The environmental health officer in an industrial society: report on a WHO consultation, Copenhagen, 20–23 November 1979

lailzfir0t I, OE TASAXIT ts and Studies OF INFORMATION ,IV,lENTATiOI"J Report on a WHO Consultation ^ r - -t rnnu\-rL. trLln\_., trno aa r6,r J-UOZ+ @-g4J ,r, EU fif[*f tsoEFERENOECOtr' ltuitoltlnental Health 0f f icer in alr lndustilal Society REGIONAL OFFICE FOR EUBOPE World Health Organization COPENHAGEN "4.i1 ir;,i fi: .1 , t t.i @ lt EURO Reports and Studies 29 The Envirolrlnental }lealth 0f f icer in alr Industria! Society Report on a WHO Consultation Copenhagen 20-23 Nowmber 1979 REGIONAL OFFICE FOR EUROPE World Health Organization COPENHAGEN r980 @ ISBN 92 9020 168 I @ World Health Organization 1980 Publications of the World Health Organization enjoy copyright pro- tection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation, in part or in toto, of publications issued by the WHO Regional Office for Europe application should be made to the Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen @, Denmark. The Regional Office welcomes such applications. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not men- tioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The views expressed in this publication are those of the participants in the Consultation and do not necessarily represent the decisions or the stated policy of the World Health Organization. PRINTED IN DENMARX Reissued under ISBN: 9789289024839 (print) in 2025. Originally published under ISBN-10: 9290201681. ISSN 0250-8710 (print) CONTENTS l. Introduction 2. The role ofthe environmental health olficer 3. Environmentd hedth systems in different countries Page I 3 5 France . German Democratic Repub[c Federal Republic of Germeny Hungary Nethcrlands Poland . Sweden UnitedKingdom..... USSR . Yugoslavia 4. Training and educatbn . . . 5. Further training and continuirg education . . 6. Employmentopportunitkg 7. Relationships with other professionals 8. Conclusions 9. Recomrnendations Annex I Training ofenvironmental health officen (or their equivalents) in nine @untri€s of the European Region . Annex II Liaircn betwcen the environmental health oflicer and other profes- sionds in specific aaMties Annex III List of participants 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 5 6 6 7 8 E 9 9 l0 l0 ll l5 l5 t7 l8 l9 2l 28 30 WHO CONSULTATION ON THE EI{VIRONMENTAL HEALTH OFFICER IN AN INDUSTRIAL SOCIETY Copenhagen, 20-23 November 1979 1. INTRODUCTION A Consultation on the Role, Functions and Training Require- ments of Environmental Health Officers (Sanitarians) in Europe,' held in December 1977, stressed the importance of developing a specialist category of personnel, to be termed "environmental health officers", who would carry out the well established duties of sanitarians/sanitary inspectors, including inspection of housing and food hygiene. However, in industrialized countries, such as most of the Member States of the WHO European Region, many new and complex problems are being encountered which logically could be dealt with by the same type of personnel, provided that adequate training and an appropriate career structure are devel- oped. Such problems include the environmental health aspects of air and water pollution, the disposal of wastes and the chemical contamination of food. This work calls for familiarity with indus- trial and agricultural processes involving a considerable degree of technical competence. The promotion of environmental health is essentially a multi- disciplinary task, but the need has been felt in many Member States for a particular type of professional officer who would be trained to deal specilically with the various environmental factors affecting human health. Consequently, a study on professional profiles has been included as a priority item in the medium-term programme of environmental health of the WHO Regional Office for Europe. a See: WHO Regionel Office for Enrcga Role, functions and training requirements of environmental health officen (sanitarians) in Europe: report on a consultation. Copenhagen, 1978 (ICP/BSM 004). I The purpose of this follow-up Consultation, held in Copen- hagen from 20 to 23 November 1979, was to establish a profes- sional pro{ile for the environmental health officer in an industrial society. The meeting was attended by l0 temporary advisers, 3 ob- servers, 7 staff members of the WHO Regional Office for Europe and I from WHO headquarters. Opening the meeting, Dr M. Postiglione, Director, Disease Prevention and Control, WHO Regional Office for Europe, on behalf of the Regional Director, Dr Leo A. Kaprio, empha- sized the need to meet changes in the environment by ensuring that properly trained personnel were available to deal with situations as they arose. While it was hoped that the discus- sions would lead to the definition of the profile of a profes- sional able to cope with environmental situations causing con- cern, it had also to be borne in mind that the role of such a professional also encompassed the protection and promo- tion of health. Mr J.l. Waddington, Director, Promotion of Environmental Health, referred to the needs of industrial societies in which economies were based on industrial and