The work of WHO in the European Region 1987: annual report of the Regional Director

T H E W O R K O F W H O IN T H E E U R O P E A N R E G IO N 19X7 W o rld H e a lth O rg a n iza t io n . R e g io n a l O ffic e fo r E u ro p e . R e g io n a l D ire cto r T h e w ork o f W H O in the E u ro p e a n R e g io n 1987 / an n u a l report o f the reg ion al d irector C o p e n h agen : W H O . R e g io n a l O ffice fo r E u ro p e , 1988 IS B N 9 2 -8 9 0 -1055-X R e g io n a l H e a lth P la n n in g — H e a lth fo r A l l — E u ro p e T h e W o rld H e a lth O rg a n iz a t io n is a spe cia lize d agency o f the U n ited N a tio n s w ith p rim a ry re sp o n sib ility for in te rn a tio n a l health m atters and p u b lic health. T h ro u g h th is O r g a n iz a t io n , w h ich was created in 1948, the health p ro fe ss io n s o f som e 160 co un tries exchange their kn ow led ge and experience w ith the a im o f m a k in g p ossib le the atta inm ent by a ll citizen s o f the w orld by the year 2000 o f a level o f health that w ill perm it them to lead a so c ia lly and e co n o m ica lly p ro d u ctive life. T h e W H O R e g io n a l O ffic e fo r E u ro p e is one o f s ix re g io n a l o ffices th ro u g h o u t the w o rld , each w ith its ow n p ro g ra m m e geared to the p a rt ic u la r health p ro b le m s o f the co u n trie s it serves. T h e E u ro p e a n R e g io n has 32 active M em b er S ta te s ,“ and is un iq u e in that a large p ro p o rt io n o f them are in d u stria lize d co un tries w ith h ig h ly ad va n ce d m edica l services. T h e Eu ro p e a n p ro gram m e therefore d iffers from those o f other reg ions in co n ce n tra tin g on the p rob lem s associated w ith in d u stria l society. In its strategy fo r a tta in in g the goa l o f “ health fo r a ll by the year 2000” the R e g io n a l O ffice is a rra n g in g its a ctiv ities in three m ain areas: p ro m o tio n o f lifesty les co nd u cive to health; reduction o f preventable co n d itio n s; and p ro v is io n o f care that is adequate, accessib le and acceptable to a ll. T h e R e g io n is a lso ch aracte rized by the large num ber o f languages spo ken by its peoples, an d the re su ltin g d iff ic u lt ie s in d isse m in a tin g in fo rm a tio n to a ll w ho m ay need it. T h e R e g io n a l O ffic e p u b lish es in fo u r lan guages — E n g lis h , F re n ch , G e rm a n and R u ss ia n — an d a p p lic a tio n s fo r righ ts o f tran sla tio n in to other languages are m ost welcom e. a A lban ia , A ustria , Belgium , Bulgaria, C zechoslovakia , D enm ark , F in land , F rance , G erm an D em ocratic Republic, F ederal R epublic o f G erm any , G reece , H ungary , Iceland , Ire lan d , Israel, Ita ly , L uxem bourg , M alta , M onaco , N etherlands, N orw ay, P o land , P ortugal, R om ania, S an M arino , S pain , Sw eden, Sw itzerland, T urkey , U SSR, U nited K ingdom and Y ugoslavia. THE WORK OF WHO IN THE EUROPEAN REGION 1987 Annual Report o f the Regional Director W O R L D H E A L T H O R G A N I Z A T I O N Regional Office for E u ro p e C O P E N H A G E N 1988 Feature Action Plan on Tobacco: Smoke-free Europe ( b e tw een pages 54 a n d 55) ISBN 92 K90 1055 X © W o r ld Health O rgan iza t ion I9XX Publicat ions o f the W o r ld I lea lth O rgan iza t ion enjoy copyrigh t pro tect ion in accordance w ith the provisions o f Pro tocol 2 o f the Universal C o p y r ig h t C onven tion . F o r r ights o f rep roduc t ion or t rans la t ion, in part o r ш loto. o f pub l ica t ions issued by the W H O Regional Off ice fo r I 'n ro p c app l ica t ion should be made to the Regional O ff ice fo r Huropc. Schcrfigsvej X, 1Ж-2100 Copenhagen 0 . D enm ark . 1 he Regional Off ice welcomes such applications. f i le designations employed and the presentation o f the materia l in this pub l ica t ion do not imply the expression o f any o p in io n whatsoever on the part ol the Secretaria l ol the W o r ld Health O rg a m /a t io n concerning the legal status o f any coun try , te r r i to ry , city or area or o f its authorit ies, o r concern ing the de l im ita t ion o f its f ront iers or boundaries. I lie m ent ion ol specific companies or o f certain m anufacturers ' products does not imply that they arc endorsed o r recommended by the W o r ld I lea lth O rgan iza t ion in preference to others o f a s im ila r nature that are not mentioned. Hrrors and omissions excepted, the names o f p rop r ie ta ry products are distinguished by in it ial capital letters. I ' l ( l \ I I I l l s 1)1 S \ 1 \ K k CONTENTS Page F o r e w o r d ................................................................ ix 1. Regional policy development, evaluation and p r o g r a m m e management ...................................... 1 General programme management and development ......................... 1 Coordination with countries ............................................. 4 Health information of the public ......................................... 5 Support programmes ................................................... 6 Personnel.......................................................... 6 General administration and services ................................... 7 Budget and finance ................................................. 7 Staff development and training ........................................... 8 Publications........................................................... 9 Epidemiology and statistics .............................................. 11 2. Health for all in Europe by the year 2000 .......................... 13 Target I. Hquitv in health .............................................. 14 Target 2. Adding life to years .......................................... 15 The elderly ........................................................ 15 Target J. Better opportunities for the disabled ............................ 16 Health legislation .................................................. 16 Community-based rehabilitation ...................................... 16 Target 4. Reducing disease and disability ................................. 17 Disability prevention ................................................ 17 Genetics services ................................................... 17 Rheumatism ....................................................... 17 Mental health ...................................................... 18 Communicable diseases .............................................. 20 Oral health ........................................................ 23 ta rg e t 5. Eliminating seven specific diseases .............................. 24 Diseases preventable by immunization ................................. 24 Malaria ........................................................... 25 v Target 6. Lite expectancy at birth ....................................... ... 25 Target 7. Reducing infant mortality rates .................................... 26 Target X. Reducing rates of maternal mortality ............................ ...27 Target 9. Combating diseases of the circulatory system .........................27 Target 10. Combating cancer ...............................................29 Target I I . Reducing accidents ...............................................31 Accident prevention ................................................ ...31 Disaster preparedness ............................................... ...32 Target 12. Stopping the increase in suicides ....................................33 3. Lifestyles conducive to health ...................................... ...37 Target 13. Healthy public policy ......................................... ...39 National health promotion policies .................................... ...39 National alcohol policies ................................................41 National drug policies ............................................... ...41 Target 14. Social support systems ........................................ ...42 Target 15. Knowledge and motivation for healthy behaviour ................. ...43 Health education and health promotion ...................................43 Sexuality and family planning ........................................ ...46 Target 16. Promoting positive health behav iour ............................ ...47 Sexuality and family planning ........................................ ...47 Nutrition .......................................................... ...48 Smoking and health ................................................. ...49 Target 17. Decreasing health-damaging behaviour .......................... ...50 Research .......................................................... ...50 Drug abuse ...........................................................51 Alcohol abuse .........................................................52 4. Healthy environment ............................................... ...55 Target IS. Policies for a healthy environment .............................. ...57 la rg e I 19. Monitoring, assessment and control ol risks in the environment ..... ...58 Chemical hazards .................................................. ...59 New technologies ................................................... ...60 Nonionizing radiation ............................................... ...60 Ionizing radiation .................................................. ...60 V I T a rg a 20. Water pollution .............................................. 62 Mediterranean Action Plan ........................................... 66 Target 21. Protection against air pollution ................................. 68 Target 22. Food safety ................................................. 70 Target 23. Protection from hazardous wastes .............................. 71 Target 24. Healthy homes ............................................... 71 Target 25. Healthy working conditions .................................... 72 5. Appropriate care ................................................... 75 Target 26. A health care system based on primary health care ................ 76 Nursing/midwifery ................................................. 76 Hospitals .......................................................... 77 Health legislation .................................................. 77 Target 27. Rational and preferential distribution of resources according to need . . 78 Health economics .................................................. 78 Health service delivery and health institutions ........................... 78 Health care providers ............................................... 79 Target 2S. Content of primary health care.................................. 80 Target 29. Providers of primary health care ................................ 81 Target 30. Coordination of community resources for primary health care....... 82 l a r g e / J I. Ensuring the quality of services ................................. 82 6. Research and health development support ......................... 85 Target J2. Research and health for all ..................................... 86 Target JJ. Policies for health for all ...................................... 87 Collaboration with other organizations ................................. 89 Target 34. Management of planning and resource allocation .................. 91 Target 35. Health information systems .................................... 94 Target 36. Planning, education and use of health personnel for health for all .... 97 Fellowships ........................................................ 99 Target 37. Education of personnel in other sectors to support health lor all ..... 102 Target 3H. Health technology assessment .................................. 102 Pharmaceuticals ................................................... 104 7. Global programmes ................................................ .. 109 Global programme l'or accident prevention ................................... 109 Global programme for health of the elderly .................................. Ill Global programme for appropriate health care technology ...................... 113 Regional activities of interregional scope .....................................114 8. Country programmes ............................................... ..119 Health for all policies .................................................. ..120 Inequity in health, and disease prevention and control .........................120 Healthy lifestyles .........................................................120 Healthy environment ................................................... ..121 Appropriate care .........................................................121 Support for health development ......................................... ..121 Improving cooperative’mechanisms....................................... ..121 Annex 1. Active and non-active Member States of the World Health Organization, huropcan Region, 31 December 1987 ...................................123 Annex 2. hstimated populations in 1987 for the active Member States of the W H O huropcan Region ..............................................124 Annex 3. Professional staff in the Huropcan Region, 31 December 1987 ..............125 Annex 4. Organizational chart of the Regional Office, 31 December 1987 ............127 Annex 5. Intercountry meetings convened by the Regional Office for Europe. 1 January — 31 December 1987 ..................................... ..128 Annex 6. WI Ю-sponsored courses in the huropcan Region, or courses relevant to Regional Office programmes, 1987 ......................... ..135 Annex 7. hist of W H O collaborating centres with which the Regional Office concluded plans of action covering the year 1987 .........................138 Index ......................................................................151 v m Foreword In the European Region o f WHO, the health fo r all (HFA) m ovem ent was horn in Septem ber 1980 when the European HFA strategy was adopted by the Regional Committee, and came o f age in 1984 with the adoption o f the 38 regional HFA targets. That the Regional C om m ittee should be ready to agree on such radical new principles in health was due to the single fa c t that those leaders in health who m ake up the Regional C om m ittee have had the vision and courage to look beyond their individual countries' existing policies. They col­ lectively com m itted them selves to a goat which, when the movement started, could not have been adopted nationally by the great m ajority o f the countries. Following on fro m this situation, the f ir s t step has been to build true political com m it­ m ent in the individual M em ber States. Since 1985, therefore, the main thrust o f the work o f the Regional O ffice has become one o f stim ulating individual countries to develop their own national HFA policies based on the regional model. In 1987, a particularly active year, several countries made great progress in this work. By the end o f the year m ore than h a lf o f the 32 M em ber S ta tes had com pleted the developm ent o f broad new national HFA policies, or were at different stages o f an official planning process to do so. Several countries were considering starting sim ilar exercises, and in m ost o f the remaining countries other efforts were being made to strengthen the HFA aspects o f national policies. In 1987 the Regional O ffice was closely associated with most o f these policy developments; frequently, its s ta f f were intim ately involved in the initial discussions and in the subsequent development o f these new policies. A particularly interest­ ing fea tu re o f the thirty-seventh session o f the Regional C om m ittee was that the M ember S ta tes spent fa r more time discussing the Regional D irector’s report than usual, because they had so much to say about their own national HFA development. Nevertheless, one should not overlook the fa c t that there are stilt countries where, although the health authorities arc actively supporting HFA, the concept o f such a policy has not ye t fully penetrated the minds o f leading politicians. The overall trend is, however, encouraging. The work o f the Regional O ffice can be effective, m eaningful and worthwhile only i f it helps to stim ulate real action fo r change in countries, (liven the small number o f professional s ta f f in the Regional O ffice — between 50 and 60 — it was obvious that very careful thought had to be given to how the O ffice could best act as a catalyst in the many areas covered by the regional HFA policy. When in 1984/1985 n r discussed how the O ffice could best tackle the form idab le task o f stim ulating and supporting national action in Europe, it became clear that new approaches had to be developed. I X New e fforts have been m ade to stim ulate translation o f the book Targets for health for all into local languages and to improve its distribution within countries. As a result, the book has now appeared in 1 7 different language editions in 14 countries. Nevertheless, there remains the major problem that only in relatively few countries does the health m inistry or other bodies ensure its distribution throughout the health services to politicians, admin­ istrators, etc., a task that needs higher priority and better planning in many countries. W HO in general, and the Regional O ffice in particular, has a problem in not being too well known by the general public. A recent survey in one o f the European M em ber S ta tes showed that slightly more than three quarters o f the population knew about WHO, but only h a lf had a good understanding o f what the Organization really stood for. In 19X7, therefore, the Regional O ffice stepped up its public relations work and decided, inter alia, to m ake a special effort through television, now a major means o f communication in the Region. As a result, cooperative agreements were concluded fo r two national and fo u r international television series that will explain to millions o f viewers during the next 2 -3 years the regional HEA policy, its different programmes, and W H O ’s role in its development. Even so, these successful initial negotiations will need to be pursued even more vigorously to fu rth er increase W HO involvement in television. A second strategic elem ent in prom oting W H O 's image and knowledge o f HEA in M em ber S ta tes was created by the decision o f the Regional C om m ittee in 1986 to see what effect could be obtained by all 32 M em ber S ta tes promoting ju s t one selected area among the 38 regional HEA targets. Since tobacco use is the single largest risk to health in the European Region — killing up to 15'Zc o f the population in some M ember S ta tes — the C om m ittee chose a regional campaign to combat tobacco. In 1987 the O ffice subm itted to the Regional C om m ittee the plan o f action for such a campaign; the proposal was accepted and its im plem entation was begun. Incidentally, this European initiative was particularly well received at the International Conference on Sm oking, held in Tokyo in November. The Regional O f fice will also use this campaign as an experim ent to see how W H O can use its existing wide-ranging network o f collaboration with m any scientific institutions and organizations to create a broad popular m ovem ent for a sm oke-free Europe, stim ulating action at m any levels o f society. In this context, the Regional O ffice first decided to put its own house in order as an exam ple to those it was trying to convince. An action plan to m ake the Regional O ffice a sm oke-free working environment (which became fully effective on 1 January 1988) was therefore worked out and adopted, and a series o f smoking withdrawal courses was organized for s ta f f and their fam ilies and friends, with considerable success. Likewise, it was felt that the M em ber S ta te s should also start with the health sector. The Regional C om m ittee therefore decided in Septem ber to urge all countries to m ake health premises (offices and clinical institutions) smoke-free, and it pleaded with all organizations o f health personnel to begin helping their own members to refrain from smoking. In the sam e spirit, the Regional O ffice convened a m eeting with all national medical associations in Europe, in Paris in November. M odel guidelines were presented on how to help physicians stop smoking, how to counsel patients in this area, and how medical associations can support national anti-sm oking programmes. This was well received by the associations, and the Regional O ffice will henceforth m onitor progress annually. The same ideas were presented during a m eeting with pharm aceutical associations o f the Region in November, and a positive response is also expected fro m them. The Regional O ffice is planning to undertake sim ilar initiatives with, fo r example, Huropcan associations o f nurses and o f teachers. Another im portant approach to increasing the effect in countries o f the European HFA m ovem ent are fo u r special projects known in the Regional O ffice as the " common delivery vehicles”. In essence, these are long-term cooperative projects between specially designed national program m es in interested M em ber S ta tes and technical s ta f f o f the Regional Office. These projects deal with the design and im plementation o f HFA policies and program m es so as to reach key target areas and decision-m aking groups in countries. A t the mom ent three o f these “ vehicles" exist, as explained below. □ N A T I O N A L H i A P O L IC Y -M A K IN G . A group in the Regional O ffice has been created fo r senior planners and decision-m akers in charge o f HFA policy-planning exercises at national and subnational levels. A special subgroup unites the so-called "p lura listic” countries. Work proceeded well in this area in 1987. □ T I I L i l l \ l T H Y ( T H I S PRO.ILCT. Focusing on HFA development at city level, this project hopes ultim ately to interest city adm inistrations throughout Furope in the HFA movement. Traditionally these administrations have not worked with WHO, and they are often very badly inform ed on health policy initiatives at international level. S ince these administrations often have more power to fo rce through m ultisectoral policies and com­ m unity involvement projects, they offer a particularly interesting target group for the European HFA movement. To respond to the great interest generated so far, a Healthy Cities project office was established at the Regional O ffice during the year, and a second group o f cities jo ined the project, bringing the to ta l at present to 25 cities fro m 16 M em ber States. Moreover. H ealthy Cities netw orks have em erged in nearly all countries, involving over 100 European cities. The only disappointment in this project is the relative scarcity o f W H O 's resources. With a little more human and financial resources at its disposal, the Regional O ffice could expand and strengthen very considerably this extrem ely prom ising project. To this end 1987 saw greater efforts to raise voluntary contributions fo r the Healthy Cities project. □ I H i : c i n d i P R O G R A M M !: . The countrywide integrated noncommunicable disease in­ tervention (C IN D I) program m e has already been described in the Annual Reports o f the Regional D irector fo r 1985 and 1986. The focus o f this 3-year-old program m e is those countries that are in terested in working together on the development o f broad-scale pro­ gram m es fo r perm anent change towards more healthy lifestyles fo r their populations. More countries jo ined the program m e in 1987, bringing to ten the number o f countries now collaborating in this activity. A ll these different ''vehicles” sell essentially the same message, addressing the four main thrusts o f the HFA movement. W H O 's role is to help with the organizational develop­ m ent and scientific infrastructure o f national programm es in these areas. In addition, these projects and program m es provide an opportunity fo r all the countries that work with the same problem s to share their experiences, successes and failures, thereby learning more quickly and gaining inspiration fro m each other's efforts. Another approach that look a more fo rce fu l turn in 1987 was W H O 's a ttem pt to interest the universities in Europe in the HFA movement. During the year several meetings were organized to prepare fo r the establishm ent o f a European netw ork o f universities fo r health fo r all. It would seem that some o f the difficulties encountered in the past are now being overcome, leading to the creation o f a firm basis fo r planned development. An im portant decision by the Regional C om m ittee in Septem ber was that the Regional O ffice would develop over 2 -3 years a special educational approach in support o f HFA. This will deal with the fundam enta l changes that need to be made in regard to the education ( both basic and continuing) o f physicians, nurses and other health personnel, and perhaps also personnel in other sectors. The intention is to build on the experience gained in developing the European HFA targets, and to involve in this work the leading European organizations related to these issues, as well as consulting with all the M em ber States. Thus, it becomes not only a question o f developing a policy document, but o f using that process as a means o f creating awareness and motivation fo r change by involving the key people and institutions in the process. Another positive development in 1987 was the identification o f three or fo u r medical schools that have sta ted their willingness to work closely with the Regional O ffice to analyse the need fo r — and thus im plement — the changes in medical education that need to be made in order to train physicians in line with the HFA policy. Finally, the basic HFA research policy that has been developed over the last two years by the Regional O ffice and its European Advisory C om m ittee on Health Research (EA CHR) was subm itted to the Regional C om m ittee and accepted in Septem ber. With this tool in hand, the FA CH R and the Regional Office, in close cooperation with national authorities, will now start a direct dialogue with the national research academies and medical research councils throughout the Region, trying to stim ulate them to develop sim ilar national research policies and reorient their research programm es accordingly. This will give the E AC H R a considerably more active, participatory and country-oriented role than hitherto. Another mechanism fo r expanding HFA development is to get the intergovernmental and nongovernm ental organizations in Europe to actively embrace the regional HFA policy as a basis fo r their own work in health-related fields, and to work more closely with the Regional O ffice in its many applications. In 1987, the Nordic Council developed a new five-year plan fo r its work in the health and social fields that m akes extensive reference to the regional HFA policy. Another very impressive piece o f work during the year was the intensive workshop dialogue with nurses throughout Europe in preparation fo r the O ffice's 1988 conference on the implications o f HFA fo r nursing. Through close collaboration between the Nursing unit o f the Regional Office, health m inistries and national nursing associations, m any thousands o f nurses attended such workshops. In Septem ber the Regional C om m ittee discussed the f ir s t draft o f a new regional program m e on A ID S, to be carried out by the Regional O ffice in close cooperation with the Special Program m e on A ID S at W HO headquarters in Geneva. The f ir s t m ember o f s ta f f o f the new unit to deal with this program m e was recruited. M l The Regional C om m ittee also discussed a widely shared concern by its members that in m any European countries public health management has gradually been losing its influence, ju s t when the HEA m ovem ent is confronting countries with radical new challenges and a greater dem and fo r better managem ent skills in public health. In this context the Regional O ffice in 1987 started a dialogue with the Association o f Schools o f Public H ealth in the European Region (A SP H E R ) to see whether a European standard fo r training in public health managem ent based on HFA could be developed. The implications o f such a develop­ m ent would be extrem ely interesting, and m ake paten tly clear what fo rm public health managem ent should really take in European countries. But 1987 was not only a positive year. The Regional O ffice had to struggle with a budget cut o f more than two million dollars fo r the 1986/1987 biennium, necessitating a consider­ able reduction in s ta f f (by keeping posts vacant and redeploying existing sta ff) and the curtailm ent o f several programmes. Particularly hard hit were efforts to build up a better epidem iological basis f or HFA development. Progress did not continue as much as had been hoped, since the O ffice sim ply had few er hands and less money to do the work. The message received fro m the D irector-G eneral in November that the Regional O ffice had to apply the fu ll "contingency p la n ' as from I January 1988 was a further hard blow. In this situation, it was decided to revise the organization o f the Office, reducing the num ber o f services from six to f iv e and moving some s ta f f to the highest priority areas. Furthermore, m odifications were made in the basic management system to give units more m anagerial flex ib ility within approved program m es and resources, thus stim ulating their innovativeness. A t the same time, monitoring and evaluation was intensified so as to ensure greater transparency and accountablity within the new management system . Fortunately, the O ffice had for the previous 18 months been hard at work developing a new computer-based integrated management inform ation system (IM IS) to provide all units, services and the O ffice as a whole with up-to-date, on-line inform ation on the development o f all programme elem ents and their budgetary status. The O ffice was able to speed up this development to coincide with the introduction o f the new management system as o f I January 1988. The effect o f these various changes will be fu lly assessed next year, since the present report covers an odd year and does not contain any actual evaluation o f programme implementation. However, 1987 was also a year in which important progress was made with regard to the country program m es o f collaboration with M ember States. As reported last year, one o f the main developm ents that the O ffice has been advocating during the last 3 -4 years has been well planned medium -term program m es o f cooperation between the Regional O ffice and individual M em ber S ta tes o f the Region. A t the end o f 1987, such program m es had been or were being developed with 23 of the 32 M em ber States, and by the end o f 1989 there should be very few countries with which the O ffice does not have such programmes. An interesting development is that it is now no longer ju st a m atter of the Regional O ffice trying to persuade the M em ber States; more and more countries that do not yet have such medium -term programmes arc asking for them to be established. The quantity o f m edium -term programmes is, however, only one measure o f success; far more im portant is their quality. In 1987 therefore the Regional O ff ice created the new unit o f C ountry Program me Coordination, which has as its sole responsibility the quality o f XII) medium -term program m es with individual M em ber States. This implies, on the one hand, improving dialogue with individual countries as to whether the medium -term program m e really addresses that country’s own priority development needs and, on the other hand, assessing whether the Regional O ffice units are providing the best possible team effort in support o f those programmes. In this work, however, it is extrem ely im portant not to fo o l ourselves; it is only too easy to be content with the program mes that the Regional O ffice and the individual countries have developed together. There is only one way to avoid complacency and ensure that we continuously learn fro m our own m istakes and ceaselessly work to improve our perform ­ ance. That tool is evaluation; an evaluation that includes not only the two partners involved in the planning o f the work, but also a more neutral, analytical and technically com petent third party that can provide a measure o f unbiased observation. To this end the Regional O ffice undertook, jo in tly with W HO headquarters and one o f the European M em ber States, a second"financia l audit in policy and program m e terms". This proved very positive indeed. As in any other endeavour, ive can o f course always improve our perform ance over tim e and with more experience, but I believe that n r already have the basic tool that we need fo r the routine evaluation o f W HO country programmes, both in the European Region and beyond. In m y view this k in d o f approach is a crucial safeguard in the continuous improvement o f W H O 's work at country level. J.E. Asvall Regional Director Par t i c ipan ts in the th i r t y -s eve n th sess ion of the Regiona l C om mi t te e , g a the re d in the c o u r t y a rd of The Hal le. Bruges . The Reg iona l D i rec to r . Dr J.E. Asval l , w e l c o m i n g the Se cre ta ry o f State fo r Publ ic Heal th and Po l i cy fo r the H a n d ic a p p e d , Be lg iu m , M r s W. De M e e s t e r - D e Meyer , to the th i r t y - seven th sess ion of the Reg ional C o m m i t te e . The o u t g o i n g Ch a i rman, Sir D o n a ld Ac h es o n , o p e n in g the th i r t y -se ve n th sess ion of the Regional C o m m i t t e e in The Hal le, Bruges. O f f i c e rs at the th i r t y -s e v e n th sess ion of the R eg iona l C o m m i t t e e . F rom left to r ight , P ro f ess or J. Szczerban (V ice -C ha i r ma n) , Mr s W. De M e e s t e r - D e M e ye r (Cha i rman) , Dr J.E. Asval l (Reg iona l D i rec to r ) , D r J . R o c h o n (D i r ec to r , P ro g r a m m e M a n a g e m e n t ) and M r J. D o n a ld (D irec to r , S u p p o r t P rogrammes) . Dr J. R o c h o n (left), p i c t u re d at the th i r t y -s e ve n th sess ion of the Regiona l C o m m i t te e , so o n af ter tak ing up his pos t as the ne w D i rec to r , P r o g r a m m e M a n a g e m e n t at the Reg iona l Of f ice. The t h e m e of the c e l e b r a t i o n of In te rna t io na l W o m e n ' s Day 1 9 8 7 in the Regiona l O f f i ce was the o u ts i d e in teres ts of the staf f . The c e le b r a t i on in c lu d e d bo th exh ib i t s and d e m o n ­ s t ra t ion s of arts, c raf t s and o th e r pe rso na l interests. As we l l as o r ga n iz in g the spor ts exhibi t . Grace T i r ado Perez is here seen d e m o n s t r a t i n g d ress ma k ing . P a r t i c i pa n ts in the m e e t in g of the C o n s u l t a t i v e G ro u p on P r o g r a m m e D e v e lo p m e n t , held at the Regiona l O f f i ce f r o m 2 1 to 2 4 Apr i l . 1Regional policy development, evaluation and programme management General programme management and development i l Many issues emana t ing from the seventy-ninth session ol the Executive Board and the Fort ieth World Heal th Assembly had impor tant implications for the work of the Regional Office throughout 1987. These were fur ther discussed at the thirty-seventh session of the Regional Commit tee , following pr ior detailed review by the Consultative G r o u p on Programme Development at its annual meeting in April. 1.2 The problems raised in the Director-Genera l ’s int roduct ion to the Organizat ion 's proposed p rogramme budget for 1988-1989 and the suggested solutions and measures for improvement , led to a thorough analysis of the present mechanisms and o p p o r ­ tunities for s t rengthening the relationships and links between headquar ters , the regional offices and countries. In general, both within W H O itself and at the Regional C o m ­ mittee, the issues raised provided real food for thought as to the management o f W H O ’s resources. The Member States conf irmed in general terms their acceptance of and satisfaction with the mechanisms established over the past few years in prog ramme budget planning, implementat ion and evaluat ion, using the regional p ro gr am me budget policies as a basis for these exercises. There was a need, however, for st reamlining and expanding some of the areas, particularly as regards the evaluat ion o f country and intercountry programmes. Initial steps are therefore being taken to improve the evalu­ a tion procedures o f both country and intercountrv programmes in keeping with existing mechanisms and methodologies, so as to submit concrete proposals to the thirty-eighth session of the Regional Commit tee in 1988. i l Dur ing the period under review work cont inued on s t rengthening the evaluation of the p rogramme of the Regional Office, and new indicators were devised to evaluate the col laborat ive activities developed with Member States. A small group met at the end of J un e to make recommendat ions on how best to report the results o f the evaluation to the Regional Committee. I 1.4 A second financial audi t in policy and p ro gr am me terms was performed in the European Region, where the use of W H O ’s resources in Hungary was reviewed against the adop ted policies, with a view to improving W H O technical cooperat ion. This was under taken jointly by the Regional Office, W H O headquar ters and the country con­ cerned, and the results proved highly positive. This type of audit aims at determining how and by whom decisions to use W H O ’s resources are arrived at, to what extent the joint g o v e r n m e n t /W H O activities comply with collective policies, and what those activities have achieved. The following issues are thus covered: the relevance o f the W H O collaborat ive p ro g ram me to country needs and policy compl iance: managerial f rame­ work; the adequacy, efficiency and effectiveness of the Organizat ion's support : and recommendations . 1.5 Work on a neu integrated managemen t information system (IMIS) was nearing complet ion at the end of the year, having been developed to assist management at all levels in the planning, programming, budget ing, implementat ion, moni tor ing and evalu­ at ion of the work of the Regional Office. It will cover the in tercountry program me as set out in the proposed p rogramme budget document with all its elements (i.e. targets, objectives, ou tpu ts and activities) including budget ing, votes and comments by Member States on the draft progr am me budget , and links to o ther organizat ions and p ro ­ grammes. It will also incorporate country medium-term programmes. It will produce project status informat ion, p rogramme moni tor ing notes and financial reports. 1.6 As regards the role of the Secretariat , and in view of the financial constra in ts that have necessitated implementa tion of the contingency plan, a comprehensive analysis of the staff functions at different organizat ional levels was carried out and a reorganization of the Regional Office s tructure in troduced as from 1 Jan u a ry 1988. Dur ing 1987, however, in orde r to maintain the level of programme delivery, several members of staff under took functions in addi tion to their own. Therefore, al though formal evaluat ion of the 1987 p ro gram me will not take place until later in 1988, it can be said now that the inputs to the main p ro gr am me thrus ts were implemented. In relation to this, special a t tent ion was paid to the horizontal approach to progr am me delivery, taking into account the necessary interplay am ong programmes in working towards the regional health for all (H F A ) targets, as well as the programme st ructures set out in the Eighth General Programme of Work adopted by the Fortieth World Health Assembly. 1.7 The progress in developing H F A policies t h ro ug ho ut the Region has indeed proved encouraging. Al though a number of countries are confronted with economic const raints, more and more Member States have genuinely taken up the challenge of actively bringing their long-term health development in line with the regional strategy and targets. In this connect ion, not only were the national health authori ties involved, but increasingly intergovernmental and nongovernmenta l organizations s tarted to join the movement, leading to new programmes at national or local levels. l.x The Regional Commit tee at its thirty-seventh session covered a wide range of topics, the major technical issues being: the AIDS situation in Europe and the proposed European activities to complement those of the global strategy, which the For t ieth World Heal th Assembly had adop ted in May 1987; the ques tion of health personnel development in support of H F A where three specific disciplines were discussed, i.e. public 2 health managers , doctors and nurses; and the action plan on tobacco, which places emphasis on the protect ion of non-smokers and the responsibility of health professionals and admin is t ra tors in setting an exemplary role, par ticularly at places of work and in all health-related institutions. I.y The Commit tee reques ted the Regional Director to ensure that , between the session of the Executive Board in Ja nua ry 19XX and the meeting of the Consultative G ro u p on Programme Development in April, the subject of the selection of the Regional Director be discussed in a regional context, so that proposals could be submitted to the thirty-eighth session of the Regional Committee. I.in The planning for the 1990-1991 p rogram me budget started in Jan u a ry 19X7 on the basis of the Regional Director ' s policy guidance, the regional contribution to the Eighth Genera l P rogramme of Work, the ou tcome of the internal evaluat ion exercise, and the restrictions imposed by the contingency plan. i n The draft p ro gr am me budget for 1990-1991 with projections up to 1995. the so-called "consul ta t ion letter” , was distributed to Member States in October. In view of the cont inued serious financial si tuation, it was decided not to convene the usual briefing seminar on the consul ta t ion letter and instead the document was d ist ributed earlier than usual, leaving Member States more than three months to collect and return their com men ts to the Office. This fulfils the request made at the Regional Commit tee in September , where it was pointed out that countries should be allowed sufficient time to give full considerat ion to the consul tat ion letter. 1.12 The 1990-1991 programme budget is the second to be prepared on the basis of the regional H F A targets and emphasis has this time been placed on four “ common delivery vehicles” , i.e. s timulat ing the interest of local administ rat ions and city councils in the Heal thy Cities project; promot ing the district health systems approach; using the C1ND1 approach to control ling noncommunicablc diseases; and suppor t ing countries interested in establishing national and subnat ional health policies. 1.13 In view of the present financial difficulties, the Consultative G ro u p on Pro­ gra mm e Development (CG PD), which met in Copenhagen in April , was asked to advise the Regional Director on mat ters that would normal ly have been submitted to the Regional Heal th Development Advisory Council . The C'GPD therefore gave advice on policy, financial and management issues such as the action plan on tobacco, manpower in suppor t of H F A , research for HI A, management of Wl lO's resources, and moni tor­ ing progress towards HEA. 114 The C G P D approved the content of the revised contingency plan, but found it regrettable that payment of contribut ions by countries in other regions was delayed, while the European Member States had always honoured their commitments. I 15 It had become clear that the Regional Office would have to mobilize extra- budgetary funds in order to implement the strategy as adopted, especially with regard to the urgent need for certain new programmes in response to ci rcumstances , such as AIDS. New sources of funds would also have to be found. The C’CiPD was generally favourable to that approach, but felt that caution should be exercised to preserve WH O 's 3 authori ty. Potential donors should be very carefully selected, and it was impor tant that donat ions be sought in areas that corresponded to the Office’s own priorities. 1 . 16 Specific proposals for improving W H O ’s public image were reviewed. The impor tance of making W H O better known through the media and the H F A policy was emphasized, especially in prepar ing for W H O ’s Fort ieth Anniversary in 1988. The C G P D felt tha t recognizable symbols, such as the regional H F A logo, should serve to make W H O bet ter known at the com muni ty level and am ong the general public. Reaching the latter on highly topical issues such as AID S and the consequences of nuclear accidents would show that W H O was actively dealing with these problems, which in turn would reassure the publ ic and give W H O the type of publicity it needed. Coordination with countries i n Increasing priority is given by W H O as a whole, and by the Regional Office in particular, to coopera tion with countries in their efforts to develop health policies and programmes in line with H F A principles. Similarly, interest by the European Member States in such coopera t ion has increased in the past few years. To suppor t this develop­ ment a post of Count ry P rogramme Coordinator , sup por ted by an administ rat ive assistant and a secretary, was created in the Regional Office as of the 1986-1987 p ro gram m e budget period, and the incumbent took up his functions in September 1987. 1.18 The Regional Director visited Albania, France, the G e rm an Democrat ic Re­ public, Hungary , Ireland, Israel, Norway, Poland and Spain for discussions with the nat ional health authori ties on H F A strategies and the development of nat ional health policies; Bulgaria to a ttend the European Conference on the Prevention and Control of Chronic N oncommun ica ble Diseases in Varna; Czechoslovakia to a t tend the Third European Regional Symposium of the In ternat ional Physicians for the Prevention of Nuclear War; France to discuss mat ters related to the thirty-ninth session of the Regional Commit tee in 1989, a health for all policy movement, and the likelihood of a second French city joining the Heal thy Cities project; the Federal Republic of Ge rm any to par ticipate in the opening ceremony of the European Congress on Heal thy Cities; Norway to join a roun d table conference on the future role of the medical doctor; Sweden to address the 10th General Assembly of ASPHER; Switzerland to a t tend the seminar “ The health of the Swiss by the year 2000: which cantonal policies?” ; the Union of Soviet Socialist Republics to have discussions with the Minister of Health of the USSR on the new nat ional health policy, and on mat ters of col laborat ion between the Office and the USSR; the Uni ted Kingdom to have discussions with the outgo ing Cha i rm an of the Regional Com mit tee on a nu mber of issues related to the thi rty-seventh session, and to discuss a special exhibit ion being prepared to celebrate the fortieth anniversary of WH O , which will include a special section on activities in the European Region; and the United States of America to par ticipate in a meet ing on the W H O Special P rogramme for Research on Aging. 1.19 Delegat ions from Spain visited the Regional Office on two occasions, first to receive a briefing on the work of the Regional Office, and to discuss the country medium-term programme, and again to discuss fur ther col laborat ion with W H O and the 4 development of a health policy in Spain. A briefing was ar ranged for a delegation from Wales, especially on the CIND1 and Healthy Cities projects. The Chief, Internat ional Organizat ions , Ministry of Heal th of Hungary visited the Regional Office to discuss col labora tive activities between the Regional Office and that country. A general briefing p ro gram me was ar ranged for a delegation from Czechoslovakia, and discussions with a San Marino delegation headed bv the Minister of Health included cooperat ive activities for 1988-1989. 1.20 In Jan uary , a mission from the Regional Office visited Italy to discuss priority mat ters to be included in the medium-term p ro g ram me of coopera t ion between that country and the Regional Office. A medium-term p ro gr am me between Turkey and the Regional Office was signed in April , with Yugoslavia in July, and with the G erm an Democrat ic Republic in September. A medium-term programme of cooperat ion be­ tween the Regional Office and Poland was initiated. 1.21 Dur ing the thirty-seventh session of the Regional Commit tee in Bruges, dis­ cussions were held with 17 delegations, i.e. those o f Albania, Bulgaria. Czechoslovakia, Finland, France, the G e rm an Democratic Republic, Greece, Hungary, Iceland, Israel. Mal ta, Norway, Poland. Portugal , Spain, Sweden and the USSR. 1.22 The second joint meet ing between representatives of the Regional Office and nat ional medical associat ions (NMAs) on H F A in Europe took place in Paris in November. This second meet ing was felt to be an even greater success than the first, held in Vienna in 1986, and all NM As considered that such joint meetings should take place every year. There was a real feeling of par tnership with WH O . and recognition of a surprising num ber of c om m on interests am ong the NMAs of the Region. Am ong the items discussed were AIDS, the role of physicians in epidemiological surveillance and risk assessment, and the European concerted action on tobacco. Various topics for future meetings were suggested over and above the cont inuing one o f informat ion exchange on the role of N M As and health policy decisions. In addi tion, three draft modules on “ tobacco or heal th" were presented to the NMAs; the participants expressed their suppor t of the texts, and commit ted themselves to making full use of the modules. Health information of the public 1.2.1 As recommended by the working group, comprising representatives of Member States and communica t ions experts, that met in Reykjavik in March 1986, simple written and audiovisual material on the regional H F A targets and the work o f the Regional Office cont inues to be issued. A brochure on the regional targets and a booklet on the Regional Office, both in English and French, and a travelling exhibit ion are now available. A newsletter, a slide series, an animated film and a video cassette are being prepared. Product ion of more specific written and audiovisual material on the Regional Office's various programmes has also begun. In addi tion, outside producers are cur­ rently working on four series of television programmes on health for all in general and more specifically on the C IN D I and Healthy Cities projects; while the producers retain full responsibility for the products , the Office has st imulated their creation and offers free technical advice. 5 1.24 Intensive long-term efforts appear to be succeeding in interesting the press in the Regional Office’s HFA-rela ted activities. The Regional Office is now clearly better known and its messages more widely d isseminated by press agencies and the media. Al though it is difficult to give an accurate evaluat ion of the results of this work, it is clear that the press increasingly see the Regional Office as an interesting source of informat ion, and many journal ists now check their material with this source. Anothe r indicator o f the success of this approach is the increasing nu mber of articles, radio broadcasts and television programmes that refer to the Regional Office’s research work and other activities. The series of television programmes currently being made will also encourage the media to mobilize themselves in this way. 1.25 Since the Organ iza t ion’s s taff are the principal spokesmen for the campaign, their mobi lizat ion is essential to its success. Meetings with “ communica to rs” , jou rn a l ­ ists, advert ising executives and public relations specialists are therefore organized at regular intervals, to make Regional Office staff more aware and better informed. 1.26 A num ber o f special activities were carried out in prepara t ion for the celebration of W H O ’s For t ieth Anniversary in 1988. Writ ten and visual material related to the work of W H O produ ced bv national bodies was collected with a view to deciding how it might best be used to explain the H F A strategy to people at all levels in the community, including children. National bodies were also encouraged to produce material in their own languages p romot ing the strategy. New contacts were established in radio and television with a view to making programmes promot ing W H O in ways that would reach a wider and more general audience. Considerat ion was also given to new ways of delivering the H F A message, and popu lar texts and designs were prepared for posters, postcards, T-shirts, leaflets and other items. 1.27 World Heal th Day 1987 was celebrated in several countries of the Region. It offered the oppor tuni ty to invite journalis ts and representatives of nongovernmental organizations to par ticipate in the celebrat ion in the Regional Office. Experts gave presentat ions on the theme: “ Immunizat ion: a chance for every chi ld” . Support programmes Personnel i.2« The implementa tion o f the cont ingency plan has led to a comprehensive review of all p rogramme s and staff posit ions in the Regional Office. The main objective has been to ensure tha t the reduced funds available to the Office are appl ied to the main priorities of the H F A movement. In addi tion, the contingency plan has had to respect the contracts of all long-term serving staff, thus avoiding forced terminat ions . Nevertheless, to mai n ­ tain staff morale a great deal of time and effort have to be applied on a daily basis in the implementat ion of the plan. 1.29 Durin g the per iod under review the post o f Project Officer for Environmental Epidemiology and Food Safety was established for a limited period of two years, with s imultaneous abol it ion of the post of Regional Officer for Occupat ional Health. It is expected that the post of Regional Officer for Occupat ional Heal th will be re-established 6 in 1989. The post of Project C oord inato r for Air Quali ty Guidel ines was abolished. A post of Responsible Officer, Official Documen ts and Texts was established by simul­ taneous abol it ion of the post of Chief, Trans la t ion and Editorial. A post of Programme Analyst , Informat ics Suppor t was established by s imultaneous abolit ion of a post in the general service category. T w o interregional posts o f Medical Officer an d Health Edu­ cation Specialist, Special P rogramme on A ID S were established; the posts are funded by W H O headquar ters but are based in Copenhagen. 1.30 The propor t ion of professional and higher grade posts held by women continued to grow and had reached 279r by the end of the year. This is the highest propor t ion in the Organ izat ion at present, and is close to the target of 30% set by the Executive Board. Women represented 80cZc o f general service staff. 1.31 Al though the field post in Morocco was transferred to the Eastern Mediter ranean Region in 1986, the Regional Office for Europe cont inued to look after technical and administ rat ive mat ters concerning UNDP-ass isted projects in Morocco up to the end of 1987. General administration and services 1.32 Fol lowing discussions at the Consultative G ro u p on Programme Development , as reported above, a systematic fund-raising effort was put into effect. Valuable contacts have since been established in several countries of the Region, where plans are in hand for fur ther consul tat ion with potential donors. These activities place special emphasis on the act ion plan on tobacco, the Heal thy Cities project, the health manpow er development pr og ram me and the C IN D I project. 1.33 Addi tional economies were achieved by using a new form of postal service, involving direct mail through a commercial dist ribution company, which gave a saving of abou t 25%. 1.34 A reduct ion of some US $100 000 in maintenance costs for data and text process­ ing equipment resulted from negotiations with the com pany concerned. 1.35 A gradual phas ing out of tobacco smoking on Regional Office premises came into effect on 1 April , following consul tat ions between staff and the Occupat ional Heal th and Health P romot ion committees. A num ber of smoking cessation workshops were organized, and by the end o f the year a survey showed that 75°Z o f s taff who had previously smoked had s topped or reduced their consumpt ion. As from 1 J a n u a ry 1988 the Office will have a smoke-free environment with the exception o f one specially designated room. Budget and finance 1.36 In connection with the total expected shortfall in income arising from the reduced receipt o f assessed contribut ions in 1986-1987 the Director-Genera l , after revising the original estimates of the implications, was obliged to reduce the regional regular budget al location by a fur ther US$250 000 in 1987. Over the biennium the reduct ion thus amou nted to US$2 329 000. If the Regional Office had also had to 7 compensate for the adverse effects of currency fluctuations arising from the continued do w nw ard t rend of the US dol lar, this would have resulted in a total reduct ion of approximate ly US $8 million. Had this si tuation occurred, the repercussions arising from the non- implementa t ion of the p ro g ram me would have been irreparable. Only through the adopt ion o f resolution WH A39 .4 by the World Heal th Assembly in May 1986, which al lowed the Director-Genera l to extend to the regional offices an ar rangement for the use of casual income to reduce the adverse effects of currency fluctuations, was this dramat ic si tuat ion avoided. Thus the Regional Office, through the central control system operated globally, received full compensat ion for currency fluctuations during 1986-1987. Regular budget (biennial) 1.37 Under this heading, US$31 596 843 were expended during the b iennium, rep­ resenting 83.1% of total expenditure. Extrabudgetary sources United Nations fu n d s (annual) 1.38 The Regional Office was the executing agency for a num ber of U N D P , U N E P and U N F P A projects. A total of US $ 1 383 742 was expended in 1986 and US $1 926 366 in 1987, a m oun t ing to 8.7% of total expenditure for the biennium. These funds covered 61 country and intercountry projects in the Region. Other fu n d s (biennial) 1.39 These funds include the Voluntary Fund for Health Promot ion, Funds-in-Trust , the Special Account for Servicing Costs and the Real Estate Fund. A total of US $3 115 211 was expended under these headings during the biennium, representing 8.2% of total expenditure. Many Member States also provided considerable assistance by covering the local costs of W H O meetings and the costs of at tendance by national experts at meetings abroad. Col laborat ion by institutes in Member States in the Regional Office’s research p rogramme is another form of assistance not easily expressed in monetary terms. A breakdown by source of voluntary contribut ions received in 1987 is shown in Table 1. Staff development and training 1.40 The post of Staff Development and Training Officer remained frozen for the whole of 1987 and the duties were assumed by the Personnel Officer, whose workload was consequently increased since there was no reduction whatsoever in programme activities. 1.41 Five new internationally recruited staff of the Regional Office a t tended briefing sessions at W H O headquar ters in 1987. A briefing p rogramme has been designed for all new locally recruited staff. About 90 people took in-house language tuition in the four official languages (English, French, G erm an , Russian); 24 sat for the United Nations language proficiency examinations and 20 were successful. 8 Table 1. V o lu n t a r y c o n t r ib u t io n s , in c l u d in g Funds- rece ived d u r i n g 1 9 8 7 (US $) in-T rust. A u s t r i a 1 4 6 9 8 2 B e l g i u m 8 6 0 9 D e n m a r k 4 9 2 0 2 F i n l a n d 1 6 5 0 9 Fr a n c e 4 8 9 2 3 G e r m a n y , F e d e r a l R e p u b l i c of 2 4 9 6 7 2 I taly 1 0 1 7 0 N e t h e r l a n d s 1 7 2 0 0 1 N o r w a y 4 1 0 0 8 S p a m 4 9 1 5 5 S w e d e n 1 8 3 4 4 S w i t z e r l a n d 2 6 1 4 3 7 C e n t r e n a t i o n a l d es é q u i p e m e n t s h o s p i t a l i e r s , Par is 3 0 9 3 5 D a n i s h W e l d i n g I n s t i t u t e 4 6 4 9 9 E u r o p e a n C o m m i t t e e f o r C l i n i c a l L a b o r a t o r y S t a n d a r d s 1 5 6 4 2 I n s t i t u t e o f S e l f - c a r e R es e a r c h . M a a s t r i c h t 2 3 7 1 9 O t h e r s 6 0 9 1 1 8 9 4 1 6 1.42 The group training programme included courses, workshops and briefing sessions for a lmost all staff. Topics included AIDS; smoking cessation; talks enti t led “ C o m ­ municate with the com mun icato rs ” ; Regional Office information systems; audiovisual presentat ion techniques; chi ldren’s surroundings and their health implications; tele­ communica t ions ; informat ics and its implementat ion in the Regional Office; health for all development in countries; adjustment to international life; creative problem solving; and health economics. An innovat ion this year was to invite family members to a t tend some of the sessions. 1.4.4 The t raining courses on presentat ion techniques continue to be a subject of great interest to staff, as well as the courses entitled “ C om pute r awareness” which are held to familiarize staff with the various informat ion systems available in the Office. Publications 1.44 A new Publications Commit tee, in line with the recommendat ions of the Global P rogramme Commit tee study on W H O ’s publ icat ions policy, was established in the Regional Office. The Commit tee meets every second month to review publ icat ion proposals , to examine and comment on publ icat ion plans, and periodically to review progress in the publ icat ions programme. 9 1.45 Th e following new books in English were issued or sent to press: W H O Regional Publicat ions, European Series, No. 21 on Nuclear power: accidental releases — practical guidance fo r public health action, No. 22 on M easurem ent in health prom otion and protection, and No. 23 on A ir quality guidelines fo r Europe; and E U R O Repor ts and Studies No. 105 on M ycotic diseases in Europe. 1.46 Five non-serial publ icat ions were issued: Drugs fo r children, Nursing care — sum m ary o f a European study. M ental health services in pilot study areas. People’s needs fo r nursing care, and A ID S diagnosis and control: current situation. 1.47 Th e 1987 edi tion of Vaccination certificate requirements and health advice foi- international travel was publ ished in German . i.4x Twenty-seven t rans la t ions o f publ ica t ions were also issued or sent to press: eight in French (E uropean Series No. 9, 17, 18 and 19, Public Health in Europe No. 23 and 24, and the two non-serial pub l ica t ions Drugs fo r the elderly and Volume 5 o f the Seventh report on the world health situa tion ); seven in G e r m a n (E uropean Series No. 9 and 18, Public Heal th in E urope No. 21 and 26, and E U R O Reports and Studies No. 97, 100 an d 102) and nine in Russian (Publ ic Health in Europe No. 21 and 26, and E U R O Repor ts and Studies No. 57, 78, 81, 90, 95, 97 and 102). The non-serial publ i ­ ca tion A ID S diagnosis and control: current situation was issued in French, G e r m a n and Russian. 1.49 Th e value o f publicat ions sold th rough W H O headquar ters and its global net ­ work of sales agents in 1987 was Sw.fr. 278 535. This represents a 13% decrease compared with 1986. More than 2100 requests for documents and free copies of publ icat ions were received. 1.50 Al though the post of Publicat ions Promot ion Officer remained frozen for the whole of 1987, a t tempts were made to increase the quant i ty and quali ty o f leaflets promot ing Regional Office publ icat ions, and addi t ional promot ional material was made available at meetings. The dist ribution of promot ional leaflets was improved by in­ cluding them in all envelopes leaving the Office, provided this did not increase the postage cost. Selected journals now receive a compl iment slip with Regional Office publ icat ions asking them to review the book, and others are sent leaflets together with a preprin ted postcard encouraging them to request a copy of the publ icat ion should they wish to review it. 1.51 In ad d i t ion to the 28 t rans la t ions of Regional Office publ ica t ions o r d o c u ­ ments into non -w or king languages produced during the year, 31 new t rans lat ions were authorized. 1 .52 Negot iat ions were finalized with a television company for a programme based on the books Targets fo r health fo r all and H ealth crisis 2000. 1. 5.1 Besides publ icat ions proper, docum enta t ion issued dur ing the year included the Environmenta l Heal th Series, fur ther described in Chap ter 4, and several newsletters reflecting the work in various p rogr amme areas. 10 Epidemiology and statistics 1.54 Several Member States have developed statements of policy along lines inspired by their participation in the H F A evaluat ion. In the long run, a corollary of this development should be the adapta t ion o f nat ional health informat ion systems to provide more appropr ia te answers to the quest ions raised by HFA. 1.55 The set o f indicators developed for the H F A evaluat ion was revised, and ap­ proved by the Regional Com mit tee at its thi rty-seventh session, to be used by Member States for the regional and country moni tor ing exercise in 1987-1988. The development of an appropr ia te dat a base to suppor t H F A informat ion will permit a better and more detai led analysis of H F A progress. Once tested, it is expected to become available progressively th rough ou t the Region, providing Member States with sets o f data on both historical and current trends in the a t tainment o f the H F A targets. 1.56 Informat ion received in the course of evaluation and monitor ing has been closely integrated with o ther information tools such as country and target profiles, and with opera t ional tools such as the medium-term programmes developed jointly with Member States. R E G I O N A L P O L I C Y D E V E L O P M E N T , E V A L U A T I O N A N D P R O G R A M M E M A N A G E M E N T Publications issued in 1987 Abelin, T. et al., ed. M easurem ent in health prom otion and protection. W H O Regional Publications, European Series, No. 22. Documents issued in 1987 Health fo r all in Europe: report on a jo int meet ing between W H O and nat ional medical associations (document I C P / E X M 016). Health fo r all prom otional campaign: report on a W H O meeting (document I C P / I E H OOl/mOl). H ealth fo r all by the year 2000: report on the Four th European Seminar for Leading Public Heal th Adminis tra tors (document I C P / E X M 015/Rev. 1 ). 11 2Health for all in Europe by the year 2000 2.1 The achievement of equity in health, exploi tat ion of the individual’s potential for a healthy life, the reduct ion of disease, disability and death rates, and the control of specific condit ions represent the major concerns of the first 12 regional H F A targets. These targets are directed towards seeking solutions to these problems, even though they require action in all elements of the regional strategy. The first three deal with equity, enhancing people’s ability to exploit their own potential for healthy living, and the provision o f better opportuni t ies for the disabled. Targets 4 and 5 concentrate on reducing disease and disability, while the remaining seven aim at cut ting down mortali ty due to different causes o r in specific groups (targets 7-12) or reducing the combined effect of all causes as measured by life expectancy (target 6). 2.2 One of the main events in 1987 was the European Conference on the Prevention and Cont rol of Chronic Noncomm un icab le Diseases, held in Varna , Bulgaria f rom 26 to 30 October . The Conference repeatedly stressed that to a large extent the major n on­ communicable diseases share the same risk factors and risk behaviour, and noted with satisfaction the favourable reports on the feasibility, acceptance and rapid development o f the countrywide integrated noncommunicab le diseases intervention ( C IN D I) p ro ­ gr amm e in the European Region. The most impor tan t message f rom the Conference was agreement on the direct link between the intensity and consistency of preventive efforts and the results achieved. In this context, it should be emphasized that most of the technical units in the Regional Office concentra te mainly on the implementa tion of mul tisectoral preventive strategies, closely integrated with the programmes on lifestyle intervention and health promot ion. This app ro ach is particularly visible in the p ro ­ gra mmes on communicable diseases, chronic diseases, cancer, oral health, mental health, maternal and child health and health o f the elderly. 2.3 Dur ing the year, the C om mun ica b le Diseases unit was charged with developing a p ro g ram me specifically related to the acquired immunodeficiency syndrome (AIDS) pandemic . This p ro g ram m e will eventually emerge as a team of two professionals with par t icular responsibility for: — s t rengthening surveil lance on infection with hum an immunodef ic iency virus (HIV) in the Region; 13 — developing approaches to facilitate and improve medical care at the initial and terminal stages of the disease; — developing prevent ion th rough informat ion campaigns on changing sexual be­ haviour, screening of blood and blood products, etc.; — s tudying par ticular aspects of HIV transmission in some pilot countries of the Region. 2.4 The World Conference on Chemical Accidents, held in Rome in July, proposed the development o f communi ty , country and international programmes based on identi­ fication of hazards , accident prevent ion systems, risk assessment and emergency re­ sponse planning, through a multidisciplinary approach and communi ty involvement. 2.5 As regards disaster preparedness, recent man-made disasters and major accidents in Europe and their t ransboundary nature have led to a shift of emphasis to communi ty preparedness and the inclusion o f all types of disaster in one overall plan. Target 1 SO 2.6 A num ber of Member States and nat ional organizat ions have expressed an interest in p romot ing fur ther activities related to the health of refugees and victims of violence, and financial suppor t has been received from Denmark and the Netherlands. The book H ealth hazards o f organized violence was publ ished in col laborat ion with the Minist ry of Welfare, Heal th and Cul tural Affairs of the Nether lands . In J anu a ry , the book M igration and health: towards an understanding o f the health care needs o f ethnic minorities was launched at the House of Lords in the United Kingdom. 2.7 The results of the study on the health effects of long-term unemployment in selected countries, coordinated by the W H O col laborat ing centre for research on social equi ty and health in Dubl in, were discussed at a meeting held in Baden-bei -Wien, Austria in May. The meeting recommended that study of the subject be cont inued, bearing in mind that unemployment is the one extreme and full-time work the other. Issues related to the “ black” economy and to overemployment and underemployment were also discussed. The proposal to establish problem-specific working groups was implemented. Th e book Unemployment, social vulnerability and health in Europe, written in col laborat ion with the M E D IS Insti tute in Munich, Federal Republic of G e rm any (a W H O col labora t ing centre for health p lanning and economics) was publ ished by Springer-Verlag. 2.x Twenty-five country profiles on social inequity in health were presented at a meet ing hosted by the Ministry of Heal th and organized by the School o f Public Heal th, 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. 14 Portugal ; this meeting was held at the Gulbenk ian Found at ion in Lisbon in September . The country profiles are to be issued in book form in 1988. 2.9 Under the medium-term programme with Greece, col laborat ion cont inued with the Inst itute of Chi ld Heal th , Athens in relation to the promot ion o f research on social inequalities. 2.10 As proposed in the medium-term programmes of coopera tion with Israel, Italy, Mal ta, Portugal and Y ugoslavia, there was close col laborat ion in the study o f systems for collecting data and assessing inequities due to geographical, social and cultural factors, and also with regard to studies on the health problems o f d isadvantaged groups. Target 2 SO The elderly 2 . 1 1 Al though target 2 concerns all age groups, the main emphasis was on the health of the elderly and the fostering of social policies that will help them to maintain and develop their health potential. Most European Member States need suppor t in the development of appropr ia t e services so that the elderly may fully use and enjoy their mental and physical capabilities. 2 .12 The balance between institutional and communi ty-based care for the elderly seems to have been a priori ty topic in 1987 in most countries o f Europe. There is un an im ous agreement tha t well designed, communi ty-based care might help to maintain more than 95% o f elderly people in their homes. It was felt that deeper insight was needed into developments in “ small a reas” (i.e. those with approximate ly 150000 popula t ion under local government adminis t ra t ion) with regard to demography , geography and the hum an , institutional and financial resources available for the elderly. This deeper insight has to be suppor t ed by appr opr ia t e tools tha t will permit assessment of functional capacit ies, assessment o f the social and physical environments , and the creat ion of healthier public policies. 2.13 The following activities contr ibuted towards dealing with this issue. — A Consul ta t ion on Small Area (District) Planning in Care of the Elderly was held in the Regional Office in June, and this was followed by a panel discussion on the cont inui ty of care for the elderly, organized within the first multidisciplinary meet ing of the Europe an Section o f the Internat ional Association o f G e ro n ­ tology in Brighton, Uni ted Kingdom in September . — The mul tidimensional functional assessment o f the elderly was discussed at a meeting in G o th en b u r g in May. By the year 2000, people should have the basic oppor­ tunity to develop and use their health potential to live socially and economically fulfilling lives. 15 — Guidel ines on housing for the elderly and the disabled are being prepared in col labora t ion with Liverpool Polytechnic in the Uni ted Kingdom. The first draft was discussed in detail at the seminar “ Creat ing non-hand icapping environ­ ments — renewal of inner cities” organized by the In ternat ional Counci l for Building Research in Prague, in October. — Th e second analysis of data generated by the 11-country study on the medical and social condi t ions of the elderly was discussed in Athens in March. A manuscr ip t providing a detailed analysis of data on functional capacities and health, lifestyles and use of services in Belgrade, Berlin (West), Kiev, Florence, Tampere and rural Greece was received in September. 2.14 These developments at in tercountry level were reflected in country programmes, with the main emphasis on improved home care of the elderly. Activities were begun in Czechoslovakia (Ostrava), Portugal (Lisbon) and Yugoslavia (Ljubljana). The global p rogramme is described in Chap te r 7. Target 3 SO Health legislation 2.15 The Health Legislation unit cont inued to advocate improvements in health and social legislation for the disabled. The report on the study entitled “ Heal th and equity for the disabled — legislation for ac t ion” is in the final stages of prepara t ion and the nongovernmenta l organizat ion Rehabi li tat ion Internat ional publ ished a summary of the findings in its j ournal International rehabilitation review. This journal has since been provided free o f charge to the ten E uro pe an Mem ber States tha t expressed interest in receiving it regularly. Plans were also made to draw on the European experience in disabil ity-related legislation with a view to contr ibut ing to the next World Congress of Rehabil i tat ion International , since most o f the observat ions derived f rom the European study ap pear to be of worldwide relevance. Community-based rehabilitation 2.16 Th e regional p ro g ram me for the disabled at tracted special interest from the European M em ber States in 1987, which was the year of the midpoint evaluat ion of the Uni ted Nat ions Decade of Disabled Persons (1983-1992). Gove rnm ent s have been encouraged to develop mechanisms for solving the problems of disabled people by creat ing oppor tuni t ies for their par t ic ipation in everyday life, by reorientat ing rehabil i­ tat ion services towards communi ty-based activities, and by giving more considerat ion to health promot ion. 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. 16 2.17 Th e issues of family involvement in the rehabi li tat ion process and suppor t to the informal provider of care were discussed at the Consul ta tion on Family Involvement in Rehabi li tat ion, held in Copenhagen in July. Environmental assessments were seen as equally important . A contrac t was offered to Liverpool Polytechnic to develop a simple checklist of ques tions relevant to housing disabled persons. This checklist was discussed in detail in the seminar “ Creat ing non-handicapp ing environments — renewal of inner cities” , held in Prague in Oc tober (see paragraph 2.13). 2 .in Th e Regional Officer for the Elderly, Disabil i ty and Rehabi li tat ion and the Act ing Director, P rogramme Managem ent par ticipated in evaluat ion meetings at the midpoint of the Uni ted Nat ions Decade of Disabled Persons (1983-1992) in Yugoslavia in March (Eu ro pean evaluation) and in Sweden in August (global evaluation). Working contacts were established with nongovernmenta l organizat ions for disabled people. 2 .19 These intercountry activities were reflected in country programmes in Czecho­ slovakia, the G e rm an Democrat ic Republic, Hungary , Portugal and Yugoslavia aiming at communi ty-based care of disabled persons. Target 4 8 0 Disability prevention 2.20 A study on measures and technologies for prevent ing or reducing sensory and locomotor impairments, disabilities and handicaps in chi ldhood is being carried out by the Postgraduate Medical Institute, Prague. The first international review of the study too k place in J anu a ry , when the scope of preventive examinat ions of children at birth, at 8 and 12 months, at 3 years and at 5 years was discussed. Genetics services 2.21 A survey o f genetics services in the Region was carried out by two tem porary advisers, one from the USSR and one from the Uni ted Kingdom. A small consultat ion was held in the USSR to fo rmulate the final report . The Regional Officer for Maternal and Chi ld Health col labora ted with a group of experts on haemoglobinopathies , and a repor t on haemoglobinopathies in Europe will be issued by the Regional Office. The Office is commissioning papers on key issues in genetics, including the legal, ethical, social and cost -benefi t aspects, to fur ther evaluate genetics services in the Region. Rheumatism 2.22 In 1987, the Chronic Diseases unit continued its col laborat ion with the European League Against Rheumat ism (EULAR). Close links were established with its Standing Commit tees on Educat ion and on Epidemiology. By the year 2000, the average number o f years that people live free from major disease and disability should be increased by at least 10%. 17 2.23 In July the Regional Office co-sponsored the E U L A R seminar “ Curr iculum in rheumatology for medical s tudents” , held in Vouligemeni in Greece, at which the current si tuat ion in the teaching o f rheumatology was discussed. Th e impor tance o f all three levels (pr imary, secondary and tert iary) of health care in the control and prevent ion of rheumat ic diseases was stressed. Futu re col laborat ion between the Regional Office and E U L A R includes p repara t ion o f guidelines on the teaching of rheumatology, with emphasis on pr imary health care and an integrated appro ach to the control and m an ­ agement of the chronic diseases. Mental health 2.24 Th e Regional Officer for Mental Heal th a t tended the first meeting organized by the Counci l of Europe on Europe an coopera t ion in epidemiological studies in mental health. Th e meet ing agreed on the updat ing of available informat ion on epidemiological studies and research relating to mental health services in the mem ber states of the Counci l of Europe, as well as the development of concerted European programmes in the field o f psychiat ric epidemiology and research. The terms of reference of a study group were adop ted . T he s tudy group approved a ques tionnaire prepared by the s tudy direc tor and agreed on a plan of work. 2.25 Th e Regional Officer for Mental Health a t tended a symposium on the epidemi­ ology and the prevent ion of mental disorder, held in Reykjavik in September and organized by the Sect ion o f Epidemiology and C o m m u n i ty Psychiatry of the World Psychiatric Association. This event provided an oppor tuni ty for discussions with those responsible for the Section, as well as with leading researchers in psychiatric epidemi­ ology, to s trengthen col labora t ion in the field of prevent ing mental , neurological and psychosocial disorders. 2.26 In May, the Regional Officer a t tended a workshop on the interaction between mental and physical illness, hosted by the University Hospi tal , Depar tment of Psy­ chiatry, Lund , Sweden and organized under the auspices o f the Eu rope an Medical Research Counci ls. Th e meet ing reviewed and defined the main areas of research that were needed on the interaction between mental and physical illness. Special a t tent ion was paid to the appl ication of research data to teaching and the development of services. 2.27 Within the context of its activities on child mental health and psychosocial development , the Regional Office sponsored the Second Invitational Meeting o f the Europe an Chi ld Psychiat ri sts’ Research G r o u p , held in Utrecht in June. This meeting was a direct fo llow-up to the W ork in g G r o u p on Child Mental Health and Psychosocial Development, held in Copenhagen in Ju n e 1985, and focused on methods of measur ing individual chi ld/adolescent behaviour. 2.28 Th e Regional Officer for Mental Heal th par t ic ipated in the Eighth Congress of the European Society of Chi ld and Adolescent Psychiatry in Varna, Bulgaria in Sep­ tember. This meeting provided an oppor tuni ty for st rengthening col laborat ion between the Society and the Regional Office in the field of child mental health. 18 2.29 In the context of the medium-term p ro g r am m e of col labora t ion between the G ove rn m en t of Turkey and the Regional Office, a nat ional workshop on mental health was organized in June. 2.30 As par t of the country mental health prog ramme, the Regional Officer for Menta l Health visited Greece in Oc tober to give technical suppor t to the Central Heal th Counci l (KESY) Standing Commit tee on Mental Heal th, to evaluate the 1986-1987 country medium-term progr am me, and to review the progress achieved by the mental health reform initiated with the new health legislation put forward in 1984. 2.31 A contrac tual agreement was established with the W H O col laborat ing centre for research and t raining in mental health in Groningen, Netherlands for the prepara t ion of a classification of services providing mental health care. The Office also sponsored the par t icipation of two tempora ry advisers from Ireland and Portugal at a consul tat ion on mental health informat ion suppor t to comprehensive health programmes, organized by the Mental Heal th Division in W H O headquarters. 2.32 The Office was represented at a symposium on peripheral neuropathies , organ­ ized by the W H O col laborat ing centre for research and training in neurosciences, Milan, and held in Geneva in August . Dur ing this meeting contacts were established for future col laborat ion in the field of prevent ion o f neurological disorders. 2.33 The Regional Office sponsored a workshop on the rights of the elderly with mental disorders, organized by the Mental Welfare Commission for Scot land in Edin­ burgh in October. The report of the meeting will be used by the Office in developing guidelines on policies and legislation concerning the elderly with mental disorders. 2.34 The repor t o f the Work ing G r o u p on Mental Heal th Services in the Southern Countries o f the European Region, held in May 1986, was finalized. This report describes the experiences o f several southern countries of the European Region in formulat ing and implement ing their mental health policies. 2.35 The country p ro g ram me on mental health in Portugal suppor t ed a meeting on the implementat ion of the nat ional mental health programme. This meeting was organ­ ized in November by the General Directorate o f Primary Heal th Care , and reviewed ways of harmoniz ing policies and programmes in mental health at central , regional and local levels. The Regional Office engaged an expert to provide technical assistance for the development of mental health programmes in primary care settings. Also, the Office suppor t ed activities in the fields o f child mental health and mental health informat ion systems, mainly through the work of experts who visited the country in December. 2.36 The book M ental health services in pilot study areas: report on a European study was published in September . This publ icat ion provides a comprehensive picture of the present state of mental health services in the European Region, and should encourage health workers and adminis tra tors to establish reliable informat ion systems or to improve those that al ready exist. 2.37 The pre liminary repor t on the study on psychiatric services under condi tions of security was received, and prepara t ions are under way for the publicat ion of the final text. The work, carried out by a group o f experts in forensic psychiat ry from six 19 Europe an countries, const itutes a major contr ibut ion to epidemiological forensic psy­ chiatry, as well as to the p lanning of cost-effective forensic psychiatric services in line with the principles of hum an rights. Communicable diseases 2.38 D ur ing the year, further coopera t ion with the Counci l of Europe, the United Nations Economic Commiss ion for Europe, the Nordic Counci l, W H O col laborat ing centres and nongovernmen ta l organizations was achieved th rough joint organization or co-sponsorship of European meetings and conferences, such as those on AIDS, legion­ ellosis, Lyme disease and rickettsioses. Acute respiratory infections 2.39 Over 90% of acute respiratory infections (ARI) in Europe are caused by viruses and f rom 10% to 35% of all pneumonias are due to pneumococci . Reviews on the magni tude of the problem were presented to the technical advisory grou p on ARI, in Geneva in March, and to the Senior Level Seminar on the Expanded Programme on Immuniza t ion , the Control of Diarrhoeal Diseases, and Acute Respiratory Infections and Control Programmes in Moscow in May. Acquired immunodeficiency syndrome (AIDS) 2.40 A meet ing on A ID S Diagnosis and Control , with the financial supp or t of the G ove rn men t o f the Federal Republ ic o f Ge rmany, took place in Munich in March. Par t icipants from Member States reviewed the epidemic, shared their experience in A ID S control , and drew conclus ions regarding surveillance, health education, infor­ mat ion, legislation and the safety o f b lood and other biologicals. 2.41 Other useful consul tat ions took place during the per iod under review, including those on A ID S and the newborn (Copenhagen, April), on the role o f health educat ion in AIDS prevent ion (Cologne, October) and on AIDS scenarios (Kiel, November). 2.42 The Regional Commit tee, at its thirty-sixth and thirty-seventh sessions, endorsed proposals for regional AID S conta inment activities. Together with the global Special P rogramme on AIDS, a new regional p ro g ram me on AID S control was prepared in July; an initial assessment o f the A ID S epidemic was made in Iceland in June, and in Albania and Greece in August. 2.43 D a ta on AIDS in Europe cont inued to be collected, analysed and publ ished every three mon ths by the W H O col labora t ing centre for A ID S in Paris. The epidemic si tuation and approaches to the control of HIV infection were published both by the Regional Office and by various journals. 2.44 By the end o f 1987 over 10 000 cases of AID S had been reported by European Member States. According to different est imates the num ber of AIDS cases in Europe may reach over 30 000 by 1991 and the n um ber of infected people will range between 1.5 and 3 million. Fur ther political and financial commitmen ts were made by European governments in order to control the epidemic. 20 245 F o l l o w i n g a p r o p o s a l by the R e g io n a l Off i ce , all E u r o p e a n M e m b e r S ta te s f o r m e d spe c ia l c o m m i t t e e s o n A I D S a n d in i t i a t e d h e a l t h e d u c a t i o n ac t iv i t i e s , t h r o u g h h e a l t h a n d o t h e r s e c to r s (e.g. e d u c a t i o n ) a s wel l as t h r o u g h o t h e r g o v e r n m e n t a l a n d n o n g o v e r n m e n t a l o r g a n i z a t i o n s . A n ess en t i a l p a r t o f this w o r k is c o n d u c t e d by the L e a g u e o f R e d C r o s s a n d R e d C r e s c e n t Socie t i e s , A I D S Hil fe, m e d ic a l a s s o c i a t i o n s a n d o t h e r o r g a n i z a t i o n s . B e t t e r c o o r d i n a t i o n o f all t h es e e f fo r t s is n e e d e d a t r eg io n a l level, w i th the R e g io n a l Off i ce as foca l po in t . 2.46 As a c o n t r i b u t i o n to th e M e e t i n g o n A I D S D i a g n o s i s a n d C o n t r o l in M u n i c h , the R e g i o n a l O f f i c e r f o r S e x u a l i t y a n d F a m i l y P l a n n i n g p r e p a r e d a p a p e r o n “ T h e ro le o f f am i l y p l a n n i n g in A I D S c o n t a i n m e n t ” a n d th e R e g io n a l O f f i ce r f o r H e a l t h Leg i s l a t i on p r e p a r e d a r ev ie w p a p e r e n t i t l e d “ A I D S : l eg is l a t ive m e a s u r e s a n d e t h ic a l i s su es” . T h e l a t t e r p a p e r fi rs t g ives a n o v e r v i e w o f th e l egi s l a t ive a c t i o n t a k e n to p r e v e n t th e s p r e a d o f t h e A I D S e p i d e m i c , b a s e d o n m e a s u r e s t a k e n m a i n l y o v e r the p a s t 3 - 4 yea r s . S e c o n d , the e t h ic a l i m p l i c a t i o n s o f th i s ne w , r a t h e r s u d d e n a n d c o m p l e x m é d i c o s o c i a l p r o b l e m a re c o n s i d e r e d . 2.47 O n e o u t c o m e o f th e M u n i c h m e e t i n g w as a r e c o m m e n d a t i o n t h a t the Re g io na l O f f i ce s h o u l d o r g a n i z e a m e e t i n g to e x a m i n e th e i s sues o f h e a l t h l e g i s l a t io n a n d e t h ic s in A I D S a n d H I V i n f e c t i o n . T h e N o r w e g i a n G o v e r n m e n t h a s t a k e n t h e in i t i a t i ve o f h o s t i n g a n d f i n a n c i n g su c h a m e e t i n g in c o l l a b o r a t i o n wi th th e R e g io n a l Off ice. T w o p r e p a r a t o r y m e e t i n g s t o o k p la c e in C o p e n h a g e n in O c t o b e r a n d N o v e m b e r w i th o f ­ f ici als f r o m th e N o r w e g i a n D i r e c t o r a t e o f H e a l t h . T h e r e will be c lose c o o p e r a t i o n wi th t h e g l o b a l Sp ec i a l P r o g r a m m e o n A I D S so as to e n s u r e th e p a r t i c i p a t i o n o f o t h e r r eg io ns in th i s i n t e r n a t i o n a l c o n s u l t a t i o n . T h i s in i t i a t iv e is p a r t i c u l a r l y t im e ly , a n d a l l o w s a d v a n t a g e to be t a k e n o f th e w i d e s p r e a d w i l l ingness o n the p a r t o f g o v e r n m e n t s to c o n s i d e r th e a p p r o p r i a t e use o f l eg i s l a t ion in th i s f ield. T h e m a i n o b je c t iv es are: to ide n t i f y a n d e x a m i n e t h e e t h ic a l i m p l i c a t i o n s o f v a r i o u s ch o i ce s o f p u b l i c h e a l t h m e a s u r e a n d t h e i r l egi s l a t ive s u p p o r t ; t o d i sc uss th e s t r e n g t h s a n d w e a k n e s s e s o f c u r r e n t in­ i t i a t ives to i n t r o d u c e o r m o d i f y l e g i s l a t ion in s u p p o r t o f e f f o r t s to c o n t a i n th e s p r e a d o f th e A I D S e p i d e m i c ; to p r o m o t e c o n s i s t e n c y in l e g i s l a t ion in the f ield o f A I D S , k e e p i n g in m i n d th e c o n c e r t e d a c t i o n r e q u i r e d a t i n t e r n a t i o n a l level; a n d to id e n t i f y th e m a i n c o m p o n e n t s o f a n e f fec t ive l eg is l a t ive s t r a t e g y a n d , m o r e spe c i f i ca l ly , t o w o r k o u t a d e t a i l e d list o f to p ic s r e q u i r i n g ca r e f u l c o n s i d e r a t i o n p r i o r to e f f ec t in g l eg i s l a t io n in the f ield o f A I D S . 2.4x T h e S e x u a l i t y a n d F a m i l y P l a n n i n g un i t a l s o c o n t r i b u t e d to th e p r o g r a m m e o n A I D S , n o t o n ly in c o n n e c t i o n w i t h t h e a b o v e - m e n t i o n e d C o n s u l t a t i o n o n A I D S a n d the N e w b o r n , b u t a l so t h r o u g h th e c o l l ec t io n a n d an a ly s i s o f d a t a o n the p r o m o t i o n o f safe sex. T h i s s t u d y b e g a n in N o v e m b e r , a n d a i m s to e s t ab l i sh g u i d e l in e s o n sexu a l c o u n - s e l l i n g t o p r e v e n t H I V in fec t io n . B e lg iu m , F r a n c e , I ta ly a n d Y u g o s la v ia a r e p a r t i c i p a t i n g in th e s tu d y . 2.49 T h e d e v e l o p m e n t o f a p r o t o c o l a n d p i lo t s t u d y o n A I D S p r e v e n t i o n p r o g r a m m e s f o r m a l e h o m o s e x u a l s b e g a n in D e c e m b e r . A s e c o n d p h a s e will c o m m e n c e in t he s e c o n d h a l f o f 1988 to t e s t t h e h e a l t h e d u c a t i o n p r o g r a m m e w i th h o m o s e x u a l g r o u p s . A u s t r i a , t h e F e d e r a l R e p u b l i c o f G e r m a n y , the N e t h e r l a n d s a n d S w e d e n a r e p a r t i c i p a t i n g in t h e s tu dy . 21 2.50 The development of a protocol and a s tudy of the impact of A ID S on the emotional at ti tudes and sexual behaviour of heterosexual couples began in December , and will finish at the end of 1988 at the latest. The study will be conducted in Switzerland. 2.51 In the European Region, int ravenous drug abusers consti tute the second most impor t ant risk group for HIV infection and AIDS; in some Medi ter ranean countries more than hal f the identified AID S cases are from this group. The report on the Consul t a t ion on Aids am o n g D ru g Abusers, held in S tockholm in 1986, was widely dist ributed throughou t the Region and beyond. 2.52 One of the follow-up activities was the Meeting on Training on A ID S for Personnel in D ru g Tre atmen t Centres, held in Bremen in August. The meeting provided a st imulus for the part icipants to start or improve t raining p rogrammes at nat ional level, and formulated very useful guidelines and recommendat ions on such training activities. The ou tcom e o f the meeting will be a publicat ion in English, French and G e rm an edit ions, which will no doub t provide fur ther st imulus and guidance to countries in their training efforts. 2.53 Preparat ions were begun on designing model programmes for the prevent ion of HIV infection am o n g drug abusers and on educating drug abusers th rough pilot o u t ­ reach projects. 2.54 In close col labora tion with W H O headquarters , prepara t ions were made to review policy measures and their effectiveness in the f ramework of a meeting of experts to be held in Geneva in Jan ua ry 1988. Diarrhoeal diseases 2.55 Control of diarrhoeal diseases cont inued to at tract at tention in the Region. At the request of the Regional Office, an accelerated control p rogram me was under taken in Turkey with the suppor t of U N I C E F and W H O headquar ters , and oral rehydrat ion therapy has been included in the curricula of many national medical schools. National managers in the field of d iarrhoeal disease control from Turkey, the USSR and Yugo­ slavia a t tended seminars and courses organized by W H O headquar ters and the Regional Office. Programmes on oral rehydrat ion therapy and communi ty health educat ion are under considerat ion in Albania, Greece, Italy, the USSR and Yugoslavia. Hepatitis 2.56 One very serious problem in Europe is viral hepatitis. It is est imated that the annual incidence of hepatitis В cases could be over one million, with particularly high rates o f infection in southern and eastern Europe. Many cases of chronic hepati t is В end in mal ignant hepatocel lular carcinoma. Hepatit is В vaccine is now available com m er­ cially, but is still too expensive for planned, effective mass immunizat ion. 2.57 The need for a special regional programme on viral hepatitis control was dis­ cussed at the Technical Advisory G r o u p held in Geneva in November. It was pointed out that mixed viral hepati t is and AID S infection accelerates the severity of a pat ient 's condi tion, with a very high (60-80%) case fatality rate within a few months. 2 2 Oral health 2.5x The main thrust of the oral health p rogramme continues to be the coordinated planning of oral health services, with emphasis on the implementat ion of effective preventive measures and appropr ia te manpower production, moni tored through a con­ t inuous updat ing of the oral health informat ion system. 2.59 The Regional Officer for Oral Heal th visited the United Kingdom in April and Ireland in November to s tudy to what extent oral health componen ts are or could be included in existing health p ro m ot ion p rogrammes. The experiences in this field will be included in the document “ Oral health in communi ty health prog ram mes” , the draft of which was prepared dur ing the Working G r o u p on Planning, Implementa t ion and Evaluation of Oral Heal th Compo nent s of Noncommunicable Disease Projects, held in Kaunas , USSR in September 1986. In November the Regional Officer presented a paper on this subject at the Royal Society, London in connect ion with the semi-annual meeting of the British Association for the Study of Com muni ty Dentistry. 2 60 As a result of a meet ing o f chief dental officers in T urk u in Oc tober 1986, guidelines for the formulat ion of national goals for oral health are in the process of being drafted. Part 2 of the document “ Financing o f dental care in E uro pe” is nearing complet ion, and Volume 1 of the “ Guidelines for self care in oral health” will be finalized in the near future. The document “ Experience on water fluoridation in Europe” was produced and distributed. An updat ing of the European part of the W H O publication World directory o f dental schools, 1963 is nearing completion. 2.61 In August , the Regional Officer presented a paper on planning of services and manpo wer needs at country level at the Panum Institute, Copenhagen, in connection with the yearly meeting at the Scandinavian Association for Dental Research. 2 62 The Regional Officer visited Szczecin in March to finalize the p lanning of the nat ional oral health pathfinder survey (N O H P S) and to calibrate the clinical examin­ at ion teams; Belgrade, Ljubljana and Zagreb in February to assist in the interpretat ion of the results of the pilot N O H PS and to finalize the planning of the actual survey; and Lisbon in J an u a ry to design a moni tor ing and evaluat ion system in oral health based on the results of the N O H PS performed in 1985. A situation analysis was performed in Israel in November and a plan for a N O H PS was prepared. 2.63 Based on the results of the N O H PS performed in Spain in 1985, several oral disease preventive programmes and projects are being launched in the different au ton ­ om ous communit ies in Spain. 2.64 The Regional Officer visited San Marino in Jun e to perform a si tuation analysis and to plan a N O H PS, the results of which will form the basis for recommendat ions on the implementat ion of various oral disease preventive programmes. 2.65 The results of the N O H PS in Greece were sent to the Ministry of Heal th, Welfare and Social Security. The Regional Officer visited Athens in December to make proposals for the implementa t ion of oral disease prevent ive p ro g ram mes based on the results of the survey. 2 3 2.66 Th e N O H P S in Mal ta was completed , and co m p u te r analysis of the d a ta is under way. 2.67 Th e Regional Officer visited Turkey in December to assist in the interpretat ion of the results obtained from the N O H PS , the first par t of which was performed in 1987. 2.6X Th e Regional Officer was the keynote speaker at a meeting on changes in dental education ar ranged by the Medical Stomatological Insti tute, Moscow ( W H O col lab­ orat ing centre for dental educat ion) and also at a fluoride symposium arranged by the Stomatological Facul ty, Medical Academy, Erfurt ( W H O col laborat ing centre for oral disease prevention). Target 5 SO Diseases preventable by immunization 2.69 During the year fur ther progress was made towards the elimination of diseases preventable by immunizat ion, and M em ber States began to provide more reliable informat ion to W H O . Current ly , all 32 European M em ber States are immunizing against d iphtheria, poliomyelitis and tetanus, 30 against pertussis and measles, 21 against rubella and 5 against mumps. As a result, during 1987 diphtheria and pol io­ myelitis were not recorded in 60% of European Mem ber States, and measles did not occur in Albania. Over 80% of M em ber States have e l iminated neonatal tetanus through improved maternal and child care and the rout ine immunizat ion o f women from early chi ldhood. Between 1972 and 1987, tuberculosis morbidi ty and mortal ity rates fell by about hal f for the Region as a whole. 2.70 The achievements and failures of the regional Expanded Programme on Im ­ munizat ion (EPI) were reviewed by European advisory groups on EPI in G o th en b u r g in August and in Rome in December , and by a global advisory group in Washington, D C in November. The first Senior Level Seminar on the Expanded Programme on Im muniz­ ation, the Contro l of Diarrhoeal Diseases, and Acute Respiratory Infections and Control P rogrammes took place in Moscow in May. Materials from the Seminar were dist ributed to all Member States. 2.71 World Heal th Day 1987, with its theme “ Immunizat ion: a chance for every child” , was ce lebrated in the Regional Office on 7 April. The first nat ional meeting on EPI in Czechoslovakia took place in Brno in April , in connection with Wor ld Heal th Day. The Ministry o f Health of Slovakia awarded the D r G u o t commemorat ive medal to the Regional Office in recogni tion of its work in the field of EPI. Du r in g the year 24 Mem ber States included measles, mumps and rubella in their communicable disease surveillance systems, and a number of them started programmes of immunizat ion with MMR vaccine. By the year 2000, there should be no indigenous measles, poliomyelitis, neonatal tetanus, congenital rubella, diphtheria, congenital syphilis or indigenous malaria in the Region. 2 4 2.72 Success in e l iminating poliomyelit is f rom a number of E uro pe an countries should make its eradicat ion from the entire Region feasible within a relatively short time. T w o W H O regions (Eur op e and the Americas) have adop ted targets for eradicat ing poliomyelitis. 2.73 With the assistance o f W H O , the Ministry of Heal th o f the USSR decided to radically improve its immunizat ion programme, start ing in 1987. It is p lanned to develop a computer ized informat ion system on the European EPI in order to improve moni tor­ ing o f the progr am me within the f ramework of the global EPI, which will be using earth satellites for global communica t ion of moni tor ing data. Malaria 2.74 Part icipants f rom Bulgaria, Greece, Turkey and Yugoslavia a ttended a Coord i ­ nat ion Meeting on Malar ia in South-eas t Europe, in Izmir in May. It was noted that the paras itological si tuat ion in the area had improved and that the epidemiological si tuation in Turkey in general and in the borde r areas in par ticular no longer seemed to present a threat to neighbouring countries, especially co mpar ed with the problem of cases im­ por ted from elsewhere. It was also noted, however, tha t in all par ticipating countries there were areas where potent vectors were present and often abu nd ant , and there was therefore a need for cont inued vigilance. The meet ing called for the specific training of health personnel in ant imalar ia activities (malariologists, entomologis ts and labora tory personnel) and for the inclusion o f neighbour ing countries of the Eastern Medi ter ranean Region of W H O in future malar ia coordination meetings. 2.75 There has been a cont inuing rise since 1981 in the incidence of malar ia amon g visitors to European M em ber States f rom other W H O regions, and the si tuat ion is reviewed at various scientific meetings co-sponsored by the Regional Office. Target 6 SO 2.76 T o facilitate the 1987-1988 H F A moni tor ing exercise, the H F A data base was up dated with the most recent values for life expectancy calculated on the basis of mortal i ty data received f rom M em ber States. The analysis of trends in life expectancy has a lready started. 2.77 M em ber States in the Region were approached to join the collaborat ive cohort study on risk factors influencing health status in infancy and chi ldhood; the guidelines and quest ionnaires for a pilot study had been prepared by a working g roup in 1986. At present five countries have clearly expressed their readiness to participate in the study, while o thers have pos tponed a decision pending the results o f the pilot study. The activities were s tarted in order to collect, integrate and subsequently disseminate epi­ demiological da ta on the contribut ion of com m on risk factors to mortal i ty and life expectancy. The possibility of using for this purpose the existing mul ti s tudy data bases By the year 2000, life expectancy at birth in the Region should be at least 75 years. 25 such as ER IC A were discussed with representatives of the ER IC A project and other similar projects in the Nordic countries. A Consulta tion on the Assessment of the Relat ion of C o m m o n Risk Factors with Mortal ity and Development of Relevant Risk Assessment Methods took place in Heidelberg in December to develop approaches to data collection f rom different epidemiological studies and to discuss o ther organi­ zational and methodological issues. 2.78 The UN F P А-suppor ted project on mortali ty differentials cont inues to be carried out by the Hunga r ian Central Statistical Office in col laborat ion with the Ministry of Health and the Regional Office. The results o f the s tudy have dem ons t ra ted the clear rela t ionship between the main socioeconomic characterist ics and mortal ity in different populat ion groups . For the cont inuat ion of the studies on mortali ty differentials an agreement between U N F P A , the Hungar ian Gov ern men t and the Regional Office has been signed for the period 1988-1992. Target 7 2C> 2.79 A num ber of nat ional or subnat ional birth conferences have been held in the Region over the last few years, and in 1987 there were bi rth conferences in Moden a (Italy), Ca tan ia (Sicily), Zurich, Jerusalem an d London. Th e boo k Having a baby in Europe (РиЪ\\с Health in Europe, No. 26) was discussed at all these conferences, and was also the subject of a full-day discussion at a large public meet ing in London in April. This publ ica t ion has been widely sold and discussed in the Region, and has been extensively reviewed in a num ber of medical journals, including a two-page review in the Lancet. The book is currently being t rans lated into French, G e rm an , Russian and Ital ian and should be available in these languages early in 1988. W o m e n ’s organizat ions in France, Italy and the Uni ted Kingdom have p roduced posters containing recommendat ions on birth technology, and thousands of these posters have been dist ributed in health facilities in these three M em ber States, as well as in Brazil and the Uni ted States. Because Having a baby in Europe demonst ra ted the high rates of obstetrical intervention and the wide divergence in these rates amon g and within countries, the Regional Office is mount ing a fol low-up s tudy o f the determinants of obstetrical intervention in col labora tion with nat ional nongovernmenta l organizat ions in the field of obstetrics. 2.80 A multidisciplinary worksho p on a systematic app ro ach to promot ing breas t­ feeding was held in Wageningen in February . Th e par t icipants represented mothers, nurses, midwives, paediatricians, health educators and health administrators . The w ork ­ shop formulated recommendat ions for a European strategy for promot ing breastfeeding. 2 .8 1 Letters were sent to M em berSta t e s in J u n e / J u ly requesting updated informat ion on infant and young child nutri t ion. By the end of the year replies had been received from 17 countries and these will be incorporated into the biennial report which is expected to be finalized by Feb rua ry 1988. Such repor t ing is a most useful means of keeping in touch with the impor tan t subject of infant feeding in the Region. Heal th workers’ organizat ions By the year 2000, infant mortality in the Region should be less than 20 per 1000 live births. 26 and infant nut ri tion research institutions seem to regard the report ing obl igation as helpful to them within their nat ional administrative structures. Target 8 SO 2.82 A study is being conducted o f the current use of drugs during pregnancy and of progr am me s in var ious M em ber States to try to control their excessive use. A meeting on this subject was held in Smolenice, Czechoslovakia in October. Target 9 SO 2.83 At a meeting o f the principal investigators of the project on moni tor ing t rends in cardiovascular diseases (M O N IC A ), held in Berlin in April , a session o f the M O N I C A opt ional psychosocial substudy (MOPSY) took place. The documen ta t ion for this study on the organization and management , protocol and data book for the first survey were discussed with the investigators. The first da ta on the analysis of the relationship between psychosocial variables such as stressful events, exhaustion, sleep dis turbance , social suppor t , socioeconomic factors and cardiovascular diseases were reported on by the M O PSY coord inators f rom the M O N I C A projects in Munich, Belfast and Barcelona. The recom mendat ions on psychosocial ins t ruments to be used for the second M O N I C A survey in centres analysing psychosocial variables were outlined. 2.84 Th e Regional Officer for Chronic Diseases a t tended a M O N IC A steering com­ mittee meeting, where the progress of the project , publ icat ion issues and the opt ional substudy were discussed. 2.85 The Chronic Diseases unit assisted two representatives from the W H O collab­ ora t ing centre for research and training in cardiovascular diseases, Budapest to a ttend the second Internat ional M O N I C A Congress, held in Helsinki in August. 2.86 Th e project on Eu ropean risk factors and incidence — a col laborat ive analysis (E RIC A) continued to show progress. Some new centres indicated an interest in joining this project . At the Consu l ta t ion on the Assessment o f the Relat ion of C o m m o n Risk Factors with Mortal ity and Development o f Relevant Risk Assessment Methods , in Heidelberg in December , the ER IC A da ta base and experience were used to discuss the future analysis of the relat ionship between the majo r risk factors and chronic non- communicable diseases. This meet ing was ar ranged by the Epidemiology and Statistics and Chronic Diseases units in col laborat ion with the W H O col laborat ing centre for research and training in cardiovascular diseases in Heidelberg. At the same time, a By the year 2000, mortality in the Region from dis­ eases o f the circulatory system in people under 65 should be reduced by at least 15%. By the year 2000, maternal mortality in the Region should be less than 15 per 100 000 live births. 27 meeting of the ER IC A coordinat ing and advisory group took place, at which the future of the development of the ER IC A study and prepara tion of publications was discussed. 2 X7 As agreed at the meeting of the principal investigators of the collaborat ive trial on the mul ti factorial prevent ion of coronary heart disease, in November 1986, the final manuscr ip t on the trial was submitted to the Regional Office for publication. 2 .xx A repor t on the comprehensive commun i ty cardiovascular control programmes (C C C C P ) was prepared and is to be publ ished by the Regional Office in the first hal f o f 1988. 2.X9 Despi te financial difficulties, the W H O European hyper tens ion research action pr og ram me (H YRAP) continued. The W H O col laborat ing centre for health care related hyper tens ion research, in G o thenbu rg , in col laborat ion with the World Hypertens ion League, organized a meeting on the hyper tension management audi t project in Milan in June, at which the current state o f the project was discussed. 2.90 The Regional Office assisted Portugal in holding a nat ional seminar on the development of intervention strategies in the field o f noncommunicable diseases, in Lisbon in May. At the request of the Por tuguese Ministry of Heal th , the Office ar ranged for an expert to visit Lisbon under the country medium-term programme to discuss the management of kidney diseases. 2 .9 1 The W H O col laborat ing centre for research and training in cardiovascular diseases, Brussels organized a meeting on noninvasive methods for the diagnosis of pulmonary hyper tension, in Pavia in November . The col laborat ing centre also organized a meeting on rehabi li tat ion after acute myocardial infarction, in Breisach-am-Rhein, later the same month. 2.92 The Regional Office assisted the Welsh authori ties with a nat ional conference on health pro mot ion, held in Cardi ff in March. A W H O consul tant presented a paper on prevention pr og ram mes in Europe in the field o f cardiovascular and other chronic noncommunicable diseases. 2.93 The Regional Office assisted U N D P in setting up a project for the establ ishment of a coronary angioplasty centre at the National Institute o f Cardiology, Warsaw. 2.94 Col labora t ion was established between the Nether lands Hear t Fou nd at ion and the Regional Office. Links were also established with the Internat ional Diabetes Feder­ ation and the Internat ional Epidemiological Association. 2.95 The Chronic Diseases unit assisted the Danish Insti tute of Clinical Epidemiology (D I K E ) in prepar ing the f ramework for the development of a strategy to prevent cardiovascular diseases in Denmark. 2.96 The Regional Officer for Chronic Diseases a t tended the meeting of national p rogramme managers of the W H O intensified programme for coronary heart disease prevention, in Prague in August, where the future development of the program me was discussed in accordance with the formulat ion o f target 9. 2.97 The Regional Office convened the first European Conference on the Prevention and Control of Chronic Non communicable Diseases in Varna , Bulgaria in October. The 2 8 par ticipants from the European Member States reviewed the available evidence on the prevention and control of chronic noncommunicable diseases, and discussed and analysed the experience from implemented projects in these fields. They considered the difficulties envisaged at local, nat ional and international levels, and delineated future tasks in­ cluding fur ther research needs in the field of prevent ion and control. 2 .9« The countrywide integrated noncommunicable diseases intervention (C INDI) progr am me was fur ther developed. Portugal became the tenth country to join this progr am me and Can ada , Czechoslovakia, the G e rm a n Democratic Republic and the Uni ted Kingdom have expressed interest. The first issue of a newsletter was prepared in col labora tion with the C IN D I coordinating centre in Moscow. The C IN D I data m an ­ agement centre in Heidelberg, together with the centres in Moscow and Helsinki and the Regional Office, prepared and publ ished the C IN D I protocol and guidelines for moni­ toring and evaluation procedures. 