At its 267th Session (November 1996) the Governing Body decided to convene a Meeting of Experts on Workers' Health Surveillance. The Meeting was held in Geneva from 2 to 9 September 1997.
Agenda of the Meeting
The agenda of the Meeting, as approved by the Governing Body at its November 1996 Session, consisted of the two following items:
Current practice and the role of health surveillance in the protection and promotion of workers' health and the
Preparation of guidelines on the technical and ethical aspects of workers' health surveillance.
Participants
Eighteen experts were invited to the Meeting, six of them appointed by Governments (Government experts), six after consultation with the Employers' group (Employers' experts) and six after consultation with the Workers' group (Workers' experts) of the Governing Body. The Meeting was attended by all 18 experts invited.
Several observers also attended the Meeting, representing the World Health Organization (WHO), the Pan-American Health Organization (PAHO), the International Organization of Employers (IOE), the International Confederation of Free Trade Unions (ICFTU), the International Social Security Association (ISSA), the International Commission on Occupational Health (ICOH), the International Occupational Hygiene Association (IOHA) and the International Council of Nurses (ICN).
The list of participants is annexed to the report.
Opening address
The Meeting was opened by Mr. Ali Taqi, Assistant Director-General of the ILO. He welcomed the participants to the Meeting and representatives from international organizations. He observed that the adoption in 1985 of the Occupational Health Services Convention (No. 161) and Recommendation (No. 171) had been a milestone in the history of occupational health. These instruments provided for a progressive extension of occupational health services to cover all workers. This required a gradual approach including development of the surveillance of workers' health. There was a need to examine how to use all relevant data and some public health approaches which had proven effective in addressing occupationally related health problems. Guidance had to be provided on the best practical ways to organize the surveillance of workers' health so that it would contribute effectively to the purpose of occupational health, to the implementation of the provisions of the Occupational Health Services Convention and Recommendation, 1985, and to the ambitious objective of occupational health for all. The emphasis placed by the new definition of occupational health adopted in 1995 by the ILO/WHO Joint Committee on Occupational Health on protecting both workers' health and their working capacity required an approach which would involve the workers themselves, their representatives and the employers in order to facilitate a prompt return to work and the maintenance of employment.
He noted that the surveillance of workers' health continued to be an essential component of preventive action and he indicated that it was now to be seen in a new competitive environment where major changes had occurred in the employment pattern. Health data were of a sensitive nature. Some health assessments may not be justified and represented an unwarranted intrusion into the private life of individual workers. Great importance was placed on the issue that health-related information be collected, processed and used in a well-controlled system, which would protect the privacy of the workers and ensure that health surveillance was not used for discriminatory purposes or in any other manner prejudicial to their interests. The main task of this Meeting was to prepare guidelines to assist governments, employers' and workers' organizations as well as occupational and public health professionals to design and establish workers' health surveillance schemes which would guide preventive action and protect and promote workers' health. The experts were also asked to advise on future activities of the ILO. Finally, he reminded the participants that experts were serving in their personal capacity and did not represent any government, group or other interest.
Election of Chairperson
Dr. Marianne Saux, the expert nominated by the Government of France, was unanimously elected as Chairperson of the Meeting. Dr. Zulmiar Yanri, the expert nominated by the Government of Indonesia, was unanimously elected as Reporter of the Meeting.
Presentation of the working documents
In his presentation of the working documents of the Meeting, Dr. Jukka Takala, Chief of the Occupational Safety and Health Branch and representative of the Director-General, underlined the need to address technical and ethical aspects of the surveillance of workers' health with due account to the diversity of situations. The experts were invited to identify some overall principles on which a consensus could be built, and various options which could be used in terms of procedures and institutional arrangements. Their work could be based on the guidance given by the Occupational Health Services Recommendation and in previous ILO meetings and on publications, such as the ILO Codes of Practice on the Protection of Workers' Personal Data, on the Recording and Notification of Occupational Accidents and Diseases and on the Management of Alcohol and Drug-related Issues in the Workplace, as well as on selected documents published by other international organizations. A working document had been prepared by the Office to serve as background information with a view to have a general discussion on current situations and trends. Another working document had been prepared in the form of draft guidelines on the technical and ethical aspects of workers' health surveillance in order to facilitate the discussions in view of their adoption. He indicated that these guidelines would be the conclusions and recommendations of the experts and were intended to be used as guiding principles by all those involved in designing, planning, establishing, implementing and evaluating the surveillance of workers' health, including the competent authority, employers' and workers' organizations.