commercial processes. The noncommunicable diseases had grown in importance as compared with communicable diseases, which had been the chief scourges in the past. These developments had created a need for trained manpower, legislation and an effective ad- ministrative structure, but these did not exist to a satisfactory degree in all countries. Food hygiene, the complex problems of chemical safety, occupational health, the long-term effects of air pollution and the relationships between life*tyles and environmental problems were examples of the problems to be faced. In some countries where legislation did exist there was evidence of inadequate enforcement. In spite of legislation, political motivation, technology and financial resources, the problems would not be dealt with properly unless personnel with the necessary skills were available for surveillance, moni- toring and management. Dr K. Grzybowski was elected Chairman and Mr R.D. Brogden Vice-Chairman;Mr K.J. Tyler acted as Rapporteur. The list of participants is given in Annex III. 2 2. THE ROLE OF THE EI{VIRONMENTAL HEALTH OFFICER As new industries develop, existing industries expand and new technology is introduced, the envilonment is increasingly placed at risk and hazards to human health arise. History has shown that industrial innovation is rarely matched in speed with. corres- ponding protection of the community and its environment. It may be the case that in some countries legislation has been enacted applying certain minimum standards for environmental health without ensuring the personnel to enforce it effectively. This may be due to the particular philosophy of law enforcement, but it is essential when introducing law designed to raise environ- mental health standards to ensure that personnel are available who can check that the law is being observed and, when necessary, take the appropriate enforcement measures. It is therefore necessary to consider staffing needs for enforce- ment and monitoring. Environmental health officers working at community level with other professionals can give an assurance to legislaton that the law they introduce can be made to work and be effective. The need is for a professional officer capable of developing and exercising professional standards in his own work in relation to that of nonprofessionals involved in environmental health. Also, his role would obviously touch on aspects with which the physician, veterinarian, toxicologist, engineer, nurse and others deal in a more specialized manner. If the concept of the professional environmental health officer as a field health worker is accepted, his role in relation to other professionals is more easily understood and his training needs more obvious. He will obviously not possess the exper- tise of the physician in personal health, of the veterinarian in animal health, of the microbiologist in microbiology, or of the sanitary engineer in the provision of water supplies. He will, however, have background and practical knowledge in these areas sufficient for him to understand the principles involved and he may develop some specialist expertise. He will be able to rvork easily with the other professionals. His wider experience will enable him to formulate an approach on a broader base 3 to contribute to the decisions to be made, or to make these decisions alone in cases where he has the necessary authority' Responsibilities may vary to some degree in different coun- tries, but the basic functions of an environmental health officer within the public service should be: (a) improving human health and protecting it from environ- mental hazards; (D) enforcing environmental legislation; (c) developing liaison between the inhabitants and the local authority and between the local and higher levels of adminis- tration; (d) acting independently to provide advice on environmental matters; (e) initiating and implementing health education programmes to promote an understanding of environmental principles. Because of the wide range of his functions, the environmental health officer will operate in a managerial capacity and in col- laboration with other environmental agencies and services. In recent times there has been, in the industrialized societies, a shift of emphasis from traditional problems of sanitation to the new hazards arising from intensive industrialization, for example, pollution by chemical and physical agents potentially harmful to the health of a community. The monitoring and control of these hazards are important, but there is a need to develop the pre- ventive role of the environmental health officer in these matters. His level of knowledge must enable him to understand the prob- lems which are the concern of other professionals so that he may contribute to their solution. The environmental health officer acts as a public arbiter of en- vironmental health standards, maintaining close contact with the community. He must at all times be aware of the general environ- mental circumstances in his district and must know what hazards to health may arise within his district because of the industry and processes that exist there, and what resources are available to him in the event of emergency. 