2 .49 In col laborat ion with the Chronic Diseases unit the CIN DI centres in Heidelberg and Helsinki prepared a paper on the C IN D I intervention strategies, which was dis­ cussed at the meeting of p ro g ram me di rectors in Varna at the end of October. At this meet ing progress in the implementat ion of the program me was discussed. The partici­ pants agreed on the list of intervention modules that should be developed and discussed at the following meeting. 2.100 The existing data base for moni tor ing and evaluat ing C IN D I country pro­ grammes was analysed by the data management centre, Heidelberg in close collab­ ora tion with the M O N I C A management centre at W H O headquar ters and the MONICA data management centre in Helsinki. The results o f this analysis were discussed at the meeting of the p rogramme directors in Varna. 2.101 The Regional Officer for Chronic Diseases visited Bulgaria, Portugal and the USSR to become acquainted with different aspects of the prevention and control of noncommunicable diseases and to discuss C IN D I implementat ion. Target 10 80 2.102 An Advisory Commit tee on Cance r Control met in Budapest in June. The purpose of the meeting was to review the activities under taken during the period 1984-1987 in the f ramework of the regional cancer programme, and to endorse further p ro g ram me activities aimed at advancing the development of nat ional cancer policies and programmes and making full use of those already existing. 2.103 A Meeting on Nat ional Cancer Control Policy Development also took place in Budapest in June; the participants, nominated by their governments, included medical and public health professionals. It was agreed that, in nat ional cancer policies and programmes, the balance between the com po nent s of cancer control from prevent ion to terminal care should be reconsidered. In al locating resources for cancer control there By the year 2000, mortality in the Region from cancer in people under 65 should be reduced by at least 15%. 29 should be a shift o f emphasis from the more prestigious curative side to the relatively neglected area o f prevention. 2.104 T o demon st ra te the impact on cancer that can be achieved by the opt imal use of available resources, a collaborat ive country demons t ra t ion project was launched. The G e rm an Democrat ic Republ ic, Hunga ry and the Nether lands have agreed to take part, and other countries (Iceland, Poland, Turkey and the USSR) are consider ing jo ining the project. 2.105 An international course on technology assessment for cancer care programmes was held, with the generous suppor t of the Gove rn men t of Austria, in Baden-bei -Wien in October . The purpose o f the course was to communica te the substance of the concepts under lying both care programmes an d technology assessment to those who influence cancer care policy in M em ber States. The progr am me focused on the methods involved in the use of these concepts in cancer care delivery. 2.106 In the same prog ram me area, the development of model care programmes and model assessment of selected technologies have been promoted. An international com ­ parative study was set up to demonst ra te the impact on cancer patient management of care prog rammes developed in combinat ion with technology assessment. 2.107 A multidisciplinary consul tat ion took place in Leeds in February to develop recommendat ions for a t rea tment policy that gave considerat ion to the quali ty o f life of patients with incurable cancer, as well as to provide guidance on the implementa tion of palliative cancer care. 2.108 C oo pe ra t ion increased with IA R C in the development o f an improved cancer info rmat ion system, with the In ternat iona l Union agains t Cancer in coordinat ing cancer education strategies, with C E C and the Nordic Counci l in their prevent ion programmes, and with CE in the organizat ion of multidiscipl inary cancer care. C o o p e r ­ at ion with the Organizat ion of European Cancer Institutes cont inued. 2.109 The fifth annual symposium organized by the Eu ropean Organizat ion for Coopera t ion in Cancer Prevent ion Studies, and co-sponsored by W H O , took place in Brussels in May under the title “ Prevention of virus-related cancers” . 2 .1 10 Col labora t ing centres in the G e r m an Democrat ic Republic, Hungary and the Uni ted Kingdom helped to conduct technical projects on the establ ishment of a data bank to assess technologies used in cancer control, on manpo wer development for cancer control, on a comparat ive study o f var ia tions in the outcom e of cancer care, and on developing and presenting informat ion for the public on recent scientific achievements and on constraints in cancer care. 2 .1 И In col laborat ion with U N D P , the Regional Office continued to suppor t the cancer control p ro g ram me in Poland, where the main focus is on implement ing preven­ tive and early detect ion measures, as well as the es tabl ishment of a nat ional cancer control p r o g r am m e in Albania. A visit was paid to Turkey to s tudy the cancer services and to plan a coopera t ive programme. Th e Regional Office assisted in developing a com puter-based informat ion and invitation system in suppor t o f the country-wide organized screening p rogramme for cervical cancer in Hungary. 30 Target 11 DO Accident prevention 2 M2 Yugoslavia held a nat ional workshop on prevent ion of accidents with partici­ pants from all the republics and all sectors concerned. Л p rogram me was agreed and priority was given to educat ion for safety, chemical accidents, and the development of emergency services. One of the republics will develop a data base, using a basic data set. 2.M3 The Regional Officer for Prevention of Accidents a t tended the first inter­ nat ional conference on road accident t raumas on transit routes, under the auspices of the Yugoslav Academy of Arts and Sciences. Special problems relating to driving long distances from southern to nor thern Europe were discussed, and driver fatigue was selected for fur ther research. 2 114 A Working G r o u p on Alcohol and Accidents, held in Reykjavik in September , reviewed the present state o f knowledge on alcohol use and abuse and accidents, and discussed countermeasures vis-à-vis t rea tment, legislation, prevent ion and health pro ­ motion. It was concluded that, since alcohol abuse and alcohol-related accidents are social problems, accidents involving the use of alcohol are an indicator of the extent of alcohol consumpt ion in society. Thus, programmes for the prevention of accidents where alcohol is a factor should be part of alcohol control programmes in general. The programmes should consider moderate and inexperienced drinkers as well as heavy drinkers. The involvement of primary health care workers is essential. Am ong the recommendat ions o f the Working G r o u p were that a glossary of terms be established, and that statistics be collected on the frequency of drunken driving and the drinking histories and lifestyles of accident victims. In relation to rehabil itat ion, there was a vital need for the early identification, through primary health care workers, of hazardous drinking pat terns and for the extension of educat ion / rehabi l i ta t ion programmes to drinkers who have been charged with driving while intoxicated. Legal countermeasures should be associated with adequate enforcement and educat ional programmes, liaison at communi ty level being improved am ong all agencies involved. 2.M5 The Regional Office was represented at a symposium on " T h e healthy com­ muni ty — child safety as part of health p ro m ot ion activities” organized in Stockholm in April by the l o lksam insurance G ro u p of Sweden and the Child Accident Prevention Trus t , London. The symposium, which was suppor ted by the Swedish Nat ional Boards of Educat ion and of Health and Welfare and the Swedish Child Council , is a good example of the involvement of insurance companies in preventive activities. One of the probable outcomes is the establishment of a European group on child accidents. By the year 2000, deaths from accidents in the Region should be reduced by at least 25% through an intensi­ fied effort to reduce traffic, home and occupational accidents. 31 Disaster preparedness 2.1 16 There is now a shift o f emphasis — firstly f rom aid to preparedness, and secondly to include technological disasters — within the overall preparedness plan. Technological disasters can involve many localities and countries. The local com muni ty must be able to cope itself should disas ter strike, and it must therefore be pr epared for that eventuality. Pr imary health care workers have a leading role in such preparedness. 2.117 This ap proach was well i llustrated in a com muni ty seminar on disaster pre­ paredness and mental health, organized by the Norwegian authorit ies in Lofoten in August. Apa r t from the health and environmenta l effects o f shipwrecks, avalanches, etc. the psychosocial effects are impor tant , not only on the stricken communi ty but also on the rescue team. This type of ap proach will form the basis for fur ther work on the mental health aspects of disasters. 2 . l ix In Greece , as a fol low-up to the ear thquake in Ka la mata in September 1986, a nat ional workshop , suppor t ed by the Regional Office and its panel o f Assessors, re­ emphasized com muni ty involvement and proposed a pr og ram me of public educat ion and t rain ing to develop com muni ty profiles and rapid assessment of needs at the t ime of disaster. There will be fur ther jo in t activities on these subjects, and also on technological disasters. The Greek ea r thquake planning and protect ion organizat ion (OASP) is very efficient, and is an excellent example o f a nat ional body working closely with local teams. 2 .1 19 The G ove rn m en t of San Marino is providing financial suppor t to the develop­ ment in tha t country o f a t raining centre on the health aspects of disasters. This is sponsored by the Counci l o f Europe and suppor t ed by the Regional Office, an d the Regional Officer for Prevent ion of Accidents represents W H O on the managemen t board. In Oc tobe r and November , the first courses were held on emergency care, technological disasters and the role o f the media. 2.120 The work on the development of communi ty profiles and needs assessment profiles cont inued. Both of these will be extended to include chemical and radiat ion aspects and hazard mapping by the local community. The first interregional meeting on emergency preparedness and management of relief operat ions, and a meeting on the development of training programmes in disaster preparedness were organized by W H O headquar ters in Geneva in April and October, respectively. 2 .12 1 The app roach to the development o f these profiles adop ted jointly by the W H O Regional Offices for the Americas and for Europe has been accepted by the relevant United Nations agencies and nongovernmenta l organizat ions. It will be tried out in various settings in 1988 and 1989, leading to an agreed protocol to be used by all agencies involved in the protec t ion of the health o f the publ ic before and at the t ime o f a disaster. 2.12 2 A World Conference on Chemical Accidents, held in Rome in July, brought together par t ic ipants f rom many sectors and from many par ts o f the world. The Confe r­ ence proposed that the main elements of a p ro g ram me for prevent ion, preparedness and emergency action should be the identification of hazards and health impact assessment, risk assessment and opt ions analysis, and emergency response planning. It emphasized 32 the importance of multidisciplinary working, the study of morbidity pat terns and psycho­ social aspects, and the role o f the communi ty in all aspects o f prevention and control. The involvement of the media was also stressed. Because of the t ransbounda ry nature of the problem, harmonizat ion of guidelines and codes o f practice are necessary. Finally, transfer of technology to developing countries must be accompanied by safety mechanisms. 2.123 Th e School o f Public Heal th, Cathol ic University o f Louvain , Brussels con­ tinues to be actively involved in disaster preparedness in the fields of t raining and development of informat ion systems. 2.124 The Health Services Division, D epa r tmen t o f Coopera t ion for Development , Ministry o f Foreign Affairs, Rome was designated a W H O col labora ting centre for disaster preparedness, management and nursing. Its work will include the training o f a cadre o f nurses to work in disaster preparedness and relief in developing countries, and the development and trial of communi ty profiles and hazard mapping in developing countries through P H C and communi ty involvement. Target 12 SO 2.125 As a follow-up to the recommendat ions of the Working G r o u p on Preventive Practices in Suicide and At tempted Suicide, held in York in 1986, a mul ticent re study on parasuicide was established. Co l labora tors from centres in Denmark , the Federal Re­ publ ic of Germ an y , Italy, the Nether lands, Sweden and the Uni ted Kingdom met in L o n d o n to agree on details of research design, the contents of the interview schedule, general methodology, dat a prepara t ion and data analysis. A protocol has been prepared and a steering group has been appointed , the first meeting of which took place in Bologna in October . Contacts were made with centres in France and Norway with a view to their par ticipating in the study. H E A L T H F OR ALL IN L U R O PL BY T H E YEAR 2000 Publications issued in 1987 M ycotic diseases: report on a W H O meeting. EURO Reports and Studies, No. 105. A ID S diagnosis and con tro l— current situation: report on a W H O meeting. Non-serial publication. M ental health services in p ilo t study areas: report on a European study. Non-serial publication. By the yea r2000, the current rising trends in suicides and attem pted suicides in the Region should be reversed. Documents issued in 1987 A ID S containment: report on a W H O meeting (document I C P / C D S 013). A ssessm ent o f levels o f hypertension control in the com m unity: report on a W H O meeting (document I C P / N C D 020). C ontinuity o f care o f the elderly: report on a W H O meet ing (document I C P / H E E 217). Countrywide integrated noncommunicable diseases intervention program me (C IN D I): repor t on a meet ing of C IN D I Managem ent Commit tee (docu­ ment I C P / N C D 023). Experience on water fluoridation in Europe: report on a study (document I C P / O R H 101Л02). Health legislation: report on a meeting of the advisory committee for the European programme (document I C P / H L E 199/m01). Leparski, E., ed. The prevention o f noncom municable diseases — ex­ periences and prospects: papers for the European Conference on the Pre­ vention and Control of Chronic Noncommunicable Diseases (document I C P / N C D 028/6). N ational cancer control policy development: report on a W H O workshop (document I C P / C A N 115). Non-invasive diagnosis o f pulm onary hypertension: repor t on a W H O meet­ ing (document I C P / C V D 111). M alaria risk fo r travellers: repor t on a W H O meeting (document 1СР/ M A L 012). M alaria in south-east Europe: report on a W H O coordinat ion meeting (document I C P / M A L 010). Optim um com m unity care o f disabled people: report on a W H O meeting (document IC P / R H B 010). Unemployment, poverty and quality o f working life — innovative inter­ ventions to counteract damaging health effects: report on a W H O meeting (document I C P / H S R 818). Co-publications issued in 1987 Leparski, E. & Niissel, F.E., ed. Protocol and guidelines fo r monitoring and evaluation procedures: C IN D I . Countrywide Integrated N o ncom m uni ­ cable Diseases Intervent ion Programme. Heidelberg, Springer-Verlag. Schwefel, D. et al., ed. Unemployment, social vulnerability, and health in Europe. Heidelberg. Springer-Verlag. 34 van Geuns, H., ed. H ealth hazards o f organized violence. Proceedings o f a working group on health hazards o f organized violence, Veldhoven, A pril 22-25, 1986. Rijswijk, Netherlands , Ministry of Welfare, Heal th and Cul tural Affairs. Articles published in 1987 Aitken, C. & Walker, J. Care of disabled people in the communi ty . In ter­ national disability studies, 9: 55-59 (1987). Hermanova, H. Mult idimensional assessment technology in care of the elderly in international perspective. In: Maddox, G.L. & Busse, E.W. , ed. Aging: the universal human experience. Selec ted papers fro m the sym posia o f the X l l l th Congress o f the International Association o f Gerontology. New York, Springer, 1987. Hermanova, H.M. Disability indicators and W H O programme: “ Heal th for all by the year 2000” . Revue d'épidém iologie et de santé publique, 35: 236-240(1987). Svensson, P.-G. Specially disadvantaged groups: a challenge for health services. International journal o f health planning and management, 2: 59-65 (1987). Svensson, P.-G. & Starrin, B. Informai solutions to health and social consequences of unemployment : the experience of the Swedish t rade unions. Health promotion, 2: 195-204 (1987). 35 3Lifestyles conducive to health 3.1 T o suppor t and enable people to choose lifestyles conducive to health continues to be one o f the most formidable challenges to the M em ber States of the Eu ro pean Region. New approaches are called for in policy formulat ion, the development o f professional skills and the health educat ion of the public. The Regional Office has tried to put a par t icular effort into helping M em ber States develop new approaches to health p ro ­ mot ion and disease prevention: high priority has been given to action-oriented efforts such as the Heal thy Cities project and the H F A campaign to reduce tobacco consum p­ t ion in the European Region. 3.2 T he move towar ds the deve lopmen t o f a healthy publ ic policy has gained m o m en tu m th ro ughou t the E uro pean Region. Th e O t taw a Char ter for health p ro ­ mot ion adop ted in 1986 has also provided the basis for new initiatives in healthy public policy. At the second in ternat ional conference on health p ro m o t io n in Adelaide, Aust ra l ia in April 1988, the W H O interregional health p romot ion project will present M em b er States with the results of two years’ work on healthy public policy, which will be i l lustrated by over 50 case studies. Policy formulat ion and implementat ion have also been the focus of work in specialized p rogram me areas such as nut ri t ion, alcohol, tobacco and drugs. All these fields call for complex policy interventions and pose difficult legislative and ethical problems that need constant re-evaluation. In few coun tr ie s is there any long-s t and ing in tersectoral coop era t ion that views health as a key fac tor in overall policy formulat ion. Only recently have several M em b er States a t tempted to formulate comprehensive health p romot ion policies tha t cover the wide range of lifestyle-related damage to health, par tly as an integral par t of their H F A policies, par tly as separa te policy documents . In several cases the Regional Office was reques ted to be par t o f the fo rmulat ion process an d to s t rengthen its role as policy adviser. 3.3 T he interest in health p ro m o t io n has emerged not only at the nat ional and federa l levels, however. Some of the most active responses to H F A have been at the local level. D ur i ng 1987, the Heal thy Cities project rapidly gained mom en tum. At present , 25 E uro pean cities form the core group of the project , with a ring of abou t 100 interested cities keeping in regular contact. As a major H F A vehicle, this project 37 allows many of the W H O programmes to work together, particularly in tackl ing the social and physical environments in cities. 3.4 The challenge of integrating health promot ion into the existing public health s t ructure calls for new organizational and educat ional initiatives. Th ro u g h o u t the Region, new organizat ional infrastructures for health promot ion and health educat ion are emerging, including a new interest in t raining for public health. Teaching health professionals to unders tand lifestyle-related health problems has become a focus of t raining th ro ughou t the Region, emphasizing special topics (such as smoking or drug abuse) or special popu la t ion group s (such as migrants) . W H O has es tabl ished new links with the European schools of public health, some of which have al ready run pilot courses in health p romot ion and lifestyles. Networks of experts have been set up by various progr am mes — for example, the nut ri t ion pr og ram me regularly contacts over 800 professionals — and several programmes run regular newsletters. 3.5 Posit ive health, and all its behavioura l and psychosocia l com pon en ts , is still a new field for health p ro m ot ion and health educat ion pro grammes . Part icular ly in the field o f sexuality and family planning, obvious lifestyle changes in society — such as the changing role of women or the visibility o f homosexual i ty — call for clear messages tha t focus on the qual i ty o f life and wellbeing. C o n su l t a t i ons have been held to explore the meaning of sexual health, studies are being conducted to unde rs tand new at t i tudes to family p lann ing and co nt racep t ion, and modules have been developed to t ra in health profess ionals in im p o r t an t emerging areas such as the preven t ion o f AIDS. 3.6 The need to under s tand A ID S as a major lifestyle issue in the European Region has become clear in the course of the work done at the Regional Office over the last two years. Several programmes — such as educat ion for health, sexuality and family p lan ­ ning, and abuse of psychoactive drugs — have made major contribut ions . It is to be welcomed that the newly established Special Programme on A ID S at the Regional Office will work with two full-time professionals (one medical and one a social scientist) to develop the special approaches needed to suppor t European Member States, particularly in their efforts to combat the disease by education. 3.7 In spite o f the high visibility and threat of AIDS, many o f the challenges faced by Member States in the field of lifestyles cont inue to lie with the lifestyle pat terns of developed societies such as alcohol and tobacco consumpt ion. The Regional Office has put a special focus on the com muni ty response to alcohol an d drug abuse and developed an approach to cross-nat ional studies that allows for the shar ing of experience, not just the compar i son of data. Schoolchildren and other young people are the groups that warrant par t icular a t tent ion — and it is here that coopera t ion with o ther intergovern­ mental organizat ions such as the EEC, C E C and Council o f Europe has been most productive. Country activities have cont inued in each of the target areas o f this chapter. Lifestyles cont inue to be a field of work where both W H O and its Member States are jointly exploring new approaches and where the move towards planning for health can most creatively be exemplified. 38 Target 13 SO National health promotion policies 3.8 The Ot t awa Char te r for health promot ion is the major policy document that gives force and di rection to the interregional health promot ion project, which is gaining a high in ternational reputa t ion and is seen by many as leading the field in health promot ion development. 3.9 A comprehensive health p romot ion p ro g ram me has been carefully built up over recent years. Its basic appr oach and principles are founded on the W H O H F A policy in general and the O t t aw a Char ter in particular. Health promot ion is making a major con tr ibu t ion towards the achievement o f target 13 an d provides the context and ap p r o ach for the achievement of most of the o ther targets, in par ticular the lifestyle targets 13-17. The essential elements of the progr am me are policy, research and training, com munica t ion and educat ion, networking and consensus building, and suppor t and assistance in practical application. З.Ю Since the formulat ion and endorsement of the Char ter , a major international effort has begun in advocacy and mediat ion, enabling Member States at the nat ional , regional and local level to achieve the objectives of the Char ter and the goal o f H FA. 3.11 The Ot tawa Char te r itself has al ready been t rans lated into 15 languages and is widely used as a basis for developing nat ional health p romot ion policies. It advocates five areas of action: build healthy public policies, create support ive environments , st rengthen communi ty action, develop personal skills, and reorient health services. 3.12 Th e first o f these five action areas was given special a t tent ion in 1987. A series of wo rkshop s and discussion groups on the theme of healthy public policies took place t h rough ou t the year. 3.13 T he fou r th s u m m er sem inar on health p ro m o t io n was held in C ard i f f from 26 Sep tem b er to 1 O c to b e r in co l l abora t ion with Hear tbea t Wales. T he aim of the seminar was to exchange expertise and development strategies to incorporate indust ry in health promot ion. Two par ticipants a t tended f rom each o f the following MemberSta tes : the Federal Republic o f Germ an y , Hungary , Norway, Poland, Spain, Switzerland and the USSR. 3.14 The second Vienna dialogue on the theme of bet ter links and balances between social an d health services in the care of the elderly took place in Vienna in October. Five By 1990, national policies in all Member States should ensure 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. 39 Member States par ticipated in analysing and discussing policy in relation to the elderly in society, a category that is given increasing at tent ion not least owing to the demographic changes in society. 3.15 An impor tant “ think t a n k ” on analysing healthy public policy took place in Berlin in November. Representat ives from five Member States part ic ipated and case studies from the G e rm an Democrat ic Republic, Hungary , Ireland, the Nether lands and the USSR were presented and discussed. 3.16 Three issues o f the popu lar health promot ion newsletter Positive health appeared in 1987. The newsletter is proving to be a most useful means of communicat ing advances in health p romot ion aroun d the globe. 3.17 The Heal th Promot ion unit also provides advice to Member States in the de­ velopment of healthy public policy. Several explicit f r ameworks and documents on healthy public policy now exist. 3.18 A major initiative of the Heal th Promot ion unit, jointly with the Environmental Heal th Planning and Management unit, is the development and promot ion of the Heal thy Cities project. This has become one of the major delivery vehicles of the targets of the European H F A strategy. The project brings together a network o f European cities to assist and suppor t the implementa t ion o f work towards H F A in their cities by promot ing the exchange of experience and the development of models of good practice. The major a im of the Heal thy Cities project is in general to prom ote H F A policies and programmes at city level, with par ticular emphasis on integrating three key aspects of health p ro m ot ion in an urban context: the prom ot ion of healthy lifestyles, a greater concern for health as a compon en t o f all public policy in the different sectors of the local communi ty and economy, and the creation of a healthier urban environment. The project is scheduled to spread over five years (1987-1991) and possibly longer. It is monitored and coordinated by a Heal thy Cities project office in the Regional Office. 3.19 Durin g the per iod under review the major event in this fast growing initiative was the first E u ro p e an Congress on Heal thy Cities, held in J u n e in Düsseldorf . Over 200 people a t tend ed f rom all over the wor ld , including 38 official city delegations and observers f rom 20 cities. 3.20 One o f the suppor t elements of the health pr omot ion p rogramme is health pro m ot ion research. A publ icat ion is being prepared enti t led Introduction to health prom otion research, the purpose of which is to promote a new perspective on health, health policies and programmes. It should provide people involved or interested in health p rom ot ion and related activities with the most recent, most relevant and most reliable knowledge on the subject. In addit ion to this, the publicat ion should serve as a textbook for people involved in training in health promot ion. 3.21 A p ro g ram m e of research for health p rom ot ion in line with the goals o f research for H F A is being prepared. In orde r to create a unified approach towards investigations in the field of research for health p romot ion , the Health P rom ot io n unit is establ ishing a network of three col labora t ing centres: the Insti tute for Social an d Preventive Medicine, University o f Berne, Switzerland; the Research Unit in Heal th and Behavioural Change, 40 University of Edinburgh, Scot land, and the Institute of Social Medicine, University of Copenhagen, Denmark. The Copenhagen Institute is looking into the influence of lifestyles on health. The Berne Institute and the Edinburgh Research Unit are jointly concerned about improving monitor ing of the health of the popula t ion and the evalu­ ation of health promot ion through the development of health promot ion indicators. 3.22 In February, representatives of these three institutes met as the core group of research centres in health promot ion, to facilitate interaction and the interrelationship of work plans and to suppor t the appl ication of research results that would be useful to policy-makers. 3.23 These institutes, together with representatives from 15 other research units in Europe, Nor th America and New Zealand, met in Edinburgh from 4 to 6 Oc tober to discuss the new public health and its implications for research. Plans were laid for cooperat ive research studies in lifestyles and health and healthy public policy. A draft f r amework for research in health promot ion was developed to be discussed fur ther in J an u a ry 1988 when, at a consul tat ion in Copenhagen, a coordinated p ro gr am me for research in health promot ion is prepared. 3.24 With the assistance and support of W H O . the Institute of Social Medicine in Copenh agen organized a workshop on health status assessment in February. The o b ­ jective o f this workshop was to provide health researchers with an overview of existing measures of health s ta tus and discuss their theore tica l as sum pt ions and potential applica t ions . National alcohol policies 3.25 A review was under taken of national policies and programmes in the field of alcohol abuse. So far, the information has been set out in a s tandard format for 16 countries of the Region. Only a few countries have not yet responded to the inquiry, which was set up as a pre-filled ques t ionnaire containing the informat ion available to the Regional Office. This activity is expected to be finalized by the beginning of 1988. National drug policies 3.26 A nat ional seminar on the development and implementat ion of a drug abuse policy at the national and communi ty level was organized in Spain in May in collab­ ora t ion with the Spanish Government . The meeting proved to be an efficient way of s t imulat ing policy development at the communi ty level and provided ample oppor tuni ty for learning from different experiences at the nat ional and international levels. C o ­ ordinat ion between local health authori ties and the national government was also strengthened. 3.27 Later in the year a second workshop on drug abuse policy was organized, again in close col laborat ion with the Spanish Government . This workshop focused on improving the involvement of primary health care in drug abuse prevention, t rea tment and rehabili­ tat ion. The most impo r tan t obstacles to achieving this were identified and ways to 41 overcome them were discussed. This meeting provided a good start to a systematic effort to get to grips with this difficult but extremely relevant subject. The results of the meeting will be used in future international activities of the programme on this topic. 3.28 A draf t repor t giving profiles of the drug abuse s ituat ion, the policies and the actual responses in six Member States has been prepared. This material provides the f r amework for fur ther data collection on this par ticular topic and will form the basis for an article in one of W H O ’s journals on drug abuse policies in the European Region. Target 14 SO 3.29 A s tudy on the role of the family in the prevent ion and t rea tment of drug abuse was commissioned. One of the tentative findings of the s tudy is a reconfi rmat ion o f the overwhelming influence of parent s’ lifestyles on the drug-related behaviour of their children. Increasingly, t rea tment and prevention services th roughout the Region are recognizing this and integrating it into their work. 3.30 One of the well es tablished W H O research projects is the cross-nat ional survey on health behaviour in schoolchi ldren, in which 11 Member States actively participate and which has been in progress since 1983. A second general survey has now been completed. A consul tat ion to review the results was held in Jyväskylä, F inland in February. This was followed by a larger consul tat ion held in Budapest in September . The presentat ions raised a variety of theoretical issues and reached a large n um ber of substantial conclus ions on specific themes, e.g. the impor tance of the family in deter ­ mining health behaviour and the existence of links between the quali ty of social relat ion­ ships and health behaviour. The survey results will have very impor tant uses such as in helping to plan health educat ion and health p romot ion in schools and as an impor tant da ta source for policy development. 3.31 It is eight years since the last repor t on H ealth education in Europe was publ ished by the Federal Centre for Heal th Educat ion, Cologne for the International Union for Health Educat ion. On the joint initiative of W H O and the In ternat ional Union for Health Educat ion, a new edit ion is now ready to be published by the D ut ch Health Educat ion Centre, Utrecht, a W H O col laborat ing centre. This will be a useful publ i­ cation in the light of the major changes taking place, not least in Europe, an d the reorienting of health educat ion within a health promot ion context. 3.32 In J anua ry , the In ternational Informat ion Centre on Self-help and Health in Leuven organized a workshop on self-help and chronic disease focusing on the contri ­ bution o f self-help groups to coping with chronic disease, the formulat ion o f an overview of past and current research, the determination of future research topics that will enhance the functioning o f self-help groups for the chronically ill, the development of a strategy to foster self-help groups, and the formulat ion of recommendat ions for further action. By 1990, all Member States should have specific programmes which enhance the major roles o f the fam ily and other social groups in developing and sup­ porting healthy lifestyles. 42 3.33 The In ternat ional In fo rmat ion Centre on Self-help and Heal th in Leuven, with w hom the Heal th P ro m o t io n uni t has had a most satisfactory working relat ionship for the last four years, cont inues to issue a newsletter on self-help projects and activities and maintains a network o f people involved in these projects. 3.34 An expert prepara tory meeting on health p romot ion and chronic disease was held in Berlin (West) in December 1986, leading to a symposium on health promot ion and chronic illness held in Bad H o n n e f in J une 1987, with more than 80 participants. The purpose o f the prepara tory meeting was to collect existing informat ion on chronic pain, examine strategies for act ion, intervention and bet ter informat ion exchange, and to find out which social and health policy initiatives ought to be most s trongly p ro m ot ed for people suffering from chronic pain. The aim of the symposium was to clarify the complex needs of people with chronic pain condit ions or with cancer and those recovering from heart at tacks, to assess the implications of these diseases, and to redefine their needs for the future. 3.35 A s tudy conduc ted in Austria, the Federal Republic o f Germ an y , Spain, Sweden and the Uni ted Kingdom to assess changes in the sex roles and their implications for family p lanning and sexual counsell ing services was completed. Th e s tudy analyses relevant developments and processes at var ious levels in society over a per iod of 15 years (1970-1985). The assu mpt ion is tha t changes in the roles o f women and men have a considerable influence on sexuality, par tnerships and contraceptive practices. Target 15 SO Health education and health promotion 3.36 Following a s tudy on substance abuse educat ion for health professionals, a meet ing was organized in Vienna in May to find ways to improve this type o f educat ion in medical schools. It was felt tha t promot ing substance abuse educat ion as a special subject must be a majo r long-term goal, in orde r to achieve an efficient response f rom the health sector to the growing problems of alcohol and drug abuse in the Region. The meeting resulted, am o n g other things, in the beginning o f a E uro pe an network o f experts and medical schools interested in carrying this topic further. The report of the meeting will be widely dist ributed and should contr ibute to the expansion of the network and to the creat ion o f a focal point for substance abuse educat ion. 3.37 A new and innovat ive approach to the role of col laborat ing centres has been developed. Each col laborat ing centre takes a lead role in an impor tant area — each in turn suppor t ed th rough its links with the others. A concrete example of the networking of col laborat ing centres, and the practical appl ication of educat ion for health within a health p ro m o t io n context , is i llustrated by the meet ing on public health educat ion on A ID S prevention, organized by the Federal Centre for Health Educa t ion in Cologne, By 1990, educational programmes in all Member States should enhance the knowledge, motivation and skills o f people to acquire and maintain health. 43 a W H O co l l abora t ing centre for health education. In addi t ion to par t ic ipants f rom 17 M em ber States, each of the W H O col laborat ing centres for health educat ion was actively involved. Th e In ternational Info rmat ion Centre on Self-Help and Heal th, Leuven was also represented, as was the proposed new W H O col laborat ing centre on training and research in self-care, to be designated in Maastr icht . Self-care in relation to being HIV-posi t ive or suffering f rom AID S itself is becoming an increasingly impor tant area, and this proposed new col labora t ing centre is p lanning to hold a consul tat ion on self-care and AIDS in 1988. 3.38 This meet ing in Cologne was the first W H O international meet ing in the E u r o ­ pean Region on A ID S and health educat ion, in which the roles, objectives and means of health educat ion in AID S prevent ion were examined. Th e meeting consisted o f a “ b azaa r” , at which the par ticipating countries presented health educat ion material on AIDS, made country presentat ions, and held discussion groups. While a num ber of recommendat ions were made, the need to integrate A ID S prevent ion, wherever feasible, into existing health education and p romot ion infrastructures and programmes was stressed. Th e challenges presented by A ID S should be incorpora ted into the concepts of health p romot ion , positive health and wellbeing. Th e impor tance o f moni tor ing and evaluat ion was also stressed. 3.39 The impor tance o f educat ion for health as an essential tool of health promot ion and for reaching the goal o f H F A was fully recognized at a consul tat ion held at the Regional Office in June. This also formed par t of a series of meetings to provide the necessary informat ion and assistance for reaching target 15, a central com ponent o f the lifestyles targets. This consul tat ion, on a coordinated infrast ructure for the delivery of the health educat ion p ro g ram m e within the context of health promot ion, was held immediately after a meeting o f W H O col laborat ing centres for health educat ion, also in Copenhagen. It was impor t ant in redefining and clarifying the impor tant role of health education and educat ion for health. The outcome of the consul tat ion will have a major impact on ensuring the provision o f the tools and mechanisms necessary for the delivery o f timely, efficient and effective health education to meet the new challenges o f a fast changing, high technology world. The report of this consultat ion has now been issued by the Scottish Health Educat ion G ro u p (SHE G) , Edinburgh, a W H O collaborat ing centre. A small core group meet ing took place at S H E G in November . This meeting identified more clearly the special function o f health education in the context o f health promot ion. It also served as prepara t ion for a major input into the X H I th World Conference on Heal th Educat ion to be held in Hous ton, Texas in 1988. 3.40 Majo r progress is being made in developing the joint C E C / W H O / C E project on p romot ing the health of young people in Europe. Th e project is a new and innovative appr oach in this area and draws from the expertise, networking and resources o f the three organizat ions concerned. 3.41 A meet ing held in L uxembou rg in February agreed in principle on the terms of reference for this joint venture. Final approval for the C E C contr ibut ion has now been obtained. A one-day consul ta t ion with CE in M adr id agreed on the outl ine o f a draft t eacher t ra in ing manua l tha t forms par t o f the jo in t projec t , an d agreed on the 44 m em bership of the small working group that was to prepare it. A further meeting of the core group took place in Utrecht in July, and again in Edinburgh in November. A draft o f the m anual was presented to the jo in t C E C /W H O /C E coord ina ting group in Brussels in December. 3.42 The second annual sem inar on selected topics in health education was organized by the G erm an Hygiene M useum , a W H O collaborating centre, in Dresden in June, on new and innovative approaches to the p ro m o tio n o f lifestyles conducive to health. The them e was tobacco, viewing tobacco use as a lifestyle problem and looking for new and appropria te strategies to p rom ote healthier lifestyles. 3.43 A small p lanning meeting took place at the University o f Perugia in November. Italy is in troducing a m ajor reorganization o f medical education, and this presents an ideal o p portun ity to develop models for health education in medical faculties. The p lanning meeting proposed holding a follow-up meeting in April 1988 on education for health p rom otion , in which the concepts and principles o f health p rom otion and the specific issues and m ethodologies o f health education would be discussed, with a view to their in troduction into the medical curriculum. The core group would also finalize plans for a w orkshop on education for health p rom otion , specifically health education in medical education, to be held in April 1989. The participants would be mainly from the medical faculty, not just in public health but also in internal medicine, with tem porary advisers from other relevant disciplines. 3.44 Nine tem porary advisers representing third-level training institutions in eight countries met in F ebruary to discuss ways of facilitating the exchange o f ideas and options for training program m es. The aim of the meeting was to review experiences in health p rom otion training and com pare them with the principles expressed in the recent O ttaw a C harter for health p rom otion. Particular emphasis was given to intersectoral and interdisciplinary approaches. 3.45 The First health prom otion training w orkshop was held in G ran ad a in A pril/M ay. This in terna tional course for Southern Europe and the M editerranean countries was organized according to the concepts and principles of health p rom otion , which were discussed in the context o f the move tow ards a new public health. The objective of the course was to develop technical capabilities for research and action program m es in health p rom otion in sou thern Europe and the M editerranean area, as well as to reinforce attitudes leading to a broad partic ipation in health. 3.46 A consultation on postgraduate train ing for health p rom otion was held in G o th en b u rg in Novem ber, bringing together 33 participants from 15 European countries to discuss the developm ent o f such courses and program m es in the Region. There has been a m ajor surge of interest in and planning for courses in health p rom otion addressed to many different groups. The principles and organization of this training are just emerging, however, and there is considerable dem and for the developm ent o f fram e­ works, curricula and new methods. This meeting has sown the seeds o f a network of t ra in ing centres in the Region for which the health p rom otion co llaborating centres may act as focal points. 45 Sexuality and family planning 3.47 The p roduc tion , evaluation, translation and distribution of teaching modules on family p lanning has continued. Eight modules have been o r are being produced , all but one in co llabora tion with the British Life Assurance Trust, London. F o u r o f these modules have already been printed and distributed, three o f them in 1987: Guidelines on psychosocial problem s o f fa m ily planning clients, Sexology fo r health professionals, and Guide pour la fo rm ation aux aspects psycho-sociaux de la planification fam ilia le (in French only, in co llabo ra t ion with the In ternational C h ild ren ’s Centre, Paris). Three more modules are in the final stages of editing before being sent for printing: Guidelines on problem s o f sexually transm itted diseases (STD ), Guidelines on certain aspects o f homo­ sexuality, and A ID S: counselling skills fo r health professions. Assistance was provided to national teams in Poland and Portugal to adap t teaching modules to their own needs. 3.48 A tra in ing video cassette on the counselling of family p lanning clients in a family p lanning centre has been produced under contract by the University of Bobigny, Paris, and eight copies are being reproduced for use by various co un te rparts for the tra in ing o f family p lanning health professionals. 3.49 An an n o ta ted bibliography on sexuality, family p lanning and m igrant p o p u ­ lations was updated , translated into English, reviewed, finalized and distributed in Ju ly /A ugust. 3.50 A four-year project with Albania to provide equ ipm ent and fellowships for the Institute of Paediatr ic Studies (1987-1990) was approved in February for an am o u n t of U S$600 000. All the equipm ent ea rm arked was ordered in 1987, although the three fellowships were postponed to 1988. 3.5! The two projects carried ou t in Bulgaria (research into the causes of, and remedies for, sterility (phase II) and family p lanning counselling o f families at risk) both ended during the year with the buying and repairing of equipm ent with the funds remaining. 3.52 An in ternational postgraduate training course on m ethods of family p lanning was held in Debrecen, Hungary in N ovem ber/D ecem ber, with English-speaking partici­ pants from all the W H O regions. 3.53 A project on the im provem ent of family planning and breastfeeding practices to be im plem ented in Poland was approved in September. It will serve target 16 as well. It is a two-year undertak ing , with a total budget o f U S $ 1 10000, consisting mainly o f the provision o f fellowships and equipm ent. It is jo intly executed by the N ational Research Institute for M other and Child (a W H O collaborating centre in Warsaw) and the Regional Office. 3.54 U nder the project for family p lanning activities in general hospitals and m a­ ternity clinics carried out in Portugal, two 2-week general courses were held this year on family p lanning and two on laparoscopic techniques. The project will end with two fu rther courses on laparoscopy and four more on family p lanning, and with the opening o f two contraceptive clinics for teenagers. 46 3.55 Also in Portugal, all the planned activities under the integrated project o f basic education in literacy, health and family planning for the Cape Verdean com m unity in the Lisbon area were implemented, including facilitating the relationship between health institutions and the Cape Verde population and producing educational material and organizing training sessions. 3.56 The third activity to benefit Portugal concerns the im provem ent and expansion o f m aternal and child hea lth /fam ily planning activities. This is a three-year project, costing US$160 500, approved in D ecem ber 1986 by U N FPA . The am oun t has been doub led by U S$50 000 a year to cover an allocation for contraceptive supplies. The project is progressing satisfactorily. In 1987, 180 physicians and 120 nurses were trained in family planning. The requested equipment supplies were delivered as planned. 3.57 In Turkey, the strengthening of integrated family p lann ing /m aterna l and child health services in 17 provinces progressed satisfactorily (this also serves target 16). An internal s tudy tou r for 40 health professionals was arranged at the end o f the year, and a s tudy tou r ab ro ad was undertaken in October. F rom the visits to G u m u sh an e Province by the Regional Officer in Septem ber, it was clear that the use of family p lanning m ethods was progressing positively and training in family planning was being imple­ mented. All the nurses and midwives of the provinces working in family p lanning were trained in 1987. A five-year extension of the project covering 11 provinces, for an am ount of US $1 984 905, was subm itted to the Regional Office for com m ents in July. It will start as soon as it has been approved. 3.5s All the above-m entioned country projects are financed entirely by U N FPA . Target 16 SO Sexuality and family planning 3.54 A working group was held at the Regional Office in May, to clarify the concepts of sexual health and suggest indicators for it. The final report went out at the end of September. 3.60 In connection with counselling in family p lanning for health professionals and with the assessment of users’ views on both traditional and m odern contraceptive m ethods, inform ation abou t the impact o f professionals is being gathered through two questionnaires for prof essionals and clients in 10 European countries. The ! hidings will con tribu te to the im provem ent o f family p lanning services. Separate reports on the health professionals and on the users are expected in 1988. The Institute for W om en, Ministry o f Culture, Spain analysed both surveys of Spain and published the analyses in a report received in November. By 1995, in all Member States, there should be sig­ nificant increases in positive health behaviour, such as balanced nutrition, nonsmoking, appropriate physical activity and good stress management. 47 3.61 The report o f a study on sexuality and people with physical disabilities was prin ted in J a n u a ry and widely d istribu ted , particularly in the United K ingdom . It is based on the experiences, ideas and recom m endations o f the handicapped people them ­ selves who contribu ted to this study. 3.62 A study on hum an sexuality and aging carried out by a researcher and her team from the Federal Republic o f G erm any is progressing well. The report o f the completed study is expected shortly. 3.63 An analysis o f the impact of occupation on fertility, sexuality, contraceptive practice and partnersh ip is being implemented in Finland and Poland. A preliminary report is expected in early 1988. 3.64 Live television debates ab o u t infertility and the trea tm ent m ethods for actually and potentially infertile people took place in H ungary and Italy between infertility counsellors and couples. Video recordings and reports on the television program m es should be received in 1988. 3.65 The report o f a study on the place and role o f men in birth and contraception, conduc ted u nder contract by the N ational School o f Public Health , Rennes was rep ro ­ duced and distributed in February. 3.66 Issue No. 10 of the newsletter Entre nous was d istributed in July. The Spanish translations of Entre nous No. 8 and 9 were received and distributed. The Portuguese trans­ lation of No. 7 is expected in early 1988, and a Turkish translation o f the newsletter will begin as from No. 10. Nutrition 3.67 By m eans o f a specific m ailing list — the so-called E u ro p ean nu tr i t ion ne t­ work — reports and recom m endations on nutrition policy form ulation and im plem en­ ta tion are d is tr ibu ted to 800 people w orking in the field o f nu tri t ion , mostly in E urope but also in o th e r parts o f the world. A letter sent out in Ju ly 1987 with inform ation ab o u t the activities in the N utri t ion unit has received a very positive response. M any orders have been received for unit docum ents th rough the order forms enclosed with the letter. In 1986 more than 3000 copies were ordered in that way. 3.6X The final draft o f a source book for the form ulation o f nutri t ion policy objectives was received and edited. It will be published in 1988 under the title H ealthy nutrition: preventing nutrition-related diseases in Europe. A bout 400 copies o f the final draft o f the manuscript were distributed. 3.69 Two o ther basic books for nutrition policy-makers are being prepared. The first will be on nutri t iona l surveillance in the context o f nutri t ion policy planning. A g roup of experts on dietary and nutritiona l da ta collection have con tribu ted to the book , and editorial assistance has been received from the Swedish F o o d Adm inis tra tion who provided one of their experts as a tem porary adviser. зло The second book is intended for policy-makers on models for the organization and im plem entation of nutrition policy. In this context a study took place in M ay to 48 analyse nu tri t ion policy fo rm ulation in Poland , and the potential for im plementing such a policy. A no ther s tudy was m ade in Ju ly of the long-term experience gained from im plem enting the Norw egian nutri t ion policy, ad o p ted by parliam ent in 1975 and now being incorporated into an overall health plan. C ontributions are also expected from A ustra lia , giving a sum m ary o f their experience. A com parative study o f conditions and events in the N ordic countries has been carried out by the N ordic Council, and a shortened version of this will be incorporated into the book. 3.71 M ass catering is one o f the most effective ways of implementing the objectives of a nu tr i t ion policy on a large scale. It is therefore an area o f pa r ticu la r concern to the nu tri t ion program m e. A com parative study of experience with mass catering in D en­ m ark and H ungary was carried out, and has been very positively received by those w orking in the field. It was one of the background docum ents to a meeting on op p o r­ tunities fo r better nu tr i t ion th rough mass catering, held in C openhagen in December. Tw enty-tw o experts in the field, from 10 countries, met to consider how mass catering, which in many ways has grow n enorm ously in size but not always in quality, could be a better instrum ent for health prom otion . 3.72 Obesity is an area of concern to the nutrition programme, which concentrates on its epidemiological aspects. The incompatibility in the presentation of an thropom etr ic data describing obesity, within and between countries, makes com parison and analysis diffi­ cult. A meeting to discuss the possibility o f s tandardiz ing the an th ropom etr ic description o f obesity was therefore held in W arsaw in O ctober. T he draft report from the meeting contains specific proposals for the collection, analysis and presentation of such data. 3.73 A w orkshop on a systematic app roach to com m unity nu tri t ion was held in Jan u a ry in Asker, N orw ay for com m unity nutritionists working in different fields. A second w orkshop on the same subject will be held in H ungary in M ay 1988. The report on the first w orkshop is available from the N utrition unit. 3.74 A w orkshop on household survey d a ta and their use in nu tri t ion policy p lanning was held in Athens in O c tober and a ttracted a ro u n d 30 statisticians and nutritionists from 17 M em ber States. Being a truly interdisciplinary venture, the w orkshop con­ cen tra ted much effort on small working groups where partic ipants could share their experience. T he w orkshop was supported financially by the C om m ission of the E uro ­ pean Com m unities . R ecom m endations were drafted concerning the p repara tion of household budget surveys, and the collection, analysis and presentation o f data. Various proposa ls were made, aimed at involving nutrition policy planners at an early stage of the survey prepara tions. The statisticians also strongly suggested tha t nutritionists be more precise abou t the type o f d a ta they needed for nutrition policy purposes. Smoking and health 3.75 A plan o f ac tion covering a five-year period was d raw n up in co llabo ra t ion with two consu ltan ts , an d was ad o p ted by the Regional C om m ittee in resolution E U R /R C 3 7 /R 9 . T he Action Plan on Tobacco urges greater coord ina tion and cooper­ a tion am ong those w orking at local, national and in ternational levels. It emphasizes 49 the efficient use o f existing resources, the sharing o f knowledge and experience, and cooperation between individuals an d groups to increase the impact and effectiveness of individual measures. 3.76 T he Action Plan on Tobacco has six objectives: (a) to help countries develop and implement comprehensive tobacco policies; (b ) to develop cooperation at an inter­ governmental level; (c) to encourage the cooperation o f nongovernm ental organizations; (d) to p rom ote public inform ation; ( e) to collect and disseminate inform ation; and (/) to establish a E uropean system to m onito r and evaluate the effectiveness o f the measures taken. 3.77 T he Action Plan was warmly received by the Regional C om m ittee, and the ensuing discussions led to a lively debate. In addition , it received good press coverage. 3.78 Legislative initiatives can reduce tobacco m arketing as well as influence indi­ vidual and social behaviour. Legislation has not yet materialized efficiently in many countries, however, because the political will, when it exists, encounters many obstacles. In o rder to su p p o r t politicians and parliam entarians in their effort to in troduce and implement legislation, the H ealth Legislation unit initiated the preparation of a model national legislative strategy on sm o k in g /to b acco control. It will provide M em ber States with the legislative fram ew ork to support a comprehensive sm ok ing /tobacco control policy, including various scenarios that could be adap ted to different situations, showing the chances o f success, the causes of failure and the impact o f legislative action under different circumstances. 3.79 T hree m odules on “ tobacco or hea lth” were presented in d raft form to a meeting o f na tional medical associa tions in Paris in N ovem ber. O ne deals with advice to patients on stopping smoking, an o th e r with sm oking cessation by doctors themselves, and the th ird with active partic ipation in no-sm oking cam paigns by members o f medical associations in the capacity o f an advocacy group. The partic ipants in the meeting strongly supported the texts, and com m itted themselves to m aking full use o f the modules. Target 17 80 Research 3.80 A consultation on health p rom otion indicators was held in Edinburgh in Jan u a ry to consider the H F A lifestyle targets and associated indicators for health prom otion. Most By 1995, in all Member States, there should be sig­ nificant decreases in health-damaging behaviour, such as overuse o f alcohol and pharmaceutical pro­ ducts; use o f illicit drugs and dangerous chemical substances; and dangerous driving and violent social behaviour. 50 o f the H F A targets are related to social and behavioural factors, in term s o f bo th structures and processes. It was felt that the social meaning of concepts ough t to be taken into account, and the consulta tion then came up with additional criteria for health p rom otion indicators. C om m ents were made on the proposed essential an d supplem en­ tary indicators as well as on new or proposed indicators. Suggestions were also offered on research methods, da ta collection and sources. 3.81 A report was subm itted to the Regional Office in time for the revision o f indicators in mid-February . Drug abuse 3.82 C ontacts were established with a num ber o f institutions th ro u g h o u t the Region interested in co llaborating in an in terna tional com parative study on the sociocultural factors associated with d rug abuse. C onsulta tions were held with experts who will play a leading role in the im plem entation of this study. The study will try, am ong other things, to identify the influences in the com m unity that act against the abuse o f psychoactive drugs in general. 3.83 A study has been carried out to explore the possibility o f early intervention techniques in drug abuse. T he study indicates that, con tra ry to generally held beliefs, early interventions are effective and efficient com pared with the trad it ional trea tm ent tha t focuses more on the established drug abuser. Models to prom ote early intervention were discussed a t a meeting held in D ecem ber in M unich. In the course o f the next biennium these models will be tested in various subregions for their applicability on a wider scale. 3.84 A study was carried out on drug abuse research in the European Region. It show ed tha t there is a fair am o u n t of research o f all types going on. Nevertheless, the links between research and policy-making, the setting of priorities and the coord ina tion o f in fo rm ation could be substantially improved. Better mechanisms for coord ina tion at the national and in terna tional levels will have to be established. F u tu re activities in this project will also look at ways and means o f calling attention to the priority areas identified by the European Advisory Com mittee on H ealth Research. 3.85 Partic ipation in the jo in t C E /C E C /W H O project on health education against d rug abuse continued th ro u g h partic ipa tion in the discussions on the conduct o f the project and th rough linking this project with the country m edium -term p rogram m es in G reece and Spain. T he Regional Office’s involvement in this project allows the partic i­ pa ting com m unities to form links with the Healthy Cities project and with health education activities. 3.86 In co llaboration with an Italian nongovernm ental o rganization, links were es­ tablished with an in terna tional E uropean netw ork tha t may provide the op p o r tu n ity for a regular update o f trends in drug abuse at the E uropean regional level, and for the identification o f innovations in trea tm ent and prevention. 51 3.87 Inform al discussions took place at regular intervals with representatives o f the Council o f Europe (Pom pidou G ro u p ) and the Com m ission of the European C o m ­ munities to ensure appropria te coord ina tion between the activities undertaken by these agencies and the W H O regional program me. Alcohol abuse 3.88 In Ju n e the second meeting o f principal investigators in the W H O collaborative study on com m unity response to alcohol-related problems took place in Lisbon. At this meeting, the principal investigators com plem ented and updated their inform ation on national and com m unity policies and program m es and presented progress reports on the responses to them in terms o f the services provided and the preven tive /p rom otive action taken in their respective communities. Discussion on the design and use o f instrum ents and definitions in each com m unity continued. 3.89 A willingness to share with and learn from each o ther has been one o f the most significant aspects o f this study and should facilitate the development of novel and innovative responses within the com m unities concerned. This may also be one o f the reasons why an increasing num ber of countries are expressing their interest in jo in ing the study. At present, 16 comm unities in 12 countries are participating. C om parative studies are not the m ain aim, but it is expected that the final report will contain a set o f case studies in which the different communities can report their response to alcohol-related problems. In this respect the principal investigators agreed to a com m on outline for the report which is expected to be ready in 1991. 3.90 Visits by the principal coo rd ina to r to the partic ipating communities in D enm ark , Iceland and Spain and by a consultan t to F rance and Portugal greatly benefited these communities, as reflected by their progress with the study activities. 3.91 A con tract was draw n up with the W H O collaborating centre for health — psy­ chosocial and psychobiological factors in Brussels to review the literature on violent social behaviour and alcohol (with special reference to alcohol-related violence involving young people). T he synthesis o f the literature will be finalized in early 1988, bu t the prelim inary findings seem to indicate a positive re la tionship between violence in general and alcohol. 3.92 Alcohol is also a con tribu to ry factor in the complex social context that involves hooliganism. In the field of alcohol use and violence within the family, more a ttention has been paid to prevention, especially to protect the healthy development o f children and adolescents. 3.93 A review o f current policies on alcohol abuse in United N ations agencies and in tergovernm ental and nongovernm ental organizations was undertaken to develop co­ ord inated action and planning am ong the organizations involved. The report is expected to be finalized in mid 1988, and will be issued jointly with the national reviews m entioned in paragraph 3.25. 52 LIFESTYLES CONDUCIVE TO HEALTH Documents issued in 1987 A ID S am ong drug abusers: report on a W H O C onsu lta tion (docum ent IC P /C D S 027). A ID S and the newborn: report on a W H O C onsu lta tion (docum ent IC P /C D S 017). Alternative approaches to the development o f fa m ily planning programmes: report on a W H O study (document IC P /M C H 503Л01). C om m unity nutrition w ork — a system a tic approach (docum en t 1 С Р / N U T 128). C om m unity response to alcohol-related problems: report on the second meeting o f principal investigators in the W H O collaborative study (docu­ ment IC P /A D A 017). Concepts o f sexual health: report on a W H O meeting (docum ent IC P /M C H 521). Fertility awareness methods: report on a W H O w orkshop (document IC P /M C H 518). Haddad, W. Safe sex: working paper p repared for a meeting on A ID S diagnosis and control (document IC P /C D S 0 2 6 /1 1). H ealth education in the fa m ily : report on a W H O meeting (docum ent IC P /P H C 115). H ealth exhibitions — m useum s— posters: report on a w orkshop organized by the G erm an Hygiene M useum o f the G erm an D em ocratic Republic (docum ent I C P /IE H 122). H ealth prom otion in the working world: report on a jo in t meeting organized by the Federal C entre for H ealth E duca tion , C ologne (docum ent IC P /H S R 603/m02). H ealth workers and the W HO International Code o f M arketing o f Breast- m ilk Substitutes: report on a W H O meeting (document IC P /N U T 112). In fant m orbidity — infant feeding: recom m endations for research (docu­ ment IC P /N U T 102Л03). Nilsson Schönesson, L. The relationship between psychological dysfunction and sexuality within a m arital context: report on a literature survey (docu­ ment IC P /M C H 519). Porter, M. Sexua lity and people with physica l disabilities: report on a study (document IC P /M C H 526). Sexuality, fa m ily planning and m igrant populations: an n o ta ted bibli­ ography (document IC P /M C H 535). The respective roles o f prim ary health care and specialized services in the developm ent and im plem entation o f program m es fo r problem drinkers: re­ port on a W H O meeting (docum ent IC P /A D A 010). Vienna dialogue on "H ealth po licy and health prom otion — towards a new conception o f public hea lth": rep o r t on a W H O meeting (docum ent IC P /H S R 623). 54 Action Plan on Tobacco Smoke-free Europe Five-year plan for a smoke-free Europe If each day of the year four ju m b o jets crashed in Europe killing all on board , there would be public dismay and outrage if the authorities failed to solve the problem. Yet tobacco causes at least an equivalent num ber of dea ths in Europe — an estim ated 500 000 each year. Tobacco is not only a legal, addictive drug, but it is also widely prom oted and advertised through images o f wealth, youth and glamour. * The s m o k i n g c lub . 1 7 9 2 W e l l c o m e Ins t i tu te Library. Lo nd o n . Un i ted K i n g d o m The deadly cure The first E uropean exposed to tobacco sm oke was C hris topher C olum bus, who found Indians sm oking when he arrived in Central A m erica in O ctober 1492. Spanish and Portuguese explorers o f the New W orld in troduced tobacco to Europe, where it was at first believed to cure headache and provide relief from a score of other maladies. By the middle o f the sixteenth century, Jean Nicot, the French A m bassador to Portugal who gave his nam e to the genus Nicotiana, was growing tobacco in Europe and p rom oting it for its “ cure-all” qualities. Until the late nineteenth century, tobacco was sm oked primarily in pipes an d by men. C igarettes, especially after the invention of the cigarette-m aking machine, made tobacco available to a wider public. U nfortunate ly , the cigarette was also a much more hazardous way o f consum ing tobacco. Cigarette consum ption increased rapidly in many parts o f Europe until after the Second W orld War. Changing fashions meant that wom en, especially those in the most industrialized countries, began to sm oke in growing num bers after the First W orld War. Evidence of the harmfulness o f sm oking appeared sporadically before the Second 5 W orld W ar, but not until the 1950s did carefully constructed epidemiological studies begin to provide solid evidence of the hazards o f tobacco. Despite the weight o f medical | evidence, tobacco consum ption is still increasing in many European countries, a l though j it has stabilized or started to fall in others. Sm o ke le ss t o b a c c o : a t t rac t i ve pa ck ag ing , f i l t hy p r o d u c t s W H O , T. Farkas An avoidable cause of death Cigarettes, the m ain way tha t people consum e tobacco in Europe , are the conti­ n en t’s greatest single avoidable cause of illness an d prem ature death. The level o f lung cancers is now alarm ing, an d a lm ost all are caused by cigarette smoking. T he habit is also a m ajor con tribu to ry factor to o ther cancers and to diseases of the heart, the circulatory system and the lungs. Sm oking during pregnancy threa tens the b ab y ’s health. Children whose paren ts smoke are more prone to chest infections and o ther illnesses. Breathing o ther people’s tobacco sm oke is called involuntary smoking, and this can harm n on­ sm oking adults , too. T obacco is dangerous no m atte r how it is consum ed, even if it is chewed or merely held in the m outh for long periods. ji T obacco use has not only medical bu t also m ajo r social and econom ic implications. ; Ï Different social g roups a ttach varying values to the habit and strongly influence whether ' I a person becomes a smoker. Powerful economic interests involved in tobacco p roduction j I and d is tr ibu tion also limit individual choices th rough the pressure of advertisements or ! the sponsorsh ip of sports an d o ther leisure activities. This reinforces the social ac- j ceptability o f tobacco and counteracts a ttem pts by health authorities to encourage people to make better choices for their health. D uring the past q u a r te r o f a century, every country in Europe has taken some steps to prevent the senseless loss of life caused by tobacco. But these isolated efforts, however good in themselves, have not been adequate to tackle this difficult and pervasive problem. The wealth that tobacco p roduction and sales bring to some sectors of the com ­ munity merely exacerbates the problem by giving countries a s trong disincentive to reduce consum ption . M oreover, since tobacco taxation provides a plentiful and easy source o f revenue, governm ents themselves can feel the conflict between wealth and health. Com prehensive tobacco policies are the most prom ising way to su rm oun t these obstacles and reduce any co u n try ’s tobacco consum ption. Such policies would coord i­ nate a wide variety o f collective and individual measures at com m unity and national levels. It is clear that widespread changes will not come abou t through the efforts o f any single governm ent ministry, health service or public interest group. Success will come from a com m on effort. Action Plan on Tobacco Because o f their growing concern abou t the epidemic o f tobacco-induced diseases, the 32 M em ber States o f the WHO E uropean Region asked the WHO Regional Office for Europe to conduct a m ajor cam paign against tobacco use, as a part o f the WHO strategy for health for all by the year 2000. In the au tu m n of 1987, the E uropean M em ber States formally approved the Action Plan on Tobacco: a five-year strategy, d raw n up by WHO, to encourage and assist countries. The Plan urges much greater cooperation between the people working at local, national and in ternational levels and between individuals and groups. It emphasizes the efficient use o f existing resources by pooling knowledge and experience o f successful projects and by encouraging coopera tion to increase the effectiveness o f individual measures. The Action Plan has six objectives: • to help countries to develop and implement comprehensive tobacco policies; • to develop international cooperation; • to encourage the involvement and support of nongovernm ental organizations; • to collect and disseminate inform ation; • to prom ote inform ation to the public; • to establish a European system to m on ito r and evaluate the effectiveness o f measures taken. NÄO FUME NEM TUDO О QUE ARDE CURAI SAßLAM BlR IRADEYLE GÜÇÜJ BlR BÜNYE W H O , H. Skougaard-Jacobsen M any activities to implement the Action Plan are already under way. In 1987, the Regional Office for Europe and in terna tional and in tergovernm ental organizations discussed the Plan and how they might work together more effectively. Especially im portan t has been the coord ina tion o f activities with the Com mission o f the European C om m unit ies’ m ajor public health initiative, the Europe against Cancer Program m e. C om m unica t ion has also been strengthened with in terna tional organizations represent­ ing different areas o f the medical profession, consum ers’ g roups and charitable organ iz­ ations concerned with health. Per cap i ta c o n s u m p t i o n of m a n u f a c t u r e d c igare t tes in 2 6 E u ro p e an cou n t r ies , a ro u n d 1 9 8 4 3000 500 POR FIN BEL SSR DEN SPA DDR IRE CZE AUT POL HUN TUR SWE ROM BUL ISR FRA NET UNK ITA DEU ICE SWI YUG GRE Country Involving the medical profession Tw o o f the Action Plan’s m ajor projects completed so far were cooperative ven­ tures. A long with WHO headquarters and the In ternational Union against Cancer, the Regional Office for Europe contribu ted to a project designed to give guidance to the prim ary health care team in more effectively helping patients to stop smoking. Closely tied to this w ork was a project to provide tools for national medical associations to use in involving their own members in the campaign against tobacco. This involvement includes getting physicians themselves to stop sm oking, encouraging them to help their patients stop, and increasing awareness o f the tobacco issue both within and outside the profession. First European Conference on Tobacco Policy and Health Few changes in the policies o f either public authorit ies o r private organizations will ! occur unless there is public awareness o f the gravity o f the tobacco problem and j w idespread support for measures to tackle it. Even when policies are changed, many will I not be accepted by the public if there is no consensus that the health and social • consequences of tobacco use are intolerable. ? With this in mind, the Regional Office for Europe is organizing the First European C onference on T obacco Policy and Health. This Conference, which is scheduled for N ovem ber in Spain, will be the m ajor activity o f the Action Plan for 1988. It aims at bringing together policy planners and adm inistrators , public interest groups such as consum er organizations, an d professional interest g roups such as health personnel, teachers, journalis ts , economists, social scientists, lawyers, agriculturists and representa­ tives o f labour unions. Because tobacco is not a problem that confines itself to national borders, international organizations, which have an im portan t and specific role to play, will also be represented at the Conference. These are the people w ho will articulate the need for policy changes: in o ther words, those w ho will s tart to build the consensus and plan the policy changes or carry them out. The Conference will be a forum where these various groups can find ways to exchange knowledge and resources, agree on a model tobacco control policy and decide on specific action that can be taken now and in the near future to raise awareness of the tobacco problem and to prom ote policies that make some headway against it. Some o ther projects to implement the proposals of the Action Plan include: • the developm ent o f a scenario o f different national policies on tobacco use in Europe, with special emphasis on legislation; • brief reports from European countries on topics such as health eduation , new tobacco products , and tobacco p rom otion , pricing and legislation (this data will be indexed and made available in printed and com puter-readable form, and the complete reports will be printed for people who need more detailed information); • the production o f a selection of written and audiovisual health education material abou t tobacco use to make existing work more widely known (this collection will be as practical as possible and will point users to further sources of information); • the identification o f existing data bases on tobacco use and o ther relevant information sources, which will be examined to see how best they can be supplem ented and made more widely accessible; ( • the development o f a series of practical brochures addressing questions on such topics as what is known about ch ildren’s tobacco habits, how physicians can help their patients s top smoking, and the effects of price increases on tobacco consum ption. Partners for action The Action Plan on Tobacco is a response to a critical, seemingly intractable problem. Public health officials are fighting an established, socially acceptable habit that is also a form o f addiction. M oreover, countries also become addicted to tobacco through their economic dependence on the revenue it generates. New solutions must be found to break the hold tobacco has on both countries and individuals. Built on ideas defined by the O ttaw a C harte r for Health P rom otion , the m ethod endorsed by the Action Plan — one that enlists the interest and support o f a wide variety o f groups, institutions and individuals — is a rational and promising solution to such problems. The Action Plan is a pilot scheme in this sense: if its m ethod is effective with tobacco, the same m ethod can be applied to o ther lifestyle issues. Ac t i o n on S m o k in g and Heal th (ASH). Un i ted K in g d o m 4Healthy environment 4.1 With the overall objective o f creating a hum an environm ent that will support the im plem entation o f the Regional Office p rogram m e as outlined under targets 18-25, work con tinued to con tribu te to the fu r ther s trengthening o f policies an d strategies to prevent an d con tro l env ironm enta l health hazards, assess and deal with environm enta l health risks, and prom ote a healthy environment. 4.2 Environm ental and health impact assessment is an im portan t tool in the preven­ tion o f health hazards. It is the element o f environm ent and health policy that should be fu r the r developed and applied on the basis o f m ultisectoral cooperation . The p rom otion o f a m ethodology and its application were two o f the m ajor concerns o f the p rogram m e o f w ork implemented during the year. 4.3 A new and significant inpu t to the p ro m o tio n o f environm enta l health during the period u nder review was the developm ent o f the H ealthy Cities project, which aims at im proving the health conditions o f urban populations. 4.4 Increased a t ten t ion was paid by M em ber States to p rob lem s associated with m unicipal waste m anagem ent. Because o f the limited disposal op tions available, incin­ e ra tion has become an increasingly preferred solution. This, in tu rn , has led to concern ab o u t the consequences fo r hu m an health and the env ironm ent from the emission into the air o f certain po llu tan ts , o r their concen tra tion on b o t to m ash an d subsequent disposal. 4.5 The European Region’s industrial developm ent is dynam ic, which results not only in new health hazards bu t also in hazards from developm ents in the past. The evaluation o f the In te rna t iona l D rink ing W ater Supply and San ita tion D ecade carried out at a consu lta tion held in N ancy indicated that m any problem s related to w ater supply and sanitation in the European Region have not yet been solved. 4.6 Chem ical po llu tion o f the environm ent remains the m ajor cause o f health hazards in the o u td o o r and in d o o r environm ent, including the occupational environm ent. The intensive m onitor ing o f po llu tion and of the sources o f chemical po llu tan ts that m an may be exposed to are rarely linked to an assessment o f the im pact tha t po llu tion may have on peop le’s health. With the aim o f improving strategies for m onitor ing chemical health hazards , a p ro g ram m e was initiated to develop guidelines on the applica tion of environ­ m ental m onito r ing in health im pact assessment, as well as to develop an environm ental health d a ta base. 55 4.7 A m ajo r achievement in developing tools to contro l health hazards associated with air po llu tion was the finalization o f work on and publication o f A ir quality guidelines fo r Europe. This publication provides guideline values for safe levels o f 28 individual and groups o f chemicals in the air. The values are based on the assessment o f the health effects o f the chemicals concerned, carried ou t by Regional Office working groups and consul­ ta tions in which over 150 experts from all over the world partic ipated. This significant achievem ent was possible thanks to the generous support received from the G overnm ent o f the Netherlands. 4.8 The updating o f the W H O guidelines for drinking-water quality was considered the next step necessary to enhance regional and global abilities to prevent and control health hazards from drinking-water. Guideline values for 11 herbicides in drinking- w ater were developed by the Regional Office in 1987 with the support o f the G overnm ent of Italy. 4.9 A lthough efforts to control chemical hazards have been increasing in Europe and o ther regions o f the world, accidents and disasters caused by the uncontrolled release o f chemicals in to the environm ent continue to occur. The causes and circumstances of such accidents, as well as the preventive measures taken, were discussed at the first W orld Conference on Chemical Accidents, organized by the Regional Office in cooperation with the central unit o f the In terna tional P rogram m e on Chemical Safety a t W H O headquarters a n d the Istituto Superiore di Sanità in Rom e, a W H O collaborating centre. The Conference revealed that large-scale catastrophes, infrequent bu t highly d ram atic in their consequences, point to the need for the fur ther developm ent of prevention p ro ­ gram m es and adequate contingency plans based on thorough environmental and health im pact assessment. The problem is t ransboundary : as the C hernobyl nuclear accident showed with startling clarity, disasters recognize no frontiers. 4.10 The consequences o f the Chernobyl ca tas trophe in 1986 remain of com m on concern in the Region. Based on the m an d a te provided by resolution E U R /R C 3 6 /R 8 of the Regional Com m ittee in 1986, the Regional Office intensified its work during 1987. This led, inter alia, to a com m on understanding being reached am ong the countries of Europe as to which actions must be taken to safeguard public health in case o f such accidents. 4.11 The implementation o f the environm ental health p rogram m e in 1987, as a p ­ proved by the Regional C om m ittee , was successful in tha t it ob ta ined the coopera tion of M em ber States an d direct support from a num ber o f them. Nevertheless, p rogram m es such as those on occupational health and food safety are particularly dependent on support from M em ber States if they are to be fully implemented. 4.12 The year 1987 was also a successful one in the distribution o f technical in for­ m ation , bo th th rough the Publications p rog ram m e o f the Office and th rough docum ents o f various kinds. One such vehicle is the Environm ental H ealth Series which, a l though officially a docum en t series, is frequently reviewed by jo u rn a ls an d is included in several widely accessed d a ta bases. These docum ents are available only on request, an d during the year some 4700 such requests were received. Thirteen new titles in this series were issued during 1987. 56 4.13 In November, a collaborative agreement was made between the Regional Office and the Research Institu te for Hygiene and M icrobiology, Bad-Elster, G erm an D em o ­ cratic Republic. T he co llaboration will be in the field of environm ental problem s and their health-related aspects. 4.14 An intensive p ro g ram m e of co llabo ra t ion has begun with the Province of N av arra in Spain, under which the Office has been invited to partic ipa te in training activities in environm ental health issues, run by the Miguel Servet F oundation of the N avarra Regional Institute o f Public Health. The Institute has started postgraduate tra in ing in environm enta l hygiene, and a series of short courses of a few weeks’ dura tion in specific environm enta l health subjects are also being run for technicians from all over Spain. In early 1988 the Institute is expected to be officially appoin ted a W H O collab­ ora ting centre for the p rom otion of environmental health activities within primary health care programmes. Target 18 SO 4.15 T he technical p repara tions for the European conference on health and the env ironm ent progressed according to plan, a l though some delays were experienced in ensuring the financing of this major event th rough voluntary funds. A consulta tion was held in C openhagen in Jan u a ry to design environm ental health indicators for m onitoring the progress of the H F A strategy in Europe. 4.16 The W H O -sponsored annual course on environm ental and health impact as­ sessment was held at A berdeen University in July , and ano ther course on the assessment o f the environm enta l and health effects o f developm ent proposals was held at the same university in September. This second course concentrated on the interface of health sciences and environm ental impact assessment. The work of the Regional Office on environm enta l and health impact assessment was consolidated in Environm ental Health Series No. 15, Health and sa fety component o f environm ental impact assessment. This docum en t was d istributed in 1987 as the Office contribu tion to the sem inar on environ­ m ental impact assessment, organized by the United N ations Economic Com mission for Europe (ECE) in W arsaw in September. 4.17 The M onitoring and Assessment Research Centre in L ondon was designated a W H O collaborating centre for environm ental health m onitoring and assessment, and the C entre for E nvironm ental M anagem ent and P lanning in Aberdeen was designated a W H O collaborating centre for environm ental and health impact assessment. 4.18 W H O recom m endations ab o u t env ironm enta l and health im pact assessment are being im p lem ented at the field level in the W H O -ass is ted , U N D P -su p p o r ted By 1990, Member States should have multisectoral policies that effectively protect the environment from health hazards, ensure community awareness and in­ volvement, and support international efforts to curb such hazards affecting more than one country. 57 project carried out in the A u to n o m o u s Province o f K osovo in Yugoslavia, on environ­ mental p ro tec tion related to the developm ent of large-scale mineral exploitation. It is also proposed to apply these recom m endations in the implementation o f the W orld B a n k /U N D P regional project on energy planning in E uropean and A rab states, and a p lanning meeting on that subject was held in Vienna in June. 4.19 T he Regional Office provided the ECE executive body for the C onven tion on Long-range T ran sb o u n d ary Air Pollu tion with in form ation and material for the health co m p o n en t o f a study on the effects o f such pollution. This in form ation concerned the effects on health o f nitrogen dioxide, sulfur dioxide and particula te matter, ozone and o ther photochem ical oxidants, cadm ium and lead. The Regional Office was represented at the sixth session o f the ECE executive bo d y ’s working g roup on effects, in G eneva in July , and a t the fifth session o f the executive body in G eneva in N ovember. A lthough delegates requested more input from W H O on health effects, they were informed tha t the Air quality guidelines fo r Europe publication now provided the most up-to-date infor­ m ation on im p o rtan t air pollutants , and that the Regional Office would subm it fur ther inform ation in the future when it became available. Target 19 SO 4.20 T he survey of the environm enta l health inspection system in Europe was con­ tinued with the assistance of the W H O collaborating centre for the training and utiliz­ ation o f environm ental health officers, located at U m eâ University, Sweden. A course on epidemiology in environm enta l health took place there in M ay /Ju n e . Direct assistance was given for the tra in ing of environm enta l health officers a t the Public H ealth Institute o f Pam plona , Spain and at the N ational Public Health Institute in Rome. The Institute of Hygiene and Epidemiology in Brussels was designated a W H O collaborating centre for environm enta l da ta assessment. Its main task will be to inventory and critically assess existing environm ental da ta , hum an exposure and uptake data , and data on related health effects for the main pollu tants in the European Region. 4.21 A refresher course for sanitary engineering professors was held at the In ter­ national Institute for Sanitary Engineering in Delft, Netherlands. 4.22 Tw o W H O docum ents on environm ental health m anpow er developm ent were issued in the Environm ental Health Series: No. 18, Development o f environm ental health manpower, and No. 19, Occupational profiles o f environm ental health personnel. 4.23 T he Regional Office is p lanning to develop activities to strengthen environm ental health tra in ing within European schools of public health (for fur ther in form ation, see under target 30). By 1990, all Member States should have adequate machinery fo r the monitoring, assessment and control o f environmental hazards which pose a threat to human health, including potentially toxic chemicals, radiation, harmful consumer goods and biological agents. 58 Chemical hazards 4.24 A health-related environm ental m onitor ing system must have clearly defined public health goals, and progress tow ards these goals must be assessable in an objective way. An informal consultation held in Copenhagen in August recom m ended that studies be undertaken to provide a background for the development of guidelines on the identification of priority problem s related to the impact on health of chemical pollutants. 4.25 The European Region, with its con tinuous industrial developm ent, must be concerned abou t chemical hazards that put the health of its population at risk. A num ber o f already recognized hazards are under thorough scrutiny, as new diagnostic criteria indicate that control m easures established in the past may not be sufficient to protect people’s health. In tercountry collaborative epidemiological studies have continued on the neurobehavioural effects of lead on children, the renal effects of cadm ium on the elderly, the neurotoxic effects of chronic exposure to organophosphorus com pounds, and the effects of welding fumes on the health o f stainless steel welders. Some of these studies (on lead and cadm ium ) are well advanced and final reports will be available during 1988-1989. A meeting held in H anover in November, sponsored by the G overn ­ ment o f the Federal Republic of G erm any and held jointly with the International P rog ram m e on Chemical Safety, evaluated the effects on health o f formaldehyde. It was recom m ended that an epidemiological study be undertaken to assess the risk to health of form aldehyde in indoor air in com bination with o ther indoor air pollutants. 4.26 A working group sponsored by the Veneto Regional G overnm ent met in A bano Terme, Italy to review studies on exposure and health risk assessment in infants exposed to polychlorinated dibenzodioxins (P C D D s) and polychlorinated d ibenzofurans (PCDFs). It concluded that a lthough average levels of P C D D s and P C D F s in breast-milk are relatively high, they are not likely to be a risk to the health and developm ent o f infants, since the safety margin is o f 2-3 orders o f m agnitude com pared with the lowest levels at present known to have toxic effects. Any limitations imposed on breastfeeding associated with the presence of P C D D s and P C D Fs would therefore not be justified. Instead, the w orking g roup recom m ended that prim ary prevention should be undertaken to reduce emissions of P C D D s and P C D F s into the environm ent, thus preventing the further accum ulation of these chemicals in the hum an body, including breast-milk. 4.27 A m ong the various chemicals present in drinking-water, herbicides are o f special concern owing to their toxicity and persistence in the hum an body. This concern has been aggravated by the fact that control measures introduced in a number of countries, based on analytical and health criteria, are considered inadequate by the countries concerned. Two consultations held in Rome in February and July evaluated the risk to health from 11 herbi­ cides. Based on this evaluation, the consultations recommended guideline values for safe levels in drinking-water o f the 11 herbicides reviewed (see under target 20). These consul­ tations and the d istribution of the report were supported by the G overnm ent of Italy. 4.2X In preventing health risks due to exposure to toxic chemicals, special a t ten tion m ust be paid to people w ho may be particu la rly susceptible to env ironm en ta l po l­ lu tan ts . G enetic pred isposition may be one such reason for a higher than average 59 susceptibility. An inform al consulta tion held in C openhagen in September reviewed the state o f knowledge in this area and discussed the need for preventive action. It was concluded tha t a num ber o f well recognized genetic traits m ay be considered as a predisposition to higher susceptibility to toxic chemicals. However, the actual signifi­ cance for health o f this phenom enon has not yet been ascertained. Adequately designed in-depth surveys and studies need to be undertaken. 4.29 Efforts to enhance international, intersectoral and interregional collaboration on chemical safety are receiving high priority in the U N D P-supported regional project on the im pact and con tro l o f chemicals, in which 12 European countries are participating. The project is s trengthened by its close links with seven cooperating United N ations agencies. Emphasis is placed on international and intersectoral capacity building. New technologies 4.30 As p lanned , a dual purpose review and editorial meeting took place on the psychosocial im pact of visual display terminals (VDTs) on operators. F o r this meeting, an expert from the United K ingdom carried out a study tha t reviews previous pub li­ cations and describes the state of the art in this Field. The report, which is expected to be published in 1988, will com plem ent a previous report on all the o ther aspects o f work with V D Ts. The conclusions o f the study and the meeting have shown that the psycho­ social elements involved in working with V D Ts are of a similar nature to those involved in the in troduction o f any new technology or procedures into the workplace over and above the usual routine. Nonionizing radiation 4.31 The second edition of the book Nonionizing radiation protection (E uropean Series, No. 10) is being prepared for publication. It provides the latest state o f the a r t in the field o f nonionizing radia tion (NIR). The texts o f two o f the seven chapters , i.e. those on radiofrequency radia tion and on electric and magnetic fields, have been completely rewritten, and four o ther chapters have been revised to some extent. 4.32 The survey o f occupational accidents involving NIR, which is being undertaken by the W H O co llaborating centre in O ttaw a , C an ad a , continues. U nfortunate ly , very little in fo rm ation on such accidents is for thcom ing , as there is a certain reluctance on the p ar t o f the users o f N IR equipm ent to report on related accidents. Nevertheless, when enough in fo rm ation is accum ulated an a t tem pt will be made to undertake a com parative study and analysis. Ionizing radiation 4.33 Following resolution E U R /R C 3 6 /R 8 of the Regional Com mittee on nuclear accidents in relation to public health, the work of the Regional Office was intensified, and during 1987 was especially concerned with the European harm oniza tion of public health 60 measures following such accidents. A lthough alm ost all countries introduced measures after the accident at C hernobyl in April 1986 to effectively safeguard public health, these actions were not consistent and statements issued to the public were sometimes confusing and contradictory . It has therefore been im portan t to reach a com m on understanding, whereby the optim um degree o f harm onization can be achieved am ong M em ber States. 4.34 In response to resolution E U R /R C 3 7 /R 2 on nuclear accidents and public health the Regional Office, together with I ARC, is in the process of establishing an international scientific steering group to study the possible long-term health effects o f the Chernobyl accident. T he design of these studies is intended to follow the guidance developed by a consu lta tion on epidemiology related to the C hernobyl nuclear accident that was held in C openhagen in May, and a subsequent jo in t IA E A /W H O w orkshop in Vienna on app rop ria te m ethods for studying the possible long-term effects of radiation on indi­ viduals exposed in a nuclear accident. The reports o f these two meetings are included in Environm ental Health Series No. 25. 4.35 T he Chernobyl accident resulted in widespread and persistent d istribution of radiocaesium within the European Region. Levels in some foodstuffs were higher than in 1986 in som e limited areas, owing to the nature o f the particular environm ental pathway involved. In such areas, levels in freshwater fish, in farmed and hunted animals and in certain crops may remain high for some years, an d some controls will continue to be necessary. T he health hazards from the deposition of radiocaesium were examined at a w ork ing g roup held at Schloß Reisensburg in the Federal Republic of G erm any in June. This meeting was financed from Swiss voluntary funds. The proceedings of the meeting were issued in Environm ental H ealth Series No. 24. It was not intended, and not even possible, to evaluate the risk to health separately for each of the European M em ber States. Hence the conclusions, averaging the risk over the whole Region (excluding the USSR), provide an average im pact and indicate that additional cancer deaths during the next 50 years would am o u n t to up to some 0.006% of the otherwise spontaneous incidence recorded in the population considered. Additional severe genetic effects on health from the first year dose would am ount to up to about 0.003% of the spontaneous incidence. T he average individual absorbed radia tion dose is estimated to be abou t 0.3 mSv for the first year and double this for a period of 50 years. (F o r com parison, it should be noted that the radia tion dose from natural radioactivity am ounts to about 1.9 mSv per year.) 4.36 Iodine prophylaxis was extensively used after the Chernobyl accident and the experience gained, including any evidence of adverse side effects, is being incorporated in to guidelines now being developed by the Regional Office on the basis of an expert consultation held in C openhagen in August. 4.37 The work carried out in the past on public health preparedness in relation to nuclear accidents has been concerned with a limited area a round the source (the so-called “ near field” ). The last in a short series of related publications was issued in May under the title Nuclear power: accidental releases — practical guidance fo r public health action (E u ropean Series, No. 21). The book is based on the results o f a w orking group in Mol, Belgium in O ctober 1985. As a result o f a recom m endation made by the working group on the European harm onization o f public health action in relation to nuclear accidents, 61 work should proceed on the conditions in the “ far field” , where the problem s are likely to be of a transfrontie r nature. 4.38 Following the adop tion by the G eneral Conference o f IA E A in Septem ber 1986 o f the C onven tion on Early Notification o f a Nuclear Accident an d the C onvention on Assistance in the Case of a Nuclear Accident or Radiological Emergency, detailed arrangem ents are being m ade with IA EA and W M O about contingency planning for such accidents o r emergencies within the E uropean Region, taking into account the need for rapid transfer o f inform ation and the provision o f public health advice. 4.39 M ost o f the work on the effects o f nuclear accidents on public health carried out by the Regional Office since the Chernobyl disaster in April 1986 has been concerned with the long-distance aspects. A ttention is now being refocused on the most critical area, tha t close to the accident, and a working group will be held in 1988 to discuss m atters of medical and general public health preparedness, including the trea tm ent of acutely affected victims. Target 20 30 4.40 The present em phasis of the In terna tional D rink ing W ate r Supply and Sani­ ta tion Decade in Europe is placed on an analysis o f the remaining problems o f the Decade at the regional level. This analysis was m ade during the internal evaluation exercise carried out in the Regional Office in late 1986 and early 1987. It showed that substantial work was still necessary in: — pro tec ting w ater sources (surface and g roundw ater) against increased industrial, agricultural and municipal pollution; — investigating the health-related effects of organic and inorganic m icropollutants; — in troducing water conservation policies that permit the rational m anagem ent of available resources, such as finding an adequate balance o f w ater use (industrial, agricu ltura l , m unicipal, dom estic , other), w ater recycling, wastewater re­ utilization, and leakage control; — elim inating the rem aining disparity in the level o f services between no rthern and southern countries, between urban and rural areas, and between water and sanitation services; and — im plem enting technologies ap p ropria te to the different geographic charac te r­ istics of the Region. 4.41 Regarding the protection of water sources against pollution, most o f the countries o f the Region have now identified the m ajor pollutants , the levels of contam ination of By 1990, all people o f the Region should have adequate supplies o f safe drinking-water, and by the year 1995 pollution o f rivers, lakes and seas should no longer pose a threat to human health. 62 water sources, and the points and the mode of entry of pollutants, and have also established protective policies. Some countries have managed to establish computerized networks of water quality monitoring, permitting the immediate introduction of pro­ tective measures in case of accidental pollution. 4.42 A consultation was organized jointly by the Regional Office and the Water Research Centre (a WHO collaborating centre) in Medmenham, United Kingdom in May to review the existing toxicological information on potentially toxic microorganic substances in drinking-water. The consultation recommended not only a revision of the guideline values already given for some organic and inorganic compounds, but also the adoption of final values for substances for which only a “ tentative value” exists, and the introduction of values for compounds for which no guideline values currently exist. 4.43 In compliance with the recommendations of the Medmenham consultation, several internal meetings were held between WHO headquarters and the Regional Office, and at a meeting in Geneva in November it was decided that the WHO guidelines on drinking-water quality would be updated jointly by the two offices. 4.44 Recent studies carried out in different countries of the Region have revealed an alarming increase in a wide range of herbicides in water supplies. At the request of the Government of Italy and in association with the Istituto Superiore di Sanità, Rome, consultations were organized in February and July to recommend guideline levels for the herbicides most commonly used in Italy and affecting drinking-water quality via ground­ water and surface water contamination (see paragraph 4.27). 4.45 The rehabilitation of contaminated water sources has become an important issue in the European Region and therefore, with the support of the Hungarian national water and health authorities, a consultation was organized jointly by the Regional Office and VITUKI (a WHO collaborating centre) in September in Siöfok, Hungary. The consul­ tation reviewed the present methods being used to remove organic and inorganic micropollutants. The advantages and disadvantages of each method were analysed and the group of experts made recommendations about the efficacy of the different methods under different conditions. 4.46 The Regional Office has continued its efforts to promote the elimination of the remaining imbalance in levels of services in many southern countries of the Region. While considerable funds are invested in the provision of water to urban settlements, the water networks do not yet reach all rural populations. In addition, coastal tourist areas along the Mediterranean Sea have to cope with a large influx of people during the summer months. Sometimes the water demand may increase by 10-50 times, or even more at weekends when local visitors are added to the number of international tourists. 4.47 Shortcomings in the drinking-water treatment facilities, not only qualitative (the degree of water purification) but also quantitative (the number and capacity of treatment plants), result in frequent interruptions of services every day in many large urban agglomerations in southern Europe. 63 4.48 A s r e g a r d s s a n i t a t i o n , se v e ra l p r o b le m s still r e m a in to b e so lv e d , tw o in p a r t i c u la r : — th e p r o v i s io n o f a d e q u a t e m e a n s o f w a s t e w a t e r d i s p o s a l : in u r b a n a r e a s h o u s e c o n n e c t i o n s t o th e s e w e ra g e sy s te m h a v e n o t y e t b e e n c o m p le t e d , a n d in m a n y r u r a l a r e a s th e c u r r e n t d i s p o s a l m e t h o d s a r e n o t e n t i r e ly safe ; — n o t al l s e w e ra g e n e t w o r k s h a v e b e e n c o n n e c t e d to w a s t e w a t e r t r e a t m e n t p la n t s , a n d in m a n y ca se s th e q u a l i t y o f e m is s io n s f r o m t r e a t m e n t p la n t s is su c h t h a t th e y c a n n o t b e sa fe ly d i s c h a r g e d in to th e e n v i r o n m e n t . 4.49 A t th e i n t e r c o u n t r y level, W H O a n d U N D P g a v e th e i r a s s i s t a n c e to th e f o r m u ­ la t io n o f th e R iv e r D a n u b e w a te r q u a l i t y p r o t e c t i o n p r o je c t a n d o f th e r e g io n a l p r o je c t o n t h e i m p a c t a n d c o n t r o l o f c h e m ic a l s . A p l a n n i n g m e e t in g w a s h e ld in L a x e n b u r g in A p r i l t o d is c u s s th e m e a n s o f i m p l e m e n t in g th e p r o p o s e d R iv e r D a n u b e p ro je c t . T h e p r o je c t d o c u m e n t w a s a m e n d e d a c c o r d in g to s u g g e s t io n s m a d e b y c o u n t r y r e p r e s e n ta t iv e s a t th is m e e t in g , a n d w a s s e n t b a c k to th e e ig h t r i p a r i a n c o u n t r i e s f o r c o n s id e r a t i o n a n d a p ­ p r o v a l . P r o j e c t a c t iv i t ie s a re e x p e c te d to s t a r t in 1988. 4.50 I n A l b a n i a , tw o W H O / U N D P - s u p p o r t e d p r o je c t s w e re r e d r a f t e d a n d se n t t o th e G o v e r n m e n t f o r c o n s i d e r a t i o n ; o n e c o n c e r n s th e c o n t r o l o f d e n t a l c a r ie s t h r o u g h f lu o r i ­ d a t i o n a n d th e o t h e r t e c h n iq u e s f o r th e t r e a t m e n t o f l iq u id w as tes . 4.51 In P o l a n d , a W H O / U N D P p r o j e c t d e a l in g w i th w a te r q u a l i t y b e g a n d u r i n g th e y e a r . A P o l i s h d e l e g a t io n v is i te d C o p e n h a g e n a t th e b e g i n n in g o f D e c e m b e r to f in a l iz e th e d e t a i l e d p r o j e c t w o r k p l a n . 4.52 I n Y u g o s la v ia , t h e W H O / U N D P - s u p p o r t e d p r o je c t d e a l in g w i th f o o d s a fe ty a n d w a te r q u a l i t y in th e R iv e r D a n u b e is b e in g c a r r i e d o u t a c c o r d in g to th e w o r k p r o g r a m m e . T h e p r o j e c t f o r th e p r o t e c t i o n o f g r o u n d w a t e r in M a c e d o n i a h a s n o w b e e n c o m p le t e d . In T u z l a , B o s n i a , a p r o j e c t o n r iv e r p o l l u t i o n c o n t r o l is a l m o s t c o m p l e t e d , b u t a p r o p o s a l f o r a o n e - y e a r e x t e n s io n is u n d e r c o n s id e r a t io n . 4.53 T h e s u p p o r t g iv e n to th e p r o g r a m m e b y th e D e c a d e c o l l a b o r a t i n g c e n t r e s h a s in c r e a s e d s u b s t a n t i a l l y . T h e W a t e r R e s e a r c h C e n t r e in M e d m e n h a m h a s a s s i s t e d th e R e g io n a l O f f ic e in c o n d u c t i n g s tu d ie s o n o r g a n ic m i c r o p o l l u t a n t s a n d h a s s e n t e x p e r t s to al l th e t e c h n ic a l c o n f e r e n c e s o r g a n i z e d b y th e O ff ic e in c o n n e c t i o n w i th th e W a t e r D e c a d e . T h e C e n t r e n a t io n a l d u m a c h in i s m e a g r ic o le , d u g én ie r u r a l , d e s e a u x e t des f o r ê t s in L y o n , F r a n c e h a s c o n t i n u e d t o p r o v id e t r a i n in g fac i l i t ie s f o r te c h n ic ia n s in s id e a n d o u t s i d e th e R e g io n . I ts e x p e r t s h a v e a t t e n d e d r e g io n a l m e e t in g s a n d h a v e r e p r e s e n te d th e R e g io n a l O ff ic e a t c o n f e re n c e s o r g a n iz e d b y o t h e r in s t i tu t i o n s . 4.54 V I T U K I , a W H O c o l l a b o r a t i n g c e n t r e f o r w a te r r e s o u r c e s p r o t e c t i o n , h a s c o n ­ d u c t e d s tu d i e s o n m e t h o d s o f r e m o v i n g m i c r o p o l l u t a n t s f r o m d r i n k i n g - w a t e r a n d h a s a s s i s te d th e R e g io n a l O ff ice in o r g a n iz in g a c o n s u l t a t i o n o n th is su b je c t . V I T U K I e x p e r t s h a v e r e p r e s e n te d th e O ff ice a t se v e ra l m e e t in g s a n d h a v e r e g u la r ly a t t e n d e d D e c a d e c o n s u l t a t i o n s . T h e c e n t r e h a s a l s o p r o v id e d in -se rv ice t r a i n in g fac il i t ies f o r te c h n ic ia n s o f v a r io u s c o u n t r i e s w i th in a n d o u t s id e th e R e g io n . 4.55 A n a g r e e m e n t f o r c o l l a b o r a t i o n w a s s ig n e d o n 9 N o v e m b e r w i th th e C e n t r e i n t e r n a t i o n a l d e l’e a u in N a n c y , F r a n c e . O n th e s a m e d a y , a n d a s p a r t o f th e c o l l a b ­ o r a t i o n a g r e e m e n t , th e f o u r t h c o n s u l t a t i o n o n th e e v a l u a t i o n o f th e W a t e r D e c a d e 64 in E u rope was opened in Nancy. Representatives o f the W orld Bank, the U nited Nations D isaster Relief Office (U N D R O ), W H O headquarters , the In terna tional Reference C en tre for C om m unity W ater Supply and Sanita tion , all the co llaborating centres w ork ing fo r the Decade and 17 E uropean countries a ttended the consultation . They had the o p p ortun ity to analyse the progress of the Decade at country level, and technical p roblem s related to water quality and water resources m anagement. 4.56 The m ain conclusion to be draw n from the evaluation meeting in Nancy was that it w ould be wrong to th ink tha t all quantita tive w ater and sanitation problem s have a lready been solved in the Region. The consultation acknowledged the priority given by the W ater Decade to w ater quality problems. Nevertheless, M em ber States were re­ m inded o f the pressing problem o f increasing the capacity of sewerage networks and im proving the level o f w astew ater trea tm ent in o rd e r to safeguard drinking-water quality. 4.57 In D en m ark , universities and private water sanitation institutions, in addition to the G overnm en t, assisted W H O in conducting studies on water po llu tion and m ethods for rem oving pollu tants from drinking-water. A m ajor financial contribu tion from the G reen land Technical O rganization permitted the Office to organize a working group in Illulissat, G reen land in O ctober, to complete and ad o p t the final version o f the guidelines on w ater an d waste m anagem ent in cold climates. The meeting was a ttended by experts in this field from C anada , China, the United States and all the Scandinavian countries. 4.58 Substantia l financial support from the Federal Republic of G erm any to W H O headquarters will m ake it possible to carry ou t a Decade consultative meeting in Lisbon in early 1988, which will enable W H O to conduct an evaluation exercise not only of the W a te r D ecade p ro g ram m e in Portugal bu t o f the p rogram m es o f all o th e r P ortuguese­ speaking countries in the world. 4.59 H ungary has provided great support to the Regional Office’s w ork on the W ater Decade. Experts from the Ministry o f Health and the National W ater A uthority attended all Decade meetings during the year. Conferences and consultations on water and sanita tion were organized in H ungary , not only under W H O responsibility bu t also th rough o ther international institutions with which the country has working relations. 4.60 In Italy, in add it ion to the support given to the Regional Office in the organiz­ a tion o f two consulta tions regarding herbicides in water, the Veneto Region and the Is t i tu to Superiore di San ità sent experts to the meeting in Siôfok, H ungary in Septem ber to present their experience with m ethods o f removing micropollu tants from water. Italy was also represented at the Decade evaluation meeting at Nancy in November. 4.61 A lthough M orocco has left the Region, the Regional Office continued to handle U N D P /W H O -s u p p o r te d projects there during 1987. The project for the im provem ent of d r ink ing-w ater quality will soon be completed. T he project on w ater supply for smaller com m unities is progressing and the activities are being extended into 1988. 