THE WORK OF WHO IN THE EUROPEAN REGION

1984

Annual Report of the Regional Director

W ORLD H EALTH ORGANIZATION Regional Office for Europe

COPENH AGEN 1985

ISBN 92 890 1031 2

© W orld Health O rgan ization 1985

Publications o f the W o r ld Health O rgan ization en joy copyright protection in accordance with the provisions o f P ro to co l 2 o f the U niversal C op yrigh t C onven tion . F o r rights o f reproduction o r translation, in part o r in toto, o f publications issued by the W H O R eg iona l O ffice fo r Europe application should be made to the Regional O ffice fo r Europe, Scherfigsvej 8, D K-2100 Copenhagen 0 , Denm ark. The Regional O ffice welcom es such applications.

T he designations em ployed and the presentation o f the material in this publication do not im ply the expression o f any op in ion whatsoever on the part o f the Secretariat o f the W orld Health O rgan ization concerning the legal status o f any country, territory, city o r area o r o f its authorities, o r concerning the delim itation o f its frontiers or boundaries.

The m ention o f specific com panies o r o f certain manufacturers’ products does not im ply that they are endorsed o r recom m ended by the W orld Health O rgan iza tion in preference to others o f a sim ilar nature that are not m entioned. Errors and om issions excepted, the names o f p roprietary products are distinguished by initial capital letters.

P R I N T E D IN D E N M A R K

CONTENTS

Forew ord ..................................................................................................................................... ix

1. D ir e c t io n , c o o r d in a t io n a n d m a n a g e m e n t ........................................................ 1

Introduction .......................................................................................................................... 1

General programme management and development ...................................................... 1

Management ................................................................................................................... 3

Information systems ..................................................................................................... 5

Staff development and training ................................................................................... 5

External coordination for health and social development ...................................... 6

Health aspects o f disaster preparedness ...................................................................... 9

2. H e a lth sys tem in fra s tru c tu re ................................................................................... 13

Introduction .......................................................................................................................... 13

Health system development ................................................................................................. 14

Health situation and trend assessment ....................... ............................................. 14

Health planning and evaluation ................................................................................. 15

Health economics .......................................................................................................... 16

Model health care and quality assurance .................................................................... 18

Nursing ............................................................................................................................ 18

Health legislation .......................................................................................................... 20

Organization o f health systems based on primary health care ...................................... 21

Lay, community and alternative health care ............................................................. 21

Primary health care ........................................................................................................ 22

Hospitals and other health institutions ...................................................................... 24

Health manpower ................................................................................................................. 25

Public education and information for health .................................................................... 32

3. H e a lth s c ien ce a n d t e c h n o lo g y — h ea lth p r o m o t io n a n d ca re ................ 35

Introduction .......................................................................................................................... 35

Research promotion and development ............................................................................... 37

General health protection and promotion ........................................................................ 39

Nutrition and food safety ............................................................................................ 39

Oral health ..................................................................................................................... 40

Page

v

3. H e a lth s c ien ce a n d t e c h n o lo g y — h ea lth p r o m o t io n a n d ca re (c o n td )

Accident prevention ............................................................................................................42

Health promotion .......................................................................................................... ......44

Protection and promotion o f health o f specific population groups ............................. ......45

Maternal and child health ................................ .................................................................45

Sexuality and family planning ............................................................................................47

W orkers’ health ............................................................................................................ ......49

Health o f the elderly ............................................................................................................50

Social equity and health .....................................................................................................51

Protection and promotion o f mental health ............................................................................52

Psychosocial factors and mental health ...................................................................... ......52

Prevention o f alcohol abuse ............................. ........................................................ ......54

Abuse o f psychoactive drugs ........................................................................................ ......55

Promotion o f environmental health ................................................................................... ......56

International Drinking Water Supply and Sanitation Decade ......................................56

Environmental health in rural and urban development and housing .................... ......60

Control o f environmental health hazards ................................................................. ..... 61

Chemical safety programme ........................................................................................ ..... 65

Diagnostic, therapeutic and rehabilitative technology .................................................... ..... 67

Clinical, laboratory and radiological technology ...................................................... ..... 67

Pharmaceuticals and drug utilization ........................................................................ ..... 69

Disability prevention and rehabilitation ......................................................................... 72

Prevention o f blindness ................................................................................................. ..... 72

4. H e a lth s c ien c e a n d te c h n o lo g y — d is ea se p r e v e n t io n a n d c o n t r o l . . . . 77

Introduction .......................................................................................................................... ..... 77

Malaria and other parasitic diseases ................................................................................. ..... 78

Expanded programme on immunization, bacterial, viral andmycotic diseases, and zoonoses ................................................................................... ..... 79

Cancer ..................................................................................................................................... 80

Cardiovascular and other noncommunicable diseases .................. ................................ 81

Smoking ................................................................................................................................. 84

VI

5. Programme support .......................................... ....................................... 87

Introduction .......................................................................................................................... 87

Health literature services ..................................................................................................... 87

Publications ..................................................................................................................................... 88

Personnel .......................................................................................................................................... 90

G eneral adm inistration and services ............................. ........................................................ 90

Budget and finance .............................................................................................................. 91

Maps showing the distribution o f health centres in Greece and Spain

(between pages 24 and 25)

Annex 1. A c tive and non-active M em ber States o f the W orld Health O rgan ization,European R egion , 31 D ecem ber 1984 ......................................................................... 93

Annex 2. Estimated populations in 1984 fo r the active M em ber States o f theW H O European Region ................................................................................................. 94

Annex 3. Professional s ta ff in the European R egion , 31 D ecem ber 1984 ........................... 95

Annex 4. O rgan izational chart o f the Regional O ffice, 31 D ecem ber 1984 ........................ 97

Annex 5. Intercountry meetings convened by the Regional O ffice fo r Europe in 1984 . . 98

Annex 6. W H O -spon sored courses in the European R egion , 1984 ....................................... 109

Annex 7. List o f W H O co llabora tin g centres currently participating inthe Regional Office programme ............................................................................. 114

Annex 8. Tab le show ing the relationship between the regional H F A targetsand programmes ........................................................................................................ 124

Index .............................................................................................................. 131

Feature

Healthy youth: our best resource(between pages 76 and 77)

Pro fessor J o s e f Ch a rvà t (Czechos lovak ia ) , w h o d ied in 1 9 8 4 at the age of 8 7 , rec e iv e d th e Léon Be rna rd Prize in 1 9 6 8 . In his s p e e c h to the W o r l d Hea l th A s s e m b ly on tha t o c ca s io n , he ex p re sse d the v ie w tha t p reve n t i v e m e d i c in e co ve re d a w i d e f ie ld ra n g in g f r o m m o l e c u la r b io l o g y to " th e reac t ion o f m an to his soc ia l e n v i r o n m e n t " .

Pro fes so r Ch arvâ t ' s ca re e r in re s e ar c h fo c u s e d on e n d o ­c r i n o lo g y , the m e t a b o l i s m and n u t r i t i o n , and it w a s fo r his w o r k on n u t r i t i o n th a t he f i rs t b e c a m e in t e r n a t io n a l l y kn ow n. He w a s a m e m b e r of the UN A d v i s o r y C o m m i t t e e on the A p p l i c a t i o n o f S c ie n c e and T e c h n o l o g y to D e v e l o p m e n t and V i c e - C h a i r m a n of W H O ' s A d v is o r y C o m m i t t e e on M e d i c a l Research.

FOREWORD

In introducing the Regional D irector’s report on the work o f W H O during 1984, I should firs t like to reiterate the gratitude and acknowledgements expressed to D r Leo A. Kaprio p rio r to his retirement, both by the Regional Committee at its thirty-fourth session and by the Executive Board in January 1985.

Although this report was finalized only after D r Kaprio’s departure from the Regional Office, he was o f course fu lly involved with and supervised the activities described in the report, and all credit is clearly due to him fo r a ll the achievements.

The year 1984 was indeed an eventful one. The report describes activities carried out during the firs t year o f the Organization’s Seventh General Programme o f Work which covers the period 1984-1989. A major task was the form ulation and adoption by the Regional Committee o f the 38 regional targets in support o f the regional strategy f o r health f o r a ll (H FA ). This decision by the 32 active Member States o f the European Region was a historic event, since the document — together with the prelim inary list o f indicators and plan o f action — brings into clearer focus their jo in t European health policy, which itse lf was born in 1980 when the Regional Committee adopted the regional strategy f o r HFA. Each Member State is now

facing the challenge o f ensuring that its own health policies incorporate the basic principles o f the regional strategy and that targets are set in those areas which it regards as priority ones.

Hopefully, this new policy will guide the reorientation and/or form ulation o f national health policies and plans by governments (which have collectively accepted the HFA movement), and will influence the health-related work o f other inter­governmental and nongovernmental organizations. In order to develop this policy framework, an extensive analysis was made o f the health situation in Europe. The problems, constraints and difficulties which will need to be faced have been reviewed and discussed at conferences such as the European Conference on Planning and Management f o r Health, held in the Netherlands in August 1984, and the Second Conference on Immunization Policies in Europe, held at Karlovy Vary, Czecho­slovakia, in December 1984. However, government action alone will not suffice; real progress towards the regional HFA targets will require input from many professional

groups and the general public. An important event in this respect was the start o f direct dialogue between the Regional Office and national medical associations in Europe at a meeting in December, when the implications o f the regional strategy fo r the work o f physicians were discussed. I t was agreed that such dialogue should become a permanent feature and involve the medical associations o f all 32 Member States o f the Region.

A ll these aspects have been reflected in the proposed European programme budget f o r 1986/87, which was endorsed by the Regional Committee. The activities f o r that biennium will fo llow sim ilar lines to those implemented in 1984 and 1985. Thus the basic principles o f the HFA movement prevail throughout the Regional Office's programme, both at country and at intercountry levels.

The year 1984 also saw the start o f the firs t evaluation to be made by countries o f progress in implementing their strategies f o r HFA. No effort is being spared to support and assist Member States in this process. An effective and realistic analysis is essential i f the gaps and obstacles are to be identified and the necessary action taken to improve the situation. This will also enable the Organization, on request, to provide technical cooperation in the areas and countries where it is most needed.

A t the Regional Office, adoption o f the regional HFA targets was immediately follow ed by a review o f the internal structure and various management issues, with the aim o f strengthening the O ffice ’s ability to support the regional drive to­wards HFA.

Asa f irs t step towards a more complete harmonization o f all planning, m onitor­ing and evaluation processes, the introduction to each chapter in the present report tries to show the relation between the work o f the Regional Office in 1984 and the regional HFA targets which were endorsed by the Regional Committee in the same year. Annex 8 presents in tabular fo rm the current relationship between the p ro ­grammes in the 1986/8 7proposed programme budget and the regional HFA targets.

I trust that this report does justice to the unfailing efforts o f my predecessor to implement the regional programme to the satisfaction o f the Member States in the Region. This could not have been done, however, without the cooperation, support and advice o f a ll the governments, advisory bodies, collaborating centres and institutions as well as a great number o f individual experts who have participated in our efforts throughout the year. On behalf o f D r Kaprio, and in my capacity as your new Regional Director, I wish to express our sincerest thanks.

J.E. Asvall Regional Director

Dr Leo A. Kapr io.W H O ' s Regional D i r e c t o r fo r Europe f r o m 1 9 6 9 to J a n u a r y 1 9 8 5 .

Dr Leo A. K ap r io (Reg iona l D i re c t o r ) add res se s Her M a je s t y Qu ee n M a r g r e t h e II of D e n m a r k at the o p e n i n g of the th i r t y - f o u r t h sess ion of the Reg ional C o m m i t t e e fo r Europe.

F r o m l e f t t o r i g h t . P r o f e s s o r D J a k o v l j e v i c ( Y u g o s l a v i a ) , C h a i r m a n o f t h e t h i r t y - f o u r t h

s e s s i o n . D r L e o A K a p r i o ( R e g i o n a l D i r e c t o r ) , a n d D r H M a h l e r ( D i r e c t o r - G e n e r a l ) .

The re t i r i ng Reg iona l D i re c t o r , Dr Leo A. Kapr io . th a n ks Pro fes so r D. Jako v l je v ic (C h a i r ­man) fo r the t r ib u t e pa id to h im by the Regiona l C om m i t te e .

A m o m e n t of d i v i d e d a t t e n t i o n fo r rep r e se n t a t i ve s at the th i r t y - fo u r th sess ion of the Reg iona l C o m m i t t e e fo r Europe .

Dr E m i l e D u h r ( L u x e m b o u r g ) ( lef t ) pa i d w a r m t r i b u t e t o t h e r e t i r i n g R e g i o n a l D i r e c t o r ' s a c h i e v e m e n t s at a c e r e m o n y d u r i n g w h i c h t h e M i n i s t e r of S o c i a l A f f a i r s a n d H e a l t h o f F i n l a n d ,M s E. K u u s k o s k i - V i k a t m a a ( b e l o w ) , o n b e h a l f o f h e r G o v e r n m e n t , p r e s e n t e d t h e O r g a n i z a t i o n w i t h a p o r t r a i t of Dr K a p r i o .

Chapter 1

DIRECTION, COORDINATION AND MANAGEMENT

INTRODUCTION

The most important event in 1984 was the adoption by the Regional Committee o f the regional H F A targets together with a plan o f action and list o f regional indi­cators. Mechanisms were established to translate this policy basis into Regional Office programmes and to prepare for the first evaluation o f the regional strategy for health for all (H F A ) , to be submitted to the thirty-fifth session o f the Regional Committee.

The key to solving many health prob­lems lies outside the health sector. This is particularly true for the prerequisites for health, as described in the regional H F A target document, which can be met only through a concerted effort by all national and international, governmental and nongovernmental organizations. Multi­sectoral activities are required to attain most o f the regional H F A targets, and more specifically those aiming at the pro­motion o f healthy public policy (target 13) and the protection o f the environment (target 18). The Regional Office collabor­ates with several U N agencies, mostly in the field o f environmental health; joint activities have been undertaken with the Council o f Europe, particularly in the preparation o f the Second Conference o f European Health Ministers, and with the

Commission o f the European Communi­ties where the opportunity to participate in meetings o f chief medical officers is o f great value. The coordination o f different sectors and organizations is, moreover, a vital component o f the programme on the health aspects o f disaster preparedness.

The development o f health informa­tion systems capable o f supporting na­tional H F A strategies is one o f the pri­orities in the regional strategy and the subject o f regional H F A target 35. The Regional Office has worked with several countries on developing computer-assisted health information systems, while techno­logical support to the Regional Office in­formation system was strengthened in or­der to improvement management o f pro­grammes and exchange o f information with Member States. Special attention was given to the information required for evaluation o f the regional strategy.

GENERAL PROGRAMME M A N AG E M E NT A ND DEVELOPMENT

1984 was significant as the first year o f the Organization’s Seventh General Pro­gramme o f Work and the year in which the Regional Committee adopted the re­gional targets in support o f health for all

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by the year 2000 (HFA2000). A new framework is now available for health policies, and the meaning o f the “ health for all” movement in the European Re­gion has been clarified.

Addressing the thirty-fourth session o f the Regional Committee, the Director- General stressed the special role that Eu­ropean countries — with their long ex­perience and considerable resources — could play in tackling new and impending problems and in transferring knowledge and offering support to the rest o f the world. When working towards the re­gional H F A targets, the resources o f the entire Organization would therefore have to be put to the best possible use.

The Regional Director, presenting his annual report for the last time, spoke o f the broader aspects o f health and health care. In striving to reach the goal o f HFA2000, the political leadership o f each country would have to judge which health risks could be tolerated and which could not, and how potential conflicts between health interests and other interests in society might be resolved. The Organiz­ation’s role was not only to promote those preventive measures for which health ministries were primarily respon­sible, but to support all those working for health in their interrelationships with other sectors o f government and society. Dr Kaprio also highlighted the need to pay more attention to information sys­tems in the health field and to the growing problems o f environmental health where responsibility was divided between many different authorities. He emphasized that Member States had to feel that they were being correctly served by W H O in Europe and therefore human contact, at both in­dividual and community levels, had to be

kept alive by an active team spirit within the Regional Office.

The Committee’s first task was to elect a successor to Dr Kaprio and, in resol­ution EUR/RC34/R1, it proposed that the Executive Board appoint Dr J.E. As- vall as Regional Director for a five-year period from 1 February 1985. Dr Asvall had been Director, Programme Manage­ment in the Regional Office since 1979. The Board confirmed this proposal in res­olution EB75.R2.

Having reviewed the reports o f the Consultative Groups on Programme De­velopment and Budgetary Questions, the Committee then considered and en­dorsed the proposed programme budget for 1986/87 (resolution EUR/RC34/R4). Although some speakers expressed reser­vations about the exchange rate used to estimate dollar requirements, the Com ­mittee understood the difficulties the Re­gional Office was facing in view o f the uncertainty o f currency fluctuations. The Committee appreciated the real growth in the provision for country programmes; these funds would be used primarily to im­prove the health infrastructure in the coun­tries concerned and to develop human re­sources. In endorsing the proposals, the Committee also requested that priority be given to activities in support o f the re­gional H F A targets.

By resolution W H A 3 7 .12, the Thirty- seventh World Health Assembly accepted the request from the Government o f A l ­geria to form part o f the African Region. As a result, negotiations have taken place between the national health authorities and the Regional Offices for Africa and Europe regarding the transfer o f respon­sibility for administering the funds ear­marked for expenditure in 1984/85, and

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it was decided that the date for transfer would be 1 December 1984. In view o f the country’s active involvement in the programme o f the European Region dur­ing 1983 and the first half o f 1984, A l ­geria sent an observer to the thirty-fourth session o f the Regional Committee.

On the same occasion, the Regional Committee was informed o f the Govern­ment o f Israel’s request to the Director- General that the Thirty-eighth World Health Assembly consider that country’s transfer to the European Region, and an observer from Israel therefore also at­tended the Regional Committee.

Management

As requested by the Regional Com ­mittee in September 1983, the draft ver­sion o f the regional H F A target document (EUR/RC33/9) was submitted to Mem­ber States and the Regional Health Devel­opment Advisory Council (R H D A C ) for comments. The European Advisory Com­mittee for Medical Research (E A C M R ) was also asked to analyse the scientific basis o f the targets and to identify what further knowledge will have to be obtained if they are to be reached. The subsequent revision o f the target document (EUR/ RC34/7) was submitted to the thirty- fourth session o f the Regional Commit­tee, together with the list o f indicators for monitoring progress towards health for all (EUR/RC34/13) and the plan o f ac­tion for implementation o f the regional strategy (EUR/RC34/14).

While endorsing the target document by resolution EUR/RC34/R5, the Re­gional Committee requested that it be amended to take account o f constitutional provisions for jurisdiction in health mat­ters, particularly in federal states. The list

o f regional indicators and the plan o f ac­tion were also endorsed as preliminary only, to be resubmitted to the Regional Committee once the first national and regional evaluations o f the implemen­tation o f health for all strategies had been carried out.

The World Health Assembly has de­cided to monitor progress in implement­ing national, regional and global strat­egies every two years, and to evaluate the effectiveness o f these strategies every six years (resolution WHA35.23). For the first evaluation, in 1985, a “ common frame­work and format” (D G O /84 .1) suitable for all regions o f the Organization has been drawn up. This is not a W H O ques­tionnaire, but a document which the coun­tries themselves can use to evaluate the progress o f their national strategy and thereby develop their health policies. This document, together with an addendum for the collection o f information on the preliminary list o f indicators, was sent to Member States in November. Information on many o f the indicators is already avail­able in the Regional Office, so data sheets containing this information have also been sent to Member States for updating. National and regional reports will be in­cluded in the Seventh Report on the World Health Situation, to be published in the second half o f 1986. On the recom­mendation o f the Consultative Group on Programme Development (C G PD ), a sub­committee met in June to consider how best to guide national health administra­tions in preparing their evaluation re­ports, while a group o f experts was con­vened to draft a document on the regional indicators.

The programme budget adopted at the thirty-fourth session o f the Regional Com­mittee contains not only the goals for the

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1986/87 period but also preliminary tar­gets for 1988-1991. In all cases, the links between European regional programmes, those o f W H O headquarters and other organizations have been shown. The re­gional strategy for health for all by the year 2000 has been taken into account when drawing up priorities and allocating resources. This has led to the creation o f completely new programmes from 1984 onwards as well as major changes in some existing programmes.

Among intercountry programmes, em­phasis has been placed on the development o f information systems, health education and health promotion, the International Drinking Water Supply and Sanitation Decade, accidents, chemical safety and cardiovascular diseases. The C G P D felt that more funds should be allocated to programmes on alcoholism, smoking and rehabilitation. Greater priority has also been given to publications and training courses.

The network o f W H O collaborating centres is to be expanded, and a larger share o f programme activities will be del­egated to them. The same number o f con­ferences will be organized in 1986/87, while there will be fewer working groups than in the 1984/85 biennium.

Over the past few years, the Regional Office has produced long-term policy guid­ance, in the form o f the regional strategy, and medium-term programmes with spe­cific targets and activities. Attention is now being focused on evaluation mech­anisms and, concurrently, on improving the information base. Programmes are evaluated every second year. In 1984, in­tercountry activities were assessed for rel­evance, adequacy, progress, efficiency, ef­fectiveness and impact, with reference to

country programmes when appropriate. The conclusions will serve as a basis for preparation o f the 1988/89 programme budget.

The advisory group on management o f the Regional Office (G R E M ) reviewed the plans for rationalization and further development o f the text and data process­ing equipment in the Office. Special em­phasis was placed on making it easier to exchange information with Member States and to access the data bases being devel­oped at the Regional Office.

Country activities

Country programmes are being given priority; medium-term plans have been drawn up with the German Democratic Republic, Greece, Hungary, Portugal, Spain and the USSR, and preliminary proposals negotiated with Albania, M o ­rocco and Turkey. Programme planning visits were made to Albania, the German Democratic Republic, Hungary, Malta, Morocco, Turkey and the USSR; the Por­tuguese Minister o f Health visited the Re­gional Office with senior staff for the same purpose.

Bulgaria. The eighth session o f the joint coordinating committee for the Bulgaria/WHO cooperative health pro­gramme took place in Sofia in February. Twenty-five interregional courses were held during the period 1976-1983, pro­viding training for 200 fellows from 94 dif­ferent countries o f the six W H O regions.

A workshop was convened in January to review the results o f evaluation o f the mass screening carried out in the Gabrovo area during the past 10 years. The partici­pants included two W H O consultants and a staff member from the Regional Office, together with 20 Bulgarian scientists.

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The Regional Office has been actively involved in drawing up a master plan for informatics support to the Organization.

The new equipment for integrated, in­teractive and decentralized data and text processing was installed in the Office, in­cluding a high-speed network to support communication between the central pro­cessing units. Work started on converting application software, and technical staff received training in the use o f the new equipment. Briefing sessions for all staff are also under way. With the collaboration o f the Data Processing Centre (U D A C ) at the University o f Uppsala, a data base management system was installed, and the health legislation notification appli­cation was transferred from U D A C to the Regional Office. A programme manage­ment system, a general bibliographic sys­tem and a system supporting the statisti­cal data base for H F A are also being de­veloped with U D A C assistance. A great deal o f support in terms o f manpower and processing time was given to analysing replies to the consultation letter and the regional H F A target questionnaire.

In preparation for the regional evalu­ation report to be presented to the thirty- fifth session o f the Regional Commit­tee, and as a fo llow-up to resolution W H A37.17 on monitoring progress in im­plementing strategies for HFA2000, a special session was organized at the Re­gional Committee to brief representatives from Member States on the use o f the common framework and format (D G O / 84.1). The briefing session included a demonstration o f a graphical, computer- assisted technique for evaluation o f the H F A strategy and constituted the first step in the process o f assisting Member

Information systems States, as required, with information sys­tems and data collection.

The Office co-sponsored the Fifth International Congress o f the European Federation for Medical Informatics in September and continues to participate in the International Medical Informatics Association’s working group on data protection.

Country activities

The possibility o f developing a two- way computer-based text and data ex­change between the Regional Office and Member States has been actively investi­gated with Hungary, Malta, Norway, Po­land, Portugal and Sweden, particularly in the context o f the regional indicators.

Yugoslavia. The Regional Office con­tinued activities, with U N D P financing, under the project to develop a computer- supported health information system. A study tour to France, the Federal Repub­lic o f Germany and Sweden was organ­ized for national staff.

S ta ff development and training

There was a general upswing in SD T activities in 1984. This can be attributed to the adoption o f computerized proce­dures, the extension o f the group training calendar and the involvement o f special­ized staff in a more structured group briefing programme. More than 20 staff members received on-entry briefing on W H O , and 10 professionals further con­solidated their knowledge o f global ob­jectives and strategies at briefing sessions in headquarters.

The in-house language training pro­gramme in English, French, German and

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Russian continued with regular classes, and a second-level self-learning cassette programme was installed for individual use. Fourteen people passed the UN lan­guage proficiency examinations.

In addition to secretarial training, some 100 general service and professional staff attended management and teamwork courses arranged for whole services at a time. Others attended courses on time management and on the organization o f meetings, while a one-week special man­agement course was held for directors and administrative assistants. Tw o courses dealing specifically with evaluation re­viewed the results o f the training series on health services management in Edinburgh and on the managerial process for na­tional health development in Leeds.

In the course o f the year, 16 staff members undertook individual training in managerial, technical and linguistic subjects to strengthen performance and personal effectiveness.

External coordination for health and social development

Several declarations o f intent and agreements with other UN agencies signed during 1984 have clearly demonstrated their intention to avoid overlapping and duplication, as well as to improve con­sultation, joint planning and program­ming, allocation o f tasks, and coordinated action. Current work with nongovern­mental organizations is described in the individual programme statements.

On 16 October, the Regional Director Designate attended the opening session o f the Venice seminar on economic, scien­tific and cultural cooperation in the Med­iterranean within the framework o f the

results o f the Valletta meeting o f experts. The Director, Development o f Compre­hensive Health Services, who also at­tended, spoke about W H O programmes on the health o f the elderly, in prepara­tion for group discussions in which demo­graphic trends and population dynamics were an important element.

During the year, a total o f 824 invi­tations to meetings were received, includ­ing 64 from organizations within the UN system, 51 from intergovernmental organ­izations and 36 from nongovernmental or­ganizations, o f which 220 were accepted. Some 32 representatives o f other organiz­ations attended meetings organized by the Regional Office.

Council o f Europe (C E )

The Regional Office was represented at the multidisciplinary symposium on health problems in the world o f work, held by CE in Paris in May.

In collaboration with CE, mental health services were reviewed prior to the preparation o f papers for the Second Conference o f European Ministers Re­sponsible for Public Health, to be held in Stockholm in 1985. These papers will cover the organization o f preventive ser­vices in mental illness and the promotion o f mental health. The Conference is ex­pected to draw attention to those issues that require further collaborative study by intergovernmental organizations.

Cooperation is continuing in the fields o f health promotion, postbasic training o f nurses and the reduction o f hospital costs, prevention o f hospital infections, pharmaceutical products, the European pharmacopoeia, drug addiction, and toxi- cological and microbiological control o f

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foodstuffs. Higher education and research, and unemployment are also areas o f mutu­al concern.

Commission o f the EuropeanCommunities (C E C )

The CEC Director-General for Em­ployment, Social Affairs and Education, accompanied by senior staff, visited the Regional Office in March. Working re­lations with the Directorate o f Health and Safety are developing, and activities are being carried out in the fields o f edu­cation, vocational training, health policy and employment. Contacts are being ex­panded to involve other Directorates- General concerned with consumer pro­tection, product safety, and medical and health research.

The Office was represented at the tenth annual general assembly o f devel­opment NGOs, organized by the Liaison Committee o f Development NG O s to the European Communities in Brussels in April.

The Director, Programme Manage­ment, and a consultant in communicable diseases attended the meeting o f chief medical officers o f the EEC in Rennes in April, and the Director, Development o f Comprehensive Health Services, attended their meeting in Bonn in December.

Council f o r Mutual EconomicAssistance (C M E A )

Dr S.A. Siagaev, Chief, Health De­partment o f the C M E A , attended the Re­gional Committee. On that occasion, he expressed his organization’s desire for greater involvement in European activi­ties o f mutual interest.

Organisation fo r Economic Co-operationand Development (O E C D )

The Office was represented at the second meeting o f O E C D ’s high-level group on concepts and methodologies for integrated safety programmes, in Ottawa in March. Cooperation continues in the fields o f health economics and environ­mental protection.

European Centre f o r Social WelfareTraining and Research (E C SW TR )

Following the visit to the Office on 30 March o f Dr H. Nowotny, Executive Director o f ECSW TR, to review areas o f common interest and to explore possibili­ties for future collaboration, a memoran­dum o f understanding was signed in Sep­tember with a view to promoting cooper­ative ventures.

The Regional Office was represented at the tenth anniversary celebration and the eleventh annual meeting o f the Board o f Directors o f EC SW TR in December.

International Institute f o r AppliedSystems Analysis ( I I A S A )

I IA S A was represented at the W ork­ing Group on Acid Rainfall in Relation to Human Health, organized by the Office in Berlin (West) in July.

Other organizations

A memorandum o f understanding has also been signed with the Turkish and International Children’s Centre, covering joint cooperation in health and health- related research.

The Office was represented at seminars run by the International Rehabilitation

7

and Research Centre for Torture Victims in Copenhagen on the examination and treatment o f torture victims and their families.

The International Council on Social Welfare’s coordination group for the Eu­ropean Region visited the Regional Office on 14 February.

Collaboration with the United Nations system

In recent years, a number o f resolu­tions and decisions have been adopted by the U N General Assembly and the Econ­omic and Social Council o f the U N which are o f immediate concern to the Regional Office in that they have a direct bearing on health, environmental and socioecon­omic programmes.

By resolution 37/16 o f 16 N ovem ­ber 1982, the United Nations General As­sembly declared that 1986 would be pro­claimed the International Year o f Peace on 24 October 1985, the fortieth anniver­sary o f the United Nations. Regional preparations are being made in view o f the fact that W H O and many other agen­cies o f the U N system have declared their interest in participating in this event.

T o strengthen relations with UN agen­cies at country level in the European Re­gion, where Resident Coordinators have been nominated by the UN Secretary- General, the Regional Director has con­firmed the appointment o f senior W H O field staff to serve as liaison officers in Greece, Morocco and Turkey.

The Regional Director visited senior officials o f the U N Department o f Inter­national Economic and Social Affairs

and o f U N D P , U N F P A and U N IC E F in New York in March.

The U N R W A Director o f Health paid an official visit to the Regional Office in July, during which matters o f common interest were discussed.

At the International Conference on Population in Mexico City in August, the Director-General o f W H O emphasized the importance o f improving health stan­dards for all and said that special atten­tion should be given to maternal and child health services within the primary health care system. The representatives o f the Regional Office for Europe urged del­egations to keep in mind the Declaration o f Alma-Ata, by having part o f it in­cluded in the Mexico City Declaration on Population and Development.

United Nations DevelopmentProgramme (U N D P )

In the framework o f the U N D P pro­gramming process at country level, the Regional Office has intensified its con­tacts with the U N agencies, recognizing the importance o f ensuring that the tech­nical cooperation activities of the U N sys­tem respond to the changing development needs and specific requirements o f indi­vidual countries.

U N D P has recently issued a new sec­tion o f its operational manual, intended to brief U N D P staff in field offices on the concept o f primary health care at com­munity level.

One important feature o f cooperation within the United Nations system is the Regional Office ’s participation in the UNDP-supported project for European

coopération on environmental health as­pects o f the control o f chemicals, in as­sociation with F A O , IL O and U N ID O . An evaluation mission visited four coun­tries (Poland, Portugal, Romania and Turkey) during the summer.

The Office is the executing agency for a total o f 18 UNDP-financed projects in10 countries o f the Region, focusing main­ly on different aspects o f the environment and relating to the International Drinking Water Supply and Sanitation Decade. Sev­eral countries o f the Region have signed or indicated their acceptance o f the new stat­ute o f the Mediterranean zoonoses con­trol programme.

The U N D P Resident Representative in Morocco visited the Regional Office in November and the Chief o f the Unit for Europe paid a visit in early December.

United Nations Economic Commissionf o r Europe (EC E )

W H O cooperates with ECE on work carried out in connection with the Con­ference o f European Statisticians. Other activities cover fields such as long-range transboundary air pollution; acid rain; water problems; low-waste technology; housing, building and planning; and road traffic accidents.

United Nations EnvironmentProgramme (U N E P )

W H O was represented at the extra­ordinary meeting o f the contracting par­ties to the Convention for Protection o f the Mediterranean Sea against Pollution and its related protocol; the Regional O f­fice, through its staff in Athens, organizes

all health-related development work with­in this programme. The Office maintains close cooperation with U N E P on housing hygiene and environmental health in the planning o f human settlements.

U N E P continued to support activities concerned with the monitoring o f both water and air, under the Global Environ­mental Monitoring System (GEM S).

A paper was prepared jointly with U N E P ’s Regional Office for Europe in Geneva on the transfrontier transport o f hazardous waste and was submitted to a U N E P conference on hazardous waste in developing countries, held in Munich in February.

United Nations Children’s Fund (U N IC E F )

The cooperation maintained with the U N IC E F Offices for Europe and the Middle East and North Africa is a reflec­tion o f the collaboration at global level in the W H O / U N IC E F joint committee on health policy.

Mr V. Soler-Sala, Director, U N IC E F Office for the Middle East and North Africa, attended the thirty-fourth session o f the Regional Committee.

Health aspects o f disaster preparedness

The potential recurrence o f natural disasters and the great damage inflicted, in human and economic terms, call for active preparedness on the part o f both governments and intergovernmental or­ganizations.

W H O ’s programme in Europe has two thrusts: first, to develop guidelines to enable Member States at risk to cope by

9

themselves, in the immediate aftermath o f the disaster, until the requested outside relief arrives; and second, to ensure that the Regional Office is able to respond immediately and adequately to requests from Member States when a disaster has struck.

A manual on the role o f primary health care in disaster preparedness and relief has been prepared for publication. The Office is establishing a task force o f assessors made up o f outside experts and staff members who will be sent to Member States, on request, to help in the after- math o f disasters and in the preparation o f national programmes.

To strengthen its ability to respond promptly and adequately to requests from Member States, the Office has also estab­lished a standing steering committee.

A workshop on the health aspects o f disaster preparedness was held in Trieste in October, at the invitation o f the Italian Government, and was hosted by the Re- gione Friuli Venezia-Giulia. There were 22 participants from the European Re­gion, nine others from Africa, the A m ­ericas, the Eastern Mediterranean and South-East Asia and two officials from the United Nations Development Pro­gramme.

The workshop focused on prepara­tions for the immediate aftermath o f a disaster, including rescue and first aid in the phase o f isolation before external aid can be mobilized and delivered. Planning, as well as education, is required at all levels to enhance the affected community’s abil­ity to cope. The aim o f the workshop was to consider the content o f guidelines not only on the health aspects o f local and national planning, but also on education and training programmes for the com­munity and relevant personnel.

Conclusions and recommendations highlighted the need for comprehensive data on which to base analyses o f vul­nerability, prediction o f risks, mapping o f environmental hazards (including chemi­cals), and provision o f logistic facilities (mainly transport and communications).

It was stressed that disaster manage­ment at the community level, especially in the immediate aftermath o f a disaster, should be part and parcel o f primary health care as defined at the International Conference on Primary Health Care in Alma-Ata in 1978. The self-reliance o f the community should therefore be enhanced by all possible means, and training in first-aid emergency procedures and hos­pital treatment should be given, with dif­ferent priorities, to health workers, health- related professionals and the public.

10

Proposed budget for country and intercountry programmes, 1984/85, revised position, and expenditure as at 31 December 1984 (U S $ )

DIRECTION, COORDINATION AND MANAGEMENT

Proposedbudget

Actualbudget

allocationExpenditure

Regular funds 5 947 400 4 956900 2 395 924

UN funds — 9 874

Voluntary funds 133 900 1 V' 900 56 775

6081 300 5 090 800 2 462573°

° Being 16.54% of total expenditure.

Documents issued in 1984

Information exchange and collaboration in health-related activities in Europe: report on a W H O meeting (document ICP/CM B 002(2)).

11

Chapter 2

HEALTH SYSTEM INFRASTRUCTURE

I N T R O D U C T I O N

Regional H F A targets 15 and 35 are concerned with disseminating information and making it easily accessible to the pub­lic. T o this end, information is being dis­tributed more rapidly to the media and meetings on key issues are being organ­ized with journalists. The traditional cel­ebration o f World Health Day is one way o f communicating W H O ’s message and more use is being made o f this occasion. A new initiative in 1984 was the start o f a series o f summer seminars on health pro­motion for health education personnel, designed to improve the coordination o f training in this area by different ministries and professional groups.

The shift from concepts and philos­ophies to the organization and functions o f primary health care is reflected in the regional H F A targets 26, 27, 28, 29 and 30. The Conference on Primary Health Care in Industrialized Countries, held in Bordeaux in 1983, stressed the importance o f planning based on needs, as well as self-help, community participation, the training o f health personnel oriented to­wards the community, teamwork and in­tersectoral cooperation, and appropriate information and monitoring systems. The new programme giving priority to the or­ganization o f the hospital sector within

the health care system is in line with tar­get 26.

Health manpower development ef­forts during the year aimed at strength­ening national health policies in support o f the H F A movement and introducing managerial mechanisms for putting that movement into effect, in line with regional H F A targets 27, 33, 34, 36 and 37. The European Conference on Planning and Management for Health, as a forum for the exchange o f opinion on and experi­ence with different managerial processes, stressed the importance o f intersectoral cooperation, the problems o f community participation and the need for a proper balance between centralization and de­centralization. It came out in support o f a flexible approach to planning but, at the same time, advocated clearly defined plan­ning processes. The scenario technique, already successfully used in Finland, the Netherlands and Sweden, attracted the attention o f several other countries will­ing to check its value as a tool in the planning process.

The study on trends in health legis­lation in Europe, which has just been completed, and the impact o f the new international course on health legislation will, it is hoped, serve as a basis for na­tional efforts to harmonize health policies and strategies with the principles o f H F A

1 3

and to put those policies into practice, as expressed in target 33. The economic evaluation o f health care strategies now goes beyond the health services and con­siders the implications o f health strategies in other sectors. This should stimulate progress towards the attainment o f tar­gets 27 and 34. New methodological ap­proaches to manpower planning and a fresh look at the question o f medical spe­cialization in relation to the development o f health services and the needs o f the community are directly related to regional H F A target 36.

The nursing programme, which relates to targets 28, 29, 30, 36 and 37, covers nursing research, management training and education. In 1984, a particularly significant event was the Symposium on Postbasic and Graduate Education for Nurses in Europe.

The programme on lay, community and alternative health care, aimed at tar­get 29, has already reviewed the state o f the art in self-help and established a net­work o f national counterparts. The book entitled Self-help and health in Europe has had excellent reviews.

In order to increase awareness o f the concepts o f model health care and quality assurance, in accordance with target 31, a new programme has been introduced; among the first activities were a European training course on the subject and the introduction o f a newsletter to build up a network o f those concerned.