4 3. ENVIRONMENTAL HEALTH SYSTEMS IN DIFFERENT COUNTRIES Many of the problems relating to the protection of the en- vironment and health of a community are common to the indus- trial societies of the WHO European Region. However, the contri- butions made by the participants in this Consultation demon- strated that there are not only different environmental health ad- ministrative systems, but also a variety of professional disciplines engaged in this work. While the aims and objectives are similar, the means of achieving them vary. The following brief summaries illustrate the variations which exist. 3.1 France The Ministry of the Environment coordinates environmental protection activities in which many administrations and special agencies are involved. Many categories of personnel at different levels are employed and belong to the different administrations concerned, e.g., Ministry of the Environment, Ministry of Agriculture, Ministry of the Interior and Ministry of Health and Social Security. These categories include engineers of different specializations, in cluding sanitary engineers, as well as veterinarians, physicians, chemists, microbiologists and others. They work at different levels, central, regional or local (i.e., department or municipality). The implementation of legislation is generally the respon- sibility of the local authorities (departmental and municipal authorities). Being concerned with the health aspects of environmental protection, the Ministry of Health and Social Security has been developing over the past few years a new structure especially for use at local level. In addition to medical doctors there are sanitary engineers, techniciens supeierurc de gdnie sanitaire (the equivalent of environmental health officen), inspecteun de salubrite (public health inspectors) and personnel for sampling and disinfection operations. There is a tendency to increase local responsibility. 5 3.2 German Democratic RePubtc The Ministry for Protection of the Environment and water Resources coordinates environmental measures by collaborating with ministries responsible for agriculture, health, food, etc' The Minstry of Public Health is responsible for food and institu- tional hygiene, communal hygiene (water and waste; housing and city planning; air pollution; noise and other physical factors, poisons and toxic substances), communicable diseases and occu- pational health. Hygiene services are provided as part of the public health serviceit central, regional and district level;some 6000 co-workers are involved and some 30 research institutes provide laboratory and surveillance suPPort. The main categories of personnel are medical doctors with a 5-year postgraduate education in hygiene or labour hygiene; scientists such as food chemists, chemists, physicists and mi- crobiologists, with a 4-year postgraduate specialist education; hygiene or labour hygiene engineers who, after matriculation or education in a distinct profession (mainly medical), receive a 3-year technical/professional education with subsequent op portunities for specialization in, for example, food hgyiene or communicable diseases; hygiene or labour hygiene inspectors, who after school, receive a 2-year education in medical schools for their subsequent duties. 3.3 Federal Republic of GermanY Numerous laws relating to environmental health are the res- ponsibility of different federal ministries, for example the Ministry for Youth, Family Affairs and Health and the Ministry for Interior Affairs. Enforcement of Federal legislation is the responsibility of the Lrinder (provinces) and the local authorities. According to the specific organization of administration in the Lrinder there are administrations, singly or in combination, for health, environment' public order, veterinary affairs and othen. Highly qualified officials such as physicians, engineers, food chemists and veterinarians work in the Lcinder and are generally 6 responsible for all important decisions in their sphere of activity. Such officials have, or gain, a good specialization in the specific subject in which they work. The officials are supported by technical assistants such as health inspectors (Gesundheitsaufseher), disinfectors (Desinfek- toren), food inspectors (Lebensmittelkonfiolleure) and meat in- spectors (Fleischbeschauer). These carry out work comparable to that of an environmental health officer but they do not have as much training and responsibility as the latter. Well equipped laboratories such as medical, chemical and veterinary units support the work of authorities and officials. 