4.62 N orw ay has supported p rogram m e activities related to water and sanitation in arctic regions. The m ain health problem related to drinking-w ater quality is w aterborne diseases, especially gastroenteritis . According to a continuing survey, ab o u t 70% o f the 65 water consum ed in Norw ay conform s to adop ted national standards. Several water netw orks are already too old, causing severe water losses an d potential con tam ination , and they therefore need rehabilitating. A new water quality classification system is being prepared, which includes bathing w ater quality. 4.63 In Portugal, the institutional restructuring of governm ent departm ents has been completed. T he new authorities for the environm ent and for the m anagem ent o f water resources, together with the health authorities, have supported Decade activities and especially the River Tagus project, which m ade considerable progress during the year. 4.64 The strategies and policies developed in Spain some years ago for the protection of the env ironm ent and for the role o f environm enta l health activities within prim ary health care p rogram m es have now started to produce results. Detailed “ inventories” of the environm ental conditions of administrative subdivisions (regions, provinces, munici­ palities and com m unes) have now been com pleted for many areas. A clear picture o f the state o f water and san itation is available in those “ inventories” , which are used as a basis for p rogram m ing the recom m ended solutions to the problem s found. A nother im portan t developm ent tak ing place in Spain is the establishm ent o f a large network o f Healthy Cities, with Barcelona in the lead role. The W ater Decade is an im portan t part o f this network. 4.65 Turkey has continued to increase the level o f public investment in the water and sanita tion sector. F rom 3.22% o f total national expenditure in 1981, its share increased to a lm ost 8% in 1987. In spite o f these efforts, several problem s still remain to be solved: the inadequacy of urban infrastructures to cope with dem ographic growth; the in­ adequacy o f services for m ain tenance and repair; the tra in ing o f personnel; and diffi­ culties in obta in ing sufficient funds to cover needs. T o reduce expenditure abroad , the country is p ro m o tin g the local m anufac tu re of supplies an d equ ipm ent needed for water and sanitation works. Mediterranean Action Plan 4.66 W H O con tinued its p ro g ram m e o f activities in the health-related aspects o f the M edite rranean Action Plan, particularly in the Long-term P rogram m e of Pollution M onitoring and Research in the M editerranean Sea (M E D PO L Phase II), which is now being gradually reorien ta ted tow ards the im plem entation o f the 1980 pro toco l on the protection o f the M editerranean Sea against pollution from land-based sources. 4.67 Technical assistance, equipm ent and fellowships con tinued to be provided to national institutions for developing or m onitoring p rogram m es related to land-based pollution sources, coastal recreational areas and shellfish w ater quality. The series of reference m ethods for determ ining microbiological and related param eters continued to be expanded and all major indicator organisms, together with the more im portan t pathogens, are now covered. 4.68 In the research com ponen t o f M E D PO L, 13 research projects were completed, 24 extended and 12 initiated. T he activities cover studies in the following b road fields: the 66 developm ent and updating o f microbiological m ethods, pathogen survival and indi­ c a to r /p a th o g en relationships, the correlation between coastal w ater quality and health, the carcinogenicity and mutagenicity of marine pollutants, pollution load assessment in relation to the capacity of receiving waters, and environm ental quality criteria. Prep­ ara t ions were com pleted for a five-country study on the efficiency o f selected subm arine outfall structures to start in 1988. 4.69 A consulta tion on environm ental quality criteria for shellfish-growing waters and shellfish in the M edite rranean was held in A thens in M arch, and was attended by partic ipan ts from Egypt, France, Greece, Italy, M orocco , Spain and Y ugoslavia, as well as by representatives of the European C om m unity , F A O and UNEP. The meeting recom m ended microbiological quality criteria for shellfish-growing waters, which were later ad o p ted by M edite rranean states during the fifth o rd inary meeting o f contracting parties to the 1976 Barcelona Convention, held in Athens in September. 4.70 A consultation on health-related aspects of marine pollution control in the M editerranean was held in C openhagen in J u n e /J u ly , and was attended by participants from Greece, Israel, Italy, Spain , Syria, Turkey and Yugoslavia, as well as by represen­ tatives o f U N EP. The meeting reviewed all aspects o f W H O ’s partic ipation in the M edite rranean Action Plan, and m ade a num ber o f recom m endations, including inter­ sectoral coord ina tion and cooperation, implementation of the land-based pollution pro tocol, the developm ent o f m onitor ing program m es, and health-related research activities. 4.71 A consultation on microbial pollution in the M editerranean and associated effects on health was held in A thens in September, and was attended by partic ipants from Egypt, France, Greece, Italy, M alta , M orocco, Spain , Turkey and Yugoslavia, as well as by representatives of the In tergovernm enta l O ceanographic C om m ission, F A O and U N EP. T he meeting reviewed the whole o f the microbiological com ponen t o f M E D POL m onitor ing and research activities, identified pathogens o f importance in the region in the light o f recent findings, and also identified specific research topics to be covered in the p rogram m e. 4.72 A w orkshop on the impact o f carcinogenic, mutagenic and teratogenic marine pollu tan ts on hum an health and the environm ent was held in R om e in N ovember, in co llaboration with the D epartm en t of P rogram m ing and Organization o f Public Health Services o f the University o f Rome. It was attended by partic ipants from C anada , France, the Federal Republic o f G erm any , Israel, Italy, Nigeria, the United Kingdom, the United States and Yugoslavia, as well as by representatives of F A O and U NEP. The w orkshop reviewed in ternational work on carcinogenic and mutagenic marine pol­ lutants and recom m ended work to be perform ed in the M editerranean context. 4.73 A consultation on m onitoring o f land-based sources o f marine pollution in the M edite rranean was held in Split in Decem ber, and a ttended by partic ipan ts from Egypt, France, Greece, Malta, M orocco, Spain, Syria, Turkey and Yugoslavia, as well as by representatives o f U N EP. T he meeting developed a com m on ap p ro ach to pollution source m onitor ing , reviewed the curren t s ta tus o f such m onitor ing in the M editerranean region, reviewed questionnaires for pollu tion source and load inventories and da ta 67 acquisition systems for waste m anagem ent, as well as prevailing legislation on land- based pollu tion control in the region, and agreed on requirem ents for the further development o f program m es for marine pollution source monitoring. 4.74 In general, good progress continued to be made in all aspects of the Action Plan for which W H O is responsible, particularly in the reorien ta tion o f activities, bo th in general and specifically, towards the acquisition of da ta required for the prevention and control o f m arine pollution. M ajor constraints remained, however, namely financial stringencies limiting possible assistance, and procedural problem s at the overall p ro ­ gram m e and national counterpart levels resulting in unavoidable delays in the im plemen­ tation of some agreed activities. Target 21 80 4.75 The newly established co llaborating centre for air quality m anagem ent and air po llu tion contro l in Langen, Federal Republic of G erm an y started its operations by holding a w orking g roup in February . This was the first meeting o f national focal points from 10 partic ipa ting M em ber States to discuss the continuing operation of the air com ponen t o f the U N E P /W H O G lobal Environm ental M onitoring System (G E M S) and m ake p roposa ls for a E uropean plan o f action. This plan o f action should enable the European partic ipants to m onito r air pollu tants and com pare the collected da ta am ong themselves, over and above the present plan o f work as it is operated globally. W ithin this plan o f ac tion , the partic ipants also agreed to start p rocedures to include nitrogen dioxide in the project. As far as available, the countries should also report da ta on the mass particula te fraction, lead, cadm ium and ozone. The experts felt that, for the purpose o f the periodic exchange o f in form ation, the evaluation of the collected da ta and the developm ent o f additional cooperation am ong the partic ipating countries, meetings should be held every 2-3 years. 4.76 T he co llaborating centre in Langen also s tarted work on a revision of the first publication o f the Regional Office in the European Series, the M anual on urban air quality m anagem ent published in 1976. 4.77 At the urgent request and with full financial support o f the health authorities of the Tuscany Region, and in cooperation with the N ational Institute o f Health, Rom e, a meeting was organized in Florence in O c tober to examine the impact on health of emissions of heavy metal and P A H com pounds from municipal incinerators. This meeting was an indirect follow-up to a meeting tha t took place the year before on dioxin and furan emissions from municipal solid waste incinerators, the report o f which was issued during the year as Environm ental Health Series No. 17. T he experts concluded that m odern designs, good construction and well operated and properly m aintained incinerators should, to a great extent, substantially reduce the quantity o f heavy metal and P A H co m p o u n d s in the environm ent. W ith regard to the heavy metal com pounds , By 1990, all people o f the Region should be effectively protected against recognized health risks from air pollution. 68 these would tend eventually to concen tra te in the b o t to m ash which, in turn , would have to be disposed of in p roper landfills or recycled for o ther purposes. 4.78 A study o f the overall im pact on hum an health o f air pollu tion from various sources, s tarted in 1987, will continue into 1988 and will examine the relative significance o f exhausts from industry, m o to r vehicles, homes and o ther sources, with respect to the a ir po llu tion they produce and its impact on health. This s tudy will be com plem ented later on by an o th e r th a t will take as its principal concept not the sources, bu t a mixture of six m ajo r air pollutants. 4.79 T he fifth W ork ing G ro u p on In d o o r A ir Quality , this time concentra ting on organic po llu tan ts , to o k place in Berlin (W est) in A ugust, immediately after the fourth In te rna t iona l C onference on In d o o r Air Q uality an d Clim ate held in the sam e place. (At this conference, which was co-sponsored by W H O , papers were presented on the work of the Regional Office in this field.) While very little is know n still ab o u t indoor organic com pounds , the G ro u p was able to consolidate the existing material and put it into a new perspective. Sensory irr i ta t ion caused by o dours is also o f significance, an d specialists in psychology made valuable contribu tions on this topic. 4.80 As more is know n ab o u t volatile organic com pounds than ab o u t very volatile, semi-volatile and partic le -bound organic com pounds (and reactive substances from all these groups) many m ore d a ta need to be collected on the distribution and effect o f the la tter groups. Organic co m pounds may cause mucosal and sensory irritation and affect the airways at the levels encoun tered indoors. Yet, evaluating the effect on health of single co m pounds may not always be adequate , because indoor po llu tan ts usually occur in mixtures and many sources emit mixtures o f pollutants. The detection limits o f analytical ins trum ents used at present are below the detection limits o f the hum an sensory systems. Therefore, many strong od o ran ts may not yet have been chemically identified. Consequently , an indoor concentra tion value based on the detection or recognition o f an o d o u r o r a sensory irritant by 50% of people will not p rotect the most sensitive p a r t o f the popu la t ion . F u rth erm o re , such a limit does not protect against the systemic o r genotoxic effects o f substances that are not odoran ts or irritants. T he meeting recom m ended a num ber o f measures to improve the da ta base for this par ticu lar indoor problem. 4.81 C oncerned by the extent o f the air pollu tion problem in E urope , the Regional Office has carried out a three-year project, with the financial support o f the G overnm en t o f the N etherlands, to establish air quality guidelines. While the basic m anuscrip t o f Air quality guidelines fo r Europe was com pleted at the end o f 1986 as expected, it took an additional year for the text to be verified and to reach final publication as European Series No. 23. M ore than 150 experts from 20 E uropean countries and N o rth America partic ipa ted in the meetings convened by W H O to complete the complex jo b o f establish­ ing these guidelines. A ir po llu tan ts o f special environm enta l and health im portance for countries o f the E u ro p ean Region were identified; 28 pollu tan ts were selected and air quality guidelines were established for them. These air quality guidelines are in tended to help the countries o f the E u ro p ean Region develop s tandards tha t , if properly im­ plem ented, will p ro tec t public health. The levels o f air constituents and contam inants 69 recom m ended in the guidelines are not s tandards in themselves; countries must m ake their own s tandards by considering the recom m endations in the context o f their own environm enta l, social, economic and cultural conditions. A lthough the main purpose of the guidelines is to provide governm ents with background inform ation and guidance in m aking risk m anagem ent decisions, and particularly in setting standards, this infor­ m ation may also help them develop alternative control procedures. 4.82 An In terna tional W orkshop on Air Quality Guidelines was held in Bilthoven in D ecem ber with the purpose o f in troducing the new guidelines to the in ternational com m unity and explaining the ra tionale behind them. This w orkshop gave the highest governm ent officials responsible for a ir quality in the E uropean Region the necessary background in fo rm ation at an early stage o f the im plem entation of the guidelines. F u rth er direct contac t will be made with health authorities in M em ber States to p rom ote the adop tion o f the guidelines at the national level. Target 22 SO 4.83 Since the first edition o f Food sa fety services (Public Health in Europe, No. 14) appeared in 1981, there have been a num ber of changes in the area o f food safety legislation and the o rganization of services within E u ro p ean countries. T o reflect as accurately as possible the actual s ituation in Europe, a country by country survey o f food safety services has been carried out, based on inform ation collected from various sources and subsequently reviewed by the responsible authorities at government level. The second edition of Food safety services is now complete and will be published in 1988. 4.84 An in te rco u n try p ro g ram m e for E u rope on effective na t iona l food safety in frastruc tu res an d legislation is being developed within the fram ew ork o f the fou r th cycle o f U N D P projects. T he p rog ram m e will s tart in early 1988 and will involve multisectoral systems to prevent the biological and chemical con tam ination o f food. Once implemented, this capacity building p rogram m e will support the efforts o f M em ber States to develop adequate surveillance o f foodborne diseases and a control infra­ structure. 4.85 O ne of the main preoccupations for European countries was the contam ination o f food with radionuclides after the C hernobyl accident. It is now considered that some controls will be necessary on certain foods for a num ber o f years, in view of the levels of radiocaesium still persisting in some places. As a part o f the Regional Office’s special project on nuclear accidents and public health, a w orking g roup was held in G eneva in Novem ber. T he partic ipants recom m ended that to pro tec t public health a m axim um individual dose of 5 mSv should be considered for the first year. Better ha rm oniza tion of approaches to food control after nuclear accidents is now urgently needed. Following a By 1990, all Member States should have significantly reduced health risks from food contamination and implemented measures to protect consumers from harmful additives. 70 recom m endation m ade by the working group, the Regional Office is now proceeding with the developm ent of emergency values applicable to European conditions, which can be recom m ended for use during the period immediately after an accident before the detailed radiological s ituation becomes fully clear. 4.86 T he final report an d proceedings o f the W o rk ing G ro u p on the H ealth Im pact an d C o n tro l M eth o d s o f I r rad ia ted F oods , held in N euherberg in N o v em b er 1986, were p repared during the year for publication on behalf o f the Regional Office by M M W Medizin Verlag in M unich. There is great interest in this publication, as it will give national health au thorities better inform ation on m ethods for identifying irradiated foods and the dosim etry involved. This, in tu rn , will allow these au thorities to improve their ability to control irradia ted foods for the benefit o f the consumer. Target 23 SO 4.87 T he final report on a com pleted study of priority chemicals in hazardous waste was sent for review to a num ber o f European experts. Their reaction was positive, and the feeling was that the priority chemicals have been reasonably listed. Experts have been con trac ted to follow up this work, and to prepare short m onographs on the chemicals in question , including their characteristics, toxicology and possible effects on health. The w ork is being carried out with the financial support o f the Ministry o f H ousing, Physical Planning and Environm ent o f the Netherlands. 4.88 W H O co-sponsored the world conference on hazardous waste, held in Budapest in O ctober. A panel on the ways o f predicting the long-term health effects of hazardous waste was organized, with the partic ipa tion o f experts from H ungary , the USSR and the U nited States. Target 24 SO 4.89 A W H O collaborating centre has been established at the Institute o f Hygiene and Epidem iology in Prague to cover the environm enta l aspects of health care o f the elderly. A meeting co-sponsored by W H O took place in Prague, in O ctober, to discuss the architectural aspects o f city accessibility for the elderly and disabled. It was attended by the W H O Regional Officer for the Elderly, Disability and R ehabilita tion and a con­ su ltan t w orking for the Environm ental Health Planning and M anagem ent unit. (See also under paragraph 2.13.) By the year 2000, all people o f the Region should have a better opportunity o f living in houses and settle­ ments which provide a healthy and safe environment. By 1995, all Member States should have eliminated major known health risks associated with the disposal o f hazardous wastes. 71 4.90 S u p p o rted by a vo luntary d o n a tio n from the host city, a W o rk sh o p on E nviron­ mental H ealth P rom otion in a Healthy City took place in Rennes in M arch. This W orkshop proposed a detailed plan o f activities to be im plemented in the cities taking part in the Healthy Cities project, to improve their physical environm ent and their environm ental health conditions. This plan of activities covers the period 1987-1995. After the W orkshop , a briefing meeting was held for those cities interested in building up a network of French-speaking healthy cities. 4.9! C ontr ibu tions were also made to the environm ental health aspects of the Healthy Cities project w orkshop on indicators, held in Barcelona in M arch , and to the E uropean Congress on H ealthy Cities held in D üsseldorf in June. Finally, cities interested in jo in ing the Healthy Cities project were briefed on the environm ental health aspects o f the project. These included U nna-K re is (Federal Republic o f G erm any) which was aw arded the European prize for environm ental protection. 4.92 T he housing hygiene project in Portugal, which is to be supported by U N D P , has been p lanned in detail and an agreem ent on its im plem entation was signed in November. 4.93 A report entitled H ealth im pact o f low indoor tem peratures was issued as En­ vironm ental H ealth Series No. 16. It is the ou tcom e of a w orking g roup held in Copenhagen in N ovem ber 1985. Target 25 80 4.94 An advisory group on occupational health was established to assist in planning, m onitor ing and evaluating the activities and ou tpu ts o f the Regional Office program m e on occupational health. At its first meeting in June, the group reviewed and evaluated the activities related to most o f the ou tp u ts o f the p rog ram m e an d m ade specific recom m en­ dations ab o u t how to fur ther implement the p rogram m e effectively, taking into con­ sideration the existing state o f organization o f occupational health services in M em ber States. 4.95 T he concept o f occupational health services is not uniform th roughou t Europe, as indicated by a survey m ade in the M em ber States. Industria l hygiene is not always a com ponen t o f occupational health. A model describing the functions of occupational health services and their re la tionship to o ther parts o f the health system is being prepared, based on studies carried ou t during the period under review. 4.96 W o rk e rs ’ health may be affected not only by work-related hazards. Lifestyles and factors in the environm ent may affect w orkers’ health in association with w orking conditions, and studies on these aspects have been initiated. By 1995, people o f the Region should be effectively protected against work-related health risks. 72 HEALTHY ENVIRONMENT Publications issued in 1987 Nuclear power: accidental releases — practical guidance for public health action: report on a W H O meeting. W H O Regional Publications, E u ro ­ pean Series, No. 21. Air quality guidelines for Europe. W H O Regional Publications, E uropean Series, No. 23. Documents issued in 1987 Health and safety component of environmental impact assessment: report on a W H O meeting (Environm ental H ealth Series, No. 15). Health impact of low indoor temperatures: report on a W H O meeting (Environm enta l H ealth Series, No. 16). PCDD and PCDF emissions from incinerators for municipal sewage sludge and solid waste — evaluation of human exposure: report on a W H O meeting (Environm ental H ealth Series, No. 17). Development of environmental health manpower (Environm enta l H ealth Series, No. 18). Occupational profiles of environmental health personnel (Environm ental H ealth Series, No. 19). Trace elements in human health and disease: extended abstracts from the Second N ordic Symposium (Environm ental H ealth Series, No. 20). Drinking-water quality and health-related risks (Environm enta l Health Series, No. 21). Organophosphorus pesticides: an epidemiological study. Part 1 — meeting repo rt on evaluation o f the pilot phase o f the study; Part 2 — core pro toco l for the study (Environm enta l Health Series, No. 22). PCBs, PCDDs and PCDFs: prevention and control of accidental and en­ vironmental exposures (Environm ental H ealth Series, No. 23). Health hazards from radiocaesium following the Chernobyl nuclear accident: report on a W H O meeting (Environm ental H ealth Series, No. 24). Nuclear accidents and epidemiology: reports on two meetings (Epidem i­ ology re lated to the C hernobyl nuclear accident; A ppropr ia te m e th o d ­ ologies fo r studying possible long-term effects o f rad ia tion on individuals exposed in a nuclear accident) (Environm enta l Health Series, No. 25). Trace elements in human health and disease: symposium report from the Second Nordic Symposium (Environmental Health Series, No. 26). Drinking-water guidelines for selected herbicides (Environmental Health Series, No. 27). Environmental quality criteria for shellfish-growing waters and shellfish in the Mediterranean: report on a joint WHO/UNEP meeting (document ICP/CEH 051). European conference on health and the human environment: report on the first steering committee meeting (document ICP/RUD 111). Health effects of methylmercury in the Mediterranean area: report on a joint WHO/FAO/UNEP meeting (document ICP/CEH 054). Mara, D.D. & Pearson, H. W. Waste stabilization ponds: design manual for Mediterranean Europe (document ICP/CWS 053). Potentially toxic microorganic substances in drinking-water: report on a consultation (document ICP/CWS 013). The River Danube water quality protection project: report on a planning meeting (document ICP/CEH 020). UNEP/WHO/GEMS air monitoring assessment and European plan of action: report on a WHO Working Group (document ICP/CEH 032). Co-publications issued in 1987 Wirth, E. et al., ed. Assessment of radiation dose commitment in Europe due to the Chernobyl accident. Report on a WHO Meeting, Bilthoven, 25-27June 1986. Munich, Institut für Strahlenhygiene des Bundesgesund­ heitsamtes (ISH — Heft 108). Articles published in 1987 Suess, M.J. Health impact of work with visual display terminals. In: Knave, B. & Widebäck, P.-G., ed. Work with display units 86. Selected papers from the International Scientific Conference on Work with Display Units, Stockholm, Sweden. May 12-15, 1986. Amsterdam, Elsevier, 1987. Suess, M.J. PCDD and PCDF emissions and possible health effects: report on a WHO Working Group. Waste management & research, 5: 257-268 (1987). 74 5Appropriate care 5.1 There has been obvious progress in health care th roughou t the European Region. This is worth m entioning, since it has occurred despite economic constraints, new dem ograph ic and morbidity patterns such as the growing elderly population, an increase in chronic conditions, and a slower decline than expected in com m unicable diseases. There are still, however, several critical areas that are clearly spelt out in the 11 FA policy on which the Office, in co llaboration with the M em ber States, concentrated its efforts during the year. 5.2 The district app roach in primary health care was addressed in a num ber of studies and working groups. This new orienta tion is in response to the need for more consumer satisfaction and involvement, better m anagem ent and op tim um use o f resources. Par­ ticularly relevant within this context were the Office's endeavours in analysing and prom oting the integration of various services provided to the population , so as to narrow the gap so often existing between services such as social and health, and to encourage truly intersectoral collaboration. 5.3 The wav hospitals provide services adap ted to changing health needs and try to satisfy various dem ands, coupled with efforts made to perfect the relationships between hospitals and prim ary health care institutions, were o ther im portan t m atters analysed in collaboration with experts in the field. 5.4 In many respects the European Region is well provided w ith health institutions, personnel and resources, and an impressive quantity of health services of all kinds is delivered by an ou ts tand ing num ber of health professionals. Nev ertheless, there is still more to be done to ensure an app rop ria te level o f quality, so that the results in terms of health are maximized and the user of the serv ices is satisfied. A ttem pting to respond to the various requests in the area of quality of care, the O rganization has started a prom ising dialogue. Particularly relevant in this respect are the various activities de­ veloped to foster quality assurance in nursing care, and also the efforts made to look inti) quality of care in hospitals and primary care institutions. 5.5 The prepara to ry activities for the 1988 European Conference on N ursing ga\ e the opportunity to hold national forums th roughout the Region and to stimulate action by various national groups and organizations. 75 Target 26 SO 5.6 Phase I o f the study on prim ary health care (PH C ) development in the European Region, involving the collection of inform ation at national level, was completed in February , at which time the contribu tions from the nine participating countries were subm itted to the Regional Office. Л consultation to discuss the protocol for Phase II, involving the collection of in form ation at district level, took place in Utrecht in March and was hosted by NI VFL ( the Netherlands Institute of Primary Health Care) which was designated a W H O collaborating centre for PH C in August. The various parts o f the study are expected to be completed by February 1988. and will serve as an im portan t source of in form ation for meetings related to the s trengthening of PH C activities at district level. 5.7 The second annual forum on PH C development in southern European countries took place in Portugal in N ovember, hosted by the N ational School of Public Health, Lisbon. It focused on inform ation for P H C and the six partic ipating countries discussed the overall development of PH C and the status of existing inform ation systems in support o f this development. 5.x A W orking G ro u p on M echanisms for C om m unity Involvement in a Health Care System based on PHC: C om m itting the C om m unity to Care took place in C openhagen in February . The participants reviewed and updated national experience in the field of com m unity involvement, and form ulated recom m endations for future action that will also have special relevance for activities to be initiated at district level. 5.9 Three issues of the newsletter 2000 were prepared and disseminated during the period under review. The most recent issue was dedicated to the topic "S trengthening district health systems". 5.10 The second in ternational course on research in PH C was held in Gilleleje, D enm ark in May. This course was supported both financially and technically by the Regional Office. A ttendance surpassed the expected num ber, and two members of the Regional Office staff acted as m oderators at the course. Nursing/midwifery 5 . П The newsletter N ursing/m idw ifery in Europe continues to be well received, and written contribu tions from countries increased considerably over the year. The news­ letter mailing list is continually updated and now comprises some 1800 addresses. A list o f top resource people for the newsletter and o ther material em anating from the Nursing unit is being revised so that the most active nursing/m idw ifery leaders and groups within By 1990, all Member States, through effective com­ munity representation, should have developed health care systems that are based on primary health care and supported by secondary and tertiary care as out­ lined at the Alma-Ata Conference. 76 the Region can be reached easily and quickly. The newsletter continues to be co-funded by the Danish Nurses’ O rganization and is translated into Russian by the W H O col­ labora ting centre for prim ary health care in A lm a-A ta , into French by the W H O collaborating centre for nursing at the Hospices civils de Lyon, and into G erm an by a volunteer in the Federal Republic of G erm any. Further, the newsletter is translated regularly into Finnish, H ungarian , Portuguese and Serbo-Croat. (M ore extensive detail on nursing activities will be found under targets 27 and 28.) Hospitals 5.12 The study on the analysis o f support by hospitals to PH C services, including hospital activities in disease prevention and health prom otion in which eight European coun tr ie s— Austria, Bulgaria, Norway, Romania, Spain, the USSR, the United Kingdom and Yugoslavia — participated, is to be finalized during 1988. It will be used as background for various activities of the hospital program me focusing on district health services. 5 . 1 3 The study on the response of hospitals to the changing needs of the population, involving contribu tions from nine European co u n tr ie s— Finland, France, the Federal Republic of G erm any , Israel, Italy, the Netherlands, Spain, Sweden and the USSR — will be finalized in the course o f 1988. It will be used as background for a working group on the co llaboration of health services within a district health system, scheduled to take place in 1988. 5 . 1 4 Six centres within the European collaborative health services studies group partic ipated in a study on the support of hospitals to district PHC services. It includes a comprehensive description o f their respective “ districts” with regard to overall structure and detailed functions. T he study was finalized at the end of the year, and it is foreseen that the results will be used as background m aterial for the same w orking group as mentioned above. 5 . 1 5 The outcom e of these three studies will also serve to support relevant country activities, as widespread partic ipation by experts from different M em ber States will provide a comprehensive and practical overview of the issues at stake. 5 . 1 6 A scientific meeting on the future developm ent o f hospitals took place in August in Utrecht in co llaboration with the National Hospital Institute of the Netherlands, which was designated a W H O collaborating centre for the hospital program me. The meeting focused on co llaboration between hospitals and PHC services at district level; specific tasks of hospitals in long-term care; the role of teaching hospitals; health education in hospitals; and the future role of hospitals in the health care system. Health legislation 5 . 1 7 A study on legislation on PH C in Europe was undertaken in order to take stock o f the progress achieved in M em ber States in support o f systems based on PHC. It is hoped to stimulate fur ther im plem entation of the A lm a-A ta principles th rough effective legislation, and to that effect the research is focusing on legislation concerning health 77 centres and their organization, planning, financing and collaboration with secondary and tertiary care facilities. The role of local governm ent has also been studied, as well as measures taken to reinforce the role o f the general practitioner, hospital care versus am b u la to ry and domiciliary care, and the need to offer integrated care coord ina ted with other sectors. The study already shows that most of the im portan t new legislation in support o f P H C in Europe deals with three broad categories of system: those based on health centres, those provided by local authorities , and those centred a round the general practitioner. T he outcom e of the study will review successes and failures of various initiatives, and propose a set o f measures that M em ber States could adap t to their national a n d /o r local circumstances and needs. Target 27 80 Health economics 5.ix T arge t 27 aims at resource d is tr ibu tion of delivery systems according to need and accessibility. This requires, am o n g o ther things, a clear shift o f health expenditure in favour of P H C at national and subnational levels. A prepara tory meeting was held in N ovem ber to plan studies on the reallocation of funds to PHC. These studies will cover the period up to 1989 and will a ttem pt to develop pilot in form ation in selected countries. M ore particularly , the studies will (a ) collect and analyse in form ation on trends and shifts in the total spending on PH C services to individual persons; (/;) summarize the results o f previous studies on trends and shifts in the resource allocation for PH C in the prevention and contro l o f selected diseases and conditions; (r) a t tem pt to estimate trends and shifts in the national allocation of resources for P H C in the wider sense of targets 28-30 (full range of services; a t ten tion to special population groups; cooperation with the com m unity ; mechanisms for the community-wide coord ina tion of health- related actions in o ther sectors); and (cl) report to health care policy-makers and health inform ation systems managers on the conclusions and recom m endations of the studies. Health service delivery and health institutions 5.19 The study on institutionalized long-term care, which is being compiled by the National Hospital Institute of the N etherlands, as W H O collaborating centre for the p rogram m e on hospitals and o ther health institutions, is proceeding according to plan and will com prise contribu tions from six countries. Its results will serve as background for a working group, to be held in 1988, on the coord ina tion of long-term institu tion­ alized care, with emphasis on efficient interaction with PH C and the reintegration of patients into their communities and families. By 1990, in all Member States, the infrastructures o f the delivery systems should be organized so that re­ sources are distributed according to need, and that services ensure physical and economic accessibility and cultural acceptability to the population. 7 8 5.20 The study on existing m ethodologies to determ ine b ed /p o p u la t io n ratio and its use is p roceed ing acco rd ing to schedule, with the p a r tic ipa tion o f experts from 17 coun tries o f the Region. 5.21 The study on cost-conta inm ent strategies in the hospital sector will give an overview o f the existing mechanisms for m aintaining hospital costs whilst ensuring quality of care in various countries in the European Region. Experts from 13 countries have provided con tribu tions to the study, which is now being compiled by the G erm an Hospital Institute, Düsseldorf, a W H O collaborating centre for the p rogram m e on hospitals and o ther health institutions. The study will be finalized during 19XX, and it is hoped that it will provide an excellent source of information on the im portan t issue of using incentives in the hospital sector. 5.22 Experts from five European countries are partic ipating in the final stages o f a s tudy on models related to medical and nursing clinical decision-m aking in hospitals. Special emphasis is being placed on describing the ov erall trends and developments in the health services in the various countries, indicating similarities, differences and problems. The study will be used as background material for a consultation on the same topic scheduled to take place in 1989. 5.23 A W orking G ro u p on Inform ation Needs for M anagem ent Decisions in H os­ pitals took place in G üters loh , Eederal Republic of G erm any in D ecem ber, in collab­ ora tion with the G erm an Hospital Institute, D üsseldorf and the Bertelsmann F o u n ­ dation . G ütersloh. The meeting identified wavs in which available information in hospitals could be most appropriately used for decisions at m anagem ent level. 5.24 A working group on the financial and social issues related to the use of tech­ nology in hospitals took place in Padua in October. The participants discussed policy decisions related to the organization of technology; rational clinical decisions in the use o f technology; technology and ethics in hospitals; the dissemination and transfer of technology; and the impact of technology on the interaction between inpatient and outpatien t care. Health care providers 5.25 As planned, the Second W orkshop on Advanced Nursing M anagem ent for E uropean Nurses, in the French language, was held in Lyon in Septem ber with the support o f the Hospices civils de Lyon, a W H O collaborating centre for nursing. As was the case with the previous w orkshop, held in English in 19X6. this was a follow-up to the in terregional conference on nursing leadership for H F A , held in T okyo in April 19X6. It is an ticipated that the effects of these w orkshops will continue to be felt th roughout the Region, particularly in s timulating similar activities at national level. The third and last such workshop, in the G erm an language, will be held in 19X9. 5.26 The University School of Ljubljana, Yugoslavia and the University of T urku , F inland are developing experim ental curricula oriented towards prim ary health care for the basic curriculum . W o rkshop material on curriculum developm ent is being produced and tested in Ljubljana and will be made available for use by o ther nursing faculties. 7 9 5.27 In Portugal, nurses at the ministry level are developing assessment instrum ents to improve the selection of students for nursing schools. Also under way are projects in prim ary health care, in occupational health, and in the developm ent of a nursing registration system. 5.28 The Nursing unit was involved in a variety of projects, studies, workshops and meetings th rough m edium -term program m es in several countries. The unit uses these p rogram m es as a way of linking in tercountrv projects with work under way at national and regional levels, and also as a means of im plementing innovative nursing practices and m onitor ing progress towards the achievement of the targets. In this regard, consul­ tations in H un garv, Portugal and Turkey have evolved into plans to develop various aspects of nursing practice and education. 5.29 T h rough the medium-term program m e with Turkey, an infrastructure to provide nursing services was initiated. A national plan for developing services was draw n up and a w orkshop for 200 Turkish nurses was held during the year. 5.30 A num ber of events have taken place within the Region reflecting the growing interest in the first European conference on nursing in 1988. Scores of requests have been received by the Nursing unit for individuals, groups, organizations and countries to participate more actively in the conference and in its follow-up. N ational forums have been held th ro u g h o u t the Region; th rough these, as well as th rough advance notice of p lanned events, it is estim ated that at least 20000 people will have been reached by the time of the conference in June 1988. 5.31 T he docum ent “ Targets for health for all: implications for nurs ing /m idw ifery ’’ and the “ N ursing discussion p a p e r” , p repared for discussions within the various countries, have been translated into various national languages including Bulgarian, Danish , D utch , Finnish, Greek, H ungarian , Italian, Polish, Portuguese, Serbo-Croat, Slovene, Spanish and Swedish. 5.32 T he m anuscrip t for a book entitled Im ages o f nursing in Europe was com pleted in conjunction with the national forums and o ther plans for the conference. The book is based on over 3000 pho tographs taken in 12 European countries. A final set o f p h o to ­ graphs has been selected both for use in the book and for display at the conference in 1988 and in several European cities in the following years. Target 28 SO 5.33 The books People’s needs fo r nursing саге: и European study and the sum m ary of that study on models for effective and efficient nursing intervention were published. These By 1990, the primary health care system of all Mem­ ber States should provide a wide range o f health- promotive, curative, rehabilitative and supportive ser­ vices to meet the basic health needs o f the population and give special attention to high-risk, vulnerable and underserved individuals and groups. 80 are the results o f part o f the sixth and seventh m edium -term p rogram m es o f the Nursing unit, and involved 11 countries for over five years in the prepara tion , implementation and evaluation o f nursing care in those countries. 5.34 T hrough the initiative of the Danish Nurses’ O rganization and the Association of Registered Nurses of N ew foundland , C anada , an innovative program m e on PH C in the com m unity was launched in co llaboration with the Regional Office. C om m unity nursing services in selected com m unes in D enm ark will provide 24-hour nursing care and will serve as a pilot area for developing standards of practice in nursing and for evaluating the ou tcom e of care. The project provides a way to develop W H O indicators on nursing practice and to stimulate self-help and PH C activities at the local level. 5.35 T he Nursing unit initiated a proposal with the European Centre for Social Welfare T rain ing and Research, Vienna to prepare a position paper on social work services for the European Region. F o u r case studies are under way, and the outcom e of the project will be a discussion paper for use by the European countries in implementing the required social work services for PHC. 5.36 T he W orking G ro u p on the Im plem entation and Evaluation of Program m es for Problem D rinking took place in M alm ö, Sweden in September. T he G ro u p , which com prised 20 tem porary advisers from 15 countries as well as representatives from CEC and the In ternational Council on Alcohol and Addictions, discussed the changing concept of alcohol-related problems and their extent. M ethodologies for identifying individuals and groups at risk were also discussed, as were the resources available for prevention, m anagem ent and health p rom otion at com m unity , p rim ary and secondary service levels. Evaluation of services and the needs for training, education and support were also included in the G r o u p ’s deliberations. A publication covering the findings of this and the two previous w orking groups in this series, held in Helsinki in 1985 and in Oslo in 1986, is being prepared. 5.37 National meetings on quality assurance were held in Portugal, the United King­ dom and Yugoslavia, at which W H O 's policies and developments in o ther countries were described. 5.3x The fourth English-language training course in quality assurance took place in K uopio , F inland at the end of June. Target 29 DO 5.39 Since 1982, the Federal Centre for Health Education in Cologne has sought out projects for the network “ Health education in the family” in selected European countries, th rough which new approaches to family health education and health prom otion were tried. They organized meetings to exchange experiences and linked the projects into a By 1990, in all Member States, primary health care systems should be based on cooperation and teamwork between health care personnel, individuals, families and community groups. 81 network. Thirteen E uropean countries were involved by the end of 1985, and 80 projects had been identified. To facilitate contacts , the Centre published a newsletter for the network. T he School o f Public Health at the Université libre de Bruxelles entered into an agreem ent with the H ealth P rom otion unit during the year to continue the project, and a plan of work for the coming years was agreed on. 5.40 In conjunction with the work of the W H O collaborating centre for health m anpow er and inform ation in Paris, data from the national midwifery survey in Hungary were analysed. T he survey assesses midwives’ perceptions of their practice and develops approaches to assessing the effects o f changes in the education of midwives on outcom es o f midwifery practice. 5.41 The annua l course on training of teachers for general medical practice took place in D ubrovn ik in May. The Regional Office arranged for the participation o f one person from F inland in the course. Target 30 SO 5.42 A W ork ing G ro u p on Interaction between Health and Social Services and the Public in the Provision of Health Care took place in Spain in Novem ber, hosted by the Andalusia School of Public Health , G ran ad a . This activity constituted a first concerted a ttem pt to study selected issues of the district health care system involving professional, lay and social personnel. The recom m endations of the W orking G ro u p will be the main guidelines for further PH C-rela ted activities at the district level. Target 31 SO 5.43 A second group of five countries was in troduced to the provisions of target 31 th rough an in tercountry w orkshop, hosted and supported by the N etherlands, using consultan ts from the first phase o f developm ent of the project on quality assurance. The Royal College of Nursing in the U nited K ingdom provided consultan t services free of charge on the subject o f quality assurance. 5.44 The country representatives involved in nursing quality assurance activities p ro ­ vided consultation to groups within their own countries and in o ther countries. T ran s­ lation and language validation continued on terminology used to develop standards in By 1990, all Member States should have built ef­ fective mechanisms for ensuring quality o f patient care within their health care systems. By 1990, all Member States should have mechanisms by which the services provided by all sectors relating to health are coordinated at the community level in a primary health care system. 82 nursing practice. W ork also began on Regional Office guidelines for s tandards of practice for nursing education. 5.45 T here were several activities in the M em ber States related to quality assurance. F o r instance, national meetings took place in Belgium, Finland, the Federal Republic of G erm any , Italy, Norw ay, Portugal, Spain, the United Kingdom and Yugoslavia o rgan­ ized by national authorities, associations, health care institutions and private foundations. 5.46 Following on from courses held in Spain, Sweden and Yugoslavia, the fourth English-language training course in quality assurance took place in Finland at the end of June , and a second French-language course was held in Brussels at the end o f November. The large num ber of applicants representing medicine, nursing, economics and health care adm in is tra tion once again dem onstra ted the need for such courses. Most encouragingly, some o f the participants have organized or p lanned corresponding national courses. 5.47 The “ European newsletter on quality assurance” , produced by the Netherlands N ational O rganization for Quality Assurance in Hospitals on behalf o f the Regional Office, continues to serve as a useful link between members of the health com m unity in Europe. The International Society for Quality Assurance in Health C are also maintains its support to the work o f the Regional Office and is currently preparing an annotated bibliography on quality assurance. A P P R O P R IA T E C A R E Publications issued in 1987 Nursing care: sum m ary of a European study. Non-serial publication. People's needs fo r nursing care: a European study. Non-serial publication. Documents issued in 1987 A telier sur la gestion des services infirm iers à l ’intention des infirm ières européennes, L yo n , France, 31 août - I I septem bre 1987 (d o cu m en t IC P /H S R 317). Indicators fo r m onitoring prim ary health care: report on a W H O study (docum ent IC P /P H C 304/s0I). Inform ation fo r prim ary health care: report on a W H O m eeting(docum ent IC P /P H C 333). M echanism s fo r com m unity involvement in a health care system based on prim ary health care — com m itting the com m unity to care: report on a W H O meeting (docum ent IC P /P H C 319). The developm ent o f standards o f nursing practice : report on a W H O meet­ ing (docum ent IC P /H S R 323). Articles published in 1987 Vuori, H. Patient satisfaction — attribute or indicator? In: Shanahan , M., ed. Proceedings o f an International Sym posium on Q uality Assurance in H ealth Care, Paris, Novem ber 1986. Chicago, Jo in t Com m ission on Ac­ creditation o f Hospitals, 1987, pp. 70-73. Vuori, H. Patient satisfaction — an attribute or indicator of the quality of care? Quality review bulletin, M arch 1987, pp. 106-108. 84 The Reg io na l D i re c t o r p re se n t ed t w o Heal th fo r Al l Me d a ls d u r i n g the year. A b o v e . M s W a d a d Haddad, Reg iona l O f f i ce r fo r Sexua l i t y and Fami ly P lanning , rece ived the M e d a l on her re t i r e m e n t in M a y in r e c o g n i t i o n of her o u ts t a n d in g se rv ice to the Or g a n i za t i o n . B elow , P ro fes sor T. F l iedner , o u t g o i n g C h a i r m a n o f the E u ro p e a n Ad v is o ry C o m m i t t e e on Hea l th Research , is p ic t u re d w i t h his M e da l d u r i n g the m e e t in g of the EACHR in February. Rapid c h a n g e s in l i festy les in Gr een land have had ser ious c o n s e q u e n c e s fo r the socia l s t r u c tu r e and hea l th of the p o p u la t io n . It is hoped , however , tha t c h i l d re n su ch as these wi l l be a m o n g thos e to bene f i t f r o m be t te r h o u s i n g and h ig h er l i ving s tandards. An i n d i c a t i o n o f the e f fec t i ve ness of the p u b l i c e d u c a t i o n c a m p a i g n on A IDS in D e n m a r k is p ro v i de d by the c o s tu m e s tha t these s c h o o lc h i ld r e n made and w o r e f o r F a s t e l a v n . t h e Dan ish ca rn iva l ce lebra t ion . 6Research and health development support 6.1 There were im portan t developments in the area o f H F A policy in a growing num ber of M em ber States during 1987. With a view to adapting the E uropean H F A policy to their respective national settings, countries in the Region debated and analysed the 38 European targets an d set in m otion processes for obtain ing consensus and active co llaboration o f the m ain partners representing both the health an d “ non-health” sectors. The Regional Office was efficiently assisted in these tasks by the E U R O G ro u p for N ational Health Policy Analysis and Development in which W H O staff, together with national experts, analyse and discuss specific ways o f supporting M em ber States in fostering leadership for H F A . In addition, the H F A task force for countries with pluralistic systems finalized the p repara tion o f a large debate scheduled to take place in Bonn, Federal Republic o f G erm any in Septem ber 1988. 6.2 Equally im portan t , various health legislation activities contribu ted to the prep­ ara tion o f national H F A policies. F u rtherm ore , insight was provided into ethics and h u m an values in H F A messages so that better argum ents are provided when advocating the need for a policy change. Within this context, in most M em ber States defining and protecting pa tien ts’ rights have been viewed as an im portan t com ponen t o f the H F A strategy and , consequently, the Office pursued new activities in this area. 6.3 The present economic stringency, requiring better allocation and use of resources and the determ ination o f M em ber States to reorient health policies towards H F A , b rough t ab o u t a dem and fo r new activities in health economics to which the Regional Office prom ptly responded. 6.4 The second triennial cycle o f H F A m onito r ing and evaluation in the European Region s tarted after extensive efforts to improve the list o f H F A indicators. Individuals and institu tions in the Region, as well as the app rop ria te units in the Regional Office and at W H O headquarters , assisted in revising the indicators in the light o f the regional evaluation and their own experience. The docum ent on the H F A m onitoring in the Region will be prepared to be presented at the thirty-eighth session o f the Regional C om m ittee in C openhagen in 1988. 6.5 The ra tionale for reorien ting the education o f health personnel was form ally es tab lished in d o cu m en t E U R /R C 3 7 /9 p resen ted to the th ir ty -seventh session of 85 the Regional Com m ittee, and in resolution E U R /R C 3 7 /R 7 the Regional D irector was requested to identify the educational changes needed to support H FA . Several associ­ ations in the field, such as the Association for Medical Education in F urope and the Association o f Medical Deans in Europe, have declared their willingness to involve themselves in the implementation o f this resolution. The Association o f Schools of Public Health in the European Region started preparing learning materials based on the regional H F A targets for the tra in ing o f public health personnel. A num ber of changes were also in troduced in courses and w orkshops organized by the Office for training teachers o f health personnel. 6.6 In the pharmaceuticals field, the universal acceptance of the support provided by W H O to M em ber States was reflected in a rapid increase in direct requests for help and advice on current issues. Target 32 SO 6.7 The docum ent on “ Research for health for all” (R H F A ) was presented to the E uropean Advisory Com m ittee on H ealth Research (E A C H R ) in February , when the results o f consultations with the M em ber States and with the research com m unity were analysed. It was subsequently revised and subm itted in Septem ber to the thirty-seventh session of the Regional Com mittee, which approved it together with a corresponding p rom otion plan, and adopted a resolution urging both M em ber States and the Regional Office to im plement the high priority research recom m ended and to develop national H F A research policies. The text is now being finalized for publication in early 1988. There have already been prom ising signs that not only the European M em ber States but also regions within those countries are willing to use R H F A as a model for their own health research policies. H ungary , San M arino, Spain and Yugoslavia have already included the development of a national H F A research policy in their plans for collabor­ ation with the Regional Of fice. The Chief, Research P rom otion and Development visited the G erm an D em ocratic Republic, H ungary and the USSR in relation to R H F A and was invited to a ttend a meeting on research policies for health organized in Andalusia, Spain. 6.8 At its th irteenth session the E A C H R reviewed the work of the regional p ro ­ gram m es on cancer, chronic diseases, health economics and health education, and discussed two o ther topics: accidental radia tion releases and the effects of radia tion on hum an health, and research on narcotics addiction. 6.9 T he E A C H R also emphasized the im portance of ethical issues in research. This has been echoed by several M em ber States, and already a meeting has been held in Antwerp on “ Bioethics in the '90s” . The subject of the hum aniza tion of medicine led to co llabo ra t ion between the Holy See and the Regional Office. A representative of Before 1990, all Member States should have formu­ lated research strategies to stimulate investigations which improve the application and expansion o f knowledge needed to support their health fo r all developments. 8 6 the Regional Office a ttended the second in ternational conference on the hum anization of medicine, organized by the Holy See in N ovem ber, and jo in t plans are under way to hold a follow-up meeting in 1988. 6.10 A sem inar was held in Ju n e on com m unica tion between the users and producers o f research findings. Research on health p rom otion was taken as an example in deter­ mining the factors ham pering com m unication and the application of such results in decision-making. 6 .11 The third and fourth meetings o f the task force for the European university netw ork for health for all were held in F ebruary and May respectively. A docum ent on the role o f universities in the strategies for health for all was subm itted to the thirty- seventh session o f the Regional Com m ittee where it was well received. Several M em ber States prom ised to support the future work of the network. 6 .12 By a ttending meetings o f national medical research councils, the European Medical Research Councils, and the C oncerted Action C om m ittee on Health Services Research of the CEC , an effort has been made to try to coordinate W H O -sponsored studies with those sponsored by o ther groups carrying out similar activities. 6.13 Guidelines were produced on the procedures for designating and redesignating co llabora ting centres, covering the initial app roach th rough to the content o f the plan of w ork , the terms o f reference, and finally the evaluation process. As a result, several M em ber States have already indicated an interest in having the w ork o f their own co llaborating centres evaluated; the first such exercise took place in the USSR in June. 6.14 With regard to health services research, the p repara tion o f learning modules for the French health systems research w orkshop to be held at La Londe-les-M aures in June 1988 was finalized by IN SERM . U nder the m edium -term program m e of cooperation with Yugoslavia, a national w orkshop on health systems research was held in Sarajevo from 30 August to 4 September. Target 33 SO 6.15 C ollabora t ion with countries in the form ulation and im plem entation o f national H F A strategies has gathered increasing m om entum . Only three years after the adoption of the regional H F A policy, approxim ately half o f the European M em berS ta te s have taken steps to create entirely new health policies in line with it, and in most o f the remaining countries different types o f development have taken place in support o f H F A policy­ making. This response by M em ber States has taken tangible form in the national policy Before 1990, all Member States should ensure that their health policies and strategies are in line with health fo r all principles and that their legislation and regulations make their implementation effective in all sectors o f society. 87 docum ents finalized by seven countries (Bulgaria, Finland, H ungary, the Netherlands, Poland, Sweden and Yugoslavia) and in the work along these lines being undertaken by six o thers (Iceland, Ireland, Israel, M alta, Norw ay and Spain). The G erm an Dem ocratic Republic has carried out a th o rough review o f its health policy and plans to see how well they match the regional targets. F u rtherm ore , agreement was reached with a num ber of countries to organize debates and meetings on H F A policy; major ones were held in Hungary in M arch and in Ireland and Israel in October. 6.16 P repara tions began for a s tock-tak ing meeting on H F A policy form ulation and im plem entation in countries, to be organized jointly with the Ministry of Social Affairs and H ealth o f F inland. The various approaches to and adap ta t ions of H F A policy in M em ber States have been analysed, and a docum ent presenting the results o f that analysis was issued. 6.17 In view o f this expansion in H F A initiatives, an internal EU R O G ro u p for National Health Policy Analysis and Development was established. In addition to coo rd ina t ing and identifying work to support H F A policy development in countries th rough inform ation exchange and staff training, consultations with outside experts were held to pool and share experiences. 6.ix H F A initiatives in Europe are also emerging at subnational, district and com ­ munity levels. These developm ents are particularly visible in D enm ark , Spain, Swit­ zerland and the United K ingdom and are being initiated in France. The Regional Office, in co llabora tion with the G overnm en t o f Switzerland and individual cantons, organized a debate in A u g u s t/S ep tem b er in which the role and potential o f subnational authorities in originating and fostering H F A action was emphasized. 6.19 In su p p o r t o f national H F A strategies, the Health Legislation unit initiated the prepara tion o f a study entitled “ Legislative strategies for health for all” , the objective being to provide M em ber States with s tructured advice on m ajor priorities for action and efficient m ethods in the field of health legislation. A multidisciplinary team of experts from different countries have w orked to provide the first outline of what could be regarded as guidelines for undertak ing systematic reviews o f national legislation in the light o f the regional H F A targets. 6.20 D uring the year advice was provided to M em ber States on formulating national legislation on such issues as procedures for notification o f com m unicable diseases, informed consent, patients’ rights, A ID S, euthanasia , the definition o f death , data protection and access to records, legislation on smoking, abo r tion , illicit drugs, accident prevention, and legislation on health services structure. 6.21 The work on developing a legislative strategy to enhance the health and wellbeing o f the elderly was pursued. D uring the year 13 M em ber States provided examples of innovative legislative measures already implemented, together with com m ents on the difficulties they meet in fostering more effective social policies. 6.22 T here is growing concern in most M em ber States for defining and pro tecting the rights of patien ts as an im portan t part o f their H F A strategy. T o this end, a study on patien ts’ rights in Europe was undertaken to clarify the present situation in each country. 8 8 6.23 F urtherm ore , a short docum ent enuncia ting com m only agreed rights o f patients in the Region is in p rep a ra t io n and will help clarify the progress achieved up to now in Europe. In this respect, it was agreed that a E uropean sym posium on patien ts’ rights would be held in 1989. 6.24 In Ju n e the M inistry of Welfare, H ealth and Cultural Affairs o f the N etherlands, in co llabo ra t ion with C IO M S and W H O , hosted the 21st C IO M S Conference on European and N orth A m erican perspectives on health policy, ethics and hum an values. This im portan t international meeting had the following objectives: to strengthen national capacities for addressing and m aking decisions abou t ethical and hum an values involved in health policy; to contribu te to an improved understanding o f W H O ’s goal o f H FA ; and to deepen unders tand ing of hum an values across cultural and political lines. The Conference addressed four main themes: screening and counselling, organ transp lan­ tation, the elderly, and lifestyles and health. 6.25 Over the year the com puterized health legislation data base regularly provided up-to-da te in form ation to bo th M em ber States and the Regional Office. The Office was inform ed o f some 400 new health laws passed in 1986 by 25 European M em ber States. This brings the total d a ta base to a ro u n d 1800 texts, which are encoded according to countries, subjects, W H O program m es and regional H F A targets. Requests from M em ­ ber States to have direct access to the da ta base are increasing; at present the G erm an D em ocratic Republic and Italy have direct access. Collaboration with other organizations 6.26 C om pila tion of da ta on health activities by various in tergovernm ental and nongovernm ental organizations continued, so as to allow the Regional Office and other organizations to better coord ina te their cooperative activities in the setting of the regional strategy and , consequently, avoid overlapping and duplication o f work. 6.27 T he Regional Office strengthened its links within the United N ations system by partic ipa ting in m ajor events in the developm ent and social fields, such as the inter­ national cam paign against traffic in drugs, the Interregional C onsu lta tion on D evelop­ mental Social Welfare Policies and Program m es, im plem entation of the In ternational Plan of Action on Aging, the United N ations Decade o f Disabled Persons, 1983-1992, and the In ternational Year of Shelter for the Homeless, 1987. 6.28 T he Regional Office is the executing agency for 19 U N D P country projects in A lbania, H ungary , Poland , Portugal, Turkey and Yugoslavia, in addit ion to various intercountry projects. These include, am ong others, an intercountry project on p ro ­ tecting the water quality o f the River D anube and ano ther on effective system appli­ cations for food safety. 6.29 T he U N D P -su p p o rted regional project on European cooperation on the en­ vironm ental health aspects o f the control o f chemicals (now referred to as “ Im pact and contro l o f chemicals” ), which is in its third phase, offers an excellent example of co llaboration within the United N ations system, since it includes the partic ipation of o ther United N ations agencies. It involves 12 E uropean countries, which between them 89 are strengthening their national and in tercountry capabilities in the field o f environm ent resource m anagem ent with special reference to the control o f chemicals in the agri­ cultural, industrial, water, health and environm ental sectors. 6.30 A n o th er excellent example of collaboration within the United N ations system is the Long-term P rogram m e o f Pollution M onitoring and Research in the M editerranean Sea (M E D POL II), developed by U N E P, in which FA O , IA E A , the Intergovernmental O ceanograph ic Com mission, U N ESC O , W M O and W H O are actively cooperating in a 17-country program m e. 6.31 In connection with relationships established with the In ternational Atomic Energy Agency, the Office was represented at an interregional training course on p lan­ ning, p reparedness and response to nuclear accidents or radiological emergencies held in A rgonne, USA. The Office was also represented at the first and second meetings o f the Interagency Com m ittee for the C o-ord inated Planning and Im plem entation o f Response to Accidental Releases of Radioactive Substances, in Vienna in February and April. 6.32 The period under review was an im portan t milestone in the relationships between the Council o f Europe and W H O , as it was the thirty-fifth anniversary of the agreement signed between the two organizations. Arrangem ents have been made for the first visit by par liam enta r ians o f the Social and H ealth Affairs Com m ittee to the Regional Office in the spring o f 1988. 6.33 C oopera tion continued with CE and C EC in running pilot health education projects focused on prevention of d rug dependence and addiction in various European cities. A new jo in t project was begun, aimed at p rom oting health education in schools. C ollaboration continued on blood transfusion and im m unohaem atology, multidisci­ plinary care o f cancer patients, the elderly, rehabilitation of disabled people, youth, equity in health, drug trafficking, food hygiene, pharmaceuticals, pesticides and the impact o f new technologies on health services. O ther subjects covered were A ID S, organ transp lan ta tion and abuse of psychoactive drugs. 6.34 The Technical Officer, C oord ina tion with o ther Organizations, visited several d irectorates of the C E C in Septem ber to identify possible means of harmonizing com ­ mon activities. Jo in t activities are taking place with the CEC , in particular with regard to the tobacco cam paign , the A ID S P rogram m e, cocaine, education for health, environ­ mental health hazards and indoor air quality. 6.35 T he Regional D irector partic ipated in a meeting of chief medical officers o f the European C om m unity in Leuven in February , and on that occasion invited them to hold their next meeting at the Regional Office in October. At these two meetings the dis­ cussion covered, am ong o ther matters, A ID S, com m unicable diseases, ethics, epidem i­ ology and organ transp lan ta tion . 6.36 The Regional D irector paid an official visit to the D eputy Secretary-General o f O E C D in N ovem ber, during which discussions took place on identifying regional H F A targets that might allow further cooperation between O E C D and W H O. 6.37 The Director, Environm ental Health partic ipated in meetings of the O E C D Expert G ro u p on In tervention Levels for Nuclear Emergencies, in Paris in Jan u a ry 90 and Ju n e , and a ttended the Com m ittee on R adiation Protection and Public Health in Paris in M arch. The Acting D irector, Env ironm ental Health partic ipated in a workshop on epidemiology and radia tion protection organized by O E C D in October. 6.38 C ollaboration strengthened with the N ordic Council as the D irector-General, accom panied by the Acting Director, P rogram m e M anagem ent, m ade a speech at the opening o f the new N ordic School of Public Health in G o th en b u rg in August. The N ordic Council o f Ministers, now based in Copenhagen, drafted its new program m e for coopera t ion within sectors o f social welfare and health, with close links to the regional H F A policy. 6.39 C ollabora t ion continued in the areas o f health and the environm ent through exchange o f inform ation with the CM EA. Target 34 SO 6.40 T he long-term planning methodologies continue to be one o f the main issues of the p ro g ram m e in view o f their relevance to the a t ta inm en t o f many H F A targets. The specific application of long-range approaches such as scenarios has been revitalized in many European M em ber States, and these experiences were discussed at a m ajor meeting held in Kiel in N ovem ber in co llaboration with the G overnm en t o f the Federal Republic of G erm any . Tw o publications on the use of scenarios and o ther long-term planning methodologies were issued in collaboration with the G overnm ent o f the Netherlands. 6.41 Support to country activities took the form of follow-up to the design of the national 5-year health plan for Malta; o f partic ipation in national workshops in planning and m anagem ent in F rance (M arch) and the United Kingdom (September); and of the organization of a sem inar in Portugal in Novem ber, geared to designing a model for p lanning for P H C involving the central and regional health authorities. 6.42 In view o f the growing emphasis on increasing leadership and m anagem ent competence in many M em ber States, the netw ork o f collaborating centres has been expanded to include the N ordic School o f Public Health in G o th en b u rg and the N ational School o f Public H ealth in Rennes. T he latter ran the annual in terna tional inter­ disciplinary course on p lanning and m anagem ent for health. In add ition , a course on epidemiology in health p lanning was conducted by the Usher Institute, University o f Edinburgh in co llaboration with the Regional Office. 6.43 In connection with the subject o f m anagerial approaches to achieving H F A in countries with a federal s tructure and m arket economy, p lanning opportunities Before 1990, Member States should have managerial processes fo r health development geared to the at­ tainment o f health for all, actively involving com­ munities and all sectors relevant to health and, accord­ ingly, ensuring preferential allocation o f resources to health development priorities. 91 and experiences in pluralistic countries were reviewed at a meeting in Brussels in September. Particu lar a tten tion was paid to planning processes as well as sociopolitical realities. 6.44 T he report on the com parative study on health financing, budgeting and pay­ ment systems, which served as factual input to the W orkshop on Primary Medical Care F inancing Systems held in Kiel in N ovem ber 1986, was merged with the findings o f the Kiel w orkshop and issued as a final report. It was recom m ended (a) that experimental and dem onstra t ion projects should be designed and comprehensively evaluated, concen­ trating on how different financing, physician payment and budgeting systems influence the structure , process, costs and outcom es of primary medical care; (b) that physician paym ent, f inancing and budgeting systems in prim ary medical care should be planned, im plemented and evaluated alongside each o ther to ensure that clearly defined policy objectives are a ttained; (c) that im portance should be placed on evaluating both existing and proposed medical procedures, program m es of care and health policies; and (cf) that co llaboration am ong clinicians, epidemiologists, statisticians, economists and other disciplines is a prerequisite for improving quality assurance and evaluation in primary medical care. 6.45 The study on the developm ent o f health economics train ing resulted in a report on education and train ing program m es in selected countries. As a follow-up, a survey on English-language textbooks and course syllabuses in the field of health economics is in prepara tion . Based on the excellent contribu tions o f health economists all over Europe, a report on train ing modules was issued by the Regional Office and is being distributed widely for national adapta tion . Parts o f the material have already been adapted in several o f the partic ipating countries. 6.46 As part o f the study to develop learning material for health professionals, there has been continued co llaboration with the North-W estern Regional Health Authority in the U nited K ingdom . Also, as a result o f the W orkshop on Econom ic Issues in In ter­ sector Policy and P lanning held in the United Kingdom in 1984, a general fram ework for the analysis o f intersectoral cooperation was worked out. As part o f the “ action p lans” proposed to be developed in a particu lar adm inistrative district, a final report was published incorporating local plans and the contents of a new training course for economists, health personnel and industry. 6.47 An international sem inar on health planning and m anagem ent was held in Jerusa lem in Ju n e , with the support o f the Regional Office. As the beginning of a national effort, plans were made for a series of workshops on health economics training to be held in Israel in 1988. These would include: two days of continuing education for 25-35 Israeli health adm inis tra tors , using W H O learning material; a 1 ‘/.-day course for the leading m anagers o f the main Israeli bodies financing health services; and 1 '/, days of discussion on p rom oting health economics as a discipline, involving the leading econ­ omists and health economists in Israel. 6.4x The Regional Officer for Health Economics visited M alta in July, together with a tem porary adviser from the Federal Republic o f G erm any , to advise the G overnm ent on 92 the econom ic efficiency o f the organization and operation o f Maltese health institutions. The visit to o k place against the b ackground o f the recent adop tion o f a comprehensive health care policy in M alta . D ue to the lack o f p ro p e r econom ic accoun ting and in fo rm ation , it is a t present neither possible to use financing, budgeting and resource allocation as an instrum ent o f H F A policy, nor to evaluate the efficiency of the health services. It was agreed that a more in-depth study on health care financing an d budgeting should be carried out. Thus the following two national activities were proposed for 1988/1989: (a) a s ituational analysis that would focus on the description and analysis of the present o rgan izational s tructures by location o f service; an d (b ) a reorganization in o rder to in troduce m odern m ethods and systems o f accounting, with the aim of setting up cost centres inside health care institutions that have decentralized managerial control and responsibility. 6.49 A W orkshop on H ealth Economics was held in Moscow from 31 August to 4 Septem ber, as a result o f a jo in t initiative from the Ministry o f H ealth o f the USSR, the Council fo r M utual Econom ic Assistance (C M E A ) and the Regional Office. It was a t tended by experts from seven countries o f the C M E A (including Bulgaria, Czecho­ slovakia, the G erm an D em ocratic Republic, H ungary , Poland, the USSR and Viet N am ) and W H O tem porary advisers from o ther countries having a national health service. The partic ipants from the countries represented though t that the w orkshop was very timely in view o f the economic reconstruction now being carried out. They felt tha t it would be desirable to strengthen economic m anagem ent capabilities, in view o f the fu r ther de­ centralization of health services m anagem ent to regional and district levels; to use health econom ics increasingly a t the strategic level as a tool for all aspects o f H F A ; to strengthen the role o f the economist in research, training, m anagem ent and adm inis­ tra tion ; and to suggest to the medical departm en t o f the C M E A that an in tercountry p rog ram m e in health economics be established. 6.50 A p lanning meeting for a s tudy on systems o f paym ent by type o f service or patient, with particu lar emphasis on diagnosis-related groupings (D R G s), took place in Leuven in O ctober. The meeting reviewed the evidence on the application an d usefulness o f D R G s. The results o f the deliberations were presented to a wider audience at a subsequent jo in t meeting with the European H ealth Policy Fo rum in Brussels in October, where the fu ture im pact o f D R G s on health care practice and m anagem ent in Europe was discussed. A num ber o f countries plan to in troduce D R G s within and outside hospitals. The purpose o f the study will be to set up pilot studies on D R G s, with emphasis on quality assurance, hospital m anagem ent and incentive budgeting. 6.51 In connection with the m edium -term p ro g ram m e with P ortugal, a W o rkshop on In tersecto ra l A ction for Health : H a rm o n iza t io n o f Econom ic an d H ealth Policies was organized by the N ational School o f Public Health , Lisbon in N ovem ber, with technical an d financial assistance from W H O . N ational reports, including reports from other sou thern E uropean countries , were presented and discussed with a view to ident­ ifying areas for fu r the r investigation in this field. The Regional Officer for Health Econom ics presented a paper on intersectoral action in the context o f H F A . It was suggested tha t health economics associations be modelled a long the lines o f those in Portugal and Spain. 93 6.52 T he Regional Officer for Health Legislation partic ipated in the C om m ittee of Experts on Medical Research on H u m an Beings, organized by the D irectorate o f Legal Affairs o f the Council o f Europe in S trasbourg in October. 6.53 T he Regional Office was represented at the third Conference o f European Health Ministers, organized by the Council o f Europe in Paris in N ovember. The main topics discussed were the ethical and sociocultural problems, the organizational and edu­ cational aspects, and legislative measures in relation to organ transp lan ta tion and E uropean cooperation. Target 35 SO 6.54 In the fram ew ork o f H F A m onitor ing and evaluation, the H F A data base has been developed and updated with the most recent inform ation available in the Regional Office. T he following materials were used as the main source o f information: replies from M em ber States received for the first H F A evaluation exercise (1984-1985); da ta bases m aintained by W H O headquarters (indicators related to mortality and incidence of specific diseases); national statistical yearbooks; and relevant data bases a n d /o r statistics from different in ternational and national organizations, W H O collaborating centres and relevant units o f the Regional Office. 6.55 Sim ultaneously the system of H F A indicators was fur ther im proved and refined. Individuals and institutions in the Region, as well as the appropria te units in the Regional Office and at W H O headquarters , assisted in revising the H F A indicators in the light of the regional evaluation and their own experience. Several consultations were held to consider the developm ent o f im proved indicators in specific areas, including health prom otion and environm ental health. Revised versions o f the indicators, as well as criteria for their developm ent, were presented to the C G P D in April; at the request o f the C G P D , the list was finalized at a consultation held for this purpose in June. 6.56 At the regional level, several indicators were reworded to take account o f the practice in M em ber States a n d /o r the practice recom m ended at global level. The non- quantita t ive indicators , whose questions previously dealt mainly with the existence of legislation and policies, were in a num ber of instances reform ulated to obtain a specific type o f answ er on the im plem entation of program m es and policies, and to enable M em ber States to indicate ways in which their impact could be assessed. 6.57 T here has been a m arked increase in the num ber o f indicators proposed in relation to environm enta l health, a l though the initial in tention of providing more quantitative indicators in this field has not been entirely fulfilled. Q uantitative indicators in the area o f water supply and sanitation now also cover the use of recreational waters. The non-quan tita t ive indicators proposed for environm ental health call for a fuller description o f mechanisms for environm ental health protection and prom otion . At its thirty-seventh session the Regional C om m ittee endorsed the revised list o f regional Before 1990, Member States should have health in­ formation systems capable o f supporting their national strategies fo r health fo r all. 94 H F A indicators to be used in the for thcom ing m onito r ing exercise o f H F A strategy developm ent in countries. T he M em ber States have now received the com m on fram e­ work which, together with the regional indicators, will be the basis for the 1988 evalu­ ation o f national H F A development. 6.58 A representative o f the Regional Office and a partic ipant from the USSR at tended the meeting on sentinel surveillance, organized by the C E C in C openhagen in N ovem ber. D uring the meeting the application of m odern epidemiological m ethods for m easuring different health-related characteristics at the population level was discussed. 6.59 A consulta tion was organized in Heidelberg in D ecem ber to prepare recom m en­ dations for the integration o f epidemiological d a ta on the re lationship o f com m on risk factors to m orbidity and mortality. The subsequent development of relevant risk as­ sessment m ethods was discussed. As far as mortality is concerned, activities on risk assessment were closely associated to corresponding activities for target 6. 6 60 T he publication M easurem ent in health prom otion and protection was issued during the year. The overall concepts of health and health p rom otion are reviewed, as well as m ethods of measuring health essential for health care planning and evaluation. 6.61 T he Office was represented at the 53rd Conference of the In ternational Feder­ ation o f L ibrary Associations and Institutions, in Brighton in August. D uring the C onference the European Association for Health Inform ation and Libraries was estab­ lished, com prising some 100 members from 13 European countries from am ong the m em ber countries o f the Council o f Europe. The aim is to prom ote in fo rm ation transfer in the fields o f biomedical research, epidemiological surveillance, public health services and health p rom otion . T he Regional Office supports the Association with a view to involving all the M em ber States in the European Region. 6.62 T he Regional Office’s bibliographic da ta base (E U R O D O C ) is now compatible with tha t in W H O headquarters (W H O L IS). E U R O D O C has been considerably ex­ panded and is available on-line in the Regional Office. A new data base containing coun try reports on tobacco was developed in line with the form at o f E U R O D O C . Regional Office docum ents are now colour coded to show to which group o f regional H F A targets they belong, they contain the relevant target text, and are indexed to allow for easy identification in the printed lists o r in au tom ated bibliographic systems. 6.63 T he development o f services for operating an H F A statistical d a ta base is progressing well, and the service is now partly operational. The object o f the da ta base is to provide com parative in form ation and analyses to M em berS ta tes on progress towards a ttain ing the regional H F A targets. 6.64 A dvanced facilities for electronic mail services th rough international networks are now fully operational. Owing to the efficiency and cost-effectiveness o f these services, M em ber States have s tarted using electronic mail for routine correspondence. A coord i­ na tion meeting was held in W H O headquarters in O c tober to dem onstra te a develop­ m ent project for the p ro d u c tio n o f a p ro to type electronic mail service to transm it textual inform ation between W H O headquarters and the regional offices for the Eastern M edite rranean , E urope and the W estern Pacific. On an experimental basis, the project 95 aims at assessing the cost-effectiveness of a full-scale electronic message com m unication service th roughou t W H O . 6.65 An in terna tional sem inar on m icrocom puter applications in health services m anagem ent took place in Florence in N ovember, organized jointly by the Regional Office, W H O headquarters and the W H O collaborating centre for health informatics at the C en tro I ta liano Studi e Indagini in Rome. The target g roup o f the sem inar was administrative and m anagem ent personnel from all W H O regions responsible for infor­ m ation support in the public health sector, and the purpose was to induce them to use m icrocom puters and to provide a fram ew ork for decision-m aking in their use. F ro m the E uropean Region, partic ipants were invited from Hungary , Israel, Portugal an d T u rk ey . 6.66 In M ay the M inistry o f Public H ealth of the G e rm an D em ocratic Republic requested the assistance of the Regional Office in investigating what type o f logistics support could be provided in connection with the development of a new national W H O office to be established at the Ministry. The issue will be discussed during a visit to the M inistry in J a n u a ry 1988, where the Regional Officer for Informatics S u pport will receive a general briefing on the s ituation in the informatics area, and also discuss future developm ents in the exchange o f inform ation between the G erm an D emocratic Republic and the Regional Office. 6.67 T he Regional Office is co llaborating technically and financially with the health au thorities in M alta on a large project involving the com puterization of the national health in form ation system. The project was expected to be implemented with the final evaluation mission (phases I and 11 ) scheduled to take place in October. Due to technical problems, however, the evaluation mission was postponed and a technical advisory g roup visited M alta in O ctober to identify problems and form ulate a solution. The final evaluation mission is now planned to take place in August 1988. 6.68 D uring a visit to Israel in April by the Regional Officer for Informatics S upport plans for a nationw ide hospital inform ation system were discussed. The project aims at providing the Ministry of Health with sufficient inform ation to operate government hospitals efficiently, to build a national da ta base o f statistical inform ation for evalu­ ation and p lanning o f the health care system, and to m easure operational efficiency through au tom ation . 6.69 A pilot project including a system to facilitate the exchange of textual (Cyrillic and Latin alphabets) and numerical da ta (statistics) between the Ministry of H ealth of the USSR and the Regional Office is being implemented. T he project will also test and evaluate the exchange of administrative procedures. The first phase of the project, including installation of hardw are and software for com bined Cyril lic /Latin text p ro ­ cessing fully com patible with similar services in the Office, has been implemented. 6.70 In conjunction with the W H O collaborating centre for health informatics at the C o m p u te r In fo rm ation Centre o f the Latvian Ministry o f Health , Riga, the second phase o f the project will include: testing and evaluating o f the exchange o f administrative procedures between the Office and the Ministry; implementing facilities for exchange of in form ation in m achine-readable form; identifying statistical and bibliographic appli­ cations where exchange of data in machine-readable form can be implemented; testing the 96 f e a s ib i l i ty o f d i r e c t e x c h a n g e o f d o c u m e n t s b e t w e e n th e O ff ic e a n d th e M i n i s t r y t h r o u g h t e l e c o m m u n i c a t i o n ; a n d p r o v id in g W H O w i th a n e v a lu a t io n r e p o r t e v e ry six m o n th s . 6.71 In o r d e r t o te s t a n d e v a lu a te th e e x c h a n g e o f a d m in i s t r a t i v e a n d s ta t i s t ic a l i n f o r m a t i o n in m a c h i n e - r e a d a b l e f o r m v ia t e l e c o m m u n i c a t i o n , a p r o je c t , i n c lu d in g lo g is t ic s s u p p o r t , is in th e p r o c e s s o f b e in g im p l e m e n t e d in H u n g a r y . T h e p r o j e c t a l so in c lu d e s c o m p r e h e n s i v e t r a i n i n g o f s ta ff . 6.72 F u r t h e r i m p r o v e m e n t w a s m a d e in t h e lo g is t ic s s u p p o r t t o th e D e p a r t m e n t o f I n t e r n a t i o n a l R e la t io n s , M in i s t r y o f H e a l th , P o r tu g a l . 6.73 In c o n j u n c t i o n w i th th e W H O c o l l a b o r a t i n g c e n t r e f o r i n f o r m a t i c s s u p p o r t a t th e C e n t r e in te r u n iv e r s i t a i r e d e t r a i t e m e n t d e l’i n f o r m a t i o n ( C I T I 2), P a r i s , in i t ia l s te p s w ere t a k e n to l in k th e R e g io n a l O ff ice to th e F r e n c h M in i te l n e tw o r k . 6.74 W i th th e a s s i s t a n c e o f th e W H O c o l l a b o r a t i n g c e n t r e f o r h e a l t h i n f o r m a t i c s in U p p s a l a , S w e d e n , th e r e l a t i o n a l d a t a b a s e m a n a g e m e n t sy s te m M I M E R is n o w in o p e r a t i o n in th e R e g io n a l O ff ic e . I t s u p p o r t s t h e i n t e g r a t e d m a n a g e m e n t i n f o r m a t i o n s y s te m ( I M I S ) , th e h e a l th le g is la t io n n o t i f i c a t i o n sy s te m a n d E U R O D O C . M I M E R w as s e le c te d a s it is a f o u r t h g e n e r a t i o n s o f tw a r e p a c k a g e t h a t a f f o r d s a n u n u s u a l l y h ig h d e g r e e o f p o r t a b i l i t y o f c o d e f r o m o n e sy s te m to a n o t h e r . Target 36 BO 6.75 T h e d a t a b a s e o n h e a l t h m a n p o w e r i n f o r m a t i o n se t u p in 1986 in a s s o c ia t io n w i th th e C e n t r e d e so c io lo g ie e t d e d é m o g r a p h i e m é d ic a le s , a W H O c o l l a b o r a t i n g c e n t r e in P a r i s , is n o w o p e r a t i o n a l . T h e d a t a b a s e r ec e iv e s s u p p o r t f r o m th e F r e n c h M in i s t r y o f S o c ia l A f f a i r s a n d E m p l o y m e n t . I n f o r m a t i o n is n o w b e in g d i s s e m in a t e d , a n d th e C e n t r e a l s o a s s is ts in a n a ly s in g , c o m p a r i n g a n d a s s e s s in g c o l le c te d d a t a a s well a s in i m p r o v in g in d i c a t o r s o n h u m a n r e s o u r c e s f o r H F A . 6.76 A fu ll d e s c r ip t i o n o f th e re su l t s o f th e s tu d y c a r r i e d o u t w i th th e W H O c o l l a b ­ o r a t i n g c e n t r e fo r th e m a n a g e r i a l p r o c e s s fo r n a t i o n a l h e a l th d e v e l o p m e n t a t th e N u f f ie ld C e n t r e in L e e d s w a s i s s u e d b y a c o m m e r c i a l p u b l i s h e r u n d e r th e t i t le Health manpower: planning, production and management. T h e b o o k e x p lo r e s m a n p o w e r p l a n n i n g , p r o ­ d u c t i o n a n d m a n a g e m e n t a i m s , m e th o d o lo g i e s a n d p r a c t i c e s a n d th e i r c o m p a t i b i l i t y w i th th e H F A s t r a te g y . 6.77 A d o c u m e n t e n t i t l e d “ H e a l th p e r s o n n e l d e v e lo p m e n t in s u p p o r t o f h e a l th fo r a l l ” w a s p r e s e n te d a t t h e th i r t y - s e v e n th se s s io n o f th e R e g io n a l C o m m i t t e e in S e p te m b e r . T h i s d o c u m e n t e x a m in e d th e b r o a d im p l ic a t io n s o f th e H F A p o l ic y f o r h e a l t h p e r s o n n e l , w i th p a r t i c u l a r r e f e r e n c e to h e a l th m a n a g e r s , n u r s e s a n d m e d ic a l p r a c t i t i o n e r s . A f t e r a Before 1990, in all Member States, the planning, training and use o f health personnel should be in accordance with health fo r all policies, with emphasis on the primary health care approach. 97 s t i m u l a t i n g d i s c u s s io n , r e s o lu t io n E U R / R C 3 7 / R 7 w a s p a s s e d a s k in g th e R e g io n a l D i r e c t o r to in i t i a t e c o n s u l t a t i o n s a n d d i a lo g u e w i th al l M e m b e r S ta te s , r e l e v a n t in s t i ­ t u t i o n s a n d a s s o c i a t i o n s in o r d e r t o id e n t i f y th e n e e d e d e d u c a t i o n a l c h a n g e s . A p la n o f a c t io n w a s a c c o r d in g ly p r e p a r e d in 1987 f o r i m p l e m e n t a t i o n in th e b i e n n iu m 1 9 8 8 /1 9 8 9 . 6.7« T h e a n n u a l c o n f e r e n c e o f th e A s s o c i a t i o n fo r M e d ic a l E d u c a t i o n in E u r o p e ( A M E E ) a n d th e A s s o c ia t i o n o f M e d ic a l D e a n s in E u r o p e ( A M D E ) , w h ic h w a s h e ld j o i n t l y w i th a m e e t i n g o f th e W o r l d F e d e r a t i o n f o r M e d ic a l E d u c a t i o n in D u b l i n in S e p t e m b e r , w a s a d d r e s s e d by th e R e g io n a l D i r e c to r . T h e v ery p o s i t iv e a t t i t u d e o f p a r t i c i p a n t s to w a r d s th e H F A p o lic y w a s re f lec te d in th e w i l l in g n ess o f se v e ra l o f t h e m to be in v o lv e d in sp e c i f ic c o l l a b o r a t i v e a c t iv i t ie s . T h e c o n t r i b u t i o n o f m e d ic a l e d u c a t i o n to th e new E u r o p e a n h e a l th p o l ic y w a s c h o s e n to be th e th e m e o f th e 1988 c o n fe re n c e . 6.79 T h e A s s o c i a t i o n o f S c h o o l s o f P u b l ic H e a l th in th e E u r o p e a n R e g i o n ( A S P H E R ) a n d th e R e g io n a l O ff ic e e s t a b l i s h e d a j o i n t t a s k fo rc e o n th e t r a i n in g o f h e a l t h p r o ­ fe s s io n a ls f o r H F A , a n d its f irs t m e e t in g to o k p la c e in th e R e g io n a l O ff ic e in F e b r u a r y . T h e p a r t i c i p a n t s p r e p a r e d le a r n in g m a te r i a l s r e la te d to a n u m b e r o f r e g io n a l t a rg e t s , a n d a b o o k le t e n t i t l e d “ S c h o o ls o f p u b l i c h e a l th a n d h e a l th - fo r -a l l : im p l ic a t io n s f o r t r a i n i n g ” w a s issu ed . T h e s e a n d o t h e r in i t i a t iv e s r e la te d to th e n ew c o n c e p t s o f p u b l ic h e a l th w ere d e b a t e d d u r i n g th e T e n t h G e n e r a l A s s e m b ly o f A S P H E R , w h ic h w a s h o s t e d jo i n t l y by th e R e g io n a l O ff ic e , th e N a t i o n a l B o a r d o f H e a l th o f D e n m a r k a n d th e N o r d i c S c h o o l o f P u b l ic H e a l t h , G o t h e n b u r g in A u g u s t . T h e in i t ia l a c h i e v e m e n t s o f th e t a s k fo rc e w ere rev ie w ed d u r i n g its s e c o n d m e e t in g in B r is to l in O c to b e r . 6.80 T h e E u r o p e a n n e t w o r k f o r m u l t i p r o f e s s io n a l e d u c a t i o n in h e a l th sc ien c es w as e s t a b l i s h e d d u r i n g its f irs t g e n e r a l m e e t in g o r g a n iz e d jo in t ly w i th W H O in P a r i s in M a r c h . T h e a im o f th e n e t w o r k is to p r o m o t e th e c o n c e p t o f m u l t i p r o f e s s io n a l e d u c a t io n as a n i m p o r t a n t m e a n s o f a t t a i n in g th e g o a l o f H F A . 6.81 T h e s e c o n d in t e r n a t i o n a l w o r k s h o p o n H F A e d u c a t i o n a l a n d m a n a g e r i a l s t r a t ­ eg ies f o r t e a c h e r s o f th e h e a l th sc ie n c e s w a s o r g a n iz e d in tw o p h a s e s in M o s c o w a n d L o n d o n in S e p t e m b e r , in c o l l a b o r a t i o n w i th th e C e n t r a l I n s t i t u t e f o r A d v a n c e d M e d ic a l S tu d ie s , M o s c o w a n d th e B L A T C e n t r e fo r H e a l th a n d M e d ic a l E d u c a t io n , L o n d o n . T h e w o r k s h o p w a s a t t e n d e d by 13 p a r t i c i p a n t s f r o m B u lg a r ia , C z e c h o s lo v a k ia , F ij i , F in l a n d , F r a n c e , I n d o n e s i a , I s ra e l , P o r tu g a l , S p a in , T u r k e y a n d th e U n i t e d K in g d o m . 6.82 T h e t h i r d i n t e r n a t io n a l w o r k s h o p o n e d u c a t i o n a l p l a n n i n g w as o r g a n iz e d in P a r i s in M a y in c o o p e r a t i o n w i th th e m e d ic a l f a c u l ty o f th e U n iv e r s i t y o f P a r i s X I I a t B o b ig n y . T h e t e n t h c o u r s e o n m o d e r n m e t h o d o l o g y fo r t e a c h e r s o f h e a l th sc ien c es a n d a c o u r s e o n th e m a n a g e m e n t o f a c o l le c t io n o f h e a l th a u d i o v i s u a l s w ere o r g a n iz e d in c o l l a b o r a t i o n w i th th e B L A T C e n t r e f o r H e a l th a n d M e d ic a l E d u c a t i o n in L o n d o n , in J u ly a n d A u g u s t respec t ive ly . 6 .8.1 A s tu d y t o f o r m u l a t e o p t i o n s o f d e v i s in g w a y s a n d m e a n s o f u t i l iz in g r e s e a r c h f in d in g s in m e d ic a l e d u c a t i o n w as u n d e r t a k e n in c o l l a b o r a t i o n w i th s c h o o ls in s e le c te d E u r o p e a n c o u n t r i e s as p a r t o f a g lo b a l s tu d y . T h e r e su l t s o f th e a n a ly s i s o f th e E u r o p e a n s i t u a t i o n will be in c lu d e d in th e g lo b a l r e p o r t to be is sued in 1988. 6.84 A s a c o o p e r a t i v e a c t iv i ty w i th th e W o r l d O r g a n i z a t i o n o f N a t i o n a l C o l le g e s , A c a d e m i e s a n d A c a d e m i c A s s o c ia t i o n s o f G e n e r a l P r a c t i t i o n e r s ( W O N C A ) a n d w i th 98 W H O headquarters , the Regional Office participated in the formulation o f a project for establishing a new university-based training scheme in general practice. The Office also provided support to the In ternational Federation of Medical S tudents’ Associations for o rganiz ing a w orkshop on prim ary health care training in Turkey. In the same country support was provided to a project to reorient medical education, with particular em­ phasis on child survival programmes. 6.K5 New approaches and practices with regard to continuing education of health personnel have been investigated in selected European countries by means of case studies. The outcom e of these case studies was examined at a workshop in Barcelona in December. Ways and means were identified to develop systems and program m es of continuing education of health professionals that will take into account changing national health needs and H FA policies, and lay emphasis on primary health care. 6 X6 Studies on encouraging PH C personnel to perform preventive and promotive activities, and on the team w ork requirements in meeting specific health needs, were undertaken in co llaboration with the N ordic School of Public Health, G othenburg , the C entra l Institu te for A dvanced Medical Studies, M oscow and the Postg raduate Medical School, Budapest. The outcom es of these studies were used as background papers for the W ork ing G ro u p on Interaction between Health and Social Services and the Public in the Provision of Health Care, which took place in G ran ad a in November. 6 X7 In 1987 the Central Institute for Advanced Medical S tudies(C IA M S), Moscow, a W H O collaborating centre for health m anagem ent and hum an resources, celebrated the 25th anniversary o f the W H O international courses for public health adm inistrators. These courses are held annually in English and Russian and were started in 1962. Cl AMS is an institute that coord ina tes all pos tg radua te medical studies in the USSR and continues to work closely with the Regional Office and W H O headquarters. Fellowships 6.XX The distribution of European fellowships in 1987 by subject of study shows that European M em ber States are using fellowships to prom ote their national H F A policies. As indicated in Fig. 1, which com pares the percentages of fellowships d istributed according to target groupings, the highest percentage relates to health development. Fig. 2 shows the regions o f origin of the fellows received in Europe, and Fig. 3 shows the num ber o f fellows from each European M em ber State studying elsewhere, as well as the num ber of fellows received in each country. 6.89 In co llaboration with M em ber States the Regional Office has been active in supporting the implementation of resolution E B 71 .R6, and a com puterized program m e for eva luating fellowships has been developed. By analysing individual fellows’ reports and the com m ents o f governm ents, subm itted to the Regional Office one year after the term ination o f the fellowship, the Regional Office will be in a position to provide a reliable appraisal o f the fellowships program me. The system has been carried out on a trial basis for some m onths and will be fully operational from Jan u a ry 1988. 99 Fig. 1. Percentage d is tr ibu t ion of European fe l low s in 1 9 87 by subject of study Health development support 27.4 Fig. 2. D is tr ibu t ion of fe l low s in the European Region in 1 9 87 by region of orig in AMR 100 Fig. 3. D is tr ibut ion by coun try of fe l lows in the European Region in 1 9 8 7 a Black figures indicate the number of fellows from each country studying elsewhere in the Region. Coloured figures indicate the number of fellows received in each country. 3 T h e s e f i g u r e s r e f e r o n l y t o t h o s e f e l l o w s w h o s t a r t e d t h e i r f e l l o w s h i p s i n 1 9 8 7 . The Fellowships unit continues to distribute the list o f W H O educational and train ing activities to European M em ber States. This list, in addition to the newly created com puter ized system for con tinuous train ing facilities in Europe, will provide national authorities with inform ation to help them to select the most relevant training o p p o r­ tunities in support o f H FA development. 6.41 S ta ff o f the Fellowships unit represented the Office at a meeting of the M edi­ cal Fellowships Selection and Assessment C om m ittee of the Council o f Europe, in S trasbourg in Septem ber, and at a meeting of senior fellowships officers of the organiz­ ations o f the United Nations system, in T urin in October. Target 37 SO 6 .9 : Representatives of the In ternational Federation of Medical S tudents ' Associ­ ations are actively co llaborating with the Regional Office in order to explore the role of the Federation in support o f target 37. f.,43 A national pilot project is expected to be launched bv Lund University in Sweden on in tersectoral co l labo ra t ion on health and health-related matters in sectors o ther than health. Target 38 SO 6.94 Many M em ber States have now brought health technology assessment into their health policy-related activities. Not only are formal a rrangem ents being made with offices, institutes, commissions, national societies and universities in many different countries, but the increase in in ternational meetings and literature indicates a growing unders tand ing o f the need to establish formal mechanisms for the systematic assessment of health technologies. 6.95 The health technology assessment p rogram m e has focused on support to M em ­ ber States in the development of concepts and principles, both in assessing technologies Before 1990, all Member States should have estab­ lished a form al mechanism for the systematic assess­ ment o f the appropriate use o f health technologies and o f their effectiveness, efficiency, safety and accept­ ability, as well as reflecting national health policies and economic restraints. Before 1990, in all Member States, education should provide personnel in sectors related to health with adequate information on the country ’s health fo r all policies and programmes and their practical appli­ cation to their own sectors. 102 and in their ap p rop ria te and effective use. It has also aimed at supporting M em ber States in the developm ent o f educational program m es in the assessment and ap p rop ria te use of health technologies. 6.96 A netw ork of researchers and institutes has been created, and access to this is offered through the W H O /L IN F O data base created in collaboration with the Centre for Medical Technology Assessment in Linköping, Sweden. 6.97 With regard to health planning and early-warning systems, a comprehensive study has been carried out in collaboration with the G overnm ent o f the Netherlands. The report on the study is available from the steering com m ittee on future health scenarios of the Netherlands Ministry o f Welfare, H ealth and Cultural Affairs. 6.98 A survey o f the current approaches and attitudes towards health technology evaluation was carried ou t in co llaboration with the Centre for Medical Technology Assessment, Linköping, Sweden. 6.99 In studying the interface between technology policy and industry, a workshop was held in S trasbourg in May, in collaboration with the Regulatory Affairs Professionals Society and the US F ood and D rug Adm inistration. 6 .Ю 0 On the subject o f developing diagnostic-related groupings, a meeting was held in Leuven in October, in co llaboration with the European Health Policy Forum . 6.101 Discussions on standard ization , evaluation and test protocols o f medical equip­ ment were held with the In ternational W orking G ro u p for Medical Device Testing, in S tockho lm in Ju n e , and with the EEC and the Italian G overnm en t in Florence in November. 6.102 In Septem ber, the Office was represented at the ECE Sem inar on A u tom ation M eans in Preventive Medicine. The views of W H O on medical equipm ent and preventive m easures were presented, and a round-tab le discussion focused on the interaction between man and machine in health care and between technology and health care systems in society. It centred a round the appropria te use, cost-effectiveness and allo­ cation o f medical technology. 6.103 A meeting o f a coo rd ina t ing group, representing different data banks on tech­ nology assessment from five countries, was arranged in Sweden in August. It was agreed that efforts should be made to network these da ta bases to try to establish a com m on way o f accessing the contents, with regard both to indexing and to keywords. 6.104 As part o f the m edium -term program m e with Spain, a consulta tion took place in Barcelona in February in support of a p rogram m e of interlaboratory external quality assessment for haematology. 6.105 Assessment o f the basic radiological system (BRS) has been carried out on a global basis. The European studies have been finalized and show a favourable response to the use of the BRS system. A report is being prepared. 6.106 T he P rogram m e M anager took part in the p repara tion of a report by the ECE on the role of the o rganization of digitized imaging and film-free radiology departm ents. 103 6.107 In co llaboration with the University of Lund, Sweden and the W orld C o n ­ ference on Surgical Efficiency and Econom y, a w orkshop on technology assessment and quality assurance in surgery was arranged in September in cooperation with the C open­ hagen C ollabora ting Centre. Participants attended from many European and several non-E uropean countries. 6.ЮХ A large international meeting on com puters and informatics in health care was held in Linköping, Sweden in October and was attended by approximately 90 participants. 6.109 Studies o f emerging and future technologies were carried out in collaboration with the G overnm en t o f the N etherlands in the following areas: developments in the regeneration, repair and reorganization of nervous tissue; health care applications of lasers — the future trea tm ent of co ronary artery disease; developments in genetic screening; applications of the new biotechnology — the case of vaccines; computer- assisted medical imaging; and potentials for home care technology. 6.1 io An international course on quality assurance, a ttended by 42 participants from 10 countries, was held in F inland in July. The many applications to this course indicate the extensive interest o f M em ber States in the issue of quality assurance in health care. 6. 11 1 While national initiatives in the field o f technology assessment are increasing in almost all European countries, there are some M em ber States where the issue of tech­ nology is still a question of technique and where the focus is still on uneven distribution o f necessary medical equipm ent as well as lack of quality o f such equipm ent. In these countries, there is still the need to support the developm ent o f the concept of technology assessment and the appropria te use o f technology. Pharmaceuticals 6.M2 As in the previous six years the development o f a balanced pharm aceuticals p rogram m e, contribu ting to the a tta inm ent of many H FA targets, continued. E stab­ lishment of new activities was unavoidably impeded by the prolonged absence o f the Regional Officer for Pharm aceuticals on o ther duties for the Organization , but existing activities continued. O ne difficulty in reporting fully upon work in the fram ework o f this p rogram m e is that a growing num ber o f M em ber States seek advice confidentially from the unit, e.g. on the development or evaluation of their systems for the regulation of pharm aceuticals or of pricing schemes; it is clear that the confidential nature of such consultations must be respected by the Regional Office. 6.1 13 T he sixteenth E uropean Sym posium on Clinical Pharm acological Evaluation in D rug C ontro l was again held in Schlangenbad, Federal Republic of G erm any in N ovem ber with the support o f the Federal Ministry for Youth, Family Affairs, W om en and Health . T he topic this time was “ C onstra in ts on trea tm ent and trials” , a p roblem of increasing concern as M em ber States seek to define reasonable ethical and financial limits within which the physician can investigate and prescribe medicines. 6.114 Sixty researchers attended the biennial meeting of the W H O D rug Utilization Research G ro u p in Oslo. The G ro u p , established by the Regional Office in 1969, has 104 to date com pleted and reported on more than 700 studies analysing prescribing patterns, as a basis for the developm ent and evaluation of healthy public policies in the medicines field. The G ro u p continued to be supported by the W H O collaborating centre for drug statistics m ethodology in Oslo, notably as regards the continuous updating o f the list o f “ defined daily doses” , the units in which d rug use is m easured and com pared inter­ nationally. 6.1 is One project that developed rapidly was the study of the present and future role o f the pharm acis t in health care. A working group met in A m sterdam in September, and in N ovem ber there was a successful global meeting in Hillerod, D enm ark organized by the Danish Pharm aceutical Society together with the Regional Office. 6. 116 In co llaboration with the Slovak authorities and professional societies, a second sym posium on the clinical physiology and pharm acology of the perinatal period was held in Smolenice. A part from draw ing up general recom m endations to investigators and prescribers, the meeting provided an opportunity to finalize two major publications devoted to the investigation o f “ behavioural teratogenicity” and the effects of drugs during lactation. 6.1 17 Notable am ong inter-unit projects was one established in 1986 together with the N utrit ion unit to examine policies as regards vitamin and mineral preparations. A working group was held in June to draft the report. 6. 118 T o an increasing extent, the Regional Officer and consultants a ttached to the p rog ram m e have played a role in external courses, meetings and symposia intended to provide participants (e.g. from the pharmaceuticals industry) with a greater insight into such matters as the regulatory process and the detection of adverse reactions. 6.119 O f the docum ents issued by the program m e, those in the European Drug Guideline Series remain am ong those most widely in dem and, followed closely by “ D rugs and m oney” and the “ D rug bulletins review” . W ork on updating these p ro ­ ceeded th ro u g h o u t the year so that they remain fully in line with the rapidly changing scene. 6.120 T he fourth issue o f the “ D rug regulation index” , prepared by the W H O collab­ o ra ting centre for drug inform ation and quality assurance in Budapest, was distributed. This issue indexed a large num ber of guidelines and regulations from all parts of the world relating to good m anufacturing practice. 