Regional target 35 clearly expresses the need for information to measure and project health status, health resources and their utilization. These are key ele­ments in achieving a better epidemiologi­cal understanding o f health patterns, in

planning and managing health services, and in assessing progress towards the goal o f HFA2000. Epidemiological evi­dence is, moreover, required for most o f the other targets; indeed, the formulation o f the regional H F A target document it­self required extensive analysis o f existing data.

The Office has begun developmental work on indicators, on the methodology o f health projection, and on measuring health promotion and protection. Train­ing programmes in epidemiology and health information are progressively be­ing reoriented to meet the priorities o f the regional strategy.

H E A L T H S Y S T E M D E V E L O P M E N T

Health situation and trend assessment

As part o f the development o f the regional H F A targets, a detailed analysis was made o f the health situation in Europe, and tentative projections were worked out to support statements on the possible range o f target levels to be achieved. In addition, a selective list o f regional indicators was established; as recommended by the R H D A C , this list was submitted to a consultation o f ex­perts in May and to a subcommittee o f the C G P D in June.

The second edition o f the Digest o f health statistics in Europe was distributed in August. The digest contains data for the countries o f the Region on a series o f indicators which are descriptive o f the health situation; most o f these are in­cluded in the list o f preliminary regional indicators.

1 4

Methodologies for studying future trends in health status are essential to Member States in the task o f formulating strategies to improve the health o f their populations. Several working groups and seminars have been held since 1980 to re­view existing methods and current appli­cations, and the results o f these meetings are to be made available in book form. National centres and intergovernmental and nongovernmental organizations with a potential interest in the work were con­tacted in 1984 to establish whether they wish to participate in further development o f the study.

In collaboration with the International Epidemiological Association ( IE A ), the final meeting o f the editorial board for a joint W H O / IE A publication on the measurement o f health and health pro­motion was held in Copenhagen in July. The book reviews the measures taken at individual or community level to promote and protect health, and examines how both the processes and their outcomes can be quantitatively assessed. Its forth­coming publication is part o f a continu­ing effort to support national officials re­sponsible for health management and policy development, and to assist them in the epidemiological tasks o f identifying problems, setting targets and assessing progress towards those targets.

The French language training course on statistical, epidemiological and opera­tional methods in medicine and public health continued in Brussels. During the year, discussions were held in London on a new programme for a joint course in medical statistics and community medi­cine to be held in 1985. A reorganized Russian language course will also be held in 1985. A consultation held late in the

year recommended that a German lan­guage course on the application o f epi­demiological and statistical methods in public health should be organized in the German Democratic Republic in 1986.

A Russian language workshop for teachers in epidemiology and health sta­tistics took place in Moscow, as part o f the continuing series o f annual workshops or seminars for teachers, organized by the Regional Office in collaboration with dif­ferent Member States.

The Regional Office was represented at the final meeting o f C E ’s select com­mittee o f experts on the evaluation o f screening methods used for preventive purposes, held in Strasbourg from 16 to 18 May.

Country activities

Hungary. The national study on mor­tality differentials in Hungary, undertaken with the support o f W H O and U N F P A , is continuing as planned.

Malta. Assistance was provided for development o f the national health infor­mation system.

Morocco. Consultant services were provided for continuation o f the project to develop a national health informationsystem in Morocco.

Health planning and evaluation

The second international meeting o f principal investigators in scenarios for HFA2000 development, which was held

1 5

in The Hague in March, examined the national experience obtained and pro­vided a substantial input to the work o f the European Conference on Planning and Management for Health. The con­ference was held in The Hague from 27 August to 1 September, in collabor­ation with the Government o f the Nether­lands, 10 years after the European Con­ference on National Health Planning, held in Bucharest in 1974. This event pro­vided for a successful exchange o f ideas and experience and gave insight into the managerial processes to be applied to achieve H F A in the European Member States. Other issues raised included a more flexible interpretation o f planning concepts, the importance o f the national “ environment” in determining the op­timum managerial approach, the need to study the H F A managerial process in pluralistic and market economy coun­tries, and the prospects for health man­agement under conditions o f austerity and economic instability. Finally, con­sideration was given to new methods o f supporting outcome-oriented and stra­tegic planning, i.e. scenarios for HFA.

International training activities in health planning and evaluation were organized by using the existing network o f collaborating centres. The Nuffield Centre for Health Services Studies, Leeds, and the Department o f Community Med­icine, Usher Institute, Edinburgh, organ­ized the fifth workshop on managerial processes for national health develop­ment (M P N H D ) . It dealt with planning for care o f the elderly and was attended by 20 participants. The Central Institute for Advanced Medical Studies, Moscow, also held a successful international work­shop on M P N H D , concentrating on pro­gramming for cardiovascular and other noncommunicable diseases.

Finland, the Netherlands and Sweden are in the process o f issuing scenarios for HFA2000, and Morocco and Poland have expressed interest in joining this devel­opment.

Morocco. The primary health care development project in Agadir and Settat was evaluated, and the stage o f building new infrastructure, with the financial sup­port o f the World Bank, has now been reached. The preparatory work carried out in the area has included assessing health needs, studying health care de­livery, designing an information system and issuing a sanitary map. A W H O senior adviser assisted in this develop­ment.

Portugal. Field exercises applying a methodology in line with M P N H D were extended from two provinces in northern Portugal to a further two in southern Por­tugal.

Spain. As part o f the endeavour to regionalize the health system, two semi­nars on health planning were organized for participants from the Ministry o f Health and Consumer Affairs and from various provinces.

Health economics

With the new project on economic evaluation o f health care strategies, the programme for the first time went beyond health service economics and tackled the economic problems o f health strategies in other sectors o f the economy. Tw o new studies were initiated: one on the econ­omic aspects o f health care for the injured and another on the economic evaluation o f strategies against tobacco, alcohol and drug abuse.

Country activities

16

Within the project on health care fi­nancing, the focus has moved away from accounting details o f funding and spend­ing towards general guiding principles, the exchange o f national experience and the collection o f basic information. The change reflects the concern that spending and financing mechanisms should pro­mote rather than hinder the implement­ation o f HFA2000 strategies.

The final editorial meeting on the draft o f guiding principles for programme bud­geting was held in March. These prin­ciples include the feasibility o f proposed policies/strategies in terms o f both their initial and recurrent costs; the shift o f resources in favour o f primary health care; mobilization o f the resources o f local communities and other sectors for health development; ways o f financing that will increase the total resources available for health in general and vulnerable popula­tion groups in particular; the selection o f cost-effective strategies; the reduction in waste and increase o f efficiency in the health system; and the control o f expen­diture together with the monitoring o f achievement. Morocco and Turkey have already expressed interest in testing these principles.

The comparative study on health bud­geting, financing and payment systems, to be implemented between 1984 and 1986, will concentrate on primary medi­cal care, especially its sources o f finance, coverage, service charges, provider pay­ment systems, size o f practice, and bud­geting inside facilities. The first task o f the study is to describe the present situ­ation in the countries. The protocol for national study participants was finalized in October, and countries have been in­vited to participate in the study through experts o f their choice.

A Workshop on Hospital Financing Systems organized by the Institute o f Health Systems Research, Kiel was held in Malente, Federal Republic o f Ger­many in May. It reviewed a number o f hospital financing systems, together with their impact on the volume and cost o f services, and reached the conclusions that the impact o f different systems is simi­lar — contrary to popular belief — so long as hospitals are allowed to incur deficits but cannot keep any o f the sav­ings they may make; that the financing and payment mechanisms inside hospitals are as important as the ways in which hospitals themselves are financed; and that case mix (such as diagnostic groups), although indispensable in hospital plan­ning, budgeting and quality control, may have disadvantages when used as a basis for paying the hospital.

A survey on education and training programmes in health economics for health workers is in progress. The final report will contain a country-by-country listing o f the training programmes avail­able, and one or two examples from each country o f typical course programmes and contents.

As part o f the study on the devel­opment o f health economics training, 83 participants from 26 countries were asked to share the learning material they use and to send it, together with any other useful material, to the five “ module syn­thesizers” . These modules cover the rela­tionship between the health sector and the economy; health policy implement­ation and performance; harmonization o f consumer and provider interests; priority- setting and strategy selection; and equity, equality and the reduction o f status dif­ferentials.

17

A Workshop on Economic Issues in Intersector Policy and Planning was held jointly with the North-Western Regional Health Authority o f the United Kingdom National Health Service in Disley, in Sep­tember. Its purpose was to contribute to the development o f learning material for health professionals on the economic as­pects o f mobilizing health action in other sectors o f the economy. The workshop concluded that the first step in intersector persuasion has to be the application, with­in the health sector itself, o f health poli­cies aimed at food, sport, alcohol and similar health-relevant concerns in other sectors. Other measures o f persuasion in­clude appeals to enlightened self-interest, health education through the mass me­dia, the direct promotion or subsidy o f “ healthy” commercial products, and lob­bying for changes in laws and regulations. Learning material in these areas is to be ready for inclusion in the study in early 1985; this material is at present being de­veloped in pilot intersector planning in a health district.

A training workshop on health econ­omics was held in Lyon in September for senior health professionals and some Re­gional Office staff. Informatics and bar­gaining processes inside and outside the health sector were taken into account. Several participants intend to carry out similar workshops at national or local level.

Model health care and quality assurance

Under this new programme, the main task in 1984 was to increase awareness o f these two concepts, both in W H O and in Member States. In the field o f model health care, research projects using low back pain as a model are under way in Finland and Sweden, and several addi­tional studies are being planned in other

Member States. The unit is also collab­orating in the development o f model pro­grammes for cancer.

A national symposium on quality as­surance was held in Madrid in May. W H O input and assistance has been requested by national health authorities, associ­ations and institutions as well as by pro­fessional associations and groups and by hospitals. The first issue o f a quality as­surance newsletter, published on behalf o f the Regional Office by the Netherlands National Institute for Quality Assurance in Hospitals, appeared in November. This publication will increase the opportuni­ties for promoting the concepts o f quality assurance and will provide an essential forum for the exchange o f information and establishment o f contacts. The first European training course in quality as­surance, jointly sponsored by W H O and the H ospital de la Santa Creu i Sant Pau, was held in Barcelona in October. Re­sponse was overwhelming and indicated that a great deal o f work is being done at country level to develop quality assurance programmes.

Nursing

When 2000 Finnish nurses gathered in Helsinki in March to talk about ways o f improving care, it was clear that a change in thinking about nursing prac­tice was under way. The nurses presented case studies, in collaboration with the W H O medium-term programme for nurs­ing in Europe, in an attempt to stimulate discussion and exchange o f views among colleagues. This is only one o f many such actions that have resulted from involve­ment with W H O ’s medium-term pro­gramme. Throughout Finland, nurses have been active in developing the idea o f teamwork, one essential element o f

18

A n u r s i n g t e a m in S o d a n k ÿ l a H e a l t h C e n t r e , F i n l a n d , d e v e l o p i n g c a r e p l a n s f o r r e s i d e n t s o f t h e c o m m u n i t y .

O c c u p a t i o n a l h e a l t h n u r s e s m a i n t a i n q u a l i t y a s s u r a n c e s t a n d a r d s in t h e f a c t o r y s et t i n g i n F i n l a n d .

C o m m u n i t y h e a l t h n u r s e c o u n s e l l i n g a m e m b e r o f a m i g r a n t fa mi I y a t t h e O E I R A S H e a l t h

C e n t r e , P o r t u g a l

S t a f f n u r s e s t a k i n g a b r e a k at t h e E r g a m H e a l t h C e n t r e in e a s t e r n T u rk ey .

primary health care, and they have devel­oped a clear long-term commitment to community care. In factories, for example, nurses work closely with employers, super­visors and workers to ensure acceptable levels o f safety and to encourage people to take responsibility for their own health care.

Like Finland, several other countries o f the European Region have begun to feel the impact o f the W H O multinational study on people’s needs for nursing care, resulting in changes in the ways nurses think about their work and in the kinds o f activity developed. For example, owing to the development o f two tools for data collection (the health assessment form and the nursing care plan), there is a growing interest in accountability for nursing care. Consequently, guidelines on standards o f practice have already been developed by representatives o f Belgium, Finland, the Netherlands, Norway and the United Kingdom, and nursing/midwifery groups are beginning to talk about quality assur­ance. A European multidisciplinary group on informatics has also been formed, in which interested nurses are actively in­volved.

The multinational study has under­scored the limitations o f the medical di­agnosis in planning for the nursing care o f two groups o f people (surgical patients and elderly clients) and suggests that nurs­ing care planning should also be based on nursing needs. Additional findings from the study will be contained in a book written by the 11 programme managers involved in this five-year effort.

The Nursing unit has contributed to the publication o f ethical guidelines for nursing research in Nordic countries, has assisted in a descriptive survey o f nursing

management programmes in Europe, and is working with the European Association o f Programmes in Health Services Studies to develop annual workshops in nursing management. Three European nurses at­tended the international workshop on M P N H D , held in Leeds in June and July.

Three major meetings were held: nurse researchers met in Yugoslavia in May to consider sections o f the final report o f the multinational study on people’s needs for nursing care; a Symposium on Postbasic and Graduate Education for Nurses in Europe was held in Finland in June; and a meeting with the professional and popu­lar press on family breakdown and its effects on children was held in the Federal Republic o f Germany in December. This meeting is o f particular interest in that it was the first time that the popular press had been asked by W H O to help in bring­ing a health message to the public’s at­tention.

A t the request o f nurses and midwives all over Europe, the unit has begun to publish a newsletter which may be freely translated and reprinted by its recipients. It is produced in collaboration with the Danish Institute for Health and Nursing Research in Copenhagen and is intended to keep the European nursing/midwifery community abreast o f current events and developments, informed o f forthcoming courses and meetings and in touch with leading personalities. By the third issue, in November, a great deal o f feedback had been received, from as far afield as Japan.

Country activities

A review o f legislation as it affects the nurse’s ability to practise primary health care was completed in collaboration with

1 9

the health ministries o f Spain and the province o f Styria (Austria).

Portugal. National workshops were held on the evaluation o f nursing in pri­mary health care services, the assessment o f nursing personnel in the national health service, and the development o f guidelines to assess the effectiveness and efficiency o f social work services and nursing care in hospitals. A survey o f occupational health nursing services was made with a view to drawing up training guidelines. Consult­ant advice was given on the integration o f nursing schools into the teaching system at postgraduate level.

Health legislation

The basic philosophy o f the European health legislation programme is embodied in target 33 (see Annex 8). The study on trends in health legislation in Europe is one o f the main tools for attaining this target and was the most important under­taking o f the programme for the period under review; the resulting book is in­tended to create an awareness o f the role o f legislation in implementing health pol­icy. It will bring examples o f a variety o f legislative solutions to the attention o f decision-makers.

A major innovation was the organiz­ation o f the first W H O international course on health legislation, held in Bel­gium in July. Its objectives were to foster the exchange o f knowledge and experi­ence and to stimulate international coop­eration in this field; to promote under­standing o f legislation as a tool for de­veloping and implementing health policy; to arouse an awareness o f the role legis­lation can play in achieving health for all at national level; and to provide an incen­tive for developing or initiating training

programmes at national level. A fter an introduction on the general principles o f health law and health legislation, em­phasis was placed on the rights o f pa­tients, in particular the rights o f vulner­able groups; legislative strategies which promote healthy lifestyles; protection o f the environment and risk reduction; pri­mary health care and institutional care; the legislation governing health care pro­viders; and the planning, management and financing o f health services. It attracted 25 health administrators from 15 countries o f the Region (as well as from Canada and the USA). The report o f the course was issued as an unedited document in order to make the objectives, the methodology and content quickly available to those wishing to start national courses.

A study was initiated in November to review the role o f health legislation in mobilizing other sectors in support o f the H F A strategy, taking into account the following factors: demographic trends in Europe (aging o f society); the reduction o f resources (resulting from a smaller per­centage o f the active population in pro­ductive sectors); changes in the work en­vironment; progress in technology; en­vironmental risks; and the dehumaniz­ation o f society.

The computerized notification system ensures a continuous service. This year, 25 Member States contributed inform- tion, and two reports, one listed by sub­ject and the other by country, were dis­tributed to all Member States and to W H O headquarters for the International digest o f health legislation.

A joint meeting o f W H O and the Eu­ropean Health Policy Forum was organ­ized in Brussels in October on the theme “ Legislative approaches with respect to

20

health care technology” . The meeting con­sidered the impact o f regulations on inno­vation, one o f the main outcomes being that a research agenda on legislation for appropriate technology was drawn up.

The Regional Officer for Health Legis­lation chaired a session on legislation at the Third International Conference on System Science in Health Care, held in Munich in July.

In collaboration with the International Agency for Research on Cancer ( IA R C ), progress was made on drawing up a draft code o f practice for data protection in cancer registries.

Country activities

France. The first national meeting o f hospital directors/doctors in law was organized on 19 January by the Hospices civils de Lyon and the Institut interna­tional supérieur de Formation des Cadres de Santé, with the participation o f W H O and the Association française de Droit de la Santé. The main theme was “ Univer­sity research in health law — evaluation and perspectives” . A fruitful debate on priorities for research in health law took place.

In December, the first annual meeting on ethics was organized by the Comité consultatif national d ’ Ethique pour les Sciences de la Vie et de la Santé. It was chaired by Professor Jean Bernard. The President o f the French Republic, in his opening speech, stressed that progress in medicine and biology concern not only physicians but society as a whole. Extend­ing the debate beyond national frontiers was held to be important, and the UN role in this respect was mentioned at the

opening ceremony. The need for an inter­sectoral approach was illustrated by the presence o f the Minister o f Social Affairs and National Solidarity, the Minister o f Justice and the Minister for W om en ’s Rights, among others.

Morocco. In 1984, graduates o f the Health Section o f the National School o f Public Administration prepared a first draft o f a “ Code marocain de la Santé” .

Spain. An international conference on health systems organization in relation to the Spanish General Health Law, or­ganized by the Spanish Ministry o f Health and Consumer Affairs in collaboration with the Regional Office, took place in Madrid from 28 May to 1 June. The draft bill lays the foundation for reorganizing the health care system in Spain and pro­vides for the necessary health programmes and infrastructure, based on principles and concepts which are in line with W H O ’s regional strategy for health for all. An article by the Regional Officer for Health Legislation appeared in a government dis­cussion paper on health reform in Spain.

O R G AN IZAT IO N OF H EALTH SYSTEMS BASED ON PR IM ARY H EALTH CARE

Lay, community and alternative health care

The central role o f the family and the importance o f social structures and com­munity participation are key elements in the strategy for HFA2000. New develop­ments in health care, including alterna­tive medicine, will have a major influence.

A successful Seminar on Family Struc­tures and Health was organized for the

2 1

Regional Office in June by the W H O col­laborating centre for health education in Cologne. A selection o f the papers pre­pared for the seminar are being published in Italy.

A review o f the state o f the art in self-help is being carried out by the Inter­national Information Centre on Self-help and Health o f the Catholic University o f Louvain, Belgium. Work on this review includes provision o f information to indi­viduals and institutions working in the field. A quarterly newsletter is published by the Centre. The book Self-help and health in Europe, published by the Re­gional Office in 1983, has had excellent reviews.

The international Conference on W o ­men and Health, held in Peebles, Scot­land, in May 1983, led to the estab­lishment o f a network o f national coun­terparts. A mailing list was compiled and an information system has been built up to provide a rapid response to requests from individuals and institutions. The study on women and health in the Region is being combined with the study on posi­tive approaches to women’s health, spe­cifically to meet enquiries in relation to the conference to review and appraise the achievements o f the United Nations Dec­ade for Women, to be held in Nairobi in 1985.

An international Workshop on “ W o ­men and Health” Documentation Centres in Europe, held in Bologna in May, suc­ceeded in identifying the importance and effectiveness o f small, local, community- based documentation centres in meeting specific health information needs. It also recognized the importance o f creating networks o f such centres to provide both

technical support and a continuing ex­change o f ideas and information.

Primary health care

The focus o f this programme has be­gun to shift from concepts and philos­ophies to the organization and functions o f primary health care. This reorientation is in line with the commitment underlying W H O ’s Seventh General Programme o f Work to translating primary health care principles into practice; it also responds to recommendations made at the Confer­ence on Primary Health Care in Industri­alized Countries, held in Bordeaux in November 1983.

The Primary Health Care unit is par­ticularly concerned with ensuring cross­programme coordination when organizing meetings, and took several opportunities o f doing so in 1984. At the Sixth In­ternational Symposium on Circumpolar Health, held in Anchorage, Alaska in May, the Regional Officer was allocated a seat on the council o f the newly estab­lished International Association o f Cir­cumpolar Health. In June, the final meet­ing for the study on organization o f primary health care in southern Europe was held in Salonica, Greece. Technology planning for health care centres is also an important issue, and a consultation meet­ing was held in Copenhagen at the end o f April to discuss this topic. An interim meeting in connection with the study on indicators suitable for monitoring pri­mary health care was held in Zagreb, Yu­goslavia, in July. The editorial board o f the forthcoming publication on informa­tion systems for primary health care met in Munich, Federal Republic o f Germany in July. A working group met in Tam­pere, Finland in December to consider the role o f primary health care personnel in health promotion.

22

Commitment to education and train­ing in primary health care is another im­portant component o f the programme. A circular letter listing all forthcoming courses relating to primary health care and organized or co-sponsored by the Office was sent to Member States in De­cember.

The second annual teacher training course in primary health care was held in Finland in June, and the fourth inter­national course on the organization and evaluation o f primary health care for de­veloping countries was held in Brussels in September. A seminar on training o f teachers o f general medical practice, an­other course co-sponsored by the Office, was held in Dubrovnik, Yugoslavia from24 to 28 April. The technical discussions at the thirty-fourth session o f the Regional Committee were on the subject “ Training for primary health care” .

The impact o f such WHO-initiated or WHO-sponsored activities becomes ap­parent when national bodies develop their own programmes and make needed changes. This effect has been particularly clear in the case o f the teacher training course in primary health care, where cor­responding activities have been organized in Belgium, Portugal, Spain and Yugo­slavia. General practice is now a medical specialty in Finland, Portugal, Spain, Sweden and the United Kingdom. Chairs or departments o f general practice/fam­ily medicine have been established in uni­versities in several countries. In the field o f continuing education, several institutes or professional associations in Member States have organized courses in primary health care.

Through contributions to professional meetings and journals, the Office con­tinues to promote an awareness o f the

relevance o f primary health care to indus­trialized countries. The periodic publi­cation o f the newsletter “ 2000” has made information on primary health care de­velopments, courses and new publications available to a wide variety o f readers with­in and beyond the European Region.

Country activities

Finland. Finland is a W H O pilot country for the development o f primary health care, having adopted a law in 1972 with the aim o f reorganizing the health service on that basis. As a result, invest­ment expenditure and the distribution o f health personnel has radically changed in favour o f primary health care (Fig. 1 and 2).

Fig. 1. Investment expenditure on health centres and hospitals

in Finland. 1 9 7 3 -1 9 8 1 (m il l ion Fmk at 1 9 7 3 prices)

Year

23

Fig. 2. N u m b e r s o f d o c t o r s a n d o t h e r p e r s o n n e l p e r 1 0 0 0 0 p o p u l a t i o n

in h o s p i t a l s a n d h e a l t h c e n t r e s in F i n l a n d , 1 9 7 3 - 1 9 8 1

100-

80-

JS

I 60.О8

40-

20 -

Other personnel, hospitals

Other personnel, health centres Doctors, hospitals Doctors, health centres

1973 1977Year

1981

Greece. A national workshop was held in July to establish a plan o f action for the development o f health centres. Greece also participated in the study on the organization o f primary health care in southern Europe.

health care and to improve collaboration between the public and private sectors. A “ brainstorming” session was held in May to discuss regionalization in health care planning and organization.

Turkey. The infant mortality rate in Turkey has been a source o f concern to the Turkish Government. A team from the Regional Office and U N IC E F , to­gether with the primary health care team o f the Turkish Ministry o f Health, pre­pared and conducted a workshop to elab­orate a national medium-term programme for health promotion. As a first step, pre­liminary plans o f action were developed for health education, data collection and training. Another objective was to secure commitments from the other ministries and sectors that have related programmes. This integrated approach is essential if effective programmes are to be developed to reduce the high infant mortality rate. It was also recognized that high priority should be given to expanding the existing efficient primary health care structure to meet the needs o f the entire country.

USSR. A course on the organization, planning and management o f primary health care was held by the W H O col­laborating centre for primary health care at Alma-Ata.

Portugal. In March, a new law was passed creating a Directorate-General o f Primary Health Care. The third phase o f the project on evaluation o f primary health care services took place in late 1984.

Spain. The Office ’ s PH C unit com­mented on the draft bill to reorganize Spain’ s national health service. The aim o f this bill is to strengthen coordination o f all aspects o f planning for primary

Hospitals and other health institutions

The medical officer responsible for this programme took up his post in mid- July, and has since concentrated on es­tablishing contacts with national health authorities and associations. Priorities for 1985 are to tackle the reorganization o f the hospital sector and its integration with the various levels o f care. Greater emphasis will also be given to the im­proved integration o f ambulatory and

24

Distr ibution of health centres in Greece and Spain

• Designated health centre

О Planned health centre

A Health centre to be incorporated in a small hospital

Spain

N u m b e r o f h e a l t h c e n t r e s e s t a b l i s h e d p e r a u t o n o m o u s c o m m u n i t y in 1 9 8 4 -1 9 8 5 . It is p l a n n e d t o i n c r e a s e t h e t o t a l n u m b e r by 1 0 % p e r y e a r u n t i l 1 9 9 4 .

hospital care, as well as to the problems related to cost-containment in hospitals.

H E A L T H M A N P O W E R

The programme aims at fostering di­alogue and promoting the coordinated development o f health services and health manpower. It addresses issues relating to the maldistribution o f qualified health personnel and medical specialization. The teamwork concept is promoted, as is the orientation o f medical education towards primary health care. Activities related to teacher training include the exchange o f information on courses and the develop­ment o f methodologies.

The Office relies on nongovernmental organizations for the implementation o f many activities. For instance, the Associ­ation for Medical Education in Europe (A M E E ) deals with primary health care education in medical schools and teacher training activities, while the Association o f Medical Deans in Europe (A M D E ) is concerned with medical education and re­search, and the Association o f Schools o f Public Health o f the European Region (A S P H E R ) has undertaken a survey o f training in community medicine at under­graduate level. Both A S P H E R and the European Association o f Programmes in Health Services Studies are involved in the evaluation o f public health schools’ training programmes. Topics o f meetings held in conjunction with these organiz­ations have been influenced by and are o f direct relevance to W H O policy. An ef­fective network o f participating and col­laborating institutions (including country “ focal points” ) is also instrumental in

attaining programme objectives. The pro­gramme increasingly encourages training activities at country level, particularly through workshops and short courses, either directly or more frequently through collaborating centres. At country request, an increasingly large number o f these activities are carried out at the level o f individual institutions.

The year 1984 was particularly signifi­cant for this programme area, as the sub­ject o f the technical discussions at the Thirty-seventh World Health Assembly in May was “ The role o f universities in health for all” .

Senior officials from the European Member States took an active part in these discussions; it is clear that universi­ties in the Region have the potential to help achieve the goal o f H F A by edu­cating all professional groups, reorient­ing research and stepping up their collab­oration with the relevant ministries and other bodies.

Another particularly important event was the first meeting o f Regional Office staff and representatives o f the national medical associations o f Member States, following preliminary contacts between the Regional Director and the President o f the Standing Committee o f Doctors o f the EEC. The meeting was held at the Regional Office in December and 16 na­tional medical associations were repre­sented. Views were exchanged on certain key issues in the regional H F A target document and the work o f the medical profession, e.g. primary health care and the appropriate use o f health care tech­nologies. The meeting led to better under­standing between the Regional Office and the medical associations and ended with

25

an agreement that such meetings should become a regular feature o f the pro­gramme, and that in the future they would involve the medical associations o f all Member States o f the Region.

Matched to health service needs

The study being carried out in col­laboration with the Nuffield Centre for Health Services Studies o f the University o f Leeds is aimed at improving coordi­nation between the producers and users o f health manpower. The first stage o f the study, describing current practices in health manpower planning at the regional level in the United Kingdom, is almost complete and preliminary results were presented at an interregional consultation in Indonesia in October. The study identi­fies and describes existing practices, ex­amines them and tests their potential for supporting the HFA2000 strategy.

The study for preparing guidelines on health personnel specialization has pro­gressed satisfactorily. In February, the steering group for the study planned a Seminar on Medical Specialization in Re­lation to Health Needs; six background papers were then prepared. The seminar took place in Abano Terme, Italy in October under a cost-sharing agreement with the Veneto Region. The 28 partici­pants reviewed progress, identified priori­ties and assessed the feasibility o f possible changes and activities proposed. Poten­tial contributors to further studies were also identified. It was decided to augment the next update o f the publication on graduate medical education (E U R O Re­ports and Studies, No. 77) with narrative descriptions o f postgraduate training ar­rangements in individual countries.

In collaboration with the Regional Office, A S P H E R has prepared the first

draft o f a workbook describing the con­tent and methodology o f health manage­ment training, to be used as a guide for organizers o f courses wishing to revise existing programmes or set up new ones. This workbook was used as a guideline for a workshop held in Düsseldorf in December, at which participants were given assistance with developing their own courses. Cooperation o f this kind within A S P H E R and between individual schools o f public health, using a network approach, increases the grass-roots com­mitment to making training more relevant to health needs.

The two annual courses for public health administrators took place in Eng­lish and Russian at the Central Institute for Advanced Medical Studies in Mos­cow. The Regional Office provided finan­cial support and lecturers. The course is regularly evaluated, and changes are in­troduced as a result. It includes work­shops on M P N H D and health manage­ment skills.

It is unlikely that workshops in health manpower planning (such as those in 1981 and 1983) will be repeated in their original form, since feedback from par­ticipants suggests that changes should be introduced.

Reoriented towards primary health care

The reorientation o f curricula, essen­tially in undergraduate education and teacher training activities, is increasingly promoted through nongovernmental or­ganizations, such as A M E E and A M D E , and by W H O ’s collaborating centres. This approach strengthens the links between the institutions involved.

Tw o courses were organized by the British Life Assurance Trust (B L A T ) , a

2 6

W H O collaborating centre. The seventh course on modern methodology for teach­ers o f the health sciences, held in London from 3 to 20 July, was attended by 17 par­ticipants from 15 different countries in­cluding six participants from Europe, some o f them supported by fellowships. The first course on audiovisual materials in the health library also took place in London, from 23 July to 3 August, and was attended by participants from three European countries.

One staff member from the B L A T Centre was sponsored by the Regional Office to be a member o f the faculty for the second teacher training course in primary health care held in Tampere and Kuopio, Finland, in June. He was also the rapporteur for the technical discus­sions on training in primary health care at the thirty-fourth session o f the Regional Committee.

In collaboration with A M E E , a study is being made o f the organization o f pri­mary health care education in medical schools in the European Region. The first results o f the A M E E survey were circu­lated to Member States for comments be­fore finalization and publication. The Re­gional Office provided technical and fi­nancial support to the A M E E conference in Oslo in September, at which a W H O temporary adviser organized a working group on the number o f doctors needed and the role o f the doctor in the future.

Increasing collaboration developed be­tween the Regional Office and the Inter­national Federation o f Medical Students Associations. Staff members from the Office acted as discussion leaders at a workshop held in Nykobing, Denmark, and participated in the Federation’s gen­eral assembly in Stockholm.

The analysis o f innovative community- oriented educational programmes in Eu­rope was jointly planned with W H O head­quarters. Several community-oriented edu­cational institutions in the European Re­gion were approached to undertake com­parative evaluations with “ traditional” institutions in their respective countries.

Continuing education

In this aspect o f the programme, the aim is to promote the development o f organization systems and proper method­ology for the continuing education o f health personnel rather than primarily to sponsor courses.

In 1984, a background document was prepared defining priority areas for future work involving countries and nongovern­mental organizations. This document was extensively used during a Consultation on Continuing Education and Multipro­fessional Training, held in Copenhagen from 31 October to 2 November. The con­sultation decided what further informa­tion was required, highlighted examples o f good practice, and specified the action to be taken by relevant bodies and associ­ations, such as A M EE , university research departments, medical faculties, specialist colleges and professional associations. Evaluation strategies were also developed, and a plan o f action on continuing edu­cation for H F A through primary health care was prepared. This plan calls for a new approach, namely analysing the cur­rent situation and trends in continuing education from the point o f view o f strategies, strategy formulation and or­ganization rather than as isolated train­ing programmes. The first phase o f the plan o f action consists o f a five-country study, designed to yield clearly defined

27

results, while in the second phase this data base will be expanded to cover other countries.

Multiprofessional training and teamwork

Relatively little progress has been made by countries in this area, probably because o f misunderstandings about the concept itself, despite the fact that team­work is widely advocated in the regional strategy. However, the consultation on multiprofessional training, mentioned in the previous section, helped to define the concept as well as facilitating factors and constraints. Discussions were based on a document pinpointing priority areas and assessing the feasibility o f change. The consultation reviewed multiprofessional training in basic/undergraduate and post- basic/postgraduate education, and a plan o f action for follow-up activities was pro­posed.

Fellowships

In following up the resolution adopted by the Executive Board in January 1983 (EB71.R6), activities are aimed at (a ) en­suring that the training programmes o f fellows from the European Region are consistent with the H F A policy and the regional H F A targets, and (b) providing the most adequate and relevant training programmes for candidates from other regions.

The European Member States and other W H O regional offices have been informed o f the Office’s plans for imple­menting this resolution, and the list o f WHO-sponsored courses (Annex 6) is now distributed quarterly to all Member States.

The Regional Office was represented at the annual meeting in October o f C E ’s

medical fellowships selection and assess­ment committee, which selected the fel­lows for the 1985 programme and evalu­ated those o f the 1984 programme.

Fig. 3 shows the number o f fellows from each European Member State study­ing elsewhere and also the number o f fel­lows received in each country. While the United Kingdom and France continue to receive the highest number o f fellows, the trend is towards a more equitable distri­bution o f fellows among the other coun­tries o f the Region.

The distribution o f European fellows by country and subject o f study is shown in Table 1.

The subject for which fellowships were most frequently granted was en­vironmental sanitation: 16.7% o f fellows were studying this subject, compared with 12.4% in 1983.

There is a growing interest in public health administration: 13% o f fellowships were in this field, compared with 9.7% in1983. At the same time, medical and sur­gical specialties decreased from 12.4% to 10.1%.

Country activities

Greece. A study on undergraduate training in public health in selected Euro­pean countries was started by A S PH E R and the Regional Office on behalf o f the Greek authorities. A regional officer and two temporary advisers visited Greece in October to complete plans for two na­tional workshops on the health centre de­velopment programme, to be held in Greece in 1985.

2 8

Fig. 3. D is tr ibu t ion by coun try of fe l low s in the European Region in 1 9 8 4 s

Black figures ind icate the num ber of fe l lows from each coun try s tudy ing elsewhere.

C oloured figures ind icate the num ber of fe l lows received in each country.

a These figures refer only to those fe llow s w ho started the ir fe llow ships in 1 984.

29

Tab le 1. F e l lo w sh ip s a w a rd e d in 1 9 8 4 by the Regiona l O f f i ce to fe l low s f r o m the E u ro p e a n Region , by s u b je c t and c o u n t r y of o r i g in

Subject o f study {m am g roups) ALB ALG AUT BEL BUL CZE DEN FIN FRA DDR DEU GRE HUN ICE IRE ITA LUX MAT MON

Public hea lth a dm in is tra tion

H ospita l and m edica l care a dm in is tra tion

C o n s tru c tio n of health in s titu tio n s

M edica l lib ra n a nsh ip

Environm enta l san ita tion

Food co n tro l

N ursing and m id w ife ry

M aternal and ch ild health

Paediatrics and obs te trics

M enta l health

Health e duca tion

O ccupa tiona l health

Health s ta tis tics

Dental health

R ehab ilita tion

C on tro l o f p ha rm a co lo g ica l and b io lo g ica l p repara tions

M alaria

Venereal diseases

Tuberculosis

Other co m m un icab le diseases

Labora tory services

Surgery and m e d ia n t;

Anaesthesio logy

R adiology

H aem ato logy

Other m edica l and surg ica l specia lties

Basic m edica l sciences

M edica l and allied educa tion

1

1

1

2

b

2

1

2

3

2

2

3

2

2

1

3

1

1

1

1

1

1

1

2

2

1

1

1

1

4

1

1

1

2

1

1

2

1

1

1

1

1

1

1

1

1

1

1 1

1

1

1

1

2

1

1

1

2

1

1

1

1

1

1

1

Total 1 1 1 b b 0 4 3 3 b 8 b b 1 1 6 2 I 3 1 1 0

Percentage of total 4 0 b 4 1 8 0 0 1 4 1 1 1 1 1 8 2 9 1 8 1 8 2 b b 8 0 / 2 b 1 1 0 4 0 4 0 0

3 0

MOR NET NOR POL POR ROM SMR SPA SWE SWI TUR SSR UNK VUG TotalPercentage

of to ta lSub ject o f study

(m ain groups)

8 1 1 3 1 4

1

5

7

3

1

2 3 5

10

2

1

12 7

3.6

0 7

0.4

Public health adm in is tra tion

H ospita l and m edica l care a dm in is tra tion

C on s tru c tio n o f health in s titu tion s

M edica l lib ra n a nsh ip

2 1

1

12 2

1 1

1

2

1

1 1 5 46

4

6

3

16 7

1 5

2 2

1 1

Environm enta l sanita tion

Food co n tro l

N ursing and m idw ife ry

M aterna l and ch ild health

2

1

2

1

2 9

7

3

3 3

2 5

1 1

Paediatrics and o bste trics

M enta l health

Health e duca tion

2 1 4 1 4 O ccu p a tio n a l health

5

1

1

1

2

1

1

1

6

2

4

15

3

4

10

5 5

1 1

1 4

3 6

Health s ta tistics

D enta l health

R ehab ilita tion

C o n tro l o f pha rm a co lo g ica l and b io lo g ica l p repara tions

2

1

2

2

1

0 7

0 7

0 4

M alaria

Venereal diseases

Tubercu los is

3 2 1 1 1 1 5 5 5O ther co m m un icab le

diseases

3

1

1

3

2 1 1 1 3 2 1

1

2

24

1 4

2

8 7

5 1

0 7

Labora tory services

S u rge ry and m edicine

A naesthesio logy

2

4

1 1 5

5

1 8

1 8

R adiology

H aem ato logy

4 1

1

5

1

2 1

1

1 2

1

28

7

8

10 2

2 5

2 9

O ther m edica l and surg ica l specia lties

Basic m edica l sciences

M edica l and allied educa tion

36 8 1 31 6 2 0 7 10 3 20 10 1 1 29 2 7 5 Total

13 0 2 9 0 4 1 1 2 2 2 0 .7 0 .0 2 5 3 6 1 1 7 2 3 6 4 0 10 5 Percentage of to ta l

3 1

M orocco. A consultant visited M o ­rocco in December to prepare a detailed action plan for a health learning materials programme.

Portugal. In order to strengthen the country’s health management planning capabilities, a national workshop on health manpower planning was held with the assistance o f a temporary adviser, and training material was provided by the Office.

