Analysis Health and Safety Programs from Inputs to Outputs Domyung Paek Occupational Health Program WHO EURO

Analysis of National H & S Program  Focus on Input-Output-Outcome linkage → → Exp Assmnt, Dis Assmnt, and H & S Solution Exp Monitoring Exp Reduction Disease Reduction Exp Monitoring Disease Increase Exp Reduction versus

 Focus on whether H & S status is different by the membership history of the country  Membership EU15+ : 15+Swiss+Norway EU+12 : new 10+Bulgaria+Romania Non-EU and Others  Status of I-P-O, scope, and content of the H & S Program Analysis of National H&S Program

Questionnaire Survey  National Focal Points and CCs  20 countries had answered  Because of the nature of the questions, not all countries could have provided relevant information  The current results are still provisional, and need to be confirmed by the providers  The survey is still open, and will continue to receive responses from other countries

Analysis of Data  Noise Assessment Coverage No of workers assessed for noise exposure = No of employees in 1st & 2ndary industries  NIHL Detection Rate No of NIHL Cases per year = No of employees in 1st & 2ndary industries  Accident Report Coverage No of workers for accident rate denominator = No of economically active employees

Croatia, even with active high level of noise assessment, low rate of detection of hearing loss

Israel, with lot of hearing loss cases, still high proportion of overexposed

Noise and Hearing Loss  As noise assessment coverage ↑ → → No of Noise Induced Hearing Loss ↑  No of Noise Induced Hearing Loss ↑ → → Proportion of Noise Overexposure ↓  EU15+ countries tend to have more Hearing Loss Cases and less Overexposures than EU+12 countries

Russia, high screening level with limited detection rate of pneumoconiosis

Dust and Pneumoconiosis →  Pneumoconiosis screening coverage ↑ → Detection rate of pneumoconiosis ↑  EU15+ countries are not that different from EU+12 countries in the screening coverage or detection rate of pneumoconiosis

Asbestos and Mesothelioma →  Mesothelioma incidence ↑ → Asbestosis detection rate ↑↑  EU15+ countries tend to have more asbestosis cases detected while with lower incidences of mesothelioma than EU+12 countries

Injury Reporting and Fatality  The broader the segment from which accidents are reported, the lower the fatal accident rates  EU15+ countries tend to have a broader accident reporting base and a lower fatal accident rate than EU+12 countries

Discussions (1)  The H & S problem solving cycle is →→ not Exp Ass → Exp Reduction → Dis Reduction, →→ but Exp Ass → Dis Detection → Exp Reduction.  Here the core ideas of problem solving strategy should lie with how to link exposure assessment with disease detection, and also how to link disease detection to source control.  Many countries still show high exposure assessment coverage with no or minimal disease detections, and high disease detection rate with no source controls.

Discussions (2)  Differences in H & S among Euro member countries could be identified as expected from membership history.  Problems of H & S usually drive the program as in the case of high mesothelioma incidence that leads to even higher detection of asbestosis, but country differences could be identified.  Comparatively higher problems should be stressed and concerns be raised for each country until the lowest possible examples can be obtained. We need collective and comparative social issue making.

Discussions (3)  Scope of the H & S program is important in that the coverage determines the detection rate of NIHL and pneumoconiosis, and for accidents, it determines the over-all accident rates of the society.  Target priority may be important, but general universal acknowledgement of H & S values by the society is more fundamental to the effectiveness of the program.  Risk population is at risk, not because of high risk works, but because of acceptance of high risks for that particular working population.  Minority populations including non-standard workers and illegal migrant workers should be given particular considerations in this issue of the H & S program scopes.

Conclusions  Europe still needs a lot of work to improve H & S at work. Some countries still need more coordinated inputs. Many countries need effectiveness in the program to harvest the first meaningful outcomes. Some countries need activation of feed-back loops and extension of the scope and coverage of the program to ever neglected areas to make the system alive. Information and evidence about the functioning of the program are not collected in most countries, and we need a really good information project.  Here the evidence shows that input of the program itself can not solve the H & S problem unless it is linked to the output and then to the feed-back loop, and serious considerations and discussions should be given to devising strategies to link input to output and output to feed-back for each country.

Recommendations  Look for strategy, first from the common sense  Goal setting: Not the best ever possible textbook solutions, but the most practical alternatives from the neighboring countries → Phased and feed-backed approach: every input should get a feed-back by examining outcomes etc.  Faced with a quandary, inevitable conditions needs to be reexamined, so that current results could be the cause of the current problem, vise versa. → Social development including health and safety is the prerequisite of economic development, not the other way around.  Risk is there, not because of the risk itself, but because of the conditions that make it risky. → Socio-cultural bias against risk perception and management is the real difference between different societies, and mechanical or managerial approaches should always be preceded by cultural approaches.