6.121 A basic long-term study formalized during the year relates to “ Health behaviour, levels o f knowledge and att i tudes related to pharm aceutical use” . Such work is seen as com plem enting the more direct approach to the pharmaceuticals situation, identifying the m otivation underlying drug-related behaviour. Such behaviour differs strongly from one part o f the Region to ano ther , and an understanding o f the reasons for this variation is needed if drug policies are to reflect a popu la t ion ’s true needs and preferences. 6.122 C ollaboration with the D epartm ents of Pharm acology and Clinical P h arm a­ cology at the University o f G roningen , the Netherlands has become much closer and more concrete. T he experimental teaching p rogram m e in pharm aco therapy and pre­ scribing for medical s tudents entered its third teaching year. Experience is now sufficient 105 t o c o n f i r m th e p r o g r a m m e ’s p r o m is e , a n d u n iv e rs i t ie s in o t h e r c o u n t r i e s h a v e e x p r e s s e d in te r e s t in p a r t i c i p a t i o n in a n e x t e n s i o n o f th e p r o g r a m m e . C o l l a b o r a t i o n w i th th e U n iv e r s i ty a l s o r e n d e r s it p o s s ib le t o m o b i l iz e c a p a c i ty , n o t a b ly b y w o r k i n g w i th g r a d u a t e s t u d e n t s t o d e v e lo p th e s e s o f d i r e c t r e le v a n c e t o th e p r o g r a m m e o f t h e W H O E u r o p e a n R e g io n . 6.123 N e w i n f o r m a t i o n m e d i a a r e b e g i n n i n g to d o m i n a t e t h e f ie ld o f m e d ic in e s , a n d a f u r t h e r t e a c h i n g v id e o o n t h e w a y in w h ic h m e d ic in e s a r e s o ld t o th e p h y s i c i a n w as p r o d u c e d f o r p u b l i c d i s t r ib u t io n . 6.124 In o n e M e m b e r S ta te , w o r k w a s u n d e r t a k e n to r e s t r u c t u r e a n e x i s t in g in s t i tu te so t h a t i t c a n p l a y a m o r e a c t iv e r o le i n t e r n a t i o n a l l y in th e p r e d i c t i o n a n d a v o i d a n c e o f d r u g - i n d u c e d in ju ry . In p a r a l le l w i th th is , lo n g - t e r m c o m p a r a t i v e s tu d ie s o f f in d in g s w i th p a r t i c u l a r d r u g s in a n i m a l s a n d in m a n w e re in i t i a t e d , a g a in a s a m e a n s o f d e v e lo p in g b e t t e r p r e d ic t iv e t e c h n iq u e s . RESEARCH AND HEALTH DEVELOPMENT SUPPORT Publications issued in 1987 Measurement in health promotion and protection. WHO Regional Publi­ cations, European Series, No. 22. Drugs for children. Non-serial publication. Documents issued in 1987 Altenstetter, C. Intersectoral action to aid maternal and child health — under­ standing the policy process (document ICP/MPN 016). Brenner, M.H. et al. Scenario approaches in health planning (document ICP/MPN 012). Economic aspects of prevention of diseases and disability, report on a consultation (document ICP/MPN 511). European Advisory Committee on Health Research', report on the thirteenth session (document ICP/RPD 112). Health for all and schools of public health: implications for training (docu­ ment ICP/HMD 117). Index to Guidelines and Regulations of Good Manufacturing Practice ( GMP) (Drug Regulation Index No. 4). Information exchange and collaboration in health-related activities in Europe: report on a WHO meeting (document ICP/COR 112). Long-term planning and scenarios in health care: report on a WHO meeting (document ICP/MPN 021). Research methodology in education for the health professions: report on a WHO intercountry travelling seminar (document ICP/HMD 138). Ritsatakis, A. Framework for the analysis of country (HFA) policies (docu­ ment ICP/MPN 032 (ex ICP/EXM 026)). Co-publications issued in 1987 Long, A. & Mercier, D. Health manpower: planning, production and man­ agement. London, Croom Helm. 107 7Global programmes 7.1 Following a decision by the D irector-General, the Regional Office’s responsibility for the m anagem ent o f its global p rog ram m e areas was increased. T he global p ro ­ gram m es located at the Regional Office, i.e. those on accident prevention, health o f the elderly and appropria te technology for health, thus have to comply with the m anagem ent procedures o f the Regional Office. The m edium -term program m es of these three p ro ­ gram m es for the period covered by the Eighth G eneral P rogram m e o f W ork were there­ fore screened by the Regional Program m e C om m ittee (a task previously perform ed by the H eadquarte rs P rogram m e Com m ittee (H PC)), assisted by the Secretary o f the HPC. Global programme for accident prevention 7.2 T he first part o f 1987 was essentially devoted to further im plementing the prin­ ciples o f intersectoral coord ina tion and decentralized policy for safety prom otion . Two interregional meetings took place in Thailand in M arch, and should pave the way for the developm ent of the p rog ram m e in the future, particularly during the Eighth General P rog ram m e of W ork. One was a meeting on accident and injury prevention at the p rim ary health care level held in Pattaya, and the o ther an Asian sem inar on road safety, which took place in Bangkok. 7.3 T he basic aims o f these two meetings were: first, to form ulate guiding principles for com m unity safety p rogram m e development as part o f health p rom otion and protec­ tion, and to cater for the need for increased intersectoral cooperation at the com m unity level; and second, to establish regional o r subregional networks of policy-makers and heads o f national institutions in the field o f road safety so as to ease inform ation exchange and technical coopera tion , particularly in research. Representatives from the health and transport sectors attended both meetings. Together with the Economic and Social C om m ission for Asia and the Pacific, W H O plans to serve as a technical resource for countries, particularly in dealing with problem s of technology transfer, and to follow up policy guidance on s trengthening com m unity involvement in road safety activities. All the recom m endations o f the sem inar were in agreement with W orld Bank guidelines for road safety, which should secure coord ina tion with the Bank at the country level. The Asian sem inar was largely a follow-up of recom m endations m ade by several European coun tries on decentralized road safety policies during European R oad Safety Year in 1986. 109 7.4 T he m ajor event in 1987 was the sem inar on injury prevention at the primary health care level in Thailand. In cooperation with the Ministry o f Health, preliminary guidelines and a protocol for the development of a pilot project in T hailand were form ulated . The report o f the seminar, which was disseminated to all Regions, has a roused definite interest and plans have been made to develop similar projects in Kenya and Venezuela. In Kenya this project is likely to be supported by collaboration between w om en’s associations in Kenya and Sweden. The Ministry of Health in Venezuela included this proposal in its ongoing accident programme. 7.5 Representatives from the C onsum er Safety Institute ( CS I ) in A m sterdam and the South A ustra lian Health Com m ission , Adelaide attended the first meeting on accident and injury prevention at the primary health care level, and a preliminary work plan has been form ulated to strengthen cooperation between these two institutions and between them and T hailand , particularly with a view to prom oting com m unity safety p ro ­ grammes. Im m ediate follow-up took place in Indonesia and Kenya. Sweden also ex­ pressed interest in this approach. The CSI will act as technical adviser for the p rogram m e and as an information repository, and will be responsible for producing a joint W H O /C S I newsletter on domestic safety. The South Australian Health Commission will assist particularly in com m unity safety training, and an interregional travelling sem inar be­ tween Australia and Thailand is under consideration. 7,(> The road safety policy analysis and evaluation in countries, m entioned in the Annual R eport o f the Regional D irector for 1986, was completed and was used as background material for the meeting of the study group on new approaches to improve road safety held in December. In relation to this meeting, an assessment was m ade of W H O activities and their impact in the field o f road safety: it showed that W H O has now set up broad policy principles in the field, giving due consideration to the specific needs of non-industrialized countries. These principles were initially based on the Luropean experience, and have been expanded through a continual national and regional consul­ tation process. The views and recom m endations o f this study group should guide the further development of the program m e into the Lighth G eneral P rogram m e o f Work. 7.7 T he W H O /P A HO protocol for the development o f research into child accidents continued to be used in the Region for the Americas. In addition to C uba, which set up a national policy and program m e on the basis o f the protocol, ministries of health in Venezuela and in the State of Sfio Paulo in Brazil established formal program mes. An evaluation o f W H O /P A H O activities took place in Caracas during the Congress of the Asociaciôn Latino Am ericana de Pediatria in October, and gave rise to the Caracas declaration for child and adolescent safety. 7.x The coord ina ted research on accidents in the aged, jointly sponsored by W H O and the In ternational Centre for Social G erontology ( I CSG) in Paris and involving seven countries, continued to focus on the prevention of falls. Sweden was invited by the Belgian Ministry o f I lealth to assist in establishing a program m e in this area. The ICSG prepared a m onograph for health professionals, as well as preliminary guidance for architects on safe housing design and information for the aged on how to exercise in order to prevent falls. 7.9 Burn prevention activities were continued in cooperation with the In ternational Society for Burn Injuries and expanded from South-East Asia (India , Nepal), the W estern Pacific (a co llaborating centre in Jap an ) and Europe (D enm ark ) to Africa (Nigeria) and the Americas (the United States). The first ou tcom e of the epidemiological network established by W H O in India, involving eight centres, came from the M adras centre with emphasis on social and cultural factors, particularly with regard to the occurrence o f burn injuries in women. Global programme for health of the elderly 7.10 T he dem ographic and health profiles of the elderly populations o f M em ber States prepared by W H O , and the data derived from three o ther international p ro ­ gram m es — the United N ations Statistical Office, the “ Aging W o rld ” project o f the US Bureau o f the Census, and the in ternational collaborative effort on aging of the US N ational C en ter for Health Statistics are being integrated. The inform ation thus be­ com ing available, which will include projections to the year 2000 and beyond, should m ake governm ents aw are that the age structure of the population is changing and that this has social and public health consequences. 7.11 An expert com m ittee on the health o f the elderly held in G eneva in N ovember, the first o f its kind since 1974, gave guidance to M em ber States on what should be done under different socioeconomic conditions to maintain people's wellbeing as they age. 7.12 W H O ’s policies and programmes on aging were presented prominently at regional and international meetings and, in pursuance of the policy of bringing the health of the elderly p rogram m e to the atten tion of scientific and professional organizations, w ork­ shops were held during regional meetings of the International Association of Gerontology and the Triennial Scientific Meeting of the In ternational Epidemiological Association. W ith W H O support , national seminars on geriatrics and gerontology were convened in A n d o rra and Portugal and , with the co llaboration of Latin American countries, an international w orkshop on prim ary health care of the elderly took place in Spain. 7.13 Som e 50 partic ipants from all six W H O regions were trained in m ethods for developing rational policies and program m es during the W H O in terna tional course on the epidem iology o f aging, held annually at the L ondon School o f Hygiene and Tropical Medicine. W H O su p p o rted a similar course in French and Spanish , organized by the In te rn a t io n a l Centre o f Social G eron to logy in Annecy, France in June; a course on gerontology organized by the Institute of Social Services for Retirees and Pensioners of A rgentina in Buenos Aires in N ovember; and a sem inar on research on aging in Asia and the Pacific in S ingapore in September. 7.U W H O ’s con tribu tion to the im plem entation of the In ternational Plan o f Action on Aging." adop ted by the W orld Assembly on Aging in 19X2, was given prominence in a Report o f the W orld Assembly on Aging. New York. United Nations. 19X2 ( II. 82.1.16). I l l the report ot the Secretary-General ol the United Nations on the question ofag ing" to the forty-first session of the United Nations General Assembly. 7.15 W H O cooperated with Burma. Indonesia, M auritius, Thailand and Zim babwe in developing comprehensive services for the elderly as an integral part o f primary health care. In the Region of the Americas significant advances were made in national surveys of the needs ot the elderly, and the first national course on self-care for the elderly was held in Mexico in February. Surveys of the needs of the elderly also advanced in M ember States ol the South-Last Asia Region. In the European Region computer-assisted p lan­ ning, a tool evolved for W H O by the Jo h n s H opkins School of Hygiene and Public Health, bv which social and health data on the elderly can be displayed in an organized and intelligible way, enabled district health policy to be p lanned in Iceland. In the Lastern M editerranean Region prepara tions were made to carry out representative sample surveys of the health and social status of the elderly in Bahrain, Egypt, Jo rd an , Pakistan and Tunisia, with a view to developing a data base on which to found national p rogram m es and policies. As the result o f an U N R W A -supported visit to Jo rd a n by representatives of W H O and HelpAge In ternational in 1986, a program m e was estab­ lished in the areas covered by UN RW A . 7.16 Various strategies were used in developing and disseminating health inform ation on aging. New knowledge on card iovascular care of the elderly was published by W H O , and the Kellogg F o unda tion issued a technical guide on the prevention of falls by the elderly. M anuscrip ts on mental health, nutrition and lifestyles were completed, and a m onograph on physical therapy is being prepared jo intly with the W orld Confederation for Physical Therapy. 7 17 A prom inent feature of the program m e is its partnership with nongovernmental organizations in advocating health care of the elderly and prom oting health in old age. In 1987 representatives of W H O partic ipated in the Congress of the In ternational Feder­ ation of Associations of Older Persons; in an international conference in Nairobi on the prevention and control of noncom m unicab le diseases; and in meetings o f HelpAge In ternational and Alzheimer’s Disease International. 7 . is In June , on the recom m endation of the Advisory C om m ittee on Health Re­ search, a W H O Special P rogram m e for Research on Aging was established at the United States N ational Institute on Aging. Steering committees in the areas of epidemiology, mental health, osteoporosis and im mune function are drafting a five-year program m e. Surveys of the needs of the elderly will form the regional contribu tions to the special program me. 7.19 The T okyo M etropolitan Institute of G eronto logy was designated a W H O collaborating centre for health o f the elderly, and training fellowships are beginning to be provided in the Western Pacific Region in this field, for example to the Republic of Korea and to Viet Nam. a U n ited Nat ions document No. Л /4 1 /6 3 1 . 1 1 2 Global programme for appropriate health care technology 7.20 D raft guidelines on the use o f com puters in prim ary health care were completed in the spring o f 1987 and were circulated to W H O headquarters , the regional offices and a num ber o f experts. The V l l th conference on medical inform ation, held in Rom e in Sep tem ber addressed the subject, and a televised conference featuring the ministers of health o f Belgium and Spain considered the im plem entation of the guidelines in those countries. The W H O guidelines emphasize the role o f com puters in planning, projection, s imulation, continuous evaluation and m onitoring, and quality assurance. 7.21 Progress was m ade in attracting more countries to the study o f regional vari­ a tions in health care, as dem onstra ted by a congress organized by the Copenhagen C o llabo ra t ing C entre in N ovem ber 1986 and w orkshops held in Oxford , L ondon and A m ste rdam in 1987. Israel jo ined a study on cholecystectomy, p rosta tec tom y and upper gastro intestinal endoscopy. P reparations were completed for a conference on evaluating the case for hysterectomy, in Copenhagen in Jan u a ry 1988, which will aim not only to assess the issue from the m ethodological viewpoint but to a ttem pt to find explanations and develop a health policy as appropriate. 7.22 A newsletter on budgetary incentives was issued in Jan u a ry with the aim of raising awareness in this subject. Insurance com panies have already taken some action, for example reim bursem ent o f the costs o f u ltrasound examination is denied in cases with no medical indications by two com panies in the U nited K ingdom and the U nited States. A com pany in the east o f the United States has restricted re im bursem ent o f the costs of m agnetic resonance imaging (M R I) to diseases that show benefit, with a consequent reduction in the num ber o f M RI machines in the east com pared with the west o f the country. T he Swiss sickness fund reimburses the costs of MRI examinations only to those practitioners who have agreed to partic ipate in a study on clinical efficacy. 7.23 Following a review o f the first 100 cases o f the W H O m ulticentre M RI study, a new and simpler postcard for evaluating patient ou tcom e was prepared. This idea was also expanded to the tonsillitis s tudy and is now under field trial. The pro tocol of the insulin pum p study, though very complex, was com pleted by partic ipa ting clinics in nine countries. 7.24 T he M O N IC A and C IN D I p rogram m es have explored the ra tional use of labora to ry investigations in confirming diagnosis o f myocardial infarction, and results are expected to be ob ta ined as from 1988. T he E uropean C om m ittee for Clinical L ab o ra to ry S tandards has agreed to take part in utilization studies, and similar interest exists at the Institute of Preventive and Social Medicine in Lausanne. 7.25 Im plem entation o f the basic radiological system (BRS) project developed only slowly because o f the artificially high cost o f BRS machines. A simpler evaluation pro toco l was distributed and the results are expected early in 1988. Video cassettes were m ade on BRS, the ra tional use o f u l trasound in obstetrics, and the ra tional use of radiological investigations. 113 7.26 T o w ard s the end of the year a simple com pute r p rog ram for m onitor ing surgical w ound infections was introduced. Fifteen countries will test this system for a six-month period and the results will be presented at a w orkshop in C openhagen in O c tober 1988. The purpose o f the study is to in troduce the concept of constan t feedback to the surgeon and, by the process o f continuous self-assessment, show tha t a reduction in the rate of w ound infection can eventually be achieved. Six countries — Belgium, France, Iceland, the Netherlands, Portugal and the United Kingdom — have already agreed to participate in the trial. 7.27 V ariations in the utilization o f aminoglycosides and the relation to incidence of drug-resistant strains of Staphylococcus and Escherichia coli have become o f interest to drug companies, which have offered to support a meeting on the rational use of antibiotics to take place in Freiburg , Federal Republic of G erm any in Septem ber 1988. F u r th e r ­ more, two curren t studies deal with app rop ria te levels of iron in the body, and were initiated as a result o f the workshop held in Pilisszentkereszt, Hungary in November 1986. One study evaluates iron status and susceptibility to infection in b lood donors , and the o ther investigates the effect o f the am o u n t o f iron in milk form ulae on ch ildren’s grow th and health. Regional activities of interregional scope Oral health 7.28 The Regional Officer for Oral Health co llaborated with the staff o f the W H O in tercoun try centre for oral health , Chiang Mai, Thailand in the p lanning o f research projects related to defluorida tion o f drinking-w ater, occurrence of dental fluorosis, use o f pit and fissure sealants, oral health status in hill tribes, and im plem entation of alternative oral health care systems. 7.29 The Regional Officer acted as d irector for the thirteenth W H O /D A N ID A course in denta l public hea lth , which took place in Beijing, C h ina from 21 S ep tem ber to 17 October. Mental health 7.30 The Regional Officer for M ental Health partic ipa ted in the W H O global co­ o rd ina ting g ro u p for mental health in Brazzaville where, inter alia, the m ain develop­ ments in the E uropean regional p rog ram m e were incorpora ted into the global mental health program m e. 7.31 As one of its collaborative activities, the Regional Office supported the a t ten d ­ ance o f the D irecto r of the D ep ar tm en t of M ental H ealth , Ministry o f Health and Social Assistance, Turkey in a training w orkshop on mental health leadership, held in T anzania in August. Maternal and child health 7.32 The Regional Office co llaborated in two birth conferences in N orth America: one in T oron to and the o ther in Seattle. 114 7.33 T he reco m m en d a t io n s on ap p ro p r ia te b ir th technology resulting from an interregional conference o f the Regional Office and the Pan Am erican H ealth O rg an ­ ization, held in Fortaleza, Brazil, led to wide discussion o f the issues in the European Region. Disaster preparedness 7.34 T he N ursing unit par tic ipa ted in p reparing a plan of work for a co llaborating centre for disaster p reparedness in Addis A baba , Ethiopia , and is currently participating in p reparing a cadre o f E uropean nurses to work in prim ary health care and disaster p reparedness both in the European Region and in developing countries. These activities are being im plemented by a multidisciplinary g roup supported by the Regional Office and W H O headquarters units concerned with disaster preparedness, the focal point for nursing at W H O headquarters , the Italian Ministries of Health and Foreign Affairs, and the W H O co llaborating centre for disaster preparedness, m anagem ent and nursing in Rome. Quality assurance 7.35 A working g roup on the organization of quality assurance took place in May and focused on health care institutions such as hospitals and prim ary health care centres. This was followed by an in ternational symposium on quality assurance organized jointly by the In terna tional Society for Quality Assurance, the In ternational Hospital Feder­ ation and the Jo in t Com m ission for the Accreditation of Hospitals. It was specifically aimed at the developing countries. Health promotion 7.36 T he activities carried out under the first action area of the O ttaw a C harter (healthy public policy) helped to prom ote its development in M em berS ta tes , to clarify its scope, and to analyse case studies from a num ber o f M em berS ta tes . These activities also form ed part o f the p repara tions for the second in ternational conference on health p ro m o tio n entitled “ Healthy public policy” , to be held in Adelaide in April 1988. The Adela ide conference will explore experiences in healthy public policy and study various ap p ro ach es to health p ro m o tio n policy from the national to the local level. O ver 50 case studies have been proposed from countries a ro u n d the world. A draft long-term plan for healthy public policy developm ent is also being considered, to ensure tha t the m om en­ tum generated at the conference is not lost. Solid wastes 7.37 T he problem of disposal o f municipal solid waste and sewage sludge is o f growing concern to the popu la ted centres of bo th highly and less industrialized countries. C onsequen tly , this issue has also a ttrac ted much atten tion in countries outside the E uropean Region, and technical expertise was provided by the Regional Office to the S tate o f Säo Paulo, Brazil. 115 Healthy working conditions 7.38 The twenty-second In terna tional Congress on Occupational H ealth was co n ­ vened in Sydney in Septem ber, and the Regional Office contribu ted a paper entitled “ Research actions in occupational and environm ental health in the European strategy for health for all of the W H O ” . D uring discussion of the paper, W H O was encouraged to p rom ote in terna tional collaborative research on new emerging problem s and to provide a forum for discussing them. A suggested example was genetic predisposition to higher susceptibility to toxic chemicals. Health manpower development 7.39 The Regional Office was represented at a meeting o f national fellowships officers o f the Eastern M editerranean Region, in Abu Dhabi in November. 7.40 Briefing on the fellowships system was given to several national coun terparts , to staff from the regional offices in Brazzaville, New Delhi and Manila, and to a staff mem ber from the Council o f Europe. Pharmaceuticals 7.41 Closer co llaboration was initiated with the Action P rogram m e on Essential Drugs at W H O headquarters , involving a jo in t project in Is lam abad with the health authorities o f Pakistan; the role of the European Regional Office in such projects is to con tr ibu te in those fields in which par ticu la r experience has been gained by its studies in industrialized countries, notably as regards the fo rm ulation and evaluation o f p h a rm a­ ceutical legislation and policies, the operation of regula tory systems, and the establish­ ment o f services for adverse reaction m onitoring and drug information. 7 42 The Regional Officers for Pharm aceuticals from the European Region and the South-East Asia Region represented the O rganization at the global meeting o f National Centres for Adverse Reaction M onitoring, held in C anberra , Australia in August. 7.43 There were some notable exceptions in 1987 to the preference by M em ber States to consult with the pharm aceuticals p rogram m e on a confidential basis. One was a request from the D epartm ent o f Health in Australia to provide a consultant and o ther help fo r a review o f the d rug regula tory process; this resulted in a publication issued in C anberra in June. GLOBAL PROGRAMMES Publications issued in 1987 Strasser, T., ed. Cardiovascular care o f the elderly. G eneva, W orld H ealth Organization. 116 Documents issued in 1987 Coordinated action on aging', report of the sixth meeting of the NGO/WHO collaborative group on aging (document IRP/MEE 115.2.2). Prevention of cardiovascular diseases among the elderly: report of a WHO meeting (document WHO/CVD/87.2). Articles published in 1987 The prevention of falls in later life: a report of the Kellogg International Work Group on the prevention of falls by the elderly. Copenhagen, Danish Medical Bulletin, 1987 (Gerontology Special Supplement Series No. 4). Quality of long-term care. Copenhagen, Danish Medical Bulletin, 1987 (Gerontology Special Supplement Series No. 5). 117 8Country programmes 8.1 In 1982 and 1983, when the first “ co u n try ” program m es were discussed and designed, the initial idea was to provide an overview o f cooperative activities between W H O and a particu la r country . Such an overview would give the opportun ity for joint assessment o f the various forms of collaboration . The usefulness of such an exercise became apparen t immediately, and a num ber of im portan t developments ensued. — It was now possible to docum ent cooperation with countries in a proper manner, and to determine whether such cooperation truly reflected the requirements of any particular country in the light o f the W H O European H F A strategy. — Coopera tive activities could now be p lanned in advance, and country medium- term program m es were draw n up and implemented. At the same time, the im portance o f intersectorality became clearer. — Following the adop tion of the European H F A targets in 1984, a com m on fram e­ work covering the country and in tercountry program m es was introduced, and this facilitated the necessary links between the two types of program m e. — C ountry funds, which up to that time had almost exclusively been used for fellowships, began to be allocated to o ther forms of cooperation with countries within the fram ew ork o f the European H F A strategy, and new funds were also transferred to the country program m es in support o f that strategy. — In fur ther support o f these developments, the Regional Com m ittee at its thirty- fifth session in 1985 approved the regional p rogram m e budget policy, which established a b road fram ew ork for priority-setting in the developm ent o f country programmes. 8.2 In 1987 the country medium-term program m es that had been draw n up for 1986/1987 were fully im plemented, and at the same time further steps were taken to strengthen the Office’s country activities. As some one third of W H O ’s European M em ber States became involved in the design, implementation and evaluation o f country p rog ram m es, so the close links between these and the different com ponen ts of the Office’s intercountry p rog ram m e became more apparen t. One im portan t aspect o f the 1986-1987 country experience, therefore, was that it stimulated the search for new ways to reinforce such links, tak ing full advantage of the specific con tribu tion o f each of these com plem entary approaches. In fact, reinforcing the links between the country and 119 in tercountry p rog ram m es has meant both benefiting from a more in-depth and extensive coun try experience, and finding ways o f reflecting in each co u n try ’s policy an d p ro ­ gram m e fram ew ork some o f the m ajor aspects o f the Regional Office’s accum ulated technical experience. The la tter has meant a high degree o f co llaboration am ong the different technical fields in the form of the four so-called “ com m on delivery vehicles” . M ost of the cooperative agreements have taken the form of medium -term program m es. These follow closely the structure o f the European H F A strategy and targets, and for this reason the same fram ew ork has been adop ted below in reporting some o f the highlights of the country activities in 1987. Health for all policies 8.3 A growing num ber o f European countries are becoming involved in the estab­ lishment of explicit and comprehensive health policies with a b road basis o f social support . As a result, supporting H F A policy developm ent has become an essential com ponen t o f a num ber o f country program m es, the m ain types o f support being in fo rm ation exchange (e.g. Bulgaria), consultations (e.g. Hungary), Regional Office missions (e.g. Spain) and partic ipa tion in national meetings (e.g. Israel). Explicit target- oriented health policies provide the appropria te basis for developing or reviewing health research policies. H F A research w orkshops were organized to review these issues, involving key con tribu to rs to the health-related research policies of a par ticu lar country. Inequity in health, and disease prevention and control 8.4 S tudying m ortality differentials within a country where these are likely to be of considerable magnitude, taking advantage o f appropria te international expertise, is an im p o r tan t co n tr ib u tio n to support ing national au thorit ies in their efforts to raise consc iousness ab o u t health inequalities an d in ad v o ca tin g ac tion . S trong co llab­ o ra tio n has been established in m any coun try p rog ram m es, especially in the areas o f oral health , accident prevention an d mental health, in gathering ap p rop ria te in fo r­ m ation fo r p lanning and implementing health program m es. New countries continue to jo in the C IN D I project, and in the field o f perinatal care, national birth ing conferences have been an adequate way o f linking international cooperation to national intersectoral forums. Healthy lifestyles 8.5 Cities par tic ipa ting in the European H ealthy Cities netw ork are already playing a role in stimulating national networks in their countries. The Regional Office has given technical support to this movement. The study of com m unity response to alcohol-related p rob lem s is prov id ing an o p p o r tu n i ty to look a t na tional policies in the light o f com m unity-based experience (e.g. Portugal). National family p lanning program m es are 120 su pported th rough jo in t project design, th rough technical discussions during site visits, an d by organizing study tours for project leaders to benefit from international experience (e.g. Turkey). Healthy environment 8.6 The aim o f strengthening national institutions to respond appropriately to en­ v ironm enta l pollu tion has become apparen t in a num ber o f coun try program m es. A m o n g o ther examples, reference may be made to supporting the train ing o f national staff in w ater and soil po llu tion control techniques th rough fellowships, an d the briefing o f national staff on in terna tional developm ents in the surveillance and control o f marine pollu tion (e.g. Albania). Jo in t reviews are made o f specific environm ental problems, such as w ater supply and waste disposal in arid zones and small islands (e.g. Greece and Spain), and there is co llaboration with countries in p lanning environm ental protection , such as that related to large-scale mineral workings (e.g. Yugoslavia). Appropriate care 8.7 Involvement in p r im ary health care in southern Europe has taken place through jo in t p lanning and partic ipa tion in national meetings aim ed a t reviewing and supporting health centre developm ent, and by facilitating the exchange o f experiences between southern E uropean countries. Nursing forum s have been organized th roughou t Europe in p rep ara tio n for the 1988 nursing conference in Vienna. National meetings on quality assurance in health care are aim ed mainly a t raising interest in quality assurance issues and a t stimulating the design and im plementation o f procedures to ensure quality o f care. Support for health development 8.8 An inform ation exchange system in health legislation is now available for country use. Tw o examples o f coopera tion in establishing appropria te m onitor ing systems in coun tries are the m on ito r ing o f trends in m anpow er supply and dem an d an d the m on ito r ing o f adverse d rug reactions. The Office has also been involved in p lanning and im plementing national health inform ation systems (e.g. Malta). Improving cooperative mechanisms 8.9 D uring 1987, coun try m edium -term program m es fur ther con tr ibu ted to im ­ proving cooperative m echanisms, namely by providing language tra in ing and the o rgan­ ization o f briefings on the Regional Office for coun try coun terparts , as well as th rough technical support to the m anagem ent of cooperative program mes. ★ ★ ★ 8.10 While the 1986/1987 country program m es were being im plemented, a num ber of steps were taken to s trengthen fu r ther the Regional Office’s capabilities to improve its coun try approach , and to deal effectively with the increasing interest in this cooperative 121 way o f working. In 1987, two more countries established steering committees to further support the design, im plem entation, m onitoring and evaluation of their cooperative agreements with the Regional Office. T о provide a s tronger and more integrated basis for developing and supporting country program m es within the Regional Office, support groups were established. These include at least one p rog ram m e m anager from each service, generally selected because o f his o r her involvement in that par ticu la r country. 8.11 Also during 1987, a country p rogram m e coord ina to r was appointed. His main responsibility is to strengthen the dialogue between W H O and its European M em ber States, to coord ina te the design, im plem entation, m onitor ing and evaluation o f the cooperative agreements with countries, and to ensure and support appropria te contri­ butions from the different W H O technical units. 8.12 “ C o un try p rog ram m es” have indeed established themselves as a rapidly de­ veloping and evolving cooperative app roach in the Regional Office. They are being technically strengthened as more countries become involved. By the early 1990s, more than two th irds o f the E uropean countries are expected to be implementing a m edium - term country p rogram m e with the support o f W H O . 1 2 2 Annex 1 ACTIVE AND NON-ACTIVE MEMBER STATES OF THE WORLD HEALTH ORGANIZATION, EUROPEAN REGION 31 December 1987 At 31 December 1987 the European Region of the World Health Organization had 32 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 of WHO. A lb a n ia 26 M a y 1947 A u str ia 30 Ju n e 1947 B e lg iu m 25 Ju n e 1948 B u lg a r ia 9 Ju n e 1948 B ye lo ru ss ia n S S R a 7 A p r il 1948 C ze c h o s lo v a k ia 1 M a rch 1948 D e n m a rk 19 A p r i l 1948 F in la n d 7 O cto b e r 1947 Fra n ce 16 Ju n e 1948 G e rm a n D e m o cra tic R e p u b lic 8 M a y 1973 G e rm a n y , Federal R e p u b lic o f 29 M a y 1951 G reece 12 M a rch 1948 H u n g a ry 17 Ju n e 1948 Ice la n d 17 Ju n e 1948 Ire la n d 20 O cto b e r 1947 Isra e l 21 Ju n e 1949 Ita ly 11 A p r il 1947 Lu x e m b o u rg 3 Ju n e 1949 M alta 1 F e b ru a ry 1965 M on aco 8 J u ly 1948 N eth erlan ds 25 A p r il 1947 N o rw a y 18 A u g u st 1947 P o la n d 6 M a y 1948 P o rtu g a l 13 F e b ru a ry 1948 R o m a n ia 8 Ju n e 1948 S a n M a rin o 12 M a y 1980 S p a in 28 M a y 1951 Sw eden 28 A u g u st 1947 S w itze rla n d 26 M arch 1947 T u rk e y 2 Ja n u a ry 1948 U k ra in ia n S S R a 3 A p r il 1948 U S S R 24 M arch 1948 U n ited K in g d o m 22 J u ly 1946 Y u g o s la v ia 19 N ovem b e r 1947 a N o n -a ctive M em ber State. 123 Annex 2 ESTIMATED POPULATIONS IN 1987 FOR THE ACTIVE MEMBER STATES OF THE WHO EUROPEAN REGION (in thousands)*1 Albania 3 181 Austria 7487 Belgium 9 884 Bulgaria 9 293 Czechoslovakia 15 772 Denmark 5148 Finland 4900 France 54924 German Democratic Republic* 16 616 Germany, Federal Republic of* 60920 Greece 10042 Hungary 10810 Iceland 246 Ireland 3 675 Israel 4455 Italy 57128 Luxembourg 362 Malta 387 Monaco 27 Netherlands 14 600 Norway 4167 Poland 38 173 Portugal 10207 Romania 23 396 San Marino 22 Spain 39 629 Sweden 8 259 Switzerland 6 244 Turkey 55 683 USSR 283 620 United Kingdom 55 683 Yugoslavia 23 503 Total estimated population in the Region: 838 443 000 a E x c e p t fo r M o n a co an d S a n M a rin o , these figu re s are based on W orld population prospects, estimates and projections as assessed in 1982. N ew Y o r k , U n ited N a tio n s, 1985. ^ T h e fig u re s fo r the G e rm a n D e m o cra t ic R e p u b lic and the F e d e ra l R e p u b lic o f G e rm a n y in c lu d e the relevant data fo r B e rlin . T h is is w ith ou t pre jud ice to any question o f status that m ay be in vo lved . PROFESSIONAL STAFF IN THE EUROPEAN REGION 31 December 1987 Annex 3 R E G I O N A L O F F I C E Executive Management R egional D irector Program m e P olicy D irector , Program m e M anagem ent A dm inistrative O fficer National Health Policies and Systems D irector H ealth E conom ics H ealth Legislation H ealth M anp ow er D evelopm ent M an p ow er Planning and M anagem ent E ducational D evelopm ent Fellow ships Regional Policy and Programme (contd) DrJ.E. Asvall Ms C. Celinder Dr J. Rochon Ms D. Halvorsen Dr/.S. Luculescu Dr H. F. K. Zöllner Ms G. Pinel Inform atics Support DrJ.-P. Menu Dr V. Vodoratski Dr A. Piga Rivero Vacant Ms E. Pelle H ealth Policies and Planning N ursing Prim ary Health Care H ospitals Regional Policy and Programme D irector E p id em io logy and Statistics H ealth fo r A ll P rom otion C oord in a tion with other O rganizations H ealth In form ation o f the Public P ublications P rom otion VacantDrJ.R. Bengoa Renteria Dr M. Farrell Ms E. Stussi Dr W. Hubrich Dr J. Vang Vacant Vacant Dr R. Prokhorskas Dr M. C. Thuriaux Ms M. Abou Shabanah Vacant Ms N. Humbert Dr M.A. Danzon Vacant O fficia l D ocum ents and Texts Planning, M on itorin g and Evaluation P rogram m e Planning P rogram m e M on itorin g and Evaluation C ountry Program m e C oord in a tion Research P rom otion and D evelopm ent Health Research Disease Prevention and Control Mr I. Vinther-Jergensen Mr A. Malagodi Vacant MrJ.-M. Deramat D irector A ccident Prevention Prevention o f A ccidents A ppropriate T ech n ology for Health Health T ech n ology Assessment C ancer C h ron ic Diseases C om m u n icab le Diseases Special Program m e on A ID S M alaria O ral Health Pharm aceuticals Vacant Ms V.S. Pedersen Dr C. Sakellarides DrH.V. Vuori Dr P.-G. Svensson Dr M.S. Tsechkowski Dr C.J. Römer Dr J. T. Jones Dr K. Stahr Johansen“ Vacant Dr L. Döbrössy Dr A. Shatchkute Dr B. Bytchenko Dr A. Gromyko* Vacant Dr I.J. Meller Dr M. N. G. Dukes Paid by W H O headquarters . ^ In te rreg ional post paid by W H O headquarte rs , based at C openhagen. 125 Lifestyles and Health Environmental Health (contd) D irector Health o f the Elderly Elderly, D isability and Rehabilitation Health P rom otion E ducation fo r Health M aternal and C hild Health M ental Health P sych osocia l Factors and M ental H ealth Mr J. Sampaio Faria A bu se o f Psychoactive Drugs Mr C. Goos Prevention o f A lc o h o l A buse MrJ.U. Hannibal N utrition Ms E. Helsing Dr P.O. Petersson Dr D.M. Macfadyena Dr H.M. Hermanova Dr I. Kickbusch Dr D. O'Byrne Dr M. G. Wagner Sexuality and Fam ily Planning Environmental Health D irector C on tro l o f Environm ental Health H azards E nvironm ental E p idem iology and F o o d Safety E nvironm ental Health Planning and M anagem ent Vacant Vacant Dr M.J. Suess Mr D. Kello Mr E. Giroult T o x ic o lo g y and O ccupation al Health Support Programmes D irector A dm inistrative Services Budget and Finance C on ference Services Personnel S ta ff D evelopm ent and Training Translation , Publications and Text Processing Publications P roduction Translation Services International W ater D ecade MrJ.O. Espinoza Cajina Dr S. Tarkovski Dr F. La Ferla Mr J. Donald Mr K. Thoby VacantMr J. Miller Mr O.H. Jergensen Vacant Ms R.C.E. Néagoé Mr D. Nolan Vacant Ms C.F. Murphy Mr F.E. Theakston Ms P.M. Charhond Vacantd MrJ.-P. Bercot Mr P. Boyled Mr A. David Mr M. Khoussainov Mr R. Kranich Ms M. Lindemann Ms C. Madanoglu Mr V. G. Paveliev Mr G. Pignasty Mr C. Robsond Ms M. Wesemann F I E L D S T A F F Greece IC P /R C E 211 (UNEP) - Mediterranean Action Plan Senior Scientist Dr L.J. Saliba M orocco M O R /C W S 004 (UNDP) - Water Supply in Sm all Communities1’ Design Sanitary Engineer Dr A. Wildt Paid by W H O headquarters . P aid by U N F P A . Paid by v o lun tary funds. Turkey TUR /P H C 001 - Primary Health Care Special Representative o f the R egional D irector Dr U. Broccolo-Tommasi 50V< part-tim e. 1 P ro jec t tra n sfe rre d to E M R O in 1986, b u t see p a ra ­ g rap h 1.31. 126 Annex 4 ORGANIZATIONAL CHART OF THE REGIONAL OFFFICE 31 December 1987 EXECUTIVE MANAGEMENT' É ~ I ---------1--------- 1 1 “ I NATIONAL HEALTH POLIC IES ANO SYSTEMS REG IONAL POLICY ANO PROGRAMME DISEASE PREVENTION AND CONTROL LIFESTYLES ANO HEALTH ENVIRONMENTAL HEALTH SUPPORT PROGRAMMES Health Economics Epidem iology and Statistics Accident Prevention Health of the Elderly Control of Environmental Health Hazards Administrative Services Elderly. Disability and Rehabilitation Health Legislation Health tor A ll Prevention of Accidents Environmental Epidem iology and Budget and finance Food Safety - Health Manpower Development other Organizations Appropriate Technology for Health Health Promotion Environmental Health Planning and Management Conference Services Health Information of the Public Health Technology Education for Health Manpower Planning and Management Publications Promotion Assessment Personnel Water Decade Development Cance Maternal and Child Health Toxicology and Staff Development and Informatics Support Occupational Health Training Chrome Diseases _ Mental Health Health Policies and Planning Translation. Official Documents Psychosocial Factors I- Publications and Text Processing Communicable Diseases Abuse of Publications Nursing - Planning, Monitoring and Evaluation Special Programme on A ID S Psychoactive Drugs Prevention of Alcohol Abuse Production Programme Planning Text Processing: Primary Health Care Systems and Training Programme Monitoring and Evaluation Malaria Hospitals Nutrition Coordination Oral Health Sexuality and Fam ily Planning Research Promotion and Development Pharmaceuticals Compfiies the оНкж of the Regionel Director end of the Director. Programme Health Research Management, at «veil и their joint tecretariat Annex S INTERCOUNTRY" MEETINGS CONVENED BY THE REGIONAL OFFICE FOR EUROPE 1 January — 31 December 1987 ICP/RHB 019 ICP/CEH 032 ICP/CEH 504 ICP/HSR 628 ICP/CWS 012 ICP/CEH 533 ICP/H M D 117 ICP/RPD 124 ICP/PHC 319 ICP/RPD 112 ICP/IEH Oil ICP/HSR 619 IС P/CDS 026 Consultation on the Study on Disability Control at Primary and Secondary Level. Prague, 13-15 January (English) Working Group on UNEP/W HO /G EM S/Air Monitoring Assessment and European Plan of Action. Langen, 3-6 February (English) Consultation on Health Hazards and Biological Effects of Welding Fumes and Gases. Copenhagen, 9-10 February (English) Consultation to Review the Results of the Second Survey on Health Behaviour in Schoolchildren. Jyväskyla, 9-11 February (English) Consultation on Herbicides in Drinking-water: Atrazine and Molinate. Rome, 11-13 February (English) Working Group on Assessment of Health Hazards in Infants As­ sociated with Exposure to PCBs, Dioxins and Related Compounds in Human Milk. Abano Terme/Padua, 16-19 February (English) Meeting of the WHO/ASPHER Task Force on the Training of Health Professionals for Health for All. Copenhagen, 19-20 February (English) Third Meeting of the Task Force on the European University Network for Health for All (EURUN). Copenhagen, 23-24 February (English) Working Group on Mechanisms for Community Involvement in a Health Care System based on Primary Health Care: Committing the Community to Care. Copenhagen, 24-26 February (English) Thirteenth Session of the European Advisory Committee on Health Research (EACHR). Copenhagen, 24-27 February (English, French, German, Russian) Consultation on Concerted European Action on Tobacco. Copen­ hagen, 26-27 February (English) Healthy Cities Project: Workshop on Indicators. Barcelona, 8-12 March (English) Meeting on AIDS Diagnosis and Control: Current Situation. Munich, 16-18 March (English, German) a Several other meetings held during the year were financed through country project funds. Some of these, though not listed here, were of considerable interest to more than one country. 128 ICP/RUD 132 ICP/HSR 625 ICP/CEH 051 ICP/MPN 010 IС P/CDS 017 ICP/CEH 538 ICP/G PD 110 ICP/CEH 020 ICP/HSR 821 IRP/HEE 115.2.2 ICP/PHC 620 ICP/MAL 010 ICP/MCH 521 ICP/CLR 033 ICP/CWS 013 ICP/HSR 818 ICP/CEH 031 ICP/CEH 031 IC P/A DA 013 Workshop on Environmental Health Promotion in Healthy Cities. Rennes, 24-27 March (English, French) Consultation on Environmental Quality Criteria for Shellfish-growing Waters and Shellfish in the Mediterranean Sea (W HO/UNEP Joint Project, MED POL Phase II). Athens, 26-27 March (English) Third Meeting of the Task Force for HFA in European Pluralistic Countries. Brussels, 31 March - 1 April (English) Consultation on AIDS and the Newborn. Copenhagen, 9-10 April (English) Third Consultation on the Epidemiological Study on the Health Effects of Exposure to Cadmium in the General Population. Copenhagen, 13-14 April (English) Consultative Group on Programme Development (CGPD). Copen­ hagen, 21-24 April (English, French, German, Russian) Planning Meeting on the River Danube Water Quality Protection Project. Laxenburg, 22-24 April (English) Meeting on Tipping the Balance towards Primary Health Care. Gothenburg, 23-25 April (English) Coordinated Action on Aging — Sixth Meeting of the NGO/WHO Collaborative Group on Aging. Geneva, 4-5 May (English, French) Working Group to Review Information Needs for Management De­ cisions in Hospitals. Düsseldorf, 4-7 May (English, German) Coordination Meeting on Malaria in South-east Europe. Izmir, 5-7 May (English) Working Group on Concepts of Sexual Health. Copenhagen, 5-7 May (English) Health for All in the Future: What Appropriate Technologies. Lyon, 7-10 May (English, French) Consultation on Potentially Toxic Micro-organic Substances in Drinking- water. Medmenham, 11-14 May (English) Meeting on Unemployment, Poverty and Quality of Working Life — Innovative Interventions to Counteract Damaging Health Effects. Baden/Vienna, 12-14 May (English) Consultation on Epidemiology Related to the Chernobyl Accident. Copenhagen, 13-14 May (English) Joint IAEA/W HO Workshop to Discuss Appropriate Methodologies for Studying Possible Long-term Effects of Radiation to Individuals Exposed in an Accident. Vienna, 18-22 May (English) Consultation on Substance Abuse Education for Health Professionals. Vienna, 20-22 May (English) 129 1CP/EP1 Oil ICP/RPD 114 1CP/HST 118 ICP/CEH 021 ICP/IEH 124 ICP/HSR 631 ICP/RPD 119 ICP/HSR 630 ICP/ADA 017 1CP/CAN 115 ICP/CAN 199 ICP/CEH 053 ICP/OCH 119 ICP/CEH 556 1CP/CWS 012 ICP/CEH 026 IС P/CDS 029 ICP/HSR 010 130 Working Group on the Organization of Quality Assurance. Copen­ hagen, 25-26 May (English) Senior Level Seminar on EPI, CDD and ARI Control Programmes. Moscow, 25-28 May ( English) Fourth Meeting of the Task Force for the European University Net­ work for Health for All. Nancy, 28-30 May (English) Meeting on Revised HFA Indicators. Copenhagen, 9-11 June(English) Working Group on Health Hazards from Radiocaesium and other Long-lived Radionuclides following the Chernobyl Accident. Schloß Reisensburg/Gtinzburg, 9-12 June (English, German) Consultation on Coordinated Infrastructure for Health Education. Copenhagen, 11-12 June (English) European Congress on Healthy Cities. Düsseldorf, 14-18 June (Eng­ lish, German) Seminar on Communication between Users and Producers of Research Findings. Linköping, 15-17 June (English) International Symposium on Health Promotion and Chronic Illness. Bad Honnef, Federal Republic of Germany, 21-25 June (English, German) Second Meeting of Principal Investigators in the WHO Collaborative Study on Community Response to Alcohol-related Problems. Lisbon, 22-25 June (English) Meeting on National Cancer Control Policy. Budapest, 23-25 June (English) Development/Advisory Committee on Cancer Control. Budapest, 23-25 June (English) Consultation on Health-related Aspects of Marine Pollution Control in the Mediterranean. Copenhagen, 29 June - 3 July (English) Joint W HO/CEC Consensus Workshop on Biological Methods for Monitoring Exposure to Genotoxic Agents. Luxembourg, 6-10 July (English) World Conference on Chemical Accidents. Rome, 7-10 July (English, French, German, Russian) Second Consultation on Herbicides in Drinking-water. Rome, 13- 18 July (English) Working Group on Indoor Air Quality: Organics. Berlin (West), 23- 28 August (English, German) Meeting on Training on AIDS for Personnel in DrugTreatment Centres. Bremen, 26-28 August (English, German) ICP/CEH 541 ICP/PHC 612 ICP/MPN 010 ICP/MPN 525 ICP/APR 117 ICP/MCH 112 ICP/CWS 059 ICP/HEE 221 ICP/ADA 031 ICP/HSR 628 ICP/CEH Oil ICP/CEH 052 ICP/DSE 127 ICP/HSR 810 ICP/DSE 146 ICP/CWS 027 ICP/CEH 034 Consultation on Quality Control Studies on Levels of PCBs, PCDDs and PCDFs in Human Milk. Umeâ, 27-28 August (English) Scientific Meeting on the Future Development of Hospitals. Zeist, 28 August (English) Consultation on HFA Management in Countries with Pluralistic Sys­ tems. Brussels, 31 August - 1 September (English, French, German) Workshop on Health Economics. Moscow, 31 August - 4 September (English, Russian) Working Group on Alcohol and Accidents. Reykjavik, 1-3 September (English) Consultation on Study of the Determinants of Obstetrical Intervention. Copenhagen, 3-5 September (English) Consultation on Removal of Organic and Inorganic Micropollutants from Drinking-water Sources. Siofok, Hungary, 15-18 September (English) Consultation and Round Table Discussion on Continuity of Care of the Elderly. Brighton, 15-18 September (English) Working Group on Implementation and Evaluation of Programmes for Problem Drinking. Malmö, 20-24 September (English) Youth and Lifestyles — Consultation on Health Behaviour in School­ children — A Cross-national Survey. Budapest, 21-25 September (English) Consultation on the Psychosocial Impact of Visual Display Terminals. Streatley-on-Thames, United Kingdom, 22-24 September (English) Consultation on Microbial Pollution of Mediterranean Coastal Areas and Associated Health Effects (W HO/UNEP Joint Project, MED POL Phase II). Athens, 22-26 September (English) Meeting of the WHO Drug Utilization Research Group. Oslo, 28-30 Sep­ tember (English) Meeting of Prinicipal Investigators on Inequities in Health. Lisbon, 28-30 September (English) Symposium on Clinical Physiology and Pharmacology of the Perinatal Period. Smolenice, Czechoslovakia, 29 September - 2 October (English) Consultation on Guidelines on Water Supply and Sanitation and on Solid Wastes Management under Cold Climatic Conditions. Jakobs- havn (Illulissat), Greenland, 3-8 October (English) Working Group on Health Hazards of Heavy Metal and PAH Com­ pounds from Municipal Waste Incineration. Florence, 12-16 October (English) 131 ICP/DSE ИЗ IС P/CDS 031 ICP/PHC 622 IС P/NUT 125 IС P/CDS 027 ICP/NCD 028 ICP/CLR 043 ICP/NCD 025 ICP/DSE 199/g20 ICP/CEH 055 ICP/CEH 536 ICP/CWS 016 ICP/CEH 598 ICP/PHC 314 ICP/CEH 013 a A lth ou gh not O rganization . Sixteenth European Symposium on Clinical Pharmacological Evalu­ ation in DrugControl: ConstraintsonTreatmentandTrials.Schlangen- bad, Federal Republic of Germany, 13-16 October (English, German) Consultation on Public Health Education with regard to AIDS pre­ vention. Cologne, 18-21 October (English) Working Group on Technology in Hospitals — Financial and Social Issues related to the Use of Technology. Padua, 18-21 October (English) Consultation on the Epidemiology of Obesity: Classification and De­ scription of Anthropometric Data. Warsaw, 21-23 October (English) Policy Measures re AIDS Among Drug Abusers. Stockholm, 26- 28 October (English) European Conference on the Prevention and Control of Chronic Non­ communicable Diseases. Varna, 26-30 October (English, French, Ger­ man, Russian) Meeting on Information Technology as a Tool in Health Care — For Whom, For What, and How Much? Linköping, 27-28 October(English) Meeting of Programme Directors of the Countrywide Integrated Non­ communicable Disease Intervention (CINDI) Programme. Varna, 31 October - 1 November (English) International Pharmaceutical Seminar on HFA by the Year 2000. Hillerod, Denmark, 5-6 November (English, French) Workshop on the Impact of Carcinogenic, Mutagenic and Tera­ togenic Marine Pollutants in Human Health and the Environment (W HO/UNEP Joint Project, MED POL Phase II). Rome, 9-11 No­ vember (English) EURO/I PCS Expert Group on Formaldehyde. Hanover, 9-13 No­ vember (English) Consultation on Sanitation and Drinking-water Supply, and on Assessment of the IDWSSD in Europe. Nancy, 9-13 November (Eng­ lish, French) Consultation on Impact and Control of Chemicals. Geneva, 10 No­ vember (English) Forum on Primary Health Care in Southern Europe. Lisbon, 10- 12 November (English) Working Group on European Harmonization of Public Health Actions in relation to Nuclear Accidents. Geneva, 10-13 November (English, French, Russian) con ven ed by ihe R egional O ffice itself, this m eeting was spon sored by the W o rld H ealth 132 IR/CLR 012 ICP/HSR 641 ICP/CEH 199/g20 IRP/H EE 120 1RP/HEE 114.5 ICP/MPN 021 ICP/PHC 330 TUR/RHB001 1CP/PSF 013 ICP/EXM 018 ICP/PHC 620 ICP/CEH 044 ICP/HSR 324 I CP/NUT 123 ICP/HST 119 ICP/HSR 634 ICP/DSE 128 ICP/ORH 115 Consultation on Basic Dental Radiographic System. Copenhagen, 12- 13 November (English) Advisory Committee Meeting on Appropriate Health Care Tech­ nology. Copenhagen, 12-13 November (English) Consultation on Health Promotion, Education and Training. Gothen­ burg, 14-20 November (English) Tenth Intersecretariat Meeting on Air Pollution Problems in Europe. Geneva, 16 November (English) WHO International Workshop on Epidemiology of Mental and Neuro­ logical Disorders in the Elderly. Beijing, 16-20 November (English) Workshop on Long-term Planning and Scenarios in Health Care. Kiel, 16-20 November (English, German) Working Group on Interaction between Health and Social Services and the Public in the Provision of Health Care. Granada, 16-20 November (English) Workshop on Better Opportunities for Disabled Persons. Ankara, 17-19 November (English) Workshop on Rights of the Elderly with Mental Disorder. Edinburgh, 19-20 November (English) Second Joint Meeting between WHO and National Medical Associ­ ations on Health for All in Europe. Paris, 26-27 November (English, French, German, Russian) Working Group on Information Needs for Management Decisions in Hospitals. Gütersloh, Federal Republic of Germany, 1-4 December (English, German) Consultation on Monitoring of Land-based Sources of Marine Pol­ lution in the Mediterranean (W HO/UNEP Joint Project, MED POL Phase II). Split, 1-5 December (English, French) Meeting on the Consultant’s Role in Quality Assurance in Nursing Practice. The Hague, 2-4 December (English) Consultation on Opportunities for Better Nutrition through Mass Catering. Seborg, Denmark, 2-4 December (English) Consultation on the Assessment of the Relation of Common Risk Factors with Mortality and Development of Relevant Risk Assessment Methods. Heidelberg, 3-5 December (English) Consultation on Ethics in Health Promotion. Tampere, 7-9 December (English) Consultation to Revise Guidelines for the Clinical Investigation of Anti­ hypertensive, Antiarrhythmic and Antianginal Drugs. Bath, 7-9 Decem­ ber (English) 133 ICP/HST 125 ICP/EPI 017 ICP/H M D 120 ICP/HSR 325 ICP/ADA 514 IRP/APR 216 ICP/CEH 541 ICP/CEH 030 Consultation on the Adequacy of Health Care and Consumer Satis­ faction. Belgrade, 7-11 December (English) Second Meeting of the European Advisory Group on EPI. Rome, 9-11 December (English) Workshop to Promote the Use of New Methods in Continuing Edu­ cation. Barcelona, 9-12 December (English) Consultation on a Regional Network of WHO Collaborating Centres for Nursing Development towards HFA/PHC. Copenhagen, 13-15 De­ cember (English) Meeting on Early Detection of Abuse of Psychoactive Drugs. Munich, 14-16 December (English) Study Group on New Approaches to Improve Road Safety. Geneva, 14-18 December (English) Consultation on Results of Analytical Studies on Levels of PCBs, PCDDs and PCDFs in Human Milk. Copenhagen, 15-16 December (English) International Workshop on Air Quality Guidelines. Bilthoven, 17- 18 December (English) 134 Annex 6 WHO-SPONSORED COURSES IN THE EUROPEAN REGION, OR COURSES RELEVANT TO REGIONAL OFFICE PROGRAMMES, 1987 International Environmental Engineering Course (French). Lausanne, Sep­ tember 1986 - June 1987 (ICP/CWS 004) International WHO Training Course for Public Health Administrators (English). Moscow, 23 September 1986 - 19 June 1987 (ICP/HM D 101/c07) International WHO Training Course for Public Health Administrators (Russian). Moscow, 23 September 1986 -19 June 1987 (ICP/HM D 101/c08) International Environmental Engineering Course (English). Ankara, Septem­ ber 1986 - June 1988 (TUR/CWS 002) International Postgraduate Course in Sanitary Engineering(Portuguese). Lisbon, October 1986 - June 1987 (POR/RUD 001) International Sanitary Engineering Course (English). Delft, 1 October 1986 - 30 September 1987 (ICP/CWS 004) International Sanitary Engineering Course (French). Rabat, 1 October 1986 - 30 June 1988 (MOR/RUD 001) Training in the Community Health Approach: Impact on Primary Health Care (French). Lyon, 21-24 October 1986, 23-27 February 1987, 18-22 May 1987 (ICP/HSR 399/g20) Workshop for District-level Nutritionists in Problem Analysis, Planning and Management of Nutrition-related Activities (English). Oslo, 19-30 January 1987 (ICP/NUT 128) Workshop on Self-help and Chronic Disease (English). Leuven, 28-30 Janu­ ary 1987 (ICP/PHC 317) Course on Statistical, Epidemiological and Operational Methods in Medicine and Public Health (English, French). Brussels, 2 February - 31 May 1987 (ICP/HST 131) Training Workshop on Breastfeeding Promotion: Assessment, Planning and Evaluation (English). Wageningen, 23-28 February 1987 (ICP/NUT 111) International Workshop on Epidemiology in Health Planning (English). Edin­ burgh, 4-16 April 1987 (ICP/MPN 025) Consultation on Health Promotion, Education andTraining(English). Granada, 27 April - 8 May 1987 (ICP/HST 641) Training for Teachers of General Medical Practice (English). Dubrovnik, 5- 9 May 1987 (ICP/PHC 324) Third International Workshop on Educational Theory in the Health Sciences (French). Bobigny, 11-14 May 1987 (ICP/HMD 145) WHO Course on Health Economics in National Service Systems (Russian). Moscow, 12-16 May 1987 (ICP/MPN 525) "From Chaos to Clarity” — International Course on Research in Primary Health Care (English). Gilleleje. Denmark, 18-22 May 1987 (ICP/PHC 324) Social Gerontology in International and Cross-cultural Perspectives — Com­ munity Care (English). Dubrovnik, 25 May - 5 June 1987 (ICP/HEE 299) Training Course for National Counterparts and other Medical Personnel on the Regional EPI Programme ( English). Moscow, 25-28 May 1987 (ICP/EPI Oil) Course on Epidemiology in Environmental Health (English). Umeâ, 31 May - 5 June 1987 (ICP/RUD 199/g51 ) Annual Seminar on New and Innovative Approaches to the Promotion of Healthy Lifestyles, with Particular Reference to Tobacco (English). Dresden, 22-26 June 1987 (ICP/NCD new)) Fourth Training Course in Quality Assurance (English). Kuopio, 28 June - 3 July 1987 (ICP/PHC 324) Tenth BLAT/WHO Course on Modern Methodology for Teachers of Health Sciences (English). London, 30 June - 17 July 1987 (ICP/HM D 134) Summer School for Professors in Sanitary Engineering (English). Delft, 13- 31 July 1987 (ICP/RUD 125) Eighth International Course on Environmental Health Impact Assessment (Eng­ lish). Aberdeen, 15-25 July 1987 (ICP/RUD 117) BLAT/WHO Course on the Management of a Collection of Health Audiovisuals (English). London, 3-14 August 1987 (ICP/HM D 135) Second Workshop on Advanced Nursing Management for European Nurses (French). Lyon, 31 August - 11 September 1987 (ICP/HSR 317) Third International Course on the Epidemiology of Aging (English). London, 31 August -25 September 1987 (IRP/HEE 115) Eighth International Postgraduate Course in Planning and Management of Pri­ mary Health Care in Developing Countries (English). Zagreb, 1 September - 31 October 1987 (ICP/PHC 324) Workshop on Health Promotion in Self-care (English). Maastricht, 13-18 Sep­ tember 1987 (ICP/HSR new) Course on the Assessment of Environmental Health Effects of Development Proposals: The Interface of Health Sciences and Environmental Impact Assess­ ment (English). Aberdeen, 13-19 September 1987 (ICP/RUD 140) WHO International Workshop on Health for All Educational and Managerial Strategies for Teachers of the Health Sciences (English). Moscow/London, 13-27 September 1987 (ICP/HM D 110) 1 3 6 Summer Seminar on Health Promotion (English). Cardiff, 26 September - 1 October 1987 (ICP/HSR 620) Multidisciplinary Workshop on Household Budget Survey Data — Their Use in Nutrition Policy Planning (English). Athens, 30 September - 2 October 1987 (ICP/NUT 129) International Training Course on Intersectoral Collaboration and Community Par­ ticipation (English). Alma-Ata, 30 September - 14 October 1987 (ICP/PHC 324) International WHO Training Course for Public Health Administrators (English). Moscow, 30 September 1987 - 22 June 1988 (ICP/HM D 146) International WHO Training Course for Public Health Administrators (Russian). Moscow, 30 September 1987 - 22 June 1988 (ICP/HM D 147) Course on the Interaction of Care Programmes for Cancer with Technology Assessment (English). Baden, Austria, 11-16 October 1987 (ICP/CAN 120) Fourth Travelling Seminar on Primary Health Care (English). Berlin/Leipzig, 12-16 October 1987 (ICP/PHC 324) International Course in Sanitary Engineering (English). Delft, 22 October 1987 - 5 September 1988 (ICP/CWS 004) Training in the Community Health Approach: Impact on Primary Health Care (French). Lyon, 27-30 October 1987, 22-26 February 1988, 16-20 May 1988 (ICP/HSR 399/g20) Pilot Workshop on Health Promotion Training (English). Gothenburg, 14- 20 November 1987 (ICP/HSR new) Second European Training Course in Quality Assurance (French). Brussels, 30 November - 4 December 1987 (ICP/HSR 011) International Postgraduate Training Course on Methods of Family Planning (Eng­ lish). Debrecen, Hungary, 30 November- 18 December 1987 (HUN/M CH 001) International Workshop on Planning and Evaluation Methodology (French). Rennes, 7-18 December 1987 (ICP/MPN 026) 137 Annex 7 LIST OF WHO COLLABORATING CENTRES WITH WHICH THE REGIONAL OFFICE CONCLUDED PLANS OF ACTION COVERING THE YEAR 1987 WHO Collaborating Centre for Research on Social Equity and Health Eastern Health Board, Research Department, Dublin, Ireland WHO Collaborating Centre for Research and Training on Psychosocial Factors and Health Stockholm, Sweden Target 2 WHO Collaborating Centre for Aging0 Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA WHO Collaborating Centre for Health of the Elderly0 Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan WHO Collaborating Centre for Health of the Elderly0 Red Cross General Hospital, Pyongyang, Democratic People’s Republic of Korea WHO Collaborating Centre for Joint Cooperation on Research on Care of the Aged0 National Institute on Aging, National Institutes of Health, Bethesda, MD, USA WHO Collaborating Centre for Research on Aging Institute of Gerontology of the Academy of Medical Sciences of the USSR, Kiev, USSR WHO Collaborating Centre for Research on Care of the Aged0 Brookdale Institute of Gerontology and Adult Human Development in Israel, Jerusalem, Israel WHO Collaborating Centre for Research on the Epidemiology of Aging0 Centre for Aging Studies of the Flinders Medical Centre, Flinders University of South Australia, Bedford Park, Australia Target 1 0 W H O co lla bora tin g centre w ork ing with a g loba l program m e. 138 Target 4 WHO Collaborating Centre for AIDS Institut de médecine et d ’épidémiologie africaines et tropicales, Hôpital Claude Bernard, Paris, France WHO Collaborating Centre for Applied Malacology Danish Bilharziasis Laboratory, Copenhagen, Denmark WHO Collaborating Centre for Bacterial Meningitis National Reference Laboratory for Bacterial Meningitis, National Institute of Public Health, Amsterdam, Netherlands WHO Collaborating Centre for Child Dental Health University Hospital, Children’s Clinical Department of Dentistry, Iassy, Romania WHO Collaborating Centre for the Coordination and Standardization of Clinical Immuno­ logical Research Faculty of Immunology, Pirogov Second Moscow State Medical Institute, Moscow, USSR WHO Collaborating Centre for Dental Education Department of Community Dental Health, Preventive Dentistry and General Practice, University of Dublin, Ireland WHO Collaborating Centre for the Development of Oral Health Manpower Medical Stomatological Institute, Moscow, USSR WHO Collaborating Centre for Education, Training and Research in Oral Health Faculty of Odontology, School of Dentistry, University of Lund, Malmö, Sweden WHO Collaborating Centre for Epidemiological Surveillance of the Trans-Saharan High­ way with regard to Vectors Institut français de recherche scientifique pour le développement en coopération (ORSTOM), Paris, France W H O /FA O /U N E P Collaborating Centre for Environmental Management for Vector Control with Special Reference to Health Aspects connected with Water Resources Development Division ofTropical and Communicable Diseases and the Ross Institute ofTropical Hygiene, London School of Hygiene and Tropical Medicine, United Kingdom WHO Collaborating Centre for the Evaluation of the Effect of New Pesticides on Insects ofTropical Origin Laboratoire d’entomologie médicale, Office de la recherche scientifique et technique outre-mer (ORSTOM), Paris, France WHO Collaborating Centre for Health and Disease Surveillance Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy WHO Collaborating Centre for Legionellosis Laboratoire national de la santé, Lyon, France WHO Collaborating Centre for Legionellosis National Bacteriological Laboratory, Stockholm, Sweden WHO Collaborating Centre for the Prevention of Oral Diseases Sektion Stomatologie, Medizinische Akademie, Erfurt, German Democratic Republic WHO Collaborating Centre for Reference and Research on Rapid Diagnosis of Viral Infections and Acute Respiratory Infections Ministry of Health and Consumer Affairs, Madrid, Spain WHO Collaborating Centre for Reference and Research on Viral Hepatitis Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Munich, Fed­ eral Republic of Germany FAO/WHO Collaborating Centre for Research and Training in Food Hygiene and Zoonoses Institut für Veterinärmedizin, Robert von Ostertag-Institut, Berlin (West) WHO Collaborating Centre for Zoonoses Central Research Institute of Epidemiology of the USSR Ministry of Health, Moscow, USSR Target 5 WHO Collaborating Centre for the Evaluation of the Effect of New Pesticides on Insects of Tropical Origin Laboratoire d ’entomologie médicale, Office de la recherche scientifique et technique outre-mer (ORSTOM), Paris, France WHO Collaborating Centre for Health and Disease Surveillance Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy WHO Collaborating Centre for Immunodiagnostic and Serological Methods in Malaria Laboratoire de parasitologie et pathologie exotique, Université scientifique et médicale de Grenoble, France Target 7 WHO Collaborating Centre for Pregnancy and Perinatal Care National Perinatal Epidemiology Unit, Oxford, United Kingdom 140 Target 9 WHO Collaborating Centre for Development of Appropriate Technology in the Control of Diabetes Mellitus Institute for Diabetes, Endocrinology and Metabolic Diseases “ Vuk Vrhovac” , Medical Faculty, University of Zagreb, Yugoslavia WHO Collaborating Centre for Research and Training in Cardiovascular Diseases Laboratoire de recherches cardiologiques, Faculté de médecine et de pharmacie, Université libre de Bruxelles, Belgium WHO Collaborating Centre for Research and Training in Cardiovascular Diseases Institute of Cardiovascular Diseases of the Medical Academy, Sofia, Bulgaria WHO Collaborating Centre for Research and Training in Cardiovascular Diseases Abteilung Klinische Sozialmedizin, Klinikum der Universität Heidelberg, Federal Republic of Germany WHO Collaborating Centre for Research and Training in Cardiovascular and Other Non­ communicable Diseases Central Institute for Cardiovascular Research, Academy of Sciences of the German Demo­ cratic Republic, Berlin, German Democratic Republic Target 10 WHO Collaborating Centre for Breast Self-examination N.N. Petrov Research Institute of Oncology, Leningrad, USSR WHO Collaborating Centre for Community Cancer Care West of Scotland Cancer Surveillance Unit, Glasgow Regional Cancer Institutes, Glasgow, United Kingdom WHO Collaborating Centre for Detection Methodology and Training in Cancer Control National Institute of Oncology, Budapest, Hungary WHO Collaborating Centre for Palliative Care Sir Michael Sobell House, The Churchill Hospital, Headington, Oxford, United Kingdom WHO Collaborating Centre for Research and Training in Methods of Assessment of Quality of Life in relation to Health Care The Netherlands Cancer Institute and Department of Clinical Psychology, University of Amsterdam, Netherlands WHO Collaborating Centre for Technology Assessment in Cancer Control Zentralinstitut für Krebsforschung, Robert Rössle-Institut, Berlin-Buch, German Demo­ cratic Republic 141 Target 11 WHO Collaborating Centre for Disaster Preparedness Université catholique de Louvain, EP1D 3034, Ecole de santé publique, Brussels, Belgium WHO Collaborating Centre for Disaster Preparedness, Management and Nursing Health Services Division, Department of Cooperation for Development, Ministry of Foreign Affairs, Rome, Italy WHO Collaborating Centre for Health and Disease Surveillance Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy WHO Collaborating Centre for Injury Prevention0 NH&MRC Road Accident Research Unit, Adelaide, Australia WHO Collaborating Centre for Injury Prevention“ Public and Environmental Health Division, South Australian Health Commission, Adelaide, Australia WHO Collaborating Centre for Injury Prevention0 Consumer Safety Institute, Amsterdam, Netherlands WHO Collaborating Centre for Injury Prevention0 Division of Injury Epidemiology and Control, Center for Environmental Health, Centers for Disease Control, Atlanta, GA, USA WHO Collaborating Centre for the Prevention of Road Traffic Accidents Transport and Road Research Laboratory, Department of the Environment and Depart­ ment of Transport, Crowthorne, United Kingdom Target 13 WHO Collaborating Centre for Health Education Bundeszentrale für Gesundheitliche Aufklärung, Cologne, Federal Republic of Germany WHO Collaborating Centre for Health Education and Health Promotion Research Scottish Health Education Group, Edinburgh, United Kingdom Target 15 WHO Collaborating Centre for Health Education Deutsches Hygiene-Museum, Dresden, German Democratic Republic 0 W H O collaborating centre working with a global programme. 142 WHO Collaborating Centre for Health Education and Health Promotion Dutch Health Education Centre, Utrecht, Netherlands WHO Collaborating Centre for the Promotion of Family Health/Family Planning National Research Institute for Mother and Child, Warsaw, Poland Target 17 WHO Collaborating Centre for Health — Psychosocial and Psychobiological Factors Fonds de la recherche scientifique médicale, Brussels, Belgium Target 18 WHO Collaborating Centre for Environmental and Health Impact Assessment Centre for Environmental Management and Planning, Aberdeen University, United Kingdom WHO Collaborating Centre for Health and Disease Surveillance Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy Target 19 WHO Collaborating Centre for Environmental Radioactivity Bureau of Radiation and Medical Devices, Health Protection Branch, Health and Wel­ fare Canada, Ottawa, Canada WHO Collaborating Centre for Health and Disease Surveillance Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy WHO Collaborating Centre for Health Effects of Exposure to Lead Medizinisches Institut für Umwelthygiene (MIU) an der Universität Düsseldorf, Federal Republic of Germany WHO Collaborating Centre for Occupational Health Institute of Occupational Health, Helsinki, Finland WHO Collaborating Centre for Occupational Health Coronel Laboratory, University of Amsterdam, Netherlands WHO Collaborating Centre for Occupational Health Institute of Occupational Health, Lodz, Poland 143 WHO Collaborating Centre for Risk Management in Chemical Safety International Institute forScientific Cooperation (IISC), University of Ulm, Schloß Reisens- burg, Federal Republic of Germany WHO Collaborating Centre for the Training and Utilization of Environmental Health Officers Department of Public Health and Environmental Studies, Umeâ University, Sweden Target 20 WHO Collaborating Centre for Community Water Supply and Sanitation International Reference Centre for Community Water Supply and Sanitation, The Hague, Netherlands WHO Collaborating Centre for Drinking-water and Water Pollution Control Water Research Centre, Medmenham, United Kingdom WHO Collaborating Centre for Environmental Problems and Health Aspects Research Institute for Hygiene and Microbiology, Bad-Elster, German Democratic Republic WHO Collaborating Centre for Primary Health Care Department of Public Health Administration and Social Hygiene, Regional Pathology Research Institute, Ministry of Health of the Kazakh SSR, Alma-Ata, USSR WHO Collaborating Centre for Rural Sanitation and Waste Disposal Centre national du machinisme agricole, du génie rural, des eaux et des forêts (CEMAGREF), Lyon, France WHO Collaborating Centre for Surface and Groundwater Quality Burlington, Ontario, Canada WHO Collaborating Centre for Water and Sanitation Centre international de l’eau, Vandœuvre-lès-Nancy, France WHO Collaborating Centre for Water Resources Protection Research Centre for Water Resources Development, Budapest, Hungary Target 21 WHO Collaborating Centre for Air Quality Management and Air Pollution Control Institute for Water, Soil and Air Hygiene, Langen, Federal Republic of Germany WHO Collaborating Centre for Primary Health Care Department of Social Medicine, Institute of Hygiene and Public Health, Bucharest, Romania 144 Target 22 FAO/WHO Collaborating Centre for Research and Training in Food Hygiene and Zoonoses Robert von Ostertag-lnstitut, Berlin (West) Target 24 WHO Collaborating Centre for the Environmental Health Aspects of the Wellbeing of the Elderly and Disabled Institute of Hygiene and Epidemiology, Prague, Czechoslovakia Target 25 WHO Collaborating Centre for Occupational Health Institute of Occupational Health, Helsinki, Finland WHO Collaborating Centre for Occupational Health Institute of Occupational Health, Lodz, Poland Target 26 WHO Collaborating Centre for Disaster Preparedness, Management and Nursing Health Services Division, Department of Cooperation for Development, Ministry of Foreign Affairs, Rome, Italy WHO Collaborating Centre for Nursing Nursing Research Institute, Helsinki, Finland WHO Collaborating Centre for Nursing Hospices civils de Lyon, France WHO Collaborating Centre for Nursing Research and Education Danish Institute for Health and Nursing Research, Copenhagen, Denmark WHO Collaborating Centre for Primary Health Care Andrija Stampar School of Public Health, Zagreb, Yugoslavia WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia Target 27 WHO Collaborating Centre for Disaster Preparedness, Management and Nursing Health Services Division, Department of Cooperation for Development, Ministry of Foreign Affairs, Rome, Italy 145 WHO Collaborating Centre for Health Economics SAGO Research Institute for Health Service Organization, Milan and Florence, Italy WHO Collaborating Centre for Hospitals and Other Health Institutions and Primary Health Care Programmes Institute of Social Hygiene and Organization of Health Services (ISOG), Berlin, German Democratic Republic WHO Collaborating Centre for Nursing Nursing Research Institute, Helsinki, Finland WHO Collaborating Centre for Nursing Hospices civils de Lyon, France WHO Collaborating Centre for Nursing Research and Education Danish Institute for Health and Nursing Research, Copenhagen, Denmark WHO Collaborating Centre for Primary Health Care Universities of Tampere and Kuopio, Finland WHO Collaborating Centre for Primary Health Care Department of Social Medicine, Institute of Hygiene and Public Health, Bucharest, Romania WHO Collaborating Centre for Primary Health Care Department of Primary Health Care and Foreign Health Services, Institute for Regional Pathology, Alma-Ata, Kazakh SSR, USSR WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia WHO Collaborating Centre for the WHO Programme on Hospitals and Other Health Institutions German Hospital Institute, Düsseldorf, Federal Republic of Germany WHO Collaborating Centre for the WHO/EURO Programme on Hospitals and Other Health Institutions National Hospital Institute of the Netherlands, Hospital Centre, Utrecht, Netherlands Target 28 WHO Collaborating Centre for Disaster Preparedness, Management and Nursing Health Services Divison, Department of Cooperation for Development, Ministry of Foreign Affairs, Rome, Italy 146 WHO Collaborating Centre for Health of the Elderly0 Red Cross General Hospital, Pyongyang, Democratic People’s Republic of Korea WHO Collaborating Centre for Health of the Elderly0 Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan WHO Collaborating Centre for Nursing Nursing Research Institute, Helsinki, Finland WHO Collaborating Centre for Nursing Research and Education Danish Institute for Health and Nursing Research, Copenhagen, Denmark WHO Collaborating Centre for Primary Health Care Netherlands Institute of Primary Health Care (NIVEL), Utrecht, Netherlands WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia WHO Collaborating Centre for Research on Aging Institute of Gerontology of the Academy of Medical Sciences of the USSR, Kiev, USSR WHO Collaborating Centre for Research on Care of the Aged0 Brookdale Institute of Gerontology and Adult Human Development in Israel, Jerusalem, Israel Target 29 WHO Collaborating Centre for Nursing Nursing Research Institute, Helsinki, Finland WHO Collaborating Centre for Nursing Hospices civils de Lyon, France WHO Collaborating Centre for Nursing Research and Education Danish Institute for Health and Nursing Research, Copenhagen, Denmark WHO Collaborating Centre for Primary Health Care National School of Public Health, Lisbon, Portugal WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia a W H O collaborating centre working with a global programme. 147 Target 31 WHO Collaborating Centre for Disaster Preparedness, Management and Nursing Health Services Division, Department of Cooperation for Development, Ministry of Foreign Affairs, Rome, Italy WHO Collaborating Centre for Nursing Nursing Research Institute, Helsinki, Finland WHO Collaborating Centre for Nursing Hospices civils de Lyon, France WHO Collaborating Centre for Nursing Research and Education Danish Institute for Health and Nursing Research, Copenhagen, Denmark WHO Collaborating Centre for Quality Assurance National Organization for Quality Assurance in Hospitals (CBO), Utrecht, Netherlands WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia Target 32 WHO Collaborating Centre for Community Medicine Centre de médecine préventive de Vandceuvre-lès-Nancy, France WHO Collaborating Centre for Public Health Research Institut für Gesundheits-System-Forschung, Kiel, Federal Republic of Germany Target 33 WHO Collaborating Centre for Health Development and Technical Cooperation among Developing Countries Centre for Health Cooperation with Non-Aligned and Developing Countries, Zagreb, Y ugoslavia WHO Collaborating Centre for Health Policies, Planning and Education Nordic School of Public Health, Gothenburg, Sweden Target 34 WHO Collaborating Centre for Health Planning and Economics Institut für Medizinische Informatik und Systemforschung (MEDIS), Munich, Federal Republic of Germany 148 WHO Collaborating Centre for the Managerial Process for National Health Development Department of Community Medicine, Usher Institute, Edinburgh, United Kingdom WHO Collaborating Centre for the Managerial Process for National Health Development Nuffield Centre for Health Services Studies, School of Medicine, University of Leeds, United Kingdom WHO Collaborating Centre for Planning and Evaluation Ecole nationale de la santé publique, Rennes, France Target 35 WHO Collaborating Centre for Health and Biomedical Documentation Institut für Wissenschaftsinformation in der Medizin, Berlin, German Democratic Republic WHO Collaborating Centre for Health Informatics Centre interuniversitaire de traitement de l’information (CITI 2), Paris, France WHO Collaborating Centre for Health Informatics Centro Italiano Studi e Indagini (CISI), Rome, Italy WHO Collaborating Centre for Health Informatics Uppsala University Computing Centre (UDAC), Uppsala, Sweden WHO Collaborating Centre for Health Informatics Computer Information Centre of the Ministry of Health of the Latvian SSR, Riga, USSR WHO Collaborating Centre for Health Information and Documentation Istituto internazionale per gli studi e l’informazione sanitaria (ISIS), Rome, Italy WHO Collaborating Centre for Health Situation Analysis Department of Epidemiology and Health Programming, National Research Institute of Mother and Child, Warsaw, Poland Target 36 WHO Collaborating Centre for Health Management and Human Resources Central Institute for Advanced Medical Studies (CIAMS), Moscow, USSR WHO Collaborating Centre for Health Manpower Development Fondazione Smith Kline (Italia), Milan, Italy 149 WHO Collaborating Centre for Health Manpower Development British Life Assurance Trust (BLAT) Centre for Health and Medical Education, London, United Kingdom WHO Collaborating Centre for Health Manpower Information Statistics Centre de sociologie et de démographie médicales (CSDM), Paris, France WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia Target 38 WHO Collaborating Centre for the Development of Research for Blood Transfusion Services Haematology and Blood Transfusion Centre, Bucharest, Romania WHO Collaborating Centre for Drug Assessment Pharmacological Committee of the All-Union Ministry of Health of the USSR, Moscow, USSR WHO Collaborating Centre for Drug Information and Quality Assurance National Institute of Pharmacy, Budapest, Hungary WHO Collaborating Centre for Drug Statistics Methodology Norwegian Medicinal Depot, Oslo, Norway WHO Collaborating Centre for Fundamental and Applied Immunology Institute of Immunology, Academy of Medical Sciences of the USSR, Moscow, USSR 150 INDEX M ain references by subject are in bold type. Abu Dhabi. 7.39 Accident prevention, 2.4, 2 .1 1 2 -2 .1 1 5 , 6.8, 7.1, 7 .2 - 7 .9 , 8.4 Acquired immunodeficiency syndrome (AIDS), 1.8, 1.15, 1.16, 1.22, 1.29, 2.3, 2.38, 2 .4 0 -2 .5 4 , 2.57, 3.5-3.7. 3.37. 3.38, 3.47, 6.33-6.35 Acute respiratory infections. 2.39, 2.70 Adolescents and voung people, 3.40, 3.54. 3.91, 3.93, 6.33 Aging, see Elderly AIDS, see Acquired immunodeficiency syndrome A ID S diagnosis and contro l: current situation. 1.46, 1.48 AIDS Hilfe, 2.45 Air pollution, 4.4, 4.7, 4.25, 4 .7 5 -4 .8 2 Albania, AIDS, 2.42 cancer, 2.111 country programme, 1.21, 8.6 diarrhoeal diseases, 2.55 environmental health, 4.50, 8.6 fellowships, 3.50, 8.6 H F A strategies, 1.18 Alcohol abuse. 2.1 14, 3.2, 3.6, 3.25, 3.36, 3 .8 8 - 3 .9 3 , 5.36, 8.5 Alzheimer's Disease International, 7.17 Andorra, 7.12 Appropriate technology for health, 6.111. 7.1, 7 .2 0 - 7 .2 7 , 7.33 see also Health technology assessment Argentina, 7.13 Association of Medical Deans in Europe, 6.5, 6.78 Association for Medical Education in Europe, 6.5, 6.78 Association of Schools of Public Health in the European Region, 1.18, 6.5, 6.79 Australia, 3.70, 7.5, 7.36, 7.38, 7.42. 7.43 Austria, AIDS, 2.49 alcohol abuse, 3.36 cancer, 2.105 drug abuse, 3.36 environmental health, 4.18, 4.34, 4.49, 6.31 epidemiology. 2.77 health manpower, 3.36 health promotion, 3.14 noncommunicable diseases, 2.86, 2.98 primary health care, 5.12, 5.35 sexuality and family planning, 3.35 social equity and health, 2.7 Bahrain, 7.15 Basic radiological system (BRS), 6.105, 7.25 Belgium, accident prevention, 7.8 AIDS, 2.48 appropriate technology, 7.20, 7.26 disaster preparedness, 2.123 environmental health, 4.20 health economics, 6.50 health manpower, 5.46 health planning, 6.43 health promotion, 3.41 quality assurance, 5.45, 5.46 Regional Committee, 1.21 151 Biologicals, 2.40 Blood transfusion and immunohaematology, 6.33 Brazil, 2.79, 7.7, 7.33, 7.37 Breastfeeding, 2.80, 3.53, 4.26 Breast-milk, 4.26 Budget and finance, 1 .3 6 -1 .3 9 Bulgaria, country programme, 1.21, 8.3 H F A strategy, 6.15, 8.3 malaria, 2.74 mental health, 2.28 noncommunicable diseases, 1.18, 2.2, 2.97, 2.99-2.101 primary health care, 5.12 sexuality and family planning, 3.51 Burma, 7.15 Burn injuries. 7.9 Canada. 2.98, 3.2, 3.8-3.11,4.32, 5.34, 7.32, 7.36 Cancer. 2.2, 2.56, 2 .1 0 2 -2 .1 1 1 , 3.34, 6.8, 6.33 Cardiovascular diseases, 2 .8 3 -2 .1 0 1 , 3.34, 6.109, 7.16, 7.24 CCCCP, see Comprehensive community cardiovascular control programmes CE. see Council of Europe CEC, see Commission of the European Communities Chemical hazards. 2.4,2.112,2.120,2.122,4.6,4.9, 4 .2 4 - 4 .2 9 , 6.29 Child abuse. 3.92 Children, accident prevention. 2.1 15. 7.7 disability. 2.20 drug abuse, 3.29 H FA strategy, 1.26 immunization, 1.27 infant feeding, 7.27 lifestyles, 3.7. 3.30 mental health, 2.27, 2.28, 2.35 nutrition, 2.81 risk factors, 2.77 toxic substances, 4.25 see also Maternal and child health China, 7.29 Chronic diseases, 1.18, 2.2, 2.22, 2.23, 3.32, 3.34, 6.8, 7.18 CINDI, see Countrywide integrated noncommunicable disease intervention program me CIOMS, see Council for International Organizations of Medical Sciences C MEA, see Council for Mutual Economic Assistance Collaborating centres, 2.38, 3.37. 3.46, 6.13. 6.42, 6.54 Collaboration with other organizations, 6 .2 6 -6 .3 9 see also under names of individual organizations Commission of the European Communities, 6.33, 6.34 alcohol abuse, 5.36 cancer, 2.108 drug abuse, 3.85, 3.87 epidemiological surveillance, 6.58 health education, 3.40, 3.41, 3.85 lifestyles, 3.7 nutrition, 3.74 research. 6.12 “Com m o n delivery vehicles”, see under Health for all by the year 2000 Communicable diseases, 2.2, 2.3, 2 .3 8 -2 .5 7 , 2.71,6.35 see also Immunization Comprehensive community cardiovascular control programmes, 2.88 Congo, 7.30 Consultative Group on Programme Development, 1.1, 1.9, 1.13-1.16, 1.32,6.55 Contingency plan, 1.6, 1.10, 1.14, 1.28 Convention on Long-range Transboundary Air Pollution, 4.19 Coronary heart disease, see Cardiovascular diseases Council for International Organizations of Medical Sciences, 6.24 Council for Mutual Economic Assistance. 6.39, 6.49 Council of Europe, 2.24. 2.38, 2.108, 2.119, 3.7, 3.40, 3.41, 3.85. 3.87. 6.32, 6.33. 6.53, 6.61, 6.91 Country programme coordination, 1.5, 1.17-1.22, 1.56' 2.10. 2.14, 2.19, 2.29, 2.30, 2.35, 8.1-8.12 Countrywide integrated noncommunicable disease intervention programme ( Cl N DI ), 1.12, 1.19, 1.23, 1.32, 2.2, 2.98-2.101, 7.24. 8.4 Cuba, 7.7 Czechoslovakia, 1.18 cardiovascular diseases, 2.96 country programme. 1.19, 1.21,2.14,2.19 disability, 2.13, 2.17, 2.20 elderly, 2.13, 2.14, 2.17 1 5 2 Czechoslovakia (contd) environmental health, 4.89 immunization, 2.71 maternal and child health, 2.82 noncommunicable diseases, 2.98 pharmaceuticals, 6.116 rehabilitation, community-based, 2.19 Data bases. 2.76, 4.6. 4.12. 4.80. 6.25. 6.54. 6.62, 6.63, 6.68. 6.75. 6.96, 6.103. 7.15 see also Information systems Demographic trends, .3.14, 7.10 Denmark, accident prevention, 7.9 alcohol abuse, 3.90 appropriate technology, 7.21 cardiovascular diseases, 2.95 environmental health, 4.57 equity in health, 2.6 health manpower, 6.79 H F A strategies, 6.18 nursing, 5.34 nutrition, 3.71 oral health, 2.61 pharmaceuticals, 6.115 primary health care. 5.10 rehabilitation, community-based, 2.17 suicide, 2.125 Diarrhoea] diseases, 2.39. 2.55. 2.70 Diphtheria. 2.69 Disability. 2.1, 2 .2 0 , 3.61,4.89. 6.27 sec also Rehabilitation, community-based Disaster preparedness, 2.4, 2.5, 2 .1 1 6 -2 .1 2 4 , 4.9, 4.10, 4.37-4.39, 6.31, 7.34 Disease prevention and control. 2.1, 3.1. 5.12, 8.4 Drug abuse. 2.51,2.53, 3.2, 3.4. 3.6. 3.7.3.26-3.28, 3.29. 3.36, 3.82-3.87, 6.8, 6.27, 6.33, 6.34 Drugs, regulation, 6.112. 6.113, 6.1 18, 6.120, 7.41-7.43 utilization, 2.82, 6.1 14. 6.121 D rugs f o r children, 1.46 Drugs f o r the elderly, 1.48 EC, sec European Community ECE. see United Nations Economic Commission lor Europe Economic and Social Commission for Asia and the Pacific. 7.3 Education, medical, see under Health manpower Egypt. 4.69, 7.15 Elderly, accident prevention, 7.8 community care, 2.12, 2.13 environmental health, 4.25. 4.89 health of, 2.2, 2.11-2.14, 6.27, 6.33, 7.1, 7.10-7.19 health promotion, 3.14 mental health, 2.33 sexuality. 3.62 social policies, 2.1 I W H O Special Programme for Research on Aging, 1.18 Emergencies, see Disaster preparedness Environmental health. 4 .1 - 4 .9 6 , 6.28, 6.34, 6.39, 6.55,6.57, 8.6 Environmental Health Series, 1.53,4.12,4.16, 4.22, 4.34. 4.35, 4.77. 4.93 Epidemiological surveillance and risk assessment, 1.22. 6.58. 6.61 Epidemiology and statistics. 1.54-1.56, 6.35, 6.37, 6.69-6.71 ' accident prevention, 2.114 elderly. 7.13, 7.18 environmental health, 1.29,4.20,4.25 health planning, 6.42 mental health, 2.24, 2.25 morbidity and mortality, 6.59 nutrition. 3.72, 3.74 rheumatism, 2.22 Equity in health. 2.1. 6.33 ERICA, see European risk factors and incidence — a collaborative analysis Ethics, 2.21, 2.46, 2.47, 3.2, 6.2, 6.9, 6.22-6.24, 6.35.6.52,6.53 Ethiopia, 7.34 European Advisory Committee on Health Research. 3.84. 6.7-6.9 European Child Psychiatrists' Research Group. 2.27 European Committee for Clinical Laboratory Standards. 7.24 European Community, 3.7, 4.69, 6.35. 6.101 European hypertension research action programme (HYRAP). 2.89 European League Against Rheumatism (EULAR). 2.22, 2.23 European Medical Research Councils, 2.26, 6.12 European Organization for Cooperation in Cancer Prevention Studies, 2.109 European risk factors and incidence — a collaborative analysis, 2.77, 2.86 153 European Road Safety Year. 7.3 European Society of Child and Adolescent Psychiatry, 2.28 Executive Board, 1.1, 1.9, 1.30 Expanded Programme on Immunization (EPI), 2.39, 2.70 Family planning, see Sexuality and family planning FAO, see Food and Agriculture Organization of the United Nations Fellowships, 3.50, 3.53, 4.67, 6 .8 8 -6 .9 3 , 7.19, 7.39, 7.40, 8.1, 8.6 Finland, cardiovascular diseases, 2.85 child health, 3.30 country programme, 1.21 health manpower, 5.46 health technology, 6.110 H F A strategy, 6.15, 6.16 noncommunicable diseases, 2.98 nursing, 5.26 oral health, 2.60 primary health care. 5.13 quality assurance, 5.38, 5.45, 5.46 sexuality and family planning. 3.63 Fluoridation, water, see under Oral health Food and Agriculture Organization of the United Nations, 4.69, 4.71, 4.72, 6.30 Foodborne diseases, 4.84 Food safety, 1.29, 4.11.4.52, 4 .8 3 - 4 .8 6 , 6.28, 6.33 Food safe ly services, 4.83 France, AIDS, 2.48 alcohol abuse, 3.90 appropriate technology for health, 7.26 country programme, 1.21 health manpower, 6.75, 6.80, 6.82 health planning and management, 6.41 health technology, 6.99 Healthy Cities, 1.18,4.90 H F A strategies, 1.18, 6.18 informatics support, 6.73 maternal and child health, 2.79 nursing. 5.25 primary health care. 5.13 Regional Committee, 1.18 research, 6.14 sexuality and family planning, 3.48 suicide, 3.125 France (contd) tobacco, 3.79 water supply and sanitation, 4.5 Funds-in-Trust, 1.39 and Table 1 Genetics services, 2.21, 6.109 German Democratic Republic, cancer, 2.104.2.110 cardiovascular diseases. 2.83 country programme. 1.20, 1.21, 2.19 environmental health, 4.13 health legislation, 6.25 health promotion, 3.15, 3.42 H F A strategies, 1.18, 6.7, 6.15 informatics support, 6.66 noncommunicable diseases, 2.98 rehabilitation, community-based, 2.19 Germany, Federal Republic of, AIDS, 2.40. 2.47, 2.48, 3.37, 3.38 appropriate technology for health, 7.26 cancer, 3.34 cardiovascular diseases, 2.91, 3.34 chronic diseases, 3.34 elderly, 3.62 environmental health, 4.25, 4.35, 4.58, 4.75, 4.91 epidemiology and statistics, 6.59 health economics, 6.44 health planning and management. 6.40 health promotion, 3.34, 3.37, 5.39 health services, 5.21, 5.23 Healthy Cities, 1.18 pharmaceuticals. 6.113 primary health care, 5.13, 5.39 publications, 2.7 quality assurance, 5.45 sexuality and family planning, 3.35, 3.62 suicide, 2.125 Gerontology, see Elderly Global Environmental Monitoring System (GEMS), 4.75 Global Programme Committee, 1.44 Greece, AIDS, 2.42 child health, 2.9 country programme. 1.21, 2.9, 2.30, 3.85, 8.6 diarrhoeal diseases, 2.55 disaster preparedness, 2.118 drug abuse, 3.85 elderly, 2.13 environmental health. 4.69, 4.71, 8.6 health legislation, 2.30 154 Ci recce (contd) malaria. 2.74 nutrition, 3.74 rheumatism, 2.23 social equity and health, 2.9 Haemoglobinopathies, 2.21 H aving a baby in Europe, 2.79 H ealth crisis 21100, 1.52 1 lealth economics, 5 .1 8 , 5.21. 5.24, 6.3, 6.8, 6.44-6.51. 7.22 Health education, 3 .1 , 3.4-3.6. 3.31, 3 .3 6 -3 .4 6 . 6.S. 6.33, 6.34 accident prevention. 2.1 12 AIDS. 2.40, 2.41, 2.45, 2.49, 2.55 cancer. 2.108 children. 3.30 disaster preparedness, 2.1 IX rheumatism. 2.22, 2.23 sexuality and tamil} planning, 3.55 Health lor all by the year 2000, passim advocacy, 3.10, 3.11 “common delivery vehicles”. 1.12,3.3, 3.18,8.2 data base, 1.55, 2.76, 6.54, 6.63 environmental health, 4.15, 6.55 ethics, 6.2 fellowships, 6.88 health legislation, 6.2 health promotion, 6.55 information of the public. 1.16, 1.23-1.27 manpower, 1.8, 1.13,6.79-6.81 medical associations, 1.22 monitoring and evaluation of progress, 1.13, 1.54-1.56, 4.15, 5.28, 6.4, 6.54-6.57, 6.63 policies and strategies, 1.17, 1.18,3.2,3.9,3.18, 5.1, 6.1,6.7,6.15-6.19,6.26,6.38,6.40.6.77, 6.78, 6.85. 6.88, 8.2, 8.3 research, 1.13 universities, 6.11 H ea lth hazards of organized violence, 2.6 Health information of the public, 1.16, 1.23-1.27, 2.40, 2.110. 3.76 Health legislation. 2 .1 5 , 5 .1 7 , 6.2, 6.20 accident prevention, 2.1 14 AIDS, 2.40, 2.46. 2.47 disability. 2.15 elderly. 2.33, 6.21 food safety. 4.83. 4.84 11 FA indicators. 6.56 mental health. 2.30, 2.33 organ transplantation. 6.53 Health legislation (contd) pharmaceuticals, 7.41 social equity and health, 2.15 tobacco, 3.78 Health manpower, 1.32. 3.4. 6 .7 5 -6 .8 7 , 7.39. 7.40. 8.8 accident prevention, 7.5 alcohol abuse, 5.36 cancer, 2.110 disaster preparedness, 2.120, 2.123 drug abuse, 2.52, 3.36 environmental health, 4.14, 4.20, 4.21. 4.23 health economics, 6.45, 6.47 health planning and management, 6.46 health promotion. 3.9, 3.41, 3.43-3.46 malaria, 2.74 medical education. 2.23, 2.26, 5.41. 6.5 oral health. 2.61 pharmacotherapy, 6.122 primary health care. 5.17 qualin assurance. 5.38. 5.46 research, 3.9. 5.17 sexualitv and lamilv planninu. 3.48. 3.52. 3.54. 3.56, 3.57 tobacco, 3.79 H ealth manpower: planning, production and management. 6.76 Health planning and management. 3.7. 6.40-6.43, 6.46. 6.47. 6Л>7, 8.4 Health policies and strategies, 1.12, 1. 17. 2.34, 3.1, 3.2, 3 .8 -3 .2 8 . 3.30, 3.34. 3.67-3.71, 3.74. 3.76, 3.78. 3.84, 3.88, 4.1. 4.2, 6.3, 6 .1 5 -6 .2 5 , 6.27, 6.56, 7.6. 7.10, 7.1 1. 7.15. 7.21 Health promotion, 1.35, 2.2, 3.1-3.5. 3 .8 -3 .2 4 , 3.31. 3.36-3.46, 7.36 accident prevention, 2.1 12. 2.1 15, 7.3 alcohol abuse, 2.112, 3.2, 3.88, 5.36 children. 3.30 chronic disease, 3.34 drug abuse. 3.2. 3.4 elderly. 3.14 health manpower. 3.41. 3.43-3.45 hospitals, 5.12 indicators. 3.21. 3.80, 3.81, 6.55 information transfer, 6.61 noncommunicable diseases, 2.92 nutrition, 3.2, 3.4 oral health. 2.59 publications, 6.60 rehabilitation, community-based. 2.16 research. 3.20-3.24. 3.45. 3.80. 6.10 self-help, 3.33 1 5 5 Health promotion (contd) tobacco. 3.2, 3.4 training, 3.9, 3.20 Health services, delivery, 4.83, 5.1, 5.2. 5.4, 5 .1 9 -5 .2 4 development, 2.26. 2.36 planning, 2.58, 2.61 research, 6.14 see also Hospitals and other health institutions and Nursing/midwifery Health systems, 1.12 Health technology assessment, 2.106, 2.110, 6 .9 4 -6 .1 1 1 sec also Appropriate technology for health Healthv Cities, 1.12, 1.18, 1.19, 1.23, 1.32,3.1.3.3, 3.18, 3.19, 3.85. 4.3. 4.64. 4.90. 4.91, 8.5 H e p a tit is , 2 .5 6 -2 .5 7 Holy See, 6.9 Hospitals and other health institutions, 5.3, 5.4, 5 .1 2 -5 .1 6 , 5 .1 9 - 5 .2 4 , 7.35 Housing, 2.17, 4 .8 9 - 4 .9 3 , 6.27, 7.8 Hungary, appropriate technology for health, 7.26 cancer, 2.102-2.104, 2.110, 2.111 child health, 3.30 country programme, 1.19, 1.21, 2.19, 8.3 environmental health, 4.45, 4.53, 4.59, 4.60, 4.88 epidemiology and statistics, 6.71 health manpower. 6.86 health promotion, 3.15 H F A strategies, 1.18. 6.7, 6.15 mortality trends. 2.78 nursing/midwifery, 5.28, 5.40 nutrition, 3.71, 3.73 pharmaceuticals, 6.120 rehabilitation, community-based, 2.19 sexuality and family planning, 3.52', 3.64 use of W H O ’s resources, 1.4 Hypertension, see Cardiovascular diseases HYRAP, see European hypertension research action programme 1A L A , see International Atomic Energy Agency IARC, see International Agency for Research on Cancer Iceland, accident prevention, 2.114 AIDS. 2.42 alcohol abuse, 3.90 appropriate technology for health, 7.26 cancer, 2.104 Iceland (contd) country programme, 1.21 elderly, 7.15 health policy. 7.15 H FA strategies, 6.15 mental health, 2.25 Images o f nursing in Europe, 5.32 Immunization, 1.27, 2.56, 2 .6 9 -2 .7 3 India, 7.9 Indonesia, 7.5, 7.15 Inequities, see Social equity and health Infectious diseases, see Communicable diseases Informatics support, 1.29, 6.65, 6.66, 6.73, 6.74 Information systems, 1.5, 6.67, 6.68, 8.8 accident prevention, 7.3 AIDS. 2.43 cancer, 2.108. 2.11 1 chronic disease. 3.34 disaster preparedness, 2.123, 4.38 drug abuse, 3.84 health economics, 5.18 health services, 5.23 immunization, 2.73 mental health, 2.31. 2.35, 2.36 oral health. 2.58 pharmaceuticals, 6.123 tobacco, 3.76 Integrated management information system (IMIS), 1.5 Intergovernmental Oceanographic Commission, 4.71, 6.30 Intergovernmental organizations, 1.7,2.16,4.55, 6.Ï3. 6.17, 6.26 International Agency for Research on Cancer, 2.108, 4.34, 4.38 International Atomic Energy Agency, 6.30, 6.31 International Association of Gerontology, 2.13, 7.12 International Centre for Social Gerontology, 7.8 International Children's Centre, 3.47 International Council on Alcohol and Addictions, 5.36 International Council for Building Research, 2.13 International Diabetes Federation, 2.94 International Drinking Water Supply and Sanitation Decade, 4.5, 4.40, 4.53-4.56, 4.58-4.60, 4.63, 4.64 see also Water supply and sanitation 156 International Epidemiological Association, 2.94, 7.12 International Federation of Associations of Older Persons, 7.17 International Federation of Library Associations and Institutions, 6.61 International Federation of Medical Students' Associations, 6.84, 6.92 International Hospital Federation, 7.35 International Physicians for the Prevention of Nuclear War. 1.18 International Plan of Action on Aging, 6.27, 7.14 International Programme on Chemical Safety, 4.9, 4.25 International Society for Quality Assurance in Health Care, 5.47, 7.35 International Union Against Cancer, 2.108 International Union for Health Education, 3.31 International Working Group for Medical Device Testing, 6.101 International Year of Shelter for the Homeless, 6.27 Ireland, health promotion. 3.15 H F A strategies, 1.18, 6.15 oral health, 2.59 social equity and health, 2.7 Israel, appropriate technology for health, 7.21 country programme, 1.21, 2.10, 8.3 health economics, 6.47 health information, 6.68 health planning and management, 6.47 H F A strategies, 1.18, 6.15 maternal and child health, 2.79 oral health, 2.62 primary health care, 5.13 social equity and health. 2.10 Italy. AIDS, 2.48 appropriate technology lor health. 7.20 cardiovascular diseases, 2.89, 2.91 country programme, 1.20, 2.10 diarrhoeal diseases, 2.55 disaster preparedness. 2.122. 2.124, 7.34 environmental health, 4.20, 4.26, 4.27, 4.44, 4.60, 4.77 health manpower, 3.43 health promotion, 3.43 health services, 5.24 health technology, 6.101 informatics support, 6.65 Italy (contd) maternal and child health, 2.79 primary health care, 5.13 quality assurance, 5.45 sexuality and family planning, 3.64 social equity and health, 2.10 suicide, 2.125 Japan. 5.25, 7.9, 7.19 Joint Commission for the Accreditation of Hospitals, 7.35 Jordan, 7.15 Kenya. 7.4, 7.5. 7.17 Kidney disease. 2.90 League of Red Cross and Red Crescent Societies, 2.45 Legionellosis, 2.38 Life expectancy, 2.1. 2.76 Lifestyles, 2.2. 2.114, 3.1-3.7, 3.9, 3.18, 3.21, 3.23, 3.29, 3.39, 3.42, 3.80. 4.96, 7.16, 8.5 Luxembourg, 3.41 Lyme disease, 2.38 Malaria. 2 .7 4 -2 .7 5 Malta, country programme. 1.21. 2.10, 8.8 health economics. 6.48 health information, 6.67 health planning and management, 6.41 H F A strategies. 6.15 oral health, 2.66 social equity and health, 2.10 M anua l on urban a ir q u a lity management, 4.76 Maternal and child health. 2.2, 2.9,2.41,2.48,2.69. 2.79, 4.26, 6.116, 7.32, 7.33, 8.4 see also Children and Sexuality and family planning Mauritius, 7.15 Measles. 2.69. 2.71 Medical associations, 1.22, 2.45 Medical technology, see Health technology assessment Mediterranean Action Plan, 4.66-4.74 Mental health. 2.2, 2 .2 4 -2 .3 7 , 2.117, 3.47, 7.16, 7.18, 7.30, 7.31, 8.4 Mexico, 7.15 Midwives, see Nursing/midwifery 157 Migrants, 3.4, 3.49 M ig ra tio n and health: towards an understanding o f the health care needs o f ethnic m inorities, 2.6 Model health care and quality assurance, 5.4,5.37, 5.38, 5.43-5.47, 7.35 M O N I C A optional psychosocial substudy (MOPSY), 2.83, 2.84 Monitoring trends in cardiovascular diseases (MONICA), 2.43-2.85, 2.100, 7.24 Morocco, 1.31, 4.61 Mortality, child, 2.77 differentials, 2.78 risk factors, 2.86 trends, 2.1, 2.76 Mumps, 2.69, 2.71 Nepal, 7.9 Netherlands, AIDS. 2.49 appropriate technology for health, 7.21, 7.26 cancer, 2.104 cardiovascular diseases, 2.94 environmental health, 4.21,4.81, 4.87 ethics, 6.24 health economics, 6.50 health education, 3.31 health planning, 6.97 health policy, 6.24 health promotion, 3.15, 3.41 health technology, 6.97, 6.100, 6.109 H F A strategies, 6.15 maternal and child health, 2.80 mental health, 2.27, 2.31 pharmaceuticals, 6.115 primary health care, 5.6, 5.13, 5.16, 5.43 suicide, 2.125 Neurological disorders, 2.32 Newsletters, 1.53, 2.98, 3.16, 3.33, 3.66, 5.9, 5.11, 6.119, 7.22 Nigeria, 7.9 Noncommunicable diseases, 1.12, 1.18,2.2,2.86, 2.90, 2.92, 2.97-2.101 Nongovernmental organizations, 1.7, 2.18, 2.38, 2.45, 2.79, 2.121, 3.76, 3.93, 6.26, 7.17 N onioniz ing rad ia tio n pro tection, 4.31 Nordic Council, 2.38, 2.108, 3.70, 6.38 Norway, 1.18 AIDS. 2.47 country programme, 1.21 disaster preparedness, 2.117 Norway (contd) environmental health, 4.62 H F A strategies, 1.18, 6.15 nutrition, 3.70, 3.73 pharmaceuticals, 6.114 primary health care, 5.12 quality assurance, 5.45 suicide, 2.125 Nuclear accidents, 1.16,4.33-4.39 Nuclear energy, see Radiation N uclear power: accidenta l releases — p ra c tic a l guidance f o r p u b lic health action, 1.45, 4.37 N ursing care — sum m ary o f a European study, 1.46 Nursing/midwifery, 5.5, 5 .1 1 , 5 .2 5 -5 .3 2 , 8.7 disaster preparedness, 2.124, 7.34 education, 5.44 health services, 5.22 quality assurance, 5.43, 5.44 Nutrition, 2.81, 3.2, 3 .6 7 - 3 .7 4 , 6.117, 7.16 Obesity, 3.72 Obstetrics, 2.79 Occupational health, 1.29, 1.35,4.6,4.11,4.32, 4 .9 4 - 4 .9 6 , 5.27, 7.38 OECD, see Organisation for Economic Co-operation and Development Oral health, 2.2, 2 .5 8 - 2 .6 8 , 7.28, 7.29, 8.4 financing, 2.60 information systems, 2.58 publications, 2.60 self-care, 2.60 services, 2.58 water fluoridation, 2.60, 2.68, 4.50 Oral rehydration therapy, 2.55 Organ transplantation. 6.33, 6.35, 6.53 Organisation for Economic Co-operation and Development, 6.36, 6.37 Organization of European Cancer Institutes, 2.108 Pakistan, 7.15, 7.41 People’s needs f o r nursing care, 1.46, 5.33 Personnel, 1.6, 1.28-1.31 Pertussis, 2.69 Pharmaceuticals, 6.6, 6.33, 6 .1 1 2 -6 .1 2 4 , 7.41-7.43 Pneumonia and pneumococcal infection, 2.39 Poland, breastfeeding, 3.53 cancer, 2.104, 2.111 cardiovascular diseases, 2.93 158 Poland (contd) country programme, 1.20, 1.21 environmental health, 4.16, 4.51 fellowships, 3.53 nutrition. 3.70. 3.72 oral health, 2.62 sexuality and family planning. 3.47, 3.63 Poliomyelitis, 2.69, 2.72 Portugal, alcohol abuse, 3.90, 8.5 appropriate technology for health, 7.26 country programme, 2.10, 2.14, 2.19, 2.35, 6.51, 8.5 elderly, 2.14, 7.12 environmental health, 4.58, 4.63, 4.92 health economics, 6.51 health manpower, 3.56 health planning and management, 6.41 logistics support. 6.72 maternal and child health, 3.56 mental health, 2.35 noncommunicable diseases, 2.90, 2.98, 2.101 nursing, 5.27, 5.28 oral health, 2.62 primary health care. 5.7 quality assurance. 5.37, 5.45 rehabilitation, community-based, 2.19 sexuality and family planning, 3.47, 3.54-3.56, 3.66 social equity and health, 2.8, 2.10 Primary health care, 2.23,2.114, 2.1 16, 2.124,3.27, 4.14, 5 .1 - 5 .4 7 . 6.41. 6.84-6.86. 7.2. 7.4. 7.12. 7.15, 7.20, 7.34, 7.35, 8.7 Programme budget, 1.2, 1.5, 1.10-1.12, 1. 17. 8.1 extrabudgetary funds. 1.15, 1.38, 1.39 Programme management and development, 1.1-1.16 Programme of Work. Eighth General, 1.6, 1.10, 7.1, 7.2, 7.6 Programme planning and evaluation, 1.2, 1.3, 1.5 Psychiatry, forensic, 2.37 Publications, 1 .4 4 -1 .5 3 . 2.6, 2.7, 2.36. 2.60. 2.79, 2.88, 3.31, 3.68-3.70, 4.7, 4.12, 4.19, 4.31,4.37, 4.76, 4.81, 4.83, 4.86, 5.32, 5.33, 6.60. 6.76 Quality assurance, sec Model health care and quality assurance Radiation, ionizing, 4 .3 3 - 4 .3 9 . 6.37 nonionizing, 4 .3 1 -4 .3 2 Refugees, 2.6 Regional Health Development Advisory Council, 1.13 Regional Programme Committee, 7.1 Rehabilitation International. 2.15 Rehabilitation, community-based, 2 .1 6 -2 .1 9 , 6.33 see also Disability Republic of Korea, 7.19 Research, 1.13, 1.39, 3.80-3.81 accident prevention, 7.7. 7.8 child health, 3.30 drug abuse, 3.84 environmental health, 4.13, 4.68 health education, 6.83 H FA, 6.7, 8.3 health legislation, 5.17 health promotion, 3.9. 3.20-3.24. 3.80 health services. 6.14 health technology. 6.96 lifestyles, 3.80 mental health. 2.24 primary health care, 5.10 self-help, 3.32 sexuality and family planning, 3.51 suicide. 2.125 Rheumatism, 2 .2 2 -2 .2 3 Romania, 5.12 Rubella. 2.69, 2.71 San Marino, country programme coordination. 1.19 disaster preparedness. 2.119 H FA strategies, 6.7 oral health. 2.64 Self-help. 3.32. 3.33. 3.37. 5.34 Sexually transmitted diseases. 3.47 see also Acquired immunodeficiency syndrome Sexuality and familv planning. 2.46. 2.48-2.50. 3.5. 3.6, 3.35. 3 .4 7 -3 .6 6 . 8?5 Singapore, 7.13 Smoking, see Tobacco Social equity and health. 2.7-2.10, 8.4 Spain, alcohol abuse, 3.90 appropriate technology for health. 7.20 country programme. 1.19, 1.21, 3.85,6.104. 8.3, 8.6 drug abuse. 3.26, 3.27, 3.85 elderly. 7.12 environmental health. 4.14, 4.20, 4.64, 4.91, 8.6 health manpower, 6.85, 6.86 159 Spain (contd) health promotion, 3.41 health policy, 3.26, 3.27 health technology, 6.104 Healthy Cities, 4.91 H F A strategies, 1.12, 6.7. 6.15, 6.IX. 6.85 oral health, 2.63 primary health care, 3.27, 5.12. 5.13, 5.42, 6.85 quality assurance, 5.45 sexuality and family planning. 3.35. 3.60, 3.66 Staff development and training. 1.40-1.43 Suicide, 2.125 Sweden, accident prevention, 2.115, 7.4, 7.5, 7.8 AIDS, 2.49, 2.51 country programme, 1.21 disability, 2.18 elderly, 2.13 environmental health, 4.20 health manpower, 1.18. 6.79, 6.86 health promotion, 3.46 health technology, 6.96, 6.98, 6.101, 6.103, 6.107,6.108 immunization. 2.70 informatics support, 6.74. 6.108 intersectoral cooperation, 6.93 mental health, 2.26 primary health care, 5.13 quality assurance, 6.107 sexuality and family planning, 3.35 suicide, 2.125 Switzerland. AIDS, 2.50 appropriate technology for health, 7.22, 7.24 environmental health. 4.19 H F A strategies, 1.18, 6.18 Tanzania, 7.31 Targets f o r health f o r a ll, 1.52 Television, 1.52, 3.64, 7.20 Tetanus, 2.69 Thailand, 7.2, 7.4, 7.5, 7.15, 7.28 Tobacco, 1.8, 1.13, 1.22, 1.35,3.1,3.2,3.4,3.7, 3.42. 3 .7 5 - 3 .7 9 , 6.34, 6.62 feature article, between pages 54 and 55 Toxic substances, see Chemical hazards Tuberculosis, 2.69 Tunisia, 7.15 Turkey, cancer, 2.104, 2.111 country programme, 1.20, 2.29, 5.29, 8.5 diarrhoeal diseases, 2.55 Turkey (contd) health manpower, 6.84 malaria, 2.74 mental health. 2.29, 7.31 nursing, 5.28. 5.29 primary health care. 6.84 sexuality and family planning. 3.57. 3.66, 8.5 UN. see United Nations UNDP, see United Nations Development Programme U N D R O . see United Nations Disaster Relief Office Unemployment, socia l vu lnerab ility and health in Europe, 2.7 Unemployment and social work, 2.7 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 Union of Soviet Socialist Republics, acute respiratory infections, 2.39. 2.70 cancer, 2.104 collaborating centres, 6.13 country programme, 1.21 diarrhoeal diseases, 2.39, 2.55, 2.70 environmental health, 4.88 epidemiology and statistics, 6.69, 6.70 genetics services, 2.21 health economics. 6.49 health information, 6.69. 6.70 health manpower, 6.81, 6.86, 6.87 health policy, 1.18 health promotion, 3.15 H F A strategies. 6.7 immunization, 2.39, 2.70, 2.73 information systems. 2.73 oral heath, 2.68 primary health care, 5.12, 5.13 United Kingdom, appropriate technology for health. 7.21. 7.22, 7.26 cancer, 2.107, 2.110 disability, 3.61 elderly, 2.13, 7.13 environmental health, 4.16, 4.17, 4.30, 4.42, 4.53 health economics, 6.46 health education, 3.39 160 United Kingdom (contd) health manpower, 6.79, 6.81, 6.82 health planning and management, 6.41, 6.42, 6.46 health promotion, 2.92, 3.13, 3.23, 3.41 Healthy Cities, 1.19 H F A strategies, 6.18 maternal and child health, 2.79 mental health, 2.33 noncommunicable diseases, 2.98 oral health, 2.59 primary health care, 5.12, 5.43 publications, 2.6 quality assurance, 5.37, 5.43, 5.45 Regional Committee, 1.18 rehabilitation, community-based, 2.17 sexuality and family planning, 3.35, 3.61 United Nations, 1.38, 1.41,2.121,3.93,4.29,6.27, 6.29, 6.30, 6.91, 7.14 United Nations Children’s Fund, 2.55 United Nations Decade of Disabled Persons, 2.16, 2.18, 6.27 United Nations Development Programme, 1.31, 2.93, 2.111, 4.18, 4.29, 4.49-4.52, 4.61, 4.84, 4.92, 6.28, 6.29 United Nations Disaster Relief Office, 4.55 United Nations Economic Commission for Europe. 2.38, 4.16, 6.102, 6.106 United Nations Educational. Scientific and Cultural Organization, 6.30 United Nations Environment Programme, 4.69-4.73, 4.75, 6.30 United Nations Fund for Population Activities, 2.78, 3.56, 3.58 United Nations Relief and Works Agency, 7.15 United States of America, accident prevention, 7.9 appropriate technology for health, 7.22 elderly, 7.18 environmental health, 4.88 immunization, 2.70 maternal and child health, 2.79, 7.32 W H O Special Programme for Research on Aging, 1.18 Vaccination ce rtifica te requirem ents and health advice f o r in te rna tiona l travel, 1.47 Vaccines, 6.109 Venezuela, 7.4, 7.7 Viet Nam, 7.19 Violence, 2.6, 3.91, 3.92 Visual display terminals, 4.30 Voluntary contributions, 1.39 and Table 1 Voluntary Fund for Health Promotion. 1.39 Wastes disposal, 4.4, 4.77, 4 .8 7 - 4 .8 8 , 7.37 Water supply and sanitation, 4.5, 4.8, 4.27, 4 .4 0 -4 .6 5 , 6.57, 8.7 see also International Drinking Water Supply and Sanitation Decade Welding fumes, 4.25 W H O headquarters, 1.2, 1.41, 1.49, 6.4 Advisory Committee on Health Research, 7.18 AIDS, 1.29, 2.54 appropriate technology for health, 7.20 data bases, 6.54, 6.62 diarrhoeal diseases. 2.55 disaster preparedness, 2.120, 7.34 electronic mail, 6.64 environmental health, 4.43. 4.55, 4.58 Global Programme Committee, 1.44 health manpower, 6.84, 6.87 H F A indicators. 6.55 informatics support, 6.65 mental health, 2.31 noncommunicable diseases, 2.101 pharmaceuticals. 7.41 Programme Committee. 7.1 W H O Regional Committee for Europe, 1.1, 1.2. 1.3. 1.8, 1.9, 1.11, 1.18, 1.21, 1.55, 2.42, 3.75, 3.77,4.10,4.33,4.34.6.4,6.5,6.7,6.57.6.77,8.1 W H O Regional Office for Africa, 7.40 W H O Regional Office for the Americas. 2.121, 7.7, 7.33 W H O Regional Office for the Eastern Mediterranean, 1.31.6.64 W H O Regional Office for South-East Asia, 7.40 W H O Regional Office for the Western Pacific. 6.64. 7.40 W H O ’s Fortieth Anniversary. 1.16, 1.18, 1.26 W H O ’s resources. 1.4, 1.13 WHO-sponsored courses, see Fellowships World Bank. 4.18, 4.55. 7.3 World Confederation for Physical Therapy. 7.16 World Conference on Surgical Efficiency and Economy, 6.107 W o rld d ire c to ry o f denta l schools, 1963. 2.60 World Federation for Medical Education, 6.78 World Health Assembly. 1.1. 1.6, 1.8, 1.36 161 World Health Day, 1.27, 2.71 World Hypertension League, 2.89 World Meteorological Organization, 4.38, 6.30 World Organization of National Colleges, Academies and Academic Associations of General Practitioners (WONCA), 6.84 World Psychiatric Association, 2.25 Youth, see Adolescents and young people and Children Yugoslavia, accident prevention, 2.112, 2.113 AIDS, 2.48 country programme, 1.20, 2.10, 2.14, 2.19, 8.6 diarrhoeal diseases, 2.55 Yugoslavia (contd) disability, 2.18 elderly, 2.14 environmental health, 4.18, 4.52, 8.6 health manpower, 5.41 H F A strategies, 6.7 malaria, 2.74 nursing, 5.26 oral health, 2.62 primary health care, 5.12 quality assurance, 5.37, 5.45 rehabilitation, community-based, 2.19 research, 6.14 social equity and health, 2.10 Zimbabwe, 7.15 1 6 2