Romania. Work continued on the re­orientation o f health personnel training curricula.

A second workshop on educational methodology was organized in October by the Dean and staff o f the Institute o f Medicine and Pharmacy o f Bucharest, as­sisted by a W H O temporary adviser. It was attended by 25 teaching staff.

Spain. The Regional Office is col­laborating with the Ministry o f Health and Consumer Affairs on establishing a new school o f public health in Madrid. Study tours have been made to schools o f public health in other countries, and A S P H E R has provided material as re­quested.

Health manpower development input was provided at the international confer­ence on health system organization re­lated to the Spanish General Health Law, held in Madrid in May.

Yugoslavia. The Office provided two temporary advisers to help organize a workshop on educational planning for the Faculty o f Medicine at Novi Sad, at the request o f the Ministry o f Health.

PUBLIC EDUCATION ANDINFORMATION FOR HEALTH

The adoption o f the European regional H F A targets will have major implications for the Office ’s public information activ­ities. These can no longer be regarded mainly as a reaction to external interest in W H O ’s programmes in Europe, but should be seen as an active means o f pro­moting and supporting the successful ex­ecution o f those programmes. From the outset, therefore, information on the re­gional strategy and targets will be placed at the disposal o f special interest groups as well as the media.

At the same time, greater emphasis has been placed on giving the media and other non-media outlets advance notice o f W H O activities in Europe and on mak­ing the technical programmes more vis­ible. Work has started on expanding the Regional Office’s media contacts, and steps have been taken to distribute infor­mation more quickly.

The Federal Minister o f Health and the Regional Director were speakers at a World Health Day ceremony in Bonn, Federal Republic o f Germany. Their speeches highlighted the 1984 theme o f “ Children’s health — tomorrow’s wealth” . The mass media were provided with World Health Day information kits. The Re­gional Office organized a special celebra­tion, in collaboration with U N IC E F , showing films on children and develop­ment in the Third World.

Journalists were invited as temporary advisers to cover the thirty-fourth session o f the Regional Committee with satisfy­ing results. Among other meetings given special attention by the media was the

32

European Conference on Planning and Management for Health, held in The Hague from 27 August to 1 September.

A series o f articles on evaluation o f health care and health technologies was commissioned from a leading French health journalist and issued in the form o f W H O features.

Scientific journalists from the radio services o f seven European countries took part in an information seminar arranged jointly by W H O headquarters and the Regional Office and held in Geneva and Copenhagen. The Regional Office pro­vided facilities for a seminar for editors o f medical journals in developing countries, organized by the International Federation o f the Periodical Press.

With the aim o f improving coordina­tion o f health education training efforts among different ministries and profes­sional groups, the first o f a series o f sum­mer seminars on health promotion was

held in Tulbinger Kogel, Austria for senior health education personnel from selected countries. This pilot seminar has already made a major contribution to health promotion policy in a number o f participating countries, e.g. Ireland and the Netherlands. The seminar was re­ported by a videotape, an innovation for the Regional Office.

An important landmark in school health education in Europe was a work­shop in the United Kingdom in April/ May.

Another important programme com­ponent is the dissemination o f knowledge about methodologies for coping with chronic disease. A review o f research on strategies for coping with specific chronic diseases was initiated. This project focuses on three conditions: diabetes, rheumatoid arthritis and psoriasis. Experts from Mem­ber States with broad experience in work­ing with these three conditions will func­tion as focal points for the collection o f information.

HEALTH SYSTEM INFRASTRUCTURE

Proposed budget for country and intercountry programmes, 1984/85, revised position, and expenditure as at 31 December 1984 (U S $)

Proposedbudget

Actualbudget

allocationExpenditure

Regular funds 7 447 200 6464 800 2 339 966UN funds — — 41487

Voluntary funds 1 896 800 1 896 800 277 163

9 344000 8 361 600 2 658 616°

a Being 17.86% o f total expenditure.

3 3

Demographic trends in the European Region. W H O Regional Publications, European Series, No. 17.

Primary health care in undergraduate medical education: report on a W H O meeting. Non-serial publication.

Publications issued in 1984

Documents issued in 1984

Pendreigh, D.M. The management and planning o f health services: report on the technical discussions at the thirty-second session o f the Regional Committee for Europe (document R4/48/2(32)C).

Health planning and management — requirements f o r HFA2000 develop­ment: report on a W H O working group (document ICP/SPM 028(1)).

The role o f W H O participating centres in continuing education, specialty training and educational research: report on a W H O seminar (document ICP/EDS 007(1)).

Information and health — policy, pressures and the public: report on a W H O working group (document IC P / IN F 003).

Availability and utilization o f self-learning materials in continuing education: report on a study (document ICP/EDS 002).

Standardization in measurement o f impairment, disability and handicap as consequence o f disease: report o f a working group. Monthly Bulletin o f Health Statistics, Netherlands Central Bureau o f Statistics, 3,2 (Febru­ary 1984).

Women and health documentation centres in Europe: report on an inter­national workshop. Health Libraries Review, 1,3: 1984.

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Chapter 3

HEALTH SCIENCE AND TECHNOLOGY — HEALTH PROMOTION AND CARE

I N T R O D U C T I O N

The new programme on social equity and health is particularly concerned with regional H F A targets 1, 6 and 28. It fo ­cuses on the relationship between health and unemployment, and on the health o f migrant workers. Several o f the meetings organized during the course o f the year were intended to provide the Member States with information relevant to attain­ment o f the regional H F A targets, and a network o f national institutions is being built up.

The programmes on health o f the el­derly and the prevention o f disability are designed to support Member States in reaching targets 2, 3 and 4, using as a basis the International Plan o f Action formulated by the U N World Assembly on Aging in 1982 and the impetus pro­vided by the U N Decade o f Disabled Per­sons (1983-1992). The population-based study entitled The elderly in eleven coun­tries has already been published in the Public Health in Europe series and, to­gether with the findings o f the working group on the prevention o f health risks, contributes to a better understanding o f the health and social problems o f elderly people. The need for community-based rehabilitation o f the disabled has been stressed.

The new health promotion programme addresses targets 2, 13, 14, 16 and 17. As a first step in this programme, a document on the concept and principles o f health promotion was given wide distribution and is beginning to influence the health promotion strategies o f some Member States. Other activities were initiated to gather and disseminate information on factors influencing beliefs and behaviour, and on social support and health.

In connection with targets 2 and 28, the programme on sexuality and family planning has already begun work on im­proving the management o f family plan­ning programmes and o f counselling and services related to family planning for the young, as well as on providing basic teaching modules and identifying inno­vative approaches in family planning programmes. The bulletin Entre nous is proving successful as a mechanism for networking.

The main thrust o f the oral health programme continues, and will continue, to be the prevention o f oral diseases, and in particular dental caries and periodon­tal diseases (target 4). However, preven­tive programmes cannot be implemented without a suitable infrastructure (tar­get 28) and appropriate oral health man­power development policies (target 36).

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The Regional Office’s oral health infor­mation system, already operational, will be used to monitor progress in this pro­gramme.

The findings o f the Perinatal Study Group, organized by the maternal and child health programme, will be a useful starting point for activities aimed at tar­gets 7 and 8. The appropriate use o f tech­nologies during pregnancy and birth, and the use o f human resources in perinatal care, are important elements in reducing infant and maternal mortality and mor­bidity, and these issues will be discussed at birth conferences throughout the Re­gion as well as at interregional meetings.

The programme on workers’ health addresses regional H F A target 25 and, to some extent, target 11. Over the past few years, the Regional Office’s occupational health programme has paid special atten­tion to vulnerable groups, including wo­men workers and people at risk o f long­term exposure to potentially hazardous chemicals. It will now focus on the train­ing o f manpower, the provision o f com­prehensive coverage for all workers — in­cluding those employed in small enter­prises and at home — in conjunction with primary health care services, and the in­troduction o f a full range o f measures to reduce the incidence o f accidents at the workplace.

A meeting in November o f counter­parts o f the Regional Officer for the Pre­vention o f Accidents agreed on a five­pronged approach to target 11: multi­sectoral policy formulation and manage­ment; comprehensive information sup­port; epidemiology o f behavioural, en­vironmental and economic factors; com­prehensive education for safety; and cost- effective service for victims. On the basis

o f work already done, model programmes can now be designed and tested at coun­try level, in accordance with the require­ments o f target 17.

Under the programmes on psychoso­cial factors and mental health, the pre­vention o f alcohol abuse, and abuse o f psychoactive drugs, work has already been done on reaching targets 12, 16 and 17. Following the publication in 1982 o f Changing patterns in suicide behaviour (E U R O Reports and Studies, No. 74) pre­liminary studies are being made in prep­aration for a working group in 1986 on trends and indicators o f suicide and at­tempted suicide. This will contribute di­rectly to the attainment o f target 12.

The nutrition and food safety pro­gramme addresses targets 16, 19 and 22, building on work already begun in the fields o f infant nutrition (especially the marketing o f breast-milk substitutes) and food quality control. The programme will also take account o f the discussions held in 1984 on the formulation o f policy for dietary counselling.

The pharmaceuticals and drug utiliz­ation programme, which covers the five broad areas o f clinical pharmacology and drug research, drug utilization studies, drug regulation and supply, drug infor­mation, and quality control and training, addresses targets 17, 19, 36and 38 in par­ticular. The dissemination o f information in this very dynamic field is effected by means o f the Drug bulletins review. Hav­ing issued recommendations in specific areas such as drugs in pregnancy and de­livery, and provided guidelines for clini­cal investigations o f various groups o f drugs, the programme is increasingly giv­ing support to individual Member States.

36

The environment o f the European Region is changing rapidly in terms o f demographic structure, lifestyles, modes o f industrial and agricultural production, transportation, tourism and migration. A ll these factors can cause, and can in­teract to produce, major impacts on health. An important aspect o f preventive health care is to ensure that socioecon­omic development is carried out in such a way as to protect, and where possible en­hance, human health and wellbeing. Such measures involve many aspects o f govern­ment at central, regional and local levels and require well integrated multisectoral planning and management. Many o f the problems reach beyond national boun­daries, so there is a need for close inter­national collaboration in carrying out surveillance and control measures.

The regional targets now bring many o f these issues into focus but, i f they are to be achieved in a timely and cost-effective manner, governments will need to ensure that adequate safeguards are introduced to protect the health and wellbeing o f workers, consumers and the community when establishing new industries, new methods o f agricultural production or new energy sources.

The efforts and achievements o f the Office’s environmental programme over the past 15 years will serve as a basis for the attainment o f targets 18,19, 21,23 and 24, while activities initiated within the con­text o f the International Drinking Water Supply and Sanitation Decade are specifi­cally related to target 20. The Office is, in addition, turning its attention to assisting Member States in improving environmen­tal data bases on the provision o f water supply and sanitation, on the levels and trends o f health-related contaminants and on morbidity and mortality.

In connection with formulation o f the regional H F A targets, the usefulness o f the work done by the European A d ­visory Committee for Medical Research on evaluating the research components o f the different Regional Office programme areas cannot be too highly stressed. So far as target 32 is concerned, the most im­portant event during the year was the or­ganization o f the first international work­shop on health services research method­ology. The learning material which was prepared will make it possible to develop training activities at both international and national levels, and this in turn will be instrumental in augmenting the exper­tise o f health personnel in selecting the strategies and technologies required to implement the regional strategy.

The programme on clinical, labor­atory and radiological technology is fo ­cused on setting up a network o f institutes and expertise for health and medical technology assessment in order to pro­vide the Member States with information relevant to the attainment o f target 38. The programme already covers a broad spectrum o f activities, from assessment o f medical technology to new systems for financing health care.

R E S E A R C H P R O M O T I O N A N D D E V E L O P M E N T

The tenth session o f the E A C M R , held in Copenhagen in February, analysed the targets in support o f the regional strategy for HFA2000 (EUR/RC33/9 and /9 Corr. 1) and issued several recommend­ations concerning the content o f the tar­gets and their scientific basis. The par­ticipants felt that criteria for research

37

priorities should be based firstly on ex­pectations o f scientific breakthroughs and secondly on a less narrowly professional assessment o f what could be most easily achieved and what would have greatest impact on people’s health. In addition, the E A C M R recommended that the chap­ter on research in the target document should be revised by an ad hoc subcom­mittee; this was done at a special meeting in Copenhagen in April.

The E A C M R also reviewed in detail the programmes on mental health, nu­trition and food safety, maternal and child health including family planning, and information systems and health sys­tems development. It approved the re­ports o f the Working Group on the Man­agement and Structure o f Health Policy Research, held in Rome in October 1983, and o f the Workshop on Scientific Analy­sis o f Health and Health Care: Paradigms, Methodologies and Organization, held near Ulm in November 1983.

The planning subcommittee o f the E A C M R met in July in Ulm to review the report o f the tenth session, the research component in the target document, the future activities o f the E A C M R and pro­gress towards setting up E A C M R sub­groups.

The Chairman o f the E A C M R pre­sented a detailed report to the Regional Committee in September and to the glo­bal A C M R in Geneva in October.

A planning meeting was held in C o ­penhagen in November on interagency research coordination with subregional and other research groups. This was at­tended by representatives o f selected sub­regional research coordinating bodies,

research funding foundations, ministries o f health and governmental and semi- governmental research authorities. The group made recommendations on the scope and purpose o f a larger European meeting to be held in Morocco in 1985 and suggested the list o f participating bodies.

Now that a social scientist has joined the Research Promotion and Develop­ment unit, a curriculum in health services research has been developed. Learning modules have been prepared by consult­ants from Finland, the USSR and the USA. This material was used for the first time at the workshop on health services research methodology, held at Alma-Ata in November. Although the majority o f the participants judged the content o f these modules positively, some changes are being made, e.g. additional modules will be included on qualitative method­ology, forecasting and health economy. To support development o f this activity, the Office has worked closely with the European Association for Programmes in Health Services Studies. The two part­ners are also conducting an evaluation o f the research and educational programmes o f schools o f public health.

The building up o f a network o f col­laborating centres continued through 1984, based on the recommendations o f technical units in the Regional Office and at headquarters. Particular emphasis was placed on the designation o f collabor­ating centres in areas directly relevant to the regional strategy for HFA2000.

A list o f collaborating centres partici­pating in the Office ’s programmes during1984 is given in Annex 7.

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G E N E R A L H E A L T H P R O T E C T I O N A N D P R O M O T I O N

Nutrition and food safety

A Nutrition unit was created in the Regional Office in September.

In 1984, the Office ’s activities in this field continued to focus on infant nutri­tion. In April, a temporary adviser visited France, the Federal Republic o f Germany and the United Kingdom to collect infor­mation about weaning food practices.

In June, a Regional Meeting o f Euro­pean Breastfeeding Mothers’ Support Groups was held in Bonn, arranged by the Arbeitsgemeinschaft freier Stillgrup­pen and funded by the Regional Office. This was the first time that such a meeting had been convened, and it gave 12 con­sumer groups and three individual repre­sentatives interested in establishing such groups from 13 European countries the opportunity o f exchanging practical and organizational experience.

In October and November a tempor­ary adviser visited Denmark, Ireland and the Netherlands for a pilot study on the effects o f the International Code o f Mar­keting o f Breast-milk Substitutes. From discussions with representatives o f health authorities and the infant food industry, it was apparent that national authorities were satisfied with developments, and that the industry felt it had adapted its marketing practices to existing national codes. The study was also discussed at an informal consultation with infant food industry representatives in the Regional Office in December.

The elderly, who form another nu­tritionally vulnerable group, were given

attention at a Consultation on the Pre­vention o f Osteoporosis, held in Sweden in November.

Overall policy issues o f food and nu­trition planning were addressed at a work­shop held in collaboration with a group o f European nutritionists in Athens in April. The scientific evidence for dietary targets in Europe was reviewed and spe­cial attention was paid to obesity, cardio­vascular diseases and cancer.

Concern continues to be expressed in many European countries about the sharp increase in outbreaks o f foodborne infec­tion during recent years. A number o f serious incidents were reported in 1984, involving deaths and serious illness among aircraft passengers and patients in several hospitals and other institutions. Inade­quate temperature control during food storage and processing appears to be a major shortcoming, and poultry appear to be a particularly important source o f infection. The Regional Office has con­tinued to emphasize the importance o f establishing adequate inspection proce­dures, using well trained manpower. A t a Working Group on Health Aspects o f Catering, held in Novi Sad (Yugoslavia) in November, special emphasis was placed on the concept o f hazard analysis critical control points.

In March, the Regional Officer for Food Safety gave three lectures as part o f the course in environmental medicine at the Nordic School o f Public Health in Gothenburg, Sweden.

Country activities

Morocco. A seminar on food hygiene was held in Morocco in October.

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Portuga l. Consultant advice was given to the Government on the devel­opment o f effective measures for food control. A monitoring and epidemiologi­cal study o f methylmercury in seafood is being carried out under U N E P ’s Medi­terranean Action Plan.

Spain. In May 1981, a unique dis­ease, later to become known as the toxicoil syndrome (TOS), broke out in Spain. This syndrome has a wide variety o f clini­cal symptoms, and virtually any tissue or organ appears to be affected. More than 20000 cases have been recorded, with 341 deaths as o f June 1984. Its cause re­mains elusive, though efforts to establish its etiology continue. The report o f a working group meeting on this syndrome, held in Madrid in March 1983, was pub­lished during 1984. In June, the first meet­ing o f the W H O Scientific Steering Com ­mittee on TOS was held in Copenhagen. The Committee formulated its terms o f reference, reviewed activities related to TOS carried out since the working group meeting the previous year, and made rec­ommendations regarding further research. The creation o f a strong data base o f all epidemiological information is needed. In addition, a number o f clinical studies should be carried out on TOS patients, including long-term follow-up. More basic research should be conducted, including creation o f a simulated refining procedure and investigation into the toxic properties o f compounds under suspicion, and the pathomechanism o f the poisoning. Activ­ities are being coordinated by the chemi­cal safety programme.

Oral health

The most striking feature in the Euro­pean Region in the field o f oral health is

the dramatic reduction in the severity o f dental caries and periodontal diseases (particularly gingivitis) that has taken place in those countries in the Region which have been most active in imple­menting comprehensive community-based oral disease preventive programmes. These countries, however, are now facing a grow­ing problem o f unemployment o f oral health manpower, in contrast to other countries in the Region where there is an increase in the severity o f oral diseases and an acute shortage o f personnel. In consequence, the Oral Health unit con­tinues to urge Member States to make a critical review o f their oral health man­power development programmes so as to adjust the type, number and distribution o f oral health personnel in accordance with present and projected future needs.

The W H O community oral health care model, which is based on the con­cepts o f delivery o f oral health care through the primary health care approach and efficient training o f various types o f oral health manpower through a perform­ance simulation training module, has so far not received the interest it deserves in the European Member States. However, a training simulator has recently been in­stalled in the dental school in Helsinki, and it will be interesting to learn about the experiences gained with this method.

The aim o f the W H O international collaborative oral health development project is to improve oral health status globally by establishing a mechanism to redeploy available resources, both finan­cial and manpower, to match the needs o f populations, especially in the developing countries. Several countries in Europe, particularly those in Scandinavia, have indicated their interest in participating in this project.

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Nearly all the European Member States are participating in the study on the financing o f dental care, the objective o f which is to identify different national models o f financing oral health care for different population groups.

The data collected in the forecasting study on dentistry by the year 2000 have been coded and are now being analysed. Similarly, the data needed for monitoring o f activities related to the attainment o f regional and national goals for oral health by the year 2000 have been collected from most countries in the Region.

Collection o f data and information for establishing a complete set o f country profiles for European Member States in the field o f oral health is close to com­pletion. These data will also be used to update the publication entitled Oral health services in Europe (W H O Regional Publi­cations, European Series, No. 5).

A training course for oral epidemi­ologists was held in Novi Sad (Yugoslavia) from 10 to 15 September, and was at­tended by 12 participants and four ob­servers from nine European countries. They were trained in the use o f W H O ’s standard epidemiological survey method­ology, as applied in the national oral health pathfinder surveys which have al­ready been carried out in several Member States.

An intercountry Workshop on Organ­ized Changes in Educational Systems for Oral Health Manpower was held in Dub­lin from 19 to 22 September, with 18 par­ticipants and observers from 10 countries in the Region and with representatives o f the International Dental Federation and the Association for Dental Education in

Europe. The purpose o f the workshop was to formulate strategies for educational changes consistent with the objectives for oral health in Europe by the year 2000. It was decided to establish a network o f dental schools — which are in the process o f changing their curricula — with the Dental School o f Trinity College, Dublin as the focal point.

The Regional Officer for Oral Health was the introductory speaker at a con­ference on oral health resources, prob­lems and possibilities, held in Malmö in April in connection with the International Hospital Exhibition.

Close contact has been maintained with the International Dental Federation and its European regional organization, and with the European Community, the Council o f Europe, the International As­sociation for Dental Research, the Euro­pean Organization for Caries Research and the Association for Dental Education in Europe.

Country activities

Albania. Im plem entation o f the drinking-water fluoridation project in Tirana has been delayed due to difficul­ties in implementing the technical feasi­bility study. The report on the feasibility study has been prepared by two consult­ant sanitary engineers. Immediately prior to the start o f actual fluoridation, an epi­demiological baseline should be estab­lished in order to monitor and evaluate the effect o f the project.

Data are being collected by the na­tional oral health pathfinder survey, and the results will serve as a basis for moni­toring and evaluating the oral health care delivery system in Albania.

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German Democratic Republic. The Regional Officer for Oral Health ad­dressed the Dental Association o f the German Democratic Republic on the “ Solution to dental public health prob­lems in an international perspective” at its twentieth anniversary celebrations in Leipzig in April.

Greece. The Regional Officer for Oral Health carried out an oral health situation analysis. Several dentists were trained in the use o f the W H O standard epidemiological survey methodology, to be used in the national oral health path­finder survey planned for 1985.

Hungary. The Regional Officer for Oral Health spoke at a seminar on pre­vention in stomatology, held in Budapest in October and attended by chief dental officers. A situation analysis was per­formed, and a plan was drawn up for a national oral health pathfinder survey in 1985.

Iceland. The Regional Officer for Oral Health assisted the staff o f the Uni­versity o f Iceland Faculty o f Dentistry in planning and implementing several epi­demiological studies, all o f which are o f direct interest to the Office ’s oral health programme.

M orocco. Officials from the Minis­try o f Health and the two dental faculties in Rabat and Casablanca visited Scan­dinavia in May to study training pro­grammes for various categories o f oral health personnel as well as the organiz­ation o f community-based oral disease preventive programmes.

Portugal. The data collection phase o f the national oral health pathfinder survey was completed in May. The data

have been analysed, and the findings will be used to plan the development o f the national oral health care system.

As a result o f collaboration in oral health manpower development, the first school for dental auxiliaries in Portugal was inaugurated in Lisbon on 26 June, in the presence o f the President ol Portugal, General Antonio Ramalho Eanes.

Spain. The Regional Officer for Oral Health visited the Ministry o f Health and Consumer Affairs in Madrid to calibrate the team for the national oral health path­finder survey which took place during April and June. The results o f the survey will serve as the basis for planning the oral health service system, including oral health manpower development and im­plementation o f community-based oral disease preventive programmes. Plans for education o f dentists (instead o f stomatol­ogists) were also developed.

Accident prevention

A Workshop on Education for Safety, held at the Scottish Health Education Group in Edinburgh in March, brought together representatives from fire brig­ades; road, consumer, sports and leisure safety officers; health education workers; epidemiologists; behavioural scientists; market researchers; community and clini­cal physicians; and architects. They con­sidered existing safety education policies and practices in Europe related to the prevention o f accidents on the road, in the home, and in sports and leisure ac­tivities.

The conclusions and recommendations o f the workshop included building up a data base to provide accurate information upon which to develop public education

42

programmes, training all safety personnel in epidemiological methods and drawing up training programmes. These and other recommendations will form the basis for development o f guidelines on safety edu­cation programmes for the public and training programmes for safety personnel working in all the sectors concerned.

The Steering Committee for Statistical Indicators for Accidents had its second meeting in Iceland in August. A subgroup had developed a basic data set for collect­ing information on the circumstances sur­rounding the accident, the treatment pro­vided for the victims, the severity o f injury and the long-term consequences, both physical and social. During the dis­cussion and subsequently in October, a final draft o f the data set and guidelines for its use by Member States were pre­pared; these are now included by coun­tries (e.g. Iceland, Morocco, Spain) in their programmes.

As a result o f the work done in the in­tercountry programme and in the collab­orative programme with Member States, it is now felt that model programmes can be developed for the prevention o f acci­dents. A meeting o f counterparts o f the Regional Officer for Prevention o f Acci­dents was therefore held in November in Vienna, hosted and supported by the Austrian Government, to consider the preparation o f model programmes. The disciplines represented among the coun­terparts were those o f road engineer, psy­chologist, transport administrator and physician (clinical and administrative).

The meeting recommended that a model programme should have five main elements: epidemiology o f behavioural, environmental and economic factors;

countermeasures to those factors; multi­sectoral prevention policy formulation and management including comprehen­sive education for safety; cost-effective health services for accident victims; and comprehensive information support. It was agreed that this approach would en­able Member States to achieve the regional H F A target o f a 25% reduction in mortal­ity from all accidents by the year 2000. The use o f the basic data set, the prin­ciples and guidelines emerging from the Edinburgh workshop mentioned above, and appropriate and cost-effective tech­nology were especially recommended.

A study has been initiated to identify priority areas for coordinated research on accidents. This study, organized by the Kuratorium für Verkehrssicherheit, Vienna, sets out to review the research currently being carried out in Europe on road and home accidents, to ascertain the degree o f coordination within Member States and between their institutions, and to make recommendations for future re­search.

A short-term consultant from Turkey has begun an epidemiological review o f all types o f accident. This will lead to the development o f a protocol for use in epi­demiological studies.

A joint O E C D / W H O study on traffic safety in elderly road users, which began in 1983, was completed in October. The joint exercise brought together experts from the transport field and health and social sciences. The resulting publication will be the first definitive work on this important subject.

The Regional Officer for Accident Prevention is working closely with the

4 3

CEC Directorate-General for the Envi­ronment, Consumer Protection and Nu­clear Safety on the collection o f data con­cerning product-related home accidents, and chaired a session o f the CEC collo­quium on product safety held in Brussels in May. He attended a workshop and the annual meeting o f the Nordic Medico- Statistical Committee (N O M E S K O ) in Iceland in August. This has resulted in a member o f N O M E S K O joining the Steer­ing Committee for Statistical Indicators for Accidents, principally to jointly plan registration systems and classification o f accidents within the concept o f the basic data set. The Regional Officer for Acci­dent Prevention also represented W H O at the World Congress on Traffic Safety organized by Prévention routière interna­tionale in Vienna in November. The con­gress focused on the social and economic aspects o f traffic safety.

Country activities

Iceland. A national workshop, sup­ported by the Regional Office, considered the accident situation in Iceland. Among the recommendations was the establish­ment o f a steering group to be chaired by a Member o f Parliament. This group will prepare a programme giving priority to collection o f comprehensive data, edu­cation and review o f legislation.

Morocco. A national workshop held in April/May in Rabat was attended by 40 people from all relevant sectors. The recommendations, covering multisectoral planning and management, the basic data set, epidemiology, provision o f services for the injured, and education, have been included in a five-year programme for accident prevention.

Portugal. As part o f the collabora­tive programme, an international seminar

on drinking and driving was held in Lis­bon in September. Portugal has methodi­cally and progressively introduced drink­ing and driving legislation, with strong emphasis on public education and semi­nars for personnel from the transport and health sectors as well as the police and lawyers. The results are encouraging.

Health promotion

This new programme, initiated under W H O ’s Seventh General Programme o f Work, began in January.

“ Health promotion” work at the Re­gional Office started in 1980 with a study to identify the meaning o f the term in Europe, both in theory and practice, and to identify the goals, approaches and con­tent o f programmes for health promotion. The outcome o f the study was discussed by a working group in November 1981, which advised the Regional Director on the focus for a new programme. The con­ceptual starting point was a positive and social notion o f health. Concurrently, a basic paper giving the outline and inten­tions o f the Regional Office’s health edu­cation programme was presented to the Regional Committee in 1981 and accepted by Member States. This paper described four main changes in thinking:

• from health prescription to health promotion;

• from modification o f individual be­haviour to a systematic public health approach;

• from a specialist orientation to recog­nition o f lay competence;

• from authoritarian health education to supportive health education.

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One o f the three major sections in the regional strategy for H F A is to develop lifestyles conducive to health and in 1984 the Regional Committee accepted targets which constitute a health promotion ap­proach. These targets call for healthy public policy, social support systems, and an understanding of, and motivation to­wards, healthy behaviour, as well as a reduction in health-damaging behaviour.

In 1984, it was felt appropriate to pull together all these elements o f health pro­motion programme development in the Regional Office and to make the concepts available in a short and precise document. The resulting discussion document, which outlines principles, subject areas, priori­ties for policy development and dilemmas, has been widely distributed and has al­ready had an influence on health pro­motion strategies in several countries.

Other activities under the programme for health promotion have included at­tempts to increase and disseminate know­ledge on factors and conditions influenc­ing the development o f particular beliefs and behaviour. T o this end, a working group met in Edinburgh in November to consider priorities, issues and strategies for research on health promotion at which broad approaches were outlined.

In addition, an overview o f available information on social support and health is being compiled, and literature searches have been completed. A secondary analy­sis is being made o f data from the US national survey o f personal health prac­tices and consequences. Data from this survey and from a national survey o f self- care behaviour in Denmark will be ana­lysed using methods appropriate for com­paring them.

P R O T E C T I O N A N D P R O M O T I O N O F H E A L T H O F S P E C IF IC

P O P U L A T I O N G R O U P S

Maternal and child health

The Perinatal Study Group has spent five years collecting information and evaluating the situation o f perinatal ser­vices in the Region. The priorities are now to disseminate its findings as widely as possible and to work together with the Member States in promoting changes in the perinatal services. Following the con­sultation in Beijing, People’s Republic o f China in November 1983, a Working Group on Appropriate Technology for Prenatal Care was convened in Washing­ton, D C in November 1984 in collabor­ation with the Regional Office for the Americas. This working group, composed o f experts from the European and Ameri­can Regions, also discussed ways o f im­proving services. Both meetings were at­tended by representatives o f various disci­plines and interest groups and appear to have been effective in stimulating the ex­change o f information and ideas about the organization o f services during preg­nancy and birth.

The impact o f the work o f the Peri­natal Study Group can also be seen with regard to specific perinatal issues in the Region. For example, several Member States which did not previously have rooming-in (newborn infants staying at their mothers’ bedside in the hospital) are now experiencing a rapid increase in this practice.

The Regional Office has been actively involved in discussion o f the appropriate use o f ultrasound technology during preg­nancy and birth. Staff members from the

4 5

Office have consulted with experts and consumers in several Member States re­garding this technology, and an article appeared in the 11 August issue o f the Lancet, giving W H O ’s position on the appropriate use o f ultrasound scanning during pregnancy. Several Member States have come forward with statements and/or recommendations during the course o f the year with regard to the appropriate use o f this technology.

Studies on the use o f human resources in perinatal care have continued, and data are being collected from a number o f Member States, including Denmark, Greece, Morocco, the USSR and the United Kingdom. Preliminary results suggest that parents and midwives are much more likely to communicate, and that the non-invasive care typically given by midwives is threatened by the more technological and medical approach.

The Regional Officer for Maternal and Child Health, together with two members o f the Perinatal Study Group, attended a planning meeting o f the CEC, where dis­cussions were held on further research needs in perinatology. The research activ­ities o f the CEC will build on the research work done to date by the Perinatal Study Group.

In August, the Office collaborated with the EEC and the National Perinatal Epi­demiology Unit in Oxford, United King­dom, in organizing a two-week course in perinatal epidemiology, with the aim o f meeting the urgent need for perinatal epi­demiologists in the Region. Thirty partici­pants from 15 Member States, including obstetricians, paediatricians, general prac­titioners, midwives and nurses, attended this course, which had an international

faculty from North America and the Eu­ropean Region. The course evaluation by the students indicated that this inaugural effort was a considerable success.

A consultant has conducted an infor­mal survey o f school health services in selected Member States. This survey sug­gests that there have been very few changes in the nature o f these services in the recent past. It would appear that the extensive work done by the Office during the 1970s on the health o f children o f school age has so far had little impact on services in the Region. For this reason, new strategies will be explored for W H O assistance to Member States in promoting changes in present-day school health.

In the summer o f 1984, a study was made o f the state o f the art in systems to monitor perinatal, infant and child mor­bidities.

Country activities

Denmark. The Regional Office col­laborated with obstetrical/midwifery and medical technology organizations in Den­mark on organizing an international Meet­ing on Appropriate Perinatal Technology, held in Copenhagen in February.

M orocco. The Regional Officer for Maternal and Child Health and the con­sultant midwife made a country visit, which led to the decision to include peri­natal activities in W H O ’s collaboration with the Centre national de Reproduction humaine et de Planification familiale in Rabat. This Centre will accordingly be­come part o f the global network o f peri­natal collaborating centres.

Norway. The Office’s M C H unit as­sisted in the organization o f a birth con­ference, held in Oslo in April, and also

46

met health authorities in Finland, Greece and Italy to assist in the planning o f simi­lar national conferences.

Turkey. The Regional Officer for Maternal and Child Health and the con­sultant midwife visited Turkey on several occasions to consult with the Ministry o f Health on development o f a programme to reduce the level o f infant mortality (see also the section on primary health care, p. 24).

Sexuality and family planning

The new title reflects the programme’s extension into the field o f human sexual relations. Assuring and preserving sexual health is to a large extent a question o f appropriate education, not only o f the public but also o f health personnel.

Guidelines on psychosocial problems o f family planning clients and a training module on the specific family planning needs o f migrants have been sent for test­ing to teaching institutions, national di­rectors o f family planning and national health education officers, as well as to national schools o f public health which conduct training courses.

Tw o issues o f the family planning bull­etin Entre nous were distributed to about 1000 addresses within the Region and 450 people and agencies outside the Re­gion. A reader feedback evaluation was done in 1984 with 200 encouraging replies. The country reports section was the most appreciated, while the section on people was found the least useful.

Tw o surveys on the improvement o f family planning services for migrants were completed during the year: one in Belgium, on Moroccan migrants, looked

at their attitudes in relation to family planning, and one in the Federal Repub­lic o f Germany, on Turkish immigrants, considered the process o f “ failed” family planning practice. The two researchers subsequently met in Belgium in August and in the Regional Office in September to draw up a combined report and make recommendations aimed at teaching in­stitutions and personnel dealing with mi­grants regarding the improvement o f ser­vices, the production o f information, education and communication material, areas o f research, and training o f health personnel.

The report was used as a background document for a joint W H O / IC C working group on the improvement o f family plan­ning services for migrants, which met in Paris in December. The survey findings were used to identify specific migrant needs in relation to family planning, to consider how far family planning ser­vices in the host countries, meet these needs, and to propose ways o f improving family planning education and services for clients. The International Planned Parenthood Federation was represented at this working group.

The Centre for Social Studies, Aber­deen has completed the study on barriers to change and identification o f the deter­minants and effects o f consumer behav­iour in family planning. The findings are to be used immediately in the U N F P A - funded family planning project in Turkey.

A study on childless couples has also been completed, which takes into con­sideration the question o f choice (can people really choose childlessness from strength or is it a sign o f moral or emo­tional weakness?) and examines how the trend towards fewer children relates to

47

the pronatalist concerns o f policy-makers and the assumption o f professionals that they understand their clients’ motivations and know what is best for them.

Other studies are under way to evalu­ate family planning programmes, investi­gate alternative approaches to the devel­opment o f family planning services, con­sider the role o f men with regard to birth and contraception, and review current concepts o f a healthy sexual life.

The Regional Officer responsible for this programme delivered a lecture on sexuality at the annual meetingon clinical sexology organized in Svendborg by the Nordic Association o f Clinical Sexology.

Country activities

Albania. The Regional Officer for Sexuality and Family Planning, together with the U N F P A Senior Liaison Officer for Europe, visited Albania to discuss im­plementation o f the project for improve­ment o f maternal and child health and to become acquainted with the Albanian health services.

Bulgaria. Tw o temporary advisers visited Bulgaria to investigate the causes o f and remedies for sterility; a W H O fel­low undertook a three-month study trip to France.

In connection with the project on fam­ily planning counselling for families at risk, a temporary adviser visited Bulgaria, and a study tour on genetic registers was made to France, the Netherlands, Sweden and the United States.

Hungary. The third international postgraduate training course on methods

o f family planning was held in Debrecen from 21 May to 8 June. It was attended by16 fellows from the regions o f Africa, the Americas, the Eastern Mediterranean, Europe, South-East Asia and the Western Pacific. The course director visited the Regional Office as a temporary adviser to plan the 1985 course.

Italy. The Office was represented at the national meeting on adolescents and sexuality, held in Rome in October and organized by the Unione Italiana Centri Educazione Matrimoniale/Pre- matrimoniale.

M orocco. The Regional Officer for Sexuality and Family Planning partici­pated in a tripartite meeting between U N F P A , the Moroccan Government and executing agencies to review the project on professional training in M C H /FPand attended several meetings on multisec­toral family planning matters. An edu­cational specialist carried out two con­sultant missions, and eight national staff went on a study tour to Canada.

Poland. The Regional Officer for Sexuality and Family Planning visited Poland at the request o f the Director o f the Mother and Child Research Institute in Warsaw to discuss a project request to U N F P A for a survey on knowledge, atti­tudes and practices and on training o f primary health care physicians in genetic counselling and prenatal diagnosis. Once approved, this project will be executed by the Regional Office’s Family Planning unit, in cooperation with the Institute.

Portugal. Extension o f the project giving assistance to national family plan­ning services has been requested.

48

A Da n is h c o n s u m e r o r g a n iz a t io n . Parents and C h i l d b i r t h , g ives a pr ize a n n u a l l y fo r o u t s t a n d i n g e f fo r t s to i m p r o v e c h i l d b i r t h c o n d i t i o n s in D en ma rk . In 1 9 8 4 . the pr ize was g iven to S u s a n n e H o ud and M a r s d e n W a g n e r o f th e M a t e rn a l and Ch i ld Heal th uni t , in r e c o g n i t i o n of the e f fo r t s of the Regiona l Of f i ce to im p ro v e per ina ta l serv ices. The c o n s u m e r o r g an iz a t i on e m ph a s i ze d the i m p o r t a n t ro le p layed by the Reg iona l O f f i ce in u rg i n g tha t pa ren ts have the r igh t to a ll i n f o r m a t io n on t e c h n o l o g y used d u r i n g p r e g ­n a n c y and b i r th, and the r i g h t to i n f o r m e d c h o i c e on all aspec ts of pe r ina ta l care. The e f f i c a c y and safety of r o u t in e u l t r a s o u n d s c a n n in g d u r i n g p r e g n a n c y has been a w id e ly d is c us se d ins t an ce of the need fo r be t te r ev a lu a t ion and c o n t r o l o f pe r inata l t e c h n o l o g y and w a s c i ted as an e x a m pl e at the p r i ze -g iv ing c e re m o n y .