Report of the discussion
During the general discussion the experts indicated that there should be a clear linkage between workers' health surveillance and workplace control measures. The purpose of surveillance to support prevention should be clearly stated. The emphasis should be on primary prevention defined in terms of occupational safety and health policies, design, and engineering control measures. It was stressed that workers' health surveillance, in itself, would not prevent injuries or diseases. It was not an independent answer but was a useful complement to guide the preventive action. It had to be placed in the right perspective which was the elimination of dangerous machinery, equipment and conditions and the improvement of working conditions and environment. This required a close collaboration between physicians and engineers and a multidisciplinary approach. Medical surveillance should be seen in the context of an overall practice of occupational safety and health, the objective of which was the establishment and maintenance of a safe and healthy working environment. Prevention should not be understood in terms of secondary prevention which included removal from employment, rotation and Aprotective reassignment@ according to a traditional medical model. It was, however, noted that, because of different stages of development in different countries, safer technology could not always be introduced immediately and protection of workers' health through secondary prevention was still needed in some cases.
The experts agreed that there was a need to clarify a number of concepts and terms. The term occupational health surveillance was used to cover both the surveillance of workers' health and the surveillance of the working environment. Medical surveillance was considered as part of the surveillance of workers' health. It was agreed that medical examinations alone were not sufficient but contributed to the occupational health surveillance which was necessary to implement programmes of prevention and to operate occupational health management systems aiming at a continuous improvement of the working environment through cooperation between employers and workers. It was indicated that workers' health surveillance was necessary for prevention purposes at the workplace level. Its focus should be on the surveillance of health in relation to work. However its scope and purpose should be broad enough to elicit new problems and address them in addition to the occupational health issues which are known.
It was pointed out that the medical examinations and workers' health surveillance had to be seen and used at two levels: individual and collective. It was indicated that the aggregate use of the results of workers' health assessments over time was often referred to as surveillance while the individual use of the results of health assessments at a given time was named screening. It should be understood that the same medical examinations, biological tests and other health assessments could be used for both screening (individual) and surveillance (collective) purposes. It was also pointed out that the assessments of health effects did not only rely on individual health assessments but also on other data sources such as mortality and morbidity data. It was noted that the current practice of individual health assessments consisted essentially and even sometimes exclusively of medical examinations while collective health assessments, including the use of statistics of occupational accidents and diseases and epidemiological studies, were usually viewed as non-medical but health-related means of surveillance.
The experts identified a number of issues that would have to be addressed in the guidelines that they had to prepare. These included the need to define who should or could initiate, request or conduct health assessments: which assessments are appropriate under which conditions. The role and the responsibility of the competent authority, as well as the manner in which the professional independence should be guaranteed were to be addressed in detail. It was stressed that the control absenteeism was not compatible with the establishment and maintenance of the climate of confidence and trust necessary for a sound occupational health practice. Experience has also shown that where preventive and curative activities coexisted, the curative activities usually developed at the expense of the preventive ones. Although it was acknowledged that occupational health services were sometimes the only channel to provide access to medical care for the working populations, it was considered particularly important that, where access to health care already exists, occupational health services would have essentially preventive functions.