3.4 Hungary The local public health facilities include branches of the public health and epidemiological network which operate at local level in district seats, towns and town districts. They are headed by doctors with co-workers who include public health and epidemiological cortrollers, health workers and adminis- traton. Public health and epidemiological stations operate in Buda- pest as well as in Hungary's l9 counties. These latterstations also operate as county supervisory bodies; the staff include specialist hygienists, epidemiologists and doctors, supported by assistants in various disciplines. Several public health stations carry out regional assignments covering several counties. These may relate to noise, air pollution and radiation matten. There are a number of national institutes which, together with the Ministry of Health, can give professional guidance on public health and epidemiology. In Hungary the public health environmental health officer is authorized to exercise official and controlling rights, but public health is a multidisciplinary assignment and relationships are necessarily wide. The spheres of work of public health specialist doctors, hygienists, epidemiologists and those of engineers, chem- ists and others are well defined and regulated. The local, county and national institutions have been modernized to develop team work and expand public health activities. 7 3.5 Netherlands The Ministry of Health and Environmental Protection co- ordinates political decisions on environmental affairs. National Councils fbr Health, Environmental Protection, Air Pollution, Water, Food and Nuclear Energy have advisory roles- The Ministry consists of 2 main divisions (Directorates4eneral), for Health und for Environmental Protection. The National In- spectorate for Health and Environmental Protection has a vital .ol" in advising the Government, provincial and municipal authori- ties. The provinces play an important part in implementing environ- mental legislation; there are I I of these and 240 municipalities. The National Inspectorate consists of a central staff of spe- cialists and there are 9 regional inspectorates. The inspectors are fully qualified specialists with university education. Each regional inspectorate consists of from 5 to l0 inspectors (Ph-D. orequiva- lent) and about the same number of technically trained persons with Bachelor degrees. The provinces have environmental pro- tection departments with speciatsts and university trained staff. The larger cities have set up their own municipal environmental protection departments. While there is a centralized approach, with coordination through Govemment departments and the National Inspectorate, it is the provincial and municipal authorities that are generally responsible for enforcement. 3.6 Poland The Ministry of Administration, Land Resources and Environ- mental Protection is responsible for the management of natural resources, general planning and the environment. This involves planning and state control for the abatement of air and water pollution and noise control. The Ministry collaborates with the Ministries of Agriculture and of Health and Social Welfare. This latter Ministry is responsible for the control of infectious diseases, occupational diseases, environmental health surveillance and the initiation and organization of health education. The Ministry of Agriculture provides the veterinary inspection service, and exercises control over food production and the proces- sing of foods of animal origin, but not over the retail sale of foods. 8 It is a state-controlled service, but in every county and larger towns with "county status" there are branches or stations which are responsible for the environmental health services. 3.7 Sweden Environmental protection legislation is relatively modern, in that many of the laws were introd uced in the I 960s and 1970s. At government level the main responsibility is vested in the Ministry of Agriculture. Public health is the responsibility of the Ministry of Social Welfare and occupational health is a func- tion of the Ministry of Labour. Central administrative authorities in the environmental health sector consist of a number of National Boards, such as those Boards dealing with Health and Welfare, Environmental Protec- tion, Food Administration, Fisheries and Urban Planning. The main responsibility for environmental protection at regional level rests with the county administration, which can act as an enforcement authority. Local responsibility rests with the municipalities, for which the public health committees are the enforcement authorities. The Swedish enyironmental health officer works in the office of the public health committee and receives a 3-year university educa- tion oriented towards public health and environmental protection. There is now a strong tendency to decentralize to the local level responsibilities which can or should be administered at this level. There are some 800 environmental health officers in Sweden(population approximately 8 000 000). 3.8 United Kingdom The principal govemment departments involved are the Department of Health and Social Security and the Ministry of Agriculture, Fisheries and Food. The role of central govemment is to prepare legislation for introduction by Parliament. Adminis- tration and enforcement of the legislation is the responsibility of the local authorities. Environmental health is primarily a respon- sibility of, in England and Wales, the 402 district councils. In almost all districts there is a separate environmental health depart- ment headed by a chief environmental health officer. 