T H E W O R K O F W H O IN T H E E U R O P E A N R E G IO N 19X7 W o rld H e a lth O rg a n iza t io n . R e g io n a l O ffic e fo r E u ro p e . R e g io n a l D ire cto r T h e w ork o f W H O in the E u ro p e a n R e g io n 1987 / an n u a l report o f the reg ion al d irector C o p e n h agen : W H O . R e g io n a l O ffice fo r E u ro p e , 1988 IS B N 9 2 -8 9 0 -1055-X R e g io n a l H e a lth P la n n in g — H e a lth fo r A l l — E u ro p e T h e W o rld H e a lth O rg a n iz a t io n is a spe cia lize d agency o f the U n ited N a tio n s w ith p rim a ry re sp o n sib ility for in te rn a tio n a l health m atters and p u b lic health. T h ro u g h th is O r g a n iz a t io n , w h ich was created in 1948, the health p ro fe ss io n s o f som e 160 co un tries exchange their kn ow led ge and experience w ith the a im o f m a k in g p ossib le the atta inm ent by a ll citizen s o f the w orld by the year 2000 o f a level o f health that w ill perm it them to lead a so c ia lly and e co n o m ica lly p ro d u ctive life. T h e W H O R e g io n a l O ffic e fo r E u ro p e is one o f s ix re g io n a l o ffices th ro u g h o u t the w o rld , each w ith its ow n p ro g ra m m e geared to the p a rt ic u la r health p ro b le m s o f the co u n trie s it serves. T h e E u ro p e a n R e g io n has 32 active M em b er S ta te s ,“ and is un iq u e in that a large p ro p o rt io n o f them are in d u stria lize d co un tries w ith h ig h ly ad va n ce d m edica l services. T h e Eu ro p e a n p ro gram m e therefore d iffers from those o f other reg ions in co n ce n tra tin g on the p rob lem s associated w ith in d u stria l society. In its strategy fo r a tta in in g the goa l o f “ health fo r a ll by the year 2000” the R e g io n a l O ffice is a rra n g in g its a ctiv ities in three m ain areas: p ro m o tio n o f lifesty les co nd u cive to health; reduction o f preventable co n d itio n s; and p ro v is io n o f care that is adequate, accessib le and acceptable to a ll. T h e R e g io n is a lso ch aracte rized by the large num ber o f languages spo ken by its peoples, an d the re su ltin g d iff ic u lt ie s in d isse m in a tin g in fo rm a tio n to a ll w ho m ay need it. T h e R e g io n a l O ffic e p u b lish es in fo u r lan guages — E n g lis h , F re n ch , G e rm a n and R u ss ia n — an d a p p lic a tio n s fo r righ ts o f tran sla tio n in to other languages are m ost welcom e. a A lban ia , A ustria , Belgium , Bulgaria, C zechoslovakia , D enm ark , F in land , F rance , G erm an D em ocratic Republic, F ederal R epublic o f G erm any , G reece , H ungary , Iceland , Ire lan d , Israel, Ita ly , L uxem bourg , M alta , M onaco , N etherlands, N orw ay, P o land , P ortugal, R om ania, S an M arino , S pain , Sw eden, Sw itzerland, T urkey , U SSR, U nited K ingdom and Y ugoslavia. THE WORK OF WHO IN THE EUROPEAN REGION 1987 Annual Report o f the Regional Director W O R L D H E A L T H O R G A N I Z A T I O N Regional Office for E u ro p e C O P E N H A G E N 1988 Feature Action Plan on Tobacco: Smoke-free Europe ( b e tw een pages 54 a n d 55) © W o r ld Health O rgan iza t ion I9XX Publicat ions o f the W o r ld I lea lth O rgan iza t ion enjoy copyrigh t pro tect ion in accordance w ith the provisions o f Pro tocol 2 o f the Universal C o p y r ig h t C onven tion . F o r r ights o f rep roduc t ion or t rans la t ion, in part o r ш loto. o f pub l ica t ions issued by the W H O Regional Off ice fo r I 'n ro p c app l ica t ion should be made to the Regional O ff ice fo r Huropc. Schcrfigsvej X, 1Ж-2100 Copenhagen 0 . D enm ark . 1 he Regional Off ice welcomes such applications. f i le designations employed and the presentation o f the materia l in this pub l ica t ion do not imply the expression o f any o p in io n whatsoever on the part ol the Secretaria l ol the W o r ld Health O rg a m /a t io n concerning the legal status o f any coun try , te r r i to ry , city or area or o f its authorit ies, o r concern ing the de l im ita t ion o f its f ront iers or boundaries. I lie m ent ion ol specific companies or o f certain m anufacturers ' products does not imply that they arc endorsed o r recommended by the W o r ld I lea lth O rgan iza t ion in preference to others o f a s im ila r nature that are not mentioned. Hrrors and omissions excepted, the names o f p rop r ie ta ry products are distinguished by in it ial capital letters. I ' l ( l \ I I I l l s 1)1 S \ 1 \ K k EUR/RC38/2 ISSN 1014-4323 (print) CONTENTS Page F o r e w o r d ................................................................ ix 1. Regional policy development, evaluation and p r o g r a m m e management ...................................... 1 General programme management and development ......................... 1 Coordination with countries ............................................. 4 Health information of the public ......................................... 5 Support programmes ................................................... 6 Personnel.......................................................... 6 General administration and services ................................... 7 Budget and finance ................................................. 7 Staff development and training ........................................... 8 Publications........................................................... 9 Epidemiology and statistics .............................................. 11 2. Health for all in Europe by the year 2000 .......................... 13 Target I. Hquitv in health .............................................. 14 Target 2. Adding life to years .......................................... 15 The elderly ........................................................ 15 Target J. Better opportunities for the disabled ............................ 16 Health legislation .................................................. 16 Community-based rehabilitation ...................................... 16 Target 4. Reducing disease and disability ................................. 17 Disability prevention ................................................ 17 Genetics services ................................................... 17 Rheumatism ....................................................... 17 Mental health ...................................................... 18 Communicable diseases .............................................. 20 Oral health ........................................................ 23 ta rg e t 5. Eliminating seven specific diseases .............................. 24 Diseases preventable by immunization ................................. 24 Malaria ........................................................... 25 v Target 6. Lite expectancy at birth ....................................... ... 25 Target 7. Reducing infant mortality rates .................................... 26 Target X. Reducing rates of maternal mortality ............................ ...27 Target 9. Combating diseases of the circulatory system .........................27 Target 10. Combating cancer ...............................................29 Target I I . Reducing accidents ...............................................31 Accident prevention ................................................ ...31 Disaster preparedness ............................................... ...32 Target 12. Stopping the increase in suicides ....................................33 3. Lifestyles conducive to health ...................................... ...37 Target 13. Healthy public policy ......................................... ...39 National health promotion policies .................................... ...39 National alcohol policies ................................................41 National drug policies ............................................... ...41 Target 14. Social support systems ........................................ ...42 Target 15. Knowledge and motivation for healthy behaviour ................. ...43 Health education and health promotion ...................................43 Sexuality and family planning ........................................ ...46 Target 16. Promoting positive health behav iour ............................ ...47 Sexuality and family planning ........................................ ...47 Nutrition .......................................................... ...48 Smoking and health ................................................. ...49 Target 17. Decreasing health-damaging behaviour .......................... ...50 Research .......................................................... ...50 Drug abuse ...........................................................51 Alcohol abuse .........................................................52 4. Healthy environment ............................................... ...55 Target IS. Policies for a healthy environment .............................. ...57 la rg e I 19. Monitoring, assessment and control ol risks in the environment ..... ...58 Chemical hazards .................................................. ...59 New technologies ................................................... ...60 Nonionizing radiation ............................................... ...60 Ionizing radiation .................................................. ...60 V I T a rg a 20. Water pollution .............................................. 62 Mediterranean Action Plan ........................................... 66 Target 21. Protection against air pollution ................................. 68 Target 22. Food safety ................................................. 70 Target 23. Protection from hazardous wastes .............................. 71 Target 24. Healthy homes ............................................... 71 Target 25. Healthy working conditions .................................... 72 5. Appropriate care ................................................... 75 Target 26. A health care system based on primary health care ................ 76 Nursing/midwifery ................................................. 76 Hospitals .......................................................... 77 Health legislation .................................................. 77 Target 27. Rational and preferential distribution of resources according to need . . 78 Health economics .................................................. 78 Health service delivery and health institutions ........................... 78 Health care providers ............................................... 79 Target 2S. Content of primary health care.................................. 80 Target 29. Providers of primary health care ................................ 81 Target 30. Coordination of community resources for primary health care....... 82 l a r g e / J I. Ensuring the quality of services ................................. 82 6. Research and health development support ......................... 85 Target J2. Research and health for all ..................................... 86 Target JJ. Policies for health for all ...................................... 87 Collaboration with other organizations ................................. 89 Target 34. Management of planning and resource allocation .................. 91 Target 35. Health information systems .................................... 94 Target 36. Planning, education and use of health personnel for health for all .... 97 Fellowships ........................................................ 99 Target 37. Education of personnel in other sectors to support health lor all ..... 102 Target 3H. Health technology assessment .................................. 102 Pharmaceuticals ................................................... 104 7. Global programmes ................................................ .. 109 Global programme l'or accident prevention ................................... 109 Global programme for health of the elderly .................................. Ill Global programme for appropriate health care technology ...................... 113 Regional activities of interregional scope .....................................114 8. Country programmes ............................................... ..119 Health for all policies .................................................. ..120 Inequity in health, and disease prevention and control .........................120 Healthy lifestyles .........................................................120 Healthy environment ................................................... ..121 Appropriate care .........................................................121 Support for health development ......................................... ..121 Improving cooperative’mechanisms....................................... ..121 Annex 1. Active and non-active Member States of the World Health Organization, huropcan Region, 31 December 1987 ...................................123 Annex 2. hstimated populations in 1987 for the active Member States of the W H O huropcan Region ..............................................124 Annex 3. Professional staff in the Huropcan Region, 31 December 1987 ..............125 Annex 4. Organizational chart of the Regional Office, 31 December 1987 ............127 Annex 5. Intercountry meetings convened by the Regional Office for Europe. 1 January — 31 December 1987 ..................................... ..128 Annex 6. WI Ю-sponsored courses in the huropcan Region, or courses relevant to Regional Office programmes, 1987 ......................... ..135 Annex 7. hist of W H O collaborating centres with which the Regional Office concluded plans of action covering the year 1987 .........................138 Index ......................................................................151 v m Foreword In the European Region o f WHO, the health fo r all (HFA) m ovem ent was horn in Septem ber 1980 when the European HFA strategy was adopted by the Regional Committee, and came o f age in 1984 with the adoption o f the 38 regional HFA targets. That the Regional C om m ittee should be ready to agree on such radical new principles in health was due to the single fa c t that those leaders in health who m ake up the Regional C om m ittee have had the vision and courage to look beyond their individual countries' existing policies. They col­ lectively com m itted them selves to a goat which, when the movement started, could not have been adopted nationally by the great m ajority o f the countries. Following on fro m this situation, the f ir s t step has been to build true political com m it­ m ent in the individual M em ber States. Since 1985, therefore, the main thrust o f the work o f the Regional O ffice has become one o f stim ulating individual countries to develop their own national HFA policies based on the regional model. In 1987, a particularly active year, several countries made great progress in this work. By the end o f the year m ore than h a lf o f the 32 M em ber S ta tes had com pleted the developm ent o f broad new national HFA policies, or were at different stages o f an official planning process to do so. Several countries were considering starting sim ilar exercises, and in m ost o f the remaining countries other efforts were being made to strengthen the HFA aspects o f national policies. In 1987 the Regional O ffice was closely associated with most o f these policy developments; frequently, its s ta f f were intim ately involved in the initial discussions and in the subsequent development o f these new policies. A particularly interest­ ing fea tu re o f the thirty-seventh session o f the Regional C om m ittee was that the M ember S ta tes spent fa r more time discussing the Regional D irector’s report than usual, because they had so much to say about their own national HFA development. Nevertheless, one should not overlook the fa c t that there are stilt countries where, although the health authorities arc actively supporting HFA, the concept o f such a policy has not ye t fully penetrated the minds o f leading politicians. The overall trend is, however, encouraging. The work o f the Regional O ffice can be effective, m eaningful and worthwhile only i f it helps to stim ulate real action fo r change in countries, (liven the small number o f professional s ta f f in the Regional O ffice — between 50 and 60 — it was obvious that very careful thought had to be given to how the O ffice could best act as a catalyst in the many areas covered by the regional HFA policy. When in 1984/1985 n r discussed how the O ffice could best tackle the form idab le task o f stim ulating and supporting national action in Europe, it became clear that new approaches had to be developed. I X New e fforts have been m ade to stim ulate translation o f the book Targets for health for all into local languages and to improve its distribution within countries. As a result, the book has now appeared in 1 7 different language editions in 14 countries. Nevertheless, there remains the major problem that only in relatively few countries does the health m inistry or other bodies ensure its distribution throughout the health services to politicians, admin­ istrators, etc., a task that needs higher priority and better planning in many countries. W HO in general, and the Regional O ffice in particular, has a problem in not being too well known by the general public. A recent survey in one o f the European M em ber S ta tes showed that slightly more than three quarters o f the population knew about WHO, but only h a lf had a good understanding o f what the Organization really stood for. In 19X7, therefore, the Regional O ffice stepped up its public relations work and decided, inter alia, to m ake a special effort through television, now a major means o f communication in the Region. As a result, cooperative agreements were concluded fo r two national and fo u r international television series that will explain to millions o f viewers during the next 2 -3 years the regional HEA policy, its different programmes, and W H O ’s role in its development. Even so, these successful initial negotiations will need to be pursued even more vigorously to fu rth er increase W HO involvement in television. A second strategic elem ent in prom oting W H O 's image and knowledge o f HEA in M em ber S ta tes was created by the decision o f the Regional C om m ittee in 1986 to see what effect could be obtained by all 32 M em ber S ta tes promoting ju s t one selected area among the 38 regional HEA targets. Since tobacco use is the single largest risk to health in the European Region — killing up to 15'Zc o f the population in some M ember S ta tes — the C om m ittee chose a regional campaign to combat tobacco. In 1987 the O ffice subm itted to the Regional C om m ittee the plan o f action for such a campaign; the proposal was accepted and its im plem entation was begun. Incidentally, this European initiative was particularly well received at the International Conference on Sm oking, held in Tokyo in November. The Regional O f fice will also use this campaign as an experim ent to see how W H O can use its existing wide-ranging network o f collaboration with m any scientific institutions and organizations to create a broad popular m ovem ent for a sm oke-free Europe, stim ulating action at m any levels o f society. In this context, the Regional O ffice first decided to put its own house in order as an exam ple to those it was trying to convince. An action plan to m ake the Regional O ffice a sm oke-free working environment (which became fully effective on 1 January 1988) was therefore worked out and adopted, and a series o f smoking withdrawal courses was organized for s ta f f and their fam ilies and friends, with considerable success. Likewise, it was felt that the M em ber S ta te s should also start with the health sector. The Regional C om m ittee therefore decided in Septem ber to urge all countries to m ake health premises (offices and clinical institutions) smoke-free, and it pleaded with all organizations o f health personnel to begin helping their own members to refrain from smoking. In the sam e spirit, the Regional O ffice convened a m eeting with all national medical associations in Europe, in Paris in November. M odel guidelines were presented on how to help physicians stop smoking, how to counsel patients in this area, and how medical associations can support national anti-sm oking programmes. This was well received by the associations, and the Regional O ffice will henceforth m onitor progress annually. The same ideas were presented during a m eeting with pharm aceutical associations o f the Region in November, and a positive response is also expected fro m them. The Regional O ffice is planning to undertake sim ilar initiatives with, fo r example, Huropcan associations o f nurses and o f teachers. Another im portant approach to increasing the effect in countries o f the European HFA m ovem ent are fo u r special projects known in the Regional O ffice as the " common delivery vehicles”. In essence, these are long-term cooperative projects between specially designed national program m es in interested M em ber S ta tes and technical s ta f f o f the Regional Office. These projects deal with the design and im plementation o f HFA policies and program m es so as to reach key target areas and decision-m aking groups in countries. A t the mom ent three o f these “ vehicles" exist, as explained below. □ N A T I O N A L H i A P O L IC Y -M A K IN G . A group in the Regional O ffice has been created fo r senior planners and decision-m akers in charge o f HFA policy-planning exercises at national and subnational levels. A special subgroup unites the so-called "p lura listic” countries. Work proceeded well in this area in 1987. □ T I I L i l l \ l T H Y ( T H I S PRO.ILCT. Focusing on HFA development at city level, this project hopes ultim ately to interest city adm inistrations throughout Furope in the HFA movement. Traditionally these administrations have not worked with WHO, and they are often very badly inform ed on health policy initiatives at international level. S ince these administrations often have more power to fo rce through m ultisectoral policies and com­ m unity involvement projects, they offer a particularly interesting target group for the European HFA movement. To respond to the great interest generated so far, a Healthy Cities project office was established at the Regional O ffice during the year, and a second group o f cities jo ined the project, bringing the to ta l at present to 25 cities fro m 16 M em ber States. Moreover. H ealthy Cities netw orks have em erged in nearly all countries, involving over 100 European cities. The only disappointment in this project is the relative scarcity o f W H O 's resources. With a little more human and financial resources at its disposal, the Regional O ffice could expand and strengthen very considerably this extrem ely prom ising project. To this end 1987 saw greater efforts to raise voluntary contributions fo r the Healthy Cities project. □ I H i : c i n d i P R O G R A M M !: . The countrywide integrated noncommunicable disease in­ tervention (C IN D I) program m e has already been described in the Annual Reports o f the Regional D irector fo r 1985 and 1986. The focus o f this 3-year-old program m e is those countries that are in terested in working together on the development o f broad-scale pro­ gram m es fo r perm anent change towards more healthy lifestyles fo r their populations. More countries jo ined the program m e in 1987, bringing to ten the number o f countries now collaborating in this activity. A ll these different ''vehicles” sell essentially the same message, addressing the four main thrusts o f the HFA movement. W H O 's role is to help with the organizational develop­ m ent and scientific infrastructure o f national programm es in these areas. In addition, these projects and program m es provide an opportunity fo r all the countries that work with the same problem s to share their experiences, successes and failures, thereby learning more quickly and gaining inspiration fro m each other's efforts. Another approach that look a more fo rce fu l turn in 1987 was W H O 's a ttem pt to interest the universities in Europe in the HFA movement. During the year several meetings were organized to prepare fo r the establishm ent o f a European netw ork o f universities fo r health fo r all. It would seem that some o f the difficulties encountered in the past are now being overcome, leading to the creation o f a firm basis fo r planned development. An im portant decision by the Regional C om m ittee in Septem ber was that the Regional O ffice would develop over 2 -3 years a special educational approach in support o f HFA. This will deal with the fundam enta l changes that need to be made in regard to the education ( both basic and continuing) o f physicians, nurses and other health personnel, and perhaps also personnel in other sectors. The intention is to build on the experience gained in developing the European HFA targets, and to involve in this work the leading European organizations related to these issues, as well as consulting with all the M em ber States. Thus, it becomes not only a question o f developing a policy document, but o f using that process as a means o f creating awareness and motivation fo r change by involving the key people and institutions in the process. Another positive development in 1987 was the identification o f three or fo u r medical schools that have sta ted their willingness to work closely with the Regional O ffice to analyse the need fo r — and thus im plement — the changes in medical education that need to be made in order to train physicians in line with the HFA policy. Finally, the basic HFA research policy that has been developed over the last two years by the Regional O ffice and its European Advisory C om m ittee on Health Research (EA CHR) was subm itted to the Regional C om m ittee and accepted in Septem ber. With this tool in hand, the FA CH R and the Regional Office, in close cooperation with national authorities, will now start a direct dialogue with the national research academies and medical research councils throughout the Region, trying to stim ulate them to develop sim ilar national research policies and reorient their research programm es accordingly. This will give the E AC H R a considerably more active, participatory and country-oriented role than hitherto. Another mechanism fo r expanding HFA development is to get the intergovernmental and nongovernm ental organizations in Europe to actively embrace the regional HFA policy as a basis fo r their own work in health-related fields, and to work more closely with the Regional O ffice in its many applications. In 1987, the Nordic Council developed a new five-year plan fo r its work in the health and social fields that m akes extensive reference to the regional HFA policy. Another very impressive piece o f work during the year was the intensive workshop dialogue with nurses throughout Europe in preparation fo r the O ffice's 1988 conference on the implications o f HFA fo r nursing. Through close collaboration between the Nursing unit o f the Regional Office, health m inistries and national nursing associations, m any thousands o f nurses attended such workshops. In Septem ber the Regional C om m ittee discussed the f ir s t draft o f a new regional program m e on A ID S, to be carried out by the Regional O ffice in close cooperation with the Special Program m e on A ID S at W HO headquarters in Geneva. The f ir s t m ember o f s ta f f o f the new unit to deal with this program m e was recruited. M l The Regional C om m ittee also discussed a widely shared concern by its members that in m any European countries public health management has gradually been losing its influence, ju s t when the HEA m ovem ent is confronting countries with radical new challenges and a greater dem and fo r better managem ent skills in public health. In this context the Regional O ffice in 1987 started a dialogue with the Association o f Schools o f Public H ealth in the European Region (A SP H E R ) to see whether a European standard fo r training in public health managem ent based on HFA could be developed. The implications o f such a develop­ m ent would be extrem ely interesting, and m ake paten tly clear what fo rm public health managem ent should really take in European countries. But 1987 was not only a positive year. The Regional O ffice had to struggle with a budget cut o f more than two million dollars fo r the 1986/1987 biennium, necessitating a consider­ able reduction in s ta f f (by keeping posts vacant and redeploying existing sta ff) and the curtailm ent o f several programmes. Particularly hard hit were efforts to build up a better epidem iological basis f or HFA development. Progress did not continue as much as had been hoped, since the O ffice sim ply had few er hands and less money to do the work. The message received fro m the D irector-G eneral in November that the Regional O ffice had to apply the fu ll "contingency p la n ' as from I January 1988 was a further hard blow. In this situation, it was decided to revise the organization o f the Office, reducing the num ber o f services from six to f iv e and moving some s ta f f to the highest priority areas. Furthermore, m odifications were made in the basic management system to give units more m anagerial flex ib ility within approved program m es and resources, thus stim ulating their innovativeness. A t the same time, monitoring and evaluation was intensified so as to ensure greater transparency and accountablity within the new management system . Fortunately, the O ffice had for the previous 18 months been hard at work developing a new computer-based integrated management inform ation system (IM IS) to provide all units, services and the O ffice as a whole with up-to-date, on-line inform ation on the development o f all programme elem ents and their budgetary status. The O ffice was able to speed up this development to coincide with the introduction o f the new management system as o f I January 1988. The effect o f these various changes will be fu lly assessed next year, since the present report covers an odd year and does not contain any actual evaluation o f programme implementation. However, 1987 was also a year in which important progress was made with regard to the country program m es o f collaboration with M ember States. As reported last year, one o f the main developm ents that the O ffice has been advocating during the last 3 -4 years has been well planned medium -term program m es o f cooperation between the Regional O ffice and individual M em ber S ta tes o f the Region. A t the end o f 1987, such program m es had been or were being developed with 23 of the 32 M em ber States, and by the end o f 1989 there should be very few countries with which the O ffice does not have such programmes. An interesting development is that it is now no longer ju st a m atter of the Regional O ffice trying to persuade the M em ber States; more and more countries that do not yet have such medium -term programmes arc asking for them to be established. The quantity o f m edium -term programmes is, however, only one measure o f success; far more im portant is their quality. In 1987 therefore the Regional O ff ice created the new unit o f C ountry Program me Coordination, which has as its sole responsibility the quality o f XII) medium -term program m es with individual M em ber States. This implies, on the one hand, improving dialogue with individual countries as to whether the medium -term program m e really addresses that country’s own priority development needs and, on the other hand, assessing whether the Regional O ffice units are providing the best possible team effort in support o f those programmes. In this work, however, it is extrem ely im portant not to fo o l ourselves; it is only too easy to be content with the program mes that the Regional O ffice and the individual countries have developed together. There is only one way to avoid complacency and ensure that we continuously learn fro m our own m istakes and ceaselessly work to improve our perform ­ ance. That tool is evaluation; an evaluation that includes not only the two partners involved in the planning o f the work, but also a more neutral, analytical and technically com petent third party that can provide a measure o f unbiased observation. To this end the Regional O ffice undertook, jo in tly with W HO headquarters and one o f the European M em ber States, a second"financia l audit in policy and program m e terms". This proved very positive indeed. As in any other endeavour, ive can o f course always improve our perform ance over tim e and with more experience, but I believe that n r already have the basic tool that we need fo r the routine evaluation o f W HO country programmes, both in the European Region and beyond. In m y view this k in d o f approach is a crucial safeguard in the continuous improvement o f W H O 's work at country level. J.E. Asvall Regional Director Par t i c ipan ts in the th i r t y -s eve n th sess ion of the Regiona l C om mi t te e , g a the re d in the c o u r t y a rd of The Hal le. Bruges . The Reg iona l D i rec to r . Dr J.E. Asval l , w e l c o m i n g the Se cre ta ry o f State fo r Publ ic Heal th and Po l i cy fo r the H a n d ic a p p e d , Be lg iu m , M r s W. De M e e s t e r - D e Meyer , to the th i r t y - seven th sess ion of the Reg ional C o m m i t te e . The o u t g o i n g Ch a i rman, Sir D o n a ld Ac h es o n , o p e n in g the th i r t y -se ve n th sess ion of the Regional C o m m i t t e e in The Hal le, Bruges. O f f i c e rs at the th i r t y -s e v e n th sess ion of the R eg iona l C o m m i t t e e . F rom left to r ight , P ro f ess or J. Szczerban (V ice -C ha i r ma n) , Mr s W. De M e e s t e r - D e M e ye r (Cha i rman) , Dr J.E. Asval l (Reg iona l D i rec to r ) , D r J . R o c h o n (D i r ec to r , P ro g r a m m e M a n a g e m e n t ) and M r J. D o n a ld (D irec to r , S u p p o r t P rogrammes) . Dr J. R o c h o n (left), p i c t u re d at the th i r t y -s e ve n th sess ion of the Regiona l C o m m i t te e , so o n af ter tak ing up his pos t as the ne w D i rec to r , P r o g r a m m e M a n a g e m e n t at the Reg iona l Of f ice. The t h e m e of the c e l e b r a t i o n of In te rna t io na l W o m e n ' s Day 1 9 8 7 in the Regiona l O f f i ce was the o u ts i d e in teres ts of the staf f . The c e le b r a t i on in c lu d e d bo th exh ib i t s and d e m o n ­ s t ra t ion s of arts, c raf t s and o th e r pe rso na l interests. As we l l as o r ga n iz in g the spor ts exhibi t . Grace T i r ado Perez is here seen d e m o n s t r a t i n g d ress ma k ing . P a r t i c i pa n ts in the m e e t in g of the C o n s u l t a t i v e G ro u p on P r o g r a m m e D e v e lo p m e n t , held at the Regiona l O f f i ce f r o m 2 1 to 2 4 Apr i l . 1Regional policy development, evaluation and programme management General programme management and development i l Many issues emana t ing from the seventy-ninth session ol the Executive Board and the Fort ieth World Heal th Assembly had impor tant implications for the work of the Regional Office throughout 1987. These were fur ther discussed at the thirty-seventh session of the Regional Commit tee , following pr ior detailed review by the Consultative G r o u p on Programme Development at its annual meeting in April. 1.2 The problems raised in the Director-Genera l ’s int roduct ion to the Organizat ion 's proposed p rogramme budget for 1988-1989 and the suggested solutions and measures for improvement , led to a thorough analysis of the present mechanisms and o p p o r ­ tunities for s t rengthening the relationships and links between headquar ters , the regional offices and countries. In general, both within W H O itself and at the Regional C o m ­ mittee, the issues raised provided real food for thought as to the management o f W H O ’s resources. The Member States conf irmed in general terms their acceptance of and satisfaction with the mechanisms established over the past few years in prog ramme budget planning, implementat ion and evaluat ion, using the regional p ro gr am me budget policies as a basis for these exercises. There was a need, however, for st reamlining and expanding some of the areas, particularly as regards the evaluat ion o f country and intercountry programmes. Initial steps are therefore being taken to improve the evalu­ a tion procedures o f both country and intercountrv programmes in keeping with existing mechanisms and methodologies, so as to submit concrete proposals to the thirty-eighth session of the Regional Commit tee in 1988. i l Dur ing the period under review work cont inued on s t rengthening the evaluation of the p rogramme of the Regional Office, and new indicators were devised to evaluate the col laborat ive activities developed with Member States. A small group met at the end of J un e to make recommendat ions on how best to report the results o f the evaluation to the Regional Committee. I 1.4 A second financial audi t in policy and p ro gr am me terms was performed in the European Region, where the use of W H O ’s resources in Hungary was reviewed against the adop ted policies, with a view to improving W H O technical cooperat ion. This was under taken jointly by the Regional Office, W H O headquar ters and the country con­ cerned, and the results proved highly positive. This type of audit aims at determining how and by whom decisions to use W H O ’s resources are arrived at, to what extent the joint g o v e r n m e n t /W H O activities comply with collective policies, and what those activities have achieved. The following issues are thus covered: the relevance o f the W H O collaborat ive p ro g ram me to country needs and policy compl iance: managerial f rame­ work; the adequacy, efficiency and effectiveness of the Organizat ion's support : and recommendations . 1.5 Work on a neu integrated managemen t information system (IMIS) was nearing complet ion at the end of the year, having been developed to assist management at all levels in the planning, programming, budget ing, implementat ion, moni tor ing and evalu­ at ion of the work of the Regional Office. It will cover the in tercountry program me as set out in the proposed p rogramme budget document with all its elements (i.e. targets, objectives, ou tpu ts and activities) including budget ing, votes and comments by Member States on the draft progr am me budget , and links to o ther organizat ions and p ro ­ grammes. It will also incorporate country medium-term programmes. It will produce project status informat ion, p rogramme moni tor ing notes and financial reports. 1.6 As regards the role of the Secretariat , and in view of the financial constra in ts that have necessitated implementa tion of the contingency plan, a comprehensive analysis of the staff functions at different organizat ional levels was carried out and a reorganization of the Regional Office s tructure in troduced as from 1 Jan u a ry 1988. Dur ing 1987, however, in orde r to maintain the level of programme delivery, several members of staff under took functions in addi tion to their own. Therefore, al though formal evaluat ion of the 1987 p ro gram me will not take place until later in 1988, it can be said now that the inputs to the main p ro gr am me thrus ts were implemented. In relation to this, special a t tent ion was paid to the horizontal approach to progr am me delivery, taking into account the necessary interplay am ong programmes in working towards the regional health for all (H F A ) targets, as well as the programme st ructures set out in the Eighth General Programme of Work adopted by the Fortieth World Health Assembly. 1.7 The progress in developing H F A policies t h ro ug ho ut the Region has indeed proved encouraging. Al though a number of countries are confronted with economic const raints, more and more Member States have genuinely taken up the challenge of actively bringing their long-term health development in line with the regional strategy and targets. In this connect ion, not only were the national health authori ties involved, but increasingly intergovernmental and nongovernmenta l organizations s tarted to join the movement, leading to new programmes at national or local levels. l.x The Regional Commit tee at its thirty-seventh session covered a wide range of topics, the major technical issues being: the AIDS situation in Europe and the proposed European activities to complement those of the global strategy, which the For t ieth World Heal th Assembly had adop ted in May 1987; the ques tion of health personnel development in support of H F A where three specific disciplines were discussed, i.e. public 2 health managers , doctors and nurses; and the action plan on tobacco, which places emphasis on the protect ion of non-smokers and the responsibility of health professionals and admin is t ra tors in setting an exemplary role, par ticularly at places of work and in all health-related institutions. I.y The Commit tee reques ted the Regional Director to ensure that , between the session of the Executive Board in Ja nua ry 19XX and the meeting of the Consultative G ro u p on Programme Development in April, the subject of the selection of the Regional Director be discussed in a regional context, so that proposals could be submitted to the thirty-eighth session of the Regional Committee. I.in The planning for the 1990-1991 p rogram me budget started in Jan u a ry 19X7 on the basis of the Regional Director ' s policy guidance, the regional contribution to the Eighth Genera l P rogramme of Work, the ou tcome of the internal evaluat ion exercise, and the restrictions imposed by the contingency plan. i n The draft p ro gr am me budget for 1990-1991 with projections up to 1995. the so-called "consul ta t ion letter” , was distributed to Member States in October. In view of the cont inued serious financial si tuation, it was decided not to convene the usual briefing seminar on the consul ta t ion letter and instead the document was d ist ributed earlier than usual, leaving Member States more than three months to collect and return their com men ts to the Office. This fulfils the request made at the Regional Commit tee in September , where it was pointed out that countries should be allowed sufficient time to give full considerat ion to the consul tat ion letter. 1.12 The 1990-1991 programme budget is the second to be prepared on the basis of the regional H F A targets and emphasis has this time been placed on four “ common delivery vehicles” , i.e. s timulat ing the interest of local administ rat ions and city councils in the Heal thy Cities project; promot ing the district health systems approach; using the C1ND1 approach to control ling noncommunicablc diseases; and suppor t ing countries interested in establishing national and subnat ional health policies. 1.13 In view of the present financial difficulties, the Consultative G ro u p on Pro­ gra mm e Development (CG PD), which met in Copenhagen in April , was asked to advise the Regional Director on mat ters that would normal ly have been submitted to the Regional Heal th Development Advisory Council . The C'GPD therefore gave advice on policy, financial and management issues such as the action plan on tobacco, manpower in suppor t of H F A , research for HI A, management of Wl lO's resources, and moni tor­ ing progress towards HEA. 114 The C G P D approved the content of the revised contingency plan, but found it regrettable that payment of contribut ions by countries in other regions was delayed, while the European Member States had always honoured their commitments. I 15 It had become clear that the Regional Office would have to mobilize extra- budgetary funds in order to implement the strategy as adopted, especially with regard to the urgent need for certain new programmes in response to ci rcumstances , such as AIDS. New sources of funds would also have to be found. The C’CiPD was generally favourable to that approach, but felt that caution should be exercised to preserve WH O 's 3 authori ty. Potential donors should be very carefully selected, and it was impor tant that donat ions be sought in areas that corresponded to the Office’s own priorities. 1 . 16 Specific proposals for improving W H O ’s public image were reviewed. The impor tance of making W H O better known through the media and the H F A policy was emphasized, especially in prepar ing for W H O ’s Fort ieth Anniversary in 1988. The C G P D felt tha t recognizable symbols, such as the regional H F A logo, should serve to make W H O bet ter known at the com muni ty level and am ong the general public. Reaching the latter on highly topical issues such as AID S and the consequences of nuclear accidents would show that W H O was actively dealing with these problems, which in turn would reassure the publ ic and give W H O the type of publicity it needed. Coordination with countries i n Increasing priority is given by W H O as a whole, and by the Regional Office in particular, to coopera tion with countries in their efforts to develop health policies and programmes in line with H F A principles. Similarly, interest by the European Member States in such coopera t ion has increased in the past few years. To suppor t this develop­ ment a post of Count ry P rogramme Coordinator , sup por ted by an administ rat ive assistant and a secretary, was created in the Regional Office as of the 1986-1987 p ro gram m e budget period, and the incumbent took up his functions in September 1987. 1.18 The Regional Director visited Albania, France, the G e rm an Democrat ic Re­ public, Hungary , Ireland, Israel, Norway, Poland and Spain for discussions with the nat ional health authori ties on H F A strategies and the development of nat ional health policies; Bulgaria to a ttend the European Conference on the Prevention and Control of Chronic N oncommun ica ble Diseases in Varna; Czechoslovakia to a t tend the Third European Regional Symposium of the In ternat ional Physicians for the Prevention of Nuclear War; France to discuss mat ters related to the thirty-ninth session of the Regional Commit tee in 1989, a health for all policy movement, and the likelihood of a second French city joining the Heal thy Cities project; the Federal Republic of Ge rm any to par ticipate in the opening ceremony of the European Congress on Heal thy Cities; Norway to join a roun d table conference on the future role of the medical doctor; Sweden to address the 10th General Assembly of ASPHER; Switzerland to a t tend the seminar “ The health of the Swiss by the year 2000: which cantonal policies?” ; the Union of Soviet Socialist Republics to have discussions with the Minister of Health of the USSR on the new nat ional health policy, and on mat ters of col laborat ion between the Office and the USSR; the Uni ted Kingdom to have discussions with the outgo ing Cha i rm an of the Regional Com mit tee on a nu mber of issues related to the thi rty-seventh session, and to discuss a special exhibit ion being prepared to celebrate the fortieth anniversary of WH O , which will include a special section on activities in the European Region; and the United States of America to par ticipate in a meet ing on the W H O Special P rogramme for Research on Aging. 1.19 Delegat ions from Spain visited the Regional Office on two occasions, first to receive a briefing on the work of the Regional Office, and to discuss the country medium-term programme, and again to discuss fur ther col laborat ion with W H O and the 4 development of a health policy in Spain. A briefing was ar ranged for a delegation from Wales, especially on the CIND1 and Healthy Cities projects. The Chief, Internat ional Organizat ions , Ministry of Heal th of Hungary visited the Regional Office to discuss col labora tive activities between the Regional Office and that country. A general briefing p ro gram me was ar ranged for a delegation from Czechoslovakia, and discussions with a San Marino delegation headed bv the Minister of Health included cooperat ive activities for 1988-1989. 1.20 In Jan uary , a mission from the Regional Office visited Italy to discuss priority mat ters to be included in the medium-term p ro g ram me of coopera t ion between that country and the Regional Office. A medium-term p ro gr am me between Turkey and the Regional Office was signed in April , with Yugoslavia in July, and with the G erm an Democrat ic Republic in September. A medium-term programme of cooperat ion be­ tween the Regional Office and Poland was initiated. 1.21 Dur ing the thirty-seventh session of the Regional Commit tee in Bruges, dis­ cussions were held with 17 delegations, i.e. those o f Albania, Bulgaria. Czechoslovakia, Finland, France, the G e rm an Democratic Republic, Greece, Hungary, Iceland, Israel. Mal ta, Norway, Poland. Portugal , Spain, Sweden and the USSR. 1.22 The second joint meet ing between representatives of the Regional Office and nat ional medical associat ions (NMAs) on H F A in Europe took place in Paris in November. This second meet ing was felt to be an even greater success than the first, held in Vienna in 1986, and all NM As considered that such joint meetings should take place every year. There was a real feeling of par tnership with WH O . and recognition of a surprising num ber of c om m on interests am ong the NMAs of the Region. Am ong the items discussed were AIDS, the role of physicians in epidemiological surveillance and risk assessment, and the European concerted action on tobacco. Various topics for future meetings were suggested over and above the cont inuing one o f informat ion exchange on the role of N M As and health policy decisions. In addi tion, three draft modules on “ tobacco or heal th" were presented to the NMAs; the participants expressed their suppor t of the texts, and commit ted themselves to making full use of the modules. Health information of the public 1.2.1 As recommended by the working group, comprising representatives of Member States and communica t ions experts, that met in Reykjavik in March 1986, simple written and audiovisual material on the regional H F A targets and the work o f the Regional Office cont inues to be issued. A brochure on the regional targets and a booklet on the Regional Office, both in English and French, and a travelling exhibit ion are now available. A newsletter, a slide series, an animated film and a video cassette are being prepared. Product ion of more specific written and audiovisual material on the Regional Office's various programmes has also begun. In addi tion, outside producers are cur­ rently working on four series of television programmes on health for all in general and more specifically on the C IN D I and Healthy Cities projects; while the producers retain full responsibility for the products , the Office has st imulated their creation and offers free technical advice. 5 1.24 Intensive long-term efforts appear to be succeeding in interesting the press in the Regional Office’s HFA-rela ted activities. The Regional Office is now clearly better known and its messages more widely d isseminated by press agencies and the media. Al though it is difficult to give an accurate evaluat ion of the results of this work, it is clear that the press increasingly see the Regional Office as an interesting source of informat ion, and many journal ists now check their material with this source. Anothe r indicator o f the success of this approach is the increasing nu mber of articles, radio broadcasts and television programmes that refer to the Regional Office’s research work and other activities. The series of television programmes currently being made will also encourage the media to mobilize themselves in this way. 1.25 Since the Organ iza t ion’s s taff are the principal spokesmen for the campaign, their mobi lizat ion is essential to its success. Meetings with “ communica to rs” , jou rn a l ­ ists, advert ising executives and public relations specialists are therefore organized at regular intervals, to make Regional Office staff more aware and better informed. 1.26 A num ber o f special activities were carried out in prepara t ion for the celebration of W H O ’s For t ieth Anniversary in 1988. Writ ten and visual material related to the work of W H O produ ced bv national bodies was collected with a view to deciding how it might best be used to explain the H F A strategy to people at all levels in the community, including children. National bodies were also encouraged to produce material in their own languages p romot ing the strategy. New contacts were established in radio and television with a view to making programmes promot ing W H O in ways that would reach a wider and more general audience. Considerat ion was also given to new ways of delivering the H F A message, and popu lar texts and designs were prepared for posters, postcards, T-shirts, leaflets and other items. 1.27 World Heal th Day 1987 was celebrated in several countries of the Region. It offered the oppor tuni ty to invite journalis ts and representatives of nongovernmental organizations to par ticipate in the celebrat ion in the Regional Office. Experts gave presentat ions on the theme: “ Immunizat ion: a chance for every chi ld” . Support programmes Personnel i.2« The implementa tion o f the cont ingency plan has led to a comprehensive review of all p rogramme s and staff posit ions in the Regional Office. The main objective has been to ensure tha t the reduced funds available to the Office are appl ied to the main priorities of the H F A movement. In addi tion, the contingency plan has had to respect the contracts of all long-term serving staff, thus avoiding forced terminat ions . Nevertheless, to mai n ­ tain staff morale a great deal of time and effort have to be applied on a daily basis in the implementat ion of the plan. 1.29 Durin g the per iod under review the post o f Project Officer for Environmental Epidemiology and Food Safety was established for a limited period of two years, with s imultaneous abol it ion of the post of Regional Officer for Occupat ional Health. It is expected that the post of Regional Officer for Occupat ional Heal th will be re-established 6 in 1989. The post of Project C oord inato r for Air Quali ty Guidel ines was abolished. A post of Responsible Officer, Official Documen ts and Texts was established by simul­ taneous abol it ion of the post of Chief, Trans la t ion and Editorial. A post of Programme Analyst , Informat ics Suppor t was established by s imultaneous abolit ion of a post in the general service category. T w o interregional posts o f Medical Officer an d Health Edu­ cation Specialist, Special P rogramme on A ID S were established; the posts are funded by W H O headquar ters but are based in Copenhagen. 1.30 The propor t ion of professional and higher grade posts held by women continued to grow and had reached 279r by the end of the year. This is the highest propor t ion in the Organ izat ion at present, and is close to the target of 30% set by the Executive Board. Women represented 80cZc o f general service staff. 1.31 Al though the field post in Morocco was transferred to the Eastern Mediter ranean Region in 1986, the Regional Office for Europe cont inued to look after technical and administ rat ive mat ters concerning UNDP-ass isted projects in Morocco up to the end of 1987. General administration and services 1.32 Fol lowing discussions at the Consultative G ro u p on Programme Development , as reported above, a systematic fund-raising effort was put into effect. Valuable contacts have since been established in several countries of the Region, where plans are in hand for fur ther consul tat ion with potential donors. These activities place special emphasis on the act ion plan on tobacco, the Heal thy Cities project, the health manpow er development pr og ram me and the C IN D I project. 1.33 Addi tional economies were achieved by using a new form of postal service, involving direct mail through a commercial dist ribution company, which gave a saving of abou t 25%. 1.34 A reduct ion of some US $100 000 in maintenance costs for data and text process­ ing equipment resulted from negotiations with the com pany concerned. 1.35 A gradual phas ing out of tobacco smoking on Regional Office premises came into effect on 1 April , following consul tat ions between staff and the Occupat ional Heal th and Health P romot ion committees. A num ber of smoking cessation workshops were organized, and by the end o f the year a survey showed that 75°Z o f s taff who had previously smoked had s topped or reduced their consumpt ion. As from 1 J a n u a ry 1988 the Office will have a smoke-free environment with the exception o f one specially designated room. Budget and finance 1.36 In connection with the total expected shortfall in income arising from the reduced receipt o f assessed contribut ions in 1986-1987 the Director-Genera l , after revising the original estimates of the implications, was obliged to reduce the regional regular budget al location by a fur ther US$250 000 in 1987. Over the biennium the reduct ion thus amou nted to US$2 329 000. If the Regional Office had also had to 7 compensate for the adverse effects of currency fluctuations arising from the continued do w nw ard t rend of the US dol lar, this would have resulted in a total reduct ion of approximate ly US $8 million. Had this si tuation occurred, the repercussions arising from the non- implementa t ion of the p ro g ram me would have been irreparable. Only through the adopt ion o f resolution WH A39 .4 by the World Heal th Assembly in May 1986, which al lowed the Director-Genera l to extend to the regional offices an ar rangement for the use of casual income to reduce the adverse effects of currency fluctuations, was this dramat ic si tuat ion avoided. Thus the Regional Office, through the central control system operated globally, received full compensat ion for currency fluctuations during 1986-1987. Regular budget (biennial) 1.37 Under this heading, US$31 596 843 were expended during the b iennium, rep­ resenting 83.1% of total expenditure. Extrabudgetary sources United Nations fu n d s (annual) 1.38 The Regional Office was the executing agency for a num ber of U N D P , U N E P and U N F P A projects. A total of US $ 1 383 742 was expended in 1986 and US $1 926 366 in 1987, a m oun t ing to 8.7% of total expenditure for the biennium. These funds covered 61 country and intercountry projects in the Region. Other fu n d s (biennial) 1.39 These funds include the Voluntary Fund for Health Promot ion, Funds-in-Trust , the Special Account for Servicing Costs and the Real Estate Fund. A total of US $3 115 211 was expended under these headings during the biennium, representing 8.2% of total expenditure. Many Member States also provided considerable assistance by covering the local costs of W H O meetings and the costs of at tendance by national experts at meetings abroad. Col laborat ion by institutes in Member States in the Regional Office’s research p rogramme is another form of assistance not easily expressed in monetary terms. A breakdown by source of voluntary contribut ions received in 1987 is shown in Table 1. Staff development and training 1.40 The post of Staff Development and Training Officer remained frozen for the whole of 1987 and the duties were assumed by the Personnel Officer, whose workload was consequently increased since there was no reduction whatsoever in programme activities. 1.41 Five new internationally recruited staff of the Regional Office a t tended briefing sessions at W H O headquar ters in 1987. A briefing p rogramme has been designed for all new locally recruited staff. About 90 people took in-house language tuition in the four official languages (English, French, G erm an , Russian); 24 sat for the United Nations language proficiency examinations and 20 were successful. 8 Table 1. V o lu n t a r y c o n t r ib u t io n s , in c l u d in g Funds- rece ived d u r i n g 1 9 8 7 (US $) in-T rust. A u s t r i a 1 4 6 9 8 2 B e l g i u m 8 6 0 9 D e n m a r k 4 9 2 0 2 F i n l a n d 1 6 5 0 9 Fr a n c e 4 8 9 2 3 G e r m a n y , F e d e r a l R e p u b l i c of 2 4 9 6 7 2 I taly 1 0 1 7 0 N e t h e r l a n d s 1 7 2 0 0 1 N o r w a y 4 1 0 0 8 S p a m 4 9 1 5 5 S w e d e n 1 8 3 4 4 S w i t z e r l a n d 2 6 1 4 3 7 C e n t r e n a t i o n a l d es é q u i p e m e n t s h o s p i t a l i e r s , Par is 3 0 9 3 5 D a n i s h W e l d i n g I n s t i t u t e 4 6 4 9 9 E u r o p e a n C o m m i t t e e f o r C l i n i c a l L a b o r a t o r y S t a n d a r d s 1 5 6 4 2 I n s t i t u t e o f S e l f - c a r e R es e a r c h . M a a s t r i c h t 2 3 7 1 9 O t h e r s 6 0 9 1 1 8 9 4 1 6 1.42 The group training programme included courses, workshops and briefing sessions for a lmost all staff. Topics included AIDS; smoking cessation; talks enti t led “ C o m ­ municate with the com mun icato rs ” ; Regional Office information systems; audiovisual presentat ion techniques; chi ldren’s surroundings and their health implications; tele­ communica t ions ; informat ics and its implementat ion in the Regional Office; health for all development in countries; adjustment to international life; creative problem solving; and health economics. An innovat ion this year was to invite family members to a t tend some of the sessions. 1.4.4 The t raining courses on presentat ion techniques continue to be a subject of great interest to staff, as well as the courses entitled “ C om pute r awareness” which are held to familiarize staff with the various informat ion systems available in the Office. Publications 1.44 A new Publications Commit tee, in line with the recommendat ions of the Global P rogramme Commit tee study on W H O ’s publ icat ions policy, was established in the Regional Office. The Commit tee meets every second month to review publ icat ion proposals , to examine and comment on publ icat ion plans, and periodically to review progress in the publ icat ions programme. 9 1.45 Th e following new books in English were issued or sent to press: W H O Regional Publicat ions, European Series, No. 21 on Nuclear power: accidental releases — practical guidance fo r public health action, No. 22 on M easurem ent in health prom otion and protection, and No. 23 on A ir quality guidelines fo r Europe; and E U R O Repor ts and Studies No. 105 on M ycotic diseases in Europe. 1.46 Five non-serial publ icat ions were issued: Drugs fo r children, Nursing care — sum m ary o f a European study. M ental health services in pilot study areas. People’s needs fo r nursing care, and A ID S diagnosis and control: current situation. 1.47 Th e 1987 edi tion of Vaccination certificate requirements and health advice foi- international travel was publ ished in German . i.4x Twenty-seven t rans la t ions o f publ ica t ions were also issued or sent to press: eight in French (E uropean Series No. 9, 17, 18 and 19, Public Health in Europe No. 23 and 24, and the two non-serial pub l ica t ions Drugs fo r the elderly and Volume 5 o f the Seventh report on the world health situa tion ); seven in G e r m a n (E uropean Series No. 9 and 18, Public Heal th in E urope No. 21 and 26, and E U R O Reports and Studies No. 97, 100 an d 102) and nine in Russian (Publ ic Health in Europe No. 21 and 26, and E U R O Repor ts and Studies No. 57, 78, 81, 90, 95, 97 and 102). The non-serial publ i ­ ca tion A ID S diagnosis and control: current situation was issued in French, G e r m a n and Russian. 1.49 Th e value o f publicat ions sold th rough W H O headquar ters and its global net ­ work of sales agents in 1987 was Sw.fr. 278 535. This represents a 13% decrease compared with 1986. More than 2100 requests for documents and free copies of publ icat ions were received. 1.50 Al though the post of Publicat ions Promot ion Officer remained frozen for the whole of 1987, a t tempts were made to increase the quant i ty and quali ty o f leaflets promot ing Regional Office publ icat ions, and addi t ional promot ional material was made available at meetings. The dist ribution of promot ional leaflets was improved by in­ cluding them in all envelopes leaving the Office, provided this did not increase the postage cost. Selected journals now receive a compl iment slip with Regional Office publ icat ions asking them to review the book, and others are sent leaflets together with a preprin ted postcard encouraging them to request a copy of the publ icat ion should they wish to review it. 1.51 In ad d i t ion to the 28 t rans la t ions of Regional Office publ ica t ions o r d o c u ­ ments into non -w or king languages produced during the year, 31 new t rans lat ions were authorized. 1 .52 Negot iat ions were finalized with a television company for a programme based on the books Targets fo r health fo r all and H ealth crisis 2000. 1. 5.1 Besides publ icat ions proper, docum enta t ion issued dur ing the year included the Environmenta l Heal th Series, fur ther described in Chap ter 4, and several newsletters reflecting the work in various p rogr amme areas. 10 Epidemiology and statistics 1.54 Several Member States have developed statements of policy along lines inspired by their participation in the H F A evaluat ion. In the long run, a corollary of this development should be the adapta t ion o f nat ional health informat ion systems to provide more appropr ia te answers to the quest ions raised by HFA. 1.55 The set o f indicators developed for the H F A evaluat ion was revised, and ap­ proved by the Regional Com mit tee at its thi rty-seventh session, to be used by Member States for the regional and country moni tor ing exercise in 1987-1988. The development of an appropr ia te dat a base to suppor t H F A informat ion will permit a better and more detai led analysis of H F A progress. Once tested, it is expected to become available progressively th rough ou t the Region, providing Member States with sets o f data on both historical and current trends in the a t tainment o f the H F A targets. 1.56 Informat ion received in the course of evaluation and monitor ing has been closely integrated with o ther information tools such as country and target profiles, and with opera t ional tools such as the medium-term programmes developed jointly with Member States. R E G I O N A L P O L I C Y D E V E L O P M E N T , E V A L U A T I O N A N D P R O G R A M M E M A N A G E M E N T Publications issued in 1987 Abelin, T. et al., ed. M easurem ent in health prom otion and protection. W H O Regional Publications, European Series, No. 22. Documents issued in 1987 Health fo r all in Europe: report on a jo int meet ing between W H O and nat ional medical associations (document I C P / E X M 016). Health fo r all prom otional campaign: report on a W H O meeting (document I C P / I E H OOl/mOl). H ealth fo r all by the year 2000: report on the Four th European Seminar for Leading Public Heal th Adminis tra tors (document I C P / E X M 015/Rev. 1 ). 11 2Health for all in Europe by the year 2000 2.1 The achievement of equity in health, exploi tat ion of the individual’s potential for a healthy life, the reduct ion of disease, disability and death rates, and the control of specific condit ions represent the major concerns of the first 12 regional H F A targets. These targets are directed towards seeking solutions to these problems, even though they require action in all elements of the regional strategy. The first three deal with equity, enhancing people’s ability to exploit their own potential for healthy living, and the provision o f better opportuni t ies for the disabled. Targets 4 and 5 concentrate on reducing disease and disability, while the remaining seven aim at cut ting down mortali ty due to different causes o r in specific groups (targets 7-12) or reducing the combined effect of all causes as measured by life expectancy (target 6). 2.2 One of the main events in 1987 was the European Conference on the Prevention and Cont rol of Chronic Noncomm un icab le Diseases, held in Varna , Bulgaria f rom 26 to 30 October . The Conference repeatedly stressed that to a large extent the major n on­ communicable diseases share the same risk factors and risk behaviour, and noted with satisfaction the favourable reports on the feasibility, acceptance and rapid development o f the countrywide integrated noncommunicab le diseases intervention ( C IN D I) p ro ­ gr amm e in the European Region. The most impor tan t message f rom the Conference was agreement on the direct link between the intensity and consistency of preventive efforts and the results achieved. In this context, it should be emphasized that most of the technical units in the Regional Office concentra te mainly on the implementa tion of mul tisectoral preventive strategies, closely integrated with the programmes on lifestyle intervention and health promot ion. This app ro ach is particularly visible in the p ro ­ gra mmes on communicable diseases, chronic diseases, cancer, oral health, mental health, maternal and child health and health o f the elderly. 2.3 Dur ing the year, the C om mun ica b le Diseases unit was charged with developing a p ro g ram me specifically related to the acquired immunodeficiency syndrome (AIDS) pandemic . This p ro g ram m e will eventually emerge as a team of two professionals with par t icular responsibility for: — s t rengthening surveil lance on infection with hum an immunodef ic iency virus (HIV) in the Region; 13 — developing approaches to facilitate and improve medical care at the initial and terminal stages of the disease; — developing prevent ion th rough informat ion campaigns on changing sexual be­ haviour, screening of blood and blood products, etc.; — s tudying par ticular aspects of HIV transmission in some pilot countries of the Region. 2.4 The World Conference on Chemical Accidents, held in Rome in July, proposed the development o f communi ty , country and international programmes based on identi­ fication of hazards , accident prevent ion systems, risk assessment and emergency re­ sponse planning, through a multidisciplinary approach and communi ty involvement. 2.5 As regards disaster preparedness, recent man-made disasters and major accidents in Europe and their t ransboundary nature have led to a shift of emphasis to communi ty preparedness and the inclusion o f all types of disaster in one overall plan. Target 1 SO 2.6 A num ber of Member States and nat ional organizat ions have expressed an interest in p romot ing fur ther activities related to the health of refugees and victims of violence, and financial suppor t has been received from Denmark and the Netherlands. The book H ealth hazards o f organized violence was publ ished in col laborat ion with the Minist ry of Welfare, Heal th and Cul tural Affairs of the Nether lands . In J anu a ry , the book M igration and health: towards an understanding o f the health care needs o f ethnic minorities was launched at the House of Lords in the United Kingdom. 2.7 The results of the study on the health effects of long-term unemployment in selected countries, coordinated by the W H O col laborat ing centre for research on social equi ty and health in Dubl in, were discussed at a meeting held in Baden-bei -Wien, Austria in May. The meeting recommended that study of the subject be cont inued, bearing in mind that unemployment is the one extreme and full-time work the other. Issues related to the “ black” economy and to overemployment and underemployment were also discussed. The proposal to establish problem-specific working groups was implemented. Th e book Unemployment, social vulnerability and health in Europe, written in col laborat ion with the M E D IS Insti tute in Munich, Federal Republic of G e rm any (a W H O col labora t ing centre for health p lanning and economics) was publ ished by Springer-Verlag. 2.x Twenty-five country profiles on social inequity in health were presented at a meet ing hosted by the Ministry of Heal th and organized by the School o f Public Heal th, 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. 14 Portugal ; this meeting was held at the Gulbenk ian Found at ion in Lisbon in September . The country profiles are to be issued in book form in 1988. 2.9 Under the medium-term programme with Greece, col laborat ion cont inued with the Inst itute of Chi ld Heal th , Athens in relation to the promot ion o f research on social inequalities. 2.10 As proposed in the medium-term programmes of coopera tion with Israel, Italy, Mal ta, Portugal and Y ugoslavia, there was close col laborat ion in the study o f systems for collecting data and assessing inequities due to geographical, social and cultural factors, and also with regard to studies on the health problems o f d isadvantaged groups. Target 2 SO The elderly 2 . 1 1 Al though target 2 concerns all age groups, the main emphasis was on the health of the elderly and the fostering of social policies that will help them to maintain and develop their health potential. Most European Member States need suppor t in the development of appropr ia t e services so that the elderly may fully use and enjoy their mental and physical capabilities. 2 .12 The balance between institutional and communi ty-based care for the elderly seems to have been a priori ty topic in 1987 in most countries o f Europe. There is un an im ous agreement tha t well designed, communi ty-based care might help to maintain more than 95% o f elderly people in their homes. It was felt that deeper insight was needed into developments in “ small a reas” (i.e. those with approximate ly 150000 popula t ion under local government adminis t ra t ion) with regard to demography , geography and the hum an , institutional and financial resources available for the elderly. This deeper insight has to be suppor t ed by appr opr ia t e tools tha t will permit assessment of functional capacit ies, assessment o f the social and physical environments , and the creat ion of healthier public policies. 2.13 The following activities contr ibuted towards dealing with this issue. — A Consul ta t ion on Small Area (District) Planning in Care of the Elderly was held in the Regional Office in June, and this was followed by a panel discussion on the cont inui ty of care for the elderly, organized within the first multidisciplinary meet ing of the Europe an Section o f the Internat ional Association o f G e ro n ­ tology in Brighton, Uni ted Kingdom in September . — The mul tidimensional functional assessment o f the elderly was discussed at a meeting in G o th en b u r g in May. By the year 2000, people should have the basic oppor­ tunity to develop and use their health potential to live socially and economically fulfilling lives. 15 — Guidel ines on housing for the elderly and the disabled are being prepared in col labora t ion with Liverpool Polytechnic in the Uni ted Kingdom. The first draft was discussed in detail at the seminar “ Creat ing non-hand icapping environ­ ments — renewal of inner cities” organized by the In ternat ional Counci l for Building Research in Prague, in October. — Th e second analysis of data generated by the 11-country study on the medical and social condi t ions of the elderly was discussed in Athens in March. A manuscr ip t providing a detailed analysis of data on functional capacities and health, lifestyles and use of services in Belgrade, Berlin (West), Kiev, Florence, Tampere and rural Greece was received in September. 2.14 These developments at in tercountry level were reflected in country programmes, with the main emphasis on improved home care of the elderly. Activities were begun in Czechoslovakia (Ostrava), Portugal (Lisbon) and Yugoslavia (Ljubljana). The global p rogramme is described in Chap te r 7. Target 3 SO Health legislation 2.15 The Health Legislation unit cont inued to advocate improvements in health and social legislation for the disabled. The report on the study entitled “ Heal th and equity for the disabled — legislation for ac t ion” is in the final stages of prepara t ion and the nongovernmenta l organizat ion Rehabi li tat ion Internat ional publ ished a summary of the findings in its j ournal International rehabilitation review. This journal has since been provided free o f charge to the ten E uro pe an Mem ber States tha t expressed interest in receiving it regularly. Plans were also made to draw on the European experience in disabil ity-related legislation with a view to contr ibut ing to the next World Congress of Rehabil i tat ion International , since most o f the observat ions derived f rom the European study ap pear to be of worldwide relevance. Community-based rehabilitation 2.16 Th e regional p ro g ram me for the disabled at tracted special interest from the European M em ber States in 1987, which was the year of the midpoint evaluat ion of the Uni ted Nat ions Decade of Disabled Persons (1983-1992). Gove rnm ent s have been encouraged to develop mechanisms for solving the problems of disabled people by creat ing oppor tuni t ies for their par t ic ipation in everyday life, by reorientat ing rehabil i­ tat ion services towards communi ty-based activities, and by giving more considerat ion to health promot ion. 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. 16 2.17 Th e issues of family involvement in the rehabi li tat ion process and suppor t to the informal provider of care were discussed at the Consul ta tion on Family Involvement in Rehabi li tat ion, held in Copenhagen in July. Environmental assessments were seen as equally important . A contrac t was offered to Liverpool Polytechnic to develop a simple checklist of ques tions relevant to housing disabled persons. This checklist was discussed in detail in the seminar “ Creat ing non-handicapp ing environments — renewal of inner cities” , held in Prague in Oc tober (see paragraph 2.13). 2 .in Th e Regional Officer for the Elderly, Disabil i ty and Rehabi li tat ion and the Act ing Director, P rogramme Managem ent par ticipated in evaluat ion meetings at the midpoint of the Uni ted Nat ions Decade of Disabled Persons (1983-1992) in Yugoslavia in March (Eu ro pean evaluation) and in Sweden in August (global evaluation). Working contacts were established with nongovernmenta l organizat ions for disabled people. 2 .19 These intercountry activities were reflected in country programmes in Czecho­ slovakia, the G e rm an Democrat ic Republic, Hungary , Portugal and Yugoslavia aiming at communi ty-based care of disabled persons. Target 4 8 0 Disability prevention 2.20 A study on measures and technologies for prevent ing or reducing sensory and locomotor impairments, disabilities and handicaps in chi ldhood is being carried out by the Postgraduate Medical Institute, Prague. The first international review of the study too k place in J anu a ry , when the scope of preventive examinat ions of children at birth, at 8 and 12 months, at 3 years and at 5 years was discussed. Genetics services 2.21 A survey o f genetics services in the Region was carried out by two tem porary advisers, one from the USSR and one from the Uni ted Kingdom. A small consultat ion was held in the USSR to fo rmulate the final report . The Regional Officer for Maternal and Chi ld Health col labora ted with a group of experts on haemoglobinopathies , and a repor t on haemoglobinopathies in Europe will be issued by the Regional Office. The Office is commissioning papers on key issues in genetics, including the legal, ethical, social and cost -benefi t aspects, to fur ther evaluate genetics services in the Region. Rheumatism 2.22 In 1987, the Chronic Diseases unit continued its col laborat ion with the European League Against Rheumat ism (EULAR). Close links were established with its Standing Commit tees on Educat ion and on Epidemiology. By the year 2000, the average number o f years that people live free from major disease and disability should be increased by at least 10%. 17 2.23 In July the Regional Office co-sponsored the E U L A R seminar “ Curr iculum in rheumatology for medical s tudents” , held in Vouligemeni in Greece, at which the current si tuat ion in the teaching o f rheumatology was discussed. Th e impor tance o f all three levels (pr imary, secondary and tert iary) of health care in the control and prevent ion of rheumat ic diseases was stressed. Futu re col laborat ion between the Regional Office and E U L A R includes p repara t ion o f guidelines on the teaching of rheumatology, with emphasis on pr imary health care and an integrated appro ach to the control and m an ­ agement of the chronic diseases. Mental health 2.24 Th e Regional Officer for Mental Heal th a t tended the first meeting organized by the Counci l of Europe on Europe an coopera t ion in epidemiological studies in mental health. Th e meet ing agreed on the updat ing of available informat ion on epidemiological studies and research relating to mental health services in the mem ber states of the Counci l of Europe, as well as the development of concerted European programmes in the field o f psychiat ric epidemiology and research. The terms of reference of a study group were adop ted . T he s tudy group approved a ques tionnaire prepared by the s tudy direc tor and agreed on a plan of work. 2.25 Th e Regional Officer for Mental Health a t tended a symposium on the epidemi­ ology and the prevent ion of mental disorder, held in Reykjavik in September and organized by the Sect ion o f Epidemiology and C o m m u n i ty Psychiatry of the World Psychiatric Association. This event provided an oppor tuni ty for discussions with those responsible for the Section, as well as with leading researchers in psychiatric epidemi­ ology, to s trengthen col labora t ion in the field of prevent ing mental , neurological and psychosocial disorders. 2.26 In May, the Regional Officer a t tended a workshop on the interaction between mental and physical illness, hosted by the University Hospi tal , Depar tment of Psy­ chiatry, Lund , Sweden and organized under the auspices o f the Eu rope an Medical Research Counci ls. Th e meet ing reviewed and defined the main areas of research that were needed on the interaction between mental and physical illness. Special a t tent ion was paid to the appl ication of research data to teaching and the development of services. 2.27 Within the context of its activities on child mental health and psychosocial development , the Regional Office sponsored the Second Invitational Meeting o f the Europe an Chi ld Psychiat ri sts’ Research G r o u p , held in Utrecht in June. This meeting was a direct fo llow-up to the W ork in g G r o u p on Child Mental Health and Psychosocial Development, held in Copenhagen in Ju n e 1985, and focused on methods of measur ing individual chi ld/adolescent behaviour. 2.28 Th e Regional Officer for Mental Heal th par t ic ipated in the Eighth Congress of the European Society of Chi ld and Adolescent Psychiatry in Varna, Bulgaria in Sep­ tember. This meeting provided an oppor tuni ty for st rengthening col laborat ion between the Society and the Regional Office in the field of child mental health. 18 2.29 In the context of the medium-term p ro g r am m e of col labora t ion between the G ove rn m en t of Turkey and the Regional Office, a nat ional workshop on mental health was organized in June. 2.30 As par t of the country mental health prog ramme, the Regional Officer for Menta l Health visited Greece in Oc tober to give technical suppor t to the Central Heal th Counci l (KESY) Standing Commit tee on Mental Heal th, to evaluate the 1986-1987 country medium-term progr am me, and to review the progress achieved by the mental health reform initiated with the new health legislation put forward in 1984. 2.31 A contrac tual agreement was established with the W H O col laborat ing centre for research and t raining in mental health in Groningen, Netherlands for the prepara t ion of a classification of services providing mental health care. The Office also sponsored the par t icipation of two tempora ry advisers from Ireland and Portugal at a consul tat ion on mental health informat ion suppor t to comprehensive health programmes, organized by the Mental Heal th Division in W H O headquarters. 2.32 The Office was represented at a symposium on peripheral neuropathies , organ­ ized by the W H O col laborat ing centre for research and training in neurosciences, Milan, and held in Geneva in August . Dur ing this meeting contacts were established for future col laborat ion in the field of prevent ion o f neurological disorders. 2.33 The Regional Office sponsored a workshop on the rights of the elderly with mental disorders, organized by the Mental Welfare Commission for Scot land in Edin­ burgh in October. The report of the meeting will be used by the Office in developing guidelines on policies and legislation concerning the elderly with mental disorders. 2.34 The repor t o f the Work ing G r o u p on Mental Heal th Services in the Southern Countries o f the European Region, held in May 1986, was finalized. This report describes the experiences o f several southern countries of the European Region in formulat ing and implement ing their mental health policies. 2.35 The country p ro g ram me on mental health in Portugal suppor t ed a meeting on the implementat ion of the nat ional mental health programme. This meeting was organ­ ized in November by the General Directorate o f Primary Heal th Care , and reviewed ways of harmoniz ing policies and programmes in mental health at central , regional and local levels. The Regional Office engaged an expert to provide technical assistance for the development of mental health programmes in primary care settings. Also, the Office suppor t ed activities in the fields o f child mental health and mental health informat ion systems, mainly through the work of experts who visited the country in December. 2.36 The book M ental health services in pilot study areas: report on a European study was published in September . This publ icat ion provides a comprehensive picture of the present state of mental health services in the European Region, and should encourage health workers and adminis tra tors to establish reliable informat ion systems or to improve those that al ready exist. 2.37 The pre liminary repor t on the study on psychiatric services under condi tions of security was received, and prepara t ions are under way for the publicat ion of the final text. The work, carried out by a group o f experts in forensic psychiat ry from six 19 Europe an countries, const itutes a major contr ibut ion to epidemiological forensic psy­ chiatry, as well as to the p lanning of cost-effective forensic psychiatric services in line with the principles of hum an rights. Communicable diseases 2.38 D ur ing the year, further coopera t ion with the Counci l of Europe, the United Nations Economic Commiss ion for Europe, the Nordic Counci l, W H O col laborat ing centres and nongovernmen ta l organizations was achieved th rough joint organization or co-sponsorship of European meetings and conferences, such as those on AIDS, legion­ ellosis, Lyme disease and rickettsioses. Acute respiratory infections 2.39 Over 90% of acute respiratory infections (ARI) in Europe are caused by viruses and f rom 10% to 35% of all pneumonias are due to pneumococci . Reviews on the magni tude of the problem were presented to the technical advisory grou p on ARI, in Geneva in March, and to the Senior Level Seminar on the Expanded Programme on Immuniza t ion , the Control of Diarrhoeal Diseases, and Acute Respiratory Infections and Control Programmes in Moscow in May. Acquired immunodeficiency syndrome (AIDS) 2.40 A meet ing on A ID S Diagnosis and Control , with the financial supp or t of the G ove rn men t o f the Federal Republ ic o f Ge rmany, took place in Munich in March. Par t icipants from Member States reviewed the epidemic, shared their experience in A ID S control , and drew conclus ions regarding surveillance, health education, infor­ mat ion, legislation and the safety o f b lood and other biologicals. 2.41 Other useful consul tat ions took place during the per iod under review, including those on A ID S and the newborn (Copenhagen, April), on the role o f health educat ion in AIDS prevent ion (Cologne, October) and on AIDS scenarios (Kiel, November). 2.42 The Regional Commit tee, at its thirty-sixth and thirty-seventh sessions, endorsed proposals for regional AID S conta inment activities. Together with the global Special P rogramme on AIDS, a new regional p ro g ram me on AID S control was prepared in July; an initial assessment o f the A ID S epidemic was made in Iceland in June, and in Albania and Greece in August. 2.43 D a ta on AIDS in Europe cont inued to be collected, analysed and publ ished every three mon ths by the W H O col labora t ing centre for A ID S in Paris. The epidemic si tuation and approaches to the control of HIV infection were published both by the Regional Office and by various journals. 2.44 By the end o f 1987 over 10 000 cases of AID S had been reported by European Member States. According to different est imates the num ber of AIDS cases in Europe may reach over 30 000 by 1991 and the n um ber of infected people will range between 1.5 and 3 million. Fur ther political and financial commitmen ts were made by European governments in order to control the epidemic. 20 245 F o l l o w i n g a p r o p o s a l by the R e g io n a l Off i ce , all E u r o p e a n M e m b e r S ta te s f o r m e d spe c ia l c o m m i t t e e s o n A I D S a n d in i t i a t e d h e a l t h e d u c a t i o n ac t iv i t i e s , t h r o u g h h e a l t h a n d o t h e r s e c to r s (e.g. e d u c a t i o n ) a s wel l as t h r o u g h o t h e r g o v e r n m e n t a l a n d n o n g o v e r n m e n t a l o r g a n i z a t i o n s . A n ess en t i a l p a r t o f this w o r k is c o n d u c t e d by the L e a g u e o f R e d C r o s s a n d R e d C r e s c e n t Socie t i e s , A I D S Hil fe, m e d ic a l a s s o c i a t i o n s a n d o t h e r o r g a n i z a t i o n s . B e t t e r c o o r d i n a t i o n o f all t h es e e f fo r t s is n e e d e d a t r eg io n a l level, w i th the R e g io n a l Off i ce as foca l po in t . 2.46 As a c o n t r i b u t i o n to th e M e e t i n g o n A I D S D i a g n o s i s a n d C o n t r o l in M u n i c h , the R e g i o n a l O f f i c e r f o r S e x u a l i t y a n d F a m i l y P l a n n i n g p r e p a r e d a p a p e r o n “ T h e ro le o f f am i l y p l a n n i n g in A I D S c o n t a i n m e n t ” a n d th e R e g io n a l O f f i ce r f o r H e a l t h Leg i s l a t i on p r e p a r e d a r ev ie w p a p e r e n t i t l e d “ A I D S : l eg is l a t ive m e a s u r e s a n d e t h ic a l i s su es” . T h e l a t t e r p a p e r fi rs t g ives a n o v e r v i e w o f th e l egi s l a t ive a c t i o n t a k e n to p r e v e n t th e s p r e a d o f t h e A I D S e p i d e m i c , b a s e d o n m e a s u r e s t a k e n m a i n l y o v e r the p a s t 3 - 4 yea r s . S e c o n d , the e t h ic a l i m p l i c a t i o n s o f th i s ne w , r a t h e r s u d d e n a n d c o m p l e x m é d i c o s o c i a l p r o b l e m a re c o n s i d e r e d . 2.47 O n e o u t c o m e o f th e M u n i c h m e e t i n g w as a r e c o m m e n d a t i o n t h a t the Re g io na l O f f i ce s h o u l d o r g a n i z e a m e e t i n g to e x a m i n e th e i s sues o f h e a l t h l e g i s l a t io n a n d e t h ic s in A I D S a n d H I V i n f e c t i o n . T h e N o r w e g i a n G o v e r n m e n t h a s t a k e n t h e in i t i a t i ve o f h o s t i n g a n d f i n a n c i n g su c h a m e e t i n g in c o l l a b o r a t i o n wi th th e R e g io n a l Off ice. T w o p r e p a r a t o r y m e e t i n g s t o o k p la c e in C o p e n h a g e n in O c t o b e r a n d N o v e m b e r w i th o f ­ f ici als f r o m th e N o r w e g i a n D i r e c t o r a t e o f H e a l t h . T h e r e will be c lose c o o p e r a t i o n wi th t h e g l o b a l Sp ec i a l P r o g r a m m e o n A I D S so as to e n s u r e th e p a r t i c i p a t i o n o f o t h e r r eg io ns in th i s i n t e r n a t i o n a l c o n s u l t a t i o n . T h i s in i t i a t iv e is p a r t i c u l a r l y t im e ly , a n d a l l o w s a d v a n t a g e to be t a k e n o f th e w i d e s p r e a d w i l l ingness o n the p a r t o f g o v e r n m e n t s to c o n s i d e r th e a p p r o p r i a t e use o f l eg i s l a t ion in th i s f ield. T h e m a i n o b je c t iv es are: to ide n t i f y a n d e x a m i n e t h e e t h ic a l i m p l i c a t i o n s o f v a r i o u s ch o i ce s o f p u b l i c h e a l t h m e a s u r e a n d t h e i r l egi s l a t ive s u p p o r t ; t o d i sc uss th e s t r e n g t h s a n d w e a k n e s s e s o f c u r r e n t in­ i t i a t ives to i n t r o d u c e o r m o d i f y l e g i s l a t ion in s u p p o r t o f e f f o r t s to c o n t a i n th e s p r e a d o f th e A I D S e p i d e m i c ; to p r o m o t e c o n s i s t e n c y in l e g i s l a t ion in the f ield o f A I D S , k e e p i n g in m i n d th e c o n c e r t e d a c t i o n r e q u i r e d a t i n t e r n a t i o n a l level; a n d to id e n t i f y th e m a i n c o m p o n e n t s o f a n e f fec t ive l eg is l a t ive s t r a t e g y a n d , m o r e spe c i f i ca l ly , t o w o r k o u t a d e t a i l e d list o f to p ic s r e q u i r i n g ca r e f u l c o n s i d e r a t i o n p r i o r to e f f ec t in g l eg i s l a t io n in the f ield o f A I D S . 2.4x T h e S e x u a l i t y a n d F a m i l y P l a n n i n g un i t a l s o c o n t r i b u t e d to th e p r o g r a m m e o n A I D S , n o t o n ly in c o n n e c t i o n w i t h t h e a b o v e - m e n t i o n e d C o n s u l t a t i o n o n A I D S a n d the N e w b o r n , b u t a l so t h r o u g h th e c o l l ec t io n a n d an a ly s i s o f d a t a o n the p r o m o t i o n o f safe sex. T h i s s t u d y b e g a n in N o v e m b e r , a n d a i m s to e s t ab l i sh g u i d e l in e s o n sexu a l c o u n - s e l l i n g t o p r e v e n t H I V in fec t io n . B e lg iu m , F r a n c e , I ta ly a n d Y u g o s la v ia a r e p a r t i c i p a t i n g in th e s tu d y . 2.49 T h e d e v e l o p m e n t o f a p r o t o c o l a n d p i lo t s t u d y o n A I D S p r e v e n t i o n p r o g r a m m e s f o r m a l e h o m o s e x u a l s b e g a n in D e c e m b e r . A s e c o n d p h a s e will c o m m e n c e in t he s e c o n d h a l f o f 1988 to t e s t t h e h e a l t h e d u c a t i o n p r o g r a m m e w i th h o m o s e x u a l g r o u p s . A u s t r i a , t h e F e d e r a l R e p u b l i c o f G e r m a n y , the N e t h e r l a n d s a n d S w e d e n a r e p a r t i c i p a t i n g in t h e s tu dy . 21 2.50 The development of a protocol and a s tudy of the impact of A ID S on the emotional at ti tudes and sexual behaviour of heterosexual couples began in December , and will finish at the end of 1988 at the latest. The study will be conducted in Switzerland. 2.51 In the European Region, int ravenous drug abusers consti tute the second most impor t ant risk group for HIV infection and AIDS; in some Medi ter ranean countries more than hal f the identified AID S cases are from this group. The report on the Consul t a t ion on Aids am o n g D ru g Abusers, held in S tockholm in 1986, was widely dist ributed throughou t the Region and beyond. 2.52 One of the follow-up activities was the Meeting on Training on A ID S for Personnel in D ru g Tre atmen t Centres, held in Bremen in August. The meeting provided a st imulus for the part icipants to start or improve t raining p rogrammes at nat ional level, and formulated very useful guidelines and recommendat ions on such training activities. The ou tcom e o f the meeting will be a publicat ion in English, French and G e rm an edit ions, which will no doub t provide fur ther st imulus and guidance to countries in their training efforts. 2.53 Preparat ions were begun on designing model programmes for the prevent ion of HIV infection am o n g drug abusers and on educating drug abusers th rough pilot o u t ­ reach projects. 2.54 In close col labora tion with W H O headquarters , prepara t ions were made to review policy measures and their effectiveness in the f ramework of a meeting of experts to be held in Geneva in Jan ua ry 1988. Diarrhoeal diseases 2.55 Control of diarrhoeal diseases cont inued to at tract at tention in the Region. At the request of the Regional Office, an accelerated control p rogram me was under taken in Turkey with the suppor t of U N I C E F and W H O headquar ters , and oral rehydrat ion therapy has been included in the curricula of many national medical schools. National managers in the field of d iarrhoeal disease control from Turkey, the USSR and Yugo­ slavia a t tended seminars and courses organized by W H O headquar ters and the Regional Office. Programmes on oral rehydrat ion therapy and communi ty health educat ion are under considerat ion in Albania, Greece, Italy, the USSR and Yugoslavia. Hepatitis 2.56 One very serious problem in Europe is viral hepatitis. It is est imated that the annual incidence of hepatitis В cases could be over one million, with particularly high rates o f infection in southern and eastern Europe. Many cases of chronic hepati t is В end in mal ignant hepatocel lular carcinoma. Hepatit is В vaccine is now available com m er­ cially, but is still too expensive for planned, effective mass immunizat ion. 2.57 The need for a special regional programme on viral hepatitis control was dis­ cussed at the Technical Advisory G r o u p held in Geneva in November. It was pointed out that mixed viral hepati t is and AID S infection accelerates the severity of a pat ient 's condi tion, with a very high (60-80%) case fatality rate within a few months. 2 2 Oral health 2.5x The main thrust of the oral health p rogramme continues to be the coordinated planning of oral health services, with emphasis on the implementat ion of effective preventive measures and appropr ia te manpower production, moni tored through a con­ t inuous updat ing of the oral health informat ion system. 2.59 The Regional Officer for Oral Heal th visited the United Kingdom in April and Ireland in November to s tudy to what extent oral health componen ts are or could be included in existing health p ro m ot ion p rogrammes. The experiences in this field will be included in the document “ Oral health in communi ty health prog ram mes” , the draft of which was prepared dur ing the Working G r o u p on Planning, Implementa t ion and Evaluation of Oral Heal th Compo nent s of Noncommunicable Disease Projects, held in Kaunas , USSR in September 1986. In November the Regional Officer presented a paper on this subject at the Royal Society, London in connect ion with the semi-annual meeting of the British Association for the Study of Com muni ty Dentistry. 2 60 As a result of a meet ing o f chief dental officers in T urk u in Oc tober 1986, guidelines for the formulat ion of national goals for oral health are in the process of being drafted. Part 2 of the document “ Financing o f dental care in E uro pe” is nearing complet ion, and Volume 1 of the “ Guidelines for self care in oral health” will be finalized in the near future. The document “ Experience on water fluoridation in Europe” was produced and distributed. An updat ing of the European part of the W H O publication World directory o f dental schools, 1963 is nearing completion. 2.61 In August , the Regional Officer presented a paper on planning of services and manpo wer needs at country level at the Panum Institute, Copenhagen, in connection with the yearly meeting at the Scandinavian Association for Dental Research. 2 62 The Regional Officer visited Szczecin in March to finalize the p lanning of the nat ional oral health pathfinder survey (N O H P S) and to calibrate the clinical examin­ at ion teams; Belgrade, Ljubljana and Zagreb in February to assist in the interpretat ion of the results of the pilot N O H PS and to finalize the planning of the actual survey; and Lisbon in J an u a ry to design a moni tor ing and evaluat ion system in oral health based on the results of the N O H PS performed in 1985. A situation analysis was performed in Israel in November and a plan for a N O H PS was prepared. 2.63 Based on the results of the N O H PS performed in Spain in 1985, several oral disease preventive programmes and projects are being launched in the different au ton ­ om ous communit ies in Spain. 2.64 The Regional Officer visited San Marino in Jun e to perform a si tuation analysis and to plan a N O H PS, the results of which will form the basis for recommendat ions on the implementat ion of various oral disease preventive programmes. 2.65 The results of the N O H PS in Greece were sent to the Ministry of Heal th, Welfare and Social Security. The Regional Officer visited Athens in December to make proposals for the implementa t ion of oral disease prevent ive p ro g ram mes based on the results of the survey. 2 3 2.66 Th e N O H P S in Mal ta was completed , and co m p u te r analysis of the d a ta is under way. 2.67 Th e Regional Officer visited Turkey in December to assist in the interpretat ion of the results obtained from the N O H PS , the first par t of which was performed in 1987. 2.6X Th e Regional Officer was the keynote speaker at a meeting on changes in dental education ar ranged by the Medical Stomatological Insti tute, Moscow ( W H O col lab­ orat ing centre for dental educat ion) and also at a fluoride symposium arranged by the Stomatological Facul ty, Medical Academy, Erfurt ( W H O col laborat ing centre for oral disease prevention). Target 5 SO Diseases preventable by immunization 2.69 During the year fur ther progress was made towards the elimination of diseases preventable by immunizat ion, and M em ber States began to provide more reliable informat ion to W H O . Current ly , all 32 European M em ber States are immunizing against d iphtheria, poliomyelitis and tetanus, 30 against pertussis and measles, 21 against rubella and 5 against mumps. As a result, during 1987 diphtheria and pol io­ myelitis were not recorded in 60% of European Mem ber States, and measles did not occur in Albania. Over 80% of M em ber States have e l iminated neonatal tetanus through improved maternal and child care and the rout ine immunizat ion o f women from early chi ldhood. Between 1972 and 1987, tuberculosis morbidi ty and mortal ity rates fell by about hal f for the Region as a whole. 2.70 The achievements and failures of the regional Expanded Programme on Im ­ munizat ion (EPI) were reviewed by European advisory groups on EPI in G o th en b u r g in August and in Rome in December , and by a global advisory group in Washington, D C in November. The first Senior Level Seminar on the Expanded Programme on Im muniz­ ation, the Contro l of Diarrhoeal Diseases, and Acute Respiratory Infections and Control P rogrammes took place in Moscow in May. Materials from the Seminar were dist ributed to all Member States. 2.71 World Heal th Day 1987, with its theme “ Immunizat ion: a chance for every child” , was ce lebrated in the Regional Office on 7 April. The first nat ional meeting on EPI in Czechoslovakia took place in Brno in April , in connection with Wor ld Heal th Day. The Ministry o f Health of Slovakia awarded the D r G u o t commemorat ive medal to the Regional Office in recogni tion of its work in the field of EPI. Du r in g the year 24 Mem ber States included measles, mumps and rubella in their communicable disease surveillance systems, and a number of them started programmes of immunizat ion with MMR vaccine. By the year 2000, there should be no indigenous measles, poliomyelitis, neonatal tetanus, congenital rubella, diphtheria, congenital syphilis or indigenous malaria in the Region. 2 4 2.72 Success in e l iminating poliomyelit is f rom a number of E uro pe an countries should make its eradicat ion from the entire Region feasible within a relatively short time. T w o W H O regions (Eur op e and the Americas) have adop ted targets for eradicat ing poliomyelitis. 2.73 With the assistance o f W H O , the Ministry of Heal th o f the USSR decided to radically improve its immunizat ion programme, start ing in 1987. It is p lanned to develop a computer ized informat ion system on the European EPI in order to improve moni tor­ ing o f the progr am me within the f ramework of the global EPI, which will be using earth satellites for global communica t ion of moni tor ing data. Malaria 2.74 Part icipants f rom Bulgaria, Greece, Turkey and Yugoslavia a ttended a Coord i ­ nat ion Meeting on Malar ia in South-eas t Europe, in Izmir in May. It was noted that the paras itological si tuat ion in the area had improved and that the epidemiological si tuation in Turkey in general and in the borde r areas in par ticular no longer seemed to present a threat to neighbouring countries, especially co mpar ed with the problem of cases im­ por ted from elsewhere. It was also noted, however, tha t in all par ticipating countries there were areas where potent vectors were present and often abu nd ant , and there was therefore a need for cont inued vigilance. The meet ing called for the specific training of health personnel in ant imalar ia activities (malariologists, entomologis ts and labora tory personnel) and for the inclusion o f neighbour ing countries of the Eastern Medi ter ranean Region of W H O in future malar ia coordination meetings. 2.75 There has been a cont inuing rise since 1981 in the incidence of malar ia amon g visitors to European M em ber States f rom other W H O regions, and the si tuat ion is reviewed at various scientific meetings co-sponsored by the Regional Office. Target 6 SO 2.76 T o facilitate the 1987-1988 H F A moni tor ing exercise, the H F A data base was up dated with the most recent values for life expectancy calculated on the basis of mortal i ty data received f rom M em ber States. The analysis of trends in life expectancy has a lready started. 2.77 M em ber States in the Region were approached to join the collaborat ive cohort study on risk factors influencing health status in infancy and chi ldhood; the guidelines and quest ionnaires for a pilot study had been prepared by a working g roup in 1986. At present five countries have clearly expressed their readiness to participate in the study, while o thers have pos tponed a decision pending the results o f the pilot study. The activities were s tarted in order to collect, integrate and subsequently disseminate epi­ demiological da ta on the contribut ion of com m on risk factors to mortal i ty and life expectancy. The possibility of using for this purpose the existing mul ti s tudy data bases By the year 2000, life expectancy at birth in the Region should be at least 75 years. 25 such as ER IC A were discussed with representatives of the ER IC A project and other similar projects in the Nordic countries. A Consulta tion on the Assessment of the Relat ion of C o m m o n Risk Factors with Mortal ity and Development of Relevant Risk Assessment Methods took place in Heidelberg in December to develop approaches to data collection f rom different epidemiological studies and to discuss o ther organi­ zational and methodological issues. 2.78 The UN F P А-suppor ted project on mortali ty differentials cont inues to be carried out by the Hunga r ian Central Statistical Office in col laborat ion with the Ministry of Health and the Regional Office. The results o f the s tudy have dem ons t ra ted the clear rela t ionship between the main socioeconomic characterist ics and mortal ity in different populat ion groups . For the cont inuat ion of the studies on mortali ty differentials an agreement between U N F P A , the Hungar ian Gov ern men t and the Regional Office has been signed for the period 1988-1992. Target 7 2C> 2.79 A num ber of nat ional or subnat ional birth conferences have been held in the Region over the last few years, and in 1987 there were bi rth conferences in Moden a (Italy), Ca tan ia (Sicily), Zurich, Jerusalem an d London. Th e boo k Having a baby in Europe (РиЪ\\с Health in Europe, No. 26) was discussed at all these conferences, and was also the subject of a full-day discussion at a large public meet ing in London in April. This publ ica t ion has been widely sold and discussed in the Region, and has been extensively reviewed in a num ber of medical journals, including a two-page review in the Lancet. The book is currently being t rans lated into French, G e rm an , Russian and Ital ian and should be available in these languages early in 1988. W o m e n ’s organizat ions in France, Italy and the Uni ted Kingdom have p roduced posters containing recommendat ions on birth technology, and thousands of these posters have been dist ributed in health facilities in these three M em ber States, as well as in Brazil and the Uni ted States. Because Having a baby in Europe demonst ra ted the high rates of obstetrical intervention and the wide divergence in these rates amon g and within countries, the Regional Office is mount ing a fol low-up s tudy o f the determinants of obstetrical intervention in col labora tion with nat ional nongovernmenta l organizat ions in the field of obstetrics. 2.80 A multidisciplinary worksho p on a systematic app ro ach to promot ing breas t­ feeding was held in Wageningen in February . Th e par t icipants represented mothers, nurses, midwives, paediatricians, health educators and health administrators . The w ork ­ shop formulated recommendat ions for a European strategy for promot ing breastfeeding. 2 .8 1 Letters were sent to M em berSta t e s in J u n e / J u ly requesting updated informat ion on infant and young child nutri t ion. By the end of the year replies had been received from 17 countries and these will be incorporated into the biennial report which is expected to be finalized by Feb rua ry 1988. Such repor t ing is a most useful means of keeping in touch with the impor tan t subject of infant feeding in the Region. Heal th workers’ organizat ions By the year 2000, infant mortality in the Region should be less than 20 per 1000 live births. 26 and infant nut ri tion research institutions seem to regard the report ing obl igation as helpful to them within their nat ional administrative structures. Target 8 SO 2.82 A study is being conducted o f the current use of drugs during pregnancy and of progr am me s in var ious M em ber States to try to control their excessive use. A meeting on this subject was held in Smolenice, Czechoslovakia in October. Target 9 SO 2.83 At a meeting o f the principal investigators of the project on moni tor ing t rends in cardiovascular diseases (M O N IC A ), held in Berlin in April , a session o f the M O N I C A opt ional psychosocial substudy (MOPSY) took place. The documen ta t ion for this study on the organization and management , protocol and data book for the first survey were discussed with the investigators. The first da ta on the analysis of the relationship between psychosocial variables such as stressful events, exhaustion, sleep dis turbance , social suppor t , socioeconomic factors and cardiovascular diseases were reported on by the M O PSY coord inators f rom the M O N I C A projects in Munich, Belfast and Barcelona. The recom mendat ions on psychosocial ins t ruments to be used for the second M O N I C A survey in centres analysing psychosocial variables were outlined. 2.84 Th e Regional Officer for Chronic Diseases a t tended a M O N IC A steering com­ mittee meeting, where the progress of the project , publ icat ion issues and the opt ional substudy were discussed. 2.85 The Chronic Diseases unit assisted two representatives from the W H O collab­ ora t ing centre for research and training in cardiovascular diseases, Budapest to a ttend the second Internat ional M O N I C A Congress, held in Helsinki in August. 2.86 Th e project on Eu ropean risk factors and incidence — a col laborat ive analysis (E RIC A) continued to show progress. Some new centres indicated an interest in joining this project . At the Consu l ta t ion on the Assessment o f the Relat ion of C o m m o n Risk Factors with Mortal ity and Development o f Relevant Risk Assessment Methods , in Heidelberg in December , the ER IC A da ta base and experience were used to discuss the future analysis of the relat ionship between the majo r risk factors and chronic non- communicable diseases. This meet ing was ar ranged by the Epidemiology and Statistics and Chronic Diseases units in col laborat ion with the W H O col laborat ing centre for research and training in cardiovascular diseases in Heidelberg. At the same time, a By the year 2000, mortality in the Region from dis­ eases o f the circulatory system in people under 65 should be reduced by at least 15%. By the year 2000, maternal mortality in the Region should be less than 15 per 100 000 live births. 27 meeting of the ER IC A coordinat ing and advisory group took place, at which the future of the development of the ER IC A study and prepara tion of publications was discussed. 2 X7 As agreed at the meeting of the principal investigators of the collaborat ive trial on the mul ti factorial prevent ion of coronary heart disease, in November 1986, the final manuscr ip t on the trial was submitted to the Regional Office for publication. 2 .xx A repor t on the comprehensive commun i ty cardiovascular control programmes (C C C C P ) was prepared and is to be publ ished by the Regional Office in the first hal f o f 1988. 2.X9 Despi te financial difficulties, the W H O European hyper tens ion research action pr og ram me (H YRAP) continued. The W H O col laborat ing centre for health care related hyper tens ion research, in G o thenbu rg , in col laborat ion with the World Hypertens ion League, organized a meeting on the hyper tension management audi t project in Milan in June, at which the current state o f the project was discussed. 2.90 The Regional Office assisted Portugal in holding a nat ional seminar on the development of intervention strategies in the field o f noncommunicable diseases, in Lisbon in May. At the request of the Por tuguese Ministry of Heal th , the Office ar ranged for an expert to visit Lisbon under the country medium-term programme to discuss the management of kidney diseases. 2 .9 1 The W H O col laborat ing centre for research and training in cardiovascular diseases, Brussels organized a meeting on noninvasive methods for the diagnosis of pulmonary hyper tension, in Pavia in November . The col laborat ing centre also organized a meeting on rehabi li tat ion after acute myocardial infarction, in Breisach-am-Rhein, later the same month. 2.92 The Regional Office assisted the Welsh authori ties with a nat ional conference on health pro mot ion, held in Cardi ff in March. A W H O consul tant presented a paper on prevention pr og ram mes in Europe in the field o f cardiovascular and other chronic noncommunicable diseases. 2.93 The Regional Office assisted U N D P in setting up a project for the establ ishment of a coronary angioplasty centre at the National Institute o f Cardiology, Warsaw. 2.94 Col labora t ion was established between the Nether lands Hear t Fou nd at ion and the Regional Office. Links were also established with the Internat ional Diabetes Feder­ ation and the Internat ional Epidemiological Association. 2.95 The Chronic Diseases unit assisted the Danish Insti tute of Clinical Epidemiology (D I K E ) in prepar ing the f ramework for the development of a strategy to prevent cardiovascular diseases in Denmark. 2.96 The Regional Officer for Chronic Diseases a t tended the meeting of national p rogramme managers of the W H O intensified programme for coronary heart disease prevention, in Prague in August, where the future development of the program me was discussed in accordance with the formulat ion o f target 9. 2.97 The Regional Office convened the first European Conference on the Prevention and Control of Chronic Non communicable Diseases in Varna , Bulgaria in October. The 2 8 par ticipants from the European Member States reviewed the available evidence on the prevention and control of chronic noncommunicable diseases, and discussed and analysed the experience from implemented projects in these fields. They considered the difficulties envisaged at local, nat ional and international levels, and delineated future tasks in­ cluding fur ther research needs in the field of prevent ion and control. 2 .9« The countrywide integrated noncommunicable diseases intervention (C INDI) progr am me was fur ther developed. Portugal became the tenth country to join this progr am me and Can ada , Czechoslovakia, the G e rm a n Democratic Republic and the Uni ted Kingdom have expressed interest. The first issue of a newsletter was prepared in col labora tion with the C IN D I coordinating centre in Moscow. The C IN D I data m an ­ agement centre in Heidelberg, together with the centres in Moscow and Helsinki and the Regional Office, prepared and publ ished the C IN D I protocol and guidelines for moni­ toring and evaluation procedures. 