The use of medical surveillance for health promotion, epidemiological and public health purposes needed to be addressed in the guidelines, as well as the question of rehabilitation, retraining and fitness criteria for jobs involving responsibilities for the safety and health of other workers and of the public. Health promotion at work should focus on work-related hazards and consequences. By eliminating occupational hazards, occupational health may contribute significantly to the improvement of public health. The guidelines could also draw on experience at the national level which uses intermediate managing bodies to finance occupational health services and guarantee their independence as well as on their links with social security schemes which have been developed in some countries. There was a consensus that the guidelines should place the medical surveillance within an occupational health perspective, indicating its purpose, means of action, and consequences in particular in terms of use of its results to protect workers' health and improve the working environment. The importance of appropriate feedback and information to workers was emphasized. This was essential since workers themselves are not passive recipients of information but contribute to the prevention and protection of their health and are expected to cooperate with employers in this respect. The guidelines should also specify the qualifying factors or conditions of operation such as confidentiality, legal and ethical aspects as well as provide guidance on the allocation of duties and responsibilities. The confidentiality of workers' personal and medical data including the context of surveys and questionnaires was of particular concern to the Workers' experts.
Examination of the draft guidelines
It was noted that the practice and needs for the surveillance of the health of workers had changed over time. The experts concluded that it was necessary to place the proposed guidelines in an historical perspective and to explain why there was a need to redefine the purpose and the manner in which the surveillance of workers' health should be carried out. Some Employers' experts considered that these introductory explanations should be given in the report of the Meeting. The advantages of presenting the guidelines as a self-sufficient document were taken into account and the experts agreed to add a short introduction to the guidelines which would provide some historical background, and link workers' health surveillance and its purpose with the definition of occupational health as adopted by the Joint ILO/WHO Committee on Occupational Health in April 1995.
The need to clarify a number of concepts and terms had been recognized during the general discussion and the experts agreed that it was useful to have a glossary which would provide guidance in this respect. The Employers' experts considered that the glossary should only include those definitions which were essential to the subject and necessary to explain terms found in the guidelines. The experts agreed that the content of the glossary should be limited to the information which was essential to the use of the document and the draft was revised accordingly.
The exchange of views which took place indicated that there were several categories of persons involved in the implementation of occupational safety and health programmes, in the improvement of the working conditions and environment, in health promotion, prevention and protection of workers' health at the workplace. Employers and workers had responsibilities and duties, including those prescribed by national laws and regulations. The competent authority, inspection services, approved bodies or institutions, persons appointed or nominated by the employers, the workers or the competent authority to carry out specific functions or tasks also had specific roles, duties and missions which were essential to the implementation of occupational health practice. Many other professionals, practitioners, officials, employees and workers are involved to some extent in occupational safety and health, among them architects, designers, toxicologists, work organization specialists, psychologists, information specialists, trainers, educators and research personnel. All these persons, professionals or not, actors and partners in prevention, protection and promotion of workers' health, had different levels of interest or involvement in the surveillance of the health of workers. Some were directly involved in the collection and use of individual health-related data, while the role of others was essentially to translate the findings of the surveillance of workers' health in order to control hazards and improve disease and injury prevention. The experts agreed that it was sufficient for the glossary to define occupational health professionals and to add the following statement: Many others, in addition to occupational health and safety professionals, are involved in the protection and promotion of the health of workers, e.g. management and workers' representatives, etc.
Having reviewed a number of basic principles during the general discussion, and having agreed on a number of definitions, the experts concluded that the draft guidelines should be examined, taking into consideration the prior discussion, in order to provide practical guidance on the implementation of workers' health surveillance. The Workers' experts proposed a text which outlined the general principles and purposes of workers' health surveillance. In their opinion, there was a need to provide a specific content to general statements, such as the need for sound technical and ethical practice. The intention was not to be exhaustive but to provide, from the start, an indication of the most important aspects of the general principles and purposes of workers' health surveillance as well as the main requirement to implement them. The proposal of the Workers' experts indicated that the central purpose of workers' health surveillance was primary prevention and that such a programme must lead to action to improve working conditions and environment. Primary prevention is the taking of preventive and protective measures in the following order of priority, after assessment of risks: (i) eliminate the risk; (ii) control the risk at source; (iii) minimize the risk by means that include the design of safe work systems; and (iv) in so far as the risk remains, provide for the use of personal protective equipment. Furthermore, procedures and practices had to meet the criteria of need and relevance, scientific validity and effectiveness. It was found that the proposed text added some useful aspects. The experts discussed the proposal in detail and revised the section on General principles and purposes accordingly.