A ' 'mi l k " b reak d u r i n g the m e e t in g of E u ro p ea n b r e a s t f ee d in g mo th ers ' s u p p o r t g ro u p s held in B on n in June. The m e et in g was a r r a n g e d by the A r b e i t s g e m e i n s c h a f t f reier S t i l l g ru p p e n and the Reg iona l Of f ice 's N u t r i t i o n unit .

S c a n n i n g e l e c t r o n m i c r o g r a p h t a k e n f r o m a l u n g o f a rat e x p o s e d t o g l a s s f i b r e s ( p h o t o g r a p h u s e d o n t h e c o v e r o f t h e P r o c e e d i n g s o f t h e C o n f e r e n c e o n t h e B i o l o g i c a l E f f e c t s o f M a n - m a d e M i n e r a l Fibr es) .

Equipment was ordered for the proj­ects on family planning activities in gen­eral hospitals and maternity clinics in Porto and on basic education in literacy, health and family planning for the Cape Verdian community in the Lisbon area.

A national workshop on family plan­ning and the role o f the paediatrician, jointly organized by the Directorate- General o f Primary Health Care and the Portuguese Paediatric Association, was held on 14 and 15 June. It was attended by 29 participants responsible for services or teaching from the various regions o f Portugal. The lecturers included the Re­gional Officer for Sexuality and Family Planning and a W H O temporary adviser.

The objectives o f the workshop were to discuss the benefits o f family planning to health in general and child and ado­lescent health in particular, to update knowledge on family planning and ado­lescence, and to define strategies for the role o f the paediatrician in family plan­ning. As a result o f the workshop, the participants felt encouraged to partici­pate more actively in family planning and in motivating parents, teachers and gen­eral practitioners in their role as sex edu­cators o f young people.

Spain. In November, the Regional Officer for Sexuality and Family Planning delivered a lecture at the first meeting on family planning organized by the govern­ment o f the autonomous community o f Castilla-Leon in Salamanca.

Turkey. In June, a project for inte­grated family planning/MCH services in17 provinces became operative. A study on identification o f risk factors in mater­nal, fetal and child health is nearing com­pletion.

A national workshop, organized by the Hacettepe School o f Nursing, on modular approaches to learning applied to family planning was held in September for instructors in nursing/midwifery; there were 62 participants. The objec­tives were to explore primary health care and its implications for nursing and mid­wifery, to review training and practice in M C H /FP , and to stimulate active teach­ing/learning processes for M C H /F P in the context o f primary health care. Writ­ten material in Turkish was distributed prior to the workshop. Teaching was done by the Regional Officer for Sexuality and Family Planning, the senior public health nurse/midwife from W H O headquarters, a temporary adviser and the national workshop organizer.

Workers’ health

The aim o f an occupational health service has often been defined as prevent­ing a deterioration in the working popu­lation’s health due to occupational fac­tors, whether o f a biological, chemical, physical or psychosocial nature. Clearly the concept o f workers’ health is far wider. The major goal is to establish a flexible model applicable to the different organiz­ational systems o f the Member States. Such a model should also cover occupa­tions (in agriculture or small-scale indus­tries, for instance) where the monitoring o f work-related risks cannot be achieved by traditional means. Apart from protect­ing those individuals who are particularly susceptible to specific hazards, a compre­hensive approach must be adopted. This presupposes an interactive relationship between occupational health and primary health care.

The new Regional Officer for Workers’ Health took up his duties in May. Since

4 9

then a major effort has been made to orient the programme so that workers’ health problems are comprehensively cov­ered. Strong emphasis is being given to activities in the Member States, and a survey o f their occupational health ser­vices is being finalized.

A draft manual on the epidemiology o f occupational health problems has been prepared and will be used as a teaching tool.

An important event during 1984 was the publication o f the proceedings o f the Conference on the Biological Effects o f Man-made Mineral Fibres (M M M F ) . While the health hazards o f various asbestos fibres have been extensively in­vestigated, little is known about those caused by long-term exposure to various man-made mineral fibres. Studies on the effects o f M M M F have been carried out in Europe by 1 A R C in collaboration with the Joint European Medical Research Board (JEM RB ) and in North America by the Thermal Insulation Manufacturers Association. The Regional Office also collaborated with JEM RB in organizing technical committee meetings in St Aug­ustin (Federal Republic o f Germany) in January and in London in September; these are part o f a series started in 1980 dealing with the development and quality control o f methods for measuring expo­sure to M M M F .

The Occupational Health unit is also responsible for two international epi­demiological studies: one on stainless steel welders’ exposure to chromium and nickel, and the other on communities’ and workers’ exposure to selected types o f pesticide. Planning o f the pilot study phases was carried out during 1984.

Demographic changes predicted by the United Nations suggest that the numbers o f elderly people will increase in the forth­coming decades. Disability and growing dependence accompany old age. The fam­ily is, o f course, the primary support for its less able and elderly members. I f a family cannot cope, or if there is no fam­ily, the health and personal social services should step in to maintain an elderly per­son in dignity and comfort.

The regional strategy for health for all by the year 2000 is in full accordance with the International Plan o f Action formu­lated by the U N World Assembly on A g ­ing, held in Vienna in 1982. New develop­ments in this field are reflected in chang­ing health and social policies, legislation and services, as well as in a reorientation o f biological, clinical and social research including the development o f simple in­dices to measure the effectiveness o f ac­tion taken.

A Consultation on Guidelines for As­sessing the Functioning o f the Elderly took place in Aberdeen in March. The participants felt that médicosocial screen­ing was an important tool, and stressed the importance o f identifying those in need o f multidimensional functional as­sessment. It was felt that more detailed information on functioning o f the elderly will enable better health and social policy decisions to be taken and thus contribute to the attainment o f health for all by the year 2000.

A Working Group on Prevention o f Health Risks that have Consequences in Old Age met in October in Tbilisi (USSR) to discuss links between primary health

Health of the elderly

50

care o f the elderly and institutional sup­port. Longitudinal studies currently be­ing carried out were presented by staff o f the Research Institute o f Experimental and Clinical Therapy in Tbilisi. It was again emphasized that more work needs to be done in some elderly populations on changes in functional capacity due to ag­ing and the ability to carry out the ac­tivities necessary for daily living. More research is also needed on genetic inherit­ance as a factor o f longevity, and on the mutual interplay o f social and physical environmental factors.

T o throw more light on the problems o f the elderly, the Regional Office initi­ated an international population-based study; the first report on this study, en­titled The elderly in eleven countries: a sociomedical survey, was published as No. 21 in the Public Health in Europe series. The book constitutes a first step towards a better understanding o f the health and social problems that old people will face during the last decades o f this century in different parts o f Europe.

A consultation on follow-up to this study was held in Jyväskylä (Finland) in November. A deeper analysis o f the exist­ing data was limited in most cases to five or six study populations, in order to fac- cilitate a comparison between areas. The main fields investigated were health and functional ability, the use o f services, life­styles, and risk factors. The results o f this analysis will be published in a series o f short articles.

At the Third International Conference on System Science in Health Care, held in Munich in July, the Regional Officer for the Health o f the Elderly was responsible for organizing the session on preventive approaches in care o f the elderly.

Algeria. The final report on the U N D P project “ Troisième age” has been submitted to the Government and de­restricted for general distribution.

Greece. The Centre o f Planning and Economic Research is collecting basic data for the research project entitled “ The aging in Greece: socioeconomic trends and implications for the family” .

Iceland. In Iceland where, because o f recently established legislation on the integration o f social and health services, health policy officials and planners are interested in various policy issues, includ­ing those relating to meeting the needs o f the elderly, a computer-assisted planning (C A P )0 software package is being used.

Norway. In Norway, where it is pre­dicted that a substantial growth in the elderly population by the year 2000 will be followed by a decline for a few decades before increasing again sharply, the C A P model has been applied to analyse alter­native mixes o f institutions and home- based services to meet the needs o f the elderly over this period o f time and to translate the projected service utilization into personnel requirements, e.g. man­power training needs for nurses, home helps and other personnel required to pursue a non-institutional long-term care policy for the elderly.

Social equity and health

A meeting o f experts on the underlying processes o f becoming socially vulnerable

Country activities

a C A P software package: graphical, computer- assisted demonstration technique for the evaluation o f dif ferent health strategies.

5 1

was held in Munich in July. The meeting focused on unemployment among youth and concluded, inter alia, that the concept o f vulnerability should be further elabor­ated. It was decided that W H O , through the Institut für Medizinische Informatik und Systemforschung in Munich, should continue to act as a clearing-house for literature as well as ongoing research.

In December, a Workshop on the Health Burden o f Social Inequities was held in Copenhagen, attended by 30 par­ticipants from 20 European countries. This workshop was organized in close col­laboration with the European Society for Medical Sociology (ESMS), established in 1983. Twenty country profiles were presented, including information on data sources and methodological problems re­lated to social inequities. It was agreed that the study o f social inequities related to health should be a priority area for the next few years. The conclusions o f the workshop will be o f great value when de­veloping appropriate indicators in rela­tion to the targets for HFA2000. In fact, social equity is one o f the prerequisites for attaining this objective. Other recom­mendations included continuing to de­velop descriptive studies at national level, at the same time putting more emphasis on in-depth qualitative approaches de­signed to clarify the concepts used in the descriptive studies. Another important finding o f the workshop was that edu­cation was more generally accepted across the Region as an indicator o f social in­equities than social class or other similar concepts.

In order to strengthen the network for the programme on social equity and health, each Member State has been asked to appoint a national focal point; so far.

ten ministries have responded positive­ly. Furthermore, through ESMS, the Regional Office has contacts in some25 countries in the Region.

T o give further input to this pro­gramme, some consultant studies have been initiated. An international anno­tated bibliography on youth unemploy­ment is being compiled, to meet the need for more factual information which will constitute a sound base for health policy statements. Information is also being col­lected in Denmark to link indicators o f economic recession (e.g. unemployment) with health data such as suicide rates. Support is being given to an intervention study in the Federal Republic o f Ger­many, promoting good health among Turkish housewives. A study is being made o f Moroccan migrants in Europe and migrants returning to Morocco, as a follow-up to the Consultative Group on Ethnic Minorities, held in The Hague in November 1983. An annotated bibli­ography on migrants’ health in French- speaking countries is being prepared and, lastly, preparatory work is being carried out for a study in Greece on social in­equities related to health.

P R O T E C T I O N A N D P R O M O T I O N O F M E N T A L H E A L T H

Psychosocial factors and mental health

This programme area deals predomi­nantly with psychiatry, neurology and re­lated health services and research, stress- related disorders, the behavioural sciences and the neurosciences, and the psycho­social elements o f health care and pro­motion.

52

The programme was reviewed at the Tenth Session o f the E A C M R in Copen­hagen in February. The Committee wel­comed developments in the two new pro­gramme areas o f alcohol and drug abuse. A need was expressed to strengthen the behavioural sciences input to mental health research activities. The Committee recognized and approved the fact that the regional programme was more committed to supporting operational or health ser­vice research, whereas the W H O head­quarters programme played a significant part in basic research in psychiatry and the neurosciences.

A consultation was held in Cologne in May, attended by representatives o f vari­ous branches o f applied psychology. The European Federation o f Professional Psy­chologists Associations hosted the meet­ing, which concluded that professional psychology had an important contribu­tion to make to W H O programme devel­opment and that psychologists should be involved at all stages o f programme devel­opment. The Federation has undertaken to inform all its member associations o f the regional strategy and to identify psy­chologists throughout the Region with the appropriate expertise and sapiential authority who might participate in the various programmes o f work.

A Conference on Mental Health Ser­vices in Pilot Study Areas was held in Trieste in April. This conference was organized in collaboration with the re­gional government o f Venezia Friuli, and was attended by representatives o f the pilot study areas and Member States. The aim o f the meeting was to present the findings and conclusions o f the W H O study, carried out in 21 areas o f 16 Mem­ber States, which had assessed mental health policies and practices over the past

ten years, with special reference to the establishment o f information systems for monitoring the development o f compre­hensive community-based mental health care.

M oves towards community-based comprehensive mental health care in Europe were recognized and generally approved, but the conference expressed concern about the slow rate o f change and the problems which may arise within care systems that are in a state o f tran­sition. The development o f ambulatory and other services as alternatives to the mental hospital must take place within a comprehensive and coherent plan which incorporates all the facilities required to serve a defined population. The partici­pants recommended that W H O should encourage the further development o f in­tegrated mental health information sys­tems, as an essential part o f any evolv­ing mental health care programme, and should support training programmes in appropriate information skills. Other pri­ority areas for action include giving health and other personnel suitable training fo­cused on non-institutional care and prac­tical community involvement, and pro­viding postgraduate training in epidemi­ological, planning and management skills.

A small working group met in Cam­bridge in December and agreed to prepare training material for the purpose o f intro­ducing mental health care as an essential component o f primary health care prac­tice. In addition, the group will consider various patterns o f multidisciplinary work on mental health issues in primary care settings and will prepare guidelines for training in this style o f work.

A study tour o f centres in Europe pro­viding services for elderly persons suffer­ing from mental illness was sponsored by

5 3

the Kellogg International Scholarship Program, the Institute o f Gerontology o f the University o f Michigan (U SA ), the W H O collaborating centre for psycho­social factors and health at the Université libre de Bruxelles in Belgium, and the Belgian Ministry o f Health. Some 20 American mental health administrators, and geriatricians, psychiatrists and public health administrators from Europe took part in the tour. Visits were made to Bel­gium, Bulgaria, Denmark, Switzerland, Yugoslavia and Michigan. A working group has prepared a report giving rec­ommendations on mental health policy and practice with regard to the elderly. Central to these recommendations is the belief that home assessment by a multi­disciplinary team is the keystone to good placement and service utilization. Nurs­ing homes were presumed to be an in­tegral component o f any comprehensive system, while various models o f day care were seen to be effective in different ser­vice settings.

The World Federation for Mental Health held a conference in Copenhagen in August, co-sponsored by W H O , on the theme “ Legal issues concerning com­mitment and civil rights o f mentally ill people” . Presentations from 15 countries in Europe revealed serious concern for the civil rights o f people diagnosed as men­tally ill, as exemplified by numerous par­liamentary or government commissions and committees studying the matter. Em­phasis was placed on the importance o f all those diagnosed as mentally ill enjoy­ing the same legal, civil, social and politi­cal rights as the rest o f the population.

Country activities

Greece. In conjunction with the Na­tional Health Council’s Standing Com ­mittee on Mental Health, a series o f

national meetings and training work­shops has been scheduled to develop and implement the national mental health plan. Special attention is being given to the development o f psychiatric units in general hospitals, community mental health centres and inservice training for mental health professionals. A great deal o f this work is being carried out in close collaboration with the CEC-supported project on mental health.

Portugal. Experts have been engaged on a temporary basis to provide technical support to national developments in child mental health and in the reorganization o f regional mental health services.

Spain. The Regional Office assisted with a national workshop on psychiatric epidemiology, organized by the Ministry o f Health and Consumer A ffairs ’ com­mission on psychiatric reform and at­tended by representatives o f the auton­omous communities’ mental health ser­vices administrations. The workshop, based on guidelines for managerial pro­cesses for national health development, is the first in a series designed to develop a cadre o f national mental health ad­ministrators at middle-management level throughout the country.

Prevention o f alcohol abuse

In February, the E A C M R discussed the new programme (started in 1984) on the prevention o f alcohol abuse, endorsed its present composition and stressed the importance o f the areas o f research it covers.

A consultation meeting was held in Edinburgh in June to prepare an inter­country project on community response to alcohol-related problems. The aim o f

54

the project is to promote and coordinate studies to determine the nature and extent o f alcohol-related problems in a com­munity and the way in which these prob­lems are dealt with, so that more effective responses can be designed and imple­mented. It was agreed that the devel­opment o f a glossary o f terms used in the study would greatly facilitate collabor­ation between centres.

A review o f different approaches to preventing alcohol-related problems in young people was finalized in June. It contains examples from some o f the Mem­ber States o f trends in consumption and in alcohol-related problems among young people. The influences on young people’s drinking behaviour are described, as are alcohol education in the school system and health-promoting activities encour­aging healthy lifestyles. In addition, the review covers treatment strategies and legislative measures. It was used as a back­ground document for the task force meet­ing on alcohol-related problems and their prevention, with emphasis on intervention in adolescence, held in Geneva in Sep­tember, which was the third task force proposed by the scientific planning group on biobehavioural sciences and mental health.

A study o f existing approaches to pro­fessional and intersectoral training with­in the European Region has been under­taken jointly with the programme on abuse o f psychoactive drugs. The study will seek information on the aims, meth­ods, content and evaluation o f results o f training, with a view to developing model curricula.

The Regional Office was represented at the Thirtieth International Institute on

the Prevention and Treatment o f Alcohol­ism, organized by the International Coun­cil on Alcohol and Addictions ( IC A A ) and held in Athens from 27 May to 2 June and, in preparation for the study on al­cohol education mentioned above, at I C A A ’s Education Section meeting in Oslo in October.

Country activities

Portugal. A consultant advised on the preparation and further development o f the national contribution to W H O ’s in­tegrated project on community responses to alcohol-related problems. In addition, she helped to prepare the national pro­gramme and strategies for prevention o f problems related to alcohol consumption.

Abuse o f psychoactive drugs

This programme will not start until1985 but is being activated with the help o f temporary advisers and consultants pending the establishment o f a permanent post.

In March, an advisory group o f con­sultants and representatives o f intergov­ernmental and nongovernmental organ­izations was convened to consider the proposed programme objectives and tar­gets. A glossary o f descriptive terms in the field o f drug abuse was also drafted, as an addition to the revised Dictionary o f pub­lic health.

The information available in the Re­gional Office relating to drug abuse was systematically reviewed, and country files as well as resource material files were es­tablished. This information is being added to extensive programme information, col­lated in some 17 countries o f the Region,

55

on laws and policies, epidemiological stu­dies, treatment facilities and prevention activities.

An inquiry is being addressed to ap­propriate individuals and organizations to determine whether curricula are needed to train primary health care personnel in identifying, treating and referring individ­uals with problems due to drugs. Guide­lines for the evaluation o f treatment pro­grammes are also being drawn up.

Collaboration with the Office’s Phar­maceuticals and Drug Utilization unit has led to several activities in the field o f licit drugs, especially the benzodiazepines. An ethnographic study is being made o f individuals who are long-term consumers o f or dependent on such drugs in Den­mark, Greece and Spain, the findings o f which are to be published as a monograph. Two other studies are also to be carried out: one in Italy on the use o f licit tran­quillizers, hypnotics, etc. among elderly people in residential care, and one in Nor­way on general practitioner prescribing patterns for these types o f drug.

On the initiative o f the Council o f Europe, a feasibility study group has been established with membership drawn from W H O , the Council o f Europe, the Com ­mission o f the European Communities and the International League o f Red Cross Societies. This group is designing pilot projects aimed at preventing depen­dence and addiction to drugs, alcohol and other substances by comprehensive health education programmes in schools.

The Regional Office was represented at the Fourteenth International Institute on the Prevention and Treatment o f Drug Dependence, sponsored by IC A A and held in Athens from 27 May to 2 June, as

well as at a CEC meeting in Rome from 3 to 6 September on epidemiological meth­odologies for survey systems in the field o f drug abuse.

P R O M O T I O N O F E N V I R O N M E N T A L H E A L T H

International Drinking Water Supplyand Sanitation Decade

A significant effort was directed to­wards achieving the objectives laid down in the resolution adopted by the thirty- first session o f the Regional Committee (EUR/RC31/R9), circulating to all Mem­ber States o f the Region the questionnaire agreed upon by the working group held in Copenhagen in March 1983. Pertinent data relating to Decade activities in a total o f 18 countries were received via the national focal points o f the International Water Supply Association. This survey revealed the extent o f the provision o f water supply and basic sanitation services in those 18 countries and highlighted the existing areas o f constraint on achieving the Decade’s objectives. The findings are published in the Statistical survey o f water and sanitation services — 1983. Unfortu­nately, some o f the countries within the European Region (many o f them with quite large populations) did not respond to the survey, but it is hoped that this shortcoming will be remedied in the repeat survey to be made in 1986. A datum line has now been established in the 18 coun­tries, upon which progress for the remain­der o f the Decade may be assessed.

One possible constraint on the pro­vision o f data relating to the Decade’s progress — if not also on attaining the

56

aims o f the Decade — is the multiplicity o f ministerial responsibility for water and sanitation services: in some countries, as many as nine ministries are involved in some aspect or other o f the water cycle (Fig. 4).

Continuing efforts are being made to pursue the collection o f Decade infor­mation and countries which have not re­sponded, and who may have problems o f coordination, have been offered assist­ance in creating national coordinating bodies with the objective o f concentrating the input o f data on water supplies and sanitation.

Both the working group meeting in March 1983 and the recent statistical sur­vey have identified manpower shortages

Fig. 4. W a te r se rv ices in Europe : r e sp o n s ib i l i t y of m i n i s t r i e s / a g e n c i e s

in ind i v id ua l c o u n t r ie s

0 1 2 3 4 5 6 7 8 9 Number of ministries/agencies

in individual countries

in several spheres fundamental to achiev­ing the Decade’s aims. During 1985/86, efforts will be concentrated on identifying those areas o f weakness in the various countries and providing the necessary as­sistance to remedy shortcomings.

A meeting was convened in Copen­hagen in January to review progress in the European Region towards attaining the goals o f the Decade and the direction in which future efforts should be concen­trated. A number o f recommendations were made, and it was stressed that Mem­ber States should stimulate and imple­ment water supply and sanitation pro­grammes if the Decade objectives were to be achieved in the European Region.

The first volume o f guidelines on drinking-water quality was published by W H O headquarters during 1984; this should enable governments to establish their own national standards and thus define the word “ safe” as used in the ex­pression o f the Decade’s aims, namely to ensure adequate supplies o f safe drinking- water. Volume 2, which contains the health-related criteria upon which the values in Volume 1 were formulated, is to be published in 1985. Fig. 5 illustrates the hazards to drinking-water o f industrial effluent discharge.

The collaborative agreement recently signed with the French Centre national du Machinisme agricole, du Génie rural, des Eaux et des Forêts in Lyon should strengthen W H O ’s ability to provide valu­able scientific and practical information to those countries wishing to solve prob­lems associated with water supplies and basic sanitation in rural areas and small communities.

An addition to the Public Health in Europe series, entitled Water services in

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Fig. 5. T h e h a z a r d s t o d r i n k i n g - w a t e r s o u r c e s r e s u l t i n g f r o m t h e d i s p o s a l o f i n d u s t r i a l e f f l u e n t d i s c h a r g e

Europe, was compiled during 1984. This publication will provide comprehensive information on various aspects o f each country’s water services and will also be useful in relation to Decade information within the European Region.

As the result o f work done during 1984, the Regional Office is to publish a set o f “ standard model designs for rural water supply systems” . This should re­lieve governments o f the laborious and costly exercise o f designing, from scratch, water schemes to meet rural community needs.

A number o f meetings were convened during the year, including a working group meeting in Budapest in February on river bankwell filtration as a method

o f producing a supply o f potable water. Another working group, on the health hazards o f nitrates in drinking-water, was held in Copenhagen in March. Ingestion o f nitrates has been associated with in­fant methaemoglobinaemia but not con­clusively with gastric or other types o f cancer, goitre, congenital malformations or cardiovascular effects. Although the levels o f nitrates in water sources used for drinking-water supply and especially in groundwater supplies are increasing in Europe, vegetables are the main source o f nitrate intake. However, the working group noted that the concentration o f ni­trates in rain and snow in Europe is in­creasing, a trend that could have adverse effects upon drinking-water sources.

Arrangements were also concluded which will lead to the publication in 1985

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o f recommendations for slow-sand filtra­tion systems suitable for installation in small communities and rural areas, in order to provide potable water from in­ferior water sources.

Country activities

Algeria. Prior to A lgeria ’s joining the African Region, the Regional Office for Europe assisted the Government by preparing a code o f practice for rural water supply and sanitation. The code has now been printed and should be o f interest to a large number o f countries.

The Regional Office has continued to provide technical assistance to the large- scale project related to solid waste man­agement, and will complete implementa­tion o f this project on behalf o f the Regional Office for Africa.

Greece. A sectoral study on rural water supply was undertaken with W H O assistance.

Malta. The projects for sewage puri­fication and improvement o f the sewerage network and for the utilization o f water resources have continued as planned.

Morocco. Morocco remains the pilot country for the Decade in the European Region o f W H O . Large-scale W H O as­sistance to Morocco was continued, and a document has been produced to inform potential donors and international in­vestors o f the legal and financial pro­cedures applicable to water supply and sanitation projects in Morocco.

The national drinking-water supply agency (O N E P ) runs two large-scale proj­ects in cooperation with W H O , supported by U N D P funds: one on improvement o f

drinking-water quality, to strengthen the capabilities o f O N E P ’s central and provin­cial laboratories, and the other on regional water supply schemes and water distribu­tion in smaller communities, to strengthen the capabilities o f O N E P ’s planning div­ision in the field o f pre-investment studies.

A new project on human resources development for the Decade, to be imple­mented with assistance from W H O and support from U N D P , has now been ap­proved.

Preparations are being made to launch two new projects, one on master planning for sewerage and sanitation, and the other to control the pollution o f water resources.

Finally, W H O , in cooperation with U N IC E F , has continued its assistance with rural water supply and sanitation activities in the two pilot provinces o f the primary health care development project.

Morocco, as well as Algeria and Tu­nisia, benefits from W H O ’s technical in­put to the UNDP-supported intercountry project for development o f water resources in North African countries. W H O ’s con­tribution is directed towards reservoir eu­trophication control and underground pollution control.

Portugal. The project dealing with pollution and water quality control o f the Tejo River has continued as planned.

Turkey. A planning consultant pro­posed measures to improve rural water supply and sanitation in Adana province. External assistance is being sought to sup­port a pre-investment study as a follow- up to the consultant proposal.

Key technical documents for the Dec­ade have been translated into Turkish.

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Yugoslavia. A preliminary consult­ant study into environmental pollution problems in Kosovo province has led to the submission o f a project document aimed at mitigating the adverse environ­mental impact by controlling the sources o f pollution.

Environmental health in rural and urbandevelopment and housing

Planning and management

In accordance with the recommen­dations o f the Working Group on Health and the Environment, which met in Vien­na in December 1983, two studies have been undertaken, one to strengthen the European environmental health data base and the other on health and safety con­siderations in the environmental health impact assessment procedure.

The fifth W H O international course on environmental health impact assess­ment took place in Aberdeen in July. A course on assessing the environmental health impact o f water development proj­ects has been prepared in French and is to take place in Liège in September 1985.

Manpower development

A consolidated report covering pro­fessional profiles o f all environmental health personnel has been drafted by Re­gional Office staff. An agreement has been reached with the University o f Umeâ in Sweden for collaborative work on the development o f middle-level environmen­tal health personnel.

Model curricula for training water supply or waste disposal technicians have been collected from collaborating institu­tions in order to contribute to human resources development for the Decade.

Housing

W H O draft guidelines on basic hous­ing hygiene and on housing hygiene in cold climates were completed, as was a handbook in French on basic housing hy­giene criteria in Mediterranean countries.

Two collaborating institutes are carry­ing out an epidemiological study on the impact o f low indoor temperature on res­piratory diseases among the elderly and preschool children.

Building design criteria for reducing domestic accidents are being prepared.

Urban development

Draft guidelines have been drawn up for assessing the environmental health impact o f urban development projects. A three-volume manual in French on urban solid wastes management has been final­ized. A comparative study o f noise pre­diction models in the urban environment has been completed.

Country activities

Greece. An environmental health impact assessment course took place in Athens at the end o f October. Technical assistance is provided by W H O for the control o f air pollution from industrial sources in the greater Athens area.

Poland. W H O has continued to as­sist the national project on environmental health impact assessment supported by UNDP.

Portugal. W H O has provided assist­ance in the field o f housing hygiene, and it is proposed that the W H O guidelines for basic housing hygiene should be field- tested in Portugal. Technical assistance to

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strengthen institutions dealing with air pollution control is also provided.

Turkey. An environmental health impact assessment course dealing with two main priorities (agricultural irriga­tion projects and hazardous industrial projects) took place in Adana at the end o f November.

Tw o case studies were made o f the health impact o f poor housing conditions in Ankara’s urban fringes.

Control o f environmental health hazards

Water

W H O extended its work on health- related aspects o f the Mediterranean A c­tion Plan, particularly in the long-term programme for pollution monitoring and research in the Mediterranean Sea (M E D PO L Phase II), in activities aimed at im­plementing the protocol for protection o f the Mediterranean Sea against pollution from land-based sources and in the Prior­ity Actions Programme.

National pollution monitoring pro­grammes became operational in 14 Medi­terranean countries. Equipment and fel­lowships were provided to national institu­tions for monitoring o f pollution sources and coastal water quality. Reference meth­ods for use by laboratories in the monitor­ing programme were drafted, tested or revised, bringing the total currently avail­able to 16.

The second Intercalibration Exercise and Consultation Meeting on Microbio­logical Methods for Coastal Water Qual­ity Monitoring was held in Athens in

June. Participants from Cyprus, Greece, Israel, Malta, Turkey and Yugoslavia attended, as well as representatives from U NEP. The third exercise was held in Tunis in November, in collaboration with the Institut Pasteur, and was attended by participants from France, Italy, Morocco, Portugal, Tunisia and Yugoslavia. In both laboratory exercises, satisfactory correla­tion was obtained between readings by individual participants working on the same samples, as well as in parallel deter­minations by the membrane filtration cul­ture (M F ) and most probable number (M P N ) methods. Both meetings reviewed the results o f the laboratory exercises, and recommended that they should be continued on a regular basis, that both methods (M F and M P N ) could be used for determination o f bacterial indicators, and that reference methods should be de­veloped for determination o f pathogenic organisms.

In the research component o f M E D POL, agreements were signed or extended with 23 Mediterranean laboratories re­garding studies on the development o f sampling and analytical techniques for pollution monitoring and research; epi­demiological studies on the correlation between coastal water quality and health effects; dietary surveys and biological monitoring o f sample populations for methylmercury; and research into the car­cinogenicity and mutagenicity o f pollu­tants, and the survival o f pathogens.

A Consultation Meeting on Biological Monitoring o f Methylmercury in Mediter­ranean Populations was held at the Public Health Institute o f Croatia in Zagreb in September, attended by participants from Canada, Egypt, France, Greece, Italy and Yugoslavia, as well as a representative o f FAO . The meeting reviewed and updated

6 1

the project on evaluation o f methylmer- cury in Mediterranean populations, re­vised the reference methods for determi­nation o f mercury and selenium in human hair, and reviewed the draft protocol for epidemiological studies on the health ef­fects o f methylmercury.

As part o f the preparations for imple­mentation o f the protocol for protection o f the Mediterranean Sea against pollu­tion from land-based sources, draft guide­lines were prepared on authorizations for waste discharge; length, depth and posi­tion o f pipelines for coastal outfalls; spe­cial requirements for effluents necessita­ting separate treatment; and the control and progressive replacement o f products, installations and industrial and other pro­cesses causing significant harm to the marine environment.

In the Priority Actions Programme, W H O was involved in preparatory work for subregional projects on island water supplies, coastal planning, rehabilitation o f historic towns, and liquid and solid waste treatment and disposal.

An extraordinary meeting o f the Con­tracting Parties to the Convention for the Protection o f the Mediterranean Sea against Pollution and its related proto­cols was held in Athens in April, at which the programme and budget o f the Medi­terranean Action Plan for 1984/85 were adopted.

A meeting on the contribution o f bi­lateral and multilateral programmes to the objectives o f the Mediterranean A c­tion Plan was held in Brussels in October.

The Office was represented as an ob­server at the Fourth European Ministerial Conference on the Environment organized

by the Council o f Europe and held in Athens in April, the main theme o f which was protection o f the coastal zone.

Considerable progress was made in the monitoring component o f M E D POL, and industrial and municipal effluents started to be monitored for the first time in a number o f countries. Adherence to standardized methodology is also contri­buting to a better comparability o f re­sults. There was a continuing trend to­wards more comprehensive protective measures vis-à-vis the marine environ­ment.

In the research component, some pro­gress was made in converting the original mosaic o f projects reflecting individual interests into more coherent need-oriented networks. However, financial stringencies, which limit assistance to collaborating centres to relatively nominal levels, con­stitute a major barrier in this respect.

The need for better overall coordina­tion o f existing and planned multilateral activities is being acutely felt, particularly in the adoption o f common standards and criteria, which overlap with those adopted by other bodies. The latter do not always have to cope with the diversity o f con­ditions encountered in the Mediterranean region as a whole.

Data on water quality continue to be collected routinely from those European countries which participate in the G lo ­bal Environmental Monitoring System (GEM S). These data were forwarded to the W H O collaborating centre in Burl­ington, Canada. The centre issued two volumes in 1984: a water quality data summary for the period 1974-1981 and a directory o f water institutions. A report

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on the results o f the 1983 analytical qual­ity control (A Q C ) laboratory exercise was also issued in 1984. This activity is the European component o f a global UNEP/ W M O / W H O project. While its results generate only a very limited amount o f information on the water quality o f fresh­water bodies, it serves as a training and management exercise for both the estab­lishment o f water monitoring stations and international AQC.

The Regional Office was represented at the 23rd intersecretariat meeting on water problems in Europe held in Geneva in May, and at the ECE Committee on Water Problems, held in Geneva in N o­vember. Statements and reports on the Office’s activities were prepared and sub­mitted.

A ir

The Working Group on Acid Rainfall in Relation to Human Health, held in Berlin (West) in July, was the result o f a commitment given to the European coun­tries at the 1982 Stockholm Ministerial Conference on Acidification o f the En­vironment. Besides the two foreseen issues o f direct and indirect effects o f acidic deposition, the host health authorities wished to add the sudden infant death syndrome (S IDS) and pseudo-croup. The working group concluded firstly that no direct effects o f acidic deposition on hu­man health have yet been demonstrated; secondly, that no detrimental effects on human health have so far been found to be the result o f metal mobilization by acidic deposition, but that such mobiliz­ation has been well documented and must be taken into account; and, thirdly, that the evidence put forward to link SIDS and pseudo-croup to air pollution is very weak.

A ir quality data continue to be col­lected from participating countries in Eu­rope under the joint project with UNEP/ G E M S and are forwarded to the W H O collaborating centre in the USA. It would be useful to evaluate the whole activity and its benefit to the 12 European coun­tries which participate actively, as well as to the 10 countries within the EC, for whom data are no longer received col­lectively from the CEC.

The report and proceeding papers o f the Workshop on A ir Pollution — Health Effects and Management, organized joint­ly by the Office and the International Institute for Applied Systems Analysis ( I IA S A ) and held in Laxenburg (Austria), were published in March.

The seventh intersecretariat meeting on air pollution problems in Europe was organized in Geneva in September, with the participation o f eight intergovern­mental and nongovernmental organiz­ations. The Office was represented at the second session o f the ECE Executive Body for the Convention on Long-range Trans­boundary A ir Pollution, held in Geneva in September. For this meeting, a report was prepared with the help o f a consult­ant on the impact o f acidic deposition on human health. The ECE invited the Office to continue its work on this subject and requested all contracting parties and sig­natories to support it.

The Office was also represented at a meeting o f the ECE Conference o f Euro­pean Statisticians, held in Geneva in Feb­ruary, on the establishment o f standard­ized statistical parameters for air quality. The conference made use o f the draft o f the handbook on ambient air pollutants from industrial sources for this purpose.

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The third meeting o f the Working Group on Indoor A ir Quality ( IA Q ) took place in Stockholm in August, and con­centrated on IA Q research, including an evaluation o f present status and activities and needs for the future. The working group began with a review o f the field as it emerged from the Third International Conference on Indoor A ir Quality and Climate. Substantial progress is being made in the field o f IA Q and especially in the description o f its effects on the occu­pants o f buildings.

The working group discussed the de­velopment o f strategies and policies aimed at effectively reducing exposure to air pol­lutants, whether they occur indoors or outdoors. It concluded that in the indoor environment the reduction o f exposure was the responsibility o f the occupants, the owners or operators, architects and engineers, suppliers o f materials and pro­ducts and, ultimately, different forms o f local and national government. Because o f this divided responsibility, the design and implementation o f effective control strategies offer special challenges that de­serve attention. The working group also reviewed the need to develop laboratory research. The characterization o f emission rates o f materials has a high priority, es­pecially for volatile organic compounds and radon. Inorganic contaminants re­quire relatively less urgent development in the laboratory. The development and validation o f biological monitoring meth­ods deserve high priority, as do the devel­opment and use o f interlaboratory com­parisons, which are an important element in any design for quality assurance and quality control o f measurements made in the field.

The air quality guidelines project, fi­nanced from Dutch voluntary contribu­tions, is now under way. The first two

working groups (in Düsseldorf in Sep­tember and in Copenhagen in Novem ­ber) considered noncarcinogenic metals and inorganic carcinogens, respectively. A consultation was also held in Delft in December to select organic and malodor­ous substances for which guidelines should be established. The W H O collaborating centre in Ottawa, Canada, is preparing a draft document on radon and other IA Q documents.

Some countries have used the results o f the Office ’s programme as a basis for launching their own national IA Q pro­gramme. The CEC joint research centre in Ispra, Italy has held some evaluation meetings o f its own, using material iden­tifiable with W H O ’s work. Generally speaking, the O ffice ’s activities have sharpened awareness about the gaps in information, and have identified require­ments for new research activities.

Solid and hazardous waste management

A Working Group on the Risk to Health o f Chemicals in Sewage Sludge Applied to Land was held in Malta in October. Sewage sludge which can no longer be disposed o f at sea should not be incinerated; the nutrients should be ex­tracted and used. The group examined evidence regarding each o f the elements that have been reported to be present in sludge, concentrating on cadmium. The organic chemicals that have been quanti­fied in sludge were reviewed. The most critical route appears to be direct inges­tion o f soil by grazing animals; only if sludge is deposited on leaves may some enter the plant. The group concluded that normal levels o f cadmium or other pol­luting chemicals in sludge do not appear to constitute a health hazard to man, pro­vided sludge is not applied in excess o f normal nitrogen demand.

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The Regional Office and U N E P pre­pared a joint paper on transfrontier trans­port o f hazardous waste for presentation to a U N E P conference on hazardous waste in developing countries, held in Munich in February. This is an important health- related issue, although no direct effects on human health have yet been demon­strated, and it has caught the attention o f both the public and national health auth­orities.

New technologies

The final report o f the W ork ing Group on the Health Implications o f Biotechnology, held in Dublin in N o ­vember 1982, was issued by the Office in the series “ Health aspects o f chemical safety” . It describes current thinking in this field and examines possible occupa­tional, public and environmental health- related issues. Contacts have been made with U N ID O , which is promoting bio­technology in connection with the indus­trialization o f developing countries.

The use o f visual display units (VD U s) is now expanding rapidly in all industri­alized countries. The W H O collaborat­ing centre for environmental radioactiv­ity at the Department o f National Health and Welfare in Ottawa, Canada, has started a study to examine the various repercussions o f the use o f VDUs.