2 .49 In col laborat ion with the Chronic Diseases unit the CIN DI centres in Heidelberg and Helsinki prepared a paper on the C IN D I intervention strategies, which was dis­ cussed at the meeting of p ro g ram me di rectors in Varna at the end of October. At this meet ing progress in the implementat ion of the program me was discussed. The partici­ pants agreed on the list of intervention modules that should be developed and discussed at the following meeting. 2.100 The existing data base for moni tor ing and evaluat ing C IN D I country pro­ grammes was analysed by the data management centre, Heidelberg in close collab­ ora tion with the M O N I C A management centre at W H O headquar ters and the MONICA data management centre in Helsinki. The results o f this analysis were discussed at the meeting of the p rogramme directors in Varna. 2.101 The Regional Officer for Chronic Diseases visited Bulgaria, Portugal and the USSR to become acquainted with different aspects of the prevention and control of noncommunicable diseases and to discuss C IN D I implementat ion. Target 10 80 2.102 An Advisory Commit tee on Cance r Control met in Budapest in June. The purpose of the meeting was to review the activities under taken during the period 1984-1987 in the f ramework of the regional cancer programme, and to endorse further p ro g ram me activities aimed at advancing the development of nat ional cancer policies and programmes and making full use of those already existing. 2.103 A Meeting on Nat ional Cancer Control Policy Development also took place in Budapest in June; the participants, nominated by their governments, included medical and public health professionals. It was agreed that, in nat ional cancer policies and programmes, the balance between the com po nent s of cancer control from prevent ion to terminal care should be reconsidered. In al locating resources for cancer control there By the year 2000, mortality in the Region from cancer in people under 65 should be reduced by at least 15%. 29 should be a shift o f emphasis from the more prestigious curative side to the relatively neglected area o f prevention. 2.104 T o demon st ra te the impact on cancer that can be achieved by the opt imal use of available resources, a collaborat ive country demons t ra t ion project was launched. The G e rm an Democrat ic Republ ic, Hunga ry and the Nether lands have agreed to take part, and other countries (Iceland, Poland, Turkey and the USSR) are consider ing jo ining the project. 2.105 An international course on technology assessment for cancer care programmes was held, with the generous suppor t of the Gove rn men t of Austria, in Baden-bei -Wien in October . The purpose o f the course was to communica te the substance of the concepts under lying both care programmes an d technology assessment to those who influence cancer care policy in M em ber States. The progr am me focused on the methods involved in the use of these concepts in cancer care delivery. 2.106 In the same prog ram me area, the development of model care programmes and model assessment of selected technologies have been promoted. An international com ­ parative study was set up to demonst ra te the impact on cancer patient management of care prog rammes developed in combinat ion with technology assessment. 2.107 A multidisciplinary consul tat ion took place in Leeds in February to develop recommendat ions for a t rea tment policy that gave considerat ion to the quali ty o f life of patients with incurable cancer, as well as to provide guidance on the implementa tion of palliative cancer care. 2.108 C oo pe ra t ion increased with IA R C in the development o f an improved cancer info rmat ion system, with the In ternat iona l Union agains t Cancer in coordinat ing cancer education strategies, with C E C and the Nordic Counci l in their prevent ion programmes, and with CE in the organizat ion of multidiscipl inary cancer care. C o o p e r ­ at ion with the Organizat ion of European Cancer Institutes cont inued. 2.109 The fifth annual symposium organized by the Eu ropean Organizat ion for Coopera t ion in Cancer Prevent ion Studies, and co-sponsored by W H O , took place in Brussels in May under the title “ Prevention of virus-related cancers” . 2 .1 10 Col labora t ing centres in the G e r m an Democrat ic Republic, Hungary and the Uni ted Kingdom helped to conduct technical projects on the establ ishment of a data bank to assess technologies used in cancer control, on manpo wer development for cancer control, on a comparat ive study o f var ia tions in the outcom e of cancer care, and on developing and presenting informat ion for the public on recent scientific achievements and on constraints in cancer care. 2 .1 И In col laborat ion with U N D P , the Regional Office continued to suppor t the cancer control p ro g ram me in Poland, where the main focus is on implement ing preven­ tive and early detect ion measures, as well as the es tabl ishment of a nat ional cancer control p r o g r am m e in Albania. A visit was paid to Turkey to s tudy the cancer services and to plan a coopera t ive programme. Th e Regional Office assisted in developing a com puter-based informat ion and invitation system in suppor t o f the country-wide organized screening p rogramme for cervical cancer in Hungary. 30 Target 11 DO Accident prevention 2 M2 Yugoslavia held a nat ional workshop on prevent ion of accidents with partici­ pants from all the republics and all sectors concerned. Л p rogram me was agreed and priority was given to educat ion for safety, chemical accidents, and the development of emergency services. One of the republics will develop a data base, using a basic data set. 2.M3 The Regional Officer for Prevention of Accidents a t tended the first inter­ nat ional conference on road accident t raumas on transit routes, under the auspices of the Yugoslav Academy of Arts and Sciences. Special problems relating to driving long distances from southern to nor thern Europe were discussed, and driver fatigue was selected for fur ther research. 2 114 A Working G r o u p on Alcohol and Accidents, held in Reykjavik in September , reviewed the present state o f knowledge on alcohol use and abuse and accidents, and discussed countermeasures vis-à-vis t rea tment, legislation, prevent ion and health pro ­ motion. It was concluded that, since alcohol abuse and alcohol-related accidents are social problems, accidents involving the use of alcohol are an indicator of the extent of alcohol consumpt ion in society. Thus, programmes for the prevention of accidents where alcohol is a factor should be part of alcohol control programmes in general. The programmes should consider moderate and inexperienced drinkers as well as heavy drinkers. The involvement of primary health care workers is essential. Am ong the recommendat ions o f the Working G r o u p were that a glossary of terms be established, and that statistics be collected on the frequency of drunken driving and the drinking histories and lifestyles of accident victims. In relation to rehabil itat ion, there was a vital need for the early identification, through primary health care workers, of hazardous drinking pat terns and for the extension of educat ion / rehabi l i ta t ion programmes to drinkers who have been charged with driving while intoxicated. Legal countermeasures should be associated with adequate enforcement and educat ional programmes, liaison at communi ty level being improved am ong all agencies involved. 2.M5 The Regional Office was represented at a symposium on " T h e healthy com­ muni ty — child safety as part of health p ro m ot ion activities” organized in Stockholm in April by the l o lksam insurance G ro u p of Sweden and the Child Accident Prevention Trus t , London. The symposium, which was suppor ted by the Swedish Nat ional Boards of Educat ion and of Health and Welfare and the Swedish Child Council , is a good example of the involvement of insurance companies in preventive activities. One of the probable outcomes is the establishment of a European group on child accidents. By the year 2000, deaths from accidents in the Region should be reduced by at least 25% through an intensi­ fied effort to reduce traffic, home and occupational accidents. 31 Disaster preparedness 2.1 16 There is now a shift o f emphasis — firstly f rom aid to preparedness, and secondly to include technological disasters — within the overall preparedness plan. Technological disasters can involve many localities and countries. The local com muni ty must be able to cope itself should disas ter strike, and it must therefore be pr epared for that eventuality. Pr imary health care workers have a leading role in such preparedness. 2.117 This ap proach was well i llustrated in a com muni ty seminar on disaster pre­ paredness and mental health, organized by the Norwegian authorit ies in Lofoten in August. Apa r t from the health and environmenta l effects o f shipwrecks, avalanches, etc. the psychosocial effects are impor tant , not only on the stricken communi ty but also on the rescue team. This type of ap proach will form the basis for fur ther work on the mental health aspects of disasters. 2 . l ix In Greece , as a fol low-up to the ear thquake in Ka la mata in September 1986, a nat ional workshop , suppor t ed by the Regional Office and its panel o f Assessors, re­ emphasized com muni ty involvement and proposed a pr og ram me of public educat ion and t rain ing to develop com muni ty profiles and rapid assessment of needs at the t ime of disaster. There will be fur ther jo in t activities on these subjects, and also on technological disasters. The Greek ea r thquake planning and protect ion organizat ion (OASP) is very efficient, and is an excellent example o f a nat ional body working closely with local teams. 2 .1 19 The G ove rn m en t of San Marino is providing financial suppor t to the develop­ ment in tha t country o f a t raining centre on the health aspects of disasters. This is sponsored by the Counci l o f Europe and suppor t ed by the Regional Office, an d the Regional Officer for Prevent ion of Accidents represents W H O on the managemen t board. In Oc tobe r and November , the first courses were held on emergency care, technological disasters and the role o f the media. 2.120 The work on the development of communi ty profiles and needs assessment profiles cont inued. Both of these will be extended to include chemical and radiat ion aspects and hazard mapping by the local community. The first interregional meeting on emergency preparedness and management of relief operat ions, and a meeting on the development of training programmes in disaster preparedness were organized by W H O headquar ters in Geneva in April and October, respectively. 2 .12 1 The app roach to the development o f these profiles adop ted jointly by the W H O Regional Offices for the Americas and for Europe has been accepted by the relevant United Nations agencies and nongovernmenta l organizat ions. It will be tried out in various settings in 1988 and 1989, leading to an agreed protocol to be used by all agencies involved in the protec t ion of the health o f the publ ic before and at the t ime o f a disaster. 2.12 2 A World Conference on Chemical Accidents, held in Rome in July, brought together par t ic ipants f rom many sectors and from many par ts o f the world. The Confe r­ ence proposed that the main elements of a p ro g ram me for prevent ion, preparedness and emergency action should be the identification of hazards and health impact assessment, risk assessment and opt ions analysis, and emergency response planning. It emphasized 32 the importance of multidisciplinary working, the study of morbidity pat terns and psycho­ social aspects, and the role o f the communi ty in all aspects o f prevention and control. The involvement of the media was also stressed. Because of the t ransbounda ry nature of the problem, harmonizat ion of guidelines and codes o f practice are necessary. Finally, transfer of technology to developing countries must be accompanied by safety mechanisms. 2.123 Th e School o f Public Heal th, Cathol ic University o f Louvain , Brussels con­ tinues to be actively involved in disaster preparedness in the fields of t raining and development of informat ion systems. 2.124 The Health Services Division, D epa r tmen t o f Coopera t ion for Development , Ministry o f Foreign Affairs, Rome was designated a W H O col labora ting centre for disaster preparedness, management and nursing. Its work will include the training o f a cadre o f nurses to work in disaster preparedness and relief in developing countries, and the development and trial of communi ty profiles and hazard mapping in developing countries through P H C and communi ty involvement. Target 12 SO 2.125 As a follow-up to the recommendat ions of the Working G r o u p on Preventive Practices in Suicide and At tempted Suicide, held in York in 1986, a mul ticent re study on parasuicide was established. Co l labora tors from centres in Denmark , the Federal Re­ publ ic of Germ an y , Italy, the Nether lands, Sweden and the Uni ted Kingdom met in L o n d o n to agree on details of research design, the contents of the interview schedule, general methodology, dat a prepara t ion and data analysis. A protocol has been prepared and a steering group has been appointed , the first meeting of which took place in Bologna in October . Contacts were made with centres in France and Norway with a view to their par ticipating in the study. H E A L T H F OR ALL IN L U R O PL BY T H E YEAR 2000 Publications issued in 1987 M ycotic diseases: report on a W H O meeting. EURO Reports and Studies, No. 105. A ID S diagnosis and con tro l— current situation: report on a W H O meeting. Non-serial publication. M ental health services in p ilo t study areas: report on a European study. Non-serial publication. By the yea r2000, the current rising trends in suicides and attem pted suicides in the Region should be reversed. Documents issued in 1987 A ID S containment: report on a W H O meeting (document I C P / C D S 013). A ssessm ent o f levels o f hypertension control in the com m unity: report on a W H O meeting (document I C P / N C D 020). C ontinuity o f care o f the elderly: report on a W H O meet ing (document I C P / H E E 217). Countrywide integrated noncommunicable diseases intervention program me (C IN D I): repor t on a meet ing of C IN D I Managem ent Commit tee (docu­ ment I C P / N C D 023). Experience on water fluoridation in Europe: report on a study (document I C P / O R H 101Л02). Health legislation: report on a meeting of the advisory committee for the European programme (document I C P / H L E 199/m01). Leparski, E., ed. The prevention o f noncom municable diseases — ex­ periences and prospects: papers for the European Conference on the Pre­ vention and Control of Chronic Noncommunicable Diseases (document I C P / N C D 028/6). N ational cancer control policy development: report on a W H O workshop (document I C P / C A N 115). Non-invasive diagnosis o f pulm onary hypertension: repor t on a W H O meet­ ing (document I C P / C V D 111). M alaria risk fo r travellers: repor t on a W H O meeting (document 1СР/ M A L 012). M alaria in south-east Europe: report on a W H O coordinat ion meeting (document I C P / M A L 010). Optim um com m unity care o f disabled people: report on a W H O meeting (document IC P / R H B 010). Unemployment, poverty and quality o f working life — innovative inter­ ventions to counteract damaging health effects: report on a W H O meeting (document I C P / H S R 818). Co-publications issued in 1987 Leparski, E. & Niissel, F.E., ed. Protocol and guidelines fo r monitoring and evaluation procedures: C IN D I . Countrywide Integrated N o ncom m uni ­ cable Diseases Intervent ion Programme. Heidelberg, Springer-Verlag. Schwefel, D. et al., ed. Unemployment, social vulnerability, and health in Europe. Heidelberg. Springer-Verlag. 34 van Geuns, H., ed. H ealth hazards o f organized violence. Proceedings o f a working group on health hazards o f organized violence, Veldhoven, A pril 22-25, 1986. Rijswijk, Netherlands , Ministry of Welfare, Heal th and Cul tural Affairs. Articles published in 1987 Aitken, C. & Walker, J. Care of disabled people in the communi ty . In ter­ national disability studies, 9: 55-59 (1987). Hermanova, H. Mult idimensional assessment technology in care of the elderly in international perspective. In: Maddox, G.L. & Busse, E.W. , ed. Aging: the universal human experience. Selec ted papers fro m the sym posia o f the X l l l th Congress o f the International Association o f Gerontology. New York, Springer, 1987. Hermanova, H.M. Disability indicators and W H O programme: “ Heal th for all by the year 2000” . Revue d'épidém iologie et de santé publique, 35: 236-240(1987). Svensson, P.-G. Specially disadvantaged groups: a challenge for health services. International journal o f health planning and management, 2: 59-65 (1987). Svensson, P.-G. & Starrin, B. Informai solutions to health and social consequences of unemployment : the experience of the Swedish t rade unions. Health promotion, 2: 195-204 (1987). 35 3Lifestyles conducive to health 3.1 T o suppor t and enable people to choose lifestyles conducive to health continues to be one o f the most formidable challenges to the M em ber States of the Eu ro pean Region. New approaches are called for in policy formulat ion, the development o f professional skills and the health educat ion of the public. The Regional Office has tried to put a par t icular effort into helping M em ber States develop new approaches to health p ro ­ mot ion and disease prevention: high priority has been given to action-oriented efforts such as the Heal thy Cities project and the H F A campaign to reduce tobacco consum p­ t ion in the European Region. 3.2 T he move towar ds the deve lopmen t o f a healthy publ ic policy has gained m o m en tu m th ro ughou t the E uro pean Region. Th e O t taw a Char ter for health p ro ­ mot ion adop ted in 1986 has also provided the basis for new initiatives in healthy public policy. At the second in ternat ional conference on health p ro m o t io n in Adelaide, Aust ra l ia in April 1988, the W H O interregional health p romot ion project will present M em b er States with the results of two years’ work on healthy public policy, which will be i l lustrated by over 50 case studies. Policy formulat ion and implementat ion have also been the focus of work in specialized p rogram me areas such as nut ri t ion, alcohol, tobacco and drugs. All these fields call for complex policy interventions and pose difficult legislative and ethical problems that need constant re-evaluation. In few coun tr ie s is there any long-s t and ing in tersectoral coop era t ion that views health as a key fac tor in overall policy formulat ion. Only recently have several M em b er States a t tempted to formulate comprehensive health p romot ion policies tha t cover the wide range of lifestyle-related damage to health, par tly as an integral par t of their H F A policies, par tly as separa te policy documents . In several cases the Regional Office was reques ted to be par t o f the fo rmulat ion process an d to s t rengthen its role as policy adviser. 3.3 T he interest in health p ro m o t io n has emerged not only at the nat ional and federa l levels, however. Some of the most active responses to H F A have been at the local level. D ur i ng 1987, the Heal thy Cities project rapidly gained mom en tum. At present , 25 E uro pean cities form the core group of the project , with a ring of abou t 100 interested cities keeping in regular contact. As a major H F A vehicle, this project 37 allows many of the W H O programmes to work together, particularly in tackl ing the social and physical environments in cities. 3.4 The challenge of integrating health promot ion into the existing public health s t ructure calls for new organizational and educat ional initiatives. Th ro u g h o u t the Region, new organizat ional infrastructures for health promot ion and health educat ion are emerging, including a new interest in t raining for public health. Teaching health professionals to unders tand lifestyle-related health problems has become a focus of t raining th ro ughou t the Region, emphasizing special topics (such as smoking or drug abuse) or special popu la t ion group s (such as migrants) . W H O has es tabl ished new links with the European schools of public health, some of which have al ready run pilot courses in health p romot ion and lifestyles. Networks of experts have been set up by various progr am mes — for example, the nut ri t ion pr og ram me regularly contacts over 800 professionals — and several programmes run regular newsletters. 3.5 Posit ive health, and all its behavioura l and psychosocia l com pon en ts , is still a new field for health p ro m ot ion and health educat ion pro grammes . Part icular ly in the field o f sexuality and family planning, obvious lifestyle changes in society — such as the changing role of women or the visibility o f homosexual i ty — call for clear messages tha t focus on the qual i ty o f life and wellbeing. C o n su l t a t i ons have been held to explore the meaning of sexual health, studies are being conducted to unde rs tand new at t i tudes to family p lann ing and co nt racep t ion, and modules have been developed to t ra in health profess ionals in im p o r t an t emerging areas such as the preven t ion o f AIDS. 3.6 The need to under s tand A ID S as a major lifestyle issue in the European Region has become clear in the course of the work done at the Regional Office over the last two years. Several programmes — such as educat ion for health, sexuality and family p lan ­ ning, and abuse of psychoactive drugs — have made major contribut ions . It is to be welcomed that the newly established Special Programme on A ID S at the Regional Office will work with two full-time professionals (one medical and one a social scientist) to develop the special approaches needed to suppor t European Member States, particularly in their efforts to combat the disease by education. 3.7 In spite o f the high visibility and threat of AIDS, many o f the challenges faced by Member States in the field of lifestyles cont inue to lie with the lifestyle pat terns of developed societies such as alcohol and tobacco consumpt ion. The Regional Office has put a special focus on the com muni ty response to alcohol an d drug abuse and developed an approach to cross-nat ional studies that allows for the shar ing of experience, not just the compar i son of data. Schoolchildren and other young people are the groups that warrant par t icular a t tent ion — and it is here that coopera t ion with o ther intergovern­ mental organizat ions such as the EEC, C E C and Council o f Europe has been most productive. Country activities have cont inued in each of the target areas o f this chapter. Lifestyles cont inue to be a field of work where both W H O and its Member States are jointly exploring new approaches and where the move towards planning for health can most creatively be exemplified. 38 Target 13 SO National health promotion policies 3.8 The Ot t awa Char te r for health promot ion is the major policy document that gives force and di rection to the interregional health promot ion project, which is gaining a high in ternational reputa t ion and is seen by many as leading the field in health promot ion development. 3.9 A comprehensive health p romot ion p ro g ram me has been carefully built up over recent years. Its basic appr oach and principles are founded on the W H O H F A policy in general and the O t t aw a Char ter in particular. Health promot ion is making a major con tr ibu t ion towards the achievement o f target 13 an d provides the context and ap p r o ach for the achievement of most of the o ther targets, in par ticular the lifestyle targets 13-17. The essential elements of the progr am me are policy, research and training, com munica t ion and educat ion, networking and consensus building, and suppor t and assistance in practical application. З.Ю Since the formulat ion and endorsement of the Char ter , a major international effort has begun in advocacy and mediat ion, enabling Member States at the nat ional , regional and local level to achieve the objectives of the Char ter and the goal o f H FA. 3.11 The Ot tawa Char te r itself has al ready been t rans lated into 15 languages and is widely used as a basis for developing nat ional health p romot ion policies. It advocates five areas of action: build healthy public policies, create support ive environments , st rengthen communi ty action, develop personal skills, and reorient health services. 3.12 Th e first o f these five action areas was given special a t tent ion in 1987. A series of wo rkshop s and discussion groups on the theme of healthy public policies took place t h rough ou t the year. 3.13 T he fou r th s u m m er sem inar on health p ro m o t io n was held in C ard i f f from 26 Sep tem b er to 1 O c to b e r in co l l abora t ion with Hear tbea t Wales. T he aim of the seminar was to exchange expertise and development strategies to incorporate indust ry in health promot ion. Two par ticipants a t tended f rom each o f the following MemberSta tes : the Federal Republic o f Germ an y , Hungary , Norway, Poland, Spain, Switzerland and the USSR. 3.14 The second Vienna dialogue on the theme of bet ter links and balances between social an d health services in the care of the elderly took place in Vienna in October. Five By 1990, national policies in all Member States should ensure 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. 39 Member States par ticipated in analysing and discussing policy in relation to the elderly in society, a category that is given increasing at tent ion not least owing to the demographic changes in society. 3.15 An impor tant “ think t a n k ” on analysing healthy public policy took place in Berlin in November. Representat ives from five Member States part ic ipated and case studies from the G e rm an Democrat ic Republic, Hungary , Ireland, the Nether lands and the USSR were presented and discussed. 3.16 Three issues o f the popu lar health promot ion newsletter Positive health appeared in 1987. The newsletter is proving to be a most useful means of communicat ing advances in health p romot ion aroun d the globe. 3.17 The Heal th Promot ion unit also provides advice to Member States in the de­ velopment of healthy public policy. Several explicit f r ameworks and documents on healthy public policy now exist. 3.18 A major initiative of the Heal th Promot ion unit, jointly with the Environmental Heal th Planning and Management unit, is the development and promot ion of the Heal thy Cities project. This has become one of the major delivery vehicles of the targets of the European H F A strategy. The project brings together a network o f European cities to assist and suppor t the implementa t ion o f work towards H F A in their cities by promot ing the exchange of experience and the development of models of good practice. The major a im of the Heal thy Cities project is in general to prom ote H F A policies and programmes at city level, with par ticular emphasis on integrating three key aspects of health p ro m ot ion in an urban context: the prom ot ion of healthy lifestyles, a greater concern for health as a compon en t o f all public policy in the different sectors of the local communi ty and economy, and the creation of a healthier urban environment. The project is scheduled to spread over five years (1987-1991) and possibly longer. It is monitored and coordinated by a Heal thy Cities project office in the Regional Office. 3.19 Durin g the per iod under review the major event in this fast growing initiative was the first E u ro p e an Congress on Heal thy Cities, held in J u n e in Düsseldorf . Over 200 people a t tend ed f rom all over the wor ld , including 38 official city delegations and observers f rom 20 cities. 3.20 One o f the suppor t elements of the health pr omot ion p rogramme is health pro m ot ion research. A publ icat ion is being prepared enti t led Introduction to health prom otion research, the purpose of which is to promote a new perspective on health, health policies and programmes. It should provide people involved or interested in health p rom ot ion and related activities with the most recent, most relevant and most reliable knowledge on the subject. In addit ion to this, the publicat ion should serve as a textbook for people involved in training in health promot ion. 3.21 A p ro g ram m e of research for health p rom ot ion in line with the goals o f research for H F A is being prepared. In orde r to create a unified approach towards investigations in the field of research for health p romot ion , the Health P rom ot io n unit is establ ishing a network of three col labora t ing centres: the Insti tute for Social an d Preventive Medicine, University o f Berne, Switzerland; the Research Unit in Heal th and Behavioural Change, 40 University of Edinburgh, Scot land, and the Institute of Social Medicine, University of Copenhagen, Denmark. The Copenhagen Institute is looking into the influence of lifestyles on health. The Berne Institute and the Edinburgh Research Unit are jointly concerned about improving monitor ing of the health of the popula t ion and the evalu­ ation of health promot ion through the development of health promot ion indicators. 3.22 In February, representatives of these three institutes met as the core group of research centres in health promot ion, to facilitate interaction and the interrelationship of work plans and to suppor t the appl ication of research results that would be useful to policy-makers. 3.23 These institutes, together with representatives from 15 other research units in Europe, Nor th America and New Zealand, met in Edinburgh from 4 to 6 Oc tober to discuss the new public health and its implications for research. Plans were laid for cooperat ive research studies in lifestyles and health and healthy public policy. A draft f r amework for research in health promot ion was developed to be discussed fur ther in J an u a ry 1988 when, at a consul tat ion in Copenhagen, a coordinated p ro gr am me for research in health promot ion is prepared. 3.24 With the assistance and support of W H O . the Institute of Social Medicine in Copenh agen organized a workshop on health status assessment in February. The o b ­ jective o f this workshop was to provide health researchers with an overview of existing measures of health s ta tus and discuss their theore tica l as sum pt ions and potential applica t ions . National alcohol policies 3.25 A review was under taken of national policies and programmes in the field of alcohol abuse. So far, the information has been set out in a s tandard format for 16 countries of the Region. Only a few countries have not yet responded to the inquiry, which was set up as a pre-filled ques t ionnaire containing the informat ion available to the Regional Office. This activity is expected to be finalized by the beginning of 1988. National drug policies 3.26 A nat ional seminar on the development and implementat ion of a drug abuse policy at the national and communi ty level was organized in Spain in May in collab­ ora t ion with the Spanish Government . The meeting proved to be an efficient way of s t imulat ing policy development at the communi ty level and provided ample oppor tuni ty for learning from different experiences at the nat ional and international levels. C o ­ ordinat ion between local health authori ties and the national government was also strengthened. 3.27 Later in the year a second workshop on drug abuse policy was organized, again in close col laborat ion with the Spanish Government . This workshop focused on improving the involvement of primary health care in drug abuse prevention, t rea tment and rehabili­ tat ion. The most impo r tan t obstacles to achieving this were identified and ways to 41 overcome them were discussed. This meeting provided a good start to a systematic effort to get to grips with this difficult but extremely relevant subject. The results of the meeting will be used in future international activities of the programme on this topic. 3.28 A draf t repor t giving profiles of the drug abuse s ituat ion, the policies and the actual responses in six Member States has been prepared. This material provides the f r amework for fur ther data collection on this par ticular topic and will form the basis for an article in one of W H O ’s journals on drug abuse policies in the European Region. Target 14 SO 3.29 A s tudy on the role of the family in the prevent ion and t rea tment of drug abuse was commissioned. One of the tentative findings of the s tudy is a reconfi rmat ion o f the overwhelming influence of parent s’ lifestyles on the drug-related behaviour of their children. Increasingly, t rea tment and prevention services th roughout the Region are recognizing this and integrating it into their work. 3.30 One of the well es tablished W H O research projects is the cross-nat ional survey on health behaviour in schoolchi ldren, in which 11 Member States actively participate and which has been in progress since 1983. A second general survey has now been completed. A consul tat ion to review the results was held in Jyväskylä, F inland in February. This was followed by a larger consul tat ion held in Budapest in September . The presentat ions raised a variety of theoretical issues and reached a large n um ber of substantial conclus ions on specific themes, e.g. the impor tance of the family in deter ­ mining health behaviour and the existence of links between the quali ty of social relat ion­ ships and health behaviour. The survey results will have very impor tant uses such as in helping to plan health educat ion and health p romot ion in schools and as an impor tant da ta source for policy development. 3.31 It is eight years since the last repor t on H ealth education in Europe was publ ished by the Federal Centre for Heal th Educat ion, Cologne for the International Union for Health Educat ion. On the joint initiative of W H O and the In ternat ional Union for Health Educat ion, a new edit ion is now ready to be published by the D ut ch Health Educat ion Centre, Utrecht, a W H O col laborat ing centre. This will be a useful publ i­ cation in the light of the major changes taking place, not least in Europe, an d the reorienting of health educat ion within a health promot ion context. 3.32 In J anua ry , the In ternational Informat ion Centre on Self-help and Health in Leuven organized a workshop on self-help and chronic disease focusing on the contri ­ bution o f self-help groups to coping with chronic disease, the formulat ion o f an overview of past and current research, the determination of future research topics that will enhance the functioning o f self-help groups for the chronically ill, the development of a strategy to foster self-help groups, and the formulat ion of recommendat ions for further action. By 1990, all Member States should have specific programmes which enhance the major roles o f the fam ily and other social groups in developing and sup­ porting healthy lifestyles. 42 3.33 The In ternat ional In fo rmat ion Centre on Self-help and Heal th in Leuven, with w hom the Heal th P ro m o t io n uni t has had a most satisfactory working relat ionship for the last four years, cont inues to issue a newsletter on self-help projects and activities and maintains a network o f people involved in these projects. 3.34 An expert prepara tory meeting on health p romot ion and chronic disease was held in Berlin (West) in December 1986, leading to a symposium on health promot ion and chronic illness held in Bad H o n n e f in J une 1987, with more than 80 participants. The purpose o f the prepara tory meeting was to collect existing informat ion on chronic pain, examine strategies for act ion, intervention and bet ter informat ion exchange, and to find out which social and health policy initiatives ought to be most s trongly p ro m ot ed for people suffering from chronic pain. The aim of the symposium was to clarify the complex needs of people with chronic pain condit ions or with cancer and those recovering from heart at tacks, to assess the implications of these diseases, and to redefine their needs for the future. 3.35 A s tudy conduc ted in Austria, the Federal Republic o f Germ an y , Spain, Sweden and the Uni ted Kingdom to assess changes in the sex roles and their implications for family p lanning and sexual counsell ing services was completed. Th e s tudy analyses relevant developments and processes at var ious levels in society over a per iod of 15 years (1970-1985). The assu mpt ion is tha t changes in the roles o f women and men have a considerable influence on sexuality, par tnerships and contraceptive practices. Target 15 SO Health education and health promotion 3.36 Following a s tudy on substance abuse educat ion for health professionals, a meet ing was organized in Vienna in May to find ways to improve this type o f educat ion in medical schools. It was felt tha t promot ing substance abuse educat ion as a special subject must be a majo r long-term goal, in orde r to achieve an efficient response f rom the health sector to the growing problems of alcohol and drug abuse in the Region. The meeting resulted, am o n g other things, in the beginning o f a E uro pe an network o f experts and medical schools interested in carrying this topic further. The report of the meeting will be widely dist ributed and should contr ibute to the expansion of the network and to the creat ion o f a focal point for substance abuse educat ion. 3.37 A new and innovat ive approach to the role of col laborat ing centres has been developed. Each col laborat ing centre takes a lead role in an impor tant area — each in turn suppor t ed th rough its links with the others. A concrete example of the networking of col laborat ing centres, and the practical appl ication of educat ion for health within a health p ro m o t io n context , is i llustrated by the meet ing on public health educat ion on A ID S prevention, organized by the Federal Centre for Health Educa t ion in Cologne, By 1990, educational programmes in all Member States should enhance the knowledge, motivation and skills o f people to acquire and maintain health. 43 a W H O co l l abora t ing centre for health education. In addi t ion to par t ic ipants f rom 17 M em ber States, each of the W H O col laborat ing centres for health educat ion was actively involved. Th e In ternational Info rmat ion Centre on Self-Help and Heal th, Leuven was also represented, as was the proposed new W H O col laborat ing centre on training and research in self-care, to be designated in Maastr icht . Self-care in relation to being HIV-posi t ive or suffering f rom AID S itself is becoming an increasingly impor tant area, and this proposed new col labora t ing centre is p lanning to hold a consul tat ion on self-care and AIDS in 1988. 3.38 This meet ing in Cologne was the first W H O international meet ing in the E u r o ­ pean Region on A ID S and health educat ion, in which the roles, objectives and means of health educat ion in AID S prevent ion were examined. Th e meeting consisted o f a “ b azaa r” , at which the par ticipating countries presented health educat ion material on AIDS, made country presentat ions, and held discussion groups. While a num ber of recommendat ions were made, the need to integrate A ID S prevent ion, wherever feasible, into existing health education and p romot ion infrastructures and programmes was stressed. Th e challenges presented by A ID S should be incorpora ted into the concepts of health p romot ion , positive health and wellbeing. Th e impor tance o f moni tor ing and evaluat ion was also stressed. 3.39 The impor tance o f educat ion for health as an essential tool of health promot ion and for reaching the goal o f H F A was fully recognized at a consul tat ion held at the Regional Office in June. This also formed par t of a series of meetings to provide the necessary informat ion and assistance for reaching target 15, a central com ponent o f the lifestyles targets. This consul tat ion, on a coordinated infrast ructure for the delivery of the health educat ion p ro g ram m e within the context of health promot ion, was held immediately after a meeting o f W H O col laborat ing centres for health educat ion, also in Copenhagen. It was impor t ant in redefining and clarifying the impor tant role of health education and educat ion for health. The outcome of the consul tat ion will have a major impact on ensuring the provision o f the tools and mechanisms necessary for the delivery o f timely, efficient and effective health education to meet the new challenges o f a fast changing, high technology world. The report of this consultat ion has now been issued by the Scottish Health Educat ion G ro u p (SHE G) , Edinburgh, a W H O collaborat ing centre. A small core group meet ing took place at S H E G in November . This meeting identified more clearly the special function o f health education in the context o f health promot ion. It also served as prepara t ion for a major input into the X H I th World Conference on Heal th Educat ion to be held in Hous ton, Texas in 1988. 3.40 Majo r progress is being made in developing the joint C E C / W H O / C E project on p romot ing the health of young people in Europe. Th e project is a new and innovative appr oach in this area and draws from the expertise, networking and resources o f the three organizat ions concerned. 3.41 A meet ing held in L uxembou rg in February agreed in principle on the terms of reference for this joint venture. Final approval for the C E C contr ibut ion has now been obtained. A one-day consul ta t ion with CE in M adr id agreed on the outl ine o f a draft t eacher t ra in ing manua l tha t forms par t o f the jo in t projec t , an d agreed on the 44 m em bership of the small working group that was to prepare it. A further meeting of the core group took place in Utrecht in July, and again in Edinburgh in November. A draft o f the m anual was presented to the jo in t C E C /W H O /C E coord ina ting group in Brussels in December. 3.42 The second annual sem inar on selected topics in health education was organized by the G erm an Hygiene M useum , a W H O collaborating centre, in Dresden in June, on new and innovative approaches to the p ro m o tio n o f lifestyles conducive to health. The them e was tobacco, viewing tobacco use as a lifestyle problem and looking for new and appropria te strategies to p rom ote healthier lifestyles. 3.43 A small p lanning meeting took place at the University o f Perugia in November. Italy is in troducing a m ajor reorganization o f medical education, and this presents an ideal o p portun ity to develop models for health education in medical faculties. The p lanning meeting proposed holding a follow-up meeting in April 1988 on education for health p rom otion , in which the concepts and principles o f health p rom otion and the specific issues and m ethodologies o f health education would be discussed, with a view to their in troduction into the medical curriculum. The core group would also finalize plans for a w orkshop on education for health p rom otion , specifically health education in medical education, to be held in April 1989. The participants would be mainly from the medical faculty, not just in public health but also in internal medicine, with tem porary advisers from other relevant disciplines. 3.44 Nine tem porary advisers representing third-level training institutions in eight countries met in F ebruary to discuss ways of facilitating the exchange o f ideas and options for training program m es. The aim of the meeting was to review experiences in health p rom otion training and com pare them with the principles expressed in the recent O ttaw a C harter for health p rom otion. Particular emphasis was given to intersectoral and interdisciplinary approaches. 3.45 The First health prom otion training w orkshop was held in G ran ad a in A pril/M ay. This in terna tional course for Southern Europe and the M editerranean countries was organized according to the concepts and principles of health p rom otion , which were discussed in the context o f the move tow ards a new public health. The objective of the course was to develop technical capabilities for research and action program m es in health p rom otion in sou thern Europe and the M editerranean area, as well as to reinforce attitudes leading to a broad partic ipation in health. 3.46 A consultation on postgraduate train ing for health p rom otion was held in G o th en b u rg in Novem ber, bringing together 33 participants from 15 European countries to discuss the developm ent o f such courses and program m es in the Region. There has been a m ajor surge of interest in and planning for courses in health p rom otion addressed to many different groups. The principles and organization of this training are just emerging, however, and there is considerable dem and for the developm ent o f fram e­ works, curricula and new methods. This meeting has sown the seeds o f a network of t ra in ing centres in the Region for which the health p rom otion co llaborating centres may act as focal points. 45 Sexuality and family planning 3.47 The p roduc tion , evaluation, translation and distribution of teaching modules on family p lanning has continued. Eight modules have been o r are being produced , all but one in co llabora tion with the British Life Assurance Trust, London. F o u r o f these modules have already been printed and distributed, three o f them in 1987: Guidelines on psychosocial problem s o f fa m ily planning clients, Sexology fo r health professionals, and Guide pour la fo rm ation aux aspects psycho-sociaux de la planification fam ilia le (in French only, in co llabo ra t ion with the In ternational C h ild ren ’s Centre, Paris). Three more modules are in the final stages of editing before being sent for printing: Guidelines on problem s o f sexually transm itted diseases (STD ), Guidelines on certain aspects o f homo­ sexuality, and A ID S: counselling skills fo r health professions. Assistance was provided to national teams in Poland and Portugal to adap t teaching modules to their own needs. 3.48 A tra in ing video cassette on the counselling of family p lanning clients in a family p lanning centre has been produced under contract by the University of Bobigny, Paris, and eight copies are being reproduced for use by various co un te rparts for the tra in ing o f family p lanning health professionals. 3.49 An an n o ta ted bibliography on sexuality, family p lanning and m igrant p o p u ­ lations was updated , translated into English, reviewed, finalized and distributed in Ju ly /A ugust. 3.50 A four-year project with Albania to provide equ ipm ent and fellowships for the Institute of Paediatr ic Studies (1987-1990) was approved in February for an am o u n t of U S$600 000. All the equipm ent ea rm arked was ordered in 1987, although the three fellowships were postponed to 1988. 3.5! The two projects carried ou t in Bulgaria (research into the causes of, and remedies for, sterility (phase II) and family p lanning counselling o f families at risk) both ended during the year with the buying and repairing of equipm ent with the funds remaining. 3.52 An in ternational postgraduate training course on m ethods of family p lanning was held in Debrecen, Hungary in N ovem ber/D ecem ber, with English-speaking partici­ pants from all the W H O regions. 3.53 A project on the im provem ent of family planning and breastfeeding practices to be im plem ented in Poland was approved in September. It will serve target 16 as well. It is a two-year undertak ing , with a total budget o f U S $ 1 10000, consisting mainly o f the provision o f fellowships and equipm ent. It is jo intly executed by the N ational Research Institute for M other and Child (a W H O collaborating centre in Warsaw) and the Regional Office. 3.54 U nder the project for family p lanning activities in general hospitals and m a­ ternity clinics carried out in Portugal, two 2-week general courses were held this year on family p lanning and two on laparoscopic techniques. The project will end with two fu rther courses on laparoscopy and four more on family p lanning, and with the opening o f two contraceptive clinics for teenagers. 46 3.55 Also in Portugal, all the planned activities under the integrated project o f basic education in literacy, health and family planning for the Cape Verdean com m unity in the Lisbon area were implemented, including facilitating the relationship between health institutions and the Cape Verde population and producing educational material and organizing training sessions. 3.56 The third activity to benefit Portugal concerns the im provem ent and expansion o f m aternal and child hea lth /fam ily planning activities. This is a three-year project, costing US$160 500, approved in D ecem ber 1986 by U N FPA . The am oun t has been doub led by U S$50 000 a year to cover an allocation for contraceptive supplies. The project is progressing satisfactorily. In 1987, 180 physicians and 120 nurses were trained in family planning. The requested equipment supplies were delivered as planned. 3.57 In Turkey, the strengthening of integrated family p lann ing /m aterna l and child health services in 17 provinces progressed satisfactorily (this also serves target 16). An internal s tudy tou r for 40 health professionals was arranged at the end o f the year, and a s tudy tou r ab ro ad was undertaken in October. F rom the visits to G u m u sh an e Province by the Regional Officer in Septem ber, it was clear that the use of family p lanning m ethods was progressing positively and training in family planning was being imple­ mented. All the nurses and midwives of the provinces working in family p lanning were trained in 1987. A five-year extension of the project covering 11 provinces, for an am ount of US $1 984 905, was subm itted to the Regional Office for com m ents in July. It will start as soon as it has been approved. 3.5s All the above-m entioned country projects are financed entirely by U N FPA . Target 16 SO Sexuality and family planning 3.54 A working group was held at the Regional Office in May, to clarify the concepts of sexual health and suggest indicators for it. The final report went out at the end of September. 3.60 In connection with counselling in family p lanning for health professionals and with the assessment of users’ views on both traditional and m odern contraceptive m ethods, inform ation abou t the impact o f professionals is being gathered through two questionnaires for prof essionals and clients in 10 European countries. The ! hidings will con tribu te to the im provem ent o f family p lanning services. Separate reports on the health professionals and on the users are expected in 1988. The Institute for W om en, Ministry o f Culture, Spain analysed both surveys of Spain and published the analyses in a report received in November. By 1995, in all Member States, there should be sig­ nificant increases in positive health behaviour, such as balanced nutrition, nonsmoking, appropriate physical activity and good stress management. 47 3.61 The report o f a study on sexuality and people with physical disabilities was prin ted in J a n u a ry and widely d istribu ted , particularly in the United K ingdom . It is based on the experiences, ideas and recom m endations o f the handicapped people them ­ selves who contribu ted to this study. 3.62 A study on hum an sexuality and aging carried out by a researcher and her team from the Federal Republic o f G erm any is progressing well. The report o f the completed study is expected shortly. 3.63 An analysis o f the impact of occupation on fertility, sexuality, contraceptive practice and partnersh ip is being implemented in Finland and Poland. A preliminary report is expected in early 1988. 3.64 Live television debates ab o u t infertility and the trea tm ent m ethods for actually and potentially infertile people took place in H ungary and Italy between infertility counsellors and couples. Video recordings and reports on the television program m es should be received in 1988. 3.65 The report o f a study on the place and role o f men in birth and contraception, conduc ted u nder contract by the N ational School o f Public Health , Rennes was rep ro ­ duced and distributed in February. 3.66 Issue No. 10 of the newsletter Entre nous was d istributed in July. The Spanish translations of Entre nous No. 8 and 9 were received and distributed. The Portuguese trans­ lation of No. 7 is expected in early 1988, and a Turkish translation o f the newsletter will begin as from No. 10. Nutrition 3.67 By m eans o f a specific m ailing list — the so-called E u ro p ean nu tr i t ion ne t­ work — reports and recom m endations on nutrition policy form ulation and im plem en­ ta tion are d is tr ibu ted to 800 people w orking in the field o f nu tri t ion , mostly in E urope but also in o th e r parts o f the world. A letter sent out in Ju ly 1987 with inform ation ab o u t the activities in the N utri t ion unit has received a very positive response. M any orders have been received for unit docum ents th rough the order forms enclosed with the letter. In 1986 more than 3000 copies were ordered in that way. 3.6X The final draft o f a source book for the form ulation o f nutri t ion policy objectives was received and edited. It will be published in 1988 under the title H ealthy nutrition: preventing nutrition-related diseases in Europe. A bout 400 copies o f the final draft o f the manuscript were distributed. 3.69 Two o ther basic books for nutrition policy-makers are being prepared. The first will be on nutri t iona l surveillance in the context o f nutri t ion policy planning. A g roup of experts on dietary and nutritiona l da ta collection have con tribu ted to the book , and editorial assistance has been received from the Swedish F o o d Adm inis tra tion who provided one of their experts as a tem porary adviser. зло The second book is intended for policy-makers on models for the organization and im plem entation of nutrition policy. In this context a study took place in M ay to 48 analyse nu tri t ion policy fo rm ulation in Poland , and the potential for im plementing such a policy. A no ther s tudy was m ade in Ju ly of the long-term experience gained from im plem enting the Norw egian nutri t ion policy, ad o p ted by parliam ent in 1975 and now being incorporated into an overall health plan. C ontributions are also expected from A ustra lia , giving a sum m ary o f their experience. A com parative study o f conditions and events in the N ordic countries has been carried out by the N ordic Council, and a shortened version of this will be incorporated into the book. 3.71 M ass catering is one o f the most effective ways of implementing the objectives of a nu tr i t ion policy on a large scale. It is therefore an area o f pa r ticu la r concern to the nu tri t ion program m e. A com parative study of experience with mass catering in D en­ m ark and H ungary was carried out, and has been very positively received by those w orking in the field. It was one of the background docum ents to a meeting on op p o r­ tunities fo r better nu tr i t ion th rough mass catering, held in C openhagen in December. Tw enty-tw o experts in the field, from 10 countries, met to consider how mass catering, which in many ways has grow n enorm ously in size but not always in quality, could be a better instrum ent for health prom otion . 3.72 Obesity is an area of concern to the nutrition programme, which concentrates on its epidemiological aspects. The incompatibility in the presentation of an thropom etr ic data describing obesity, within and between countries, makes com parison and analysis diffi­ cult. A meeting to discuss the possibility o f s tandardiz ing the an th ropom etr ic description o f obesity was therefore held in W arsaw in O ctober. T he draft report from the meeting contains specific proposals for the collection, analysis and presentation of such data. 3.73 A w orkshop on a systematic app roach to com m unity nu tri t ion was held in Jan u a ry in Asker, N orw ay for com m unity nutritionists working in different fields. A second w orkshop on the same subject will be held in H ungary in M ay 1988. The report on the first w orkshop is available from the N utrition unit. 3.74 A w orkshop on household survey d a ta and their use in nu tri t ion policy p lanning was held in Athens in O c tober and a ttracted a ro u n d 30 statisticians and nutritionists from 17 M em ber States. Being a truly interdisciplinary venture, the w orkshop con­ cen tra ted much effort on small working groups where partic ipants could share their experience. T he w orkshop was supported financially by the C om m ission of the E uro ­ pean Com m unities . R ecom m endations were drafted concerning the p repara tion of household budget surveys, and the collection, analysis and presentation o f data. Various proposa ls were made, aimed at involving nutrition policy planners at an early stage of the survey prepara tions. The statisticians also strongly suggested tha t nutritionists be more precise abou t the type o f d a ta they needed for nutrition policy purposes. Smoking and health 3.75 A plan o f ac tion covering a five-year period was d raw n up in co llabo ra t ion with two consu ltan ts , an d was ad o p ted by the Regional C om m ittee in resolution E U R /R C 3 7 /R 9 . T he Action Plan on Tobacco urges greater coord ina tion and cooper­ a tion am ong those w orking at local, national and in ternational levels. It emphasizes 49 the efficient use o f existing resources, the sharing o f knowledge and experience, and cooperation between individuals an d groups to increase the impact and effectiveness of individual measures. 3.76 T he Action Plan on Tobacco has six objectives: (a) to help countries develop and implement comprehensive tobacco policies; (b ) to develop cooperation at an inter­ governmental level; (c) to encourage the cooperation o f nongovernm ental organizations; (d) to p rom ote public inform ation; ( e) to collect and disseminate inform ation; and (/) to establish a E uropean system to m onito r and evaluate the effectiveness o f the measures taken. 3.77 T he Action Plan was warmly received by the Regional C om m ittee, and the ensuing discussions led to a lively debate. In addition , it received good press coverage. 3.78 Legislative initiatives can reduce tobacco m arketing as well as influence indi­ vidual and social behaviour. Legislation has not yet materialized efficiently in many countries, however, because the political will, when it exists, encounters many obstacles. In o rder to su p p o r t politicians and parliam entarians in their effort to in troduce and implement legislation, the H ealth Legislation unit initiated the preparation of a model national legislative strategy on sm o k in g /to b acco control. It will provide M em ber States with the legislative fram ew ork to support a comprehensive sm ok ing /tobacco control policy, including various scenarios that could be adap ted to different situations, showing the chances o f success, the causes of failure and the impact o f legislative action under different circumstances. 3.79 T hree m odules on “ tobacco or hea lth” were presented in d raft form to a meeting o f na tional medical associa tions in Paris in N ovem ber. O ne deals with advice to patients on stopping smoking, an o th e r with sm oking cessation by doctors themselves, and the th ird with active partic ipation in no-sm oking cam paigns by members o f medical associations in the capacity o f an advocacy group. The partic ipants in the meeting strongly supported the texts, and com m itted themselves to m aking full use o f the modules. Target 17 80 Research 3.80 A consultation on health p rom otion indicators was held in Edinburgh in Jan u a ry to consider the H F A lifestyle targets and associated indicators for health prom otion. Most By 1995, in all Member States, there should be sig­ nificant decreases in health-damaging behaviour, such as overuse o f alcohol and pharmaceutical pro­ ducts; use o f illicit drugs and dangerous chemical substances; and dangerous driving and violent social behaviour. 50 o f the H F A targets are related to social and behavioural factors, in term s o f bo th structures and processes. It was felt that the social meaning of concepts ough t to be taken into account, and the consulta tion then came up with additional criteria for health p rom otion indicators. C om m ents were made on the proposed essential an d supplem en­ tary indicators as well as on new or proposed indicators. Suggestions were also offered on research methods, da ta collection and sources. 3.81 A report was subm itted to the Regional Office in time for the revision o f indicators in mid-February . Drug abuse 3.82 C ontacts were established with a num ber o f institutions th ro u g h o u t the Region interested in co llaborating in an in terna tional com parative study on the sociocultural factors associated with d rug abuse. C onsulta tions were held with experts who will play a leading role in the im plem entation of this study. The study will try, am ong other things, to identify the influences in the com m unity that act against the abuse o f psychoactive drugs in general. 3.83 A study has been carried out to explore the possibility o f early intervention techniques in drug abuse. T he study indicates that, con tra ry to generally held beliefs, early interventions are effective and efficient com pared with the trad it ional trea tm ent tha t focuses more on the established drug abuser. Models to prom ote early intervention were discussed a t a meeting held in D ecem ber in M unich. In the course o f the next biennium these models will be tested in various subregions for their applicability on a wider scale. 3.84 A study was carried out on drug abuse research in the European Region. It show ed tha t there is a fair am o u n t of research o f all types going on. Nevertheless, the links between research and policy-making, the setting of priorities and the coord ina tion o f in fo rm ation could be substantially improved. Better mechanisms for coord ina tion at the national and in terna tional levels will have to be established. F u tu re activities in this project will also look at ways and means o f calling attention to the priority areas identified by the European Advisory Com mittee on H ealth Research. 3.85 Partic ipation in the jo in t C E /C E C /W H O project on health education against d rug abuse continued th ro u g h partic ipa tion in the discussions on the conduct o f the project and th rough linking this project with the country m edium -term p rogram m es in G reece and Spain. T he Regional Office’s involvement in this project allows the partic i­ pa ting com m unities to form links with the Healthy Cities project and with health education activities. 3.86 In co llaboration with an Italian nongovernm ental o rganization, links were es­ tablished with an in terna tional E uropean netw ork tha t may provide the op p o r tu n ity for a regular update o f trends in drug abuse at the E uropean regional level, and for the identification o f innovations in trea tm ent and prevention. 51 3.87 Inform al discussions took place at regular intervals with representatives o f the Council o f Europe (Pom pidou G ro u p ) and the Com m ission of the European C o m ­ munities to ensure appropria te coord ina tion between the activities undertaken by these agencies and the W H O regional program me. Alcohol abuse 3.88 In Ju n e the second meeting o f principal investigators in the W H O collaborative study on com m unity response to alcohol-related problems took place in Lisbon. At this meeting, the principal investigators com plem ented and updated their inform ation on national and com m unity policies and program m es and presented progress reports on the responses to them in terms o f the services provided and the preven tive /p rom otive action taken in their respective communities. Discussion on the design and use o f instrum ents and definitions in each com m unity continued. 3.89 A willingness to share with and learn from each o ther has been one o f the most significant aspects o f this study and should facilitate the development of novel and innovative responses within the com m unities concerned. This may also be one o f the reasons why an increasing num ber of countries are expressing their interest in jo in ing the study. At present, 16 comm unities in 12 countries are participating. C om parative studies are not the m ain aim, but it is expected that the final report will contain a set o f case studies in which the different communities can report their response to alcohol-related problems. In this respect the principal investigators agreed to a com m on outline for the report which is expected to be ready in 1991. 3.90 Visits by the principal coo rd ina to r to the partic ipating communities in D enm ark , Iceland and Spain and by a consultan t to F rance and Portugal greatly benefited these communities, as reflected by their progress with the study activities. 3.91 A con tract was draw n up with the W H O collaborating centre for health — psy­ chosocial and psychobiological factors in Brussels to review the literature on violent social behaviour and alcohol (with special reference to alcohol-related violence involving young people). T he synthesis o f the literature will be finalized in early 1988, bu t the prelim inary findings seem to indicate a positive re la tionship between violence in general and alcohol. 3.92 Alcohol is also a con tribu to ry factor in the complex social context that involves hooliganism. In the field of alcohol use and violence within the family, more a ttention has been paid to prevention, especially to protect the healthy development o f children and adolescents. 3.93 A review o f current policies on alcohol abuse in United N ations agencies and in tergovernm ental and nongovernm ental organizations was undertaken to develop co­ ord inated action and planning am ong the organizations involved. The report is expected to be finalized in mid 1988, and will be issued jointly with the national reviews m entioned in paragraph 3.25. 52 LIFESTYLES CONDUCIVE TO HEALTH Documents issued in 1987 A ID S am ong drug abusers: report on a W H O C onsu lta tion (docum ent IC P /C D S 027). A ID S and the newborn: report on a W H O C onsu lta tion (docum ent IC P /C D S 017). Alternative approaches to the development o f fa m ily planning programmes: report on a W H O study (document IC P /M C H 503Л01). C om m unity nutrition w ork — a system a tic approach (docum en t 1 С Р / N U T 128). C om m unity response to alcohol-related problems: report on the second meeting o f principal investigators in the W H O collaborative study (docu­ ment IC P /A D A 017). Concepts o f sexual health: report on a W H O meeting (docum ent IC P /M C H 521). Fertility awareness methods: report on a W H O w orkshop (document IC P /M C H 518). Haddad, W. Safe sex: working paper p repared for a meeting on A ID S diagnosis and control (document IC P /C D S 0 2 6 /1 1). H ealth education in the fa m ily : report on a W H O meeting (docum ent IC P /P H C 115). H ealth exhibitions — m useum s— posters: report on a w orkshop organized by the G erm an Hygiene M useum o f the G erm an D em ocratic Republic (docum ent I C P /IE H 122). H ealth prom otion in the working world: report on a jo in t meeting organized by the Federal C entre for H ealth E duca tion , C ologne (docum ent IC P /H S R 603/m02). H ealth workers and the W HO International Code o f M arketing o f Breast- m ilk Substitutes: report on a W H O meeting (document IC P /N U T 112). In fant m orbidity — infant feeding: recom m endations for research (docu­ ment IC P /N U T 102Л03). Nilsson Schönesson, L. The relationship between psychological dysfunction and sexuality within a m arital context: report on a literature survey (docu­ ment IC P /M C H 519). Porter, M. Sexua lity and people with physica l disabilities: report on a study (document IC P /M C H 526). Sexuality, fa m ily planning and m igrant populations: an n o ta ted bibli­ ography (document IC P /M C H 535). The respective roles o f prim ary health care and specialized services in the developm ent and im plem entation o f program m es fo r problem drinkers: re­ port on a W H O meeting (docum ent IC P /A D A 010). Vienna dialogue on "H ealth po licy and health prom otion — towards a new conception o f public hea lth": rep o r t on a W H O meeting (docum ent IC P /H S R 623). 54 Action Plan on Tobacco Smoke-free Europe Five-year plan for a smoke-free Europe If each day of the year four ju m b o jets crashed in Europe killing all on board , there would be public dismay and outrage if the authorities failed to solve the problem. Yet tobacco causes at least an equivalent num ber of dea ths in Europe — an estim ated 500 000 each year. Tobacco is not only a legal, addictive drug, but it is also widely prom oted and advertised through images o f wealth, youth and glamour. * The s m o k i n g c lub . 1 7 9 2 W e l l c o m e Ins t i tu te Library. Lo nd o n . Un i ted K i n g d o m The deadly cure The first E uropean exposed to tobacco sm oke was C hris topher C olum bus, who found Indians sm oking when he arrived in Central A m erica in O ctober 1492. Spanish and Portuguese explorers o f the New W orld in troduced tobacco to Europe, where it was at first believed to cure headache and provide relief from a score of other maladies. By the middle o f the sixteenth century, Jean Nicot, the French A m bassador to Portugal who gave his nam e to the genus Nicotiana, was growing tobacco in Europe and p rom oting it for its “ cure-all” qualities. Until the late nineteenth century, tobacco was sm oked primarily in pipes an d by men. C igarettes, especially after the invention of the cigarette-m aking machine, made tobacco available to a wider public. U nfortunate ly , the cigarette was also a much more hazardous way o f consum ing tobacco. Cigarette consum ption increased rapidly in many parts o f Europe until after the Second W orld War. Changing fashions meant that wom en, especially those in the most industrialized countries, began to sm oke in growing num bers after the First W orld War. Evidence of the harmfulness o f sm oking appeared sporadically before the Second 5 W orld W ar, but not until the 1950s did carefully constructed epidemiological studies begin to provide solid evidence of the hazards o f tobacco. Despite the weight o f medical | evidence, tobacco consum ption is still increasing in many European countries, a l though j it has stabilized or started to fall in others. Sm o ke le ss t o b a c c o : a t t rac t i ve pa ck ag ing , f i l t hy p r o d u c t s W H O , T. Farkas An avoidable cause of death Cigarettes, the m ain way tha t people consum e tobacco in Europe , are the conti­ n en t’s greatest single avoidable cause of illness an d prem ature death. The level o f lung cancers is now alarm ing, an d a lm ost all are caused by cigarette smoking. T he habit is also a m ajor con tribu to ry factor to o ther cancers and to diseases of the heart, the circulatory system and the lungs. Sm oking during pregnancy threa tens the b ab y ’s health. Children whose paren ts smoke are more prone to chest infections and o ther illnesses. Breathing o ther people’s tobacco sm oke is called involuntary smoking, and this can harm n on­ sm oking adults , too. T obacco is dangerous no m atte r how it is consum ed, even if it is chewed or merely held in the m outh for long periods. ji T obacco use has not only medical bu t also m ajo r social and econom ic implications. ; Ï Different social g roups a ttach varying values to the habit and strongly influence whether ' I a person becomes a smoker. Powerful economic interests involved in tobacco p roduction j I and d is tr ibu tion also limit individual choices th rough the pressure of advertisements or ! the sponsorsh ip of sports an d o ther leisure activities. This reinforces the social ac- j ceptability o f tobacco and counteracts a ttem pts by health authorities to encourage people to make better choices for their health. D uring the past q u a r te r o f a century, every country in Europe has taken some steps to prevent the senseless loss of life caused by tobacco. But these isolated efforts, however good in themselves, have not been adequate to tackle this difficult and pervasive problem. The wealth that tobacco p roduction and sales bring to some sectors of the com ­ munity merely exacerbates the problem by giving countries a s trong disincentive to reduce consum ption . M oreover, since tobacco taxation provides a plentiful and easy source o f revenue, governm ents themselves can feel the conflict between wealth and health. Com prehensive tobacco policies are the most prom ising way to su rm oun t these obstacles and reduce any co u n try ’s tobacco consum ption. Such policies would coord i­ nate a wide variety o f collective and individual measures at com m unity and national levels. It is clear that widespread changes will not come abou t through the efforts o f any single governm ent ministry, health service or public interest group. Success will come from a com m on effort. Action Plan on Tobacco Because o f their growing concern abou t the epidemic o f tobacco-induced diseases, the 32 M em ber States o f the WHO E uropean Region asked the WHO Regional Office for Europe to conduct a m ajor cam paign against tobacco use, as a part o f the WHO strategy for health for all by the year 2000. In the au tu m n of 1987, the E uropean M em ber States formally approved the Action Plan on Tobacco: a five-year strategy, d raw n up by WHO, to encourage and assist countries. The Plan urges much greater cooperation between the people working at local, national and in ternational levels and between individuals and groups. It emphasizes the efficient use o f existing resources by pooling knowledge and experience o f successful projects and by encouraging coopera tion to increase the effectiveness o f individual measures. The Action Plan has six objectives: • to help countries to develop and implement comprehensive tobacco policies; • to develop international cooperation; • to encourage the involvement and support of nongovernm ental organizations; • to collect and disseminate inform ation; • to prom ote inform ation to the public; • to establish a European system to m on ito r and evaluate the effectiveness o f measures taken. NÄO FUME NEM TUDO О QUE ARDE CURAI SAßLAM BlR IRADEYLE GÜÇÜJ BlR BÜNYE W H O , H. Skougaard-Jacobsen M any activities to implement the Action Plan are already under way. In 1987, the Regional Office for Europe and in terna tional and in tergovernm ental organizations discussed the Plan and how they might work together more effectively. Especially im portan t has been the coord ina tion o f activities with the Com mission o f the European C om m unit ies’ m ajor public health initiative, the Europe against Cancer Program m e. C om m unica t ion has also been strengthened with in terna tional organizations represent­ ing different areas o f the medical profession, consum ers’ g roups and charitable organ iz­ ations concerned with health. Per cap i ta c o n s u m p t i o n of m a n u f a c t u r e d c igare t tes in 2 6 E u ro p e an cou n t r ies , a ro u n d 1 9 8 4 3000 500 POR FIN BEL SSR DEN SPA DDR IRE CZE AUT POL HUN TUR SWE ROM BUL ISR FRA NET UNK ITA DEU ICE SWI YUG GRE Country Involving the medical profession Tw o o f the Action Plan’s m ajor projects completed so far were cooperative ven­ tures. A long with WHO headquarters and the In ternational Union against Cancer, the Regional Office for Europe contribu ted to a project designed to give guidance to the prim ary health care team in more effectively helping patients to stop smoking. Closely tied to this w ork was a project to provide tools for national medical associations to use in involving their own members in the campaign against tobacco. This involvement includes getting physicians themselves to stop sm oking, encouraging them to help their patients stop, and increasing awareness o f the tobacco issue both within and outside the profession. First European Conference on Tobacco Policy and Health Few changes in the policies o f either public authorit ies o r private organizations will ! occur unless there is public awareness o f the gravity o f the tobacco problem and j w idespread support for measures to tackle it. Even when policies are changed, many will I not be accepted by the public if there is no consensus that the health and social • consequences of tobacco use are intolerable. ? With this in mind, the Regional Office for Europe is organizing the First European C onference on T obacco Policy and Health. This Conference, which is scheduled for N ovem ber in Spain, will be the m ajor activity o f the Action Plan for 1988. It aims at bringing together policy planners and adm inistrators , public interest groups such as consum er organizations, an d professional interest g roups such as health personnel, teachers, journalis ts , economists, social scientists, lawyers, agriculturists and representa­ tives o f labour unions. Because tobacco is not a problem that confines itself to national borders, international organizations, which have an im portan t and specific role to play, will also be represented at the Conference. These are the people w ho will articulate the need for policy changes: in o ther words, those w ho will s tart to build the consensus and plan the policy changes or carry them out. The Conference will be a forum where these various groups can find ways to exchange knowledge and resources, agree on a model tobacco control policy and decide on specific action that can be taken now and in the near future to raise awareness of the tobacco problem and to prom ote policies that make some headway against it. Some o ther projects to implement the proposals of the Action Plan include: • the developm ent o f a scenario o f different national policies on tobacco use in Europe, with special emphasis on legislation; • brief reports from European countries on topics such as health eduation , new tobacco products , and tobacco p rom otion , pricing and legislation (this data will be indexed and made available in printed and com puter-readable form, and the complete reports will be printed for people who need more detailed information); • the production o f a selection of written and audiovisual health education material abou t tobacco use to make existing work more widely known (this collection will be as practical as possible and will point users to further sources of information); • the identification o f existing data bases on tobacco use and o ther relevant information sources, which will be examined to see how best they can be supplem ented and made more widely accessible; ( • the development o f a series of practical brochures addressing questions on such topics as what is known about ch ildren’s tobacco habits, how physicians can help their patients s top smoking, and the effects of price increases on tobacco consum ption. Partners for action The Action Plan on Tobacco is a response to a critical, seemingly intractable problem. Public health officials are fighting an established, socially acceptable habit that is also a form o f addiction. M oreover, countries also become addicted to tobacco through their economic dependence on the revenue it generates. New solutions must be found to break the hold tobacco has on both countries and individuals. Built on ideas defined by the O ttaw a C harte r for Health P rom otion , the m ethod endorsed by the Action Plan — one that enlists the interest and support o f a wide variety o f groups, institutions and individuals — is a rational and promising solution to such problems. The Action Plan is a pilot scheme in this sense: if its m ethod is effective with tobacco, the same m ethod can be applied to o ther lifestyle issues. Ac t i o n on S m o k in g and Heal th (ASH). Un i ted K in g d o m 4Healthy environment 4.1 With the overall objective o f creating a hum an environm ent that will support the im plem entation o f the Regional Office p rogram m e as outlined under targets 18-25, work con tinued to con tribu te to the fu r ther s trengthening o f policies an d strategies to prevent an d con tro l env ironm enta l health hazards, assess and deal with environm enta l health risks, and prom ote a healthy environment. 4.2 Environm ental and health impact assessment is an im portan t tool in the preven­ tion o f health hazards. It is the element o f environm ent and health policy that should be fu r the r developed and applied on the basis o f m ultisectoral cooperation . The p rom otion o f a m ethodology and its application were two o f the m ajor concerns o f the p rogram m e o f w ork implemented during the year. 4.3 A new and significant inpu t to the p ro m o tio n o f environm enta l health during the period u nder review was the developm ent o f the H ealthy Cities project, which aims at im proving the health conditions o f urban populations. 4.4 Increased a t ten t ion was paid by M em ber States to p rob lem s associated with m unicipal waste m anagem ent. Because o f the limited disposal op tions available, incin­ e ra tion has become an increasingly preferred solution. This, in tu rn , has led to concern ab o u t the consequences fo r hu m an health and the env ironm ent from the emission into the air o f certain po llu tan ts , o r their concen tra tion on b o t to m ash an d subsequent disposal. 4.5 The European Region’s industrial developm ent is dynam ic, which results not only in new health hazards bu t also in hazards from developm ents in the past. The evaluation o f the In te rna t iona l D rink ing W ater Supply and San ita tion D ecade carried out at a consu lta tion held in N ancy indicated that m any problem s related to w ater supply and sanitation in the European Region have not yet been solved. 4.6 Chem ical po llu tion o f the environm ent remains the m ajor cause o f health hazards in the o u td o o r and in d o o r environm ent, including the occupational environm ent. The intensive m onitor ing o f po llu tion and of the sources o f chemical po llu tan ts that m an may be exposed to are rarely linked to an assessment o f the im pact tha t po llu tion may have on peop le’s health. With the aim o f improving strategies for m onitor ing chemical health hazards , a p ro g ram m e was initiated to develop guidelines on the applica tion of environ­ m ental m onito r ing in health im pact assessment, as well as to develop an environm ental health d a ta base. 55 4.7 A m ajo r achievement in developing tools to contro l health hazards associated with air po llu tion was the finalization o f work on and publication o f A ir quality guidelines fo r Europe. This publication provides guideline values for safe levels o f 28 individual and groups o f chemicals in the air. The values are based on the assessment o f the health effects o f the chemicals concerned, carried ou t by Regional Office working groups and consul­ ta tions in which over 150 experts from all over the world partic ipated. This significant achievem ent was possible thanks to the generous support received from the G overnm ent o f the Netherlands. 4.8 The updating o f the W H O guidelines for drinking-water quality was considered the next step necessary to enhance regional and global abilities to prevent and control health hazards from drinking-water. Guideline values for 11 herbicides in drinking- w ater were developed by the Regional Office in 1987 with the support o f the G overnm ent of Italy. 4.9 A lthough efforts to control chemical hazards have been increasing in Europe and o ther regions o f the world, accidents and disasters caused by the uncontrolled release o f chemicals in to the environm ent continue to occur. The causes and circumstances of such accidents, as well as the preventive measures taken, were discussed at the first W orld Conference on Chemical Accidents, organized by the Regional Office in cooperation with the central unit o f the In terna tional P rogram m e on Chemical Safety a t W H O headquarters a n d the Istituto Superiore di Sanità in Rom e, a W H O collaborating centre. The Conference revealed that large-scale catastrophes, infrequent bu t highly d ram atic in their consequences, point to the need for the fur ther developm ent of prevention p ro ­ gram m es and adequate contingency plans based on thorough environmental and health im pact assessment. The problem is t ransboundary : as the C hernobyl nuclear accident showed with startling clarity, disasters recognize no frontiers. 4.10 The consequences o f the Chernobyl ca tas trophe in 1986 remain of com m on concern in the Region. Based on the m an d a te provided by resolution E U R /R C 3 6 /R 8 of the Regional Com m ittee in 1986, the Regional Office intensified its work during 1987. This led, inter alia, to a com m on understanding being reached am ong the countries of Europe as to which actions must be taken to safeguard public health in case o f such accidents. 4.11 The implementation o f the environm ental health p rogram m e in 1987, as a p ­ proved by the Regional C om m ittee , was successful in tha t it ob ta ined the coopera tion of M em ber States an d direct support from a num ber o f them. Nevertheless, p rogram m es such as those on occupational health and food safety are particularly dependent on support from M em ber States if they are to be fully implemented. 4.12 The year 1987 was also a successful one in the distribution o f technical in for­ m ation , bo th th rough the Publications p rog ram m e o f the Office and th rough docum ents o f various kinds. One such vehicle is the Environm ental H ealth Series which, a l though officially a docum en t series, is frequently reviewed by jo u rn a ls an d is included in several widely accessed d a ta bases. These docum ents are available only on request, an d during the year some 4700 such requests were received. Thirteen new titles in this series were issued during 1987. 56 4.13 In November, a collaborative agreement was made between the Regional Office and the Research Institu te for Hygiene and M icrobiology, Bad-Elster, G erm an D em o ­ cratic Republic. T he co llaboration will be in the field of environm ental problem s and their health-related aspects. 4.14 An intensive p ro g ram m e of co llabo ra t ion has begun with the Province of N av arra in Spain, under which the Office has been invited to partic ipa te in training activities in environm ental health issues, run by the Miguel Servet F oundation of the N avarra Regional Institute o f Public Health. The Institute has started postgraduate tra in ing in environm enta l hygiene, and a series of short courses of a few weeks’ dura tion in specific environm enta l health subjects are also being run for technicians from all over Spain. In early 1988 the Institute is expected to be officially appoin ted a W H O collab­ ora ting centre for the p rom otion of environmental health activities within primary health care programmes. Target 18 SO 4.15 T he technical p repara tions for the European conference on health and the env ironm ent progressed according to plan, a l though some delays were experienced in ensuring the financing of this major event th rough voluntary funds. A consulta tion was held in C openhagen in Jan u a ry to design environm ental health indicators for m onitoring the progress of the H F A strategy in Europe. 4.16 The W H O -sponsored annual course on environm ental and health impact as­ sessment was held at A berdeen University in July , and ano ther course on the assessment o f the environm enta l and health effects o f developm ent proposals was held at the same university in September. This second course concentrated on the interface of health sciences and environm ental impact assessment. The work of the Regional Office on environm enta l and health impact assessment was consolidated in Environm ental Health Series No. 15, Health and sa fety component o f environm ental impact assessment. This docum en t was d istributed in 1987 as the Office contribu tion to the sem inar on environ­ m ental impact assessment, organized by the United N ations Economic Com mission for Europe (ECE) in W arsaw in September. 4.17 The M onitoring and Assessment Research Centre in L ondon was designated a W H O collaborating centre for environm ental health m onitoring and assessment, and the C entre for E nvironm ental M anagem ent and P lanning in Aberdeen was designated a W H O collaborating centre for environm ental and health impact assessment. 4.18 W H O recom m endations ab o u t env ironm enta l and health im pact assessment are being im p lem ented at the field level in the W H O -ass is ted , U N D P -su p p o r ted By 1990, Member States should have multisectoral policies that effectively protect the environment from health hazards, ensure community awareness and in­ volvement, and support international efforts to curb such hazards affecting more than one country. 57 project carried out in the A u to n o m o u s Province o f K osovo in Yugoslavia, on environ­ mental p ro tec tion related to the developm ent of large-scale mineral exploitation. It is also proposed to apply these recom m endations in the implementation o f the W orld B a n k /U N D P regional project on energy planning in E uropean and A rab states, and a p lanning meeting on that subject was held in Vienna in June. 4.19 T he Regional Office provided the ECE executive body for the C onven tion on Long-range T ran sb o u n d ary Air Pollu tion with in form ation and material for the health co m p o n en t o f a study on the effects o f such pollution. This in form ation concerned the effects on health o f nitrogen dioxide, sulfur dioxide and particula te matter, ozone and o ther photochem ical oxidants, cadm ium and lead. The Regional Office was represented at the sixth session o f the ECE executive bo d y ’s working g roup on effects, in G eneva in July , and a t the fifth session o f the executive body in G eneva in N ovember. A lthough delegates requested more input from W H O on health effects, they were informed tha t the Air quality guidelines fo r Europe publication now provided the most up-to-date infor­ m ation on im p o rtan t air pollutants , and that the Regional Office would subm it fur ther inform ation in the future when it became available. Target 19 SO 4.20 T he survey of the environm enta l health inspection system in Europe was con­ tinued with the assistance of the W H O collaborating centre for the training and utiliz­ ation o f environm ental health officers, located at U m eâ University, Sweden. A course on epidemiology in environm enta l health took place there in M ay /Ju n e . Direct assistance was given for the tra in ing of environm enta l health officers a t the Public H ealth Institute o f Pam plona , Spain and at the N ational Public Health Institute in Rome. The Institute of Hygiene and Epidemiology in Brussels was designated a W H O collaborating centre for environm enta l da ta assessment. Its main task will be to inventory and critically assess existing environm ental da ta , hum an exposure and uptake data , and data on related health effects for the main pollu tants in the European Region. 4.21 A refresher course for sanitary engineering professors was held at the In ter­ national Institute for Sanitary Engineering in Delft, Netherlands. 4.22 Tw o W H O docum ents on environm ental health m anpow er developm ent were issued in the Environm ental Health Series: No. 18, Development o f environm ental health manpower, and No. 19, Occupational profiles o f environm ental health personnel. 4.23 T he Regional Office is p lanning to develop activities to strengthen environm ental health tra in ing within European schools of public health (for fur ther in form ation, see under target 30). By 1990, all Member States should have adequate machinery fo r the monitoring, assessment and control o f environmental hazards which pose a threat to human health, including potentially toxic chemicals, radiation, harmful consumer goods and biological agents. 58 Chemical hazards 4.24 A health-related environm ental m onitor ing system must have clearly defined public health goals, and progress tow ards these goals must be assessable in an objective way. An informal consultation held in Copenhagen in August recom m ended that studies be undertaken to provide a background for the development of guidelines on the identification of priority problem s related to the impact on health of chemical pollutants. 4.25 The European Region, with its con tinuous industrial developm ent, must be concerned abou t chemical hazards that put the health of its population at risk. A num ber o f already recognized hazards are under thorough scrutiny, as new diagnostic criteria indicate that control m easures established in the past may not be sufficient to protect people’s health. In tercountry collaborative epidemiological studies have continued on the neurobehavioural effects of lead on children, the renal effects of cadm ium on the elderly, the neurotoxic effects of chronic exposure to organophosphorus com pounds, and the effects of welding fumes on the health o f stainless steel welders. Some of these studies (on lead and cadm ium ) are well advanced and final reports will be available during 1988-1989. A meeting held in H anover in November, sponsored by the G overn ­ ment o f the Federal Republic of G erm any and held jointly with the International P rog ram m e on Chemical Safety, evaluated the effects on health o f formaldehyde. It was recom m ended that an epidemiological study be undertaken to assess the risk to health of form aldehyde in indoor air in com bination with o ther indoor air pollutants. 4.26 A working group sponsored by the Veneto Regional G overnm ent met in A bano Terme, Italy to review studies on exposure and health risk assessment in infants exposed to polychlorinated dibenzodioxins (P C D D s) and polychlorinated d ibenzofurans (PCDFs). It concluded that a lthough average levels of P C D D s and P C D F s in breast-milk are relatively high, they are not likely to be a risk to the health and developm ent o f infants, since the safety margin is o f 2-3 orders o f m agnitude com pared with the lowest levels at present known to have toxic effects. Any limitations imposed on breastfeeding associated with the presence of P C D D s and P C D Fs would therefore not be justified. Instead, the w orking g roup recom m ended that prim ary prevention should be undertaken to reduce emissions of P C D D s and P C D F s into the environm ent, thus preventing the further accum ulation of these chemicals in the hum an body, including breast-milk. 4.27 A m ong the various chemicals present in drinking-water, herbicides are o f special concern owing to their toxicity and persistence in the hum an body. This concern has been aggravated by the fact that control measures introduced in a number of countries, based on analytical and health criteria, are considered inadequate by the countries concerned. Two consultations held in Rome in February and July evaluated the risk to health from 11 herbi­ cides. Based on this evaluation, the consultations recommended guideline values for safe levels in drinking-water o f the 11 herbicides reviewed (see under target 20). These consul­ tations and the d istribution of the report were supported by the G overnm ent of Italy. 4.2X In preventing health risks due to exposure to toxic chemicals, special a t ten tion m ust be paid to people w ho may be particu la rly susceptible to env ironm en ta l po l­ lu tan ts . G enetic pred isposition may be one such reason for a higher than average 59 susceptibility. An inform al consulta tion held in C openhagen in September reviewed the state o f knowledge in this area and discussed the need for preventive action. It was concluded tha t a num ber o f well recognized genetic traits m ay be considered as a predisposition to higher susceptibility to toxic chemicals. However, the actual signifi­ cance for health o f this phenom enon has not yet been ascertained. Adequately designed in-depth surveys and studies need to be undertaken. 4.29 Efforts to enhance international, intersectoral and interregional collaboration on chemical safety are receiving high priority in the U N D P-supported regional project on the im pact and con tro l o f chemicals, in which 12 European countries are participating. The project is s trengthened by its close links with seven cooperating United N ations agencies. Emphasis is placed on international and intersectoral capacity building. New technologies 4.30 As p lanned , a dual purpose review and editorial meeting took place on the psychosocial im pact of visual display terminals (VDTs) on operators. F o r this meeting, an expert from the United K ingdom carried out a study tha t reviews previous pub li­ cations and describes the state of the art in this Field. The report, which is expected to be published in 1988, will com plem ent a previous report on all the o ther aspects o f work with V D Ts. The conclusions o f the study and the meeting have shown that the psycho­ social elements involved in working with V D Ts are of a similar nature to those involved in the in troduction o f any new technology or procedures into the workplace over and above the usual routine. Nonionizing radiation 4.31 The second edition of the book Nonionizing radiation protection (E uropean Series, No. 10) is being prepared for publication. It provides the latest state o f the a r t in the field o f nonionizing radia tion (NIR). The texts o f two o f the seven chapters , i.e. those on radiofrequency radia tion and on electric and magnetic fields, have been completely rewritten, and four o ther chapters have been revised to some extent. 4.32 The survey o f occupational accidents involving NIR, which is being undertaken by the W H O co llaborating centre in O ttaw a , C an ad a , continues. U nfortunate ly , very little in fo rm ation on such accidents is for thcom ing , as there is a certain reluctance on the p ar t o f the users o f N IR equipm ent to report on related accidents. Nevertheless, when enough in fo rm ation is accum ulated an a t tem pt will be made to undertake a com parative study and analysis. Ionizing radiation 4.33 Following resolution E U R /R C 3 6 /R 8 of the Regional Com mittee on nuclear accidents in relation to public health, the work of the Regional Office was intensified, and during 1987 was especially concerned with the European harm oniza tion of public health 60 measures following such accidents. A lthough alm ost all countries introduced measures after the accident at C hernobyl in April 1986 to effectively safeguard public health, these actions were not consistent and statements issued to the public were sometimes confusing and contradictory . It has therefore been im portan t to reach a com m on understanding, whereby the optim um degree o f harm onization can be achieved am ong M em ber States. 4.34 In response to resolution E U R /R C 3 7 /R 2 on nuclear accidents and public health the Regional Office, together with I ARC, is in the process of establishing an international scientific steering group to study the possible long-term health effects o f the Chernobyl accident. T he design of these studies is intended to follow the guidance developed by a consu lta tion on epidemiology related to the C hernobyl nuclear accident that was held in C openhagen in May, and a subsequent jo in t IA E A /W H O w orkshop in Vienna on app rop ria te m ethods for studying the possible long-term effects of radiation on indi­ viduals exposed in a nuclear accident. The reports o f these two meetings are included in Environm ental Health Series No. 25. 4.35 T he Chernobyl accident resulted in widespread and persistent d istribution of radiocaesium within the European Region. Levels in some foodstuffs were higher than in 1986 in som e limited areas, owing to the nature o f the particular environm ental pathway involved. In such areas, levels in freshwater fish, in farmed and hunted animals and in certain crops may remain high for some years, an d some controls will continue to be necessary. T he health hazards from the deposition of radiocaesium were examined at a w ork ing g roup held at Schloß Reisensburg in the Federal Republic of G erm any in June. This meeting was financed from Swiss voluntary funds. The proceedings of the meeting were issued in Environm ental H ealth Series No. 24. It was not intended, and not even possible, to evaluate the risk to health separately for each of the European M em ber States. Hence the conclusions, averaging the risk over the whole Region (excluding the USSR), provide an average im pact and indicate that additional cancer deaths during the next 50 years would am o u n t to up to some 0.006% of the otherwise spontaneous incidence recorded in the population considered. Additional severe genetic effects on health from the first year dose would am ount to up to about 0.003% of the spontaneous incidence. T he average individual absorbed radia tion dose is estimated to be abou t 0.3 mSv for the first year and double this for a period of 50 years. (F o r com parison, it should be noted that the radia tion dose from natural radioactivity am ounts to about 1.9 mSv per year.) 4.36 Iodine prophylaxis was extensively used after the Chernobyl accident and the experience gained, including any evidence of adverse side effects, is being incorporated in to guidelines now being developed by the Regional Office on the basis of an expert consultation held in C openhagen in August. 4.37 The work carried out in the past on public health preparedness in relation to nuclear accidents has been concerned with a limited area a round the source (the so-called “ near field” ). The last in a short series of related publications was issued in May under the title Nuclear power: accidental releases — practical guidance fo r public health action (E u ropean Series, No. 21). The book is based on the results o f a w orking group in Mol, Belgium in O ctober 1985. As a result o f a recom m endation made by the working group on the European harm onization o f public health action in relation to nuclear accidents, 61 work should proceed on the conditions in the “ far field” , where the problem s are likely to be of a transfrontie r nature. 4.38 Following the adop tion by the G eneral Conference o f IA E A in Septem ber 1986 o f the C onven tion on Early Notification o f a Nuclear Accident an d the C onvention on Assistance in the Case of a Nuclear Accident or Radiological Emergency, detailed arrangem ents are being m ade with IA EA and W M O about contingency planning for such accidents o r emergencies within the E uropean Region, taking into account the need for rapid transfer o f inform ation and the provision o f public health advice. 4.39 M ost o f the work on the effects o f nuclear accidents on public health carried out by the Regional Office since the Chernobyl disaster in April 1986 has been concerned with the long-distance aspects. A ttention is now being refocused on the most critical area, tha t close to the accident, and a working group will be held in 1988 to discuss m atters of medical and general public health preparedness, including the trea tm ent of acutely affected victims. Target 20 30 4.40 The present em phasis of the In terna tional D rink ing W ate r Supply and Sani­ ta tion Decade in Europe is placed on an analysis o f the remaining problems o f the Decade at the regional level. This analysis was m ade during the internal evaluation exercise carried out in the Regional Office in late 1986 and early 1987. It showed that substantial work was still necessary in: — pro tec ting w ater sources (surface and g roundw ater) against increased industrial, agricultural and municipal pollution; — investigating the health-related effects of organic and inorganic m icropollutants; — in troducing water conservation policies that permit the rational m anagem ent of available resources, such as finding an adequate balance o f w ater use (industrial, agricu ltura l , m unicipal, dom estic , other), w ater recycling, wastewater re­ utilization, and leakage control; — elim inating the rem aining disparity in the level o f services between no rthern and southern countries, between urban and rural areas, and between water and sanitation services; and — im plem enting technologies ap p ropria te to the different geographic charac te r­ istics of the Region. 4.41 Regarding the protection of water sources against pollution, most o f the countries o f the Region have now identified the m ajor pollutants , the levels of contam ination of By 1990, all people o f the Region should have adequate supplies o f safe drinking-water, and by the year 1995 pollution o f rivers, lakes and seas should no longer pose a threat to human health. 62 water sources, and the points and the mode of entry of pollutants, and have also established protective policies. Some countries have managed to establish computerized networks of water quality monitoring, permitting the immediate introduction of pro­ tective measures in case of accidental pollution. 4.42 A consultation was organized jointly by the Regional Office and the Water Research Centre (a WHO collaborating centre) in Medmenham, United Kingdom in May to review the existing toxicological information on potentially toxic microorganic substances in drinking-water. The consultation recommended not only a revision of the guideline values already given for some organic and inorganic compounds, but also the adoption of final values for substances for which only a “ tentative value” exists, and the introduction of values for compounds for which no guideline values currently exist. 4.43 In compliance with the recommendations of the Medmenham consultation, several internal meetings were held between WHO headquarters and the Regional Office, and at a meeting in Geneva in November it was decided that the WHO guidelines on drinking-water quality would be updated jointly by the two offices. 4.44 Recent studies carried out in different countries of the Region have revealed an alarming increase in a wide range of herbicides in water supplies. At the request of the Government of Italy and in association with the Istituto Superiore di Sanità, Rome, consultations were organized in February and July to recommend guideline levels for the herbicides most commonly used in Italy and affecting drinking-water quality via ground­ water and surface water contamination (see paragraph 4.27). 4.45 The rehabilitation of contaminated water sources has become an important issue in the European Region and therefore, with the support of the Hungarian national water and health authorities, a consultation was organized jointly by the Regional Office and VITUKI (a WHO collaborating centre) in September in Siöfok, Hungary. The consul­ tation reviewed the present methods being used to remove organic and inorganic micropollutants. The advantages and disadvantages of each method were analysed and the group of experts made recommendations about the efficacy of the different methods under different conditions. 4.46 The Regional Office has continued its efforts to promote the elimination of the remaining imbalance in levels of services in many southern countries of the Region. While considerable funds are invested in the provision of water to urban settlements, the water networks do not yet reach all rural populations. In addition, coastal tourist areas along the Mediterranean Sea have to cope with a large influx of people during the summer months. Sometimes the water demand may increase by 10-50 times, or even more at weekends when local visitors are added to the number of international tourists. 4.47 Shortcomings in the drinking-water treatment facilities, not only qualitative (the degree of water purification) but also quantitative (the number and capacity of treatment plants), result in frequent interruptions of services every day in many large urban agglomerations in southern Europe. 63 4.48 A s r e g a r d s s a n i t a t i o n , se v e ra l p r o b le m s still r e m a in to b e so lv e d , tw o in p a r t i c u la r : — th e p r o v i s io n o f a d e q u a t e m e a n s o f w a s t e w a t e r d i s p o s a l : in u r b a n a r e a s h o u s e c o n n e c t i o n s t o th e s e w e ra g e sy s te m h a v e n o t y e t b e e n c o m p le t e d , a n d in m a n y r u r a l a r e a s th e c u r r e n t d i s p o s a l m e t h o d s a r e n o t e n t i r e ly safe ; — n o t al l s e w e ra g e n e t w o r k s h a v e b e e n c o n n e c t e d to w a s t e w a t e r t r e a t m e n t p la n t s , a n d in m a n y ca se s th e q u a l i t y o f e m is s io n s f r o m t r e a t m e n t p la n t s is su c h t h a t th e y c a n n o t b e sa fe ly d i s c h a r g e d in to th e e n v i r o n m e n t . 4.49 A t th e i n t e r c o u n t r y level, W H O a n d U N D P g a v e th e i r a s s i s t a n c e to th e f o r m u ­ la t io n o f th e R iv e r D a n u b e w a te r q u a l i t y p r o t e c t i o n p r o je c t a n d o f th e r e g io n a l p r o je c t o n t h e i m p a c t a n d c o n t r o l o f c h e m ic a l s . A p l a n n i n g m e e t in g w a s h e ld in L a x e n b u r g in A p r i l t o d is c u s s th e m e a n s o f i m p l e m e n t in g th e p r o p o s e d R iv e r D a n u b e p ro je c t . T h e p r o je c t d o c u m e n t w a s a m e n d e d a c c o r d in g to s u g g e s t io n s m a d e b y c o u n t r y r e p r e s e n ta t iv e s a t th is m e e t in g , a n d w a s s e n t b a c k to th e e ig h t r i p a r i a n c o u n t r i e s f o r c o n s id e r a t i o n a n d a p ­ p r o v a l . P r o j e c t a c t iv i t ie s a re e x p e c te d to s t a r t in 1988. 4.50 I n A l b a n i a , tw o W H O / U N D P - s u p p o r t e d p r o je c t s w e re r e d r a f t e d a n d se n t t o th e G o v e r n m e n t f o r c o n s i d e r a t i o n ; o n e c o n c e r n s th e c o n t r o l o f d e n t a l c a r ie s t h r o u g h f lu o r i ­ d a t i o n a n d th e o t h e r t e c h n iq u e s f o r th e t r e a t m e n t o f l iq u id w as tes . 4.51 In P o l a n d , a W H O / U N D P p r o j e c t d e a l in g w i th w a te r q u a l i t y b e g a n d u r i n g th e y e a r . A P o l i s h d e l e g a t io n v is i te d C o p e n h a g e n a t th e b e g i n n in g o f D e c e m b e r to f in a l iz e th e d e t a i l e d p r o j e c t w o r k p l a n . 4.52 I n Y u g o s la v ia , t h e W H O / U N D P - s u p p o r t e d p r o je c t d e a l in g w i th f o o d s a fe ty a n d w a te r q u a l i t y in th e R iv e r D a n u b e is b e in g c a r r i e d o u t a c c o r d in g to th e w o r k p r o g r a m m e . T h e p r o j e c t f o r th e p r o t e c t i o n o f g r o u n d w a t e r in M a c e d o n i a h a s n o w b e e n c o m p le t e d . In T u z l a , B o s n i a , a p r o j e c t o n r iv e r p o l l u t i o n c o n t r o l is a l m o s t c o m p l e t e d , b u t a p r o p o s a l f o r a o n e - y e a r e x t e n s io n is u n d e r c o n s id e r a t io n . 4.53 T h e s u p p o r t g iv e n to th e p r o g r a m m e b y th e D e c a d e c o l l a b o r a t i n g c e n t r e s h a s in c r e a s e d s u b s t a n t i a l l y . T h e W a t e r R e s e a r c h C e n t r e in M e d m e n h a m h a s a s s i s t e d th e R e g io n a l O f f ic e in c o n d u c t i n g s tu d ie s o n o r g a n ic m i c r o p o l l u t a n t s a n d h a s s e n t e x p e r t s to al l th e t e c h n ic a l c o n f e r e n c e s o r g a n i z e d b y th e O ff ic e in c o n n e c t i o n w i th th e W a t e r D e c a d e . T h e C e n t r e n a t io n a l d u m a c h in i s m e a g r ic o le , d u g én ie r u r a l , d e s e a u x e t des f o r ê t s in L y o n , F r a n c e h a s c o n t i n u e d t o p r o v id e t r a i n in g fac i l i t ie s f o r te c h n ic ia n s in s id e a n d o u t s i d e th e R e g io n . I ts e x p e r t s h a v e a t t e n d e d r e g io n a l m e e t in g s a n d h a v e r e p r e s e n te d th e R e g io n a l O ff ic e a t c o n f e re n c e s o r g a n iz e d b y o t h e r in s t i tu t i o n s . 4.54 V I T U K I , a W H O c o l l a b o r a t i n g c e n t r e f o r w a te r r e s o u r c e s p r o t e c t i o n , h a s c o n ­ d u c t e d s tu d i e s o n m e t h o d s o f r e m o v i n g m i c r o p o l l u t a n t s f r o m d r i n k i n g - w a t e r a n d h a s a s s i s te d th e R e g io n a l O ff ice in o r g a n iz in g a c o n s u l t a t i o n o n th is su b je c t . V I T U K I e x p e r t s h a v e r e p r e s e n te d th e O ff ice a t se v e ra l m e e t in g s a n d h a v e r e g u la r ly a t t e n d e d D e c a d e c o n s u l t a t i o n s . T h e c e n t r e h a s a l s o p r o v id e d in -se rv ice t r a i n in g fac il i t ies f o r te c h n ic ia n s o f v a r io u s c o u n t r i e s w i th in a n d o u t s id e th e R e g io n . 4.55 A n a g r e e m e n t f o r c o l l a b o r a t i o n w a s s ig n e d o n 9 N o v e m b e r w i th th e C e n t r e i n t e r n a t i o n a l d e l’e a u in N a n c y , F r a n c e . O n th e s a m e d a y , a n d a s p a r t o f th e c o l l a b ­ o r a t i o n a g r e e m e n t , th e f o u r t h c o n s u l t a t i o n o n th e e v a l u a t i o n o f th e W a t e r D e c a d e 64 in E u rope was opened in Nancy. Representatives o f the W orld Bank, the U nited Nations D isaster Relief Office (U N D R O ), W H O headquarters , the In terna tional Reference C en tre for C om m unity W ater Supply and Sanita tion , all the co llaborating centres w ork ing fo r the Decade and 17 E uropean countries a ttended the consultation . They had the o p p ortun ity to analyse the progress of the Decade at country level, and technical p roblem s related to water quality and water resources m anagement. 4.56 The m ain conclusion to be draw n from the evaluation meeting in Nancy was that it w ould be wrong to th ink tha t all quantita tive w ater and sanitation problem s have a lready been solved in the Region. The consultation acknowledged the priority given by the W ater Decade to w ater quality problems. Nevertheless, M em ber States were re­ m inded o f the pressing problem o f increasing the capacity of sewerage networks and im proving the level o f w astew ater trea tm ent in o rd e r to safeguard drinking-water quality. 4.57 In D en m ark , universities and private water sanitation institutions, in addition to the G overnm en t, assisted W H O in conducting studies on water po llu tion and m ethods for rem oving pollu tants from drinking-water. A m ajor financial contribu tion from the G reen land Technical O rganization permitted the Office to organize a working group in Illulissat, G reen land in O ctober, to complete and ad o p t the final version o f the guidelines on w ater an d waste m anagem ent in cold climates. The meeting was a ttended by experts in this field from C anada , China, the United States and all the Scandinavian countries. 4.58 Substantia l financial support from the Federal Republic of G erm any to W H O headquarters will m ake it possible to carry ou t a Decade consultative meeting in Lisbon in early 1988, which will enable W H O to conduct an evaluation exercise not only of the W a te r D ecade p ro g ram m e in Portugal bu t o f the p rogram m es o f all o th e r P ortuguese­ speaking countries in the world. 4.59 H ungary has provided great support to the Regional Office’s w ork on the W ater Decade. Experts from the Ministry o f Health and the National W ater A uthority attended all Decade meetings during the year. Conferences and consultations on water and sanita tion were organized in H ungary , not only under W H O responsibility bu t also th rough o ther international institutions with which the country has working relations. 4.60 In Italy, in add it ion to the support given to the Regional Office in the organiz­ a tion o f two consulta tions regarding herbicides in water, the Veneto Region and the Is t i tu to Superiore di San ità sent experts to the meeting in Siôfok, H ungary in Septem ber to present their experience with m ethods o f removing micropollu tants from water. Italy was also represented at the Decade evaluation meeting at Nancy in November. 4.61 A lthough M orocco has left the Region, the Regional Office continued to handle U N D P /W H O -s u p p o r te d projects there during 1987. The project for the im provem ent of d r ink ing-w ater quality will soon be completed. T he project on w ater supply for smaller com m unities is progressing and the activities are being extended into 1988. 