The Employers' experts objected to the use of the term guarantees which implied inflexibility. There was a consensus that there was a need for some safeguards or for certain conditions of operation, such as those provided by the Occupational Health Services Recommendation, 1985 (No. 171). It was agreed that the Occupational Health Services Convention (No. 161) and Recommendation (No.171), 1985, would be appended to the guidelines. After discussion of the term guarantee, the term safeguards was accepted in the English version of the guidelines.
In revising the third section of the draft guidelines on Organization of workers' health surveillance, the experts agreed that workers' health surveillance programmes should be conducted on the basis of the basic principles contained in section 2 whether they were statutory or non-statutory, voluntary or compulsory. The experts had a detailed discussion on the outcome of the medical examinations, in particular concerning communication of results to workers relating to individual and collective health, improvement of the working environment and of control measures. The result of their exchange of view was incorporated into three paragraphs which provided comprehensive guidance on the purpose and on the desired outcome of medical examinations.
The experts agreed that genetic monitoring was a biological test similar to other tests used for biological monitoring purposes which did not deserve a special reference in the guidelines. The provisions of the subsection on Biological tests and other investigations applied to them in the same manner as they applied to other tests and investigations covered by this subsection.
The experts noted genetic information was particularly sensitive and raised a number of scientific, technical and ethical issues. It was generally believed that genetic screening in relation to work was a disproportionate infringement of individual rights. The experts also noted that the ILO Code of Practice on the Protection of Workers' Personal Data provides that genetic screening should be prohibited or limited to cases explicitly authorized by national legislation. There was a consensus that current scientific knowledge was not sufficient to warrant the use of genetic screening for an occupational health purpose.
The experts felt that before entering into a detailed discussion of the subsection entitled Surveys, voluntary programmes and inspections, there was a need for an exchange of views on the meaning of these terms and the underlying concepts.
In reply to a question from an expert, the secretariat provided the following information. The concept of voluntary programmes emerged in the early 1970s, notably with the publication of the Report of the Robens Commission in the United Kingdom, which advocated the importance of voluntary programmes at the enterprise level based on a strong management involvement and on workers' participation comprising the adoption of enterprises' occupational safety and health policies, self-inspections and safety audits. This concept developed over the years and spread progressively all over the world having, as a result, a greater emphasis on the role of joint occupational safety and health committees, renewed efforts to train their members and the development of participatory programmes. Various efforts occurred subsequently at the national level, such as the development of internal responsibility systems in Canada. Voluntary programmes were promoted in the United States and, more recently in the European Union. More recently, occupational health and safety management systems were developed in some countries. Such programmes were generally based on the principles of total quality management and continuing improvement. The term voluntary programmes was intended to cover a large number of programmes and means of actions, such as walk-through surveys, voluntary inspections and audits, the design and implementation of which varied largely according to national working cultures but had in common to be voluntary.