Radiation protection and energy

With the help o f the W H O collabor­ating centre in Ottawa, Canada, a ques­tionnaire on accidents involving nonion­izing radiation (N IR ) was prepared and will be distributed to the national auth­orities and institutions concerned. The replies will serve as a data base for an N IR accident registry. A directory o f

institutions and legislation concerned with research into, and protection against, N IR is almost completed. A third line o f ac­tivity is evaluation o f the latest develop­ments in the field o f protection against N IR , and a number o f experts have al­ready been approached. Microwave and radiofrequency radiation and electric and magnetic fields are fast developing areas that require careful review and restate­ment. Ultrasound radiation has recently attracted considerable attention because o f the controversy surrounding the rou­tine scanning o f pregnant women (see p. 45, Maternal and child health). Ultra­violet, visible light (including lasers) and infrared radiation will also be reviewed.

The Regional Officer for Recognition and Control o f Environmental Hazards represented W H O at the Sixth Interna­tional Congress o f the International Radi­ation Protection Association, held in Ber­lin (West) in May.

Chem ical safety programme

Environmental monitoring

As part o f the move to improve sys­tems for monitoring exposure to toxic chemicals, uniform methods have been adopted for studies on the health effects o f cadmium, on biological indicators o f lead neurotoxicity in children, on the health effects o f occupational exposure o f welders to chromium and nickel, the health significance o f formaldehyde in the indoor environment, health effects o f exposure to pesticides, and health effects o f methylmercury in Mediterranean popu­lations. Further progress has been made in implementing the studies on lead, chromium and nickel, methylmercury, cadmium and pesticides. Tw o meetings on the pesticide study (in Istanbul in

65

March and in Sofia in June) and one on the lead study (in Düsseldorf in June) were held with participating countries to amend the protocols.

Emergency response and rehabilitation

Chemical accidents such as the release o f poisonous gas at Bhopal, India, in De­cember are a sharp reminder o f the need for prevention, contingency planning and rehabilitation. The Regional Office has drawn up guidelines for contingency plan­ning, and for the rehabilitation o f areas affected by accidental release o f toxic chemicals. The latter cover topics such as post-emergency health and social care; the legislative and regulatory framework for rehabilitation; rehabilitation o f con­taminated soil, biota and water; and safe­ty and protection measures for rehabili­tation personnel. In addition, the Direc­tor, Environmental Health and the former manager o f this programme, Dr A. Gilad, contributed a chapter on this subject to the book Environmental protection: stand­ards, compliance and costs, published for the Water Research Centre, United King­dom by Ellis Horwood Ltd.

How do the public health systems in Europe respond to acute poisonings, in­cluding accidents? The answer involves a multitude o f approaches: system organ­ization; methods o f rescue, treatment and rehabilitation o f affected people; preven­tion o f acute effects; and opportunities for international cooperation. This ques­tion and its multifaceted aspects were the topic o f a workshop held in Lodz, Poland in June. Initial surveys o f the organ­ization and structure o f acute poisoning services in selected European countries (Belgium, Czechoslovakia, Poland, Por­tugal and Sweden) presented at the work­shop indicated a wide range o f organiz­ational patterns, structures and functions.

They also pointed to the need for a broader and at the same time more detailed survey o f poison control services in Europe. This survey is now being conducted jointly with the World Federation o f Associ­ations o f Clinical Toxicology Centres and Poison Control Centres and in collab­oration with C EC and the joint ILO / W H O / U N E P International Programme on Chemical Safety (IPCS).

Manpower development

Over the last four years, a comprehen­sive and integrated training programme in toxicology and chemical safety has been built up by the Regional Office. Much o f this work was evaluated at a joint C EC /IPC S/W H O workshop on manpower development and training in toxicology and chemical safety, held in Luxembourg in November. As a result o f one o f the recommendations, training curricula have been developed for clinical and analytical toxicologists.

The fifth international training course in toxicology focused on pesticides. Held in Belgrade in May, it provided partici­pating chemists and health personnel from developing countries with both basic theoretical knowledge and practical train­ing. Special emphasis was placed on meth­ods to evaluate occupational exposure to pesticides.

Decision-making models and tools

A Consultation on Risk Management in Chemical Safety was held in Ulm in November. The meeting examined risk assessment and management practices as related to chemical safety and identified the weak links in the process. These in­clude scarcity o f data, particularly the re­sults o f toxicity studies conducted prior

6 6

to manufacturing and marketing o f pro­ducts, and lack o f understandable infor­mation aimed at the public and decision­makers. The meeting recommended, inter alia, that the risk evaluation process and the process by which subsequent decisions are reached should be a matter o f public record. In addition, it was recommended that governments should establish appro­priate mechanisms for review and synthe­sis o f all inputs to chemical risk manage­ment, and that the distribution o f chemi­cal risks and the costs/benefits o f chemi­cal control among the various sectors o f society should be studied to identify ways o f instituting fiscal and other incentive schemes.

Technical cooperation and informationexchange

To speed up the dissemination o f re­sults o f the Regional O ff ice ’s activities on toxic chemical control, the Health Aspects o f Chemical Safety — Interim Document series was initiated in 1981. To date, 17 volumes have appeared. Three were issued in 1984, covering legislation on toxic chemical control in Europe; pro­tocols for epidemiological studies on lead, cadmium, and chromium and nickel; and the health impact o f biotechnology.

An important component o f the Re­gional Office’s chemical safety programme is the UNDP-supported project for Euro­pean cooperation on environmental health aspects o f the control o f chemicals. In1984, some 50 country projects were be­ing implemented with U N D P support. National focal points have been estab­lished in all the ten countries participating in this project. Progress has also been made on setting up a system o f “ lead” institutes, each taking international re­sponsibility for developing and imple­menting a specific topic. In 1984, three

such institutes were designated in the areas o f exposure to pesticides, acute poisonings, and exposure to lead.

The chemical safety programme has cooperative arrangements with the IPCS, U N D P , U N ID O , ILO , F A O , CEC and UNEP.

D I A G N O S T I C , T H E R A P E U T I C A N D R E H A B I L I T A T I V E T E C H N O L O G Y

C linical, laboratory and radiologicaltechnology

Medical technology is an essential ele­ment in health care, whether promotive, preventive, diagnostic, therapeutic or re­habilitative, and since this is a field where rapid developments are taking place, the programme endeavours to bridge the gap between the knowledge and technology currently available and their use, on the one hand, and information about inno­vations, on the other. The main thrust o f the programme is directed towards creat­ing general awareness among politicians, health care administrators and health professionals, o f basic issues in the appro­priate use o f health care technologies. Special attention is given to building up a network o f institutes and expertise for medical technology assessment and pro­viding information to the Member States. Several projects also deal with issues such as introduction o f the basic radiological system (BRS) for rational imaging, cor­rect utilization o f laboratory tests and comprehensive evaluation o f the continu­ous subcutaneous insulin infusion pump. The designation o f a regional coordinator for the insulin pump study and her visits to all the participatingcentres have led to

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improved communication and a better understanding o f the project. A t present six countries (Finland, France, German Democratic Republic, Hungary, Norway and the United Kingdom) are participat­ing and two more (Albania and Spain) are expected to join.

The appropriate use o f technical aids at different health care levels with empha­sis on those that can be used in the home was the subject o f a joint W H O /Euro­pean Health Policy Forum Meeting on Appropriate Siting o f Health Technol­ogies, held in Brussels in March. The legis­lative and budgetary obstacles encoun­tered and the question o f cost-effectiveness were main points in the discussions. Sub­sequently, another joint meeting in Brus­sels in October considered legislative ap­proaches with respect to health care tech­nology, and noted that legislation is an important aspect o f the development, as­sessment and utilization o f technology.

In March, a joint W HO/Rand Cor- poration/Ciba Foundation Consultation on Priority-setting in the Assessment o f Individual Clinical Technologies (i.e. pro­cedures) took place in London. The main features o f this consultation were a study o f variations in clinical practices, proce­dures and use o f technologies, a review o f the level o f resource investment in health care, and determination o f the factors to be taken into account in clinical decision­making and in public policies governing the supply and distribution o f resources. It was decided to designate the Institute o f Social Medicine in Copenhagen as an international centre to develop studies analysing these variations and to deter­mine more cost-effective approaches to certain types o f clinical intervention.

A Consultation on Technology Plan­ning in Health Care Centres took place in

the Regional Office from 29 April to1 May. Ways and means o f developing technologies at this level were determined, and plans were drawn up for workshops on BRS and on the cost-effective utiliz­ation o f laboratory tests and o f infor­mation and communication technology.

The Sixth Meeting o f Directors o f Public Health Laboratories in Europe took place in Copenhagen in October. These annual meetings are sponsored by the Regional Office, and this one was hosted by the Danish Statens Serumin­stitut. Recommendations were made on centralization and decentralization, on the use o f kit tests and on biosafety. Re­cent information on screening measures in pregnancy, A ID S and new vaccines was also discussed.

Budgetary incentives and disincentives in the appropriate utilization o f medical technologies were the subject o f discussion at a meeting held in Cologne in October, at which experiences from 11 countries were presented.

Health care financing based on the estimated costs o f treating patients with different diagnoses (known as “ diagnosis- related group financing” ) has become a prime subject for discussion among health care officials and insurance companies in European Member States. A joint W H O / E H PF Meeting on Diagnostic-related Group Financing and Technology D if­fusion took place in Brussels on 23 and 24 May; the participants discussed experi­ence o f this method in the USA and Euro­pean trends in this field.

The W H O collaborating centres con­cerned contributed to organizing the very effective quality assurance programme in microbiology, collaborated in studies on

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essential laboratory tests and their util­ization, and put the finishing touches to the manual for the W H O on-line pilot data base for medical technology.

The appointment o f a Regional O f­ficer for Health Technology Assessment made it possible to speed up the develop­ment o f an information system, compris­ing both device and technique registers, and a literature data base which will en­able the unit to respond to new trends and requests for information on particularly important developments in medical tech­nologies.

Country activities

The Regional Office ’s unit for Appro­priate Technology for Health is collabor­ating with national hospital infection con­trol programmes in Denmark, France, the Federal Republic o f Germany, Italy, Portugal and Spain.

Albania. BRS equipment has been installed and is being evaluated.

Denmark. A meeting between Re­gional Office staff, the Danish Medical Technology Organization and the Danish Society o f Obstetrics and Gynaecology took place in Herlev on 17 February, to consider specific forms o f perinatal tech­nology, their organization and prospec­tive utility. The meeting has had an im­pact on medical decision-making in the host country.

France. The Institut national de la Santé et de la Recherche médicale is co­ordinating the economic and statistical aspects o f W H O ’s multicentre study on the continuous insulin infusion pumpand is developing final versions o f the study protocol and questionnaires.

Hungary. Following a round-table conference in Munich on the biological iron needs o f man, a project on the appro­priate iron store will be implemented.

Iceland. BRS equipment is being evaluated at health centre level.

Morocco. BRS equipment has been installed and is being evaluated at uni­versity and health centre level.

Norway. The Regional Officer for Appropriate Technology for Health par­ticipated in discussions on future trends in antibiotic policies in Oslo in February.

Portugal. A national workshop on the correct utilization o f laboratory tests, prevention and control o f hospital infec­tions and communicable disease surveil­lance was held in March, and another follow-up workshop with participants from Spain took place in November. These workshops helped to improve the dialogue between clinicians and labora­tory scientists for better utilization o f laboratory tests.

Yugoslavia. Regional Office repre­sentatives, together with other interna­tional experts, attended a national meet­ing on the role o f nuclear magnetic reson­ance in health care services.

Pharm aceuticals and drug utilization

When the Regional Office ’s pharma­ceuticals programme was restructured in 1982 to cover five broad areas, the pur­pose was to take account o f the many wishes expressed over the years by the Regional Committee, advisory groups or individual Member States. In 1984, the second full year o f operation o f the re­structured programme, some o f the con­sequences o f this broad approach became

6 9

clear. One was that many projects were found to complement one another; for example, the clinical pharmacological project is providing important factual input into projects concerned with edu­cation, regulation and information. At the same time, valuable links have been forged with other programmes; since pharmaceuticals play a role in so many areas o f health and a substantial part o f total health spending (in European coun­tries typically 10-20%) is currently de­voted to drugs, the programme is in ef­fect becoming an interdisciplinary one, already contributing to work in the fields o f mental health, maternal and child health, and the health care o f the elderly. A third major consequence has been the increasing number o f calls for help made upon the programme by individual Mem­ber States in the Region.

Clinical pharmacology and drug research

The thirteenth annual Symposium on Clinical Pharmacological Evaluation in Drug Control, again sponsored by the Federal Republic o f Germany and held in Schlangenbad from 30 October to 2 N o ­vember, was devoted to drugs in preg­nancy and obstetrics. It became all too clear that, 25 years after the thalidomide disaster, the techniques available to pre­vent a recurrence o f such a tragedy are still too fragmentary. The symposium made a number o f proposals for dealing with this problem; some o f these, involv­ing a thorough re-analysis o f current knowledge o f drug effects in pregnancy, will have direct consequences for the work o f the programme.

The working group dealing with the Action Plan for Clinical Pharmacology continued its work on schedule, with the development o f draft texts for teaching

curricula, recruitment material, and a comprehensive European guide to clinical pharmacology teaching.

The number o f guidelines for the clini­cal investigation o f various groups o f drugs issued in final or revised draft form increased to 11. The Pharmaceuticals and Drug Utilization unit played an active role at the international meeting o f na­tional centres for adverse reaction moni­toring, which was held in Washington in October. Since this is the only Regional Office o f W H O with its own training pro­gramme for staff from national adverse reaction monitoring centres, its interre­gional role is likely to develop further.

Drug utilization studies

A successful conference o f investiga­tors belonging to the Drug Utilization Research Group — set up 15 years ago — was held in Birmingham in April. The 1984 edition o f the Drug utilization bibli­ography, covering 193 publications from the last three years alone, bears witness to the volume o f work being done and the extent to which this information is reach­ing a world forum.

A new project in this field, started in 1984 and implemented in collaboration with the mental health programme, in­volves both extensive interviews with long-term tranquillizer users in a number o f European countries and studies o f the use o f these drugs in specific situations (e.g. homes for the elderly). This type o f work provides not merely figures but also insight into the underlying reasons for overuse o f drugs, and helps to identify ways o f correcting this overuse.

All the necessary data for the Euro­pean study o f self-medication patterns,

70

being made in collaboration with the health education programme, have now been collected; a total o f 32 Member States have been involved in this project.

The interregional programme also came into play in this field, and enabled the Office’s Pharmaceuticals and Drug Utilization unit to cooperate with the American Region at an international con­ference in Washington, D C in September on the overuse o f antibiotics, its conse­quences and means o f preventing it. This meeting laid the basis for global team­work during the next year designed to established the facts underlying this situ­ation and to define the remedies which need to be applied.

Drug regulation and supply

The first stage o f the European Studies o f Drug Regulation began in 1980 and was completed with a successful meeting in Oslo in March, at which a book on this work was issued. A series o f proposals for new projects have been made, and these are now gradually being put into motion. One, directly emanating from concerns expressed by the global cancer control programme, relates to the possible effects o f international and national narcotics control on the development o f newer and safer agents to relieve severe pain.

The first issue o f the Drug regulation index has been revised and extended. Ma­terial for two further issues has been edited, in response to the wide welcome given to this publication.

The formal scheme for the collection and dissemination o f information on regulatory decisions relating to new drugs (the “ Summary Basis o f Drug Decisions” ) continued on a very small experimental

scale and will be re-evaluated in 1985. The Pharmaceuticals and Drug Utilization unit has also met numerous requests from individual Member States for information on specific regulatory matters.

Drug information

The Drug bulletins review continues to provide two-monthly translations o f papers from numerous national drugs bulletins, care being taken to complement but not to duplicate the quarterly bulletin, Drug information, issued by the global programme. Towards the end o f 1984, a questionnaire was sent out to determine the usefulness o f the review; replies to date indicate that a great many recipients have used material in providing drug in­formation services in their own countries. Late in 1984, the first texts were produced for a national bulletin in one Member State as a direct collaborative effort be­tween national staff and the Pharmaceu­ticals and Drug Utilization unit in Copen­hagen.

Quality control and training

The major training activity in 1984 was a course in Oslo in May on drug regulation, designed for scientists jo in ­ing regulatory agencies. In addition, nu­merous fellows were placed in European centres, primarily for training in quality control, drug regulation and vaccine pro­duction, and a series o f study tours were arranged.

Country activities

Direct assistance was provided to Spain, Greece and (in the framework o f the interregional programme) to Indo­nesia in the establishment o f adverse re­action monitoring centres and the training

7 1

o f hospital monitoring staff; a manual for adverse reaction monitoring was drafted in Indonesia, and this is likely to prove o f value to other countries as well.

Federal Republic o f Germany. Fo l­lowing reports o f considerable overutiliz­ation o f psychoactive drugs in children, a meeting held in December pinpointed some o f the prescribing problems and means o f solving them, but found itself faced with incomplete and contested util­ization data; there is clearly a continuing need for objective research into such spe­cialized areas o f utilization as this. Only by obtaining complete and incontrovert­ible information on such questions will it be possible to ensure that the real issues are identified and acknowledged.

Netherlands. A direct but unexpected consequence o f the European Studies o f Drug Regulation, with their emphasis on the need for integrated drug policies at national level, was the creation by the University o f Groningen o f a Chair o f Drug Policy Science, the first o f its type in any country.

USSR. The planning o f large-scale clinical trials continued with on-site visits to some o f the investigators and finaliz­ation o f protocols and working arrange­ments. This work is intended both to con­tribute to medical knowledge in under­researched fields and to foster interna­tional investigational collaboration o f a novel type.

Disability prevention and rehabilitation

The International Year o f Disabled Persons in 1981 and the global programme o f action drawn up the following year, together with the United Nations Decade o f Disabled Persons (1983-1992), have

created great awareness among the Mem ­ber States in the European Region o f the problems o f disability. Governments have been encouraged to promote multi­sectoral and multidisciplinary cooper­ation in solving these problems, to adopt a community-based approach to disability and integration o f services, to foster the overall development o f the individual within the family and the local com­munity, and to focus on abilities rather than on disabilities.

In order to respond to these develop­ments within the U N family, the Regional Office started a programme on disability prevention and rehabilitation at the be­ginning o f 1984.

The first Consultation on Disabil­ity Prevention and Rehabilitation was held in Turku, Finland, in September. Community-based rehabilitation was re­cognized as the most important approach in future years. The meeting considered that it is important to identify structures enabling this new approach to be intro­duced and to disseminate knowledge on successful models among Member States. It was also felt that more epidemiological data on the prevalence o f various dis­abilities are urgently needed.

Prevention o f blindness

A Planning Meetingon Social and Be­havioural Aspects o f Comprehensive Eye Care was held in Brussels on 25 and26 January to refine the concept o f com­prehensive eye care; to clarify the multi­disciplinary dimensions o f visual impair­ments; to expand the psychosocial, econ­omic, educational and occupational ap­proaches to handicaps due to visual im­pairment; to propose innovative ways o f providing comprehensive eye care; and to

72

identify directions for the research and planning necessary to improve compre­hensive eye care. This meeting was a follow-up o f two previous meetings, one in 1978 on the role and function o f na­tional institutes o f ophthalmology, and the other in 1981 on the use o f residual vision by visually impaired and disabled persons.

The participants, representing dispar­ate specialties in health education and re­search, health care delivery and behav­ioural sciences research, as well as in ad­ministration, education and research in public health, emphasized the need for further research into both the extent and the effects o f the misdiagnosis o f visual impairments by inappropriately skilled specialists who are nonetheless respon­sible for the care, treatment and rehabili­tation o f people with visual impairments.

The subjects identified by the partici­pants as important areas for research in­cluded barriers to communication and the effects o f behaviour in exchanges among patients, other members o f the community, care-providers and policy­makers; the extent and locus o f impact o f the economic costs o f visual impairments and discriminatory handicaps; and the extent o f vision problems within national populations and in subgroups such as the aged, transients, the mentally ill or the handicapped. Finally, they recommended further planning efforts with multidisci­plinary participation at national and in­ternational levels.

During 1984 close cooperation with the newly established International As­sociation for Cataract-related Research

in Rome culminated in a joint meeting from 11 to 12 December devoted to the elaboration o f guidelines for clinical in­vestigation o f anti-cataract drugs.

In October, a study on the nursing process in the field o f comprehensive eye health care was initiated as a result o f the Brussels planning meeting. The aims are to identify and collect data on specific aspects o f nursing care o f ophthalmic pa­tients in present-day practice; to analyse data in the light o f the basic concepts o f comprehensive eye health care, on the one hand, and principles o f the nursing process, on the other; and to propose a unifying framework for further develop­ment o f nursing care o f ophthalmic patients and persons at risk in certain settings, i.e. clinical wards, operating- theatres, outpatient departments, labora­tories, extramural activities, etc. Centres in Denmark, Italy, Morocco, Poland, Portugal, Sweden, the United Kingdom and Yugoslavia have been selected to participate in the study, and a report is scheduled to be available early in 1985.

Country activities

M orocco. Initial steps have been taken to implement a project on disabil­ity prevention and rehabilitation, with emphasis on health manpower develop­ment in the fields o f rehabilitation, pros- thetics/orthotics, and optics.

Romania. Under the UNDP-assisted project on public health ophthalmology and corneal grafts, several W H O fellow­ships have been awarded for relevant studies.

73

HEALTH SCIENCE A ND TECHNOLOGY — HEALTH PROMOTION AND CARE

Proposed budget for country and intercountry programmes, 1 9 84 /85 , revised position, and expenditure as at 31 Decem ber 1984 (US $)

Proposedbudget

Actualbudget

allocationExpenditure

Regular funds 7 258 200 6 290 200 2 659 270

UN funds 6 254000 6 254 000 905 003

Voluntary funds 2 473 100 2 473 100 516562

Special Account for Servicing Costs 16985

15 985 300 15017300 4097 820°

a Being 2 7.52% o f total expenditure.

Publications issued in 1984

Family planning and sex education o f young people: report on a W H O meeting. EU RO Reports and Studies, No. 89.

First-contact mental health care: report on a W H O meeting. EURO Re­ports and Studies, No. 92.

Sex and fam ily planning — how we teach the young: report on a study. Public Health in Europe, No. 23.

Nuclear power: accidental releases — principles o f public health action: report on a W H O meeting. W H O Regional Publications, European Series, No. 16.

Toxic o il syndrome — mass fo o d poisoning in Spain: report on a W H O meeting. Non-serial publication.

7 4

Biological effects o f man-made mineralfibres: proceedings o f a W H O /I A RC conference, vols I and II. Non-serial publication.

The effects o f drug regulation, by Graham Dukes. Published on behalf o f W H O by M T P Press Ltd, Lancaster, United Kingdom.

Docum ents issued in 1984

Studies on health care o f the elderly: report on a working group (docu­ment IC P / A D R 046).

The effects o f the indoor housing climate on the health o f the elderly: report on a W H O working group (document ICP/BSM 002(3)).

Women and health: report on a W H O meeting (document IC P/M C H 030).

Management and structure o f health policy research: report on a W H O meeting (document IC P/R PD 012(2)).

International Drinking Water Supply and Sanitation Decade in Europe: report on a consultation (document ICP/CW S 001/m01).

European Advisory Committee on Medical Research: report on the tenth session (document IC P/R PD I03/m01).

Food inspection: report on a W H O working group (document 1СР/ FSP 002(2)).

Pesticide residue analysis. Health aspects o f chemical safety. Interim docu­ment, No. 14.

Studies in epidemiology. Health aspects o f chemical safety. Interim docu­ment, No. 15.

Housing hygiene in Mediterranean countries: report on a W H O workshop (document ICP/BSM 002(5)).

Child mental health and psychosocial development: report on a W H O meeting (document IC P /M N H 065(1)).

Health impact o f biotechnology: report on a W H O working group. Health aspects o f chemical safety. Interim document, No. 16 (also in Swiss bio­tech, 2(5): 7-32(1984)).

Preventing alcohol-related problems amongst young people, by Marcus Grant (document IC P / A D A 002Л01).

Statistical survey o f water and sanitation services — 1983 (document ICP/CW S 001/g01).

The concept and principles o f health promotion: a discussion document (document ICP/HSR 602/m01).

Drugs in pregnancy and delivery: report on the Thirteenth European Sym­posium on Clinical Pharmacological Evaluation in Drug Control (pro­visional edition) (document ICP/DSE 105/m01).

Hazardous waste — a public health problem and how to handle it, by M. Suess. ERL Perspectives, Issue No. 1, 1984.

Ambient air pollution — health effects and management: report and pro­ceeding papers o f a joint W H O / I IA S A workshop. In : Atmospheric en­vironment, 18(3): 487-652 (1984).

76

Healthy Y outh: Our Best Resource

International Youth Year (IYY): Participation, Development and Peace

T h ere are now 1 445 m ill ion peop le — 30 per cent o f the w or ld popu la­t ion — aged between 10 and 24. T h a t ’ s m ore you n g peop le — as a p ro ­port ion o f the popu lat ion — than there m ay ever be again.

W h i le the I Y Y highlights the concerns o f you th during 1985, the need fo r action w ill remain long beyond that year. It is by placing the I Y Y within the fra m ew ork o f the European reg iona l H F A targets and W H O ’s Seventh G en era l P rog ra m m e o f W o r k that sustained attention can be g iven to youth, whose partic ipation is an essential factor in the achievement o f H F A .

V.

Unemployment

In some countries o f the R eg ion the situation o f youth is characterized by unem ploym ent and a lack o f appropriate training. The new technological revolution has weakened the link between production and employment. In many cases, new technolog ies enable industries, in both the manufacturing and service sectors, to increase output while em p loym ent declines. A lthough such rapid and far-reaching changes will have m ajo r consequences fo r the whole o f society, the young are particularly at risk. It is hoped that eventually techno logy will also create new em ploym ent opportunities either directly or indirectly but, during this per iod o f transition, unem ploym ent levels are still rising — with the number o f young peop le w ho remain unem ployed fo r more than a year, o r are never em p loyed at all, increasing in the m ixed econom y countries o f Europe.

W a i t i n g f o r j o b s : p e r c e n t a g e o f t o t a l u n e m p l o y e d w h o a re a g e d < 2 4 y e a r s

Luxembourg, 53.9%Italy, 50.1% П Ш Ш Ш Ш Ш

France, 45.3% М М М United Kingdom, 40.8% ff ft ft ft ft ft ft j

Netherlands, 40.6% MMMMMÂ Belgium, 39.0% MMMMMMM

Ireland, 30.2% MMMMM Germany, Fed. Rep. of, 29.2% MMMMM

Denmark, 26.9% Д М М М М

MMMÂ MM

Source: Soc ia l ind ica to rs fo r the EC. 1 9 8 3 .

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HFA2000 — 38 targets for Europe

Th e aims o f the I Y Y are closely linked to W H O ’s goa l o f health fo r all ( H F A ) . Equally , the main social target o f governm ents and W H O — “ the attainment by all citizens o f the w or ld by the year 2000 o f a level o f health that w ill perm it them to lead a socia lly and econom ica lly p roductive l i fe ” — is inextr icab ly linked to the em p loym ent potentia l o f a particular country or region. Inev itab ly , the opportunit ies and prospects o f ob ta in ing w ork will have a m ajo r influence on the lifestyles and partic ipation o f young peop le in society. So, o f course, w ill the safeguarding o f peace — fo r w ithout peace, what have the young to look fo rw ard to? W a r is indeed “ the most serious o f all threats to health” .0

Th e 38 reg iona l H F A targets, endorsed by the R eg iona l C om m ittee at its thirty-fourth session in Septem ber 1984, set out the fundamental require­ments fo r people to be healthy. Peace, equity, com m unity partic ipation, healthy lifestyles and know ledge o f and m otiva tion fo r positive healthy behaviour are identified in the targets as prerequisites fo r H F A , and this focus is in line with the emphasis o f the I Y Y on partic ipation, deve lopm ent and peace.

It is o f param ount im portance to link the goals o f the I Y Y to the H F A m ovem ent, and to the targets in support o f the regional strategy. Th e I Y Y will then be seen in a broader, m ore supportive context as an undertaking whose aims, though high lighted in 1985, are deep ly roo ted in an expanding movement.

a Regional targets in support o f the regional strategy fo r health fo r all (document EUR/RC34/7 Rev. 1, p. 7).

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O n e n e c e s s a r y c o n d i t i o n f o r h e a l t h p r o m o t i o n is t o s t r e n g t h e n w o m e n ' s p o t e n t i a l a t w o r k .

(Photo: WHO)

У

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Health education

Th e Reg iona l O f f i c e ’ s Health Education unit, which is the focal point fo r the I Y Y , has prepared fo r the event by integrating ac­tivities fo r youth within its cur­rent program m e, so that the goals o f the I Y Y and the particular em ­phasis on youth will remain a last­ing concern o f the p rogram m e.0

In Septem ber 1982, a meeting was held in Salzburg, Austria , to discuss youth lifestyles in big city areas and their impact on health. T h e experts noted that the crisis in the w elfa re states o f western industrialized countries had led to a basic reconsideration o f the meaning o f work , education and leisure. Th ey recogn ized the need to reorient labour policies as well as social and health services and to create structures to mediate be­tween young people and tradi­tional social institutions.

A W ork sh op on Hea lth P ro ­m otion and You th , convened in Heidelberg, Federal Republic o f Germ any, in July 1983, concluded that there is a need to motivate peop le to adopt healthy lifestyles, not primarily in the perspective o f m orb id ity or morta lity but as a com ponen t o f ethical and moral education. It was stressed that young peop le must be invo lved in the process o f deve lop ing w o rk ­ing and living conditions that are conducive to health. Th e m ain­tenance o f peace and the preven­t ion o f nuclear war were seen as one o f the most im portan t re­quirements fo r health prom otion .

A W o rk in g G ro u p on You th L ifestyles, Risk Behaviour and Hea lth was held in Spitzingsee, Federa l Republic o f G erm any , in O ctob er 1983, and addressed the

a WHO Collaborating Centre for Health Education. Healthy lifestyles of young people: participation — development — peace. Dresden, Institute fo r Health Education o f the G erm an H yg iene M useum in the G D R , 1985.

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topics o f w ork (em p loym ent/un­em p loym ent), youth in education and training, young migrants, and health p rom ot ion fo r girls and wom en. It was emphasized that, to be successful, health education measures must be planned with the invo lvem ent o f young peop le themselves. A tten t ion was drawn to the im portance o f the school in creating or recreating the neces­sary condit ions fo r health p r o m o ­tive measures and to the need fo r teacher tra in ing and systems o f support fo r teachers. B ilingual education fo r you ng peop le , and form s o f administrative au tonom y and partic ipation in everyday life were considered o f great im por t­ance fo r young m igrant workers. A s far as w om en and girls are concerned, personal deve lopm ent, the foster ing o f a new im age based on equal rights fo r all, and the strengthening o f w o m en ’ s po ten­tial in the fam ily , at w ork and in society were all seen as necessary conditions fo r health prom otion .

A p a rt f rom specific I Y Y w ork , other health education activities contribute to attainment o f the goals, fo r example:

• an eight-country survey on health behav iou r in s ch oo l­ch ildren, cover ing such areas

as sm ok ing , leisure, nutrition and substance abuse patterns, will m ake an im portan t co n ­tribution to our understand­ing o f youth;

• a W o rk in g G rou p on School Health Education in the Euro­pean R eg ion (Burley, United K in gd o m , A p r i l/ M a y 1984) helped to advance know ledge o f this fie ld, and the proceed­ings, together with the results o f a survey carried out in a number o f European countries on the same topic, will prov ide source material fo r a brochure on school health education to be published this year;

• a meeting on health education in schools (M s ida , M a lta , July 1984) d rew on the findings o f the Burley w ork in g g roup and reached a number o f im port­ant conclusions;

• research was undertaken to prepare a paper on a E u ro ­pean initiative on teacher edu­cation, which will be presented at the W o r ld Conference on Health Education to be held in Dublin in 1985.

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Y o u t h is t h e p e r i o d o f p e a k p h y s i c a l f i t n e s s . H e a l t h p r o m o t i o n p r o g r a m m e s s h o u l d c a t c h p e o p l e y o u n g .

(Photo M Gimnt. toi WHO)

Sex

A report g iv ing guidelines on how to design educational p ro ­gram m es fo r young peop le and sex educators has been issued (E U R O Reports and Studies, N o . 89). It is based on a study conducted by the O f f ic e ’ s Fam ily Planning unit.

Alcohol

A Sym pos ium on C on tro l o f A lcoh o l Consum ption (Paris, June 1983) identified w om en and young peop le as the new high-risk groups fo r a lcoho l-re lated problems. A rev iew o f d ifferent approaches to preventing alcoho l abuse in young people was completed in June 1984. It deals with consumption trends, the types o f prob lem faced in some M em b er States, treatment strat­egies and legislative measures.

Drugs

D ru g abuse does not invo lve as many young peop le as a lcoho l abuse, but the illegal aspects put it in a d if ferent perspective. C on tro l o f supply lies with Customs, police and the courts. The health sector has the responsibility o f prov id ing in form ation and education about

the deleterious effects o f psycho­active substances, besides treating the casualties. Adults in influential contact with young people, such as parents, teachers, and youth club leaders, can help young peop le learn how to resist pressure ( from their peers and from other groups in society). Th e new Reg iona l O f ­fice p rog ram m e fo r the prevention o f abuse o f psychoactive drugs in­cludes e fforts to tackle the identi­fication, treatment and rehabilita­tion o f drug abusers.

SuicideThe report o f a W ork in g G rou p

on Chang ing Patterns in Suicide Behaviour (E U R O Reports and Studies, N o . 74) highlights the marked rise in attempted suicide am ong teenagers and young adults in the decade 1972-1982. Th e rec­om m endations deal with problems o f suicide prevention and handling o f a ttem pted suicide, with special emphasis on the psychological a f­tercare o f teenagers and young adults. A consultant study on pat­terns o f suicide and attempted sui­cide, with reference also to the in­vo lvem ent o f nongovernmental or ­ganizations in the assessment o f preventive interventions, will con ­tinue up to 1986.

C o p i n g w i t h s e x is a g r o w i n g p r o b l e m f o r y o u n g p e o p l e . W h a t y o u t h w a n t s a n d n e e d s is n o t p e r m i s s i v e n e s s b u t u n d e r s t a n d i n g .

(Photo J Mohr, for WHO)

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Conclusion

T h e R eg iona l O ff ice can on ly help M em b er States to draw attention to this very im portan t section o f society by such means as w orkshops and publications. It is fo r M em b er States, governm ental and nongovernmental organizations, the com m unity and, in a supportive environment, young peop le themselves to use these and other sources to enhance their awareness o f the steps that must be taken to attain H F A .

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Chapter 4

HEALTH SCIENCE AND TECHNOLOGY — DISEASE PREVENTION AND CONTROL

INTRODUCTION

The reduction o f disease and disability in general and the control o f specific con­ditions represent the major concern in section 2 o f the regional H F A target docu­ment. Targets 4-12 are expressed in terms o f results to be achieved, but they require action in all sectors o f the regional strat­egy. Many o f these actions have been re­ported in previous chapters o f the present report. Chapter 4 describes the work o f regional programmes dealing with the con­trol o f communicable and cardiovascular diseases, as well as cancer and other non- communicable diseases.

The programmes on communicable diseases undertook specific activities for the control o f malaria and other parasitic diseases in the countries affected. Empha­sis was placed on the primary health care approach and appropriate training. The Second Conference on Immunization Pol­icies in Europe analysed national pro­grammes and recommended the action re­quired to reach the goals o f the expanded programme on immunization. These ac­tivities are directly related to regional H F A target 5 and will also have an im­pact on targets 6, 7 and 8.

The European Conference on Primary Prevention o f Coronary Heart Disease recommended a population-based, multi­sectoral approach to controlling unhealthy lifestyles and related risk factors. This ac­tivity bears a direct relation to the achieve­ment o f target 9. So do other activities carried out under countrywide integrated programmes for the prevention o f non- communicable diseases and the project for monitoring the incidence and determi­nants o f cardiovascular diseases in popu­lations (M O N IC A ) .

In order to reach target 10, a working group on cancer control recommended the reorientation o f national health pol­icies and services, with special attention to site-specific care programmes and the improvement o f postgraduate training in oncology.

Although it is directly linked to re­gional H F A target 16, the regional pro­gramme on smoking is also intended to contribute extensively to the attainment o f targets 9 and 10. The existing situation has been reviewed at country level and in intercountry meetings. A pilot survey o f smoking among health professionals has been initiated, and the activities o f the survey on the health behaviour o f school­children continued.

7 7

M A L A R IA A N D OTHER PARASITIC DISEASES

The malaria situation in Turkey still gives cause for concern, although the pic­ture improved after a shift to another in­secticide for indoor residual spraying. A coordination meeting between Iraq, Syria and Turkey took place in Istanbul in March, with the purpose o f streamlining malaria control activities on both sides o f the southern border o f Turkey. In order to ensure the compatible use o f insecti­cides along the Syrian/Turkish border, decisions were also taken regarding ento­mological tests and future consultation meetings.

Another meeting on Malaria Coordi­nation in South-east Europe took place in Athens in October. Strong recommen­dations were made to improve malaria control in the region and to step up inter­national support to Turkey, the point o f entry into Europe for malaria from the Orient.

A third international training course in malariology took place in Italy and Turkey from March to June, with partici­pants from all W H O regions, including five from the European Region (one from Greece, three from Italy and one from Turkey). There will be no course in 1985, but it is planned to hold further courses in 1986, 1987 and 1988.

A Meeting on the Epidemiological and Public Health Aspects o f Leishmani­asis in Countries Bordering the Mediter­ranean Sea was held in Murcia, Spain in May. Among the many recommendations made was one emphasizing the need for compulsory notification o f all cases o f

human leishmaniases, both visceral and cutaneous. This already takes place in Italy and Spain and is being introduced in Yugoslavia. It is hoped that other coun­tries will fo llow suit.

A consultant from the Danish Bil- harziasis Laboratory in Copenhagen re­visited Morocco in April to help prepare a field guide on freshwater snails in north­west Africa.

W H O headquarters held a meeting in November in Geneva with the purpose o f establishing strategies for schistosomiasis control in different W H O regions. No change o f strategy was envisaged for the European Region.

Country activities

Algeria. Malaria control is operating effectively in the north o f the country. A total o f 41 cases were reported for the whole country in 1983, and nine cases were found during the first quarter o f1984. The programme was evaluated in March by a short-term consultant who found the development o f the work satis­factory. The W H O collaborating centre at the Faculty o f Medicine in Grenoble is assisting the malaria control programme in carrying out immunofluorescent anti­body tests.

The leishmaniasis outbreak in M ’Sila has been controlled.

Bulgaria. The number o f imported cases o f malaria is falling, but surveillance is being maintained at a high level o f alertness.

M orocco. A small focus o f malaria transmission was detected in the northern part o f the country and spray-protection

78

measures were immediately instituted. For the country as a whole, there were a total o f 75 cases o f malaria in 1983 and 152 during the First nine months o f 1984.