4.62 N orw ay has supported p rogram m e activities related to water and sanitation in arctic regions. The m ain health problem related to drinking-w ater quality is w aterborne diseases, especially gastroenteritis . According to a continuing survey, ab o u t 70% o f the 65 water consum ed in Norw ay conform s to adop ted national standards. Several water netw orks are already too old, causing severe water losses an d potential con tam ination , and they therefore need rehabilitating. A new water quality classification system is being prepared, which includes bathing w ater quality. 4.63 In Portugal, the institutional restructuring of governm ent departm ents has been completed. T he new authorities for the environm ent and for the m anagem ent o f water resources, together with the health authorities, have supported Decade activities and especially the River Tagus project, which m ade considerable progress during the year. 4.64 The strategies and policies developed in Spain some years ago for the protection of the env ironm ent and for the role o f environm enta l health activities within prim ary health care p rogram m es have now started to produce results. Detailed “ inventories” of the environm ental conditions of administrative subdivisions (regions, provinces, munici­ palities and com m unes) have now been com pleted for many areas. A clear picture o f the state o f water and san itation is available in those “ inventories” , which are used as a basis for p rogram m ing the recom m ended solutions to the problem s found. A nother im portan t developm ent tak ing place in Spain is the establishm ent o f a large network o f Healthy Cities, with Barcelona in the lead role. The W ater Decade is an im portan t part o f this network. 4.65 Turkey has continued to increase the level o f public investment in the water and sanita tion sector. F rom 3.22% o f total national expenditure in 1981, its share increased to a lm ost 8% in 1987. In spite o f these efforts, several problem s still remain to be solved: the inadequacy of urban infrastructures to cope with dem ographic growth; the in­ adequacy o f services for m ain tenance and repair; the tra in ing o f personnel; and diffi­ culties in obta in ing sufficient funds to cover needs. T o reduce expenditure abroad , the country is p ro m o tin g the local m anufac tu re of supplies an d equ ipm ent needed for water and sanitation works. Mediterranean Action Plan 4.66 W H O con tinued its p ro g ram m e o f activities in the health-related aspects o f the M edite rranean Action Plan, particularly in the Long-term P rogram m e of Pollution M onitoring and Research in the M editerranean Sea (M E D PO L Phase II), which is now being gradually reorien ta ted tow ards the im plem entation o f the 1980 pro toco l on the protection o f the M editerranean Sea against pollution from land-based sources. 4.67 Technical assistance, equipm ent and fellowships con tinued to be provided to national institutions for developing or m onitoring p rogram m es related to land-based pollution sources, coastal recreational areas and shellfish w ater quality. The series of reference m ethods for determ ining microbiological and related param eters continued to be expanded and all major indicator organisms, together with the more im portan t pathogens, are now covered. 4.68 In the research com ponen t o f M E D PO L, 13 research projects were completed, 24 extended and 12 initiated. T he activities cover studies in the following b road fields: the 66 developm ent and updating o f microbiological m ethods, pathogen survival and indi­ c a to r /p a th o g en relationships, the correlation between coastal w ater quality and health, the carcinogenicity and mutagenicity of marine pollutants, pollution load assessment in relation to the capacity of receiving waters, and environm ental quality criteria. Prep­ ara t ions were com pleted for a five-country study on the efficiency o f selected subm arine outfall structures to start in 1988. 4.69 A consulta tion on environm ental quality criteria for shellfish-growing waters and shellfish in the M edite rranean was held in A thens in M arch, and was attended by partic ipan ts from Egypt, France, Greece, Italy, M orocco , Spain and Y ugoslavia, as well as by representatives of the European C om m unity , F A O and UNEP. The meeting recom m ended microbiological quality criteria for shellfish-growing waters, which were later ad o p ted by M edite rranean states during the fifth o rd inary meeting o f contracting parties to the 1976 Barcelona Convention, held in Athens in September. 4.70 A consultation on health-related aspects of marine pollution control in the M editerranean was held in C openhagen in J u n e /J u ly , and was attended by participants from Greece, Israel, Italy, Spain , Syria, Turkey and Yugoslavia, as well as by represen­ tatives o f U N EP. The meeting reviewed all aspects o f W H O ’s partic ipation in the M edite rranean Action Plan, and m ade a num ber o f recom m endations, including inter­ sectoral coord ina tion and cooperation, implementation of the land-based pollution pro tocol, the developm ent o f m onitor ing program m es, and health-related research activities. 4.71 A consultation on microbial pollution in the M editerranean and associated effects on health was held in A thens in September, and was attended by partic ipants from Egypt, France, Greece, Italy, M alta , M orocco, Spain , Turkey and Yugoslavia, as well as by representatives of the In tergovernm enta l O ceanographic C om m ission, F A O and U N EP. T he meeting reviewed the whole o f the microbiological com ponen t o f M E D POL m onitor ing and research activities, identified pathogens o f importance in the region in the light o f recent findings, and also identified specific research topics to be covered in the p rogram m e. 4.72 A w orkshop on the impact o f carcinogenic, mutagenic and teratogenic marine pollu tan ts on hum an health and the environm ent was held in R om e in N ovember, in co llaboration with the D epartm en t of P rogram m ing and Organization o f Public Health Services o f the University o f Rome. It was attended by partic ipants from C anada , France, the Federal Republic o f G erm any , Israel, Italy, Nigeria, the United Kingdom, the United States and Yugoslavia, as well as by representatives of F A O and U NEP. The w orkshop reviewed in ternational work on carcinogenic and mutagenic marine pol­ lutants and recom m ended work to be perform ed in the M editerranean context. 4.73 A consultation on m onitoring o f land-based sources o f marine pollution in the M edite rranean was held in Split in Decem ber, and a ttended by partic ipan ts from Egypt, France, Greece, Malta, M orocco, Spain, Syria, Turkey and Yugoslavia, as well as by representatives o f U N EP. T he meeting developed a com m on ap p ro ach to pollution source m onitor ing , reviewed the curren t s ta tus o f such m onitor ing in the M editerranean region, reviewed questionnaires for pollu tion source and load inventories and da ta 67 acquisition systems for waste m anagem ent, as well as prevailing legislation on land- based pollu tion control in the region, and agreed on requirem ents for the further development o f program m es for marine pollution source monitoring. 4.74 In general, good progress continued to be made in all aspects of the Action Plan for which W H O is responsible, particularly in the reorien ta tion o f activities, bo th in general and specifically, towards the acquisition of da ta required for the prevention and control o f m arine pollution. M ajor constraints remained, however, namely financial stringencies limiting possible assistance, and procedural problem s at the overall p ro ­ gram m e and national counterpart levels resulting in unavoidable delays in the im plemen­ tation of some agreed activities. Target 21 80 4.75 The newly established co llaborating centre for air quality m anagem ent and air po llu tion contro l in Langen, Federal Republic of G erm an y started its operations by holding a w orking g roup in February . This was the first meeting o f national focal points from 10 partic ipa ting M em ber States to discuss the continuing operation of the air com ponen t o f the U N E P /W H O G lobal Environm ental M onitoring System (G E M S) and m ake p roposa ls for a E uropean plan o f action. This plan o f action should enable the European partic ipants to m onito r air pollu tants and com pare the collected da ta am ong themselves, over and above the present plan o f work as it is operated globally. W ithin this plan o f ac tion , the partic ipants also agreed to start p rocedures to include nitrogen dioxide in the project. As far as available, the countries should also report da ta on the mass particula te fraction, lead, cadm ium and ozone. The experts felt that, for the purpose o f the periodic exchange o f in form ation, the evaluation of the collected da ta and the developm ent o f additional cooperation am ong the partic ipating countries, meetings should be held every 2-3 years. 4.76 T he co llaborating centre in Langen also s tarted work on a revision of the first publication o f the Regional Office in the European Series, the M anual on urban air quality m anagem ent published in 1976. 4.77 At the urgent request and with full financial support o f the health authorities of the Tuscany Region, and in cooperation with the N ational Institute o f Health, Rom e, a meeting was organized in Florence in O c tober to examine the impact on health of emissions of heavy metal and P A H com pounds from municipal incinerators. This meeting was an indirect follow-up to a meeting tha t took place the year before on dioxin and furan emissions from municipal solid waste incinerators, the report o f which was issued during the year as Environm ental Health Series No. 17. T he experts concluded that m odern designs, good construction and well operated and properly m aintained incinerators should, to a great extent, substantially reduce the quantity o f heavy metal and P A H co m p o u n d s in the environm ent. W ith regard to the heavy metal com pounds , By 1990, all people o f the Region should be effectively protected against recognized health risks from air pollution. 68 these would tend eventually to concen tra te in the b o t to m ash which, in turn , would have to be disposed of in p roper landfills or recycled for o ther purposes. 4.78 A study o f the overall im pact on hum an health o f air pollu tion from various sources, s tarted in 1987, will continue into 1988 and will examine the relative significance o f exhausts from industry, m o to r vehicles, homes and o ther sources, with respect to the a ir po llu tion they produce and its impact on health. This s tudy will be com plem ented later on by an o th e r th a t will take as its principal concept not the sources, bu t a mixture of six m ajo r air pollutants. 4.79 T he fifth W ork ing G ro u p on In d o o r A ir Quality , this time concentra ting on organic po llu tan ts , to o k place in Berlin (W est) in A ugust, immediately after the fourth In te rna t iona l C onference on In d o o r Air Q uality an d Clim ate held in the sam e place. (At this conference, which was co-sponsored by W H O , papers were presented on the work of the Regional Office in this field.) While very little is know n still ab o u t indoor organic com pounds , the G ro u p was able to consolidate the existing material and put it into a new perspective. Sensory irr i ta t ion caused by o dours is also o f significance, an d specialists in psychology made valuable contribu tions on this topic. 4.80 As more is know n ab o u t volatile organic com pounds than ab o u t very volatile, semi-volatile and partic le -bound organic com pounds (and reactive substances from all these groups) many m ore d a ta need to be collected on the distribution and effect o f the la tter groups. Organic co m pounds may cause mucosal and sensory irritation and affect the airways at the levels encoun tered indoors. Yet, evaluating the effect on health of single co m pounds may not always be adequate , because indoor po llu tan ts usually occur in mixtures and many sources emit mixtures o f pollutants. The detection limits o f analytical ins trum ents used at present are below the detection limits o f the hum an sensory systems. Therefore, many strong od o ran ts may not yet have been chemically identified. Consequently , an indoor concentra tion value based on the detection or recognition o f an o d o u r o r a sensory irritant by 50% of people will not p rotect the most sensitive p a r t o f the popu la t ion . F u rth erm o re , such a limit does not protect against the systemic o r genotoxic effects o f substances that are not odoran ts or irritants. T he meeting recom m ended a num ber o f measures to improve the da ta base for this par ticu lar indoor problem. 4.81 C oncerned by the extent o f the air pollu tion problem in E urope , the Regional Office has carried out a three-year project, with the financial support o f the G overnm en t o f the N etherlands, to establish air quality guidelines. While the basic m anuscrip t o f Air quality guidelines fo r Europe was com pleted at the end o f 1986 as expected, it took an additional year for the text to be verified and to reach final publication as European Series No. 23. M ore than 150 experts from 20 E uropean countries and N o rth America partic ipa ted in the meetings convened by W H O to complete the complex jo b o f establish­ ing these guidelines. A ir po llu tan ts o f special environm enta l and health im portance for countries o f the E u ro p ean Region were identified; 28 pollu tan ts were selected and air quality guidelines were established for them. These air quality guidelines are in tended to help the countries o f the E u ro p ean Region develop s tandards tha t , if properly im­ plem ented, will p ro tec t public health. The levels o f air constituents and contam inants 69 recom m ended in the guidelines are not s tandards in themselves; countries must m ake their own s tandards by considering the recom m endations in the context o f their own environm enta l, social, economic and cultural conditions. A lthough the main purpose of the guidelines is to provide governm ents with background inform ation and guidance in m aking risk m anagem ent decisions, and particularly in setting standards, this infor­ m ation may also help them develop alternative control procedures. 4.82 An In terna tional W orkshop on Air Quality Guidelines was held in Bilthoven in D ecem ber with the purpose o f in troducing the new guidelines to the in ternational com m unity and explaining the ra tionale behind them. This w orkshop gave the highest governm ent officials responsible for a ir quality in the E uropean Region the necessary background in fo rm ation at an early stage o f the im plem entation of the guidelines. F u rth er direct contac t will be made with health authorities in M em ber States to p rom ote the adop tion o f the guidelines at the national level. Target 22 SO 4.83 Since the first edition o f Food sa fety services (Public Health in Europe, No. 14) appeared in 1981, there have been a num ber of changes in the area o f food safety legislation and the o rganization of services within E u ro p ean countries. T o reflect as accurately as possible the actual s ituation in Europe, a country by country survey o f food safety services has been carried out, based on inform ation collected from various sources and subsequently reviewed by the responsible authorities at government level. The second edition of Food safety services is now complete and will be published in 1988. 4.84 An in te rco u n try p ro g ram m e for E u rope on effective na t iona l food safety in frastruc tu res an d legislation is being developed within the fram ew ork o f the fou r th cycle o f U N D P projects. T he p rog ram m e will s tart in early 1988 and will involve multisectoral systems to prevent the biological and chemical con tam ination o f food. Once implemented, this capacity building p rogram m e will support the efforts o f M em ber States to develop adequate surveillance o f foodborne diseases and a control infra­ structure. 4.85 O ne of the main preoccupations for European countries was the contam ination o f food with radionuclides after the C hernobyl accident. It is now considered that some controls will be necessary on certain foods for a num ber o f years, in view of the levels of radiocaesium still persisting in some places. As a part o f the Regional Office’s special project on nuclear accidents and public health, a w orking g roup was held in G eneva in Novem ber. T he partic ipants recom m ended that to pro tec t public health a m axim um individual dose of 5 mSv should be considered for the first year. Better ha rm oniza tion of approaches to food control after nuclear accidents is now urgently needed. Following a By 1990, all Member States should have significantly reduced health risks from food contamination and implemented measures to protect consumers from harmful additives. 70 recom m endation m ade by the working group, the Regional Office is now proceeding with the developm ent of emergency values applicable to European conditions, which can be recom m ended for use during the period immediately after an accident before the detailed radiological s ituation becomes fully clear. 4.86 T he final report an d proceedings o f the W o rk ing G ro u p on the H ealth Im pact an d C o n tro l M eth o d s o f I r rad ia ted F oods , held in N euherberg in N o v em b er 1986, were p repared during the year for publication on behalf o f the Regional Office by M M W Medizin Verlag in M unich. There is great interest in this publication, as it will give national health au thorities better inform ation on m ethods for identifying irradiated foods and the dosim etry involved. This, in tu rn , will allow these au thorities to improve their ability to control irradia ted foods for the benefit o f the consumer. Target 23 SO 4.87 T he final report on a com pleted study of priority chemicals in hazardous waste was sent for review to a num ber o f European experts. Their reaction was positive, and the feeling was that the priority chemicals have been reasonably listed. Experts have been con trac ted to follow up this work, and to prepare short m onographs on the chemicals in question , including their characteristics, toxicology and possible effects on health. The w ork is being carried out with the financial support o f the Ministry o f H ousing, Physical Planning and Environm ent o f the Netherlands. 4.88 W H O co-sponsored the world conference on hazardous waste, held in Budapest in O ctober. A panel on the ways o f predicting the long-term health effects of hazardous waste was organized, with the partic ipa tion o f experts from H ungary , the USSR and the U nited States. Target 24 SO 4.89 A W H O collaborating centre has been established at the Institute o f Hygiene and Epidem iology in Prague to cover the environm enta l aspects of health care o f the elderly. A meeting co-sponsored by W H O took place in Prague, in O ctober, to discuss the architectural aspects o f city accessibility for the elderly and disabled. It was attended by the W H O Regional Officer for the Elderly, Disability and R ehabilita tion and a con­ su ltan t w orking for the Environm ental Health Planning and M anagem ent unit. (See also under paragraph 2.13.) By the year 2000, all people o f the Region should have a better opportunity o f living in houses and settle­ ments which provide a healthy and safe environment. By 1995, all Member States should have eliminated major known health risks associated with the disposal o f hazardous wastes. 71 4.90 S u p p o rted by a vo luntary d o n a tio n from the host city, a W o rk sh o p on E nviron­ mental H ealth P rom otion in a Healthy City took place in Rennes in M arch. This W orkshop proposed a detailed plan o f activities to be im plemented in the cities taking part in the Healthy Cities project, to improve their physical environm ent and their environm ental health conditions. This plan of activities covers the period 1987-1995. After the W orkshop , a briefing meeting was held for those cities interested in building up a network of French-speaking healthy cities. 4.9! C ontr ibu tions were also made to the environm ental health aspects of the Healthy Cities project w orkshop on indicators, held in Barcelona in M arch , and to the E uropean Congress on H ealthy Cities held in D üsseldorf in June. Finally, cities interested in jo in ing the Healthy Cities project were briefed on the environm ental health aspects o f the project. These included U nna-K re is (Federal Republic o f G erm any) which was aw arded the European prize for environm ental protection. 4.92 T he housing hygiene project in Portugal, which is to be supported by U N D P , has been p lanned in detail and an agreem ent on its im plem entation was signed in November. 4.93 A report entitled H ealth im pact o f low indoor tem peratures was issued as En­ vironm ental H ealth Series No. 16. It is the ou tcom e of a w orking g roup held in Copenhagen in N ovem ber 1985. Target 25 80 4.94 An advisory group on occupational health was established to assist in planning, m onitor ing and evaluating the activities and ou tpu ts o f the Regional Office program m e on occupational health. At its first meeting in June, the group reviewed and evaluated the activities related to most o f the ou tp u ts o f the p rog ram m e an d m ade specific recom m en­ dations ab o u t how to fur ther implement the p rogram m e effectively, taking into con­ sideration the existing state o f organization o f occupational health services in M em ber States. 4.95 T he concept o f occupational health services is not uniform th roughou t Europe, as indicated by a survey m ade in the M em ber States. Industria l hygiene is not always a com ponen t o f occupational health. A model describing the functions of occupational health services and their re la tionship to o ther parts o f the health system is being prepared, based on studies carried ou t during the period under review. 4.96 W o rk e rs ’ health may be affected not only by work-related hazards. Lifestyles and factors in the environm ent may affect w orkers’ health in association with w orking conditions, and studies on these aspects have been initiated. By 1995, people o f the Region should be effectively protected against work-related health risks. 72 HEALTHY ENVIRONMENT Publications issued in 1987 Nuclear power: accidental releases — practical guidance for public health action: report on a W H O meeting. W H O Regional Publications, E u ro ­ pean Series, No. 21. Air quality guidelines for Europe. W H O Regional Publications, E uropean Series, No. 23. Documents issued in 1987 Health and safety component of environmental impact assessment: report on a W H O meeting (Environm ental H ealth Series, No. 15). Health impact of low indoor temperatures: report on a W H O meeting (Environm enta l H ealth Series, No. 16). PCDD and PCDF emissions from incinerators for municipal sewage sludge and solid waste — evaluation of human exposure: report on a W H O meeting (Environm ental H ealth Series, No. 17). Development of environmental health manpower (Environm enta l H ealth Series, No. 18). Occupational profiles of environmental health personnel (Environm ental H ealth Series, No. 19). Trace elements in human health and disease: extended abstracts from the Second N ordic Symposium (Environm ental H ealth Series, No. 20). Drinking-water quality and health-related risks (Environm enta l Health Series, No. 21). Organophosphorus pesticides: an epidemiological study. Part 1 — meeting repo rt on evaluation o f the pilot phase o f the study; Part 2 — core pro toco l for the study (Environm enta l Health Series, No. 22). PCBs, PCDDs and PCDFs: prevention and control of accidental and en­ vironmental exposures (Environm ental H ealth Series, No. 23). Health hazards from radiocaesium following the Chernobyl nuclear accident: report on a W H O meeting (Environm ental H ealth Series, No. 24). Nuclear accidents and epidemiology: reports on two meetings (Epidem i­ ology re lated to the C hernobyl nuclear accident; A ppropr ia te m e th o d ­ ologies fo r studying possible long-term effects o f rad ia tion on individuals exposed in a nuclear accident) (Environm enta l Health Series, No. 25). Trace elements in human health and disease: symposium report from the Second Nordic Symposium (Environmental Health Series, No. 26). Drinking-water guidelines for selected herbicides (Environmental Health Series, No. 27). Environmental quality criteria for shellfish-growing waters and shellfish in the Mediterranean: report on a joint WHO/UNEP meeting (document ICP/CEH 051). European conference on health and the human environment: report on the first steering committee meeting (document ICP/RUD 111). Health effects of methylmercury in the Mediterranean area: report on a joint WHO/FAO/UNEP meeting (document ICP/CEH 054). Mara, D.D. & Pearson, H. W. Waste stabilization ponds: design manual for Mediterranean Europe (document ICP/CWS 053). Potentially toxic microorganic substances in drinking-water: report on a consultation (document ICP/CWS 013). The River Danube water quality protection project: report on a planning meeting (document ICP/CEH 020). UNEP/WHO/GEMS air monitoring assessment and European plan of action: report on a WHO Working Group (document ICP/CEH 032). Co-publications issued in 1987 Wirth, E. et al., ed. Assessment of radiation dose commitment in Europe due to the Chernobyl accident. Report on a WHO Meeting, Bilthoven, 25-27June 1986. Munich, Institut für Strahlenhygiene des Bundesgesund­ heitsamtes (ISH — Heft 108). Articles published in 1987 Suess, M.J. Health impact of work with visual display terminals. In: Knave, B. & Widebäck, P.-G., ed. Work with display units 86. Selected papers from the International Scientific Conference on Work with Display Units, Stockholm, Sweden. May 12-15, 1986. Amsterdam, Elsevier, 1987. Suess, M.J. PCDD and PCDF emissions and possible health effects: report on a WHO Working Group. Waste management & research, 5: 257-268 (1987). 74 5Appropriate care 5.1 There has been obvious progress in health care th roughou t the European Region. This is worth m entioning, since it has occurred despite economic constraints, new dem ograph ic and morbidity patterns such as the growing elderly population, an increase in chronic conditions, and a slower decline than expected in com m unicable diseases. There are still, however, several critical areas that are clearly spelt out in the 11 FA policy on which the Office, in co llaboration with the M em ber States, concentrated its efforts during the year. 5.2 The district app roach in primary health care was addressed in a num ber of studies and working groups. This new orienta tion is in response to the need for more consumer satisfaction and involvement, better m anagem ent and op tim um use o f resources. Par­ ticularly relevant within this context were the Office's endeavours in analysing and prom oting the integration of various services provided to the population , so as to narrow the gap so often existing between services such as social and health, and to encourage truly intersectoral collaboration. 5.3 The wav hospitals provide services adap ted to changing health needs and try to satisfy various dem ands, coupled with efforts made to perfect the relationships between hospitals and prim ary health care institutions, were o ther im portan t m atters analysed in collaboration with experts in the field. 5.4 In many respects the European Region is well provided w ith health institutions, personnel and resources, and an impressive quantity of health services of all kinds is delivered by an ou ts tand ing num ber of health professionals. Nev ertheless, there is still more to be done to ensure an app rop ria te level o f quality, so that the results in terms of health are maximized and the user of the serv ices is satisfied. A ttem pting to respond to the various requests in the area of quality of care, the O rganization has started a prom ising dialogue. Particularly relevant in this respect are the various activities de­ veloped to foster quality assurance in nursing care, and also the efforts made to look inti) quality of care in hospitals and primary care institutions. 5.5 The prepara to ry activities for the 1988 European Conference on N ursing ga\ e the opportunity to hold national forums th roughout the Region and to stimulate action by various national groups and organizations. 75 Target 26 SO 5.6 Phase I o f the study on prim ary health care (PH C ) development in the European Region, involving the collection of inform ation at national level, was completed in February , at which time the contribu tions from the nine participating countries were subm itted to the Regional Office. Л consultation to discuss the protocol for Phase II, involving the collection of in form ation at district level, took place in Utrecht in March and was hosted by NI VFL ( the Netherlands Institute of Primary Health Care) which was designated a W H O collaborating centre for PH C in August. The various parts o f the study are expected to be completed by February 1988. and will serve as an im portan t source of in form ation for meetings related to the s trengthening of PH C activities at district level. 5.7 The second annual forum on PH C development in southern European countries took place in Portugal in N ovember, hosted by the N ational School of Public Health, Lisbon. It focused on inform ation for P H C and the six partic ipating countries discussed the overall development of PH C and the status of existing inform ation systems in support o f this development. 5.x A W orking G ro u p on M echanisms for C om m unity Involvement in a Health Care System based on PHC: C om m itting the C om m unity to Care took place in C openhagen in February . The participants reviewed and updated national experience in the field of com m unity involvement, and form ulated recom m endations for future action that will also have special relevance for activities to be initiated at district level. 5.9 Three issues of the newsletter 2000 were prepared and disseminated during the period under review. The most recent issue was dedicated to the topic "S trengthening district health systems". 5.10 The second in ternational course on research in PH C was held in Gilleleje, D enm ark in May. This course was supported both financially and technically by the Regional Office. A ttendance surpassed the expected num ber, and two members of the Regional Office staff acted as m oderators at the course. Nursing/midwifery 5 . П The newsletter N ursing/m idw ifery in Europe continues to be well received, and written contribu tions from countries increased considerably over the year. The news­ letter mailing list is continually updated and now comprises some 1800 addresses. A list o f top resource people for the newsletter and o ther material em anating from the Nursing unit is being revised so that the most active nursing/m idw ifery leaders and groups within By 1990, all Member States, through effective com­ munity representation, should have developed health care systems that are based on primary health care and supported by secondary and tertiary care as out­ lined at the Alma-Ata Conference. 76 the Region can be reached easily and quickly. The newsletter continues to be co-funded by the Danish Nurses’ O rganization and is translated into Russian by the W H O col­ labora ting centre for prim ary health care in A lm a-A ta , into French by the W H O collaborating centre for nursing at the Hospices civils de Lyon, and into G erm an by a volunteer in the Federal Republic of G erm any. Further, the newsletter is translated regularly into Finnish, H ungarian , Portuguese and Serbo-Croat. (M ore extensive detail on nursing activities will be found under targets 27 and 28.) Hospitals 5.12 The study on the analysis o f support by hospitals to PH C services, including hospital activities in disease prevention and health prom otion in which eight European coun tr ie s— Austria, Bulgaria, Norway, Romania, Spain, the USSR, the United Kingdom and Yugoslavia — participated, is to be finalized during 1988. It will be used as background for various activities of the hospital program me focusing on district health services. 5 . 1 3 The study on the response of hospitals to the changing needs of the population, involving contribu tions from nine European co u n tr ie s— Finland, France, the Federal Republic of G erm any , Israel, Italy, the Netherlands, Spain, Sweden and the USSR — will be finalized in the course o f 1988. It will be used as background for a working group on the co llaboration of health services within a district health system, scheduled to take place in 1988. 5 . 1 4 Six centres within the European collaborative health services studies group partic ipated in a study on the support of hospitals to district PHC services. It includes a comprehensive description o f their respective “ districts” with regard to overall structure and detailed functions. T he study was finalized at the end of the year, and it is foreseen that the results will be used as background m aterial for the same w orking group as mentioned above. 5 . 1 5 The outcom e of these three studies will also serve to support relevant country activities, as widespread partic ipation by experts from different M em ber States will provide a comprehensive and practical overview of the issues at stake. 5 . 1 6 A scientific meeting on the future developm ent o f hospitals took place in August in Utrecht in co llaboration with the National Hospital Institute of the Netherlands, which was designated a W H O collaborating centre for the hospital program me. The meeting focused on co llaboration between hospitals and PHC services at district level; specific tasks of hospitals in long-term care; the role of teaching hospitals; health education in hospitals; and the future role of hospitals in the health care system. Health legislation 5 . 1 7 A study on legislation on PH C in Europe was undertaken in order to take stock o f the progress achieved in M em ber States in support o f systems based on PHC. It is hoped to stimulate fur ther im plem entation of the A lm a-A ta principles th rough effective legislation, and to that effect the research is focusing on legislation concerning health 77 centres and their organization, planning, financing and collaboration with secondary and tertiary care facilities. The role of local governm ent has also been studied, as well as measures taken to reinforce the role o f the general practitioner, hospital care versus am b u la to ry and domiciliary care, and the need to offer integrated care coord ina ted with other sectors. The study already shows that most of the im portan t new legislation in support o f P H C in Europe deals with three broad categories of system: those based on health centres, those provided by local authorities , and those centred a round the general practitioner. T he outcom e of the study will review successes and failures of various initiatives, and propose a set o f measures that M em ber States could adap t to their national a n d /o r local circumstances and needs. Target 27 80 Health economics 5.ix T arge t 27 aims at resource d is tr ibu tion of delivery systems according to need and accessibility. This requires, am o n g o ther things, a clear shift o f health expenditure in favour of P H C at national and subnational levels. A prepara tory meeting was held in N ovem ber to plan studies on the reallocation of funds to PHC. These studies will cover the period up to 1989 and will a ttem pt to develop pilot in form ation in selected countries. M ore particularly , the studies will (a ) collect and analyse in form ation on trends and shifts in the total spending on PH C services to individual persons; (/;) summarize the results o f previous studies on trends and shifts in the resource allocation for PH C in the prevention and contro l o f selected diseases and conditions; (r) a t tem pt to estimate trends and shifts in the national allocation of resources for P H C in the wider sense of targets 28-30 (full range of services; a t ten tion to special population groups; cooperation with the com m unity ; mechanisms for the community-wide coord ina tion of health- related actions in o ther sectors); and (cl) report to health care policy-makers and health inform ation systems managers on the conclusions and recom m endations of the studies. Health service delivery and health institutions 5.19 The study on institutionalized long-term care, which is being compiled by the National Hospital Institute of the N etherlands, as W H O collaborating centre for the p rogram m e on hospitals and o ther health institutions, is proceeding according to plan and will com prise contribu tions from six countries. Its results will serve as background for a working group, to be held in 1988, on the coord ina tion of long-term institu tion­ alized care, with emphasis on efficient interaction with PH C and the reintegration of patients into their communities and families. By 1990, in all Member States, the infrastructures o f the delivery systems should be organized so that re­ sources are distributed according to need, and that services ensure physical and economic accessibility and cultural acceptability to the population. 7 8 5.20 The study on existing m ethodologies to determ ine b ed /p o p u la t io n ratio and its use is p roceed ing acco rd ing to schedule, with the p a r tic ipa tion o f experts from 17 coun tries o f the Region. 5.21 The study on cost-conta inm ent strategies in the hospital sector will give an overview o f the existing mechanisms for m aintaining hospital costs whilst ensuring quality of care in various countries in the European Region. Experts from 13 countries have provided con tribu tions to the study, which is now being compiled by the G erm an Hospital Institute, Düsseldorf, a W H O collaborating centre for the p rogram m e on hospitals and o ther health institutions. The study will be finalized during 19XX, and it is hoped that it will provide an excellent source of information on the im portan t issue of using incentives in the hospital sector. 5.22 Experts from five European countries are partic ipating in the final stages o f a s tudy on models related to medical and nursing clinical decision-m aking in hospitals. Special emphasis is being placed on describing the ov erall trends and developments in the health services in the various countries, indicating similarities, differences and problems. The study will be used as background material for a consultation on the same topic scheduled to take place in 1989. 5.23 A W orking G ro u p on Inform ation Needs for M anagem ent Decisions in H os­ pitals took place in G üters loh , Eederal Republic of G erm any in D ecem ber, in collab­ ora tion with the G erm an Hospital Institute, D üsseldorf and the Bertelsmann F o u n ­ dation . G ütersloh. The meeting identified wavs in which available information in hospitals could be most appropriately used for decisions at m anagem ent level. 5.24 A working group on the financial and social issues related to the use of tech­ nology in hospitals took place in Padua in October. The participants discussed policy decisions related to the organization of technology; rational clinical decisions in the use o f technology; technology and ethics in hospitals; the dissemination and transfer of technology; and the impact of technology on the interaction between inpatient and outpatien t care. Health care providers 5.25 As planned, the Second W orkshop on Advanced Nursing M anagem ent for E uropean Nurses, in the French language, was held in Lyon in Septem ber with the support o f the Hospices civils de Lyon, a W H O collaborating centre for nursing. As was the case with the previous w orkshop, held in English in 19X6. this was a follow-up to the in terregional conference on nursing leadership for H F A , held in T okyo in April 19X6. It is an ticipated that the effects of these w orkshops will continue to be felt th roughout the Region, particularly in s timulating similar activities at national level. The third and last such workshop, in the G erm an language, will be held in 19X9. 5.26 The University School of Ljubljana, Yugoslavia and the University of T urku , F inland are developing experim ental curricula oriented towards prim ary health care for the basic curriculum . W o rkshop material on curriculum developm ent is being produced and tested in Ljubljana and will be made available for use by o ther nursing faculties. 7 9 5.27 In Portugal, nurses at the ministry level are developing assessment instrum ents to improve the selection of students for nursing schools. Also under way are projects in prim ary health care, in occupational health, and in the developm ent of a nursing registration system. 5.28 The Nursing unit was involved in a variety of projects, studies, workshops and meetings th rough m edium -term program m es in several countries. The unit uses these p rogram m es as a way of linking in tercountrv projects with work under way at national and regional levels, and also as a means of im plementing innovative nursing practices and m onitor ing progress towards the achievement of the targets. In this regard, consul­ tations in H un garv, Portugal and Turkey have evolved into plans to develop various aspects of nursing practice and education. 5.29 T h rough the medium-term program m e with Turkey, an infrastructure to provide nursing services was initiated. A national plan for developing services was draw n up and a w orkshop for 200 Turkish nurses was held during the year. 5.30 A num ber of events have taken place within the Region reflecting the growing interest in the first European conference on nursing in 1988. Scores of requests have been received by the Nursing unit for individuals, groups, organizations and countries to participate more actively in the conference and in its follow-up. N ational forums have been held th ro u g h o u t the Region; th rough these, as well as th rough advance notice of p lanned events, it is estim ated that at least 20000 people will have been reached by the time of the conference in June 1988. 5.31 T he docum ent “ Targets for health for all: implications for nurs ing /m idw ifery ’’ and the “ N ursing discussion p a p e r” , p repared for discussions within the various countries, have been translated into various national languages including Bulgarian, Danish , D utch , Finnish, Greek, H ungarian , Italian, Polish, Portuguese, Serbo-Croat, Slovene, Spanish and Swedish. 5.32 T he m anuscrip t for a book entitled Im ages o f nursing in Europe was com pleted in conjunction with the national forums and o ther plans for the conference. The book is based on over 3000 pho tographs taken in 12 European countries. A final set o f p h o to ­ graphs has been selected both for use in the book and for display at the conference in 1988 and in several European cities in the following years. Target 28 SO 5.33 The books People’s needs fo r nursing саге: и European study and the sum m ary of that study on models for effective and efficient nursing intervention were published. These By 1990, the primary health care system of all Mem­ ber States should provide a wide range o f health- promotive, curative, rehabilitative and supportive ser­ vices to meet the basic health needs o f the population and give special attention to high-risk, vulnerable and underserved individuals and groups. 80 are the results o f part o f the sixth and seventh m edium -term p rogram m es o f the Nursing unit, and involved 11 countries for over five years in the prepara tion , implementation and evaluation o f nursing care in those countries. 5.34 T hrough the initiative of the Danish Nurses’ O rganization and the Association of Registered Nurses of N ew foundland , C anada , an innovative program m e on PH C in the com m unity was launched in co llaboration with the Regional Office. C om m unity nursing services in selected com m unes in D enm ark will provide 24-hour nursing care and will serve as a pilot area for developing standards of practice in nursing and for evaluating the ou tcom e of care. The project provides a way to develop W H O indicators on nursing practice and to stimulate self-help and PH C activities at the local level. 5.35 T he Nursing unit initiated a proposal with the European Centre for Social Welfare T rain ing and Research, Vienna to prepare a position paper on social work services for the European Region. F o u r case studies are under way, and the outcom e of the project will be a discussion paper for use by the European countries in implementing the required social work services for PHC. 5.36 T he W orking G ro u p on the Im plem entation and Evaluation of Program m es for Problem D rinking took place in M alm ö, Sweden in September. T he G ro u p , which com prised 20 tem porary advisers from 15 countries as well as representatives from CEC and the In ternational Council on Alcohol and Addictions, discussed the changing concept of alcohol-related problems and their extent. M ethodologies for identifying individuals and groups at risk were also discussed, as were the resources available for prevention, m anagem ent and health p rom otion at com m unity , p rim ary and secondary service levels. Evaluation of services and the needs for training, education and support were also included in the G r o u p ’s deliberations. A publication covering the findings of this and the two previous w orking groups in this series, held in Helsinki in 1985 and in Oslo in 1986, is being prepared. 5.37 National meetings on quality assurance were held in Portugal, the United King­ dom and Yugoslavia, at which W H O 's policies and developments in o ther countries were described. 5.3x The fourth English-language training course in quality assurance took place in K uopio , F inland at the end of June. Target 29 DO 5.39 Since 1982, the Federal Centre for Health Education in Cologne has sought out projects for the network “ Health education in the family” in selected European countries, th rough which new approaches to family health education and health prom otion were tried. They organized meetings to exchange experiences and linked the projects into a By 1990, in all Member States, primary health care systems should be based on cooperation and teamwork between health care personnel, individuals, families and community groups. 81 network. Thirteen E uropean countries were involved by the end of 1985, and 80 projects had been identified. To facilitate contacts , the Centre published a newsletter for the network. T he School o f Public Health at the Université libre de Bruxelles entered into an agreem ent with the H ealth P rom otion unit during the year to continue the project, and a plan of work for the coming years was agreed on. 5.40 In conjunction with the work of the W H O collaborating centre for health m anpow er and inform ation in Paris, data from the national midwifery survey in Hungary were analysed. T he survey assesses midwives’ perceptions of their practice and develops approaches to assessing the effects o f changes in the education of midwives on outcom es o f midwifery practice. 5.41 The annua l course on training of teachers for general medical practice took place in D ubrovn ik in May. The Regional Office arranged for the participation o f one person from F inland in the course. Target 30 SO 5.42 A W ork ing G ro u p on Interaction between Health and Social Services and the Public in the Provision of Health Care took place in Spain in Novem ber, hosted by the Andalusia School of Public Health , G ran ad a . This activity constituted a first concerted a ttem pt to study selected issues of the district health care system involving professional, lay and social personnel. The recom m endations of the W orking G ro u p will be the main guidelines for further PH C-rela ted activities at the district level. Target 31 SO 5.43 A second group of five countries was in troduced to the provisions of target 31 th rough an in tercountry w orkshop, hosted and supported by the N etherlands, using consultan ts from the first phase o f developm ent of the project on quality assurance. The Royal College of Nursing in the U nited K ingdom provided consultan t services free of charge on the subject o f quality assurance. 5.44 The country representatives involved in nursing quality assurance activities p ro ­ vided consultation to groups within their own countries and in o ther countries. T ran s­ lation and language validation continued on terminology used to develop standards in By 1990, all Member States should have built ef­ fective mechanisms for ensuring quality o f patient care within their health care systems. By 1990, all Member States should have mechanisms by which the services provided by all sectors relating to health are coordinated at the community level in a primary health care system. 82 nursing practice. W ork also began on Regional Office guidelines for s tandards of practice for nursing education. 5.45 T here were several activities in the M em ber States related to quality assurance. F o r instance, national meetings took place in Belgium, Finland, the Federal Republic of G erm any , Italy, Norw ay, Portugal, Spain, the United Kingdom and Yugoslavia o rgan­ ized by national authorities, associations, health care institutions and private foundations. 5.46 Following on from courses held in Spain, Sweden and Yugoslavia, the fourth English-language training course in quality assurance took place in Finland at the end of June , and a second French-language course was held in Brussels at the end o f November. The large num ber of applicants representing medicine, nursing, economics and health care adm in is tra tion once again dem onstra ted the need for such courses. Most encouragingly, some o f the participants have organized or p lanned corresponding national courses. 5.47 The “ European newsletter on quality assurance” , produced by the Netherlands N ational O rganization for Quality Assurance in Hospitals on behalf o f the Regional Office, continues to serve as a useful link between members of the health com m unity in Europe. The International Society for Quality Assurance in Health C are also maintains its support to the work o f the Regional Office and is currently preparing an annotated bibliography on quality assurance. A P P R O P R IA T E C A R E Publications issued in 1987 Nursing care: sum m ary of a European study. Non-serial publication. People's needs fo r nursing care: a European study. Non-serial publication. Documents issued in 1987 A telier sur la gestion des services infirm iers à l ’intention des infirm ières européennes, L yo n , France, 31 août - I I septem bre 1987 (d o cu m en t IC P /H S R 317). Indicators fo r m onitoring prim ary health care: report on a W H O study (docum ent IC P /P H C 304/s0I). Inform ation fo r prim ary health care: report on a W H O m eeting(docum ent IC P /P H C 333). M echanism s fo r com m unity involvement in a health care system based on prim ary health care — com m itting the com m unity to care: report on a W H O meeting (docum ent IC P /P H C 319). The developm ent o f standards o f nursing practice : report on a W H O meet­ ing (docum ent IC P /H S R 323). Articles published in 1987 Vuori, H. Patient satisfaction — attribute or indicator? In: Shanahan , M., ed. Proceedings o f an International Sym posium on Q uality Assurance in H ealth Care, Paris, Novem ber 1986. Chicago, Jo in t Com m ission on Ac­ creditation o f Hospitals, 1987, pp. 70-73. Vuori, H. Patient satisfaction — an attribute or indicator of the quality of care? Quality review bulletin, M arch 1987, pp. 106-108. 84 The Reg io na l D i re c t o r p re se n t ed t w o Heal th fo r Al l Me d a ls d u r i n g the year. A b o v e . M s W a d a d Haddad, Reg iona l O f f i ce r fo r Sexua l i t y and Fami ly P lanning , rece ived the M e d a l on her re t i r e m e n t in M a y in r e c o g n i t i o n of her o u ts t a n d in g se rv ice to the Or g a n i za t i o n . B elow , P ro fes sor T. F l iedner , o u t g o i n g C h a i r m a n o f the E u ro p e a n Ad v is o ry C o m m i t t e e on Hea l th Research , is p ic t u re d w i t h his M e da l d u r i n g the m e e t in g of the EACHR in February. Rapid c h a n g e s in l i festy les in Gr een land have had ser ious c o n s e q u e n c e s fo r the socia l s t r u c tu r e and hea l th of the p o p u la t io n . It is hoped , however , tha t c h i l d re n su ch as these wi l l be a m o n g thos e to bene f i t f r o m be t te r h o u s i n g and h ig h er l i ving s tandards. An i n d i c a t i o n o f the e f fec t i ve ness of the p u b l i c e d u c a t i o n c a m p a i g n on A IDS in D e n m a r k is p ro v i de d by the c o s tu m e s tha t these s c h o o lc h i ld r e n made and w o r e f o r F a s t e l a v n . t h e Dan ish ca rn iva l ce lebra t ion . 6Research and health development support 6.1 There were im portan t developments in the area o f H F A policy in a growing num ber of M em ber States during 1987. With a view to adapting the E uropean H F A policy to their respective national settings, countries in the Region debated and analysed the 38 European targets an d set in m otion processes for obtain ing consensus and active co llaboration o f the m ain partners representing both the health an d “ non-health” sectors. The Regional Office was efficiently assisted in these tasks by the E U R O G ro u p for N ational Health Policy Analysis and Development in which W H O staff, together with national experts, analyse and discuss specific ways o f supporting M em ber States in fostering leadership for H F A . In addition, the H F A task force for countries with pluralistic systems finalized the p repara tion o f a large debate scheduled to take place in Bonn, Federal Republic o f G erm any in Septem ber 1988. 6.2 Equally im portan t , various health legislation activities contribu ted to the prep­ ara tion o f national H F A policies. F u rtherm ore , insight was provided into ethics and h u m an values in H F A messages so that better argum ents are provided when advocating the need for a policy change. Within this context, in most M em ber States defining and protecting pa tien ts’ rights have been viewed as an im portan t com ponen t o f the H F A strategy and , consequently, the Office pursued new activities in this area. 6.3 The present economic stringency, requiring better allocation and use of resources and the determ ination o f M em ber States to reorient health policies towards H F A , b rough t ab o u t a dem and fo r new activities in health economics to which the Regional Office prom ptly responded. 6.4 The second triennial cycle o f H F A m onito r ing and evaluation in the European Region s tarted after extensive efforts to improve the list o f H F A indicators. Individuals and institu tions in the Region, as well as the app rop ria te units in the Regional Office and at W H O headquarters , assisted in revising the indicators in the light o f the regional evaluation and their own experience. The docum ent on the H F A m onitoring in the Region will be prepared to be presented at the thirty-eighth session o f the Regional C om m ittee in C openhagen in 1988. 6.5 The ra tionale for reorien ting the education o f health personnel was form ally es tab lished in d o cu m en t E U R /R C 3 7 /9 p resen ted to the th ir ty -seventh session of 85 the Regional Com m ittee, and in resolution E U R /R C 3 7 /R 7 the Regional D irector was requested to identify the educational changes needed to support H FA . Several associ­ ations in the field, such as the Association for Medical Education in F urope and the Association o f Medical Deans in Europe, have declared their willingness to involve themselves in the implementation o f this resolution. The Association o f Schools of Public Health in the European Region started preparing learning materials based on the regional H F A targets for the tra in ing o f public health personnel. A num ber of changes were also in troduced in courses and w orkshops organized by the Office for training teachers o f health personnel. 6.6 In the pharmaceuticals field, the universal acceptance of the support provided by W H O to M em ber States was reflected in a rapid increase in direct requests for help and advice on current issues. Target 32 SO 6.7 The docum ent on “ Research for health for all” (R H F A ) was presented to the E uropean Advisory Com m ittee on H ealth Research (E A C H R ) in February , when the results o f consultations with the M em ber States and with the research com m unity were analysed. It was subsequently revised and subm itted in Septem ber to the thirty-seventh session of the Regional Com mittee, which approved it together with a corresponding p rom otion plan, and adopted a resolution urging both M em ber States and the Regional Office to im plement the high priority research recom m ended and to develop national H F A research policies. The text is now being finalized for publication in early 1988. There have already been prom ising signs that not only the European M em ber States but also regions within those countries are willing to use R H F A as a model for their own health research policies. H ungary , San M arino, Spain and Yugoslavia have already included the development of a national H F A research policy in their plans for collabor­ ation with the Regional Of fice. The Chief, Research P rom otion and Development visited the G erm an D em ocratic Republic, H ungary and the USSR in relation to R H F A and was invited to a ttend a meeting on research policies for health organized in Andalusia, Spain. 6.8 At its th irteenth session the E A C H R reviewed the work of the regional p ro ­ gram m es on cancer, chronic diseases, health economics and health education, and discussed two o ther topics: accidental radia tion releases and the effects of radia tion on hum an health, and research on narcotics addiction. 6.9 T he E A C H R also emphasized the im portance of ethical issues in research. This has been echoed by several M em ber States, and already a meeting has been held in Antwerp on “ Bioethics in the '90s” . The subject of the hum aniza tion of medicine led to co llabo ra t ion between the Holy See and the Regional Office. A representative of Before 1990, all Member States should have formu­ lated research strategies to stimulate investigations which improve the application and expansion o f knowledge needed to support their health fo r all developments. 8 6 the Regional Office a ttended the second in ternational conference on the hum anization of medicine, organized by the Holy See in N ovem ber, and jo in t plans are under way to hold a follow-up meeting in 1988. 6.10 A sem inar was held in Ju n e on com m unica tion between the users and producers o f research findings. Research on health p rom otion was taken as an example in deter­ mining the factors ham pering com m unication and the application of such results in decision-making. 6 .11 The third and fourth meetings o f the task force for the European university netw ork for health for all were held in F ebruary and May respectively. A docum ent on the role o f universities in the strategies for health for all was subm itted to the thirty- seventh session o f the Regional Com m ittee where it was well received. Several M em ber States prom ised to support the future work of the network. 6 .12 By a ttending meetings o f national medical research councils, the European Medical Research Councils, and the C oncerted Action C om m ittee on Health Services Research of the CEC , an effort has been made to try to coordinate W H O -sponsored studies with those sponsored by o ther groups carrying out similar activities. 6.13 Guidelines were produced on the procedures for designating and redesignating co llabora ting centres, covering the initial app roach th rough to the content o f the plan of w ork , the terms o f reference, and finally the evaluation process. As a result, several M em ber States have already indicated an interest in having the w ork o f their own co llaborating centres evaluated; the first such exercise took place in the USSR in June. 6.14 With regard to health services research, the p repara tion o f learning modules for the French health systems research w orkshop to be held at La Londe-les-M aures in June 1988 was finalized by IN SERM . U nder the m edium -term program m e of cooperation with Yugoslavia, a national w orkshop on health systems research was held in Sarajevo from 30 August to 4 September. Target 33 SO 6.15 C ollabora t ion with countries in the form ulation and im plem entation o f national H F A strategies has gathered increasing m om entum . Only three years after the adoption of the regional H F A policy, approxim ately half o f the European M em berS ta te s have taken steps to create entirely new health policies in line with it, and in most o f the remaining countries different types o f development have taken place in support o f H F A policy­ making. This response by M em ber States has taken tangible form in the national policy Before 1990, all Member States should ensure that their health policies and strategies are in line with health fo r all principles and that their legislation and regulations make their implementation effective in all sectors o f society. 87 docum ents finalized by seven countries (Bulgaria, Finland, H ungary, the Netherlands, Poland, Sweden and Yugoslavia) and in the work along these lines being undertaken by six o thers (Iceland, Ireland, Israel, M alta, Norw ay and Spain). The G erm an Dem ocratic Republic has carried out a th o rough review o f its health policy and plans to see how well they match the regional targets. F u rtherm ore , agreement was reached with a num ber of countries to organize debates and meetings on H F A policy; major ones were held in Hungary in M arch and in Ireland and Israel in October. 6.16 P repara tions began for a s tock-tak ing meeting on H F A policy form ulation and im plem entation in countries, to be organized jointly with the Ministry of Social Affairs and H ealth o f F inland. The various approaches to and adap ta t ions of H F A policy in M em ber States have been analysed, and a docum ent presenting the results o f that analysis was issued. 6.17 In view o f this expansion in H F A initiatives, an internal EU R O G ro u p for National Health Policy Analysis and Development was established. In addition to coo rd ina t ing and identifying work to support H F A policy development in countries th rough inform ation exchange and staff training, consultations with outside experts were held to pool and share experiences. 6.ix H F A initiatives in Europe are also emerging at subnational, district and com ­ munity levels. These developm ents are particularly visible in D enm ark , Spain, Swit­ zerland and the United K ingdom and are being initiated in France. The Regional Office, in co llabora tion with the G overnm en t o f Switzerland and individual cantons, organized a debate in A u g u s t/S ep tem b er in which the role and potential o f subnational authorities in originating and fostering H F A action was emphasized. 6.19 In su p p o r t o f national H F A strategies, the Health Legislation unit initiated the prepara tion o f a study entitled “ Legislative strategies for health for all” , the objective being to provide M em ber States with s tructured advice on m ajor priorities for action and efficient m ethods in the field of health legislation. A multidisciplinary team of experts from different countries have w orked to provide the first outline of what could be regarded as guidelines for undertak ing systematic reviews o f national legislation in the light o f the regional H F A targets. 6.20 D uring the year advice was provided to M em ber States on formulating national legislation on such issues as procedures for notification o f com m unicable diseases, informed consent, patients’ rights, A ID S, euthanasia , the definition o f death , data protection and access to records, legislation on smoking, abo r tion , illicit drugs, accident prevention, and legislation on health services structure. 6.21 The work on developing a legislative strategy to enhance the health and wellbeing o f the elderly was pursued. D uring the year 13 M em ber States provided examples of innovative legislative measures already implemented, together with com m ents on the difficulties they meet in fostering more effective social policies. 6.22 T here is growing concern in most M em ber States for defining and pro tecting the rights of patien ts as an im portan t part o f their H F A strategy. T o this end, a study on patien ts’ rights in Europe was undertaken to clarify the present situation in each country. 8 8 6.23 F urtherm ore , a short docum ent enuncia ting com m only agreed rights o f patients in the Region is in p rep a ra t io n and will help clarify the progress achieved up to now in Europe. In this respect, it was agreed that a E uropean sym posium on patien ts’ rights would be held in 1989. 6.24 In Ju n e the M inistry of Welfare, H ealth and Cultural Affairs o f the N etherlands, in co llabo ra t ion with C IO M S and W H O , hosted the 21st C IO M S Conference on European and N orth A m erican perspectives on health policy, ethics and hum an values. This im portan t international meeting had the following objectives: to strengthen national capacities for addressing and m aking decisions abou t ethical and hum an values involved in health policy; to contribu te to an improved understanding o f W H O ’s goal o f H FA ; and to deepen unders tand ing of hum an values across cultural and political lines. The Conference addressed four main themes: screening and counselling, organ transp lan­ tation, the elderly, and lifestyles and health. 6.25 Over the year the com puterized health legislation data base regularly provided up-to-da te in form ation to bo th M em ber States and the Regional Office. The Office was inform ed o f some 400 new health laws passed in 1986 by 25 European M em ber States. This brings the total d a ta base to a ro u n d 1800 texts, which are encoded according to countries, subjects, W H O program m es and regional H F A targets. Requests from M em ­ ber States to have direct access to the da ta base are increasing; at present the G erm an D em ocratic Republic and Italy have direct access. Collaboration with other organizations 6.26 C om pila tion of da ta on health activities by various in tergovernm ental and nongovernm ental organizations continued, so as to allow the Regional Office and other organizations to better coord ina te their cooperative activities in the setting of the regional strategy and , consequently, avoid overlapping and duplication o f work. 6.27 T he Regional Office strengthened its links within the United N ations system by partic ipa ting in m ajor events in the developm ent and social fields, such as the inter­ national cam paign against traffic in drugs, the Interregional C onsu lta tion on D evelop­ mental Social Welfare Policies and Program m es, im plem entation of the In ternational Plan of Action on Aging, the United N ations Decade o f Disabled Persons, 1983-1992, and the In ternational Year of Shelter for the Homeless, 1987. 6.28 T he Regional Office is the executing agency for 19 U N D P country projects in A lbania, H ungary , Poland , Portugal, Turkey and Yugoslavia, in addit ion to various intercountry projects. These include, am ong others, an intercountry project on p ro ­ tecting the water quality o f the River D anube and ano ther on effective system appli­ cations for food safety. 6.29 T he U N D P -su p p o rted regional project on European cooperation on the en­ vironm ental health aspects o f the control o f chemicals (now referred to as “ Im pact and contro l o f chemicals” ), which is in its third phase, offers an excellent example of co llaboration within the United N ations system, since it includes the partic ipation of o ther United N ations agencies. It involves 12 E uropean countries, which between them 89 are strengthening their national and in tercountry capabilities in the field o f environm ent resource m anagem ent with special reference to the control o f chemicals in the agri­ cultural, industrial, water, health and environm ental sectors. 6.30 A n o th er excellent example of collaboration within the United N ations system is the Long-term P rogram m e o f Pollution M onitoring and Research in the M editerranean Sea (M E D POL II), developed by U N E P, in which FA O , IA E A , the Intergovernmental O ceanograph ic Com mission, U N ESC O , W M O and W H O are actively cooperating in a 17-country program m e. 6.31 In connection with relationships established with the In ternational Atomic Energy Agency, the Office was represented at an interregional training course on p lan­ ning, p reparedness and response to nuclear accidents or radiological emergencies held in A rgonne, USA. The Office was also represented at the first and second meetings o f the Interagency Com m ittee for the C o-ord inated Planning and Im plem entation o f Response to Accidental Releases of Radioactive Substances, in Vienna in February and April. 6.32 The period under review was an im portan t milestone in the relationships between the Council o f Europe and W H O , as it was the thirty-fifth anniversary of the agreement signed between the two organizations. Arrangem ents have been made for the first visit by par liam enta r ians o f the Social and H ealth Affairs Com m ittee to the Regional Office in the spring o f 1988. 6.33 C oopera tion continued with CE and C EC in running pilot health education projects focused on prevention of d rug dependence and addiction in various European cities. A new jo in t project was begun, aimed at p rom oting health education in schools. C ollaboration continued on blood transfusion and im m unohaem atology, multidisci­ plinary care o f cancer patients, the elderly, rehabilitation of disabled people, youth, equity in health, drug trafficking, food hygiene, pharmaceuticals, pesticides and the impact o f new technologies on health services. O ther subjects covered were A ID S, organ transp lan ta tion and abuse of psychoactive drugs. 6.34 The Technical Officer, C oord ina tion with o ther Organizations, visited several d irectorates of the C E C in Septem ber to identify possible means of harmonizing com ­ mon activities. Jo in t activities are taking place with the CEC , in particular with regard to the tobacco cam paign , the A ID S P rogram m e, cocaine, education for health, environ­ mental health hazards and indoor air quality. 6.35 T he Regional D irector partic ipated in a meeting of chief medical officers o f the European C om m unity in Leuven in February , and on that occasion invited them to hold their next meeting at the Regional Office in October. At these two meetings the dis­ cussion covered, am ong o ther matters, A ID S, com m unicable diseases, ethics, epidem i­ ology and organ transp lan ta tion . 6.36 The Regional D irector paid an official visit to the D eputy Secretary-General o f O E C D in N ovem ber, during which discussions took place on identifying regional H F A targets that might allow further cooperation between O E C D and W H O. 6.37 The Director, Environm ental Health partic ipated in meetings of the O E C D Expert G ro u p on In tervention Levels for Nuclear Emergencies, in Paris in Jan u a ry 90 and Ju n e , and a ttended the Com m ittee on R adiation Protection and Public Health in Paris in M arch. The Acting D irector, Env ironm ental Health partic ipated in a workshop on epidemiology and radia tion protection organized by O E C D in October. 6.38 C ollaboration strengthened with the N ordic Council as the D irector-General, accom panied by the Acting Director, P rogram m e M anagem ent, m ade a speech at the opening o f the new N ordic School of Public Health in G o th en b u rg in August. The N ordic Council o f Ministers, now based in Copenhagen, drafted its new program m e for coopera t ion within sectors o f social welfare and health, with close links to the regional H F A policy. 6.39 C ollabora t ion continued in the areas o f health and the environm ent through exchange o f inform ation with the CM EA. Target 34 SO 6.40 T he long-term planning methodologies continue to be one o f the main issues of the p ro g ram m e in view o f their relevance to the a t ta inm en t o f many H F A targets. The specific application of long-range approaches such as scenarios has been revitalized in many European M em ber States, and these experiences were discussed at a m ajor meeting held in Kiel in N ovem ber in co llaboration with the G overnm en t o f the Federal Republic of G erm any . Tw o publications on the use of scenarios and o ther long-term planning methodologies were issued in collaboration with the G overnm ent o f the Netherlands. 6.41 Support to country activities took the form of follow-up to the design of the national 5-year health plan for Malta; o f partic ipation in national workshops in planning and m anagem ent in F rance (M arch) and the United Kingdom (September); and of the organization of a sem inar in Portugal in Novem ber, geared to designing a model for p lanning for P H C involving the central and regional health authorities. 6.42 In view o f the growing emphasis on increasing leadership and m anagem ent competence in many M em ber States, the netw ork o f collaborating centres has been expanded to include the N ordic School o f Public Health in G o th en b u rg and the N ational School o f Public H ealth in Rennes. T he latter ran the annual in terna tional inter­ disciplinary course on p lanning and m anagem ent for health. In add ition , a course on epidemiology in health p lanning was conducted by the Usher Institute, University o f Edinburgh in co llaboration with the Regional Office. 6.43 In connection with the subject o f m anagerial approaches to achieving H F A in countries with a federal s tructure and m arket economy, p lanning opportunities Before 1990, Member States should have managerial processes fo r health development geared to the at­ tainment o f health for all, actively involving com­ munities and all sectors relevant to health and, accord­ ingly, ensuring preferential allocation o f resources to health development priorities. 91 and experiences in pluralistic countries were reviewed at a meeting in Brussels in September. Particu lar a tten tion was paid to planning processes as well as sociopolitical realities. 6.44 T he report on the com parative study on health financing, budgeting and pay­ ment systems, which served as factual input to the W orkshop on Primary Medical Care F inancing Systems held in Kiel in N ovem ber 1986, was merged with the findings o f the Kiel w orkshop and issued as a final report. It was recom m ended (a) that experimental and dem onstra t ion projects should be designed and comprehensively evaluated, concen­ trating on how different financing, physician payment and budgeting systems influence the structure , process, costs and outcom es of primary medical care; (b) that physician paym ent, f inancing and budgeting systems in prim ary medical care should be planned, im plemented and evaluated alongside each o ther to ensure that clearly defined policy objectives are a ttained; (c) that im portance should be placed on evaluating both existing and proposed medical procedures, program m es of care and health policies; and (cf) that co llaboration am ong clinicians, epidemiologists, statisticians, economists and other disciplines is a prerequisite for improving quality assurance and evaluation in primary medical care. 6.45 The study on the developm ent o f health economics train ing resulted in a report on education and train ing program m es in selected countries. As a follow-up, a survey on English-language textbooks and course syllabuses in the field of health economics is in prepara tion . Based on the excellent contribu tions o f health economists all over Europe, a report on train ing modules was issued by the Regional Office and is being distributed widely for national adapta tion . Parts o f the material have already been adapted in several o f the partic ipating countries. 6.46 As part o f the study to develop learning material for health professionals, there has been continued co llaboration with the North-W estern Regional Health Authority in the U nited K ingdom . Also, as a result o f the W orkshop on Econom ic Issues in In ter­ sector Policy and P lanning held in the United Kingdom in 1984, a general fram ework for the analysis o f intersectoral cooperation was worked out. As part o f the “ action p lans” proposed to be developed in a particu lar adm inistrative district, a final report was published incorporating local plans and the contents of a new training course for economists, health personnel and industry. 6.47 An international sem inar on health planning and m anagem ent was held in Jerusa lem in Ju n e , with the support o f the Regional Office. As the beginning of a national effort, plans were made for a series of workshops on health economics training to be held in Israel in 1988. These would include: two days of continuing education for 25-35 Israeli health adm inis tra tors , using W H O learning material; a 1 ‘/.-day course for the leading m anagers o f the main Israeli bodies financing health services; and 1 '/, days of discussion on p rom oting health economics as a discipline, involving the leading econ­ omists and health economists in Israel. 6.4x The Regional Officer for Health Economics visited M alta in July, together with a tem porary adviser from the Federal Republic o f G erm any , to advise the G overnm ent on 92 the econom ic efficiency o f the organization and operation o f Maltese health institutions. The visit to o k place against the b ackground o f the recent adop tion o f a comprehensive health care policy in M alta . D ue to the lack o f p ro p e r econom ic accoun ting and in fo rm ation , it is a t present neither possible to use financing, budgeting and resource allocation as an instrum ent o f H F A policy, nor to evaluate the efficiency of the health services. It was agreed that a more in-depth study on health care financing an d budgeting should be carried out. Thus the following two national activities were proposed for 1988/1989: (a) a s ituational analysis that would focus on the description and analysis of the present o rgan izational s tructures by location o f service; an d (b ) a reorganization in o rder to in troduce m odern m ethods and systems o f accounting, with the aim of setting up cost centres inside health care institutions that have decentralized managerial control and responsibility. 6.49 A W orkshop on H ealth Economics was held in Moscow from 31 August to 4 Septem ber, as a result o f a jo in t initiative from the Ministry o f H ealth o f the USSR, the Council fo r M utual Econom ic Assistance (C M E A ) and the Regional Office. It was a t tended by experts from seven countries o f the C M E A (including Bulgaria, Czecho­ slovakia, the G erm an D em ocratic Republic, H ungary , Poland, the USSR and Viet N am ) and W H O tem porary advisers from o ther countries having a national health service. The partic ipants from the countries represented though t that the w orkshop was very timely in view o f the economic reconstruction now being carried out. They felt tha t it would be desirable to strengthen economic m anagem ent capabilities, in view o f the fu r ther de­ centralization of health services m anagem ent to regional and district levels; to use health econom ics increasingly a t the strategic level as a tool for all aspects o f H F A ; to strengthen the role o f the economist in research, training, m anagem ent and adm inis­ tra tion ; and to suggest to the medical departm en t o f the C M E A that an in tercountry p rog ram m e in health economics be established. 6.50 A p lanning meeting for a s tudy on systems o f paym ent by type o f service or patient, with particu lar emphasis on diagnosis-related groupings (D R G s), took place in Leuven in O ctober. The meeting reviewed the evidence on the application an d usefulness o f D R G s. The results o f the deliberations were presented to a wider audience at a subsequent jo in t meeting with the European H ealth Policy Fo rum in Brussels in October, where the fu ture im pact o f D R G s on health care practice and m anagem ent in Europe was discussed. A num ber o f countries plan to in troduce D R G s within and outside hospitals. The purpose o f the study will be to set up pilot studies on D R G s, with emphasis on quality assurance, hospital m anagem ent and incentive budgeting. 6.51 In connection with the m edium -term p ro g ram m e with P ortugal, a W o rkshop on In tersecto ra l A ction for Health : H a rm o n iza t io n o f Econom ic an d H ealth Policies was organized by the N ational School o f Public Health , Lisbon in N ovem ber, with technical an d financial assistance from W H O . N ational reports, including reports from other sou thern E uropean countries , were presented and discussed with a view to ident­ ifying areas for fu r the r investigation in this field. The Regional Officer for Health Econom ics presented a paper on intersectoral action in the context o f H F A . It was suggested tha t health economics associations be modelled a long the lines o f those in Portugal and Spain. 93 6.52 T he Regional Officer for Health Legislation partic ipated in the C om m ittee of Experts on Medical Research on H u m an Beings, organized by the D irectorate o f Legal Affairs o f the Council o f Europe in S trasbourg in October. 6.53 T he Regional Office was represented at the third Conference o f European Health Ministers, organized by the Council o f Europe in Paris in N ovember. The main topics discussed were the ethical and sociocultural problems, the organizational and edu­ cational aspects, and legislative measures in relation to organ transp lan ta tion and E uropean cooperation. Target 35 SO 6.54 In the fram ew ork o f H F A m onitor ing and evaluation, the H F A data base has been developed and updated with the most recent inform ation available in the Regional Office. T he following materials were used as the main source o f information: replies from M em ber States received for the first H F A evaluation exercise (1984-1985); da ta bases m aintained by W H O headquarters (indicators related to mortality and incidence of specific diseases); national statistical yearbooks; and relevant data bases a n d /o r statistics from different in ternational and national organizations, W H O collaborating centres and relevant units o f the Regional Office. 6.55 Sim ultaneously the system of H F A indicators was fur ther im proved and refined. Individuals and institutions in the Region, as well as the appropria te units in the Regional Office and at W H O headquarters , assisted in revising the H F A indicators in the light of the regional evaluation and their own experience. Several consultations were held to consider the developm ent o f im proved indicators in specific areas, including health prom otion and environm ental health. Revised versions o f the indicators, as well as criteria for their developm ent, were presented to the C G P D in April; at the request o f the C G P D , the list was finalized at a consultation held for this purpose in June. 6.56 At the regional level, several indicators were reworded to take account o f the practice in M em ber States a n d /o r the practice recom m ended at global level. The non- quantita t ive indicators , whose questions previously dealt mainly with the existence of legislation and policies, were in a num ber of instances reform ulated to obtain a specific type o f answ er on the im plem entation of program m es and policies, and to enable M em ber States to indicate ways in which their impact could be assessed. 6.57 T here has been a m arked increase in the num ber o f indicators proposed in relation to environm enta l health, a l though the initial in tention of providing more quantitative indicators in this field has not been entirely fulfilled. Q uantitative indicators in the area o f water supply and sanitation now also cover the use of recreational waters. The non-quan tita t ive indicators proposed for environm ental health call for a fuller description o f mechanisms for environm ental health protection and prom otion . At its thirty-seventh session the Regional C om m ittee endorsed the revised list o f regional Before 1990, Member States should have health in­ formation systems capable o f supporting their national strategies fo r health fo r all. 94 H F A indicators to be used in the for thcom ing m onito r ing exercise o f H F A strategy developm ent in countries. T he M em ber States have now received the com m on fram e­ work which, together with the regional indicators, will be the basis for the 1988 evalu­ ation o f national H F A development. 6.58 A representative o f the Regional Office and a partic ipant from the USSR at tended the meeting on sentinel surveillance, organized by the C E C in C openhagen in N ovem ber. D uring the meeting the application of m odern epidemiological m ethods for m easuring different health-related characteristics at the population level was discussed. 6.59 A consulta tion was organized in Heidelberg in D ecem ber to prepare recom m en­ dations for the integration o f epidemiological d a ta on the re lationship o f com m on risk factors to m orbidity and mortality. The subsequent development of relevant risk as­ sessment m ethods was discussed. As far as mortality is concerned, activities on risk assessment were closely associated to corresponding activities for target 6. 6 60 T he publication M easurem ent in health prom otion and protection was issued during the year. The overall concepts of health and health p rom otion are reviewed, as well as m ethods of measuring health essential for health care planning and evaluation. 6.61 T he Office was represented at the 53rd Conference of the In ternational Feder­ ation o f L ibrary Associations and Institutions, in Brighton in August. D uring the C onference the European Association for Health Inform ation and Libraries was estab­ lished, com prising some 100 members from 13 European countries from am ong the m em ber countries o f the Council o f Europe. The aim is to prom ote in fo rm ation transfer in the fields o f biomedical research, epidemiological surveillance, public health services and health p rom otion . T he Regional Office supports the Association with a view to involving all the M em ber States in the European Region. 6.62 T he Regional Office’s bibliographic da ta base (E U R O D O C ) is now compatible with tha t in W H O headquarters (W H O L IS). E U R O D O C has been considerably ex­ panded and is available on-line in the Regional Office. A new data base containing coun try reports on tobacco was developed in line with the form at o f E U R O D O C . Regional Office docum ents are now colour coded to show to which group o f regional H F A targets they belong, they contain the relevant target text, and are indexed to allow for easy identification in the printed lists o r in au tom ated bibliographic systems. 6.63 T he development o f services for operating an H F A statistical d a ta base is progressing well, and the service is now partly operational. The object o f the da ta base is to provide com parative in form ation and analyses to M em berS ta tes on progress towards a ttain ing the regional H F A targets. 6.64 A dvanced facilities for electronic mail services th rough international networks are now fully operational. Owing to the efficiency and cost-effectiveness o f these services, M em ber States have s tarted using electronic mail for routine correspondence. A coord i­ na tion meeting was held in W H O headquarters in O c tober to dem onstra te a develop­ m ent project for the p ro d u c tio n o f a p ro to type electronic mail service to transm it textual inform ation between W H O headquarters and the regional offices for the Eastern M edite rranean , E urope and the W estern Pacific. On an experimental basis, the project 95 aims at assessing the cost-effectiveness of a full-scale electronic message com m unication service th roughou t W H O . 6.65 An in terna tional sem inar on m icrocom puter applications in health services m anagem ent took place in Florence in N ovember, organized jointly by the Regional Office, W H O headquarters and the W H O collaborating centre for health informatics at the C en tro I ta liano Studi e Indagini in Rome. The target g roup o f the sem inar was administrative and m anagem ent personnel from all W H O regions responsible for infor­ m ation support in the public health sector, and the purpose was to induce them to use m icrocom puters and to provide a fram ew ork for decision-m aking in their use. F ro m the E uropean Region, partic ipants were invited from Hungary , Israel, Portugal an d T u rk ey . 6.66 In M ay the M inistry o f Public H ealth of the G e rm an D em ocratic Republic requested the assistance of the Regional Office in investigating what type o f logistics support could be provided in connection with the development of a new national W H O office to be established at the Ministry. The issue will be discussed during a visit to the M inistry in J a n u a ry 1988, where the Regional Officer for Informatics S u pport will receive a general briefing on the s ituation in the informatics area, and also discuss future developm ents in the exchange o f inform ation between the G erm an D emocratic Republic and the Regional Office. 6.67 T he Regional Office is co llaborating technically and financially with the health au thorities in M alta on a large project involving the com puterization of the national health in form ation system. The project was expected to be implemented with the final evaluation mission (phases I and 11 ) scheduled to take place in October. Due to technical problems, however, the evaluation mission was postponed and a technical advisory g roup visited M alta in O ctober to identify problems and form ulate a solution. The final evaluation mission is now planned to take place in August 1988. 6.68 D uring a visit to Israel in April by the Regional Officer for Informatics S upport plans for a nationw ide hospital inform ation system were discussed. The project aims at providing the Ministry of Health with sufficient inform ation to operate government hospitals efficiently, to build a national da ta base o f statistical inform ation for evalu­ ation and p lanning o f the health care system, and to m easure operational efficiency through au tom ation . 6.69 A pilot project including a system to facilitate the exchange of textual (Cyrillic and Latin alphabets) and numerical da ta (statistics) between the Ministry of H ealth of the USSR and the Regional Office is being implemented. T he project will also test and evaluate the exchange of administrative procedures. The first phase of the project, including installation of hardw are and software for com bined Cyril lic /Latin text p ro ­ cessing fully com patible with similar services in the Office, has been implemented. 6.70 In conjunction with the W H O collaborating centre for health informatics at the C o m p u te r In fo rm ation Centre o f the Latvian Ministry o f Health , Riga, the second phase o f the project will include: testing and evaluating o f the exchange o f administrative procedures between the Office and the Ministry; implementing facilities for exchange of in form ation in m achine-readable form; identifying statistical and bibliographic appli­ cations where exchange of data in machine-readable form can be implemented; testing the 96 f e a s ib i l i ty o f d i r e c t e x c h a n g e o f d o c u m e n t s b e t w e e n th e O ff ic e a n d th e M i n i s t r y t h r o u g h t e l e c o m m u n i c a t i o n ; a n d p r o v id in g W H O w i th a n e v a lu a t io n r e p o r t e v e ry six m o n th s . 6.71 In o r d e r t o te s t a n d e v a lu a te th e e x c h a n g e o f a d m in i s t r a t i v e a n d s ta t i s t ic a l i n f o r m a t i o n in m a c h i n e - r e a d a b l e f o r m v ia t e l e c o m m u n i c a t i o n , a p r o je c t , i n c lu d in g lo g is t ic s s u p p o r t , is in th e p r o c e s s o f b e in g im p l e m e n t e d in H u n g a r y . T h e p r o j e c t a l so in c lu d e s c o m p r e h e n s i v e t r a i n i n g o f s ta ff . 6.72 F u r t h e r i m p r o v e m e n t w a s m a d e in t h e lo g is t ic s s u p p o r t t o th e D e p a r t m e n t o f I n t e r n a t i o n a l R e la t io n s , M in i s t r y o f H e a l th , P o r tu g a l . 6.73 In c o n j u n c t i o n w i th th e W H O c o l l a b o r a t i n g c e n t r e f o r i n f o r m a t i c s s u p p o r t a t th e C e n t r e in te r u n iv e r s i t a i r e d e t r a i t e m e n t d e l’i n f o r m a t i o n ( C I T I 2), P a r i s , in i t ia l s te p s w ere t a k e n to l in k th e R e g io n a l O ff ice to th e F r e n c h M in i te l n e tw o r k . 6.74 W i th th e a s s i s t a n c e o f th e W H O c o l l a b o r a t i n g c e n t r e f o r h e a l t h i n f o r m a t i c s in U p p s a l a , S w e d e n , th e r e l a t i o n a l d a t a b a s e m a n a g e m e n t sy s te m M I M E R is n o w in o p e r a t i o n in th e R e g io n a l O ff ic e . I t s u p p o r t s t h e i n t e g r a t e d m a n a g e m e n t i n f o r m a t i o n s y s te m ( I M I S ) , th e h e a l th le g is la t io n n o t i f i c a t i o n sy s te m a n d E U R O D O C . M I M E R w as s e le c te d a s it is a f o u r t h g e n e r a t i o n s o f tw a r e p a c k a g e t h a t a f f o r d s a n u n u s u a l l y h ig h d e g r e e o f p o r t a b i l i t y o f c o d e f r o m o n e sy s te m to a n o t h e r . Target 36 BO 6.75 T h e d a t a b a s e o n h e a l t h m a n p o w e r i n f o r m a t i o n se t u p in 1986 in a s s o c ia t io n w i th th e C e n t r e d e so c io lo g ie e t d e d é m o g r a p h i e m é d ic a le s , a W H O c o l l a b o r a t i n g c e n t r e in P a r i s , is n o w o p e r a t i o n a l . T h e d a t a b a s e r ec e iv e s s u p p o r t f r o m th e F r e n c h M in i s t r y o f S o c ia l A f f a i r s a n d E m p l o y m e n t . I n f o r m a t i o n is n o w b e in g d i s s e m in a t e d , a n d th e C e n t r e a l s o a s s is ts in a n a ly s in g , c o m p a r i n g a n d a s s e s s in g c o l le c te d d a t a a s well a s in i m p r o v in g in d i c a t o r s o n h u m a n r e s o u r c e s f o r H F A . 6.76 A fu ll d e s c r ip t i o n o f th e re su l t s o f th e s tu d y c a r r i e d o u t w i th th e W H O c o l l a b ­ o r a t i n g c e n t r e fo r th e m a n a g e r i a l p r o c e s s fo r n a t i o n a l h e a l th d e v e l o p m e n t a t th e N u f f ie ld C e n t r e in L e e d s w a s i s s u e d b y a c o m m e r c i a l p u b l i s h e r u n d e r th e t i t le Health manpower: planning, production and management. T h e b o o k e x p lo r e s m a n p o w e r p l a n n i n g , p r o ­ d u c t i o n a n d m a n a g e m e n t a i m s , m e th o d o lo g i e s a n d p r a c t i c e s a n d th e i r c o m p a t i b i l i t y w i th th e H F A s t r a te g y . 6.77 A d o c u m e n t e n t i t l e d “ H e a l th p e r s o n n e l d e v e lo p m e n t in s u p p o r t o f h e a l th fo r a l l ” w a s p r e s e n te d a t t h e th i r t y - s e v e n th se s s io n o f th e R e g io n a l C o m m i t t e e in S e p te m b e r . T h i s d o c u m e n t e x a m in e d th e b r o a d im p l ic a t io n s o f th e H F A p o l ic y f o r h e a l t h p e r s o n n e l , w i th p a r t i c u l a r r e f e r e n c e to h e a l th m a n a g e r s , n u r s e s a n d m e d ic a l p r a c t i t i o n e r s . A f t e r a Before 1990, in all Member States, the planning, training and use o f health personnel should be in accordance with health fo r all policies, with emphasis on the primary health care approach. 97 s t i m u l a t i n g d i s c u s s io n , r e s o lu t io n E U R / R C 3 7 / R 7 w a s p a s s e d a s k in g th e R e g io n a l D i r e c t o r to in i t i a t e c o n s u l t a t i o n s a n d d i a lo g u e w i th al l M e m b e r S ta te s , r e l e v a n t in s t i ­ t u t i o n s a n d a s s o c i a t i o n s in o r d e r t o id e n t i f y th e n e e d e d e d u c a t i o n a l c h a n g e s . A p la n o f a c t io n w a s a c c o r d in g ly p r e p a r e d in 1987 f o r i m p l e m e n t a t i o n in th e b i e n n iu m 1 9 8 8 /1 9 8 9 . 6.7« T h e a n n u a l c o n f e r e n c e o f th e A s s o c i a t i o n fo r M e d ic a l E d u c a t i o n in E u r o p e ( A M E E ) a n d th e A s s o c ia t i o n o f M e d ic a l D e a n s in E u r o p e ( A M D E ) , w h ic h w a s h e ld j o i n t l y w i th a m e e t i n g o f th e W o r l d F e d e r a t i o n f o r M e d ic a l E d u c a t i o n in D u b l i n in S e p t e m b e r , w a s a d d r e s s e d by th e R e g io n a l D i r e c to r . T h e v ery p o s i t iv e a t t i t u d e o f p a r t i c i p a n t s to w a r d s th e H F A p o lic y w a s re f lec te d in th e w i l l in g n ess o f se v e ra l o f t h e m to be in v o lv e d in sp e c i f ic c o l l a b o r a t i v e a c t iv i t ie s . T h e c o n t r i b u t i o n o f m e d ic a l e d u c a t i o n to th e new E u r o p e a n h e a l th p o l ic y w a s c h o s e n to be th e th e m e o f th e 1988 c o n fe re n c e . 6.79 T h e A s s o c i a t i o n o f S c h o o l s o f P u b l ic H e a l th in th e E u r o p e a n R e g i o n ( A S P H E R ) a n d th e R e g io n a l O ff ic e e s t a b l i s h e d a j o i n t t a s k fo rc e o n th e t r a i n in g o f h e a l t h p r o ­ fe s s io n a ls f o r H F A , a n d its f irs t m e e t in g to o k p la c e in th e R e g io n a l O ff ic e in F e b r u a r y . T h e p a r t i c i p a n t s p r e p a r e d le a r n in g m a te r i a l s r e la te d to a n u m b e r o f r e g io n a l t a rg e t s , a n d a b o o k le t e n t i t l e d “ S c h o o ls o f p u b l i c h e a l th a n d h e a l th - fo r -a l l : im p l ic a t io n s f o r t r a i n i n g ” w a s issu ed . T h e s e a n d o t h e r in i t i a t iv e s r e la te d to th e n ew c o n c e p t s o f p u b l ic h e a l th w ere d e b a t e d d u r i n g th e T e n t h G e n e r a l A s s e m b ly o f A S P H E R , w h ic h w a s h o s t e d jo i n t l y by th e R e g io n a l O ff ic e , th e N a t i o n a l B o a r d o f H e a l th o f D e n m a r k a n d th e N o r d i c S c h o o l o f P u b l ic H e a l t h , G o t h e n b u r g in A u g u s t . T h e in i t ia l a c h i e v e m e n t s o f th e t a s k fo rc e w ere rev ie w ed d u r i n g its s e c o n d m e e t in g in B r is to l in O c to b e r . 6.80 T h e E u r o p e a n n e t w o r k f o r m u l t i p r o f e s s io n a l e d u c a t i o n in h e a l th sc ien c es w as e s t a b l i s h e d d u r i n g its f irs t g e n e r a l m e e t in g o r g a n iz e d jo in t ly w i th W H O in P a r i s in M a r c h . T h e a im o f th e n e t w o r k is to p r o m o t e th e c o n c e p t o f m u l t i p r o f e s s io n a l e d u c a t io n as a n i m p o r t a n t m e a n s o f a t t a i n in g th e g o a l o f H F A . 6.81 T h e s e c o n d in t e r n a t i o n a l w o r k s h o p o n H F A e d u c a t i o n a l a n d m a n a g e r i a l s t r a t ­ eg ies f o r t e a c h e r s o f th e h e a l th sc ie n c e s w a s o r g a n iz e d in tw o p h a s e s in M o s c o w a n d L o n d o n in S e p t e m b e r , in c o l l a b o r a t i o n w i th th e C e n t r a l I n s t i t u t e f o r A d v a n c e d M e d ic a l S tu d ie s , M o s c o w a n d th e B L A T C e n t r e fo r H e a l th a n d M e d ic a l E d u c a t io n , L o n d o n . T h e w o r k s h o p w a s a t t e n d e d by 13 p a r t i c i p a n t s f r o m B u lg a r ia , C z e c h o s lo v a k ia , F ij i , F in l a n d , F r a n c e , I n d o n e s i a , I s ra e l , P o r tu g a l , S p a in , T u r k e y a n d th e U n i t e d K in g d o m . 6.82 T h e t h i r d i n t e r n a t io n a l w o r k s h o p o n e d u c a t i o n a l p l a n n i n g w as o r g a n iz e d in P a r i s in M a y in c o o p e r a t i o n w i th th e m e d ic a l f a c u l ty o f th e U n iv e r s i t y o f P a r i s X I I a t B o b ig n y . T h e t e n t h c o u r s e o n m o d e r n m e t h o d o l o g y fo r t e a c h e r s o f h e a l th sc ien c es a n d a c o u r s e o n th e m a n a g e m e n t o f a c o l le c t io n o f h e a l th a u d i o v i s u a l s w ere o r g a n iz e d in c o l l a b o r a t i o n w i th th e B L A T C e n t r e f o r H e a l th a n d M e d ic a l E d u c a t i o n in L o n d o n , in J u ly a n d A u g u s t respec t ive ly . 6 .8.1 A s tu d y t o f o r m u l a t e o p t i o n s o f d e v i s in g w a y s a n d m e a n s o f u t i l iz in g r e s e a r c h f in d in g s in m e d ic a l e d u c a t i o n w as u n d e r t a k e n in c o l l a b o r a t i o n w i th s c h o o ls in s e le c te d E u r o p e a n c o u n t r i e s as p a r t o f a g lo b a l s tu d y . T h e r e su l t s o f th e a n a ly s i s o f th e E u r o p e a n s i t u a t i o n will be in c lu d e d in th e g lo b a l r e p o r t to be is sued in 1988. 6.84 A s a c o o p e r a t i v e a c t iv i ty w i th th e W o r l d O r g a n i z a t i o n o f N a t i o n a l C o l le g e s , A c a d e m i e s a n d A c a d e m i c A s s o c ia t i o n s o f G e n e r a l P r a c t i t i o n e r s ( W O N C A ) a n d w i th 98 W H O headquarters , the Regional Office participated in the formulation o f a project for establishing a new university-based training scheme in general practice. The Office also provided support to the In ternational Federation of Medical S tudents’ Associations for o rganiz ing a w orkshop on prim ary health care training in Turkey. In the same country support was provided to a project to reorient medical education, with particular em­ phasis on child survival programmes. 6.K5 New approaches and practices with regard to continuing education of health personnel have been investigated in selected European countries by means of case studies. The outcom e of these case studies was examined at a workshop in Barcelona in December. Ways and means were identified to develop systems and program m es of continuing education of health professionals that will take into account changing national health needs and H FA policies, and lay emphasis on primary health care. 6 X6 Studies on encouraging PH C personnel to perform preventive and promotive activities, and on the team w ork requirements in meeting specific health needs, were undertaken in co llaboration with the N ordic School of Public Health, G othenburg , the C entra l Institu te for A dvanced Medical Studies, M oscow and the Postg raduate Medical School, Budapest. The outcom es of these studies were used as background papers for the W ork ing G ro u p on Interaction between Health and Social Services and the Public in the Provision of Health Care, which took place in G ran ad a in November. 6 X7 In 1987 the Central Institute for Advanced Medical S tudies(C IA M S), Moscow, a W H O collaborating centre for health m anagem ent and hum an resources, celebrated the 25th anniversary o f the W H O international courses for public health adm inistrators. These courses are held annually in English and Russian and were started in 1962. Cl AMS is an institute that coord ina tes all pos tg radua te medical studies in the USSR and continues to work closely with the Regional Office and W H O headquarters. Fellowships 6.XX The distribution of European fellowships in 1987 by subject of study shows that European M em ber States are using fellowships to prom ote their national H F A policies. As indicated in Fig. 1, which com pares the percentages of fellowships d istributed according to target groupings, the highest percentage relates to health development. Fig. 2 shows the regions o f origin of the fellows received in Europe, and Fig. 3 shows the num ber o f fellows from each European M em ber State studying elsewhere, as well as the num ber of fellows received in each country. 6.89 In co llaboration with M em ber States the Regional Office has been active in supporting the implementation of resolution E B 71 .R6, and a com puterized program m e for eva luating fellowships has been developed. By analysing individual fellows’ reports and the com m ents o f governm ents, subm itted to the Regional Office one year after the term ination o f the fellowship, the Regional Office will be in a position to provide a reliable appraisal o f the fellowships program me. The system has been carried out on a trial basis for some m onths and will be fully operational from Jan u a ry 1988. 99 Fig. 1. Percentage d is tr ibu t ion of European fe l low s in 1 9 87 by subject of study Health development support 27.4 Fig. 2. D is tr ibu t ion of fe l low s in the European Region in 1 9 87 by region of orig in AMR 100 Fig. 3. D is tr ibut ion by coun try of fe l lows in the European Region in 1 9 8 7 a Black figures indicate the number of fellows from each country studying elsewhere in the Region. Coloured figures indicate the number of fellows received in each country. 3 T h e s e f i g u r e s r e f e r o n l y t o t h o s e f e l l o w s w h o s t a r t e d t h e i r f e l l o w s h i p s i n 1 9 8 7 . The Fellowships unit continues to distribute the list o f W H O educational and train ing activities to European M em ber States. This list, in addition to the newly created com puter ized system for con tinuous train ing facilities in Europe, will provide national authorities with inform ation to help them to select the most relevant training o p p o r­ tunities in support o f H FA development. 6.41 S ta ff o f the Fellowships unit represented the Office at a meeting of the M edi­ cal Fellowships Selection and Assessment C om m ittee of the Council o f Europe, in S trasbourg in Septem ber, and at a meeting of senior fellowships officers of the organiz­ ations o f the United Nations system, in T urin in October. Target 37 SO 6 .9 : Representatives of the In ternational Federation of Medical S tudents ' Associ­ ations are actively co llaborating with the Regional Office in order to explore the role of the Federation in support o f target 37. f.,43 A national pilot project is expected to be launched bv Lund University in Sweden on in tersectoral co l labo ra t ion on health and health-related matters in sectors o ther than health. Target 38 SO 6.94 Many M em ber States have now brought health technology assessment into their health policy-related activities. Not only are formal a rrangem ents being made with offices, institutes, commissions, national societies and universities in many different countries, but the increase in in ternational meetings and literature indicates a growing unders tand ing o f the need to establish formal mechanisms for the systematic assessment of health technologies. 6.95 The health technology assessment p rogram m e has focused on support to M em ­ ber States in the development of concepts and principles, both in assessing technologies Before 1990, all Member States should have estab­ lished a form al mechanism for the systematic assess­ ment o f the appropriate use o f health technologies and o f their effectiveness, efficiency, safety and accept­ ability, as well as reflecting national health policies and economic restraints. Before 1990, in all Member States, education should provide personnel in sectors related to health with adequate information on the country ’s health fo r all policies and programmes and their practical appli­ cation to their own sectors. 102 and in their ap p rop ria te and effective use. It has also aimed at supporting M em ber States in the developm ent o f educational program m es in the assessment and ap p rop ria te use of health technologies. 6.96 A netw ork of researchers and institutes has been created, and access to this is offered through the W H O /L IN F O data base created in collaboration with the Centre for Medical Technology Assessment in Linköping, Sweden. 6.97 With regard to health planning and early-warning systems, a comprehensive study has been carried out in collaboration with the G overnm ent o f the Netherlands. The report on the study is available from the steering com m ittee on future health scenarios of the Netherlands Ministry o f Welfare, H ealth and Cultural Affairs. 6.98 A survey o f the current approaches and attitudes towards health technology evaluation was carried ou t in co llaboration with the Centre for Medical Technology Assessment, Linköping, Sweden. 6.99 In studying the interface between technology policy and industry, a workshop was held in S trasbourg in May, in collaboration with the Regulatory Affairs Professionals Society and the US F ood and D rug Adm inistration. 6 .Ю 0 On the subject o f developing diagnostic-related groupings, a meeting was held in Leuven in October, in co llaboration with the European Health Policy Forum . 6.101 Discussions on standard ization , evaluation and test protocols o f medical equip­ ment were held with the In ternational W orking G ro u p for Medical Device Testing, in S tockho lm in Ju n e , and with the EEC and the Italian G overnm en t in Florence in November. 6.102 In Septem ber, the Office was represented at the ECE Sem inar on A u tom ation M eans in Preventive Medicine. The views of W H O on medical equipm ent and preventive m easures were presented, and a round-tab le discussion focused on the interaction between man and machine in health care and between technology and health care systems in society. It centred a round the appropria te use, cost-effectiveness and allo­ cation o f medical technology. 6.103 A meeting o f a coo rd ina t ing group, representing different data banks on tech­ nology assessment from five countries, was arranged in Sweden in August. It was agreed that efforts should be made to network these da ta bases to try to establish a com m on way o f accessing the contents, with regard both to indexing and to keywords. 6.104 As part o f the m edium -term program m e with Spain, a consulta tion took place in Barcelona in February in support of a p rogram m e of interlaboratory external quality assessment for haematology. 6.105 Assessment o f the basic radiological system (BRS) has been carried out on a global basis. The European studies have been finalized and show a favourable response to the use of the BRS system. A report is being prepared. 6.106 T he P rogram m e M anager took part in the p repara tion of a report by the ECE on the role of the o rganization of digitized imaging and film-free radiology departm ents. 103 6.107 In co llaboration with the University of Lund, Sweden and the W orld C o n ­ ference on Surgical Efficiency and Econom y, a w orkshop on technology assessment and quality assurance in surgery was arranged in September in cooperation with the C open­ hagen C ollabora ting Centre. Participants attended from many European and several non-E uropean countries. 6.ЮХ A large international meeting on com puters and informatics in health care was held in Linköping, Sweden in October and was attended by approximately 90 participants. 6.109 Studies o f emerging and future technologies were carried out in collaboration with the G overnm en t o f the N etherlands in the following areas: developments in the regeneration, repair and reorganization of nervous tissue; health care applications of lasers — the future trea tm ent of co ronary artery disease; developments in genetic screening; applications of the new biotechnology — the case of vaccines; computer- assisted medical imaging; and potentials for home care technology. 6.1 io An international course on quality assurance, a ttended by 42 participants from 10 countries, was held in F inland in July. The many applications to this course indicate the extensive interest o f M em ber States in the issue of quality assurance in health care. 6. 11 1 While national initiatives in the field o f technology assessment are increasing in almost all European countries, there are some M em ber States where the issue of tech­ nology is still a question of technique and where the focus is still on uneven distribution o f necessary medical equipm ent as well as lack of quality o f such equipm ent. In these countries, there is still the need to support the developm ent o f the concept of technology assessment and the appropria te use o f technology. Pharmaceuticals 6.M2 As in the previous six years the development o f a balanced pharm aceuticals p rogram m e, contribu ting to the a tta inm ent of many H FA targets, continued. E stab­ lishment of new activities was unavoidably impeded by the prolonged absence o f the Regional Officer for Pharm aceuticals on o ther duties for the Organization , but existing activities continued. O ne difficulty in reporting fully upon work in the fram ework o f this p rogram m e is that a growing num ber o f M em ber States seek advice confidentially from the unit, e.g. on the development or evaluation of their systems for the regulation of pharm aceuticals or of pricing schemes; it is clear that the confidential nature of such consultations must be respected by the Regional Office. 6.1 13 T he sixteenth E uropean Sym posium on Clinical Pharm acological Evaluation in D rug C ontro l was again held in Schlangenbad, Federal Republic of G erm any in N ovem ber with the support o f the Federal Ministry for Youth, Family Affairs, W om en and Health . T he topic this time was “ C onstra in ts on trea tm ent and trials” , a p roblem of increasing concern as M em ber States seek to define reasonable ethical and financial limits within which the physician can investigate and prescribe medicines. 6.114 Sixty researchers attended the biennial meeting of the W H O D rug Utilization Research G ro u p in Oslo. The G ro u p , established by the Regional Office in 1969, has 104 to date com pleted and reported on more than 700 studies analysing prescribing patterns, as a basis for the developm ent and evaluation of healthy public policies in the medicines field. The G ro u p continued to be supported by the W H O collaborating centre for drug statistics m ethodology in Oslo, notably as regards the continuous updating o f the list o f “ defined daily doses” , the units in which d rug use is m easured and com pared inter­ nationally. 6.1 is One project that developed rapidly was the study of the present and future role o f the pharm acis t in health care. A working group met in A m sterdam in September, and in N ovem ber there was a successful global meeting in Hillerod, D enm ark organized by the Danish Pharm aceutical Society together with the Regional Office. 6. 116 In co llaboration with the Slovak authorities and professional societies, a second sym posium on the clinical physiology and pharm acology of the perinatal period was held in Smolenice. A part from draw ing up general recom m endations to investigators and prescribers, the meeting provided an opportunity to finalize two major publications devoted to the investigation o f “ behavioural teratogenicity” and the effects of drugs during lactation. 6.1 17 Notable am ong inter-unit projects was one established in 1986 together with the N utrit ion unit to examine policies as regards vitamin and mineral preparations. A working group was held in June to draft the report. 6. 118 T o an increasing extent, the Regional Officer and consultants a ttached to the p rog ram m e have played a role in external courses, meetings and symposia intended to provide participants (e.g. from the pharmaceuticals industry) with a greater insight into such matters as the regulatory process and the detection of adverse reactions. 6.119 O f the docum ents issued by the program m e, those in the European Drug Guideline Series remain am ong those most widely in dem and, followed closely by “ D rugs and m oney” and the “ D rug bulletins review” . W ork on updating these p ro ­ ceeded th ro u g h o u t the year so that they remain fully in line with the rapidly changing scene. 6.120 T he fourth issue o f the “ D rug regulation index” , prepared by the W H O collab­ o ra ting centre for drug inform ation and quality assurance in Budapest, was distributed. This issue indexed a large num ber of guidelines and regulations from all parts of the world relating to good m anufacturing practice. 