In reply to a question from an expert, the secretariat provided the following information. The term surveys was intended to cover a large variety of investigations which were generally well targeted and carried out at a given time (cross-sectional). These characteristics differentiated them from the recording and notification systems which were usually expanded over time (longitudinal). They may be carried out by universities, occupational safety and health institutions, governmental occupational safety and health inspectors, industry, workers' organizations, research institutions, occupational health services, etc. They may be carried out at the level of an enterprise or of a group of enterprises manufacturing similar material or equipment, or of a sector of activity (e.g. construction, agriculture, mines). They may address working populations exposed to specific occupational hazard (e.g. lead, isocyanate, solvents, noise) or to some kind of health disorder (e.g. repetitive strain, low back pain) or they may address certain diseases (e.g. silicosis, occupational cancer, dermatitis, occupational asthma). They may address the whole population (national health surveys which include an occupational health component) or specific groups (e.g. young workers, migrants). Surveys may contribute to epidemiological research and studies, assessments of the working environment (measurements), risk assessments (evaluations, hazards mapping), health assessments (medical examinations, health questionnaires), action-oriented research, intervention epidemiology, etc. They may use a very broad variety of tools including medical examinations, measurement of ambient factors, health questionnaires and a variety of other means of collecting information, such as examination of medical files, exploitation of health and trauma registers, postal questionnaires, etc. The analysis of the information is carried out by a variety of means but often includes statistical analysis.
When the experts examined the section on the use of health-related data they noted the emphasis placed on training and qualification of occupational health professionals but considered that this was a requirement of general nature which concerned also the collection, processing and communication of health-related data and several other aspects. They concluded that this important issue should be included in the section on responsibilities, rights and duties.
In paragraph 6.1 of the section entitled Responsibilities, rights and duties the experts decided to use the wording as required or recommended by the Occupational Safety and Health Convention, 1981 (No. 155), the Occupational Health Services Convention, 1985 (No. 161), and Recommendations (Nos. 164 and 171) in order to take into account the fact that some countries had ratified one or both Conventions and that their provisions were requirements for these countries. The Conventions serve as Recommendations for the countries that have not yet ratified these Conventions.
The experts discussed in detail the use of the terms must, should, and may. In each particular case an agreement was reached. In certain cases the solution appearing in the guidelines was the result of compromise.
Recommendations for future action
The guidelines acknowledged the need to redefine the surveillance of workers' health. Such surveillance activities should be redirected taking into account these guidelines in the light of national circumstances. There is a need for the ILO and the WHO to publicize the guidelines and to promote education and training in this respect, giving examples of good and poor practice. Proactive education and training campaigns should be implemented. The target audience of such campaigns should not only be ILO constituents - governments, employers and workers - but also occupational health professionals who carry out the bulk of the work relating to workers' health surveillance. In conducting such campaigns, the ILO should rely on national centres, employers, workers and governments.
There was a need to promote discussions at the national level on the guidelines adopted by the experts as well as to promote their technical and ethical principles, insisting on the need for such discussions to take place in multipartite committees comprising representatives of employers, of workers, of relevant ministerial departments and of various occupational health professional groups.
There was a need to recommend and promote the adoption of the principles embodied in the guidelines in member States, emphasizing the role of the competent authority. Detailed guidance at the national and international levels could be elaborated on specific chapters or sections of the guidelines. These may be expanded to new spin-off documents.
It would be advisable for the ILO and other international organizations to act as promoters of exchange of information about the workers' health surveillance activities carried out in the different countries. To such an end, a report outline could be prepared by means of which each country would report on the different measures planned or implemented regarding workers' health surveillance. It would be advisable that the description of such measures or means of action be accompanied by an analysis of their effectiveness.
Governments of member States were advised to establish and clarify the respective and shared responsibilities of the general health system and of the occupational health system.
To the extent that some countries could not put the present principles into effect in their entirety (due primarily to restrictions of a political, economic and social nature), the setting up of gradual step-wise programmes of workers' health surveillance was recommended.
The ILO, in cooperation with the WHO, should further develop the concept of an integrated workers' health surveillance system in relation with the concepts of occupational health care and of occupational health and safety management systems at the enterprise level.
Cooperation should be promoted among all those who share a managerial responsibility in the field of health and safety in order to study the means of ensuring a multiple financing of preventive health, including occupational health. In this connection, there was an expressed need to take into account both the contribution of occupational health to the health of the working populations and the burden on health systems of unreported and unrecorded injuries and diseases due to work.