Staff from the Regional Office and headquarters made a joint evaluation o f the schistosomiasis control programme in Morocco in April. They considered that the project is developing well and is a good illustration o f how a polyvalent ser­vice can be developed from a vertical one. It is also an excellent example o f the pro­cess o f delegating authority to the peri­phery. With its sound administration, it could serve as a good model for other countries.

correctly and rapidly, may turn the situ­ation in the right way. Regular evaluation o f the results o f control activities con­tinues, as do training courses; the latter are conducted on an extensive scale, in view o f the need to train all categories o f general health worker in the essentials o f malaria epidemiology and control and thereby enable primary health care to play its role to the full.

EXPANDED PROGRAMME ON IM M UNIZATION , BACTERIAL, V IR AL

AN D MYCOTIC DISEASES,AN D ZOONOSES

Turkey. There were 55 020 cases o f malaria in 1984 (Fig. 6). A change o f in­secticide for residual indoor spraying (to pirimiphos-methyl) stopped the rising trend in malaria prevalence and has there­by provided a respite which, i f it is used

Fig. 6. Numbers of cases of malaria in Turkey. 1 9 8 0 - 1 9 8 5

66 681

62 03870 -I

60 -

« 50- ?R

40

'S 30 &£>E

z 20 H

10 -

54 415

34 154

55 020

1980 1981 1982 1983 1984 Year

The Second Conference on Immuniz­ation Policies in Europe took place in Karlovy Vary, Czechoslovakia, in De­cember. This was the first major intergov­ernmental review o f immunization pol­icies in Europe since October 1959. The participants analysed the present status o f immunization programmes, with ref­erence to both their achievements and their shortcomings, in individual coun­tries and in the Region as a whole, and recommended the action necessary to reach the goals o f the expanded pro­gramme on immunization and target 5 o f the regional strategy (see Annex 8).

A W H O collaborating centre on the acquired immune deficiency syndrome (A ID S ) has been established in Paris at the Institut de Médecine et d ’ Epidémio- logie tropicales, in cooperation with the Institut Pasteur. Fifteen European coun­tries have already agreed to participate in the surveillance programme. At the end o f December, the centre reported that a total o f 762 cases, 376 o f them fatal (case fatality rate: 49%) had occurred in the European Region. The principal diseases

7 9

were opportunistic infections alone (64% o f the cases), Kaposi’s sarcoma (20%) and opportunistic infection together with Kaposi’s sarcoma (16%).

The Institute o f Tuberculosis in Bu­charest, in close cooperation with the Regional Office, organized a seminar on the chemotherapy o f tuberculosis from30 September to 3 October. Delegates from nine countries o f the southern part o f the Region described and discussed re­cent advances in the chemotherapy o f tu­berculosis, with special regard to short course regimen and new knowledge o f the pharmacological properties o f antituber­culosis drugs, particularly rifampicin and pyrazinamide. In addition, they formu­lated guidelines relevant to the present situation o f tuberculosis treatment in the participating countries.

A Working Group on the Control o f Streptococcal and Staphylococcal Infec­tions, held in Lyon in November, discussed the magnitude o f the public health prob­lem caused by these diseases and recom­mended measures for laboratory diagno­sis and prevention, especially hospital staphylococcal infections.

A meeting on toxoplasmosis was held in Graz, Austria in December. Partici­pants from 16 European countries drew up guidelines for implementing national programmes to prevent and control con­genital toxoplasmosis.

Sets o f teaching slides on meningitis, chlamydia and mycoplasma have been produced and are available on request.

Country activities

Turkey. A consultant carried out a two-week mission in connection with the leprosy rehabilitation project.

CANCER

A Working Group on National Can­cer Control Programmes met in London in and was followed by a session o f an Advisory Committee on Cancer Control. The purpose o f these meetings was to review the activities undertaken since 1981 in the framework o f the regional cancer programme and to endorse the draft guidelines on cancer control pro­gramming. This comprehensive document (covering issues related to policy formu­lation, information support and mana­gerial processes, including planning and evaluation) has been evolved on the basis o f the conclusions reached and recom­mendations made by previous working groups. It will be presented to Member States for consideration and implement­ation once it has been adapted to local requirements and opportunities.

Cooperative efforts to set up “ model” care programmes for specific types o f can­cer led to a Consultation on Practical A p­proaches to the Development o f Problem- specific Care Programmes in Cancer, held in Stockholm in November. The meeting reviewed existing care programmes and recommended that guidelines should be developed on how to evolve care pro­grammes based on the best achievable standards and on how to define the cur­rent standards in cancer patient man­agement. The participants also said that priority should be given to the most common and resource-demanding cancer sites, where maximum benefit can be derived from improved coordination in prevention and the provision o f care. Lastly, they advocated that medical and related professionals in Member States should be encouraged to adjust W H O ’s “ central” guidance to local needs, organ­ization patterns and available resources.

8 0

Consultations continued with major cancer institutes and expert groups with regard to interaction between the devel­opment o f care programmes and the O f­fice’ s programme for regular assessment o f selected cancer-specific technologies.

A joint meeting organized by the Re­gional Office and W H O headquarters was held in Geneva in December, to pre­pare a report and recommendations on the management o f cancer pain, in con­nection with a comprehensive regional approach to community-oriented control o f cancer symptoms.

T w o collaborating centres in this field are now working on methods o f detection, technology assessment and training in cancer control. Cooperation with IA R C on regional cancer programmes has been extended, particularly in planning pro­grammes for the prevention o f occupa­tional cancers.

Country activities

Poland. The Regional Office, in col­laboration with U N D P , continues to strengthen education o f the public about cancer, to implement early detection measures at community level, and to in­troduce modern methods for more effec­tive care o f patients in whom cancer has been detected at an early stage.

CARDIOVASCU LAR A N D OTHER NONCOM M UNICABLE DISEASES

A European Conference on Primary Prevention o f Coronary Heart Disease was held in collaboration with W H O headquarters in Anacapri in October. Representatives from 22 countries o f the Region discussed general principles and

implementation o f the recommendations made by a W H O Expert Committee on the Prevention o f Coronary Heart Disease which met in Geneva in 1981. The par­ticipants stressed that the main emphasis must be on a population-based approach to controlling those features o f modern lifestyles that cause the high incidence o f coronary heart disease. This calls for the involvement not only o f medical services but also o f many government depart­ments, the food and agriculture indus­tries, and a wide range o f agencies and individuals in the community.

There has been intensive development o f the European Health Care Related Hy­pertension Research Action Programme (H Y R A P ) . Under this programme, the W H O collaborating centre in Gothen­burg convened three meetings during the year.

Representatives from the cardiovascu­lar diseases and alimentary comparison study, C M E A , the European diet and cancer study, the Regional Office’s Nu­trition unit and the W H O project for monitoring trends in cardiovascular dis­eases (M O N IC A ) met at an International Liaison and Coordination Meeting on Epidemiological Studies Involving Assess­ment o f Sodium Intake and Excretion, held in Louvain in May. The meeting proved useful for the exchange o f infor­mation concerning international stan­dardization o f measurement techniques in this area, and was important for the planning and evaluation o f community- based primary prevention programmes. The need for further coordination o f the above-mentioned studies was stressed.

A meeting on the initiation o f a study o f asssessment o f hypertension control levels was held in Budapest in May, to

8 1

discuss the protocol o f the proposed study which had been presented at the Meeting on Hypertension Management Audit, held in Geneva in December 1983. It was re­iterated that the assessment o f levels o f hypertension care was a precondition for the further improvement o f hypertension control. The proposal for a core study to be started early in 1985 was accepted. Representatives o f 12 centres expressed their intention o f taking part in the study.

The Meeting on Intervention Methods Aimed at Salt Moderation, held in Madrid in September, was a logical continuation o f the above-mentioned H Y R A P meet­ings in Louvain and Budapest. It was agreed that the principles and interven­tion strategies outlined at the meeting should be tested in practice under various local conditions and in different cultures. Their flexibility and applicability to local situations, and the effectiveness o f inter­ventions based upon them, should be evaluated before designing and launching a cooperative international project o f this kind.

One o f the most dynamic parts o f W H O ’s programme on cardiovascular diseases has been work on the psycho­social aspects. This has been done mainly within the framework o f two large-scale projects, H Y R A P and M O N IC A . Four H Y R A P meetings in this field were or­ganized by the Regional Office during the year: in Maastricht in May, in Kaunas in June, at the Regional Office in October and in M oscow in November. These meetings were devoted to the new and most important issues in this domain: (a ) psychosocial factors related to hyper­tension control; (b ) methods o f assessing those factors; (c) psychosocial methods o f improving compliance in hypertension control programmes; and (d) behavioural

and psychotherapeutic intervention tech­niques in multidimensional hypertension control. The reports from these meetings will form the basis for a W H O publi­cation on the state o f the art in this im­portant area, with conclusions and rec­ommendations for research and imple­mentation. Even simple and low-cost behavioural methods such as relaxation or autogenous training may consistently produce some blood pressure reduction, especially in mildly hypertensive patients, although behaviour modification should be considered as part o f a comprehensive therapeutic approach, but not as an alternative to drug treatment, dietary changes, etc.

A Consultation on Psychosocial De­terminants o f Cardiovascular Diseases (the first M O N IC A psychosocial meeting) was held at the Regional Office in De­cember. The participants discussed hy­potheses and methodology as well as pro­cedures for optimizing the comparability o f study designs and instruments. A net­work o f participating centres responsible for different aspects o f coordination and data processing for the psychosocial sub­study o f the M O N IC A project has been established.

A Meeting on European Risk Factors and Incidence — A Collaborative Analy­sis (E R IC A ) was held at the University Clinic o f Heidelberg in May, to discuss initial findings concerning the prevalence o f cardiovascular diseases and their risk factors in different parts o f Europe. The meeting was part o f the European pool­ing project on coordination o f epidemi­ological studies in cardiovascular dis­eases, under which data from 21 studies in 13 countries are available to date.

In May, a Meeting on Comprehen­sive Community Cardiovascular Control

8 2

Programmes (C C C C P ) was held in Udine, Italy, with the assistance o f the National Public Health Institute o f Finland. Prog­ress reports from the C C C C P areas show that the various programmes have en­joyed substantial success. On the basis o f this experience, a W H O monograph will be prepared to provide guidelines for action by health authorities. Innovations are expected in the fields o f information and evaluation systems, intervention strat­egies, impact on children and incorpor­ation into W H O ’s integrated country­wide programmes for the prevention o f noncommunicable diseases.

Investigators from the project for pre­vention o f noncommunicable disease risk factors and health promotion in youth met in Joensuu, Finland in September to ex­change information on current or planned intervention studies. Strategies based on sound behavioural principles are needed to ensure the effectiveness o f such inter­vention. Increased efforts must therefore be put into developing standardized tools for assessing behaviour.

The Regional Office also sponsored a meeting on early evaluation o f prognosis after myocardial infarction and its practi­cal consequences for the choice o f an opti­mal rehabilitation programme, organized in Prague in July by the W H O collabor­ating centre at the Free University o f Brussels.

An informal meeting was held in Buda­pest in December to discuss data pro­cessing and interpretation o f preliminary findings from the Regional Office’ s study o f non-invasive diagnosis o f pulmonary hypertension. A booklet on the use o f this technique in chronic lung disease was pub­lished by the W H O collaborating centre in Brussels and was widely distributed at the

Ninth European Congress o f Cardiology in Düsseldorf in July and at the Congress o f the European Society o f Pulmonary Pathophysiology in Barcelona.

The tradition o f cooperation with the European Society o f Cardiology (ESC) was maintained. The Regional Officer for Chronic Diseases attended the meetings o f the ESC Board in Düsseldorf in July and in Mainz in September. The Regional Office, in collaboration with W H O head­quarters, held a session on W H O ’s cardio­vascular diseases programme in Europe at the Ninth European Congress o f Car­diology. The Regional Officer for Chronic Diseases was co-chairman o f this session and reported on the psychosocial aspects o f the programme.

In the course o f the year Bulgaria, Finland, Hungary, Iceland, Malta and the Lithuanian SSR signed plans o f co­operation with the Regional Office on countrywide integrated programmes for the prevention o f noncommunicable dis­eases. The aim o f these programmes is to develop integrated preventive measures as part o f primary health systems, simul­taneously attacking several risk factors known to be implicated in the develop­ment o f noncommunicable diseases.

Continuous monitoring and evalu­ation o f risk factors and diseases will also be part o f the programmes. This will be coordinated with other monitoring pro­grammes, such as the M O N IC A study and the monitoring o f indicators related to targets for HFA2000. A working group has been established to work out a specific protocol for monitoring and evaluation o f the countrywide programmes, and the group met twice in the course o f the year.

The principal investigators from the programmes in each o f the participating

8 3

countries met for an annual coordination meeting in Brioni, Yugoslavia in Septem­ber. Apart from technical discussions on matters related to the programme (such as physical exercise, occupational stress, smoking control, etc.) the participants reported on the situation in their coun­tries and on progress in preparation o f the programmes. It was decided that more emphasis should be placed on nutrition.

Country activities

Belgium. The W H O collaborating centre at the Laboratory for Cardiologi­cal Research o f the Free University o f Brussels coordinated activities in cardiac rehabilitation within the framework o f W H O ’s decentralized cardiovascular dis­ease programme in Europe.

Finland. The W H O collaborating centre at the National Public Health In­stitute in Helsinki coordinated the prep­aration o f two W H O meetings during the year. An international symposium on diet and primary prevention o f hypertension, co-sponsored by the Regional Office, was held in Kuopio in June. A Finnish con­sultant was recruited to assist in the prep­aration o f a series o f H Y R A P meetings.

Hungary. The National Institute o f Cardiology in Budapest provided the centres participating in the M O N IC A project with an ECG standardization ser­vice. The Institute also coordinated ac­tivities on the evaluation o f advances in cardiology and hosted a W H O meeting on the H Y R A P programme and an infor­mal meeting on the W H O study on non- invasive diagnosis o f pulmonary hyper­tension, held respectively in May and December in Budapest.

Malta. Tw o consultants assisted the Ministry o f Health with developing a

national integrated programme for pre­vention o f noncommunicable diseases and with establishing a computerized health record system.

Romania. Within the framework o f the medium-term programme for this country, two consultants assisted in the development o f a programme for the de­tection and control o f high blood pressure among adult workers and in the assess­ment o f the economic effectiveness o f pre­ventive measures in cardiology.

Sweden. The W H O collaborating centre in Gothenburg convened three meetings within the framework o f the H Y R A P programme, with the assistance o f a W H O consultant from Yugoslavia.

USSR. A coordinating centre for the W H O countrywide integrated programme for the prevention o f noncommunicable diseases was established in Moscow. The Regional Officer for Chronic Diseases visited the centre to assist in the prep­aration o f a plan o f work.

The country also hosted two W H O meetings within the framework o f the H Y R A P programme.

Yugoslavia. A consultant from Yu­goslavia was invited to deliver a lecture on behalf o f the Regional Office at the international symposium in Kuopio in June. A considerable amount o f new knowledge in this important field was presented.

SMOKING

Development o f the antismoking pro­gramme began in 1982 with meetings o f two consultative groups. A t the same time, the Regional Office began to collect

84

information on the incidence o f smoking in areas where no data were available and to describe the status o f smoking preven­tion and control activities throughout the Region.

During the year, a Southern European Committee on Health Promotion and Smoking Control was created (currently consisting o f representatives from France, Italy, Portugal and Spain, and with pre­liminary contacts with Greece, Morocco and Turkey) and a pilot survey o f smok­ing among health professionals began in France, Greece, Italy, Portugal, Spain and Turkey.

The survey on the health behaviour o f schoolchildren is continuing. Tw o meet­ings to monitor progress took place in Copenhagen in February and in London in November. Results from the first part o f the survey, implemented by Austria, Finland, Norway and the United King­dom, are now available. Hungary, Spain

and Switzerland are to join the second stage o f the survey, while Denmark, the Federal Republic o f Germany and Sweden are considering participation. Agreement has been reached on a series o f articles to report on the most important findings. These articles will be published at inter­national level in specialized journals.

The Health Education unit sent a tem­porary adviser to participate in a sympo­sium on protection o f children and ado­lescents from smoking (held in Lodz, Poland in October) and he informed the symposium o f advance results o f the above-mentioned survey.

Country activities

Portugal. The first annual nonsmok­ing day was held on 17 November and two seminars for health educators on smoking were held in Lisbon, from 14 to17 November, with the participation o f a short-term consultant in health education.

HEALTH SCIENCE A ND TECHNOLOGY — DISEASE PREVENTION A ND CONTROL

Proposed budget for country and intercountry programmes, 1984/8S, revised position, and expenditure as at 31 December 1984 (US$)

Proposedbudget

Actualbudget

allocationExpenditure

Regular funds 1792 900 1622 200 623 228

UN funds — (5960)

Voluntary funds 878 900 878 900 190942

2 671800 2501100 808 210°

a Being 5.43% o f total expenditure.

8 5

Infectious diseases in Europe — a fresh look, by B. Velimirovic. Non-serial publication.

Documents issued in 1984

Social and behavioural aspects o f comprehensive eye care: report on a W H O meeting (document ICP/PBL 101/m01).

Publications issued in 1984

8 6

H e r M a j e s t y Q u e e n M a r g r e t h e II o f D e n m a r k a r r i v e s f o r t h e o p e n i n g o f t h e t h i r t y - f o u r t h s e s s i o n o f t h e R e g i o n a l C o m m i t t e e a n d t h e i n a u g u r a t i o n o f t h e n e w b u i l d i n g d o n a t e d b y t h e D a n i s h G o v e r n m e n t . S h e is a c c o m p a n i e d by t h e M i n i s t e r o f t h e I n t e r i o r , M r s B. S c h a l l H o l b e r g .

H e r M a j e s t y w i t h r e p r e s e n t a t i v e s o f M e m b e r S t a t e s a f t e r i n a u g u r a t i n g t h e n e w b u i l d i n g d o n a t e d b y t h e D a n i s h G o v e r n m e n t .

T h e n e w a n n e x , d o n a t e d b y t h e D a n i s h G o v e r n m e n t , is c o n n e c t e d b y a b r i d g e t o t h e m a i n b u i l d i n g . It m a i n l y h o u s e s s t a f f f r o m t h e H e a l t h I n f o r m at i o n serv i ce.

Chapter 5

PROGRAMME SUPPORT

I N T R O D U C T I O N H E A L T H L I T E R A T U R E S E R V IC E S

The health literature services o f the Regional Office are constantly striving to o ffer more active support to the Member States, in line with regional H F A target 35. The systematic collection o f information on topics related to the regional H F A targets and indicators has begun. A study aimed at identifying needs and resources for health documentation in Member States clearly shows that docu­mentation is often inadequate or not properly used for the management o f health services, especially at primary health care level, so the health documen­tation programme is being reoriented accordingly.

The publications programme will be­come progressively more involved in promoting the health for all strategy. Its immediate concern is to produce de­scriptions o f the regional strategy for dif­ferent groups o f readers, such as poli­ticians, health managers, health workers and the public in general. It will also be responsible for promoting a wider under­standing o f the prerequisites for health for all.

The documentation services continue to lay stress on the systematic use o f cur­rent awareness services at the inception o f activities, and on recourse to computer­ized data bases. These have been avail­able on-line at the Office since Febru­ary 1982, through the Deutsches Institut für Medizinische Dokumentation und In­formation in Cologne and the European Space Agency. Current awareness searches are made at quarterly intervals on topics related to the targets and indicators o f the regional strategy for health for all by the year 2000 and, in this connection, docu­mentation activities are coordinated with the EEC and UNESCO. Full use is made o f the Danish library and information system.

A consultant mission undertaken in the latter half o f 1983 identified the in­formation problems faced by health man­agers and primary health care workers in Europe. Although clinical and biomedical research increasingly relies on facilities for retrieval and acquisition, as witness the increasing use o f on-line data bases, information and documentation are often

8 7

inadequate in the field o f management and primary health care. These inade­quacies take two forms:

• the documentation available is pre­sented in a form not readily usable by the potential customer (lack o f critical assessment is the drawback most often mentioned);

• the potential user is not aware o f de­ficiencies in documentation.

The first area is one which can be remedied by what may be called “ docu­mentation techniques” . The second is an area which calls for long-term multidisci­plinary efforts by both the providers and the potential users. The report o f this mission is scheduled for publication un­der the title Health and biomedical infor­mation in Europe.

Country activities

German Democratic Republic. The Institut für Wissenschaftsinformation in der Medizin, Berlin, established as a W H O collaborating centre in 1984, serves as a national reference centre, undertakes re­search and provides methodological ad­vice on information and documentation. It also provides information services for senior health managers and serves as a focal point for the C M E A countries. The Institute will assist the Regional Office, and W H O in general, with the develop­ment o f documentation services in the bio­medical and public health fields, and will help to ensure literature coverage and to analyse the use o f documentation needs and resources, including training.

M orocco. The Regional Officer for Health Documentation Services helped to identify problems and resources in the field o f documentation and to develop

health documentation units at the Min­istry o f Health and in the provinces, in cooperation with other ministries.

P U B L I C A T I O N S

The Publications Advisory Group met in the Regional Office in April. This biennial meeting brings together rep­resentatives from Member States experi­enced in the need for and uses o f Re­gional Office publications, independent publishers and publishing consultants, and senior staff in W H O headquarters concerned with the production, distribu­tion and sales o f W H O books. The Group recommended, among other things, that the Regional Office should concentrate on publishing the results o f Regional Office activities, especially the outcome o f intercountry studies, generally in the original language only, and according to the expressed priorities o f Member States. More effort, and if necessary resources, should be devoted to promoting the dis­semination and sale o f what is published. The Regional Office should collaborate actively with national documentation centres and librarians to make known the existence o f W H O publications.

The 1984 catalogue listing all books published to the end o f 1983 was widely distributed. For the first time, it contained an index o f titles, as well as the usual subject and author index. This is particu­larly useful for libraries and sales agents, the main outlets for W H O publications.

A leaflet promoting the non-serial pub­lication Infectious diseases in Europe was printed and widely distributed through­out Europe and by headquarters’ distri­bution and sales service and their sales

agents. A leaflet describing all books pro­duced by the Regional Office in German was prepared for the Frankfurt Book Fair and reprinted for distribution to all the German-speaking addressees on the Office’s mailing list. W H O headquarters arranged several promotional activities on books published by the Office, as well as a special promotion to a particular group o f credit card holders in Switzer­land o f the Regional Office’s German edi­tion o f Vaccination certificate requirements fo r international travel.

A consultant prepared a feasibility study for a technical bulletin that may be used to disseminate information on W H O ’s regional policies and programmes to a wider, multisectoral audience, and drafted a provisional first issue o f the bulletin.

The following new books were either issued or went to press in English: in the W H O Regional Publications, European Series, No. 16, Nuclear power: accidental releases — principles o f public health ac­tion, and No. 17, Demographic trends in the European Region: in the Public Health in Europe series, No. 23, Sex and fam ily planning: how we teach the young: and in the E U R O Reports and Studies series, No. 89, Family planning and sex education o f young people, and No. 92, First-contact mental health care. The non-serial publi­cations issued were: Infectious diseases in Europe — a fresh look, Tox ic o il syn­drome — mass fo o d poisoning in Spain, Education in primary health care and Bio­logical effects o f man-made mineralfibres. Proceedings o f a W H O /IA R C conference. Vols I and II.

French translations o f 12 publica­tions that had previously appeared in English were issued: Public Health in

Europe Nos 15-18, and EU RO Reports and Studies Nos 47, 66, 68, 73-76 and 86. Tw o original titles were issued in the EU RO Reports and Studies series: No. 82, L ’amélioration des programmes de planifi­cation fam ilia le, and No. 90, La techno­logie appropriée au traitement des eaux usées dans les petites localités rurales.

Tw o books published by headquar­ters, Vaccination certificate requirements f o r international travel and Effects o f nuclear war on health and health services, were published in German, and German translations o f two Regional Office books that had previously appeared in English were issued: EU RO Reports and Studies Nos 74 and 76.

The Russian translations o f 16 publi­cations that had previously appeared in English (E U R O Reports and Studies Nos 31-36, 38, 44, 48, 56, 68, 70, 73, 74 and 83; Public Health in Europe No. 17) were issued.

Arrangements were made with Ma­sson to publish Législation sanitaire . p ro ­gramm es et moyens de fo rm a tio n en Europe. This is the first such contract to be negotiated with a French publisher. A German edition o f Health crisis 2000 was published by Verlagsgesellschaft Gesund­heit, Berlin; a Norwegian edition by Gyld- endal, Oslo; and a Swedish edition by Liber Forlag, Lund.

Some o f the income that the sale o f Regional Office books had contributed to the headquarters revolving fund for sales promotion was used for the first time this year to finance a half-time post for a sales promotion clerk. This has strengthened the efforts to maintain an up-to-date com­puterized mailing list that can be used to improve the distribution o f information

89

issued by the Regional Office and to pro­mote the wider sale o f its books.

The value o f publications sold through W H O headquarters and its global network o f sales agents in 1984 was Sw.fr. 167 470. More than 2400 requests for documents and free copies o f publications were re­ceived, and there were 17 requests for rights to translate publications or docu­ments into non-working languages.

P E R S O N N E L

The period under review saw the estab­lishment o f one regular budget post in the Regional Office, funded by the Director- General’s Development Programme until the end o f 1985. Tw o professional staff members were recruited in advance against two regular budget posts approved from1985. In addition, one professional post (in food safety) was abolished and replaced by another (in nutrition), also funded from the regular budget. Tw o field posts were established, one funded by U N D P and the other from the regular budget. One field post in Algeria was transferred to the African Region.

The proportion o f female professionals in the Regional Office remained at 24%.

G E N E R A L A D M I N I S T R A T I O N A N D S E R V IC E S

At its fourth meeting in April, the Consultative Group on Budgetary Ques­tions gave valuable advice on preparation o f the proposed programme budget for

1986/87, and particularly on calculating cost increases, projecting fluctuations in exchange rates, distributing the regional budget allocation and staffing.

The new office space available in the annex to the Regional Office building has been fully utilized since January. Her Majesty Queen Margrethe II o f Denmark officially opened the building on 24 Sep­tember. The Fellowships unit has moved back to its former location in the Regional Office complex.

In May, the Thirty-seventh World Health Assembly approved a number o f repairs and improvements to the existing office buildings at a cost o f approximately US$ 185 000.

The Director, Support Programme, visited Algeria in November 1984 for dis­cussions with the Government, represen­tatives o f the W H O Regional Office for Africa and U N D P concerning practical arrangements for the transfer o f respon­sibilities for WHO-assisted projects to the Regional Office for Africa.

During the year, 60 meetings were held in the Regional Office attended by 1538 participants, and 2996 participants attended 119 meetings held away from the Office. In addition, 11 non-WHO meetings with 657 participants took place at the Regional Office.

The installation o f a fire alarm system in sensitive areas has been completed. Ex­tension o f the telephone exchange is in progress. Twenty films were produced for technical units in the video studio, and two technicians from the Regional Office assisted the Ministry o f Health o f Malta in establishing a video studio for their health education unit.

90

B U D G E T A ND FI NAN CE

With effect from January 1984, the Director-General put into operation his proposal to withdraw, from the working allocations, net savings resulting from up­ward fluctuations in the actual average accounting rate o f exchange in excess o f 10% over the budgetary rate o f exchange. The adjustments made by headquarters in this respect are reflected in the second column o f figures in the tables at the end o f each chapter o f this report.

Regular budget (biennial)

O f a total o f US$29463 200 for the biennium after adjustment, US $ 12 636 573 had been spent by 31 December, repre­senting 42.89% o f the regular budget for 1984/85.

Extrabudgetary sources

United Nations funds (annual)

The European Region has been the executing agency for various U N D P , U N E P and U N F P A projects. A total o f US $950 404 was expended in 1984 cover­ing 41 country and intercountry projects in the Region.

Other funds (biennial)

These funds include the Voluntary Fund for Health Promotion, Funds-in- Trust, the Special Account for Servicing Costs and the Real Estate Fund. A total o f US$1 301 670 was expended in 1984.

Many Member States also provided considerable assistance by covering the

local costs o f W H O meetings and o f at­tendance by national experts at meetings abroad. The collaboration o f institutes in Member States in the research programme o f the Regional Office is another form o f assistance not easily expressed in mon­etary terms.

A breakdown by source o f voluntary contributions received during 1984 is shown in Table 2.

Table 2. Vo lun ta ry con tr ibu t ions , inc lud ing Funds-in-Trust. received

during 1 9 8 4 (US S)

Austria 9 8 5 7 2

Belgium 4 8 5 5 7

Finland 81 649

Germany. Federal Republic of 2 0 1 5 0 5

Italy 37 754

Netherlands 1 6 8 1 3

Norway 1 7 8 8 6

Turkey 1 6 9 4 9

Autosynnge/Travenol. USA 1 4 8 0 0

CEC. Luxembourg 1 0 3 0 7

European Proprietary Association 2 0 0 0 0

Joint European Medical Research Board 8 0 0 0

Nordisk Insulin Laboratory. Denmark 10 8 0 0

NOVO Research. Denmark 3 6 0 0

Salvat Editores, Spam 6 0 5 0

Water Research Centre. United Kingdom 41 551

6 3 4 793

9 1

PROGRAMME SUPPORTProposed budget for country and intercountry programmes, 1984/85,

revised position, and expenditure as at 31 December 1984 (US $)

P r o p o s e db udge t

A c tu a l

b u d ge ta l l o c a t io n

E xp en d itu re

R e g u la r fun ds 13 137 300 10 129 100 4 61 8 185

U N funds

V o lu n ta r y funds 52 800 52 800 2 750

S pec ia l A c c o u n t f o r

S e r v ic in g C os ts 62 421

R ea l Esta te F u n d 178072

13 190 100 10 181900 4 861 428 "

° Being 32.6 5 ' ! of total expenditure.

92

Annex 1

ACTIVE AND NON-ACTIVE MEMBER STATES OF THE WORLD HEALTH ORGANIZATION, EUROPEAN REGION

31 December 1984

A t 31 December 1984 the European Region o f the W orld Health Organization had32 active Member States and 2 non-active Member States. They are listed below with the date on which each became a party to the Constitution o f W H O . Algeria moved to the African Region in 1984.

Albania 26 May 1947

Austria 30 June 1947

Belgium 25 June 1948

Bulgaria 9 June 1948

Byelorussian SSRa 7 April 1948

Czechoslovakia 1 March 1948

Denmark 19 April 1948

Finland 7 October 1947

France 16 June 1948

German Democratic Republic 8 May 1973

Germany. Federal Republic of 29 May 1951

Greece 12 March 1948

Hungary 17 June 1948

Iceland 17 June 1948

Ireland 20 October 1947

Italy 11 April 1947

Luxembourg 3 June 1949

Malta 1 February 1965

Monaco 8 July 1948

Morocco 14 May 1956

Netherlands 25 April 1947

Norway 18 August 1947

Poland 6 May 1948

Portugal 13 February 1948

Romania 8 June 1948

San Marino 12 May 1980

Spain 28 May 1951

Sweden 28 August 1947

Switzerland 26 March 1947

Turkey 2 January 1948

Ukrainian SSRa 3 April 1948

USSR 24 March 1948

United Kingdom 22 July 1946

Yugoslavia 19 November 1947

a Non-active Mem ber State.

93

Annex 2

E STIM A TE D P O P U L A T IO N S IN 1984 FOR TH E ACT IVE M EM BER STATES O F TH E W H O EU RO PEAN REGION

(in thousands)17

Albania 2 978

Austria 7 457

Belgium 9 860

Bulgaria 9 188

Czechoslovakia 15 658

Denmark 5 154

Finland 4943

France 54 132

German Democratic Republic* 16 874

Germany, Federal Republic of* 60 274

Greece 9 551

Hungary 10 854

Iceland 239

Ireland 3 457

Italy 57 626

Luxembourg 358

Malta 355

Monaco 26

Morocco 23 058

Netherlands 14 334

Norway 4 131

Poland 37 199

Portugal 10 122

Romania 22 971

San Marino 21

Spain 38 665

Sweden 8 270

Switzerland 6486

Turkey 49 816

USSR 275 618

United Kingdom 55 686

Yugoslavia 23015

Total estimated population in the Region: 88 376 000

a Based on W orld population prospects as assessed in 19X0. N e w Y o r k , U nited N ation s, 1 9 8 1 .

^ T h e figu res fo r the G e rm a n D e m o cra tic R ep u b lic and the F ed eral R ep u b lic o f G e rm a n y include the relevant data fo r B erlin. T h is is w ith out prejudice to an y question o f statu s that m ay be involved.

Annex 3

PROFESSIONAL STAFF IN THE EUROPEAN REGION

31 December 1984

R E G I O N A L O F F I C E

Executive Management

Regional Director Dr Leo A. Kaprio

Director, Programme Management DrJ.E. Asvall

Programme Monitoring Ms V.S. Pedersen

Programme Planning M r P. Lamarche

Programme Policy Ms C. Celinder

Development o f Comprehensive Health Services

Director

Appropriate Technology for Health

Family Planning

Health Education

Health of the Elderly (Global Programme)

Elderly, Disability and Rehabilitation (Regional Programme)

Maternal and Child Health

Nursing

Pharmaceuticals and Drug Utilization

Primary Health Care

Dr P. O. Pelersson

Dr K. Sttrhr Johansen DrJ.O . Vanga

Ms W. Haddad6

Dr I. Kickbusch Dr D. O'Byrne1

Dr D. M. Macfadyen^

D r H.M. Hermanovâ

Dr M. G. Wagner

Dr M. Farrell Ms E. Slussi

Dr M. Dukes

Dr II. V. Vuori Dr W. Hubrich‘

a Paid by the D ire c to r-G e n e ra l's D eve lopm ent Program m e u n til 31 Decem ber 1985.

* Paid by U N F P A .

1 A p p ro ve d post advanced fro m 1985.

^ Paid by W H O headquarters.

Disease Prevention and Control

Director

Accident Prevention (Global Programme)

Accident Prevention (Regional Programme)

Cancer

Chronic Diseases

Communicable Diseases

Malaria

Mental Health

Nutrition

Oral Health

Environmental Health

Director

A ir Quality Guidelines

Dr E. Leparski

Dr C.J. Römerd

Dr J. T. Jones

Dr L. Döbrössy

Dr V. Zaitsev

Dr B. Bytchenko

Dr K. Lassen

Dr J. H. Henderson M r J.-U. Hannibal

Ms E. Helsing

Dr l.J. Meller

M rJ .I. H'addingtone

Dr R. Tiirckf

Environmental Health Planning and Management

International Water Decade

Occupational Health

Recognition and Control of Environmental Hazards

Toxicology

Mr £ '. Giroult

Vacant

Dr J. Järvisalo

Dr M.J. Suess

Dr S. TarkoH-ski Vacant*

1 Pro tempore also responsib le fo r Food Safety.

f Paid by v o lu n ta ry funds.

Я Vacancy o m itte d in e rro r fro m the 1983 report.

95

Research, Planning and Human Resources Health Inform ation (contd)

Director

Country Health Programming

Health Economics

Health Legislation

Health Manpower Development

Manpower Planning and Management

Educational Development

Fellowships Dr R.

Dr A.M. Wojtczak

Dr 1. S. Luculescu

Dr H. Zöllner

Ms G. Pinet

Research Promotion and Development

Health Information

Director

Coordination with other Organizations

Epidemiology and Information Support

Health Documentation Services

Health Information of the Public

D r J.-P. Menu

Dr V. Vodor at ski

Manrique de Lara Dr V. Telish

M r P. W. Jolly

Dr B. Nizetic Dr P.-Ci. Svens son

Dr A.A. Weber

Dr W. Pritsche Ms N. Humbert

Dr J.-P. Jar del Dr A. Romensky

M r I. Vin ther-Jergensen Ms M. A bo и Shabanah

M r A. Malagodi

Dr М. C. Thuriaux

Vacant

Publications

Reports and Secretarial Services

Translation and Editorial

(Chief)

(English)

(French)

(German)

(Russian)

Support Programme

Director

Administrative Services

Budget and Finance

Conference Services

Personnel

Staff Development and Training

M r M. Jones M r F.E. Theakston Ms P.M. Charlton

Ms C.F. Murphy

M r J.-M. Deramat

M r P.J. Boyle

Ms M. de Nervaux-Loÿs Ms M. Lindemann

M r R. Compton-Smith У a cant

M r R. Kranich Ms C. Madanoglu

M r U. Senn

M r V. Khortsev M r G. Pignasty

Vacant

M r E. Westenberger

M r C. G. Сhate Her

Vacant M r J. M iller

M r O.H. Jvrgensen

Ms R.C.E. Néagoe

M r I. Soos

Vacant

F I E L D S T A F F

Greece

IC P/R C E 211 (U N E P ) — Mediterranean Action Plan

Senior Scientist Dr L.J. Saliba

Morocco

M O R /C W S 004 — Water Supply in Small Communities

Design Engineer Vacant

M O R /PH C 001 — Assistance in Primary Health Care

Senior Technical Adviser DrJ.P . Fortin

Turkey

TUR/PHC 001 — Primary Health Care

Field Operations Manager M rJ.O . Espinoza Cajina

Intercountry Project

IC P/M A L 199 — Entomological Services

Scientist M r J.L. Clarke

96

Annex 4

O R G A N IZ A T IO N A L C H AR T OF TH E R E G IO N A L OFFICE,31 December 1984

Comprises the offices of the Regional Director and of the Director, Programme Management.

Annex 5

IN TE R C O U N TR Y " M EETING S C O NV E N E D BY TH E R E G IO N A L O FF ICE FOR EUROPE

IN 1984

ICP/CWS 001

ICP/PBL 101

ICP/OCH 004

ICP/HSR 699

1CP/HMD 101

ICP/DSE 199

1CP/RPD 103

ICP/M CH 102

ICP/CW S 002

1CP/NCD 503

ICP/CEH 002

Consultation on the International Drinking Water Supply and Sanitation Decade in Europe, Copenhagen. 9-12 January (English)

Planning Meeting on Social and Behavioural Aspects o f Compre­hensive Eye Care, Brussels, 25-26 January (English)

Technical Committee on Monitoring and Evaluating Airborne Man- made Mineral Fibres, St Augustin/Bonn, 26 January (English)

Third Meeting o f H ED Collaborating Centres, Copenhagen, 26- 27 January (English)

Consultation on Specialties Study, Copenhagen, 8—10 February (English)

Advisory Committee on Pharmaceuticals and Drug Utilization, Copenhagen, 9-10 February (English)

European Advisory Committee on Medical Research (E A C M R ), Copenhagen. 15-17 February ( English, French, German, Russian)

Meeting on Appropriate Perinatal Technology, Herlev, 17 Feb­ruary (English)

Working Group on Bankwell Filtration, Budapest, 20-24 February (English)

Planning Meeting for the W H O Collaborative Study on “ Health Behaviour in Schoolchildren — A Cross-national Survey” , Copen­hagen, 22-24 February (English)

Planning Meeting on Air Quality Guidelines, Copenhagen, 28 Feb­ruary — 2 March (English)

a S ev eral oth er m eetings held d urin g the year were financed through co u n try project funds. So m e o f these, though not listed here, were o f con sid erab le interest to m ore than one co un try.