6.121 A basic long-term study formalized during the year relates to “ Health behaviour, levels o f knowledge and att i tudes related to pharm aceutical use” . Such work is seen as com plem enting the more direct approach to the pharmaceuticals situation, identifying the m otivation underlying drug-related behaviour. Such behaviour differs strongly from one part o f the Region to ano ther , and an understanding o f the reasons for this variation is needed if drug policies are to reflect a popu la t ion ’s true needs and preferences. 6.122 C ollaboration with the D epartm ents of Pharm acology and Clinical P h arm a­ cology at the University o f G roningen , the Netherlands has become much closer and more concrete. T he experimental teaching p rogram m e in pharm aco therapy and pre­ scribing for medical s tudents entered its third teaching year. Experience is now sufficient 105 t o c o n f i r m th e p r o g r a m m e ’s p r o m is e , a n d u n iv e rs i t ie s in o t h e r c o u n t r i e s h a v e e x p r e s s e d in te r e s t in p a r t i c i p a t i o n in a n e x t e n s i o n o f th e p r o g r a m m e . C o l l a b o r a t i o n w i th th e U n iv e r s i ty a l s o r e n d e r s it p o s s ib le t o m o b i l iz e c a p a c i ty , n o t a b ly b y w o r k i n g w i th g r a d u a t e s t u d e n t s t o d e v e lo p th e s e s o f d i r e c t r e le v a n c e t o th e p r o g r a m m e o f t h e W H O E u r o p e a n R e g io n . 6.123 N e w i n f o r m a t i o n m e d i a a r e b e g i n n i n g to d o m i n a t e t h e f ie ld o f m e d ic in e s , a n d a f u r t h e r t e a c h i n g v id e o o n t h e w a y in w h ic h m e d ic in e s a r e s o ld t o th e p h y s i c i a n w as p r o d u c e d f o r p u b l i c d i s t r ib u t io n . 6.124 In o n e M e m b e r S ta te , w o r k w a s u n d e r t a k e n to r e s t r u c t u r e a n e x i s t in g in s t i tu te so t h a t i t c a n p l a y a m o r e a c t iv e r o le i n t e r n a t i o n a l l y in th e p r e d i c t i o n a n d a v o i d a n c e o f d r u g - i n d u c e d in ju ry . In p a r a l le l w i th th is , lo n g - t e r m c o m p a r a t i v e s tu d ie s o f f in d in g s w i th p a r t i c u l a r d r u g s in a n i m a l s a n d in m a n w e re in i t i a t e d , a g a in a s a m e a n s o f d e v e lo p in g b e t t e r p r e d ic t iv e t e c h n iq u e s . RESEARCH AND HEALTH DEVELOPMENT SUPPORT Publications issued in 1987 Measurement in health promotion and protection. WHO Regional Publi­ cations, European Series, No. 22. Drugs for children. Non-serial publication. Documents issued in 1987 Altenstetter, C. Intersectoral action to aid maternal and child health — under­ standing the policy process (document ICP/MPN 016). Brenner, M.H. et al. Scenario approaches in health planning (document ICP/MPN 012). Economic aspects of prevention of diseases and disability, report on a consultation (document ICP/MPN 511). European Advisory Committee on Health Research', report on the thirteenth session (document ICP/RPD 112). Health for all and schools of public health: implications for training (docu­ ment ICP/HMD 117). Index to Guidelines and Regulations of Good Manufacturing Practice ( GMP) (Drug Regulation Index No. 4). Information exchange and collaboration in health-related activities in Europe: report on a WHO meeting (document ICP/COR 112). Long-term planning and scenarios in health care: report on a WHO meeting (document ICP/MPN 021). Research methodology in education for the health professions: report on a WHO intercountry travelling seminar (document ICP/HMD 138). Ritsatakis, A. Framework for the analysis of country (HFA) policies (docu­ ment ICP/MPN 032 (ex ICP/EXM 026)). Co-publications issued in 1987 Long, A. & Mercier, D. Health manpower: planning, production and man­ agement. London, Croom Helm. 107 7Global programmes 7.1 Following a decision by the D irector-General, the Regional Office’s responsibility for the m anagem ent o f its global p rog ram m e areas was increased. T he global p ro ­ gram m es located at the Regional Office, i.e. those on accident prevention, health o f the elderly and appropria te technology for health, thus have to comply with the m anagem ent procedures o f the Regional Office. The m edium -term program m es of these three p ro ­ gram m es for the period covered by the Eighth G eneral P rogram m e o f W ork were there­ fore screened by the Regional Program m e C om m ittee (a task previously perform ed by the H eadquarte rs P rogram m e Com m ittee (H PC)), assisted by the Secretary o f the HPC. Global programme for accident prevention 7.2 T he first part o f 1987 was essentially devoted to further im plementing the prin­ ciples o f intersectoral coord ina tion and decentralized policy for safety prom otion . Two interregional meetings took place in Thailand in M arch, and should pave the way for the developm ent of the p rog ram m e in the future, particularly during the Eighth General P rog ram m e of W ork. One was a meeting on accident and injury prevention at the p rim ary health care level held in Pattaya, and the o ther an Asian sem inar on road safety, which took place in Bangkok. 7.3 T he basic aims o f these two meetings were: first, to form ulate guiding principles for com m unity safety p rogram m e development as part o f health p rom otion and protec­ tion, and to cater for the need for increased intersectoral cooperation at the com m unity level; and second, to establish regional o r subregional networks of policy-makers and heads o f national institutions in the field o f road safety so as to ease inform ation exchange and technical coopera tion , particularly in research. Representatives from the health and transport sectors attended both meetings. Together with the Economic and Social C om m ission for Asia and the Pacific, W H O plans to serve as a technical resource for countries, particularly in dealing with problem s of technology transfer, and to follow up policy guidance on s trengthening com m unity involvement in road safety activities. All the recom m endations o f the sem inar were in agreement with W orld Bank guidelines for road safety, which should secure coord ina tion with the Bank at the country level. The Asian sem inar was largely a follow-up of recom m endations m ade by several European coun tries on decentralized road safety policies during European R oad Safety Year in 1986. 109 7.4 T he m ajor event in 1987 was the sem inar on injury prevention at the primary health care level in Thailand. In cooperation with the Ministry o f Health, preliminary guidelines and a protocol for the development of a pilot project in T hailand were form ulated . The report o f the seminar, which was disseminated to all Regions, has a roused definite interest and plans have been made to develop similar projects in Kenya and Venezuela. In Kenya this project is likely to be supported by collaboration between w om en’s associations in Kenya and Sweden. The Ministry of Health in Venezuela included this proposal in its ongoing accident programme. 7.5 Representatives from the C onsum er Safety Institute ( CS I ) in A m sterdam and the South A ustra lian Health Com m ission , Adelaide attended the first meeting on accident and injury prevention at the primary health care level, and a preliminary work plan has been form ulated to strengthen cooperation between these two institutions and between them and T hailand , particularly with a view to prom oting com m unity safety p ro ­ grammes. Im m ediate follow-up took place in Indonesia and Kenya. Sweden also ex­ pressed interest in this approach. The CSI will act as technical adviser for the p rogram m e and as an information repository, and will be responsible for producing a joint W H O /C S I newsletter on domestic safety. The South Australian Health Commission will assist particularly in com m unity safety training, and an interregional travelling sem inar be­ tween Australia and Thailand is under consideration. 7,(> The road safety policy analysis and evaluation in countries, m entioned in the Annual R eport o f the Regional D irector for 1986, was completed and was used as background material for the meeting of the study group on new approaches to improve road safety held in December. In relation to this meeting, an assessment was m ade of W H O activities and their impact in the field o f road safety: it showed that W H O has now set up broad policy principles in the field, giving due consideration to the specific needs of non-industrialized countries. These principles were initially based on the Luropean experience, and have been expanded through a continual national and regional consul­ tation process. The views and recom m endations o f this study group should guide the further development of the program m e into the Lighth G eneral P rogram m e o f Work. 7.7 T he W H O /P A HO protocol for the development o f research into child accidents continued to be used in the Region for the Americas. In addition to C uba, which set up a national policy and program m e on the basis o f the protocol, ministries of health in Venezuela and in the State of Sfio Paulo in Brazil established formal program mes. An evaluation o f W H O /P A H O activities took place in Caracas during the Congress of the Asociaciôn Latino Am ericana de Pediatria in October, and gave rise to the Caracas declaration for child and adolescent safety. 7.x The coord ina ted research on accidents in the aged, jointly sponsored by W H O and the In ternational Centre for Social G erontology ( I CSG) in Paris and involving seven countries, continued to focus on the prevention of falls. Sweden was invited by the Belgian Ministry o f I lealth to assist in establishing a program m e in this area. The ICSG prepared a m onograph for health professionals, as well as preliminary guidance for architects on safe housing design and information for the aged on how to exercise in order to prevent falls. 7.9 Burn prevention activities were continued in cooperation with the In ternational Society for Burn Injuries and expanded from South-East Asia (India , Nepal), the W estern Pacific (a co llaborating centre in Jap an ) and Europe (D enm ark ) to Africa (Nigeria) and the Americas (the United States). The first ou tcom e of the epidemiological network established by W H O in India, involving eight centres, came from the M adras centre with emphasis on social and cultural factors, particularly with regard to the occurrence o f burn injuries in women. Global programme for health of the elderly 7.10 T he dem ographic and health profiles of the elderly populations o f M em ber States prepared by W H O , and the data derived from three o ther international p ro ­ gram m es — the United N ations Statistical Office, the “ Aging W o rld ” project o f the US Bureau o f the Census, and the in ternational collaborative effort on aging of the US N ational C en ter for Health Statistics are being integrated. The inform ation thus be­ com ing available, which will include projections to the year 2000 and beyond, should m ake governm ents aw are that the age structure of the population is changing and that this has social and public health consequences. 7.11 An expert com m ittee on the health o f the elderly held in G eneva in N ovember, the first o f its kind since 1974, gave guidance to M em ber States on what should be done under different socioeconomic conditions to maintain people's wellbeing as they age. 7.12 W H O ’s policies and programmes on aging were presented prominently at regional and international meetings and, in pursuance of the policy of bringing the health of the elderly p rogram m e to the atten tion of scientific and professional organizations, w ork­ shops were held during regional meetings of the International Association of Gerontology and the Triennial Scientific Meeting of the In ternational Epidemiological Association. W ith W H O support , national seminars on geriatrics and gerontology were convened in A n d o rra and Portugal and , with the co llaboration of Latin American countries, an international w orkshop on prim ary health care of the elderly took place in Spain. 7.13 Som e 50 partic ipants from all six W H O regions were trained in m ethods for developing rational policies and program m es during the W H O in terna tional course on the epidem iology o f aging, held annually at the L ondon School o f Hygiene and Tropical Medicine. W H O su p p o rted a similar course in French and Spanish , organized by the In te rn a t io n a l Centre o f Social G eron to logy in Annecy, France in June; a course on gerontology organized by the Institute of Social Services for Retirees and Pensioners of A rgentina in Buenos Aires in N ovember; and a sem inar on research on aging in Asia and the Pacific in S ingapore in September. 7.U W H O ’s con tribu tion to the im plem entation of the In ternational Plan o f Action on Aging." adop ted by the W orld Assembly on Aging in 19X2, was given prominence in a Report o f the W orld Assembly on Aging. New York. United Nations. 19X2 ( II. 82.1.16). I l l the report ot the Secretary-General ol the United Nations on the question ofag ing" to the forty-first session of the United Nations General Assembly. 7.15 W H O cooperated with Burma. Indonesia, M auritius, Thailand and Zim babwe in developing comprehensive services for the elderly as an integral part o f primary health care. In the Region of the Americas significant advances were made in national surveys of the needs ot the elderly, and the first national course on self-care for the elderly was held in Mexico in February. Surveys of the needs of the elderly also advanced in M ember States ol the South-Last Asia Region. In the European Region computer-assisted p lan­ ning, a tool evolved for W H O by the Jo h n s H opkins School of Hygiene and Public Health, bv which social and health data on the elderly can be displayed in an organized and intelligible way, enabled district health policy to be p lanned in Iceland. In the Lastern M editerranean Region prepara tions were made to carry out representative sample surveys of the health and social status of the elderly in Bahrain, Egypt, Jo rd an , Pakistan and Tunisia, with a view to developing a data base on which to found national p rogram m es and policies. As the result o f an U N R W A -supported visit to Jo rd a n by representatives of W H O and HelpAge In ternational in 1986, a program m e was estab­ lished in the areas covered by UN RW A . 7.16 Various strategies were used in developing and disseminating health inform ation on aging. New knowledge on card iovascular care of the elderly was published by W H O , and the Kellogg F o unda tion issued a technical guide on the prevention of falls by the elderly. M anuscrip ts on mental health, nutrition and lifestyles were completed, and a m onograph on physical therapy is being prepared jo intly with the W orld Confederation for Physical Therapy. 7 17 A prom inent feature of the program m e is its partnership with nongovernmental organizations in advocating health care of the elderly and prom oting health in old age. In 1987 representatives of W H O partic ipated in the Congress of the In ternational Feder­ ation of Associations of Older Persons; in an international conference in Nairobi on the prevention and control of noncom m unicab le diseases; and in meetings o f HelpAge In ternational and Alzheimer’s Disease International. 7 . is In June , on the recom m endation of the Advisory C om m ittee on Health Re­ search, a W H O Special P rogram m e for Research on Aging was established at the United States N ational Institute on Aging. Steering committees in the areas of epidemiology, mental health, osteoporosis and im mune function are drafting a five-year program m e. Surveys of the needs of the elderly will form the regional contribu tions to the special program me. 7.19 The T okyo M etropolitan Institute of G eronto logy was designated a W H O collaborating centre for health o f the elderly, and training fellowships are beginning to be provided in the Western Pacific Region in this field, for example to the Republic of Korea and to Viet Nam. a U n ited Nat ions document No. Л /4 1 /6 3 1 . 1 1 2 Global programme for appropriate health care technology 7.20 D raft guidelines on the use o f com puters in prim ary health care were completed in the spring o f 1987 and were circulated to W H O headquarters , the regional offices and a num ber o f experts. The V l l th conference on medical inform ation, held in Rom e in Sep tem ber addressed the subject, and a televised conference featuring the ministers of health o f Belgium and Spain considered the im plem entation of the guidelines in those countries. The W H O guidelines emphasize the role o f com puters in planning, projection, s imulation, continuous evaluation and m onitoring, and quality assurance. 7.21 Progress was m ade in attracting more countries to the study o f regional vari­ a tions in health care, as dem onstra ted by a congress organized by the Copenhagen C o llabo ra t ing C entre in N ovem ber 1986 and w orkshops held in Oxford , L ondon and A m ste rdam in 1987. Israel jo ined a study on cholecystectomy, p rosta tec tom y and upper gastro intestinal endoscopy. P reparations were completed for a conference on evaluating the case for hysterectomy, in Copenhagen in Jan u a ry 1988, which will aim not only to assess the issue from the m ethodological viewpoint but to a ttem pt to find explanations and develop a health policy as appropriate. 7.22 A newsletter on budgetary incentives was issued in Jan u a ry with the aim of raising awareness in this subject. Insurance com panies have already taken some action, for example reim bursem ent o f the costs o f u ltrasound examination is denied in cases with no medical indications by two com panies in the U nited K ingdom and the U nited States. A com pany in the east o f the United States has restricted re im bursem ent o f the costs of m agnetic resonance imaging (M R I) to diseases that show benefit, with a consequent reduction in the num ber o f M RI machines in the east com pared with the west o f the country. T he Swiss sickness fund reimburses the costs of MRI examinations only to those practitioners who have agreed to partic ipate in a study on clinical efficacy. 7.23 Following a review o f the first 100 cases o f the W H O m ulticentre M RI study, a new and simpler postcard for evaluating patient ou tcom e was prepared. This idea was also expanded to the tonsillitis s tudy and is now under field trial. The pro tocol of the insulin pum p study, though very complex, was com pleted by partic ipa ting clinics in nine countries. 7.24 T he M O N IC A and C IN D I p rogram m es have explored the ra tional use of labora to ry investigations in confirming diagnosis o f myocardial infarction, and results are expected to be ob ta ined as from 1988. T he E uropean C om m ittee for Clinical L ab o ra to ry S tandards has agreed to take part in utilization studies, and similar interest exists at the Institute of Preventive and Social Medicine in Lausanne. 7.25 Im plem entation o f the basic radiological system (BRS) project developed only slowly because o f the artificially high cost o f BRS machines. A simpler evaluation pro toco l was distributed and the results are expected early in 1988. Video cassettes were m ade on BRS, the ra tional use o f u l trasound in obstetrics, and the ra tional use of radiological investigations. 113 7.26 T o w ard s the end of the year a simple com pute r p rog ram for m onitor ing surgical w ound infections was introduced. Fifteen countries will test this system for a six-month period and the results will be presented at a w orkshop in C openhagen in O c tober 1988. The purpose o f the study is to in troduce the concept of constan t feedback to the surgeon and, by the process o f continuous self-assessment, show tha t a reduction in the rate of w ound infection can eventually be achieved. Six countries — Belgium, France, Iceland, the Netherlands, Portugal and the United Kingdom — have already agreed to participate in the trial. 7.27 V ariations in the utilization o f aminoglycosides and the relation to incidence of drug-resistant strains of Staphylococcus and Escherichia coli have become o f interest to drug companies, which have offered to support a meeting on the rational use of antibiotics to take place in Freiburg , Federal Republic of G erm any in Septem ber 1988. F u r th e r ­ more, two curren t studies deal with app rop ria te levels of iron in the body, and were initiated as a result o f the workshop held in Pilisszentkereszt, Hungary in November 1986. One study evaluates iron status and susceptibility to infection in b lood donors , and the o ther investigates the effect o f the am o u n t o f iron in milk form ulae on ch ildren’s grow th and health. Regional activities of interregional scope Oral health 7.28 The Regional Officer for Oral Health co llaborated with the staff o f the W H O in tercoun try centre for oral health , Chiang Mai, Thailand in the p lanning o f research projects related to defluorida tion o f drinking-w ater, occurrence of dental fluorosis, use o f pit and fissure sealants, oral health status in hill tribes, and im plem entation of alternative oral health care systems. 7.29 The Regional Officer acted as d irector for the thirteenth W H O /D A N ID A course in denta l public hea lth , which took place in Beijing, C h ina from 21 S ep tem ber to 17 October. Mental health 7.30 The Regional Officer for M ental Health partic ipa ted in the W H O global co­ o rd ina ting g ro u p for mental health in Brazzaville where, inter alia, the m ain develop­ ments in the E uropean regional p rog ram m e were incorpora ted into the global mental health program m e. 7.31 As one of its collaborative activities, the Regional Office supported the a t ten d ­ ance o f the D irecto r of the D ep ar tm en t of M ental H ealth , Ministry o f Health and Social Assistance, Turkey in a training w orkshop on mental health leadership, held in T anzania in August. Maternal and child health 7.32 The Regional Office co llaborated in two birth conferences in N orth America: one in T oron to and the o ther in Seattle. 114 7.33 T he reco m m en d a t io n s on ap p ro p r ia te b ir th technology resulting from an interregional conference o f the Regional Office and the Pan Am erican H ealth O rg an ­ ization, held in Fortaleza, Brazil, led to wide discussion o f the issues in the European Region. Disaster preparedness 7.34 T he N ursing unit par tic ipa ted in p reparing a plan of work for a co llaborating centre for disaster p reparedness in Addis A baba , Ethiopia , and is currently participating in p reparing a cadre o f E uropean nurses to work in prim ary health care and disaster p reparedness both in the European Region and in developing countries. These activities are being im plemented by a multidisciplinary g roup supported by the Regional Office and W H O headquarters units concerned with disaster preparedness, the focal point for nursing at W H O headquarters , the Italian Ministries of Health and Foreign Affairs, and the W H O co llaborating centre for disaster preparedness, m anagem ent and nursing in Rome. Quality assurance 7.35 A working g roup on the organization of quality assurance took place in May and focused on health care institutions such as hospitals and prim ary health care centres. This was followed by an in ternational symposium on quality assurance organized jointly by the In terna tional Society for Quality Assurance, the In ternational Hospital Feder­ ation and the Jo in t Com m ission for the Accreditation of Hospitals. It was specifically aimed at the developing countries. Health promotion 7.36 T he activities carried out under the first action area of the O ttaw a C harter (healthy public policy) helped to prom ote its development in M em berS ta tes , to clarify its scope, and to analyse case studies from a num ber o f M em berS ta tes . These activities also form ed part o f the p repara tions for the second in ternational conference on health p ro m o tio n entitled “ Healthy public policy” , to be held in Adelaide in April 1988. The Adela ide conference will explore experiences in healthy public policy and study various ap p ro ach es to health p ro m o tio n policy from the national to the local level. O ver 50 case studies have been proposed from countries a ro u n d the world. A draft long-term plan for healthy public policy developm ent is also being considered, to ensure tha t the m om en­ tum generated at the conference is not lost. Solid wastes 7.37 T he problem of disposal o f municipal solid waste and sewage sludge is o f growing concern to the popu la ted centres of bo th highly and less industrialized countries. C onsequen tly , this issue has also a ttrac ted much atten tion in countries outside the E uropean Region, and technical expertise was provided by the Regional Office to the S tate o f Säo Paulo, Brazil. 115 Healthy working conditions 7.38 The twenty-second In terna tional Congress on Occupational H ealth was co n ­ vened in Sydney in Septem ber, and the Regional Office contribu ted a paper entitled “ Research actions in occupational and environm ental health in the European strategy for health for all of the W H O ” . D uring discussion of the paper, W H O was encouraged to p rom ote in terna tional collaborative research on new emerging problem s and to provide a forum for discussing them. A suggested example was genetic predisposition to higher susceptibility to toxic chemicals. Health manpower development 7.39 The Regional Office was represented at a meeting o f national fellowships officers o f the Eastern M editerranean Region, in Abu Dhabi in November. 7.40 Briefing on the fellowships system was given to several national coun terparts , to staff from the regional offices in Brazzaville, New Delhi and Manila, and to a staff mem ber from the Council o f Europe. Pharmaceuticals 7.41 Closer co llaboration was initiated with the Action P rogram m e on Essential Drugs at W H O headquarters , involving a jo in t project in Is lam abad with the health authorities o f Pakistan; the role of the European Regional Office in such projects is to con tr ibu te in those fields in which par ticu la r experience has been gained by its studies in industrialized countries, notably as regards the fo rm ulation and evaluation o f p h a rm a­ ceutical legislation and policies, the operation of regula tory systems, and the establish­ ment o f services for adverse reaction m onitoring and drug information. 7 42 The Regional Officers for Pharm aceuticals from the European Region and the South-East Asia Region represented the O rganization at the global meeting o f National Centres for Adverse Reaction M onitoring, held in C anberra , Australia in August. 7.43 There were some notable exceptions in 1987 to the preference by M em ber States to consult with the pharm aceuticals p rogram m e on a confidential basis. One was a request from the D epartm ent o f Health in Australia to provide a consultant and o ther help fo r a review o f the d rug regula tory process; this resulted in a publication issued in C anberra in June. GLOBAL PROGRAMMES Publications issued in 1987 Strasser, T., ed. Cardiovascular care o f the elderly. G eneva, W orld H ealth Organization. 116 Documents issued in 1987 Coordinated action on aging', report of the sixth meeting of the NGO/WHO collaborative group on aging (document IRP/MEE 115.2.2). Prevention of cardiovascular diseases among the elderly: report of a WHO meeting (document WHO/CVD/87.2). Articles published in 1987 The prevention of falls in later life: a report of the Kellogg International Work Group on the prevention of falls by the elderly. Copenhagen, Danish Medical Bulletin, 1987 (Gerontology Special Supplement Series No. 4). Quality of long-term care. Copenhagen, Danish Medical Bulletin, 1987 (Gerontology Special Supplement Series No. 5). 117 8Country programmes 8.1 In 1982 and 1983, when the first “ co u n try ” program m es were discussed and designed, the initial idea was to provide an overview o f cooperative activities between W H O and a particu la r country . Such an overview would give the opportun ity for joint assessment o f the various forms of collaboration . The usefulness of such an exercise became apparen t immediately, and a num ber of im portan t developments ensued. — It was now possible to docum ent cooperation with countries in a proper manner, and to determine whether such cooperation truly reflected the requirements of any particular country in the light o f the W H O European H F A strategy. — Coopera tive activities could now be p lanned in advance, and country medium- term program m es were draw n up and implemented. At the same time, the im portance o f intersectorality became clearer. — Following the adop tion of the European H F A targets in 1984, a com m on fram e­ work covering the country and in tercountry program m es was introduced, and this facilitated the necessary links between the two types of program m e. — C ountry funds, which up to that time had almost exclusively been used for fellowships, began to be allocated to o ther forms of cooperation with countries within the fram ew ork o f the European H F A strategy, and new funds were also transferred to the country program m es in support o f that strategy. — In fur ther support o f these developments, the Regional Com m ittee at its thirty- fifth session in 1985 approved the regional p rogram m e budget policy, which established a b road fram ew ork for priority-setting in the developm ent o f country programmes. 8.2 In 1987 the country medium-term program m es that had been draw n up for 1986/1987 were fully im plemented, and at the same time further steps were taken to strengthen the Office’s country activities. As some one third of W H O ’s European M em ber States became involved in the design, implementation and evaluation o f country p rog ram m es, so the close links between these and the different com ponen ts of the Office’s intercountry p rog ram m e became more apparen t. One im portan t aspect o f the 1986-1987 country experience, therefore, was that it stimulated the search for new ways to reinforce such links, tak ing full advantage of the specific con tribu tion o f each of these com plem entary approaches. In fact, reinforcing the links between the country and 119 in tercountry p rog ram m es has meant both benefiting from a more in-depth and extensive coun try experience, and finding ways o f reflecting in each co u n try ’s policy an d p ro ­ gram m e fram ew ork some o f the m ajor aspects o f the Regional Office’s accum ulated technical experience. The la tter has meant a high degree o f co llaboration am ong the different technical fields in the form of the four so-called “ com m on delivery vehicles” . M ost of the cooperative agreements have taken the form of medium -term program m es. These follow closely the structure o f the European H F A strategy and targets, and for this reason the same fram ew ork has been adop ted below in reporting some o f the highlights of the country activities in 1987. Health for all policies 8.3 A growing num ber o f European countries are becoming involved in the estab­ lishment of explicit and comprehensive health policies with a b road basis o f social support . As a result, supporting H F A policy developm ent has become an essential com ponen t o f a num ber o f country program m es, the m ain types o f support being in fo rm ation exchange (e.g. Bulgaria), consultations (e.g. Hungary), Regional Office missions (e.g. Spain) and partic ipa tion in national meetings (e.g. Israel). Explicit target- oriented health policies provide the appropria te basis for developing or reviewing health research policies. H F A research w orkshops were organized to review these issues, involving key con tribu to rs to the health-related research policies of a par ticu lar country. Inequity in health, and disease prevention and control 8.4 S tudying m ortality differentials within a country where these are likely to be of considerable magnitude, taking advantage o f appropria te international expertise, is an im p o r tan t co n tr ib u tio n to support ing national au thorit ies in their efforts to raise consc iousness ab o u t health inequalities an d in ad v o ca tin g ac tion . S trong co llab­ o ra tio n has been established in m any coun try p rog ram m es, especially in the areas o f oral health , accident prevention an d mental health, in gathering ap p rop ria te in fo r­ m ation fo r p lanning and implementing health program m es. New countries continue to jo in the C IN D I project, and in the field o f perinatal care, national birth ing conferences have been an adequate way o f linking international cooperation to national intersectoral forums. Healthy lifestyles 8.5 Cities par tic ipa ting in the European H ealthy Cities netw ork are already playing a role in stimulating national networks in their countries. The Regional Office has given technical support to this movement. The study of com m unity response to alcohol-related p rob lem s is prov id ing an o p p o r tu n i ty to look a t na tional policies in the light o f com m unity-based experience (e.g. Portugal). National family p lanning program m es are 120 su pported th rough jo in t project design, th rough technical discussions during site visits, an d by organizing study tours for project leaders to benefit from international experience (e.g. Turkey). Healthy environment 8.6 The aim o f strengthening national institutions to respond appropriately to en­ v ironm enta l pollu tion has become apparen t in a num ber o f coun try program m es. A m o n g o ther examples, reference may be made to supporting the train ing o f national staff in w ater and soil po llu tion control techniques th rough fellowships, an d the briefing o f national staff on in terna tional developm ents in the surveillance and control o f marine pollu tion (e.g. Albania). Jo in t reviews are made o f specific environm ental problems, such as w ater supply and waste disposal in arid zones and small islands (e.g. Greece and Spain), and there is co llaboration with countries in p lanning environm ental protection , such as that related to large-scale mineral workings (e.g. Yugoslavia). Appropriate care 8.7 Involvement in p r im ary health care in southern Europe has taken place through jo in t p lanning and partic ipa tion in national meetings aim ed a t reviewing and supporting health centre developm ent, and by facilitating the exchange o f experiences between southern E uropean countries. Nursing forum s have been organized th roughou t Europe in p rep ara tio n for the 1988 nursing conference in Vienna. National meetings on quality assurance in health care are aim ed mainly a t raising interest in quality assurance issues and a t stimulating the design and im plementation o f procedures to ensure quality o f care. Support for health development 8.8 An inform ation exchange system in health legislation is now available for country use. Tw o examples o f coopera tion in establishing appropria te m onitor ing systems in coun tries are the m on ito r ing o f trends in m anpow er supply and dem an d an d the m on ito r ing o f adverse d rug reactions. The Office has also been involved in p lanning and im plementing national health inform ation systems (e.g. Malta). Improving cooperative mechanisms 8.9 D uring 1987, coun try m edium -term program m es fur ther con tr ibu ted to im ­ proving cooperative m echanisms, namely by providing language tra in ing and the o rgan­ ization o f briefings on the Regional Office for coun try coun terparts , as well as th rough technical support to the m anagem ent of cooperative program mes. ★ ★ ★ 8.10 While the 1986/1987 country program m es were being im plemented, a num ber of steps were taken to s trengthen fu r ther the Regional Office’s capabilities to improve its coun try approach , and to deal effectively with the increasing interest in this cooperative 121 way o f working. In 1987, two more countries established steering committees to further support the design, im plem entation, m onitoring and evaluation of their cooperative agreements with the Regional Office. T о provide a s tronger and more integrated basis for developing and supporting country program m es within the Regional Office, support groups were established. These include at least one p rog ram m e m anager from each service, generally selected because o f his o r her involvement in that par ticu la r country. 8.11 Also during 1987, a country p rogram m e coord ina to r was appointed. His main responsibility is to strengthen the dialogue between W H O and its European M em ber States, to coord ina te the design, im plem entation, m onitor ing and evaluation o f the cooperative agreements with countries, and to ensure and support appropria te contri­ butions from the different W H O technical units. 8.12 “ C o un try p rog ram m es” have indeed established themselves as a rapidly de­ veloping and evolving cooperative app roach in the Regional Office. They are being technically strengthened as more countries become involved. By the early 1990s, more than two th irds o f the E uropean countries are expected to be implementing a m edium - term country p rogram m e with the support o f W H O . 1 2 2 Annex 1 ACTIVE AND NON-ACTIVE MEMBER STATES OF THE WORLD HEALTH ORGANIZATION, EUROPEAN REGION 31 December 1987 At 31 December 1987 the European Region of the World Health Organization had 32 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 of WHO. A lb a n ia 26 M a y 1947 A u str ia 30 Ju n e 1947 B e lg iu m 25 Ju n e 1948 B u lg a r ia 9 Ju n e 1948 B ye lo ru ss ia n S S R a 7 A p r il 1948 C ze c h o s lo v a k ia 1 M a rch 1948 D e n m a rk 19 A p r i l 1948 F in la n d 7 O cto b e r 1947 Fra n ce 16 Ju n e 1948 G e rm a n D e m o cra tic R e p u b lic 8 M a y 1973 G e rm a n y , Federal R e p u b lic o f 29 M a y 1951 G reece 12 M a rch 1948 H u n g a ry 17 Ju n e 1948 Ice la n d 17 Ju n e 1948 Ire la n d 20 O cto b e r 1947 Isra e l 21 Ju n e 1949 Ita ly 11 A p r il 1947 Lu x e m b o u rg 3 Ju n e 1949 M alta 1 F e b ru a ry 1965 M on aco 8 J u ly 1948 N eth erlan ds 25 A p r il 1947 N o rw a y 18 A u g u st 1947 P o la n d 6 M a y 1948 P o rtu g a l 13 F e b ru a ry 1948 R o m a n ia 8 Ju n e 1948 S a n M a rin o 12 M a y 1980 S p a in 28 M a y 1951 Sw eden 28 A u g u st 1947 S w itze rla n d 26 M arch 1947 T u rk e y 2 Ja n u a ry 1948 U k ra in ia n S S R a 3 A p r il 1948 U S S R 24 M arch 1948 U n ited K in g d o m 22 J u ly 1946 Y u g o s la v ia 19 N ovem b e r 1947 a N o n -a ctive M em ber State. 123 Annex 2 ESTIMATED POPULATIONS IN 1987 FOR THE ACTIVE MEMBER STATES OF THE WHO EUROPEAN REGION (in thousands)*1 Albania 3 181 Austria 7487 Belgium 9 884 Bulgaria 9 293 Czechoslovakia 15 772 Denmark 5148 Finland 4900 France 54924 German Democratic Republic* 16 616 Germany, Federal Republic of* 60920 Greece 10042 Hungary 10810 Iceland 246 Ireland 3 675 Israel 4455 Italy 57128 Luxembourg 362 Malta 387 Monaco 27 Netherlands 14 600 Norway 4167 Poland 38 173 Portugal 10207 Romania 23 396 San Marino 22 Spain 39 629 Sweden 8 259 Switzerland 6 244 Turkey 55 683 USSR 283 620 United Kingdom 55 683 Yugoslavia 23 503 Total estimated population in the Region: 838 443 000 a E x c e p t fo r M o n a co an d S a n M a rin o , these figu re s are based on W orld population prospects, estimates and projections as assessed in 1982. N ew Y o r k , U n ited N a tio n s, 1985. ^ T h e fig u re s fo r the G e rm a n D e m o cra t ic R e p u b lic and the F e d e ra l R e p u b lic o f G e rm a n y in c lu d e the relevant data fo r B e rlin . T h is is w ith ou t pre jud ice to any question o f status that m ay be in vo lved . PROFESSIONAL STAFF IN THE EUROPEAN REGION 31 December 1987 Annex 3 R E G I O N A L O F F I C E Executive Management R egional D irector Program m e P olicy D irector , Program m e M anagem ent A dm inistrative O fficer National Health Policies and Systems D irector H ealth E conom ics H ealth Legislation H ealth M anp ow er D evelopm ent M an p ow er Planning and M anagem ent E ducational D evelopm ent Fellow ships Regional Policy and Programme (contd) DrJ.E. Asvall Ms C. Celinder Dr J. Rochon Ms D. Halvorsen Dr/.S. Luculescu Dr H. F. K. Zöllner Ms G. Pinel Inform atics Support DrJ.-P. Menu Dr V. Vodoratski Dr A. Piga Rivero Vacant Ms E. Pelle H ealth Policies and Planning N ursing Prim ary Health Care H ospitals Regional Policy and Programme D irector E p id em io logy and Statistics H ealth fo r A ll P rom otion C oord in a tion with other O rganizations H ealth In form ation o f the Public P ublications P rom otion VacantDrJ.R. Bengoa Renteria Dr M. Farrell Ms E. Stussi Dr W. Hubrich Dr J. Vang Vacant Vacant Dr R. Prokhorskas Dr M. C. Thuriaux Ms M. Abou Shabanah Vacant Ms N. Humbert Dr M.A. Danzon Vacant O fficia l D ocum ents and Texts Planning, M on itorin g and Evaluation P rogram m e Planning P rogram m e M on itorin g and Evaluation C ountry Program m e C oord in a tion Research P rom otion and D evelopm ent Health Research Disease Prevention and Control Mr I. Vinther-Jergensen Mr A. Malagodi Vacant MrJ.-M. Deramat D irector A ccident Prevention Prevention o f A ccidents A ppropriate T ech n ology for Health Health T ech n ology Assessment C ancer C h ron ic Diseases C om m u n icab le Diseases Special Program m e on A ID S M alaria O ral Health Pharm aceuticals Vacant Ms V.S. Pedersen Dr C. Sakellarides DrH.V. Vuori Dr P.-G. Svensson Dr M.S. Tsechkowski Dr C.J. Römer Dr J. T. Jones Dr K. Stahr Johansen“ Vacant Dr L. Döbrössy Dr A. Shatchkute Dr B. Bytchenko Dr A. Gromyko* Vacant Dr I.J. Meller Dr M. N. G. Dukes Paid by W H O headquarters . ^ In te rreg ional post paid by W H O headquarte rs , based at C openhagen. 125 Lifestyles and Health Environmental Health (contd) D irector Health o f the Elderly Elderly, D isability and Rehabilitation Health P rom otion E ducation fo r Health M aternal and C hild Health M ental Health P sych osocia l Factors and M ental H ealth Mr J. Sampaio Faria A bu se o f Psychoactive Drugs Mr C. Goos Prevention o f A lc o h o l A buse MrJ.U. Hannibal N utrition Ms E. Helsing Dr P.O. Petersson Dr D.M. Macfadyena Dr H.M. Hermanova Dr I. Kickbusch Dr D. O'Byrne Dr M. G. Wagner Sexuality and Fam ily Planning Environmental Health D irector C on tro l o f Environm ental Health H azards E nvironm ental E p idem iology and F o o d Safety E nvironm ental Health Planning and M anagem ent Vacant Vacant Dr M.J. Suess Mr D. Kello Mr E. Giroult T o x ic o lo g y and O ccupation al Health Support Programmes D irector A dm inistrative Services Budget and Finance C on ference Services Personnel S ta ff D evelopm ent and Training Translation , Publications and Text Processing Publications P roduction Translation Services International W ater D ecade MrJ.O. Espinoza Cajina Dr S. Tarkovski Dr F. La Ferla Mr J. Donald Mr K. Thoby VacantMr J. Miller Mr O.H. Jergensen Vacant Ms R.C.E. Néagoé Mr D. Nolan Vacant Ms C.F. Murphy Mr F.E. Theakston Ms P.M. Charhond Vacantd MrJ.-P. Bercot Mr P. Boyled Mr A. David Mr M. Khoussainov Mr R. Kranich Ms M. Lindemann Ms C. Madanoglu Mr V. G. Paveliev Mr G. Pignasty Mr C. Robsond Ms M. Wesemann F I E L D S T A F F Greece IC P /R C E 211 (UNEP) - Mediterranean Action Plan Senior Scientist Dr L.J. Saliba M orocco M O R /C W S 004 (UNDP) - Water Supply in Sm all Communities1’ Design Sanitary Engineer Dr A. Wildt Paid by W H O headquarters . P aid by U N F P A . Paid by v o lun tary funds. Turkey TUR /P H C 001 - Primary Health Care Special Representative o f the R egional D irector Dr U. Broccolo-Tommasi 50V< part-tim e. 1 P ro jec t tra n sfe rre d to E M R O in 1986, b u t see p a ra ­ g rap h 1.31. 126 Annex 4 ORGANIZATIONAL CHART OF THE REGIONAL OFFFICE 31 December 1987 EXECUTIVE MANAGEMENT' É ~ I ---------1--------- 1 1 “ I NATIONAL HEALTH POLIC IES ANO SYSTEMS REG IONAL POLICY ANO PROGRAMME DISEASE PREVENTION AND CONTROL LIFESTYLES ANO HEALTH ENVIRONMENTAL HEALTH SUPPORT PROGRAMMES Health Economics Epidem iology and Statistics Accident Prevention Health of the Elderly Control of Environmental Health Hazards Administrative Services Elderly. Disability and Rehabilitation Health Legislation Health tor A ll Prevention of Accidents Environmental Epidem iology and Budget and finance Food Safety - Health Manpower Development other Organizations Appropriate Technology for Health Health Promotion Environmental Health Planning and Management Conference Services Health Information of the Public Health Technology Education for Health Manpower Planning and Management Publications Promotion Assessment Personnel Water Decade Development Cance Maternal and Child Health Toxicology and Staff Development and Informatics Support Occupational Health Training Chrome Diseases _ Mental Health Health Policies and Planning Translation. Official Documents Psychosocial Factors I- Publications and Text Processing Communicable Diseases Abuse of Publications Nursing - Planning, Monitoring and Evaluation Special Programme on A ID S Psychoactive Drugs Prevention of Alcohol Abuse Production Programme Planning Text Processing: Primary Health Care Systems and Training Programme Monitoring and Evaluation Malaria Hospitals Nutrition Coordination Oral Health Sexuality and Fam ily Planning Research Promotion and Development Pharmaceuticals Compfiies the оНкж of the Regionel Director end of the Director. Programme Health Research Management, at «veil и their joint tecretariat Annex S INTERCOUNTRY" MEETINGS CONVENED BY THE REGIONAL OFFICE FOR EUROPE 1 January — 31 December 1987 ICP/RHB 019 ICP/CEH 032 ICP/CEH 504 ICP/HSR 628 ICP/CWS 012 ICP/CEH 533 ICP/H M D 117 ICP/RPD 124 ICP/PHC 319 ICP/RPD 112 ICP/IEH Oil ICP/HSR 619 IС P/CDS 026 Consultation on the Study on Disability Control at Primary and Secondary Level. Prague, 13-15 January (English) Working Group on UNEP/W HO /G EM S/Air Monitoring Assessment and European Plan of Action. Langen, 3-6 February (English) Consultation on Health Hazards and Biological Effects of Welding Fumes and Gases. Copenhagen, 9-10 February (English) Consultation to Review the Results of the Second Survey on Health Behaviour in Schoolchildren. Jyväskyla, 9-11 February (English) Consultation on Herbicides in Drinking-water: Atrazine and Molinate. Rome, 11-13 February (English) Working Group on Assessment of Health Hazards in Infants As­ sociated with Exposure to PCBs, Dioxins and Related Compounds in Human Milk. Abano Terme/Padua, 16-19 February (English) Meeting of the WHO/ASPHER Task Force on the Training of Health Professionals for Health for All. Copenhagen, 19-20 February (English) Third Meeting of the Task Force on the European University Network for Health for All (EURUN). Copenhagen, 23-24 February (English) Working Group on Mechanisms for Community Involvement in a Health Care System based on Primary Health Care: Committing the Community to Care. Copenhagen, 24-26 February (English) Thirteenth Session of the European Advisory Committee on Health Research (EACHR). Copenhagen, 24-27 February (English, French, German, Russian) Consultation on Concerted European Action on Tobacco. Copen­ hagen, 26-27 February (English) Healthy Cities Project: Workshop on Indicators. Barcelona, 8-12 March (English) Meeting on AIDS Diagnosis and Control: Current Situation. Munich, 16-18 March (English, German) a Several other meetings held during the year were financed through country project funds. Some of these, though not listed here, were of considerable interest to more than one country. 128 ICP/RUD 132 ICP/HSR 625 ICP/CEH 051 ICP/MPN 010 IС P/CDS 017 ICP/CEH 538 ICP/G PD 110 ICP/CEH 020 ICP/HSR 821 IRP/HEE 115.2.2 ICP/PHC 620 ICP/MAL 010 ICP/MCH 521 ICP/CLR 033 ICP/CWS 013 ICP/HSR 818 ICP/CEH 031 ICP/CEH 031 IC P/A DA 013 Workshop on Environmental Health Promotion in Healthy Cities. Rennes, 24-27 March (English, French) Consultation on Environmental Quality Criteria for Shellfish-growing Waters and Shellfish in the Mediterranean Sea (W HO/UNEP Joint Project, MED POL Phase II). Athens, 26-27 March (English) Third Meeting of the Task Force for HFA in European Pluralistic Countries. Brussels, 31 March - 1 April (English) Consultation on AIDS and the Newborn. Copenhagen, 9-10 April (English) Third Consultation on the Epidemiological Study on the Health Effects of Exposure to Cadmium in the General Population. Copenhagen, 13-14 April (English) Consultative Group on Programme Development (CGPD). Copen­ hagen, 21-24 April (English, French, German, Russian) Planning Meeting on the River Danube Water Quality Protection Project. Laxenburg, 22-24 April (English) Meeting on Tipping the Balance towards Primary Health Care. Gothenburg, 23-25 April (English) Coordinated Action on Aging — Sixth Meeting of the NGO/WHO Collaborative Group on Aging. Geneva, 4-5 May (English, French) Working Group to Review Information Needs for Management De­ cisions in Hospitals. Düsseldorf, 4-7 May (English, German) Coordination Meeting on Malaria in South-east Europe. Izmir, 5-7 May (English) Working Group on Concepts of Sexual Health. Copenhagen, 5-7 May (English) Health for All in the Future: What Appropriate Technologies. Lyon, 7-10 May (English, French) Consultation on Potentially Toxic Micro-organic Substances in Drinking- water. Medmenham, 11-14 May (English) Meeting on Unemployment, Poverty and Quality of Working Life — Innovative Interventions to Counteract Damaging Health Effects. Baden/Vienna, 12-14 May (English) Consultation on Epidemiology Related to the Chernobyl Accident. Copenhagen, 13-14 May (English) Joint IAEA/W HO Workshop to Discuss Appropriate Methodologies for Studying Possible Long-term Effects of Radiation to Individuals Exposed in an Accident. Vienna, 18-22 May (English) Consultation on Substance Abuse Education for Health Professionals. Vienna, 20-22 May (English) 129 1CP/EP1 Oil ICP/RPD 114 1CP/HST 118 ICP/CEH 021 ICP/IEH 124 ICP/HSR 631 ICP/RPD 119 ICP/HSR 630 ICP/ADA 017 1CP/CAN 115 ICP/CAN 199 ICP/CEH 053 ICP/OCH 119 ICP/CEH 556 1CP/CWS 012 ICP/CEH 026 IС P/CDS 029 ICP/HSR 010 130 Working Group on the Organization of Quality Assurance. Copen­ hagen, 25-26 May (English) Senior Level Seminar on EPI, CDD and ARI Control Programmes. Moscow, 25-28 May ( English) Fourth Meeting of the Task Force for the European University Net­ work for Health for All. Nancy, 28-30 May (English) Meeting on Revised HFA Indicators. Copenhagen, 9-11 June(English) Working Group on Health Hazards from Radiocaesium and other Long-lived Radionuclides following the Chernobyl Accident. Schloß Reisensburg/Gtinzburg, 9-12 June (English, German) Consultation on Coordinated Infrastructure for Health Education. Copenhagen, 11-12 June (English) European Congress on Healthy Cities. Düsseldorf, 14-18 June (Eng­ lish, German) Seminar on Communication between Users and Producers of Research Findings. Linköping, 15-17 June (English) International Symposium on Health Promotion and Chronic Illness. Bad Honnef, Federal Republic of Germany, 21-25 June (English, German) Second Meeting of Principal Investigators in the WHO Collaborative Study on Community Response to Alcohol-related Problems. Lisbon, 22-25 June (English) Meeting on National Cancer Control Policy. Budapest, 23-25 June (English) Development/Advisory Committee on Cancer Control. Budapest, 23-25 June (English) Consultation on Health-related Aspects of Marine Pollution Control in the Mediterranean. Copenhagen, 29 June - 3 July (English) Joint W HO/CEC Consensus Workshop on Biological Methods for Monitoring Exposure to Genotoxic Agents. Luxembourg, 6-10 July (English) World Conference on Chemical Accidents. Rome, 7-10 July (English, French, German, Russian) Second Consultation on Herbicides in Drinking-water. Rome, 13- 18 July (English) Working Group on Indoor Air Quality: Organics. Berlin (West), 23- 28 August (English, German) Meeting on Training on AIDS for Personnel in DrugTreatment Centres. Bremen, 26-28 August (English, German) ICP/CEH 541 ICP/PHC 612 ICP/MPN 010 ICP/MPN 525 ICP/APR 117 ICP/MCH 112 ICP/CWS 059 ICP/HEE 221 ICP/ADA 031 ICP/HSR 628 ICP/CEH Oil ICP/CEH 052 ICP/DSE 127 ICP/HSR 810 ICP/DSE 146 ICP/CWS 027 ICP/CEH 034 Consultation on Quality Control Studies on Levels of PCBs, PCDDs and PCDFs in Human Milk. Umeâ, 27-28 August (English) Scientific Meeting on the Future Development of Hospitals. Zeist, 28 August (English) Consultation on HFA Management in Countries with Pluralistic Sys­ tems. Brussels, 31 August - 1 September (English, French, German) Workshop on Health Economics. Moscow, 31 August - 4 September (English, Russian) Working Group on Alcohol and Accidents. Reykjavik, 1-3 September (English) Consultation on Study of the Determinants of Obstetrical Intervention. Copenhagen, 3-5 September (English) Consultation on Removal of Organic and Inorganic Micropollutants from Drinking-water Sources. Siofok, Hungary, 15-18 September (English) Consultation and Round Table Discussion on Continuity of Care of the Elderly. Brighton, 15-18 September (English) Working Group on Implementation and Evaluation of Programmes for Problem Drinking. Malmö, 20-24 September (English) Youth and Lifestyles — Consultation on Health Behaviour in School­ children — A Cross-national Survey. Budapest, 21-25 September (English) Consultation on the Psychosocial Impact of Visual Display Terminals. Streatley-on-Thames, United Kingdom, 22-24 September (English) Consultation on Microbial Pollution of Mediterranean Coastal Areas and Associated Health Effects (W HO/UNEP Joint Project, MED POL Phase II). Athens, 22-26 September (English) Meeting of the WHO Drug Utilization Research Group. Oslo, 28-30 Sep­ tember (English) Meeting of Prinicipal Investigators on Inequities in Health. Lisbon, 28-30 September (English) Symposium on Clinical Physiology and Pharmacology of the Perinatal Period. Smolenice, Czechoslovakia, 29 September - 2 October (English) Consultation on Guidelines on Water Supply and Sanitation and on Solid Wastes Management under Cold Climatic Conditions. Jakobs- havn (Illulissat), Greenland, 3-8 October (English) Working Group on Health Hazards of Heavy Metal and PAH Com­ pounds from Municipal Waste Incineration. Florence, 12-16 October (English) 131 ICP/DSE ИЗ IС P/CDS 031 ICP/PHC 622 IС P/NUT 125 IС P/CDS 027 ICP/NCD 028 ICP/CLR 043 ICP/NCD 025 ICP/DSE 199/g20 ICP/CEH 055 ICP/CEH 536 ICP/CWS 016 ICP/CEH 598 ICP/PHC 314 ICP/CEH 013 a A lth ou gh not O rganization . Sixteenth European Symposium on Clinical Pharmacological Evalu­ ation in DrugControl: ConstraintsonTreatmentandTrials.Schlangen- bad, Federal Republic of Germany, 13-16 October (English, German) Consultation on Public Health Education with regard to AIDS pre­ vention. Cologne, 18-21 October (English) Working Group on Technology in Hospitals — Financial and Social Issues related to the Use of Technology. Padua, 18-21 October (English) Consultation on the Epidemiology of Obesity: Classification and De­ scription of Anthropometric Data. Warsaw, 21-23 October (English) Policy Measures re AIDS Among Drug Abusers. Stockholm, 26- 28 October (English) European Conference on the Prevention and Control of Chronic Non­ communicable Diseases. Varna, 26-30 October (English, French, Ger­ man, Russian) Meeting on Information Technology as a Tool in Health Care — For Whom, For What, and How Much? Linköping, 27-28 October(English) Meeting of Programme Directors of the Countrywide Integrated Non­ communicable Disease Intervention (CINDI) Programme. Varna, 31 October - 1 November (English) International Pharmaceutical Seminar on HFA by the Year 2000. Hillerod, Denmark, 5-6 November (English, French) Workshop on the Impact of Carcinogenic, Mutagenic and Tera­ togenic Marine Pollutants in Human Health and the Environment (W HO/UNEP Joint Project, MED POL Phase II). Rome, 9-11 No­ vember (English) EURO/I PCS Expert Group on Formaldehyde. Hanover, 9-13 No­ vember (English) Consultation on Sanitation and Drinking-water Supply, and on Assessment of the IDWSSD in Europe. Nancy, 9-13 November (Eng­ lish, French) Consultation on Impact and Control of Chemicals. Geneva, 10 No­ vember (English) Forum on Primary Health Care in Southern Europe. Lisbon, 10- 12 November (English) Working Group on European Harmonization of Public Health Actions in relation to Nuclear Accidents. Geneva, 10-13 November (English, French, Russian) con ven ed by ihe R egional O ffice itself, this m eeting was spon sored by the W o rld H ealth 132 IR/CLR 012 ICP/HSR 641 ICP/CEH 199/g20 IRP/H EE 120 1RP/HEE 114.5 ICP/MPN 021 ICP/PHC 330 TUR/RHB001 1CP/PSF 013 ICP/EXM 018 ICP/PHC 620 ICP/CEH 044 ICP/HSR 324 I CP/NUT 123 ICP/HST 119 ICP/HSR 634 ICP/DSE 128 ICP/ORH 115 Consultation on Basic Dental Radiographic System. Copenhagen, 12- 13 November (English) Advisory Committee Meeting on Appropriate Health Care Tech­ nology. Copenhagen, 12-13 November (English) Consultation on Health Promotion, Education and Training. Gothen­ burg, 14-20 November (English) Tenth Intersecretariat Meeting on Air Pollution Problems in Europe. Geneva, 16 November (English) WHO International Workshop on Epidemiology of Mental and Neuro­ logical Disorders in the Elderly. Beijing, 16-20 November (English) Workshop on Long-term Planning and Scenarios in Health Care. Kiel, 16-20 November (English, German) Working Group on Interaction between Health and Social Services and the Public in the Provision of Health Care. Granada, 16-20 November (English) Workshop on Better Opportunities for Disabled Persons. Ankara, 17-19 November (English) Workshop on Rights of the Elderly with Mental Disorder. Edinburgh, 19-20 November (English) Second Joint Meeting between WHO and National Medical Associ­ ations on Health for All in Europe. Paris, 26-27 November (English, French, German, Russian) Working Group on Information Needs for Management Decisions in Hospitals. Gütersloh, Federal Republic of Germany, 1-4 December (English, German) Consultation on Monitoring of Land-based Sources of Marine Pol­ lution in the Mediterranean (W HO/UNEP Joint Project, MED POL Phase II). Split, 1-5 December (English, French) Meeting on the Consultant’s Role in Quality Assurance in Nursing Practice. The Hague, 2-4 December (English) Consultation on Opportunities for Better Nutrition through Mass Catering. Seborg, Denmark, 2-4 December (English) Consultation on the Assessment of the Relation of Common Risk Factors with Mortality and Development of Relevant Risk Assessment Methods. Heidelberg, 3-5 December (English) Consultation on Ethics in Health Promotion. Tampere, 7-9 December (English) Consultation to Revise Guidelines for the Clinical Investigation of Anti­ hypertensive, Antiarrhythmic and Antianginal Drugs. Bath, 7-9 Decem­ ber (English) 133 ICP/HST 125 ICP/EPI 017 ICP/H M D 120 ICP/HSR 325 ICP/ADA 514 IRP/APR 216 ICP/CEH 541 ICP/CEH 030 Consultation on the Adequacy of Health Care and Consumer Satis­ faction. Belgrade, 7-11 December (English) Second Meeting of the European Advisory Group on EPI. Rome, 9-11 December (English) Workshop to Promote the Use of New Methods in Continuing Edu­ cation. Barcelona, 9-12 December (English) Consultation on a Regional Network of WHO Collaborating Centres for Nursing Development towards HFA/PHC. Copenhagen, 13-15 De­ cember (English) Meeting on Early Detection of Abuse of Psychoactive Drugs. Munich, 14-16 December (English) Study Group on New Approaches to Improve Road Safety. Geneva, 14-18 December (English) Consultation on Results of Analytical Studies on Levels of PCBs, PCDDs and PCDFs in Human Milk. Copenhagen, 15-16 December (English) International Workshop on Air Quality Guidelines. Bilthoven, 17- 18 December (English) 134 Annex 6 WHO-SPONSORED COURSES IN THE EUROPEAN REGION, OR COURSES RELEVANT TO REGIONAL OFFICE PROGRAMMES, 1987 International Environmental Engineering Course (French). Lausanne, Sep­ tember 1986 - June 1987 (ICP/CWS 004) International WHO Training Course for Public Health Administrators (English). Moscow, 23 September 1986 - 19 June 1987 (ICP/HM D 101/c07) International WHO Training Course for Public Health Administrators (Russian). Moscow, 23 September 1986 -19 June 1987 (ICP/HM D 101/c08) International Environmental Engineering Course (English). Ankara, Septem­ ber 1986 - June 1988 (TUR/CWS 002) International Postgraduate Course in Sanitary Engineering(Portuguese). Lisbon, October 1986 - June 1987 (POR/RUD 001) International Sanitary Engineering Course (English). Delft, 1 October 1986 - 30 September 1987 (ICP/CWS 004) International Sanitary Engineering Course (French). Rabat, 1 October 1986 - 30 June 1988 (MOR/RUD 001) Training in the Community Health Approach: Impact on Primary Health Care (French). Lyon, 21-24 October 1986, 23-27 February 1987, 18-22 May 1987 (ICP/HSR 399/g20) Workshop for District-level Nutritionists in Problem Analysis, Planning and Management of Nutrition-related Activities (English). Oslo, 19-30 January 1987 (ICP/NUT 128) Workshop on Self-help and Chronic Disease (English). Leuven, 28-30 Janu­ ary 1987 (ICP/PHC 317) Course on Statistical, Epidemiological and Operational Methods in Medicine and Public Health (English, French). Brussels, 2 February - 31 May 1987 (ICP/HST 131) Training Workshop on Breastfeeding Promotion: Assessment, Planning and Evaluation (English). Wageningen, 23-28 February 1987 (ICP/NUT 111) International Workshop on Epidemiology in Health Planning (English). Edin­ burgh, 4-16 April 1987 (ICP/MPN 025) Consultation on Health Promotion, Education andTraining(English). Granada, 27 April - 8 May 1987 (ICP/HST 641) Training for Teachers of General Medical Practice (English). Dubrovnik, 5- 9 May 1987 (ICP/PHC 324) Third International Workshop on Educational Theory in the Health Sciences (French). Bobigny, 11-14 May 1987 (ICP/HMD 145) WHO Course on Health Economics in National Service Systems (Russian). Moscow, 12-16 May 1987 (ICP/MPN 525) "From Chaos to Clarity” — International Course on Research in Primary Health Care (English). Gilleleje. Denmark, 18-22 May 1987 (ICP/PHC 324) Social Gerontology in International and Cross-cultural Perspectives — Com­ munity Care (English). Dubrovnik, 25 May - 5 June 1987 (ICP/HEE 299) Training Course for National Counterparts and other Medical Personnel on the Regional EPI Programme ( English). Moscow, 25-28 May 1987 (ICP/EPI Oil) Course on Epidemiology in Environmental Health (English). Umeâ, 31 May - 5 June 1987 (ICP/RUD 199/g51 ) Annual Seminar on New and Innovative Approaches to the Promotion of Healthy Lifestyles, with Particular Reference to Tobacco (English). Dresden, 22-26 June 1987 (ICP/NCD new)) Fourth Training Course in Quality Assurance (English). Kuopio, 28 June - 3 July 1987 (ICP/PHC 324) Tenth BLAT/WHO Course on Modern Methodology for Teachers of Health Sciences (English). London, 30 June - 17 July 1987 (ICP/HM D 134) Summer School for Professors in Sanitary Engineering (English). Delft, 13- 31 July 1987 (ICP/RUD 125) Eighth International Course on Environmental Health Impact Assessment (Eng­ lish). Aberdeen, 15-25 July 1987 (ICP/RUD 117) BLAT/WHO Course on the Management of a Collection of Health Audiovisuals (English). London, 3-14 August 1987 (ICP/HM D 135) Second Workshop on Advanced Nursing Management for European Nurses (French). Lyon, 31 August - 11 September 1987 (ICP/HSR 317) Third International Course on the Epidemiology of Aging (English). London, 31 August -25 September 1987 (IRP/HEE 115) Eighth International Postgraduate Course in Planning and Management of Pri­ mary Health Care in Developing Countries (English). Zagreb, 1 September - 31 October 1987 (ICP/PHC 324) Workshop on Health Promotion in Self-care (English). Maastricht, 13-18 Sep­ tember 1987 (ICP/HSR new) Course on the Assessment of Environmental Health Effects of Development Proposals: The Interface of Health Sciences and Environmental Impact Assess­ ment (English). Aberdeen, 13-19 September 1987 (ICP/RUD 140) WHO International Workshop on Health for All Educational and Managerial Strategies for Teachers of the Health Sciences (English). Moscow/London, 13-27 September 1987 (ICP/HM D 110) 1 3 6 Summer Seminar on Health Promotion (English). Cardiff, 26 September - 1 October 1987 (ICP/HSR 620) Multidisciplinary Workshop on Household Budget Survey Data — Their Use in Nutrition Policy Planning (English). Athens, 30 September - 2 October 1987 (ICP/NUT 129) International Training Course on Intersectoral Collaboration and Community Par­ ticipation (English). Alma-Ata, 30 September - 14 October 1987 (ICP/PHC 324) International WHO Training Course for Public Health Administrators (English). Moscow, 30 September 1987 - 22 June 1988 (ICP/HM D 146) International WHO Training Course for Public Health Administrators (Russian). Moscow, 30 September 1987 - 22 June 1988 (ICP/HM D 147) Course on the Interaction of Care Programmes for Cancer with Technology Assessment (English). Baden, Austria, 11-16 October 1987 (ICP/CAN 120) Fourth Travelling Seminar on Primary Health Care (English). Berlin/Leipzig, 12-16 October 1987 (ICP/PHC 324) International Course in Sanitary Engineering (English). Delft, 22 October 1987 - 5 September 1988 (ICP/CWS 004) Training in the Community Health Approach: Impact on Primary Health Care (French). Lyon, 27-30 October 1987, 22-26 February 1988, 16-20 May 1988 (ICP/HSR 399/g20) Pilot Workshop on Health Promotion Training (English). Gothenburg, 14- 20 November 1987 (ICP/HSR new) Second European Training Course in Quality Assurance (French). Brussels, 30 November - 4 December 1987 (ICP/HSR 011) International Postgraduate Training Course on Methods of Family Planning (Eng­ lish). Debrecen, Hungary, 30 November- 18 December 1987 (HUN/M CH 001) International Workshop on Planning and Evaluation Methodology (French). Rennes, 7-18 December 1987 (ICP/MPN 026) 137 Annex 7 LIST OF WHO COLLABORATING CENTRES WITH WHICH THE REGIONAL OFFICE CONCLUDED PLANS OF ACTION COVERING THE YEAR 1987 WHO Collaborating Centre for Research on Social Equity and Health Eastern Health Board, Research Department, Dublin, Ireland WHO Collaborating Centre for Research and Training on Psychosocial Factors and Health Stockholm, Sweden Target 2 WHO Collaborating Centre for Aging0 Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA WHO Collaborating Centre for Health of the Elderly0 Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan WHO Collaborating Centre for Health of the Elderly0 Red Cross General Hospital, Pyongyang, Democratic People’s Republic of Korea WHO Collaborating Centre for Joint Cooperation on Research on Care of the Aged0 National Institute on Aging, National Institutes of Health, Bethesda, MD, USA WHO Collaborating Centre for Research on Aging Institute of Gerontology of the Academy of Medical Sciences of the USSR, Kiev, USSR WHO Collaborating Centre for Research on Care of the Aged0 Brookdale Institute of Gerontology and Adult Human Development in Israel, Jerusalem, Israel WHO Collaborating Centre for Research on the Epidemiology of Aging0 Centre for Aging Studies of the Flinders Medical Centre, Flinders University of South Australia, Bedford Park, Australia Target 1 0 W H O co lla bora tin g centre w ork ing with a g loba l program m e. 138 Target 4 WHO Collaborating Centre for AIDS Institut de médecine et d ’épidémiologie africaines et tropicales, Hôpital Claude Bernard, Paris, France WHO Collaborating Centre for Applied Malacology Danish Bilharziasis Laboratory, Copenhagen, Denmark WHO Collaborating Centre for Bacterial Meningitis National Reference Laboratory for Bacterial Meningitis, National Institute of Public Health, Amsterdam, Netherlands WHO Collaborating Centre for Child Dental Health University Hospital, Children’s Clinical Department of Dentistry, Iassy, Romania WHO Collaborating Centre for the Coordination and Standardization of Clinical Immuno­ logical Research Faculty of Immunology, Pirogov Second Moscow State Medical Institute, Moscow, USSR WHO Collaborating Centre for Dental Education Department of Community Dental Health, Preventive Dentistry and General Practice, University of Dublin, Ireland WHO Collaborating Centre for the Development of Oral Health Manpower Medical Stomatological Institute, Moscow, USSR WHO Collaborating Centre for Education, Training and Research in Oral Health Faculty of Odontology, School of Dentistry, University of Lund, Malmö, Sweden WHO Collaborating Centre for Epidemiological Surveillance of the Trans-Saharan High­ way with regard to Vectors Institut français de recherche scientifique pour le développement en coopération (ORSTOM), Paris, France W H O /FA O /U N E P Collaborating Centre for Environmental Management for Vector Control with Special Reference to Health Aspects connected with Water Resources Development Division ofTropical and Communicable Diseases and the Ross Institute ofTropical Hygiene, London School of Hygiene and Tropical Medicine, United Kingdom WHO Collaborating Centre for the Evaluation of the Effect of New Pesticides on Insects ofTropical Origin Laboratoire d’entomologie médicale, Office de la recherche scientifique et technique outre-mer (ORSTOM), Paris, France WHO Collaborating Centre for Health and Disease Surveillance Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy WHO Collaborating Centre for Legionellosis Laboratoire national de la santé, Lyon, France WHO Collaborating Centre for Legionellosis National Bacteriological Laboratory, Stockholm, Sweden WHO Collaborating Centre for the Prevention of Oral Diseases Sektion Stomatologie, Medizinische Akademie, Erfurt, German Democratic Republic WHO Collaborating Centre for Reference and Research on Rapid Diagnosis of Viral Infections and Acute Respiratory Infections Ministry of Health and Consumer Affairs, Madrid, Spain WHO Collaborating Centre for Reference and Research on Viral Hepatitis Max von Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Munich, Fed­ eral Republic of Germany FAO/WHO Collaborating Centre for Research and Training in Food Hygiene and Zoonoses Institut für Veterinärmedizin, Robert von Ostertag-Institut, Berlin (West) WHO Collaborating Centre for Zoonoses Central Research Institute of Epidemiology of the USSR Ministry of Health, Moscow, USSR Target 5 WHO Collaborating Centre for the Evaluation of the Effect of New Pesticides on Insects of Tropical Origin Laboratoire d ’entomologie médicale, Office de la recherche scientifique et technique outre-mer (ORSTOM), Paris, France WHO Collaborating Centre for Health and Disease Surveillance Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy WHO Collaborating Centre for Immunodiagnostic and Serological Methods in Malaria Laboratoire de parasitologie et pathologie exotique, Université scientifique et médicale de Grenoble, France Target 7 WHO Collaborating Centre for Pregnancy and Perinatal Care National Perinatal Epidemiology Unit, Oxford, United Kingdom 140 Target 9 WHO Collaborating Centre for Development of Appropriate Technology in the Control of Diabetes Mellitus Institute for Diabetes, Endocrinology and Metabolic Diseases “ Vuk Vrhovac” , Medical Faculty, University of Zagreb, Yugoslavia WHO Collaborating Centre for Research and Training in Cardiovascular Diseases Laboratoire de recherches cardiologiques, Faculté de médecine et de pharmacie, Université libre de Bruxelles, Belgium WHO Collaborating Centre for Research and Training in Cardiovascular Diseases Institute of Cardiovascular Diseases of the Medical Academy, Sofia, Bulgaria WHO Collaborating Centre for Research and Training in Cardiovascular Diseases Abteilung Klinische Sozialmedizin, Klinikum der Universität Heidelberg, Federal Republic of Germany WHO Collaborating Centre for Research and Training in Cardiovascular and Other Non­ communicable Diseases Central Institute for Cardiovascular Research, Academy of Sciences of the German Demo­ cratic Republic, Berlin, German Democratic Republic Target 10 WHO Collaborating Centre for Breast Self-examination N.N. Petrov Research Institute of Oncology, Leningrad, USSR WHO Collaborating Centre for Community Cancer Care West of Scotland Cancer Surveillance Unit, Glasgow Regional Cancer Institutes, Glasgow, United Kingdom WHO Collaborating Centre for Detection Methodology and Training in Cancer Control National Institute of Oncology, Budapest, Hungary WHO Collaborating Centre for Palliative Care Sir Michael Sobell House, The Churchill Hospital, Headington, Oxford, United Kingdom WHO Collaborating Centre for Research and Training in Methods of Assessment of Quality of Life in relation to Health Care The Netherlands Cancer Institute and Department of Clinical Psychology, University of Amsterdam, Netherlands WHO Collaborating Centre for Technology Assessment in Cancer Control Zentralinstitut für Krebsforschung, Robert Rössle-Institut, Berlin-Buch, German Demo­ cratic Republic 141 Target 11 WHO Collaborating Centre for Disaster Preparedness Université catholique de Louvain, EP1D 3034, Ecole de santé publique, Brussels, Belgium WHO Collaborating Centre for Disaster Preparedness, Management and Nursing Health Services Division, Department of Cooperation for Development, Ministry of Foreign Affairs, Rome, Italy WHO Collaborating Centre for Health and Disease Surveillance Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy WHO Collaborating Centre for Injury Prevention0 NH&MRC Road Accident Research Unit, Adelaide, Australia WHO Collaborating Centre for Injury Prevention“ Public and Environmental Health Division, South Australian Health Commission, Adelaide, Australia WHO Collaborating Centre for Injury Prevention0 Consumer Safety Institute, Amsterdam, Netherlands WHO Collaborating Centre for Injury Prevention0 Division of Injury Epidemiology and Control, Center for Environmental Health, Centers for Disease Control, Atlanta, GA, USA WHO Collaborating Centre for the Prevention of Road Traffic Accidents Transport and Road Research Laboratory, Department of the Environment and Depart­ ment of Transport, Crowthorne, United Kingdom Target 13 WHO Collaborating Centre for Health Education Bundeszentrale für Gesundheitliche Aufklärung, Cologne, Federal Republic of Germany WHO Collaborating Centre for Health Education and Health Promotion Research Scottish Health Education Group, Edinburgh, United Kingdom Target 15 WHO Collaborating Centre for Health Education Deutsches Hygiene-Museum, Dresden, German Democratic Republic 0 W H O collaborating centre working with a global programme. 142 WHO Collaborating Centre for Health Education and Health Promotion Dutch Health Education Centre, Utrecht, Netherlands WHO Collaborating Centre for the Promotion of Family Health/Family Planning National Research Institute for Mother and Child, Warsaw, Poland Target 17 WHO Collaborating Centre for Health — Psychosocial and Psychobiological Factors Fonds de la recherche scientifique médicale, Brussels, Belgium Target 18 WHO Collaborating Centre for Environmental and Health Impact Assessment Centre for Environmental Management and Planning, Aberdeen University, United Kingdom WHO Collaborating Centre for Health and Disease Surveillance Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy Target 19 WHO Collaborating Centre for Environmental Radioactivity Bureau of Radiation and Medical Devices, Health Protection Branch, Health and Wel­ fare Canada, Ottawa, Canada WHO Collaborating Centre for Health and Disease Surveillance Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Rome, Italy WHO Collaborating Centre for Health Effects of Exposure to Lead Medizinisches Institut für Umwelthygiene (MIU) an der Universität Düsseldorf, Federal Republic of Germany WHO Collaborating Centre for Occupational Health Institute of Occupational Health, Helsinki, Finland WHO Collaborating Centre for Occupational Health Coronel Laboratory, University of Amsterdam, Netherlands WHO Collaborating Centre for Occupational Health Institute of Occupational Health, Lodz, Poland 143 WHO Collaborating Centre for Risk Management in Chemical Safety International Institute forScientific Cooperation (IISC), University of Ulm, Schloß Reisens- burg, Federal Republic of Germany WHO Collaborating Centre for the Training and Utilization of Environmental Health Officers Department of Public Health and Environmental Studies, Umeâ University, Sweden Target 20 WHO Collaborating Centre for Community Water Supply and Sanitation International Reference Centre for Community Water Supply and Sanitation, The Hague, Netherlands WHO Collaborating Centre for Drinking-water and Water Pollution Control Water Research Centre, Medmenham, United Kingdom WHO Collaborating Centre for Environmental Problems and Health Aspects Research Institute for Hygiene and Microbiology, Bad-Elster, German Democratic Republic WHO Collaborating Centre for Primary Health Care Department of Public Health Administration and Social Hygiene, Regional Pathology Research Institute, Ministry of Health of the Kazakh SSR, Alma-Ata, USSR WHO Collaborating Centre for Rural Sanitation and Waste Disposal Centre national du machinisme agricole, du génie rural, des eaux et des forêts (CEMAGREF), Lyon, France WHO Collaborating Centre for Surface and Groundwater Quality Burlington, Ontario, Canada WHO Collaborating Centre for Water and Sanitation Centre international de l’eau, Vandœuvre-lès-Nancy, France WHO Collaborating Centre for Water Resources Protection Research Centre for Water Resources Development, Budapest, Hungary Target 21 WHO Collaborating Centre for Air Quality Management and Air Pollution Control Institute for Water, Soil and Air Hygiene, Langen, Federal Republic of Germany WHO Collaborating Centre for Primary Health Care Department of Social Medicine, Institute of Hygiene and Public Health, Bucharest, Romania 144 Target 22 FAO/WHO Collaborating Centre for Research and Training in Food Hygiene and Zoonoses Robert von Ostertag-lnstitut, Berlin (West) Target 24 WHO Collaborating Centre for the Environmental Health Aspects of the Wellbeing of the Elderly and Disabled Institute of Hygiene and Epidemiology, Prague, Czechoslovakia Target 25 WHO Collaborating Centre for Occupational Health Institute of Occupational Health, Helsinki, Finland WHO Collaborating Centre for Occupational Health Institute of Occupational Health, Lodz, Poland Target 26 WHO Collaborating Centre for Disaster Preparedness, Management and Nursing Health Services Division, Department of Cooperation for Development, Ministry of Foreign Affairs, Rome, Italy WHO Collaborating Centre for Nursing Nursing Research Institute, Helsinki, Finland WHO Collaborating Centre for Nursing Hospices civils de Lyon, France WHO Collaborating Centre for Nursing Research and Education Danish Institute for Health and Nursing Research, Copenhagen, Denmark WHO Collaborating Centre for Primary Health Care Andrija Stampar School of Public Health, Zagreb, Yugoslavia WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia Target 27 WHO Collaborating Centre for Disaster Preparedness, Management and Nursing Health Services Division, Department of Cooperation for Development, Ministry of Foreign Affairs, Rome, Italy 145 WHO Collaborating Centre for Health Economics SAGO Research Institute for Health Service Organization, Milan and Florence, Italy WHO Collaborating Centre for Hospitals and Other Health Institutions and Primary Health Care Programmes Institute of Social Hygiene and Organization of Health Services (ISOG), Berlin, German Democratic Republic WHO Collaborating Centre for Nursing Nursing Research Institute, Helsinki, Finland WHO Collaborating Centre for Nursing Hospices civils de Lyon, France WHO Collaborating Centre for Nursing Research and Education Danish Institute for Health and Nursing Research, Copenhagen, Denmark WHO Collaborating Centre for Primary Health Care Universities of Tampere and Kuopio, Finland WHO Collaborating Centre for Primary Health Care Department of Social Medicine, Institute of Hygiene and Public Health, Bucharest, Romania WHO Collaborating Centre for Primary Health Care Department of Primary Health Care and Foreign Health Services, Institute for Regional Pathology, Alma-Ata, Kazakh SSR, USSR WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia WHO Collaborating Centre for the WHO Programme on Hospitals and Other Health Institutions German Hospital Institute, Düsseldorf, Federal Republic of Germany WHO Collaborating Centre for the WHO/EURO Programme on Hospitals and Other Health Institutions National Hospital Institute of the Netherlands, Hospital Centre, Utrecht, Netherlands Target 28 WHO Collaborating Centre for Disaster Preparedness, Management and Nursing Health Services Divison, Department of Cooperation for Development, Ministry of Foreign Affairs, Rome, Italy 146 WHO Collaborating Centre for Health of the Elderly0 Red Cross General Hospital, Pyongyang, Democratic People’s Republic of Korea WHO Collaborating Centre for Health of the Elderly0 Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan WHO Collaborating Centre for Nursing Nursing Research Institute, Helsinki, Finland WHO Collaborating Centre for Nursing Research and Education Danish Institute for Health and Nursing Research, Copenhagen, Denmark WHO Collaborating Centre for Primary Health Care Netherlands Institute of Primary Health Care (NIVEL), Utrecht, Netherlands WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia WHO Collaborating Centre for Research on Aging Institute of Gerontology of the Academy of Medical Sciences of the USSR, Kiev, USSR WHO Collaborating Centre for Research on Care of the Aged0 Brookdale Institute of Gerontology and Adult Human Development in Israel, Jerusalem, Israel Target 29 WHO Collaborating Centre for Nursing Nursing Research Institute, Helsinki, Finland WHO Collaborating Centre for Nursing Hospices civils de Lyon, France WHO Collaborating Centre for Nursing Research and Education Danish Institute for Health and Nursing Research, Copenhagen, Denmark WHO Collaborating Centre for Primary Health Care National School of Public Health, Lisbon, Portugal WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia a W H O collaborating centre working with a global programme. 147 Target 31 WHO Collaborating Centre for Disaster Preparedness, Management and Nursing Health Services Division, Department of Cooperation for Development, Ministry of Foreign Affairs, Rome, Italy WHO Collaborating Centre for Nursing Nursing Research Institute, Helsinki, Finland WHO Collaborating Centre for Nursing Hospices civils de Lyon, France WHO Collaborating Centre for Nursing Research and Education Danish Institute for Health and Nursing Research, Copenhagen, Denmark WHO Collaborating Centre for Quality Assurance National Organization for Quality Assurance in Hospitals (CBO), Utrecht, Netherlands WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia Target 32 WHO Collaborating Centre for Community Medicine Centre de médecine préventive de Vandceuvre-lès-Nancy, France WHO Collaborating Centre for Public Health Research Institut für Gesundheits-System-Forschung, Kiel, Federal Republic of Germany Target 33 WHO Collaborating Centre for Health Development and Technical Cooperation among Developing Countries Centre for Health Cooperation with Non-Aligned and Developing Countries, Zagreb, Y ugoslavia WHO Collaborating Centre for Health Policies, Planning and Education Nordic School of Public Health, Gothenburg, Sweden Target 34 WHO Collaborating Centre for Health Planning and Economics Institut für Medizinische Informatik und Systemforschung (MEDIS), Munich, Federal Republic of Germany 148 WHO Collaborating Centre for the Managerial Process for National Health Development Department of Community Medicine, Usher Institute, Edinburgh, United Kingdom WHO Collaborating Centre for the Managerial Process for National Health Development Nuffield Centre for Health Services Studies, School of Medicine, University of Leeds, United Kingdom WHO Collaborating Centre for Planning and Evaluation Ecole nationale de la santé publique, Rennes, France Target 35 WHO Collaborating Centre for Health and Biomedical Documentation Institut für Wissenschaftsinformation in der Medizin, Berlin, German Democratic Republic WHO Collaborating Centre for Health Informatics Centre interuniversitaire de traitement de l’information (CITI 2), Paris, France WHO Collaborating Centre for Health Informatics Centro Italiano Studi e Indagini (CISI), Rome, Italy WHO Collaborating Centre for Health Informatics Uppsala University Computing Centre (UDAC), Uppsala, Sweden WHO Collaborating Centre for Health Informatics Computer Information Centre of the Ministry of Health of the Latvian SSR, Riga, USSR WHO Collaborating Centre for Health Information and Documentation Istituto internazionale per gli studi e l’informazione sanitaria (ISIS), Rome, Italy WHO Collaborating Centre for Health Situation Analysis Department of Epidemiology and Health Programming, National Research Institute of Mother and Child, Warsaw, Poland Target 36 WHO Collaborating Centre for Health Management and Human Resources Central Institute for Advanced Medical Studies (CIAMS), Moscow, USSR WHO Collaborating Centre for Health Manpower Development Fondazione Smith Kline (Italia), Milan, Italy 149 WHO Collaborating Centre for Health Manpower Development British Life Assurance Trust (BLAT) Centre for Health and Medical Education, London, United Kingdom WHO Collaborating Centre for Health Manpower Information Statistics Centre de sociologie et de démographie médicales (CSDM), Paris, France WHO Collaborating Centre for Primary Health Care Nursing Public Health Nursing Service, Maribor, Yugoslavia Target 38 WHO Collaborating Centre for the Development of Research for Blood Transfusion Services Haematology and Blood Transfusion Centre, Bucharest, Romania WHO Collaborating Centre for Drug Assessment Pharmacological Committee of the All-Union Ministry of Health of the USSR, Moscow, USSR WHO Collaborating Centre for Drug Information and Quality Assurance National Institute of Pharmacy, Budapest, Hungary WHO Collaborating Centre for Drug Statistics Methodology Norwegian Medicinal Depot, Oslo, Norway WHO Collaborating Centre for Fundamental and Applied Immunology Institute of Immunology, Academy of Medical Sciences of the USSR, Moscow, USSR 150 INDEX M ain references by subject are in bold type. Abu Dhabi. 7.39 Accident prevention, 2.4, 2 .1 1 2 -2 .1 1 5 , 6.8, 7.1, 7 .2 - 7 .9 , 8.4 Acquired immunodeficiency syndrome (AIDS), 1.8, 1.15, 1.16, 1.22, 1.29, 2.3, 2.38, 2 .4 0 -2 .5 4 , 2.57, 3.5-3.7. 3.37. 3.38, 3.47, 6.33-6.35 Acute respiratory infections. 2.39, 2.70 Adolescents and voung people, 3.40, 3.54. 3.91, 3.93, 6.33 Aging, see Elderly AIDS, see Acquired immunodeficiency syndrome A ID S diagnosis and contro l: current situation. 1.46, 1.48 AIDS Hilfe, 2.45 Air pollution, 4.4, 4.7, 4.25, 4 .7 5 -4 .8 2 Albania, AIDS, 2.42 cancer, 2.111 country programme, 1.21, 8.6 diarrhoeal diseases, 2.55 environmental health, 4.50, 8.6 fellowships, 3.50, 8.6 H F A strategies, 1.18 Alcohol abuse. 2.1 14, 3.2, 3.6, 3.25, 3.36, 3 .8 8 - 3 .9 3 , 5.36, 8.5 Alzheimer's Disease International, 7.17 Andorra, 7.12 Appropriate technology for health, 6.111. 7.1, 7 .2 0 - 7 .2 7 , 7.33 see also Health technology assessment Argentina, 7.13 Association of Medical Deans in Europe, 6.5, 6.78 Association for Medical Education in Europe, 6.5, 6.78 Association of Schools of Public Health in the European Region, 1.18, 6.5, 6.79 Australia, 3.70, 7.5, 7.36, 7.38, 7.42. 7.43 Austria, AIDS, 2.49 alcohol abuse, 3.36 cancer, 2.105 drug abuse, 3.36 environmental health, 4.18, 4.34, 4.49, 6.31 epidemiology. 2.77 health manpower, 3.36 health promotion, 3.14 noncommunicable diseases, 2.86, 2.98 primary health care, 5.12, 5.35 sexuality and family planning, 3.35 social equity and health, 2.7 Bahrain, 7.15 Basic radiological system (BRS), 6.105, 7.25 Belgium, accident prevention, 7.8 AIDS, 2.48 appropriate technology, 7.20, 7.26 disaster preparedness, 2.123 environmental health, 4.20 health economics, 6.50 health manpower, 5.46 health planning, 6.43 health promotion, 3.41 quality assurance, 5.45, 5.46 Regional Committee, 1.21 151 Biologicals, 2.40 Blood transfusion and immunohaematology, 6.33 Brazil, 2.79, 7.7, 7.33, 7.37 Breastfeeding, 2.80, 3.53, 4.26 Breast-milk, 4.26 Budget and finance, 1 .3 6 -1 .3 9 Bulgaria, country programme, 1.21, 8.3 H F A strategy, 6.15, 8.3 malaria, 2.74 mental health, 2.28 noncommunicable diseases, 1.18, 2.2, 2.97, 2.99-2.101 primary health care, 5.12 sexuality and family planning, 3.51 Burma, 7.15 Burn injuries. 7.9 Canada. 2.98, 3.2, 3.8-3.11,4.32, 5.34, 7.32, 7.36 Cancer. 2.2, 2.56, 2 .1 0 2 -2 .1 1 1 , 3.34, 6.8, 6.33 Cardiovascular diseases, 2 .8 3 -2 .1 0 1 , 3.34, 6.109, 7.16, 7.24 CCCCP, see Comprehensive community cardiovascular control programmes CE. see Council of Europe CEC, see Commission of the European Communities Chemical hazards. 2.4,2.112,2.120,2.122,4.6,4.9, 4 .2 4 - 4 .2 9 , 6.29 Child abuse. 3.92 Children, accident prevention. 2.1 15. 7.7 disability. 2.20 drug abuse, 3.29 H FA strategy, 1.26 immunization, 1.27 infant feeding, 7.27 lifestyles, 3.7. 3.30 mental health, 2.27, 2.28, 2.35 nutrition, 2.81 risk factors, 2.77 toxic substances, 4.25 see also Maternal and child health China, 7.29 Chronic diseases, 1.18, 2.2, 2.22, 2.23, 3.32, 3.34, 6.8, 7.18 CINDI, see Countrywide integrated noncommunicable disease intervention program me CIOMS, see Council for International Organizations of Medical Sciences C MEA, see Council for Mutual Economic Assistance Collaborating centres, 2.38, 3.37. 3.46, 6.13. 6.42, 6.54 Collaboration with other organizations, 6 .2 6 -6 .3 9 see also under names of individual organizations Commission of the European Communities, 6.33, 6.34 alcohol abuse, 5.36 cancer, 2.108 drug abuse, 3.85, 3.87 epidemiological surveillance, 6.58 health education, 3.40, 3.41, 3.85 lifestyles, 3.7 nutrition, 3.74 research. 6.12 “Com m o n delivery vehicles”, see under Health for all by the year 2000 Communicable diseases, 2.2, 2.3, 2 .3 8 -2 .5 7 , 2.71,6.35 see also Immunization Comprehensive community cardiovascular control programmes, 2.88 Congo, 7.30 Consultative Group on Programme Development, 1.1, 1.9, 1.13-1.16, 1.32,6.55 Contingency plan, 1.6, 1.10, 1.14, 1.28 Convention on Long-range Transboundary Air Pollution, 4.19 Coronary heart disease, see Cardiovascular diseases Council for International Organizations of Medical Sciences, 6.24 Council for Mutual Economic Assistance. 6.39, 6.49 Council of Europe, 2.24. 2.38, 2.108, 2.119, 3.7, 3.40, 3.41, 3.85. 3.87. 6.32, 6.33. 6.53, 6.61, 6.91 Country programme coordination, 1.5, 1.17-1.22, 1.56' 2.10. 2.14, 2.19, 2.29, 2.30, 2.35, 8.1-8.12 Countrywide integrated noncommunicable disease intervention programme ( Cl N DI ), 1.12, 1.19, 1.23, 1.32, 2.2, 2.98-2.101, 7.24. 8.4 Cuba, 7.7 Czechoslovakia, 1.18 cardiovascular diseases, 2.96 country programme. 1.19, 1.21,2.14,2.19 disability, 2.13, 2.17, 2.20 elderly, 2.13, 2.14, 2.17 1 5 2 Czechoslovakia (contd) environmental health, 4.89 immunization, 2.71 maternal and child health, 2.82 noncommunicable diseases, 2.98 pharmaceuticals, 6.116 rehabilitation, community-based, 2.19 Data bases. 2.76, 4.6. 4.12. 4.80. 6.25. 6.54. 6.62, 6.63, 6.68. 6.75. 6.96, 6.103. 7.15 see also Information systems Demographic trends, .3.14, 7.10 Denmark, accident prevention, 7.9 alcohol abuse, 3.90 appropriate technology, 7.21 cardiovascular diseases, 2.95 environmental health, 4.57 equity in health, 2.6 health manpower, 6.79 H F A strategies, 6.18 nursing, 5.34 nutrition, 3.71 oral health, 2.61 pharmaceuticals, 6.115 primary health care. 5.10 rehabilitation, community-based, 2.17 suicide, 2.125 Diarrhoea] diseases, 2.39. 2.55. 2.70 Diphtheria. 2.69 Disability. 2.1, 2 .2 0 , 3.61,4.89. 6.27 sec also Rehabilitation, community-based Disaster preparedness, 2.4, 2.5, 2 .1 1 6 -2 .1 2 4 , 4.9, 4.10, 4.37-4.39, 6.31, 7.34 Disease prevention and control. 2.1, 3.1. 5.12, 8.4 Drug abuse. 2.51,2.53, 3.2, 3.4. 3.6. 3.7.3.26-3.28, 3.29. 3.36, 3.82-3.87, 6.8, 6.27, 6.33, 6.34 Drugs, regulation, 6.112. 6.113, 6.1 18, 6.120, 7.41-7.43 utilization, 2.82, 6.1 14. 6.121 D rugs f o r children, 1.46 Drugs f o r the elderly, 1.48 EC, sec European Community ECE. see United Nations Economic Commission lor Europe Economic and Social Commission for Asia and the Pacific. 7.3 Education, medical, see under Health manpower Egypt. 4.69, 7.15 Elderly, accident prevention, 7.8 community care, 2.12, 2.13 environmental health, 4.25. 4.89 health of, 2.2, 2.11-2.14, 6.27, 6.33, 7.1, 7.10-7.19 health promotion, 3.14 mental health, 2.33 sexuality. 3.62 social policies, 2.1 I W H O Special Programme for Research on Aging, 1.18 Emergencies, see Disaster preparedness Environmental health. 4 .1 - 4 .9 6 , 6.28, 6.34, 6.39, 6.55,6.57, 8.6 Environmental Health Series, 1.53,4.12,4.16, 4.22, 4.34. 4.35, 4.77. 4.93 Epidemiological surveillance and risk assessment, 1.22. 6.58. 6.61 Epidemiology and statistics. 1.54-1.56, 6.35, 6.37, 6.69-6.71 ' accident prevention, 2.114 elderly. 7.13, 7.18 environmental health, 1.29,4.20,4.25 health planning, 6.42 mental health, 2.24, 2.25 morbidity and mortality, 6.59 nutrition. 3.72, 3.74 rheumatism, 2.22 Equity in health. 2.1. 6.33 ERICA, see European risk factors and incidence — a collaborative analysis Ethics, 2.21, 2.46, 2.47, 3.2, 6.2, 6.9, 6.22-6.24, 6.35.6.52,6.53 Ethiopia, 7.34 European Advisory Committee on Health Research. 3.84. 6.7-6.9 European Child Psychiatrists' Research Group. 2.27 European Committee for Clinical Laboratory Standards. 7.24 European Community, 3.7, 4.69, 6.35. 6.101 European hypertension research action programme (HYRAP). 2.89 European League Against Rheumatism (EULAR). 2.22, 2.23 European Medical Research Councils, 2.26, 6.12 European Organization for Cooperation in Cancer Prevention Studies, 2.109 European risk factors and incidence — a collaborative analysis, 2.77, 2.86 153 European Road Safety Year. 7.3 European Society of Child and Adolescent Psychiatry, 2.28 Executive Board, 1.1, 1.9, 1.30 Expanded Programme on Immunization (EPI), 2.39, 2.70 Family planning, see Sexuality and family planning FAO, see Food and Agriculture Organization of the United Nations Fellowships, 3.50, 3.53, 4.67, 6 .8 8 -6 .9 3 , 7.19, 7.39, 7.40, 8.1, 8.6 Finland, cardiovascular diseases, 2.85 child health, 3.30 country programme, 1.21 health manpower, 5.46 health technology, 6.110 H F A strategy, 6.15, 6.16 noncommunicable diseases, 2.98 nursing, 5.26 oral health, 2.60 primary health care. 5.13 quality assurance, 5.38, 5.45, 5.46 sexuality and family planning. 3.63 Fluoridation, water, see under Oral health Food and Agriculture Organization of the United Nations, 4.69, 4.71, 4.72, 6.30 Foodborne diseases, 4.84 Food safety, 1.29, 4.11.4.52, 4 .8 3 - 4 .8 6 , 6.28, 6.33 Food safe ly services, 4.83 France, AIDS, 2.48 alcohol abuse, 3.90 appropriate technology for health, 7.26 country programme, 1.21 health manpower, 6.75, 6.80, 6.82 health planning and management, 6.41 health technology, 6.99 Healthy Cities, 1.18,4.90 H F A strategies, 1.18, 6.18 informatics support, 6.73 maternal and child health, 2.79 nursing. 5.25 primary health care. 5.13 Regional Committee, 1.18 research, 6.14 sexuality and family planning, 3.48 suicide, 3.125 France (contd) tobacco, 3.79 water supply and sanitation, 4.5 Funds-in-Trust, 1.39 and Table 1 Genetics services, 2.21, 6.109 German Democratic Republic, cancer, 2.104.2.110 cardiovascular diseases. 2.83 country programme. 1.20, 1.21, 2.19 environmental health, 4.13 health legislation, 6.25 health promotion, 3.15, 3.42 H F A strategies, 1.18, 6.7, 6.15 informatics support, 6.66 noncommunicable diseases, 2.98 rehabilitation, community-based, 2.19 Germany, Federal Republic of, AIDS, 2.40. 2.47, 2.48, 3.37, 3.38 appropriate technology for health, 7.26 cancer, 3.34 cardiovascular diseases, 2.91, 3.34 chronic diseases, 3.34 elderly, 3.62 environmental health, 4.25, 4.35, 4.58, 4.75, 4.91 epidemiology and statistics, 6.59 health economics, 6.44 health planning and management. 6.40 health promotion, 3.34, 3.37, 5.39 health services, 5.21, 5.23 Healthy Cities, 1.18 pharmaceuticals. 6.113 primary health care, 5.13, 5.39 publications, 2.7 quality assurance, 5.45 sexuality and family planning, 3.35, 3.62 suicide, 2.125 Gerontology, see Elderly Global Environmental Monitoring System (GEMS), 4.75 Global Programme Committee, 1.44 Greece, AIDS, 2.42 child health, 2.9 country programme. 1.21, 2.9, 2.30, 3.85, 8.6 diarrhoeal diseases, 2.55 disaster preparedness, 2.118 drug abuse, 3.85 elderly, 2.13 environmental health. 4.69, 4.71, 8.6 health legislation, 2.30 154 Ci recce (contd) malaria. 2.74 nutrition, 3.74 rheumatism, 2.23 social equity and health, 2.9 Haemoglobinopathies, 2.21 H aving a baby in Europe, 2.79 H ealth crisis 21100, 1.52 1 lealth economics, 5 .1 8 , 5.21. 5.24, 6.3, 6.8, 6.44-6.51. 7.22 Health education, 3 .1 , 3.4-3.6. 3.31, 3 .3 6 -3 .4 6 . 6.S. 6.33, 6.34 accident prevention. 2.1 12 AIDS. 2.40, 2.41, 2.45, 2.49, 2.55 cancer. 2.108 children. 3.30 disaster preparedness, 2.1 IX rheumatism. 2.22, 2.23 sexuality and tamil} planning, 3.55 Health lor all by the year 2000, passim advocacy, 3.10, 3.11 “common delivery vehicles”. 1.12,3.3, 3.18,8.2 data base, 1.55, 2.76, 6.54, 6.63 environmental health, 4.15, 6.55 ethics, 6.2 fellowships, 6.88 health legislation, 6.2 health promotion, 6.55 information of the public. 1.16, 1.23-1.27 manpower, 1.8, 1.13,6.79-6.81 medical associations, 1.22 monitoring and evaluation of progress, 1.13, 1.54-1.56, 4.15, 5.28, 6.4, 6.54-6.57, 6.63 policies and strategies, 1.17, 1.18,3.2,3.9,3.18, 5.1, 6.1,6.7,6.15-6.19,6.26,6.38,6.40.6.77, 6.78, 6.85. 6.88, 8.2, 8.3 research, 1.13 universities, 6.11 H ea lth hazards of organized violence, 2.6 Health information of the public, 1.16, 1.23-1.27, 2.40, 2.110. 3.76 Health legislation. 2 .1 5 , 5 .1 7 , 6.2, 6.20 accident prevention, 2.1 14 AIDS, 2.40, 2.46. 2.47 disability. 2.15 elderly. 2.33, 6.21 food safety. 4.83. 4.84 11 FA indicators. 6.56 mental health. 2.30, 2.33 organ transplantation. 6.53 Health legislation (contd) pharmaceuticals, 7.41 social equity and health, 2.15 tobacco, 3.78 Health manpower, 1.32. 3.4. 6 .7 5 -6 .8 7 , 7.39. 7.40. 8.8 accident prevention, 7.5 alcohol abuse, 5.36 cancer, 2.110 disaster preparedness, 2.120, 2.123 drug abuse, 2.52, 3.36 environmental health, 4.14, 4.20, 4.21. 4.23 health economics, 6.45, 6.47 health planning and management, 6.46 health promotion. 3.9, 3.41, 3.43-3.46 malaria, 2.74 medical education. 2.23, 2.26, 5.41. 6.5 oral health. 2.61 pharmacotherapy, 6.122 primary health care. 5.17 qualin assurance. 5.38. 5.46 research, 3.9. 5.17 sexualitv and lamilv planninu. 3.48. 3.52. 3.54. 3.56, 3.57 tobacco, 3.79 H ealth manpower: planning, production and management. 6.76 Health planning and management. 3.7. 6.40-6.43, 6.46. 6.47. 6Л>7, 8.4 Health policies and strategies, 1.12, 1. 17. 2.34, 3.1, 3.2, 3 .8 -3 .2 8 . 3.30, 3.34. 3.67-3.71, 3.74. 3.76, 3.78. 3.84, 3.88, 4.1. 4.2, 6.3, 6 .1 5 -6 .2 5 , 6.27, 6.56, 7.6. 7.10, 7.1 1. 7.15. 7.21 Health promotion, 1.35, 2.2, 3.1-3.5. 3 .8 -3 .2 4 , 3.31. 3.36-3.46, 7.36 accident prevention, 2.1 12. 2.1 15, 7.3 alcohol abuse, 2.112, 3.2, 3.88, 5.36 children. 3.30 chronic disease, 3.34 drug abuse. 3.2. 3.4 elderly. 3.14 health manpower. 3.41. 3.43-3.45 hospitals, 5.12 indicators. 3.21. 3.80, 3.81, 6.55 information transfer, 6.61 noncommunicable diseases, 2.92 nutrition, 3.2, 3.4 oral health. 2.59 publications, 6.60 rehabilitation, community-based. 2.16 research. 3.20-3.24. 3.45. 3.80. 6.10 self-help, 3.33 1 5 5 Health promotion (contd) tobacco. 3.2, 3.4 training, 3.9, 3.20 Health services, delivery, 4.83, 5.1, 5.2. 5.4, 5 .1 9 -5 .2 4 development, 2.26. 2.36 planning, 2.58, 2.61 research, 6.14 see also Hospitals and other health institutions and Nursing/midwifery Health systems, 1.12 Health technology assessment, 2.106, 2.110, 6 .9 4 -6 .1 1 1 sec also Appropriate technology for health Healthv Cities, 1.12, 1.18, 1.19, 1.23, 1.32,3.1.3.3, 3.18, 3.19, 3.85. 4.3. 4.64. 4.90. 4.91, 8.5 H e p a tit is , 2 .5 6 -2 .5 7 Holy See, 6.9 Hospitals and other health institutions, 5.3, 5.4, 5 .1 2 -5 .1 6 , 5 .1 9 - 5 .2 4 , 7.35 Housing, 2.17, 4 .8 9 - 4 .9 3 , 6.27, 7.8 Hungary, appropriate technology for health, 7.26 cancer, 2.102-2.104, 2.110, 2.111 child health, 3.30 country programme, 1.19, 1.21, 2.19, 8.3 environmental health, 4.45, 4.53, 4.59, 4.60, 4.88 epidemiology and statistics, 6.71 health manpower. 6.86 health promotion, 3.15 H F A strategies, 1.18. 6.7, 6.15 mortality trends. 2.78 nursing/midwifery, 5.28, 5.40 nutrition, 3.71, 3.73 pharmaceuticals, 6.120 rehabilitation, community-based, 2.19 sexuality and family planning, 3.52', 3.64 use of W H O ’s resources, 1.4 Hypertension, see Cardiovascular diseases HYRAP, see European hypertension research action programme 1A L A , see International Atomic Energy Agency IARC, see International Agency for Research on Cancer Iceland, accident prevention, 2.114 AIDS. 2.42 alcohol abuse, 3.90 appropriate technology for health, 7.26 cancer, 2.104 Iceland (contd) country programme, 1.21 elderly, 7.15 health policy. 7.15 H FA strategies, 6.15 mental health, 2.25 Images o f nursing in Europe, 5.32 Immunization, 1.27, 2.56, 2 .6 9 -2 .7 3 India, 7.9 Indonesia, 7.5, 7.15 Inequities, see Social equity and health Infectious diseases, see Communicable diseases Informatics support, 1.29, 6.65, 6.66, 6.73, 6.74 Information systems, 1.5, 6.67, 6.68, 8.8 accident prevention, 7.3 AIDS. 2.43 cancer, 2.108. 2.11 1 chronic disease. 3.34 disaster preparedness, 2.123, 4.38 drug abuse, 3.84 health economics, 5.18 health services, 5.23 immunization, 2.73 mental health, 2.31. 2.35, 2.36 oral health. 2.58 pharmaceuticals, 6.123 tobacco, 3.76 Integrated management information system (IMIS), 1.5 Intergovernmental Oceanographic Commission, 4.71, 6.30 Intergovernmental organizations, 1.7,2.16,4.55, 6.Ï3. 6.17, 6.26 International Agency for Research on Cancer, 2.108, 4.34, 4.38 International Atomic Energy Agency, 6.30, 6.31 International Association of Gerontology, 2.13, 7.12 International Centre for Social Gerontology, 7.8 International Children's Centre, 3.47 International Council on Alcohol and Addictions, 5.36 International Council for Building Research, 2.13 International Diabetes Federation, 2.94 International Drinking Water Supply and Sanitation Decade, 4.5, 4.40, 4.53-4.56, 4.58-4.60, 4.63, 4.64 see also Water supply and sanitation 156 International Epidemiological Association, 2.94, 7.12 International Federation of Associations of Older Persons, 7.17 International Federation of Library Associations and Institutions, 6.61 International Federation of Medical Students' Associations, 6.84, 6.92 International Hospital Federation, 7.35 International Physicians for the Prevention of Nuclear War. 1.18 International Plan of Action on Aging, 6.27, 7.14 International Programme on Chemical Safety, 4.9, 4.25 International Society for Quality Assurance in Health Care, 5.47, 7.35 International Union Against Cancer, 2.108 International Union for Health Education, 3.31 International Working Group for Medical Device Testing, 6.101 International Year of Shelter for the Homeless, 6.27 Ireland, health promotion. 3.15 H F A strategies, 1.18, 6.15 oral health, 2.59 social equity and health, 2.7 Israel, appropriate technology for health, 7.21 country programme, 1.21, 2.10, 8.3 health economics, 6.47 health information, 6.68 health planning and management, 6.47 H F A strategies, 1.18, 6.15 maternal and child health, 2.79 oral health, 2.62 primary health care, 5.13 social equity and health. 2.10 Italy. AIDS, 2.48 appropriate technology lor health. 7.20 cardiovascular diseases, 2.89, 2.91 country programme, 1.20, 2.10 diarrhoeal diseases, 2.55 disaster preparedness. 2.122. 2.124, 7.34 environmental health, 4.20, 4.26, 4.27, 4.44, 4.60, 4.77 health manpower, 3.43 health promotion, 3.43 health services, 5.24 health technology, 6.101 informatics support, 6.65 Italy (contd) maternal and child health, 2.79 primary health care, 5.13 quality assurance, 5.45 sexuality and family planning, 3.64 social equity and health, 2.10 suicide, 2.125 Japan. 5.25, 7.9, 7.19 Joint Commission for the Accreditation of Hospitals, 7.35 Jordan, 7.15 Kenya. 7.4, 7.5. 7.17 Kidney disease. 2.90 League of Red Cross and Red Crescent Societies, 2.45 Legionellosis, 2.38 Life expectancy, 2.1. 2.76 Lifestyles, 2.2. 2.114, 3.1-3.7, 3.9, 3.18, 3.21, 3.23, 3.29, 3.39, 3.42, 3.80. 4.96, 7.16, 8.5 Luxembourg, 3.41 Lyme disease, 2.38 Malaria. 2 .7 4 -2 .7 5 Malta, country programme. 1.21. 2.10, 8.8 health economics. 6.48 health information, 6.67 health planning and management, 6.41 H F A strategies. 6.15 oral health, 2.66 social equity and health, 2.10 M anua l on urban a ir q u a lity management, 4.76 Maternal and child health. 2.2, 2.9,2.41,2.48,2.69. 2.79, 4.26, 6.116, 7.32, 7.33, 8.4 see also Children and Sexuality and family planning Mauritius, 7.15 Measles. 2.69. 2.71 Medical associations, 1.22, 2.45 Medical technology, see Health technology assessment Mediterranean Action Plan, 4.66-4.74 Mental health. 2.2, 2 .2 4 -2 .3 7 , 2.117, 3.47, 7.16, 7.18, 7.30, 7.31, 8.4 Mexico, 7.15 Midwives, see Nursing/midwifery 157 Migrants, 3.4, 3.49 M ig ra tio n and health: towards an understanding o f the health care needs o f ethnic m inorities, 2.6 Model health care and quality assurance, 5.4,5.37, 5.38, 5.43-5.47, 7.35 M O N I C A optional psychosocial substudy (MOPSY), 2.83, 2.84 Monitoring trends in cardiovascular diseases (MONICA), 2.43-2.85, 2.100, 7.24 Morocco, 1.31, 4.61 Mortality, child, 2.77 differentials, 2.78 risk factors, 2.86 trends, 2.1, 2.76 Mumps, 2.69, 2.71 Nepal, 7.9 Netherlands, AIDS. 2.49 appropriate technology for health, 7.21, 7.26 cancer, 2.104 cardiovascular diseases, 2.94 environmental health, 4.21,4.81, 4.87 ethics, 6.24 health economics, 6.50 health education, 3.31 health planning, 6.97 health policy, 6.24 health promotion, 3.15, 3.41 health technology, 6.97, 6.100, 6.109 H F A strategies, 6.15 maternal and child health, 2.80 mental health, 2.27, 2.31 pharmaceuticals, 6.115 primary health care, 5.6, 5.13, 5.16, 5.43 suicide, 2.125 Neurological disorders, 2.32 Newsletters, 1.53, 2.98, 3.16, 3.33, 3.66, 5.9, 5.11, 6.119, 7.22 Nigeria, 7.9 Noncommunicable diseases, 1.12, 1.18,2.2,2.86, 2.90, 2.92, 2.97-2.101 Nongovernmental organizations, 1.7, 2.18, 2.38, 2.45, 2.79, 2.121, 3.76, 3.93, 6.26, 7.17 N onioniz ing rad ia tio n pro tection, 4.31 Nordic Council, 2.38, 2.108, 3.70, 6.38 Norway, 1.18 AIDS. 2.47 country programme, 1.21 disaster preparedness, 2.117 Norway (contd) environmental health, 4.62 H F A strategies, 1.18, 6.15 nutrition, 3.70, 3.73 pharmaceuticals, 6.114 primary health care, 5.12 quality assurance, 5.45 suicide, 2.125 Nuclear accidents, 1.16,4.33-4.39 Nuclear energy, see Radiation N uclear power: accidenta l releases — p ra c tic a l guidance f o r p u b lic health action, 1.45, 4.37 N ursing care — sum m ary o f a European study, 1.46 Nursing/midwifery, 5.5, 5 .1 1 , 5 .2 5 -5 .3 2 , 8.7 disaster preparedness, 2.124, 7.34 education, 5.44 health services, 5.22 quality assurance, 5.43, 5.44 Nutrition, 2.81, 3.2, 3 .6 7 - 3 .7 4 , 6.117, 7.16 Obesity, 3.72 Obstetrics, 2.79 Occupational health, 1.29, 1.35,4.6,4.11,4.32, 4 .9 4 - 4 .9 6 , 5.27, 7.38 OECD, see Organisation for Economic Co-operation and Development Oral health, 2.2, 2 .5 8 - 2 .6 8 , 7.28, 7.29, 8.4 financing, 2.60 information systems, 2.58 publications, 2.60 self-care, 2.60 services, 2.58 water fluoridation, 2.60, 2.68, 4.50 Oral rehydration therapy, 2.55 Organ transplantation. 6.33, 6.35, 6.53 Organisation for Economic Co-operation and Development, 6.36, 6.37 Organization of European Cancer Institutes, 2.108 Pakistan, 7.15, 7.41 People’s needs f o r nursing care, 1.46, 5.33 Personnel, 1.6, 1.28-1.31 Pertussis, 2.69 Pharmaceuticals, 6.6, 6.33, 6 .1 1 2 -6 .1 2 4 , 7.41-7.43 Pneumonia and pneumococcal infection, 2.39 Poland, breastfeeding, 3.53 cancer, 2.104, 2.111 cardiovascular diseases, 2.93 158 Poland (contd) country programme, 1.20, 1.21 environmental health, 4.16, 4.51 fellowships, 3.53 nutrition. 3.70. 3.72 oral health, 2.62 sexuality and family planning. 3.47, 3.63 Poliomyelitis, 2.69, 2.72 Portugal, alcohol abuse, 3.90, 8.5 appropriate technology for health, 7.26 country programme, 2.10, 2.14, 2.19, 2.35, 6.51, 8.5 elderly, 2.14, 7.12 environmental health, 4.58, 4.63, 4.92 health economics, 6.51 health manpower, 3.56 health planning and management, 6.41 logistics support. 6.72 maternal and child health, 3.56 mental health, 2.35 noncommunicable diseases, 2.90, 2.98, 2.101 nursing, 5.27, 5.28 oral health, 2.62 primary health care. 5.7 quality assurance. 5.37, 5.45 rehabilitation, community-based, 2.19 sexuality and family planning, 3.47, 3.54-3.56, 3.66 social equity and health, 2.8, 2.10 Primary health care, 2.23,2.114, 2.1 16, 2.124,3.27, 4.14, 5 .1 - 5 .4 7 . 6.41. 6.84-6.86. 7.2. 7.4. 7.12. 7.15, 7.20, 7.34, 7.35, 8.7 Programme budget, 1.2, 1.5, 1.10-1.12, 1. 17. 8.1 extrabudgetary funds. 1.15, 1.38, 1.39 Programme management and development, 1.1-1.16 Programme of Work. Eighth General, 1.6, 1.10, 7.1, 7.2, 7.6 Programme planning and evaluation, 1.2, 1.3, 1.5 Psychiatry, forensic, 2.37 Publications, 1 .4 4 -1 .5 3 . 2.6, 2.7, 2.36. 2.60. 2.79, 2.88, 3.31, 3.68-3.70, 4.7, 4.12, 4.19, 4.31,4.37, 4.76, 4.81, 4.83, 4.86, 5.32, 5.33, 6.60. 6.76 Quality assurance, sec Model health care and quality assurance Radiation, ionizing, 4 .3 3 - 4 .3 9 . 6.37 nonionizing, 4 .3 1 -4 .3 2 Refugees, 2.6 Regional Health Development Advisory Council, 1.13 Regional Programme Committee, 7.1 Rehabilitation International. 2.15 Rehabilitation, community-based, 2 .1 6 -2 .1 9 , 6.33 see also Disability Republic of Korea, 7.19 Research, 1.13, 1.39, 3.80-3.81 accident prevention, 7.7. 7.8 child health, 3.30 drug abuse, 3.84 environmental health, 4.13, 4.68 health education, 6.83 H FA, 6.7, 8.3 health legislation, 5.17 health promotion, 3.9. 3.20-3.24. 3.80 health services. 6.14 health technology. 6.96 lifestyles, 3.80 mental health. 2.24 primary health care, 5.10 self-help, 3.32 sexuality and family planning, 3.51 suicide. 2.125 Rheumatism, 2 .2 2 -2 .2 3 Romania, 5.12 Rubella. 2.69, 2.71 San Marino, country programme coordination. 1.19 disaster preparedness. 2.119 H FA strategies, 6.7 oral health. 2.64 Self-help. 3.32. 3.33. 3.37. 5.34 Sexually transmitted diseases. 3.47 see also Acquired immunodeficiency syndrome Sexuality and familv planning. 2.46. 2.48-2.50. 3.5. 3.6, 3.35. 3 .4 7 -3 .6 6 . 8?5 Singapore, 7.13 Smoking, see Tobacco Social equity and health. 2.7-2.10, 8.4 Spain, alcohol abuse, 3.90 appropriate technology for health. 7.20 country programme. 1.19, 1.21, 3.85,6.104. 8.3, 8.6 drug abuse. 3.26, 3.27, 3.85 elderly. 7.12 environmental health. 4.14, 4.20, 4.64, 4.91, 8.6 health manpower, 6.85, 6.86 159 Spain (contd) health promotion, 3.41 health policy, 3.26, 3.27 health technology, 6.104 Healthy Cities, 4.91 H F A strategies, 1.12, 6.7. 6.15, 6.IX. 6.85 oral health, 2.63 primary health care, 3.27, 5.12. 5.13, 5.42, 6.85 quality assurance, 5.45 sexuality and family planning. 3.35. 3.60, 3.66 Staff development and training. 1.40-1.43 Suicide, 2.125 Sweden, accident prevention, 2.115, 7.4, 7.5, 7.8 AIDS, 2.49, 2.51 country programme, 1.21 disability, 2.18 elderly, 2.13 environmental health, 4.20 health manpower, 1.18. 6.79, 6.86 health promotion, 3.46 health technology, 6.96, 6.98, 6.101, 6.103, 6.107,6.108 immunization. 2.70 informatics support, 6.74. 6.108 intersectoral cooperation, 6.93 mental health, 2.26 primary health care, 5.13 quality assurance, 6.107 sexuality and family planning, 3.35 suicide, 2.125 Switzerland. AIDS, 2.50 appropriate technology for health, 7.22, 7.24 environmental health. 4.19 H F A strategies, 1.18, 6.18 Tanzania, 7.31 Targets f o r health f o r a ll, 1.52 Television, 1.52, 3.64, 7.20 Tetanus, 2.69 Thailand, 7.2, 7.4, 7.5, 7.15, 7.28 Tobacco, 1.8, 1.13, 1.22, 1.35,3.1,3.2,3.4,3.7, 3.42. 3 .7 5 - 3 .7 9 , 6.34, 6.62 feature article, between pages 54 and 55 Toxic substances, see Chemical hazards Tuberculosis, 2.69 Tunisia, 7.15 Turkey, cancer, 2.104, 2.111 country programme, 1.20, 2.29, 5.29, 8.5 diarrhoeal diseases, 2.55 Turkey (contd) health manpower, 6.84 malaria, 2.74 mental health. 2.29, 7.31 nursing, 5.28. 5.29 primary health care. 6.84 sexuality and family planning. 3.57. 3.66, 8.5 UN. see United Nations UNDP, see United Nations Development Programme U N D R O . see United Nations Disaster Relief Office Unemployment, socia l vu lnerab ility and health in Europe, 2.7 Unemployment and social work, 2.7 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 Union of Soviet Socialist Republics, acute respiratory infections, 2.39. 2.70 cancer, 2.104 collaborating centres, 6.13 country programme, 1.21 diarrhoeal diseases, 2.39, 2.55, 2.70 environmental health, 4.88 epidemiology and statistics, 6.69, 6.70 genetics services, 2.21 health economics. 6.49 health information, 6.69. 6.70 health manpower, 6.81, 6.86, 6.87 health policy, 1.18 health promotion, 3.15 H F A strategies. 6.7 immunization, 2.39, 2.70, 2.73 information systems. 2.73 oral heath, 2.68 primary health care, 5.12, 5.13 United Kingdom, appropriate technology for health. 7.21. 7.22, 7.26 cancer, 2.107, 2.110 disability, 3.61 elderly, 2.13, 7.13 environmental health, 4.16, 4.17, 4.30, 4.42, 4.53 health economics, 6.46 health education, 3.39 160 United Kingdom (contd) health manpower, 6.79, 6.81, 6.82 health planning and management, 6.41, 6.42, 6.46 health promotion, 2.92, 3.13, 3.23, 3.41 Healthy Cities, 1.19 H F A strategies, 6.18 maternal and child health, 2.79 mental health, 2.33 noncommunicable diseases, 2.98 oral health, 2.59 primary health care, 5.12, 5.43 publications, 2.6 quality assurance, 5.37, 5.43, 5.45 Regional Committee, 1.18 rehabilitation, community-based, 2.17 sexuality and family planning, 3.35, 3.61 United Nations, 1.38, 1.41,2.121,3.93,4.29,6.27, 6.29, 6.30, 6.91, 7.14 United Nations Children’s Fund, 2.55 United Nations Decade of Disabled Persons, 2.16, 2.18, 6.27 United Nations Development Programme, 1.31, 2.93, 2.111, 4.18, 4.29, 4.49-4.52, 4.61, 4.84, 4.92, 6.28, 6.29 United Nations Disaster Relief Office, 4.55 United Nations Economic Commission for Europe. 2.38, 4.16, 6.102, 6.106 United Nations Educational. Scientific and Cultural Organization, 6.30 United Nations Environment Programme, 4.69-4.73, 4.75, 6.30 United Nations Fund for Population Activities, 2.78, 3.56, 3.58 United Nations Relief and Works Agency, 7.15 United States of America, accident prevention, 7.9 appropriate technology for health, 7.22 elderly, 7.18 environmental health, 4.88 immunization, 2.70 maternal and child health, 2.79, 7.32 W H O Special Programme for Research on Aging, 1.18 Vaccination ce rtifica te requirem ents and health advice f o r in te rna tiona l travel, 1.47 Vaccines, 6.109 Venezuela, 7.4, 7.7 Viet Nam, 7.19 Violence, 2.6, 3.91, 3.92 Visual display terminals, 4.30 Voluntary contributions, 1.39 and Table 1 Voluntary Fund for Health Promotion. 1.39 Wastes disposal, 4.4, 4.77, 4 .8 7 - 4 .8 8 , 7.37 Water supply and sanitation, 4.5, 4.8, 4.27, 4 .4 0 -4 .6 5 , 6.57, 8.7 see also International Drinking Water Supply and Sanitation Decade Welding fumes, 4.25 W H O headquarters, 1.2, 1.41, 1.49, 6.4 Advisory Committee on Health Research, 7.18 AIDS, 1.29, 2.54 appropriate technology for health, 7.20 data bases, 6.54, 6.62 diarrhoeal diseases. 2.55 disaster preparedness, 2.120, 7.34 electronic mail, 6.64 environmental health, 4.43. 4.55, 4.58 Global Programme Committee, 1.44 health manpower, 6.84, 6.87 H F A indicators. 6.55 informatics support, 6.65 mental health, 2.31 noncommunicable diseases, 2.101 pharmaceuticals. 7.41 Programme Committee. 7.1 W H O Regional Committee for Europe, 1.1, 1.2. 1.3. 1.8, 1.9, 1.11, 1.18, 1.21, 1.55, 2.42, 3.75, 3.77,4.10,4.33,4.34.6.4,6.5,6.7,6.57.6.77,8.1 W H O Regional Office for Africa, 7.40 W H O Regional Office for the Americas. 2.121, 7.7, 7.33 W H O Regional Office for the Eastern Mediterranean, 1.31.6.64 W H O Regional Office for South-East Asia, 7.40 W H O Regional Office for the Western Pacific. 6.64. 7.40 W H O ’s Fortieth Anniversary. 1.16, 1.18, 1.26 W H O ’s resources. 1.4, 1.13 WHO-sponsored courses, see Fellowships World Bank. 4.18, 4.55. 7.3 World Confederation for Physical Therapy. 7.16 World Conference on Surgical Efficiency and Economy, 6.107 W o rld d ire c to ry o f denta l schools, 1963. 2.60 World Federation for Medical Education, 6.78 World Health Assembly. 1.1. 1.6, 1.8, 1.36 161 World Health Day, 1.27, 2.71 World Hypertension League, 2.89 World Meteorological Organization, 4.38, 6.30 World Organization of National Colleges, Academies and Academic Associations of General Practitioners (WONCA), 6.84 World Psychiatric Association, 2.25 Youth, see Adolescents and young people and Children Yugoslavia, accident prevention, 2.112, 2.113 AIDS, 2.48 country programme, 1.20, 2.10, 2.14, 2.19, 8.6 diarrhoeal diseases, 2.55 Yugoslavia (contd) disability, 2.18 elderly, 2.14 environmental health, 4.18, 4.52, 8.6 health manpower, 5.41 H F A strategies, 6.7 malaria, 2.74 nursing, 5.26 oral health, 2.62 primary health care, 5.12 quality assurance, 5.37, 5.45 rehabilitation, community-based, 2.19 research, 6.14 social equity and health, 2.10 Zimbabwe, 7.15 1 6 2