There is a need to invite occupational health professionals and their organizations, in consultation with employers and workers, to advise the competent authority on scientific approaches to health surveillance and to adopt national codes of ethics. Occupational health professionals and their organizations should also be encouraged to establish a system of specialized consultations made available to employers, workers and health professionals. They should define by consensus the scientific aspects of the content and organization of a medical surveillance system adapted to the nature and the level of risk to health. Such harmonized scientific views would be useful not only to the occupational health professionals but also to the general practitioners who, in many countries, are engaged in the surveillance of workers' health.
Adequate resources and sufficient means should be made available to meet occupational health needs. The attention of competent authorities should be drawn on the need to devote specific and sufficient resources to occupational health in their budget, after discussions and in consultation with all partners concerned.
The guidelines should be introduced at regional and national levels taking into account the various levels of development in the occupational health practice. Regional and national seminars and workshops should be organized by the ILO, with special emphasis on action at the national level supported by technical cooperation projects. In addition to the publication of these guidelines, the ILO should monitor the acceptance of the guidelines at the national level.
The ILO should develop a strategy to promote an effective implementation of the guidelines and cooperate with the WHO to ensure that the guidelines are taken into account in efforts to promote a global strategy on occupational health for all and to implement a global programme on occupational safety, health and the environment. Cooperation should be strengthened with the WHO and its collaborating centres as well as with other existing networks of resource institutions such as technical and scientific committees established within the framework of non-governmental international organizations.
There is a need to study, define and provide guidance on the technical and ethical aspects of the surveillance of the working environment, in addition to the guidance provided by this document on the surveillance of workers' health.
Since scientific knowledge on genetic testing may change very rapidly, progress in knowledge concerning these tests and, in particular, genetic screening should be monitored.
The objective set by the relevant provisions of the Occupational Health Services Convention, 1985 (No. 161), of extending progressively occupational health services to all workers should be reaffirmed. The objective to provide access to health surveillance to all workers including self-employed also needs reinforcement.
Discussion on the adoption of the report
The experts unanimously adopted the report and guidelines and recommended their publication. Despite the efforts of the secretariat, some repetition and stylistic shortcomings remain which can be explained by the complexity of the subject studied.
Adoption of the guidelines and the report
After examining the draft guidelines on the technical and ethical aspects of workers' health surveillance, the experts adopted the guidelines as amended.
After examination of the report, the experts adopted it as amended.
9 September 1997.
(Signed)
Dr. Marianne SAUX,
Chairperson.
(Signed)
Dr. Zulmiar YANRI,
Reporter.
Annex
List of participants and observers
Experts appointed after consultation with Governments
Mr. Wenqi Wang, Senior Engineer, Ministry of Labour, 12, Hepingli Zhongjie, 100716 Beijing, China
Dr. Zulmiar Yanri, Deputy Director for the Supervision of Workers' Safety and Working Environment, Directorate-General of Industrial Relations and Labour Standards Development, Department of Manpower, Jalan Gatot Subroto Kav. No. 51, P.O. Box 45, Jakarta, Indonesia