98

IC P/A PR 103

ICP/CW S 002

IC P / A D A 599

IC P/C LR 004

IC P / M A L 002

ICP/CEH 501

ICP/DSE 101

IC P/N C D 504

ICP/CDS 003

IC P/A PR 104

ICP/HEE 004

IC P/N C D 001

ICP/HBI 599

ICP/HSR 603

ICP/CLR 001 Joint W H O / E H P F (European Health Policy Forum) Meeting on Appropriate Siting o f Health Technologies, Brussels, 1-2 March (English)

Joint O E C D / W H O Scientific Expert Group on Traffic Safety o f the Elderly Road User, Paris, 5-7 March (English)

Working Group on Health Hazards from Nitrates in Drinking- water, Copenhagen, 5-9 March (English)

Advisory Group for the Regional Programme on Abuse o f Pyscho- active Drugs, Copenhagen, 13-14 March (English)

Consultation on Priority-setting in the Assessment o f Individual Clinical Technologies, London, 15-16 March (English)

Malaria Coordination Meeting (Iraq, Syria, Turkey), Istanbul, 19-22 March (English)

Workshop on Monitoring and Control o f Exposure and Assessment o f Health Effects o f Pesticides, Istanbul, 19-23 March (English)

Meeting on European Studies o f Drug Regulation, Oslo, 20-23 March (English)

Symposium on Smoking and Health in Southern Europe, Barce­lona, 22-24 March (English, French)

Meeting o f the Epidemiologist Group on A ID S , Paris, 26 March (English)

Workshop on Education for Safety, Edinburgh, 26-30 March (English)

Consultation on Guidelines for Assessing the Functioning o f the Elderly, Aberdeen, 27-30 March (English)

Cationic Markers o f Hypertension: Update on Recent Progress, Gothenburg, 3-4 April (English)

Second Meeting o f the Publications Advisory Group for EURO, Copenhagen, 5-6 April (English)

Workshop on Legislative Measures in Relation to the Development o f Lifestyles Conducive to Health, Dresden, 9-10 April (English, German)

ICP/DSE 103

ICP/PSF 001

IC P/EX M 001

ICP/DSE 102

ICP/EX M 001

IC P/G PD 102

IC P/G PD 102

ICP/CLR 001

ICP/IEH 005

ICP/DSE 103

ICP/PD P 001

IC P/N C D 001

ICP/HSR 301

ICP/NCD 001

W H O Drug Utilization Research Group, Birmingham, 9-12 April (English)

Conference on Mental Health Services in Pilot Study Areas, T rieste,10-13 April (English, French, German)

Regional Health Development Advisory Council (R H D A C ) , C o­penhagen, 24-26 April (English, French, German, Russian)

Working Group on Drugs in Breast-milk, Copenhagen, 26-27 April (English)

Meeting on Empirical Support for HFA2000, Copenhagen, 26- 27 April (English)

Consultative Group on Programme Development (C G P D ), Copen­hagen, 26-27 April (English, French, German, Russian)

Consultative Group on Budgetary Questions (C G B Q ), Copen­hagen, 27 April (English, French, German, Russian)

Consultation on Technology Planning in Health Care Centres, Copenhagen, 29 April — 1 May (English)

Working Group on School Health Education in the European Region, Burley/Southampton, 30 April — 4 May (English)

Working Group on Inappropriate Use o f Psychopharmaca, Copen­hagen, 2 May (English)

Meeting on the Epidemiological and Public Health Aspects o f Leishmaniasis in Countries Bordering the Mediterranean Sea, Mur­cia, 2-4 May (English)

Meeting on European Risk Factors and Incidence — A Collabor­ative Analysis (E R IC A ), Heidelberg, 3-4 May (English)

Meeting o f Nurse Researchers from Collaborating Centres and Selected Participating Centres Associated with the Medium-term Programme in Nursing/Midwifery in Europe, Ljubljana, 6-12 May (English)

International Liaison and Coordination Meeting on Epidemiologi­cal Studies Involving Assessment o f Sodium Intake and Excretion, Louvain, 7-9 May (English)

100

IC P/H ST 101

IC P/PH C 101

IC P/PH C 305

ICP/DSE 105

IC P/G PD 502

IC P/N C D 001

IC P/M P N 502

IC P/PH C 104

ICP/PSF 199

IC P/E X M 001

ICP/DSE 105

IC P/M P N 501

IC P/C LR 001

IC P/N C D 001

ICP/NCD 003

Consultation on the Use o f Epidemetric Models, Copenhagen, 10-11 May (English)

Planning Meeting on Ethics o f Prevention, Copenhagen, 10-11 May (English)

W ork ing Group on Selection o f Personnel to Work in Circumpolar Regions, Anchorage, Alaska, 10-13 May (English)

Consultation on Development o f Clinical Pharmacology in Europe, Copenhagen, 14-15 May (English)

Consultation on Regional Indicators for HFA2000, Copenhagen, 14-15 May (English)

Meeting on Psychosocial Factors Related to Hypertension Control, Maastricht, 14-16 May (English)

Workshop on Hospital Financing Systems, Malente/Kiel, 14-18 May (English, German)

Workshop on “ Women and Health” Documentation Centres in Europe, Bologna, 15-18 May (English)

Consultation on Contribution o f Psychology to Programme De­velopment in the W H O Regional Office for Europe, Cologne, 16- 17 M ay (English)

R H D A C Subgroup on Revision o f the Research Chapter o f the Target Document, Copenhagen, 17 May (English)

Meeting on Guidelines for the Clinical Investigation o f Antihyper­tensive, Antiarrhythmic and Antianginal Drugs, Moscow, 22- 24 May (English)

Planning Meeting for the Study on Economic Aspects o f Health Care for the Injured, Leeds, 22-24 May (English)

Joint W H O / E H P F Meeting on Diagnostic-related Group Finan­cing and Technology Diffusion, Brussels, 23-24 May (English)

E U R O -H Y R A P W ork ing Group on Assessment o f Levels o f Hypertension Control and Management, Budapest, 24-26 May (English)

Meeting on Comprehensive Community Cardiovascular Control Programmes, Udine, 28-30 May (English)

101

IC P/N C D 001

IC P / A D A 001

ICP/HSR 303

IC P/G PD 102

ICP/DSE 105

ICP/CEH 501

IC P/N U T 102

SPA/CEH 502

IC P/C A N 101

ICP/CEH 501

ICP/CEH 001

ICP/CEH 503

ICP/PH C 102

ICP/PHC 302

IC P/C A N 199

102

Meeting on Psychosocial Methods o f Improving Compliance in Hypertension Control Programmes, Kaunas, 4-6 June (English)

Consultation Meeting for a Study on Community Response to Alcohol-related Problems, Edinburgh, 4-7 June (English)

Symposium on Postbasic and Graduate Education for Nurses in Europe, Helsinki, 4-8 June (English, French, German)

Subcommittee o f the Consultative Group on Programme Develop­ment, Copenhagen, 6-8 June (English)

Working Group on Guidelines for Clinical Investigations o f Anti- glaucomatous Drugs, Rotterdam, 14-15 June (English)

Consultation on Monitoring o f Lead Neurotoxicity in Children, Düsseldorf, 18-21 June (English, German)

Regional Meeting o f Breastfeeding Mothers’ Support Groups in Europe, Bonn, 19-24 June (English)

First Meeting o f Scientific Steering Committee on Toxic Oil Syn­drome, Madrid, 20-22 June (English)

Working Group on National Cancer Control Programmes, Lon­don, 25-27 June (English)

Consultation on Neurobehavioural Tests for Monitoring Health Effects o f Organophosphorus Pesticides, Sofia, 25-28 June (English)

Intercalibration Exercise and Consultation Meeting on Microbio­logical Methods for Coastal Water Quality Monitoring, Athens, 25-29 June (English)

Workshop on Response o f the Public Health System to Acute Poisonings (including Accidents), Lodz, 25-29 June (English)

Seminar on Family Structures and Health, Hennef/Cologne, 26-29 June (French, German)

Third Coordination Meeting on the Organization o f Primary Health Care in Southern Europe, Salonica, 27-29 June (English)

Advisory Committee on Cancer Control, London, 28-29 June (English)

IC P/R PD 103

ICP/HSR 602

ICP/HSR 802

IC P/PH C 304

IC P/A PR 102

IC P/R U D 003

IC P/M PN 001

ICP/DSE 105

ICP/DSE 105

ICP/DSE 105

IC P/M PN 503

ICP/RH B 002

IC P/N C D 003

ICP/CEH 002 Working Group on Acid Rainfall in Relation to Human Health, Berlin (West), 3-6 July (English, German)

Planning Subcommittee o f the E A C M R , Ulm, 5-6 July (English)

Working Group on Concepts and Principles o f Health Promotion, Copenhagen, 9-13 July (English)

Meeting o f Experts on Underlying Processes o f Becoming Socially Vulnerable: Special Focus on Youth and Methodological Issues, Munich, 20-21 July (English)

Interim Meeting on the Study on Indicators Suitable for Monitoring Primary Health Care, Zagreb, 30 July — 2 August (English)

Steering Committee for Statistical Indicators for Accidents, Rey­kjavik, 20-21 August (English)

Working Group on Indoor A ir Research, Stockholm, 27-31 August (English)

European Conference on Planning and Management for Health, Scheveningen/The Hague, 27 August — 1 September (English, French, German, Russian)

Consultation on Developments in Clinical Pharmacology: Clinical Pharmacology in Primary Health Care, Copenhagen, 28-29 August (English)

Consultation on Developments in Clinical Pharmacology: Guide to Clinical Pharmacology, Copenhagen, 30 August (English)

W ork ing Group on the Clinical Investigation o f Drugs used in the Treatment o f Cerebral Function, Copenhagen, 30-31 August (English)

Workshop on Economic Issues in Intersector Policy and Planning, Disley, 2-5 September (English)

Consultation on Disability Prevention and Rehabilitation, Turku,3-4 September (English)

Meeting o f Principal Investigators o f the Countrywide Integrated Programme for the Prevention o f Noncommunicable Diseases, Bri- oni, 4-7 September (English)

103

IC P/M PN 501

IC P/N C D 001

ICP/DSE 105

ICP/CEH 001

IC P/N C D 001

ICP/O RH 103

ICP/CEH 002

ICP/HSR 602

IC P/EX M 001

ICP/HSR 603

IC P/N C D 504

IC P/A PR 103

ICP/C LR 001

ICP/OCH 004

ICP/M AL 003

104

Meeting o f the Technical Committee on Monitoring and Evaluating A irborne Man-made Mineral Fibres, London, 6 September (English)

Planning Meeting for the Study on Economic Evaluation o f Strat­egies against Tobacco, Alcohol and Drug Abuse, Disley, 6-8 Sep­tember (English)

Meeting o f Investigators in Prevention o f Noncommunicable Dis­ease Risk Factors and Health Promotion in Youth, Joensuu, JO-12 September (English)

Working Group on Clinical Investigation o f Psychotropic Drugs, Copenhagen, 17-18 September (English)

Consultation Meeting on Biological Monitoring o f Methylmercury in Mediterranean Populations, Zagreb, 17-21 September (English)

Meeting on Intervention Methods A imed at Salt Moderation, Madrid, 18-19 September (English)

Workshop on Organized Changes in Educational Systems for Oral Health Manpower, Dublin, 19-21 September (English)

Working Group on Air Quality Guidelines for Noncarcinogenic Metals, Düsseldorf, 24-28 September (English)

Nordic Meeting on Health Promotion, Dalby, 1 October (English)

Workshop on the Use o f Microcomputers in National Monitoring o f Health Indicators, Copenhagen, 1-2 October (English)

Study on Legislative Measures in relation to the Development o f Lifestyles conducive to Health, Copenhagen, 8-9 October (English)

Second Meeting o f the Mediterranean Committee on Health Pro­motion and Smoking Control, Padua, 8-9 October (English)

Fourth Joint O E C D / W H O Meeting on Traffic Safety o f Elderly Road Users, Copenhagen, 8-10 October (English, French)

Meeting on Budgetary Incentives for the Appropriate Use o f Medi­cal Technology, Cologne/Düsseldorf, 8-10 October (English)

Malaria Coordination in South-East Europe, Athens, 9-11 October (English)

IC P/C O R 003

IC P/H LE 102

ICP/CW S 002

IC P / H M D 101

ICP/HSR 302

ICP/IEH 005

IC P/C D D 001

ICP/CEH 003

ICP/HSR 604

IC P/N C D 001

ICP/HEE 003

ICP/DSE 105

ICP/NCD 001

ICP/HSR 603

European Conference on Primary Prevention o f Coronary Heart Disease, Anacapri, 15-19 October (English, French, German, Russian)

Second Workshop on Health Aspects o f Disaster Preparedness, Trieste, 15-20 October (English, French, Italian)

Joint W H O / E H P F Meeting on Legislative Approaches with Re­spect to Health Care Technology, Brussels, 17-18 October (English)

Seminar on Guidelines for Drinking-water Quality, Strasbourg, 22-24 October (English)

Seminar on Medical Specialization in Relation to Health Needs, Abano Terme, 22-25 October (English)

Working Group on the Preparation o f Guidelines for Standards o f Nursing Practice, Brussels, 22-25 October (English)

Advisory Group for International Course on Health Education for Southern European and Mediterranean Countries, Perugia, 23-24 October (English)

European Scientific Working Group on Diarrhoeal Diseases, Ankara, 23-25 October (English)

W ork ing Group on the Risk to Health o f Chemicals in Sewage Sludge Applied to Land, Valletta/Marsascala, 23-26 October (English)

Working Group on Health Education in Primary Health Care, Budapest, 23-26 October (English)

Consultation on Behavioural and Psychotherapeutic Intervention Techniques in Multidimensional Hypertension Control, Copen­hagen, 24-26 October (English)

Working Group on Prevention o f Health Risks that have Conse­quences in Old Age, Tbilisi, 24-27 October (English, Russian)

Thirteenth Symposium on Clinical Pharmacological Evaluation in Drug Control: Drugs in Pregnancy and Obstetrics, Schlangenbad, 30 October — 2 November (English, German)

Workshop on Young Migrants and Health, Lahnstein/Koblenz,30 October — 2 November (German)

105

IC P /H M D 103

ICP/HSR 601

ICP/FOS 002

ICP/DSE 105

IC P/N C D 503

ICP/CEH 506

ICP/CEH 001

IC P/A PR 101

ICP/DSE 103

ICP/CEH 002

IC P/N CD 001

IC P/C A N 102

IC P /N U T 102

IC P/M C H 102

106

Consultation on Continuing Education and Multiprofessional Training, Copenhagen, 31 October — 2 November (English)

Working Group on Research in Health Promotion: Priorities, Issues, Strategies, Edinburgh, 5-7 November (English)

Working Group on Health Aspects o f Catering, Novi Sad, 5-9 November (English)

Working Group on Clinical Investigation o f Drugs used in Rheu­matic Diseases, Copenhagen, 6-7 November (English)

Health Behaviour in Schoolchildren — A Cross-national Survey: Second Planning Meeting, London, 7-9 November (English)

Consultation on Risk Management in Chemical Safety, Ulm, 8-10 November (English, German)

Third Intercalibration Exercise and Consultation Meeting on Micro­biological Methods for Coastal Water Quality Monitoring, Tunis, 12-16 November (French)

Meeting o f National Counterparts on Accident Prevention Pro­grammes to Consider Preparation o f Model Programmes, Vienna, 14-16 November (English, German)

Working Group on Inappropriate Use o f Psychopharmaca, Oslo, 19-20 November (English)

Working Group on A ir Quality Guidelines for Inorganic Carcino­genic Air Pollutants, Copenhagen, 19-23 November (English)

Consultation on Methods o f Assessment o f Psychosocial Factors Related to Hypertension Control, Moscow, 20-22 November (English)

Consultation on Practical Approaches to the Development o f Problem-specific Care Programmes in Cancer, Stockholm, 22-23 November (English)

Consultation on the Prevention o f Osteoporosis, Gothenburg, 22-23 November (English)

Working Group on Appropriate Technology for Prenatal Care, Washington, DC, 26-30 November (English, Spanish)

ICP/CDS 007

ICP/H SR 699

ICP/H SR 301

IC P/VPH 101

ICP/DSE 102

ICP/HSR 804

ICP/H ST 104

IC P / N U T 102

IC P/E X M 001

ICP/CEH 002

ICP/EPI 001

ICP/DSE 105

IC P/N C D 001

ICP/CEH 502 Consultation on the Epidemiological Study on Health Effects o f Exposure to Cadmium in the General Population, Copenhagen, 27-28 November (English)

Working Group on the Control o f Streptococcal and Staphylo­coccal Infections, Lyon, 27-29 November (English)

Fourth Meeting o f H E D Collaborating Centres, Edinburgh, 3- 4 December (English)

Children and Family Breakdown: The Positive Role o f Nurses and Midwives — Meeting with the Professional and Public Press, Kiel,4-7 December (English, German)

European Meeting on the Prevention o f Toxoplasmosis, Graz, 5-6 December (English)

Working Group on Drugs in Breast-milk, Bath, 5-7 December (English)

Workshop on the Health Burden o f Social Inequities, Copenhagen,5-7 December (English)

Consultation on the International Course on the Application o f Statistical, Epidemiological and Managerial Methods to Medicine and Public Health, Copenhagen, 6-7 December (English)

Informal Consultation with Infant Food Industries, Copenhagen,7 December (English)

Joint Meeting between W H O and National Medical Associations on Health for A ll in Europe, Copenhagen, 7-8 December (English, French, German)

Consultation on Selection o f Organic and Malodourous Substances for Inclusion in Guidelines for A ir Quality, Delft, 10-11 December (English)

Second Conference on Immunization Policies in Europe, Karlovy Vary, 10-12 December (English, French, Russian)

Meeting on Guidelines for the Clinical Investigation o f Anti­cataract Drugs, Rome, 11-12 December (English)

Consultation on Psychosocial Determinants o f Cardiovascular Dis­eases, Copenhagen, 11-13 December (English)

107

IC P/C A N 104

IC P/M C H 504

ICP/PSF 003

ICP/DSE 103

ICP/PHC 303 Working Group on the Role o f Primary Health Care Personnel in Health Promotion (with Special Reference to Physical Activity), Tampere, 11-13 December (English)

Working Group on Problems with Cancer: Comprehensive Man­agement o f Cancer Pain, Geneva, 11-14 December (English)

Working Group on Contraceptive Needs o f Migrant Women, Paris,11-14 December (French)

Working Group on Mental Health Practice in Primary Health Care: Requirements for Training and Multidisciplinary Teamwork, Cam­bridge, 13-16 December (English)

Meeting on Psychopharmaca and the Child, Hamburg, 17-18 De­cember (English, German)

108

Annex 6

WHO-SPONSORED COURSES IN THE EUROPEAN REGION, 1984

Training Course for Sanitarians and Vector Control Technicians (French language), Algiers/Oran/Constantine, September 1982 — July 1984 (A L G / E H P 002)

International Sanitary Engineering Postgraduate Course (French lan­guage), Rabat, February 1983 — July 1984 ( ICP/E H P 007)

Sanitary Engineering Course (French language), Algiers, February 1983 — July 1984 (A L G / E H P 001)

Courses leading to the European Certificate in Human Ecology, Sep­tember 1983 — October 1984 ( IC P/E H P 001)

Training Course for Sanitarians and Vector Control Technicians (French language), Algiers/Oran/Constantine, September 1983 — July 1985 (A L G / E H P 002)

Course for Public Health Administrators (Russian language), Moscow, September 1983 — June 1984 ( IC P / M P M 006)

Course for Public Health Administrators (English language), Moscow, September 1983 — June 1984 ( IC P / M P M 007)

International Sanitary Engineering Postgraduate Course (English lan­guage), Delft, October 1983 — September 1984 ( IC P/E H P 001)

International Environmental Services Postgraduate Course (English lan­guage), Delft, October 1983 — September 1984 ( IC P/E H P 001)

Course in Statistical, Epidemiological and Operational Methods in Medi­cine and Public Health (French language), Brussels, 1 February —31 May 1984 (IC P /H S T 104)

International Sanitary Engineering Postgraduate Course (French lan­guage), Rabat, 15 February 1984 — 30 June 1985

Fifth International Advanced Training Course in Health Education (German language), Cologne, 20 February — 16 March 1984 and 23-27 July 1984 ( IC P/PH C 102)

Third Basic Course on Malaria and Planning Malaria Control (English language), Italy/Turkey, 7 March — 29 June 1984

Course in Cancer Epidemiology (English language), Rome, 19-30 March 1984

Seminar on Training o f Teachers o f General Medical Practice (English language), Dubrovnik, 24-27 April 1984

W H O / D A N ID A Seminar on Drug Quality Assurance (English language), Copenhagen, 25 April — 16 May 1984

Course on Food Microbiology (French language), Lille, 2-12 May 1984

Course on Immunology o f Infectious Diseases (French language), Lausanne, 2-30 May 1984

Course in Drug Evaluation (English language), Oslo, 7-11 May 1984

Fifth International Training Course in Toxicology (English language), Belgrade, 8-30 May 1984 ( ICP/C E H 505)

Course on Microbiology o f Milk and Milk Products (French language), Lille, 14-26 May 1984

Training Course in Health Aspects o f Environmental Pollution (English language), Sofia, 14 May — 2 June 1984

International Postgraduate Training Course in Methods o f Family Plan­ning (English language), Debrecen, 21 May — 8 June 1984 (H U N / M C H 001)

International Course in Health Aspects o f Planning for Natural Dis­asters (English language), Ankara, 28 May 1984 ( IC P/C O R 003)

Course in Planning and Management o f Primary Health Care in De­veloping Countries (English language), Zagreb, 1 June — 31 July 1984

Seventeenth Ten-Day International Teaching Seminar on Cardiovas­cular Epidemiology and Prevention (English language), Netherlands, 3-14 June 1984

110

Second Teacher Training Course in Primary Health Care (English lan­guage), Kuopio/Tampere, 4-22 June 1984 ( IC P/PH C 034)

National Workshop on Family Planning and the Role o f the Paedia­trician (French language), Lisbon, 14-15 June 1984 ( IC P /M C H 502)

University o f Oslo International Summer School Course on Medical Care and Health Services in Norway (English language), Oslo, 23 June — 20 July 1984

International Workshop on the Managerial Process for National Health Development — Planning for Care o f the Elderly (English language), Leeds/Edinburgh, 27 June — 11 July 1984

First W H O International Course in Health Legislation (English lan­guage), Louvain, 2-13 July 1984 ( IC P /H LE 105)

B L A T / W H O Seventh Course on Modern Methodology for Teachers o f Health Sciences (English language), London, 3-20 July 1984 ( IC P / H M D 102)

Course in Environmental Health Impact Assessment (English language), Aberdeen, 8-21 July 1984 ( IC P /R U D 001)

B L A T / W H O Course for Librarians dealing with Audiovisual Materials (English language), London, 23 July — 3 August 1984

Perinatal Epidemiology Training Course (English language), Oxford,12-25 August 1984

Summer Seminar on Health Promotion (English language), Tulbinger Kogel, 16-25 August 1984 ( IC P/ IE H 005)

Training Course in Quality Control o f Vaccines (English language), Bilthoven, 27 August — 22 September 1984

Interregional Training Course and Study Tour on Nuclear Medicine (English/Russian language), Moscow, 1 September — 31 October 1984

W H O Postgraduate Course in the Pathogenesis o f Diabetes (English language), Gentofte, 2-7 September 1984

National Workshop on the Modular Approach applied to Family Plan­ning (English language), Ankara, 3-6 September 1984 ( IC P / M C H 502)

1 1 1

International Course on the Epidemiology and Control o f Tuberculosis (French language), Paris/Algeria, 5 September — 20 October 1984

Intercountry Workshop for Dental Epidemiologists on the Use o f Com­munity Periodontal Index o f Treatment Needs (C P IT N ) (English lan­guage), Novi Sad, 10-15 September 1984

Tenth International Course on Epidemiology (French language), Paris/ Rennes, 10 September — 21 December 1984

International Course in the Organization and Evaluation o f Primary Health Care (French language), Brussels, 11-28 September 1984 (1СР/ P H C 304)

Course on Immunology o f Infectious Diseases (English language), Lausanne, 11 September — 18 October 1984 ( IC P / C L R 199)

Course for Public Health Administrators (English language), Moscow,24 September 1984 — 21 June 1985 ( IC P / H M D 101)

Course for Public Health Administrators (Russian language), Moscow,24 September 1984 — 21 June 1985 ( IC P / H M D 101)

Course in Planning, Organization and Management o f Health Care Delivery (English language), Sofia, 25 September — 13 October 1984

International Course on Malariology (French language), Paris/Gre­noble/ Bordeaux/Bobo-Dioulasso, 1 October 1984 — 28 January 1985

International Sanitary Engineering Course (English language), Delft, 1 October 1984 — 30 September 1985 ( IC P /R U D 002)

First International Training Course in Quality Assurance o f Health Services (English language), Barcelona, 15-20 October 1984 (1СР/ HSR 003)

Course in Maintenance and Repair o f Medical Equipment (French lan­guage), Lyon, 15 October 1984 — 21 June 1985 ( IC P /C LR 199)

Course in Environmental Health Impact Assessment (English language), Athens, 29 October — 2 November 1984 (G R E /R U D 001)

Training Course on Nutrition in Primary Health Care (English lan­guage), Wageningen, 3 November — 14 December 1984

1 1 2

Workshop on Sampling Strategy for Drinking-water Distribution Net­works (French language), Rabat, 3-5 December 1984

Workshop on Managerial Process for National Health Development (M P N H D ) (English language), Moscow, 12-30 November 1984 (1СР/ M P N 004)

Workshop on Health Services Research Methodology (English lan­guage), Moscow/Alma-Ata, 19-30 November 1984 ( IC P /R P D 102)

Course in Environmental Health Impact Assessment (English language), Adana, 26 November — 5 December 1984 (T U R / R U D 001)

1 1 3

Annex 7

L IS T O F W H O C O L L A B O R A T IN G CENTRES C U R R E N T LY PA R T IC IP A T IN G IN TH E

R E G IO N A L O FF IC E PR O G R A M M E

Information Systems Programme

W H O Collaborating Centre for Medical Information

W H O Collaborating Centre for Medical Information and Data Processing

W H O Collaborating Centre for Health Information

External Coordination for Health and Social

W H O Collaborating Centre for Health Development and Technical Cooperation among Developing Countries

W H O Collaborating Centre for the Study o f Disasters and Emergency Situations

Health Situation and Trend Assessment

W H O Collaborating Centre for Classification o f Diseases

W H O Collaborating Centre for Classification o f Diseases

Centre interuniversitaire de Traitement de l’ information 2 des Universités de Paris (C IT I 2), France

Data Processing Centre (U D A C ) , University o f Uppsala, Sweden

Computer Centre o f theMinistry o f Health o f the Latvian SSR,Riga, USSR

Development

Centre for Health Cooperation with Non-Aligned and Developing Countries, Zagreb, Yugoslavia

Centre de Recherche sur l’Epidémiologie des Désastres, Université catholique de Louvain, Brussels, Belgium

Section “ Information sur la Santé publique” , Institut national de la Santé et de la Recherche médicale,Paris, France

Department o f Public Health Statistics, Semasko Ail-Union Scientific Research Institute o f Social Hygiene and Public Health Administration, Moscow, USSR

1 14

Health Planning and Evaluation

W H O Collaborating Centre for the Managerial Process for National Health Development

W H O Collaborating Centre for the Managerial Process for National Health Development

W HO Collaborating Centre forClassification o f Diseases

Office o f Population Censuses and Surveys, London, United Kingdom

Nuffield Centre for Health Services Studies, University o f Leeds,United Kingdom

Department o f Community Medicine, Usher Institute, Edinburgh,United Kingdom

Health Economics

W H O Collaborating Centre for Health Planning and Economics

Institut für Medizinische Informatik und Systemforschung (M E D IS ), Munich, Federal Republic o f Germany

Nursing

W H O Collaborating Centre for the Medium-Term Programme in Nursing/Midwifery in Europe

W H O Collaborating Centre for the Medium-Term Programme in Nursing/Midwifery in Europe

W H O Collaborating Centre for the Medium-Term Programme in Nursing/Midwifery in Europe

W H O Collaborating Centre for the Medium-Term Programme in Nursing/Midwifery in Europe

W H O Collaborating Centre for the Medium-Term Programme in Nursing/Midwifery in Europe

W H O Collaborating Centre for the Medium-Term Programme in Nursing/Midwifery in Europe

W H O Collaborating Centre for the Medium-Term Programme in Nursing/Midwifery in Europe

Hôpital Saint-Raphael, Université catholique de Louvain, Belgium

Danish Institute for Health and Nursing Research, Copenhagen, Denmark

Nursing Research Institute, Helsinki, Finland

Department o f Nursing, University o f Edinburgh, United Kingdom

Department o f Nursing, Royal Victoria Hospital, University o f Manchester, United Kingdom

Hospices civils de Lyon,France

Faculty o f Nursing, Medical Academy, Lublin, Poland

1 15

W H O Collaborating Centre for Primary Health Care

Primary Health Care

W H O Collaborating Centre for Primary Health Care

Health Manpower Development

W H O Collaborating Centre for Educational Technology in the Health Sciences

Department o f Public Health Administration and Social Hygiene, Institute for Research on Regional Pathology, Ministry o f Health o f the Kazakh SSR, A lm a-Ata, USSR

Andrija Stampar School o f Public Health, Zagreb, Yugoslavia

British L ife Assurance Trust (B L A T ), Centre for Health and Medical Education, London, United Kingdom

Public Education and Information for Health(ialso: Health Promotion; Lay, Community and Alternative Health Care; and Smoking)

W H O Collaborating Centre for Health Education and Health Prom otion Research

W H O Collaborating Centre for Health Education

W H O Collaborating Centre for Health Education

Scottish Health Education Group, Edinburgh, United Kingdom

Deutsches Hygienemuseum, Dresden, German Democratic Republic

Bundeszentrale für gesundheitliche Aufklärung, Cologne, Federal Republic o f Germany

Research Promotion and Development

W H O Collaborating Centre for Community Medicine

W H O Collaborating Centre for Public Health Research

Centre coopératif d ’Etudes et de Recherches “ De la Santé de la Famille à la Santé communautaire” , Nancy, France

Institut für Gesundheits-System- Forschung, Kiel, Federal Republic o f Germany

Nutrition

W H O Collaborating Centre for Nutrition

Institute o f Nutrition, Academy o f Medical Sciences o f the USSR, Kazakh Branch, A lm a-Ata, USSR

116

Oral Health

W HO Collaborating Centre forOral Disease Prevention

W H O Collaborating Centre for Fluoride Research

W H O Collaborating Centre for Oral Epidemiology

W H O Collaborating Centre for Research in Dental Epidemiology

W H O Collaborating Centre for the Development o f Oral Health Manpower

Accident Prevention

W H O Collaborating Centre for the Prevention o f Road Traffic Accidents

Maternal and Child Health

W H O Collaborating Centre for Perinatal Studies in Europe

Sexuality and Family Planning

W H O Collaborating Centre for Teaching and Research in Human Reproduction and Family Planning

W H O Collaborating Centre for Family Health

Sektion Stomatologie, Medizinische Akademie, Erfurt, German Democratic Republic

Department o f Oral B iology, School o f Dentistry, University o f Leeds, United Kingdom

Institute o f Medical Biological Sciences San Paulo, Faculty o f Medicine and Surgery, University o f Milan, Italy

M oscow Central Research Institute o f Stomatology, Ministry o f Health o f the USSR, Moscow, USSR

Medical Stomatological Institute, Moscow, USSR

Transport and Road Research Laboratory, Department o f the Environment and Department o f Transport, Crowthorne,United Kingdom

Institute o f Child Health, Aghia Sophia Children’s Hospital, Athens, Greece

Centre national de Reproduction humaine et de Planning familial, Rabat, M orocco

Centre international de l’Enfance, Château de Longchamp, Bois de Boulogne, Paris, France

1 1 7

Workers’ Health

W H O Collaborating Centre for Occupational Health

W H O Collaborating Centre for Occupational Health

W H O Collaborating Centre for Occupational Health

W H O Collaborating Centre for Occupational Health

W H O Collaborating Centre for Occupational Health

Health of the Elderly

W H O Collaborating Centre for Research on Aging

Psychosocial Factors and Mental Health

W H O Collaborating Centre for Psychosocial Factors and Health

W H O Collaborating Centre for Research and Training in Mental Health

W H O Collaborating Centre for Research and Training in Mental Health

W H O Collaborating Centre for Research and Training in Mental Health

Institute o f Hygiene and Occupational Health, Academy o f Medicine, Sofia, Bulgaria

National Institute o f Occupational Health, Helsinki, Finland

Institute o f Occupational Medicine, Lodz, Poland

Kiev Research Institute o f Labour Hygiene and Occupational Diseases, USSR

TU C Centenary Institute o f Occupational Health, London School o f Hygiene and Tropical Medicine, United Kingdom

Institute o f Gerontology o f the Academy o f Medical Sciences o f the USSR, Kiev, USSR

Centre interuniversitaire belge de Recherche et d ’Action, Ecole de Santé publique, Université libre de Bruxelles, Belgium

Psychiatric Hospital, Medical Faculty, University o f Aarhus, Denmark

Unité de Recherches sur l’Epidémiologie des Troubles mentaux, Institut national de la Santé et de la Recherche médicale, Paris, France

Zentralinstitut für Seelische Gesundheit, Mannheim, Federal Republic o f Germany

118

W H O Collaborating Centre for Research and Training in Mental Health

W H O Collaborating Centre for Research and Training in Mental Health

W HO Collaborating Centre forthe Study o f Psychotropic Drugs

Department o f Psychiatry, Eginition Hospital, Faculty o f Medicine, University o f Athens, Greece «

Department o f Social Psychiatry, Faculty o f Medicine, State University o f Groningen Academic Hospital, Netherlands

Scientific Institute o f Neurology, Psychiatry and Neurosurgery, Medical Academy o f Sofia, Bulgaria

International Drinking Water Supply and Sanitation Decade

W H O Collaborating Centre for Water Resources Protection

W H O Collaborating Centre for Drinking-W ater and Water Pollution Control

Research Centre for W ater Resources Development, Budapest, Hungary

W ater Research Centre, Medmenham, United Kingdom

Environmental Health in Rural and Urban Development and Housing

W H O Collaborating Centre for Rural Sanitation and Waste Disposal

Centre national du Machinisme agricole, du Génie rural, des Eaux et des Forêts (C E M A G R E F ),Paris, France

Control of Environmental Health Hazards

W H O Collaborating Centre for Environmental Health Effects

W H O Collaborating Centre for Surface- and Groundwater Quality

W H O Collaborating Centre for Environmental Radioactivity

W H O Collaborating Centre for Radiopathology

Department o f Environmental Hygiene and Department o f Toxicology, Karolinska Institute and National Institute o f Environmental Medicine, Stockholm, Sweden

Canada Centre fo r Inland Waters, Burlington, Canada

Radiation Protection Division, Department o f National Health and Welfare, Ottawa, Canada

Institut de Protection et de Sûreté nucléaire, Fontenay- aux-Roses, France

1 1 9

Chemical Safety Programme

W H O Collaborating Centre for Health Effects o f Exposure to Lead

W HO Collaborating Centre forEnvironmental Pollution Control

Environmental Protection Agency, Washington, DC, U SA

Medizinisches Institut für Umwelthygiene (M IU ) an der Universität Düsseldorf, Federal Republic o f Germany

Clinical, Laboratory and Radiological Technology

W H O Collaborating Centre for Studies on the Efficacy and Efficiency o f the Diagnostic Application o f Radiation and Radionuclides

W H O Collaborating Centre for Quality Evaluation in the Field o f Bacteriology

W H O Collaborating Centre for Research and Reference Services in Clinical Chemistry

W H O Collaborating Centre for Research and Reference Services in Clinical Chemistry

W H O Collaborating Centre for Research and Reference Services in Clinical Chemistry

W H O Collaborating Centre for Biosafety Research and Training

Institut für Strahlenhygiene des Bundesgesundheitsamtes, Neuherberg, Federal Republic o f Germany

Laboratoire de Bactériologie, Hôpital Saint-Raphael, Université de Louvain, Belgium

Department o f Clinical Chemistry, Bispebjerg Hospital, Copenhagen, Denmark

W olfson Research Laboratories, Department o f Clinical Chemistry, Queen Elizabeth Medical Centre, Birmingham, United Kingdom

Division o f Clinical Chemistry, Clinical Research Centre, Harrow, United Kingdom

Public Health Laboratory Service for Applied M icrobiology and Research, Porton Down, United Kingdom

Drug Policies and Management

W H O Collaborating Centre for Drug Information and Quality Assurance

W H O Collaborating Centre for Drug Statistics M ethodology

National Institute o f Pharmacy, Budapest, Hungary

Norwegian Medicinal Depot, Oslo, Norway

120

W H O Collaborating Centre forDrug Assessment

Malaria and other Parasitic Diseases

W H O Collaborating Centre for the Evaluation o f the Effect o f New Pesticides on Insects o f Tropical Origin

W H O Collaborating Centre fo r Immunodiagnostic and Serological Methods in Malaria

W H O Collaborating Centre for Applied M alacology

W H O /F A O /U N E P Collaborating Centre fo r Environmental Management for Vector Control with Special Reference to Health Aspects connnected with Water Resources Development

Expanded Programme on Immunization Zoonoses

F A O / W H O Collaborating Centre for Research and Training in Food Hygiene and Zoonoses

W H O Collaborating Centre for Reference and Research on Viral Hepatitis

W H O Collaborating Centre for Legionellosis

W H O Collaborating Centre for Legionellosis

W H O Collaborating Centre for Health and Disease Surveillance

Pharmacological Comittee o f the All-Union Ministry o f Health o f the USSR, Moscow, USSR

Laboratoire d ’Entomologie médicale de rO ffice de la Recherche scientifique et technique d ’Outre Mer (O R S TO M ), Paris, France

Laboratoire de Parasitologie et Pathologie exotique, Faculté de Médecine de Grenoble, France

Danish Bilharziasis Laboratory, Copenhagen, Denmark

Division o f Tropical and Communicable Diseases and the Ross Institute, London School o f Hygiene and Tropical Medicine, United Kingdom

Bacterial, Viral and Mycotic Diseases and

Institut für Veterinärmedizin (Robert-von-Ostertag-Institut),Berlin (W est)

Max-von-Pettenkofer-Institut für Hygiene und Medizinsche M ikrobiologie, Munich, Federal Republic o f Germany

Laboratoire national de la Santé, Lyon, France

National Bacteriological Laboratory, Stockholm, Sweden

Laboratory o f Epidem iology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy

1 2 1

W H O Collaborating Centre for the Acquired Immune Deficiency Syndrome (A ID S )

Cancer

W H O Collaborating Centre for Detection M ethodology and Training in Cancer Control

W H O Collaborating Centre for Technology Assessment in Cancer Control

Cardiovascular and Other Noncommunicable

W H O Collaborating Centre for Blood Research in Atherosclerosis and Ischaemic Heart Diseases

W HO Collaborating Centre forZoonoses

W H O Collaborating Centre for Research and Training in Cardiovascular Diseases

W H O Collaborating Centre for Research and Training in Prevention and Control o f Cardiovascular Diseases

W H O Collaborating Centre for Community Control Programmes in Cardiovascular Diseases

W H O Collaborating Centre for Research and Training in Cardiovascular Diseases

W H O Collaborating Centre for Research and Training in Cardiovascular Diseases

Central Research Institute o f Epidemiology o f the USSR Ministry o f Health, M oscow, USSR

Institut de Médecine et d ’Epidémiologie africaine et tropicale, Hôpital Claude Bernard, Paris, France

National Institute o f Oncology, Budapest, Hungary

Zentralinstitut für Krebsforschung, Robert-Rössle-Institut, Berlin-Buch, German Democratic Republic

Diseases

Lipid Laboratory, Division o f Cardiovascular Research, Institute o f Clinical and Experimental Medicine, Prague, Czechoslovakia

Laboratoire de Recherches cardiologiques, Faculté de Médecine et de Pharmacie, Université libre de Bruxelles, Belgium

Institute o f Cardiovascular Diseases o f the Medical Academy, Sofia, Bulgaria

National Public Health Institute, Helsinki, Finland

Abteilung Klinische Sozialmedizin, Klinikum der Universität Heidelberg, Federal Republic o f Germany

Hungarian Institute o f Cardiology, Ministry o f Health, Budapest, Hungary

122

W H O Collaborating Centre for Research and Training in Cardiovascular Diseases

W H O Collaborating Centre for the Prevention and Control o f Cardiovascular and Other Noncommunicable Diseases

W H O Collaborating Centre for the Prevention and Control o f Cardiovascular and Other Noncommunicable Diseases

W H O Collaborating Centre for Development o f Appropriate Technology in the Control o f Diabetes Mellitus

Health Literature Services

W H O Collaborating Centre for Health and Biomedical Documentation

Department o f Medicine, Ostra Hospital, Gothenburg, Sweden

Kaunas Medical Institute, Kaunas, USSR

Cardiology Research Institute, Ministry o f Health o f the Byelorussian SSR, Minsk, USSR

Institute fo r Diabetes, Endocrinology and Metabolic Diseases “ Vuk Vrhovac” , Medical Faculty, University o f Zagreb, Yugoslavia

Institut für Wissenschaftsinformation in der Medizin, Berlin, German Democratic Republic

123

Annex 8

TABLE SHOWING THE RELATIONSHIP BETWEEN THE REGIONAL HFA TARGETS AND PROGRAMMES"

Target number and text

1. By the year 2000, the actual differences in health status between countries and between groups within countries should be reduced by at least 25%, by improving the level o f health o f disadvantaged nations and groups.

