How Does Medical Surveillance Contribute to the Objectives of Directive 89/391 ?

Abstract

The European Union Directive 89/391, among other stipulations, requires that the employer makes sure that employees are provided with opportunities for medical screening of possible disease related to his or her working conditions. The provisions shall conform with national legislation and/or practice, and the opportunities are to be available to everyone who desires to use them. It is further said that the services might be provided by any part of the medical system, and not only by multidisciplinary services.

The purpose of the workshop was to review what medical screening might be beneficial. There are different purposes for early detection programmes in the occupational health context. The purpose is not only to improve survival and quality of life for the worker, but also to serve as a signal system for identification of hazardous working conditions. Although the first principle is to detect and eliminate such conditions beforehand, a second line of defence or prevention is to ascertain that the measures taken have been sufficient and no harm caused.

The workshop invited some distinguished scientists from the EU and the US to address the topic from both a strategic and a clinical point of view. From the clinical perspective reviews were given of the state of the art for early diagnosis of relevant diseases like those of the respiratory, metabolic, neurological and blood forming systems. Certain regulations, such as for carcinogens, demand that medical surveillance continues after retirement age. The feasibility of such programmes, and where responsibility lies, requires thorough consideration. The relevance of pre-employment screening as a tool for prevention of musculo-skeletal diseases is another area of concern in view of recent national legislation against discrimination against the disabled.

Historically there have been different views on the role of medical screening in occupational safety and health in the different member states of the EU. The workshop considered these differences, with a view to reaching a common opinion on ways forward.

The workshop leader was A riders Englund, of the National Board for Occupational Safety and Health, Sweden. The rapporteurs were Leif Aringer, NBOSH, Sweden and Karel van Damme, Univ de Louvain, Belgium. The workshop was held in Brussels, 7–9 September 1998 at the Office of the Swedish Trade Unions.