Mr. Leen Van Vliet, Directorate for Working Conditions, Ministry of Social Affairs and Employment, P.O. Box 90801, NL-2509 LV, The Hague, Netherlands
Dr. Marianne Saux, Ministère de l'Emploi et de la Solidarité, Chef du Service de l'Inspection Médicale du Travail, Direction des Relations du Travail (Ministère du Travail), 20 bis Rue d'Estrée, F-75007 Paris, France
Dr. Mohamed Ben Laiba, Ministèr des Affaires Sociales, Directeur Général, Institut de santé et de sécurite au travail, 5, Bd. M. Khaznadar, 1007 Tunis, Tunisie
Sra. Mara Ivana Bettiol, Economista, Superintendencia de Riesgos del Trabajo, Calle Florida 537, Piso 10, C.P. 1005, Capital Federal, Provincia Buenos Aires, Argentina
Experts appointed after consultation with the Employers' group
Dr. Nicholas Anoruo Okere, Medical Director, Nigerite Limited, Oba Akran Road, Ikeja, Lagos, Nigeria
Dr. Geir Øyvind Bakka, Assistant Director, Occupational Health and Safety, Confederation of Norwegian Business and Industry (NHO), P.O. Box 5250 Majorstua, 0303 Oslo, Norway
Dr. Amjad Ali, In-charge of the Medical Department, Pakistan Petroleum Ltd., PIDC House, Dr. Ziauddin Ahmed Road, P.O. Box 3942, Karachi, Pakistan
Dr. Jan Van Charante, Occupational Physician, Managing Director, Foundation on Occupational Health, Dr. S. Redmondstraat 250, Paramaribo, Suriname
Dr. Derek White, Chief Medical Officer, British Telecommunications plc, BT Centre, 81 Newgate Street, London EC1A 7AJ, United Kingdom
M. Ali M'kaissi, Union Tunisienne de l'Industrie, du Commerce et de l'Artisanat (UTICA), 103, avenue de la Liberté, 1002 Tunis-Belvédère, Tunisie
Experts appointed after consultation with the Workers' group
Mr. David Bennett, Canadian Labour Congress, 2841 Riverside Drive, Ottawa K1V 8X7, Canada
Mr. Kenichi Kumagai, Japanese Trade Union Confederation, RENGO-JTUC, 2-11, Kanda-Surugadai 3-chome, Chiyoda-ku, Tokyo 101, Japan
M. Ahmed Khalef, Union générale des travailleurs algériens (UGTA), Cité des 200 Logements, BT A.2, No. 10, Rouiba, Alger, Algérie
Mme Bergie van den Bossche, Confédération des syndicats chrétiens, Rue de la Loi 121, B-1040 Bruxelles, Belgique
Mme Ellen Imbernon, Confédération générale du travail, (CGT), 2 ter, passage du Chemin Vert, 75011 Paris, France
Observers
International Commission on Occupational Health (ICOH), Professor Bengt Knave, Vice-President, ICOH/CIST, National Institute of Occupational Health, Ekelundsvagen 16, 17184 Solna, Sweden
International Confederation of Free Trade Unions (ICFTU), Mr. Guy Ryder, Director and Mr. Dan Cunniah, Assistant Director, of the ICFTU Geneva Office, Bd. Emile Jacqmain 155, B-1210 Bruxelles, Belgique
International Organization of Employers (IOE), Ms. Barbara Perkins, 26 Chemin de Joinville, P.O. Box 68, 1216 Cointrin, Geneva, Switzerland
International Council of Nurses (ICN), Dr. G. Tesfamicael, 3, place Jean-Marteau, 1202 Geneva, Switzerland
International Occupational Hygiene Association (IOHA), Mr. T.G.E. Gillanders, President, Hillcrest, Leazes Lane, Hexham, Northumberland, United Kingdom
International Social Security Association (ISSA), Dr. Med. Sigfried Sandner, Chief, Occupational Health Service Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), Pappelallee 35-37, D-22089 Hamburg, Germany
Pan American Health Organization (PAHO), Dr. Luz Maritza Tennassee, Regional Adviser in Workers' Health, Pan American Health Organization, Pan American Sanitary Bureau, Regional Office of the World Health Organization, 525 Twenty-Third Street N.W., Washington, DC, 20037-2895, United States
World Health Organization (WHO), Mrs. B. Goelzer, Occupational Hygienist, Office of Occupational Health, Division of Health Promotion, Education and Communication, Avenue Appia 20, 1211 Geneva 27, Switzerland
ILO secretariat
Dr. J. Takala, representative of the Director-General
Dr. G.H. Coppée, deputy representative of the Director-General
Dr. S. Niu, Expert
Dr. G. Wagner, Expert
Updated by EC. It was approved by JT. Last updated 18 May 1998.