2. By the year 2000, people should have the basic opportunity to develop and use their health potential to live socially and economically fulfilling lives.

3. By the year 2000, disabled persons should have the physical, social and economic opportunities that allow at least fo r a socially and economically fulfilling and mentally creative life.

4. By the year 2000, the average number o f years that people live free from major diseases and disability should be increased by at least 10%.

5. By the year 2000, there should be no indigenous measles, poliomyelitis, neonatal tetanus, congenital rubella, diphtheria, congenital syphilis or indigenous malaria in the Region.

Programmenumber

3.9.X

3.8.X

3.9.4

3.9.1(b)

3.12.5

3.12.5

3.8.2

4.13.2/5

4.13.13

Programme title

Social Equity and Health

Health Promotion

Health o f the Elderly

Sexuality and Family Planning

Disability Prevention and Rehabilitation

Disability Prevention andRehabilitation

Oral Health

Malaria and other Parasitic Diseases

Expanded Programme on Immunization and Bacterial, Viral and Mycotic Diseases and Zoonoses

a Generally, the European classified list o f programmes for the Seventh General Programme o f W o rk is the same as that used at g lobal level. H ow eve r , the European programmes 3.8.X and 3.9.X are, in the global classification, contained in program me 2.3.3 — Health Systems Research.

124

6 . By the year 2000, life expectancy at birth in the Region should be at least 75 years.

7. By the year 2000, infant mortality in the Region should be less than 20 per 1000 live births.

8 . By the year 2000, maternal mortality in the Region should be less than 15 per 100000 live births.

9. By the year 2000, mortality in the 4.13.16/17(a) Region from diseases o f thecirculatory system in people under 65 should be reduced by at least 15%.

10. By the year 2000, mortality in the 4.13.15 Region from cancer in peopleunder 65 should be reduced by at least 15%.

11. By the year 2000, deaths from accidents in the Region should be reduced by at least 25% through an intensified effort to reduce traffic, home and occupational accidents.

12. By the year 2000, the current rising 3.10.1 trends in suicides or attempted suicides in the Region should be reversed.

13. By 1990, national policies in 3.8.X all Member States should ensure 1 2.4 that legislative, administrative and economic mechanisms provide broad intersectoral support and resources fo r the promotion o f healthy lifestyles and ensure effective participation o f the people at all levels o f such policy-making.

Target number and text

3.8.3

3.9.3

3.9.1(a)

3.9.1(a)

Programmenumber

no programme

Programme title

Maternal and Child Health

Maternal and Child Health

Cardiovascular and Other Noncommunicable Diseases

Cancer

Accident Prevention

W orkers’ Health

Psychosocial Factors and Mental Health

Health promotion

External Coordination for Health and Social Development

125

14. By 1990, all Member States should have specific programmes which enhance the major roles o f the family and other primary social groups in developing and supporting healthy lifestyles.

15. By 1990, educational programmes in all Member States should enhance the knowledge, motivation and skills o f people to acquire and maintain health.

16. By 1995, in all Member States there should be significant increases in positive health behaviour such as balanced nutrition, non-smoking, appropriate physical activity,and good stress management.

17. By 1995, in all Member States there should be significant decreases in health-damaging behaviour such as overuse o f alcohol and pharmaceutical products; useo f illicit drugs; and dangerous chemical substances, dangerous driving and violent social behaviour.

Target number and text

3.8.X

2.4.0(a)

Programmenumber

3.10.1

2 .6.0

5.14.0(b)

3.8.X

3.8.1

3.10.1

4.13.16/17(b)

3.8.X

3.8.3

3.10.1

3.10.2(a)

3.10.2(b)

3.11.3(b)

3.12.2/3

18. By 1990, Member States should 3.11.0have multisectoral policies that effectively protect the human j 2 4environment from health hazards, ensure community awareness and involvement, and effectively support international efforts to curb such hazards affecting more than one country.

Health Promotion

Lay, Community and Alternative Health Care (nonprofessional care)

Psychosocial Factors and Mental Health

Public Education and Information for Health

Publications

Health Promotion

Nutrition and Food Safety

Psychosocial Factors and Mental Health

Smoking

Health Promotion

Accident Prevention

Psychosocial Factors and Mental Health

Prevention o f A lcohol Abuse

Abuse o f Psychoactive Drugs

Chemical Safety Programme

Drug Policies and Management

Promotion o f Environmental Health

External Coordination for Health and Social Development

Programme title

126

19. By 1990, all Member States should 3.8.1have adequate machinery for the 3 .11.2monitoring, assessment and control o f environmental hazards which pose a threat to human health, including potentially toxic ̂ j j y .chemicals, radiation, harmful consumer goods and biological agents. 3.11.3(b)

3.12.2/3

- , , , ProgrammeTarget number and text number

20. By 1990, all people o f the 3.11.1 Region should have adequatesupplies o f safe drinking-water,and by the year 1995 pollution 3.11.3(a)o f rivers, lakes and seas shouldno longer pose a threat tohuman health.

21. By 1995, all people o f the Region 3.11.3(a) should be effectively protectedagainst recognized health risks from air pollution.

22. By 1990, all Member States 3.8.1 should have significantly reducedhealth risks from food contamination and implemented measures to protect consumers from harmful additives.

23. By 1995, all Member States 3.11.3(a) should have eliminated majorknown health risks associated with 3 1 1.3(b)the disposal o f hazardouswastes.

24. By the year 2000, all people o f 3.11.2 the Region should have abetter opportunity o f living in houses and settlements which provide a healthy and safe environment.

Nutrition and Food Safety

Environmental Health in Rural and Urban Development and Housing

Control o f Environmental Health Hazards

Chemical Safety Programme

Drug Policies and Management

International Drinking Water Supply and Sanitation Decade

Control o f Environmental Hazards

Programme title

Control o f Environmental Hazards

Nutrition and Food Safety

Control o f Environmental Hazards

Chemical Safety Programme

Environmental Health in Rural and Urban Development and Housing

127

25. By 1995, people o f the Region 3.9.3 should be effectively protectedagainst work-related health risks.

26. By 1990, all Member States, 2.4.0(b) through effective community 2 .4 .0(c ) representation, should havedeveloped health care systems that are based on primary health care, and supported by secondary and tertiary care as outlined at the A lm a-Ata Conference.

27. By 1990, in all Member 2.4.0(b) States, the infrastructures o f 2.3.2(a) the delivery systems shouldbe organized so that 2 3 2(b )resources are distributedaccording to need, and thatservices ensure physicaland economic accessibilityand cultural acceptabilityto the population.

28. By 1990, the primary health 2.4.0(b) care system o f all Member 2 3.3(b) States should provide a wide 3 8 2 range o f health-promotive,curative, rehabilitative and 3.9.1(b)supportive services to meet thebasic health needs o f 3.9.Xthe population and givespecial attention to high-risk,vulnerable and underservedindividuals and groups.

29. By 1990, in all Member 2.4.0(a) States, primary health caresystems should be based on 2 4 0(b )cooperation and teamwork between ^ 3 3 ^ 4 health care personnel, 'individuals, families and community groups.

-, , , ProgrammeTarget number and text number

W orkers’ Health

Programme title

Primary Health Care

Hospitals and Other Health Institutions

Primary Health Care Health Planning and Evaluation

Health Economics

Primary Health Care

Nursing

Oral Health

Sexuality and Family Planning

Social Equity and Health

Lay, Community and Alternative Health Care

Primary Health Care

Nursing

1 2 8

30. By 1990, all Member States 2.4.0(b) should have mechanisms by 2 .3 .3(b ) which the services providedby all sectors relating to health care are coordinated at the community level in a primary health care system.

31. By 1990, all Member 2.3.3(a) States should have builteffective mechanisms fo r ensuring quality o f patient care within their health care systems.

32. Before 1990, all Member 3.7.0 States should have formulated aresearch strategy to stimulate investigations which improve the application and expansion o f knowledge needed to support their national health fo r all movements.

33. Before 1990, all Member 2.3.2(a) States should ensure that theirhealth policies and strategies 2 3 4are in line with health forall principles and that nationallegislation and regulationsmake their implementationeffective in all sectorso f society.

34. Before 1990, Member 2.3.2(a) States should have a managerialprocess for health development 2 3 2(b )geared to the attainment o fhealth for all, actively involvingcommunities and all sectorsrelevant to health and,accordingly, ensuring preferentialallocation o f resources tohealth development priorities.

^ , ProgrammeTarget number and text number

Primary Health Care

Nursing

Programme title

M odel Health Care and Quality Assurance

Research Promotion and Development

Health Planning and Evaluation

Health Legislation

Health Planning and Evaluation

Health Economics

129

_ , , ProgrammeTarget number and text number

35. Before 1990, Member 1(b) States should have healthinformation systems capable o f 2 3.1supporting their national strategiesfor health for all. « , лz.o.U

5.14.0(a)

5.14.0(b)

36. Before 1990, in all Member 2.5.0 States the planning, trainingand use o f health personnel 2 3 3(b )should be in accordance with health for all policies, with emphasis on the primary health care approach. 3.8.2

3.12.2/3

37. Before 1990, in all Member 2.5.0 States, education should providepersonnel in sectors related to 2 3 3(b )health with adequate informationon national health for allpolicies and programmes and theirpractical application in theirown sectors.

38. Before 1990, all Member States 3.12.1 should have established a formalmechanism for the systematic 3 12 2 /3assessment o f the appropriate useo f health technologies and o f theireffectiveness, efficiency, safetyand acceptability, as well asreflecting national health policyand economic restraints.

Information Systems Programme

Health Situation and Trend Assessment

Public Education and Information for Health

Health Literature Services

Publications

Health ManpowerDevelopment

Nursing

Drug Policies and Management

Oral Health

Health Manpower Development

Nursing

Programme title

Clinical, Laboratory and Radiological Technology

Drug Policies and Management

130

INDEX

Main references by subject are in bold type.

Accident prevention. 4, 42- 44 , 60

Acid rainfall, 63

Acquired immune deficiency syndrome (A I D S ) . 68. 79

Administration and services, general, 90Adv isory Committee on Medical Research,

global. 38

Adv isory group on management o f the Regional Office, 4

Afr ican Region, 2, 90

Ag ing , U N W or ld Assembly on ( 1982), 35, 50 see also Elderly, health o f

A ir pollution. 63-65

Albania, basic radio logical system, 69 f luoridation project, 41 insulin pump study, 68 maternal and child health, 48 medium-term plan. 4 oral health, 41 programme planning, 4

A lcoho l abuse, prevention o f, 4 , 54 -5 5Algeria , health o f the elderly, 51

malaria control, 78 Regional Committee for Europe. 3 rural water supply and sanitation, 59 transfer to African Region, 2, 90 waste management, 59

Alternative care, see Lay, community and alternative care

Am bient a ir po llu tion — health effects and management, 76

A M D E . see Association o f Medical Deans in Europe

A M EE. see Association for Medical Education in Europe

Americas, Region o f the, 71

Analytical quality control. 63

Arbeitsgemeinschaft freier Sti llgruppen, 39

A S P H E R , .see Association o f Schools o f Public Health o f the European Region

Association for Dental Education in Europe, 41

Association o f Medical Deans in Europe. 25, 26

Association for Medical Education in Europe, 25, 26. 27

Association o f Schools o f Public Health o f the European Region, 25, 26, 28

Audiovisual materials, 27

Austria, accident prevention, 43

aging, 50

air pollution, 63

health legislation, 19

health promotion , 33

primary health care, 20

school health, 85

toxoplasmosis, 80

A vailahility and u tilization o f self-learning materials in continuing education. 34

Bacterial diseases, 79-80

Basic radiological system. 67, 69

Belgium, acute poisoning services, 66

cardiac rehabilitation, 84

Catholic University o f Louvain . 22

131

Belgium (contd )environmental health, 60 eye health care, 72 family planning, 47 health economics, 68 health legislation, 20 health technologies, 68 hypertension control, 82 mental health, 54 nursing, 19primary health care, 23 sodium intake and excretion. 81 Université libre de Bruxelles. 54

Berlin (W est) , 63, 65

Bilharziasis, see Schistosomiasis

B io log ica l effects o f man-made m inera l fibres, 75, 89

Biotechnology, 65

B L A T , see United K ingdom , British Life Assurance Trust

Breastfeeding, 39

Budget and finance, 91

Bulgaria, cooperative health programme, 4 family planning, 48 malaria control, 78 mass screening, 4 mental health, 54 noncommunicable diseases, 83

Canada. 20, 48, 65

Cancer, 39. 80-81Cardiovascular diseases, project for monitoring

trends in ( M O N I C A ) . 81, 82

Cardiovascular and other noncommunicable diseases. 4, 39, 81 -8 4

Caries, dental, see Oral health

CE C , see Commission o f the European Communities

Changing patterns in suicide behaviour, 36

Chemical safety, 4, 9, 65-67

Child health, see Maternal and child health

C hild m enta l health and psychosocial development, 75

China, People's Republic of, 45

Chlamydia, 80

Chronic diseases, 33

Ciba Foundation, 68

C M E A , see Council for Mutual Economic Assistance

Collaborat ing centre, acquired immune deficiency syndrome, 79

cardiovascular diseases, 81

environmental radioactivity, 65 health education, 22 health literature services. 88 primary health care, 24

Collaboration with the United Nations system. 8-9Commission o f the European Communities

(C E C ) . I. 7. 63 cooperative arrangements with, 67 drug abuse. 56 environment, 44 mental health, 54 perinatology, 46 poison control, 66 research, 64 tox icology, 66

Com m on framework and format, 3, 5

Community care, see Lay. community and alternative care

Computer-assisted planning. 51

Concept and princip les o f health prom otion , lb

Conference on Primary Health Care in Industrialized Countries ( 1983). 13, 22

Consultative G roup on Budgetary Questions, 2, 90

Consultative G roup on Programme Deve lopment, 2, 3, 14

Continuing education, 27-28

Contributions, voluntary, 91

Convention for Protection o! the Mediterranean Sea against Pollution, 9, 62

Council for Mutual Economic Assistance (C M E A ) , 7, 81

Council o f Europe, 1,6, 1 5 ,28 ,41 ,56 ,62

Country programmes, 4

Czechoslovakia, acute poisoning services. 66 cardiovascular diseases. 83 immunization, 79

Data Processing Centre ( U D A C ) . 5

D em ograph ic trends in the European Region. 34. 89

Denmark, appropriate technology for health, 46, 69

clinical sexology, 48 Danish Bilharziasis Laboratory. 78 Danish Institute for Health and Nursing

Research. 19 Danish Medical Technology Organizat ion. 69

132

Denmark (contd )Danish Society o f Obstetrics and

G ynaeco logy , 69 drug abuse, 56 eye health care, 73 Institute o f Social Medicine, 68 International Code o f M arket ing o f

Breast-milk Substitutes, 39 International Federation o f Medical

Students Associations, 27 mental health, 54 perinatal care, 46 self-care, 45Statens Seruminstitut, Copenhagen, 68

Dental care, see Oral health

Diagnosis-related group financing, 68

Diagnostic , therapeutic and rehabilitat ive technology, 67-73

Dictionary o f public health, 55Diet and cancer study, European, 81

Digest o f health statistics in Europe, 14

D irector-Genera l ’s Deve lopment Program m e, 90

Disabil ity prevention and rehabil itation, 72, 73Disasters, see Health aspects o f disaster

preparedness

Drug abuse, see Psychoactive drugs, abuse o f

Drug bulletins review, 36, 71Drug decisions, summary basis o f, 71

Drug information, 71

Drug regulation index, 1 1

Drug utilization, see Pharmaceuticals and drug utilization

Drug utilization bibliography, 70Drug Util ization Research G roup , 70

Drugs in pregnancy and delivery, 76

E A C M R , see European Adv iso ry Committee on Medica l Research

ECE, see United Nations Econom ic Commission fo r Europe

Education in primary health care, 89EEC, see European Economic Community

Effects o f drug regulation, 75Effects o f the indoor housing climate on the health

o f the elderly. 75Effects o f nuclear war on health and health

services, 89

Effluents, 62Elderly in eleven countries: a sociomedical

survey. 35, 51Elderly, health of, 6, 39. 50-51

Entre nous. 35, 47Environmental hazards, 10, 61-65

Environmental health, 56-67

Environmental protection: standards, compliance and costs. 66

Epidem iology , 15, 46, 49European Adv isory Committee on Medical

Research ( E A C M R ) , 3, 37, 38, 53European Association for Programmes in Health

Services Studies, 19, 25, 38European Centre for Social W el fare Tra in ing and

Research, 7

European Community, oral health, 41European Conference on Planning and

Management for Health, 13, 16, 33European Conference on Primary Prevention ol

Coronary Heart Disease, 77, 81European Congress o f Card io logy , Ninth, 83

European Economic Community (E E C ) , health literature services, 87

perinatal ep idem iology , 46 Standing Committee o f Doctors, 25 see also Commission o f the European

Communities (C E C )

European Federation for Medical Informatics. 5

European Federation o f Professional Psychologists Associations, 53

European Health Care Related Hypertension Research Ac t ion P rogram m e ( H Y R A P ) , 81, 82

European Health Policy Forum, 20, 68European Ministerial Conference on

the Environment, Fourth, 62European Organization for Caries Research, 41

European Society o f Card io logy , 83European Society fo r Medical Socio logy, 52

European Society o f Pulmonary Pathophysiology, 83

European Space Agency, 87Executive Board, 28External coordination fo r health and social

development, 6-10Eye health care, 72-73

133

Family planning and sex education o f young people, 74, 89

Family planning, see Sexuality and family planning

FAO, see Food and Agriculture Organization of the United Nations

Fellowships, 28-31

Finance, see Budget and finance

Finland, dental school, Helsinki, 40disability prevention and rehabilitation, 72general practice, 23health of the elderly, 51health promotion, 22, 83health services research, 38hypertension, 84insulin pump study, 68model health care, 18National Public Health Institute, 83, 84noncommunicable diseases, 83nursing, 18, 19primary health care, 23, 27scenarios for HFA, 13, 16school health, 85sexuality and family planning, 47

First-contact mental health care, 74, 89

Fluoridation, 41

Food and Agriculture Organization of the United Nations (FAO), 9, 61

Food inspection, 75

Food safety, see Nutrition and food safety

France, appropriate technology for health, 69 Association française de Droit de la Santé, 21 Centre national du Machinisme agricole, du

Génie rural, des Eaux et des Forêts, 57 Comité consultatif national d’ Ethique pour les

Sciences de la Vie et de la Santé. 21 family planning, 47 fellowships, 28 health economics, 18 health legislation, 21 Hospices civils de Lyon, 21 infant nutrition, 39Institut international supérieur de Formation

des Cadres de Santé, 21 Institut de Médecine et d’Epidémiologie

tropicales, 79 Institut national de la Santé et de la Recherche

médicale, 69 Institut Pasteur, 61, 79 insulin pump study, 68

France (contd)medical ethics, 21sexuality and family planning, 48smoking control, 85streptococcal and staphylococcal infections, 80

Funds-in-Trust, 91

General practice, 23General Programme of Work, Seventh, 22, 24 German Democratic Republic, Dental

Association, 42 Deutsches Institut für Medizinische

Dokumentation und Information, 87 epidemiology, 15 health literature services, 88 Institut für Wissenschaftsinformation in der

Medizin, 88 insulin pump study, 68 medium-term plan, 4 programme planning, 4

Germany, Federal Republic of, applied psychology, 53

appropriate technology for health, 68, 69 cardiovascular diseases, 82 drug control, 70, 72 environmental health, 64, 65, 66 family planning, 47 health promotion, 52 hospital financing systems, 17 infant nutrition, 39Institut für Medizinische Informatik und

Systemforschung, 52 Institute of Health Systems Research, 17 nursing, 19social equity and health, 52 system science in health care, 51 workers’ health, 50 World Health Day ceremony in, 32

Global Environmental Monitoring System (GEMS), 9, 62, 63

Graduate medical education in the European Region, 26

Greece, adverse drug reactions, 71 alcoholism, 55Centre of Planning and Economic Research, 51drug dependence, 56environmental health, 60, 61, 62health of the elderly, 51malaria control, 78medium-term plan, 4mental health, 54oral health, 42

134

Greece (contd) perinatal care, 46 primary health care, 22, 24 rural water supply, 59 sexuality and family planning, 47 smoking control, 85 social inequities, 52 undergraduate training, 28

Hazardous waste — a public health problem and how to handle it, lis

Health aspects o f chemical safety, 65

Health aspects o f chemical safety — Interim documents, 67

Health aspects of disaster preparedness, 9 -1 0Health budgeting, financing and payment

systems, comparative study on, 17

Health crisis 2000, 89

Health documentation, see Health literature services

Health economics, 16- 18, 68

Health education, 4, 33, 90 see also Health promotion

Health impact o f biotechnology, 75

Health legislation, 13, 19, 20- 21 , 24

Health literature services, 87 -8 8

Health management, 26

Health manpower, 25-32

Health planning and evaluation, 15- 16 , 24

Health planning and management — requirements f o r HFA2000 development, 34

Health promotion, 4, 24, 33, 44-45, 52, 83. 85

Health services research, 38

Health situation and trend assessment, 14-15

Health system development, 14-21Hospital financing systems, 17

Hospitals and other health institutions, 24-25

Housing hygiene in Mediterranean countries, 75

Housing, 60

Hungary, appropriate technology for health, 69 computer-based text and data exchange, 5 drinking-water, 58 family planning, 48 insulin pump study, 68 medium-term plan, 4 mortality differentials, 15 National Institute o f Cardiology, 84

Hungary (contd)noncommunicable diseases, 81, 83, 84 oral health, 42 school health, 85

Hypertension, 81, 82, 84

IARC, see International Agency for Research on Cancer

Iceland, accident prevention, 43, 44 basic radiological system, 69 health of the elderly, 51 noncommunicable diseases, 83 Nordic Medico-Statistical Committee, 44 oral health, 42

IEA, see International Epidemiological Association

ILO, see International Labour Organisation

Immunization, Expanded Programme on, 79-80Indonesia, 26, 71

Indoor air quality, 64

Infectious diseases in Europe — a fresh look, 86, 89

Informatics, 5

Information exchange and collaboration in health-related activities in Europe, 11

Information and health — policy, pressures and the public, 34

Information, public, see Public education and information for health

Information systems, 4- 5 , 15, 38

Insecticides, 78

Insulin pump study, 67, 68

Interagency research coordination, 38

International Agency for Research on Cancer ( IARC), 21,50, 81

International Association for Cataract-related Research, 73

International Association of Circumpolar Health, 22

International Association for Dental Research, 41

International Children’s Centre (ICC), 7, 47

International Code o f Marketing of Breast-milk Substitutes, 39

International Conference on System Science in Health Care, Third, 21,51

International Conference on Women and Health (1983), 22

International Council on Alcohol and Addictions ( ICAA ), 55, 56

135

International Council on Social Welfare, 8

International Dental Federation, 41

International digest o f health legislation, 20

International Drinking Water Supply and Sanitation Decade, 4, 9, 37, 56-60

International Drinking Water Supply and Sanitation Decade in Europe, 75

International Epidemiological Association (IEA), 15

International Federation of Medical Students Associations, 27

International Federation of the Periodical Press, 33

International Institute for Applied Systems Analysis (IIASA), 63

International Labour Organisation (ILO), 9,66,67

International League of Red Cross Societies, 56

International Medical Informatics Association, 5

International Planned Parenthood Federation, 47

International Programme on Chemical Safety (IPCS), 66, 67see also United Nations Environment

Programme (UNEP)

International Radiation Protection Association, 65

International Rehabilitation and Research Centre for Torture Victims, 7

International Water Supply Association, 56

International Year of Disabled Persons ( 1981 ), 72

International Year of Peace, 8

International Youth Year, see Youth (feature article)

Intersector policy and planning, 18

Iraq, 78

Ireland, biotechnology, 65Dental School of Trinity College, Dublin, 41 health promotion, 33 infant nutrition, 39 oral health, 41

Israel, 3

Italy, appropriate technology for health, 69 cardiovascular diseases, 81, 82 disaster preparedness, 10 drug abuse, 56 eye health care, 73 indoor air quality, 64 leishmaniasis, 78

Italy (contd)malariology, 78 medical specialization, 26 mental health, 53 sexuality, 48 smoking control, 85

Joint European Medical Research Board, 50

Kaposi’s sarcoma, see Acquired immune deficiency syndrome (AIDS)

Kellogg International Scholarship Program, 54

L 'amélioration des programmes de planification familiale, 89

La technologie appropriée au traitement des eaux usées dans les petites localités rurales, 89

Language training programme, in-house, 5

Lay, community and alternative care, 21-22Législation sanitaire : programmes et moyens de

form ation en Europe, 89

Leishmaniasis, 78

Leprosy, 80

Lifestyles conducive to health, 45

Lithuanian SSR, 83

Luxembourg, 66

Malaria and other parasitic diseases, 78-79

Malta, computer-based text and data exchange, 5 environmental health, 64 health information system, 15 medium-term plan, 4 noncommunicable diseases, 83, 84 video facilities, 90 water supply and sanitation, 59

Management. 3-4

Management and planning o f health services, 34

Management and structure o f health policy research, 75

Management and teamwork courses, 6

Managerial processes for national health development (MPNHD), 16, 26

Man-made mineral fibres (MMMF), 50

Maternal and child health, 38, 45- 47 . 48

Medical associations, national, 25

Mediterranean Action Plan, 61, 62

136

Meningitis, 80

Mental health, 6, 38, 52-56

Methylmercury, 40, 61

Mexico City Declaration on Population and Development, 8

Migrants, family planning services for, 47

Model health care and quality assurance, 18

Morocco, accident prevention, 43, 44 basic radiological system, 69 Code marocain de la Santé, 21 disability prevention, 73 drinking-water, 59 eye health care, 73 family planning, 48 food hygiene, 39 health information system, 15 health learning materials, 32 health literature services, 88 health planning, 16 malaria control, 78, 79 medium-term plan, 4 migrant workers, 52 oral health, 42 perinatal care. 46 primary health care, 16 programme budgeting, 17 research coordination, 38 scenarios for HFA, 16 schistosomiasis, 78, 79 smoking control, 85 water supply and sanitation, 59

Mycoplasma, 80

Mycotic diseases, 79-80

Myocardial infarction, 83

Netherlands, air quality guidelines, 64 drug policies, 72European Conference on Planning and

Management for Health, 16 health promotion, 33 infant nutrition, 39National Institute for Quality Assurance in

Hospitals, 18 nursing, 19scenarios for HFA, 13, 16 University of Groningen, 72

NOMESKO, see Nordic Medico-Statistical Committee

Mediterranean zoonoses control programme, 9 Noncommunicable diseases, see Cardiovascular and other noncommunicable diseases

Nonionizing radiation, see Radiation

Nordic Association of Clinical Sexology, 48

Nordic Medico-Statistical Committee (NOMESKO), 44

Norway, appropriate technology for health, 69 computer-based text and data exchange, 5 drug abuse, 55, 56 drug regulation, 71 health of the elderly, 51 insulin pump study. 68 nursing, 19 perinatal care, 46 school health, 85

Nuclear power: accidental releases — principles o f public health action, 74, 89

Nursing, 14, 18-20

Nutrition and food safety, 38, 39 -4 0

Obesity, see Nutrition and food safety

Occupational health, see Workers' health

OECD, see Organisation for Economic Co-operation and Development

Ophthalmology, see Eye health care

Oral health, 40-42Ural health services in Europe, 41

Organisation for Economic Co-operation and Development (OECD), 7, 43

Organization of health systems based on primary health care, 21-25

Osteoporosis, 39

Outfalls, coastal, 62

Periodontal diseases, see Oral health

Personnel, 90Pesticide residue analysis, 75

Pharmaceuticals and drug utilization, 69-72

Pharmacology, clinical, 70

Poisoning, see Chemical safety

Poland, acute poisoning services, 66 cancer control, 81computer-based text and data exchange, 5 environmental health, 60 eye health care, 73genetic counselling and prenatal diagnosis, 48 scenarios for HFA, 16 smoking, 85

137

Pollution monitoring, 61

Portugal, accident prevention, 44 acute poisoning services, 66 air pollution, 61 alcohol-related problems, 55 appropriate technology for health, 69 computer-based text and data exchange, 5 eye health care, 73 family planning, 48, 49 food safety, 40 general practice, 23 health manpower, 32 health planning, 16 housing hygiene, 60 laboratory technology, 69 medium-term plan, 4 mental health, 54 nursing, 20 oral health, 42Portuguese Paediatric Association, 49 primary health care. 23, 24 programme planning, 4 smoking control, 85 water quality and pollution control, 59

Pregnancy, see Maternal and child health

Preventing alcohol-related problems amongst young people, 16

Prévention routière internationale, 44

Primary health care, 20, 22-24, 27

Primary health care in undergraduate medical education. 34

Programme budget, 2, 4

Programme budgeting, draft guiding principlesfor, 17

Programme management and development, 1-21

Programme support, 87-92

Pseudo-croup, 63

Psychoactive drugs, abuse of, 55-56

Psychology, applied, 53

Psychosocial factors, 52-54see also Mental health

Public education and information for health, 32-33

Publications, 4, 87, 88-90

Publications Advisory Group, 88

Pulmonary hypertension, 83

Quality assurance, see Model health care and quality assurance

Radiation. 65

Rand Corporation, 68

Real Estate Fund. 9 1

Regional Committee for Europe, 1-3, 23, 32,45, 56

Regional Health Development Advisory Council (RHDAC), 3, 14

Regional Office for Africa, 2, 59, 90

Regional Office for the Americas, 45

Rehabilitation, 4

Report on the World Health Situation, Seventh, 3

Research promotion and development, 37-38Role o f W HO participating centres in continuing

education, specialty training and educational research, 34

Romania, chemical safety, 9 educational methodology, 32 hypertension, 84Institute of Medicine and Pharmacy,

Bucharest, 32 Institute of Tuberculosis, Bucharest, 80 ophthalmology, 73

Safety, see Accident prevention

Scenarios for HFA, 13, 16

Schistosomiasis, 78

School health, 46, 85

Schoolchildren, health behaviour of, 85

Self-help and health in Europe. 14, 22

Self-medication, 70

Sewage sludge, see Solid and hazardous waste

Sex and fam ily planning — how ne leach the young, 74, 89

Sexuality and family planning, 47-49

Smoking, 4, 84 -8 9Social and behavioural aspects o f comprehensive eye

care. 86

Social equity and health, 51-52Sodium intake and excretion, 81

Southern European Committee on Health Promotion and Smoking Control, 85

Spain, accidents, 43adverse drug reactions, 71 appropriate technology for health, 69 cardiovascular disease, 82

138

Spain (contd) drug abuse, 56 family planning, 49 general practice, 23 health legislation, 19, 21, 24 health planning, 16, 24 insulin pump study, 68 leishmaniasis, 78 medium-term plan, 4 mental health, 54 oral health, 42 primary health care, 20 school health, 85 school of public health, 32 smoking control, 85 toxic oil syndrome, 40

Special Account for Servicing Costs, 91

Specialization, medical, 26

Specific population groups, protection and promotion of the health of, 45-52

Staff development and training, 5-6

Standardization in measurement o f impairment, disability and handicap as consequence o f disease, 34

Staphylococcal infections, 80

Statistical methods, training courses in, 15

Statistical survey o f water and sanitation services — 1983, 56, 76

Streptococcal infections, 80

Studies in epidemiology, 75

Studies on health care o f the elderly, 75

Sudden infant death syndrome, 63

Support services, see Programme support

Sweden, acute poisoning services, 66 cancer, 80computer-based text and data exchange, 5eye health care, 73general practice, 23hypertension, 84indoor air quality, 64International Hospital Exhibition, Malmö, 41 model health care, 18 Nordic School of Public Health, 39 osteoporosis, 39 scenarios for HFA, 13, 16 University of Umeâ, 60

Switzerland, air pollution, 63Conference of European Statisticians, 63 hypertension management audit, 82

Switzerland (contd)management of cancer pain, 81 mental health, 54 prevention of alcohol abuse, 55 school health, 85 water problems in Europe, 63

Syria, 78

Technology, medical, 67-69Thermal Insulation Manufacturers

Association, 50

Toxic oil syndrome, 40

Toxic o il syndrome — mass food poisoning in Spain, 74. 89

Toxicology, training programme in, 66

Toxoplasmosis, 80

Training, professional, 28

Tuberculosis, 80

Tunisia, coastal water quality, 61

Turkey, accidents, 43environmental health, 9, 61family planning, 47, 49Hacettepe School of Nursing, 49health promotion, 24infant mortality, 24, 47leprosy, 80malaria control, 79medium-term plan, 4pesticides, 65programme budgeting, 17rural water supply and sanitation, 59smoking control. 85

Ultrasound, 45-46

UNDP, see United Nations Development Programme

UNEP, see United Nations Environment Programme

UNESCO, see United Nations Educational, Scientific and Cultural Organization

UNFPA, see United Nations Fund for Population Activities

UNICEF, see United Nations Children's Fund

UNIDO, see United Nations Industrial Development Organization

Union of Soviet Socialist Republics, Central Institute for Advanced Medical Studies, Moscow, 16, 26

drug trials, 72

139

Union of Soviet Socialist Republics (contd) health of the elderly, 50 health services research, 38 hypertension control, 82 medium-term plan, 4 noncommunicable diseases, 84 perinatal care, 46 primary health care, 24Research Institute of Experimental and Clinical

Therapy, Tbilisi, 51 Unione Italiana Centri Educazione

Matrimoniale/Prematrimoniale, 48 United Kingdom, British Life Assurance

Trust, 26 cancer control, 80 Centre for Social Studies, 47 clinical technology, 68 Department of Community Medicine, Usher

Institute, Edinburgh, 16 drug utilization studies, 70 education for safety, 43 environmental health, 60 eye health care, 73 fellowships, 28 general practice, 23 health education, 33 health of the elderly, 50 infant nutrition, 39 insulin pump study, 68 intersector policy and planning, 18 mental health, 53National Perinatal Epidemiology Unit,

Oxford, 46Nuffield Centre for Health Services Studies,

Leeds, 16, 26 nursing, 19 perinatal care, 46 prevention of alcohol abuse, 54 school health, 85 Water Research Centre, 66 workers’ health, 50

United Nations Children's Fund (UNICEF), 8,9,32, 59

United Nations Decade of Disabled Persons (1983-1992). 35, 72

United Nations Decade for Women. 22

United Nations Department of International Economic and Social Affairs, 8

United Nations Development Programme (UNDP), 8-9

cooperative arrangements with. 67 environmental health, 60, 67

United Nations Development Programme (UNDP) (contd)

health of the elderly, 51 ophthalmology, 73 posts funded by, 90transfer of Algeria to African Region, 90 water supply, 59WHO Regional Office for Europe as executing

agency for, 91

United Nations Economic and Social Council. 8

United Nations Economic Commission for Europe (ECE), 9, 63

United Nations Educational, Scientific and Cultural Organization (UNESCO), 87

United Nations Environment Programme (UNEP), 9

air quality monitoring, 63 analytical quality control, 63 cooperative arrangements with, 67 hazardous waste in developing countries, 65 International Programme on Chemical

Safety, 66 Mediterranean Action Plan, 40 monitoring of coastal water quality, 61 WHO Regional Office for Europe as executing

agency for, 91

United Nations Food and Agriculture Organization (FAO), 67

United Nations Fund for Population Activities (UNFPA), 8, 47-48, 91

United Nations General Assembly, 8

United Nations Industrial Development Organization (UNIDO), 9, 65, 67

United Nations International Conference on Population (Mexico City), 8

United Nations Relief and Works Agency (UNRW A), 8

United States of America, clinical pharmacology and drug research, 70

drug utilization studies, 71 health legislation, 20 health services research, 38 Institute of Gerontology, University of

Michigan, 54 personal health practices, 45 prenatal care, 45

Vaccination certificate requirements fo r international travel. 89

Viral diseases, 79-80Voluntary Fund for Health Promotion, 91

140

Waste management, 59, 62, 64-65

Water pollution, 61-63

WHO headquarters, 27, 33, 57

Women and health, 75

Women and health documentation centres in Europe, 34

Workers’ health, 49-50

World Federation for Mental Health, 54

World Federation of Associations of Clinical Toxicology Centres and Poison Control Centres, 66

World Health Assembly, 2, 3, 25

World Health Day, 13, 32

World Meteorological Organization, 63

Youth (feature article), between pages 76 and 77 Yugoslavia, appropriate technology for health, 69

educational planning, 32 environmental pollution, 60, 61 eye health care, 73 general medical practice, 23 health information system, 5 leishmaniases, 78 mental health, 54 nurse researchers, 19 nutrition and food safety, 39 oral health, 41 primary health care, 22, 23 Public Health Institute o f Croatia, Zagreb, 61 toxicology, 66

Zoonoses, 79-80

141