9 3.10 Yugoslavia The main central departments concerned are the Ministries of Public Health and Social Insurance;Work; Urbanization and Uti- lization of Space; Water Protection and General Administration. l0 Although various disciplines are involved in environmental health, it is the environmental health officer who occupies the central position in this work. There are approximately 6000 es- stablished posts. Environmental health officers are supported by technical staff and are qualified to be "general practitioners" in environ- mental health matters. when required, specialist advice is available from other professionals and agencies and within the local health departments. Environmental health officen have opportunities for subseq uent specialization. The two recognized qualifications are the Bachelor of Science degree in environmental health (4 years) and the Diploma in En- vironmental Health of the Environmental Health officers Educa- tion Board (3 years). 3.9 USSR A fully developed state-controlled system exists in the USSR, with a regional health organization offering a comprehensive service through the public health service. Environmental, preventive and curative services are combined within the main structure. Environ- mental sanitation and the control of communicable diseases are dealt with by a network of sanitary and epidemiological stations. A special profession, the sanitary doctor, has responsibility for environmental health matten; a special system of postgraduate (medical) education in environmental health is provided for such doctors and continuous updating of this specialist knowledge is ensured. The duties are similar to those of the environmental health officer. The sanitary doctor is assisted by feldsher sanitarians who, working from the sanitary and epidemiological stations, help in vaccinations, controlling epidemics, conducting health surveys and performing other duties such as disinfection. They generally work under the supervision of the sanitary doctor. In addition, there are institutes of public health, specialized hygiene -epidemiological and sociomedical health institutions, and other speciahzed institutions performing analyses of the human environment. At the level of Repubhc, physicians who have undergone postgraduate environmental health training are employed. At the regional level (groups of communes), there are physicians, phar- macists and veterinarians, while at the commune or municipality level sanitary technicians are employed. 4. TRAINING AND EDUCATION It is possible that some problems relating to the protection of the health of the population from environmental hazards and the protection of the environment may be dealt with by the specialist. Many of the problems necessitate an integrated analysis involving a broader approach than the more narrow sectional solution by the specialist in environmental health. The environmental health officer performs the generalist role and therefore needs to have training in a wide area of activities. A balance has to be struck between the depth of in- struction given on specific subjects, the desirable amount of knowledge to be aimed at, and the practical application of that knowledge. For admission to training courses a standard of general education equivalent to university entrance level should be re- quired. Training should lead to university graduation or an equi- valent qualification. Professional or practical training integrated with the academic course provides the student with sound technical and administrative experience; it encourages self- reliance and initiative and produces an officer capable of iden- tifying and solving environmental health problems. provision should also be made for appropriate postgraduate specializa- tion. In view of the wide range of activities to be carried out by environmental health officers, the following basic concepts should be incorporated in the planning of their training: 1l (a) general - to include the natural and social sciences, scien- tific bases for understanding environmental health effects and relevant health and environmental aspects; (b) taskoriented fundamentals of environmental health -planning, management, legislation, surveillance systems, cost- effectiveness, information, documentation, data collection and processing and environmental health education of the public; (c) taskoriented education in specific environmental health problems - this can vary according to the administrative structure and control systems of a particular country. The following sub- jects were recommended as a model curriculum for this section: llate r quality manaSe me nt l.l Drinking-water supply 1.2 Water for other uses, e.g., recreational, agricultural, industrial, emergency purposes 1.3 Water pollution control (inland and coastal) 2. Food safety 2.1 Food production: (a) of animal origin; (b) of vegetable origin 2.2 Food distribution, sale and consumption 2.3 Microbiological and chemical control 3. llaste management 3.1 Solid wastes - municipal and industrial 3.2 Liquid wastes - municipal and industrial 3.3 Recycling of solid and liquid wastes 4. Principles ol'urban and regional planning 4.1 Analysis of projects 4.2 Zontng 4.3 Specially protected areas (coastal zones, parks, etc.) 5. Housing 5.1 Permanent dwellings 5.2 Temporary dwellings, including tourist camping sites and caravan dwellings 5.3 Community institutions, e.g., schools, hospitals, etc. 6. Air quality manogement 6.1 Plannhg and zoning 6.2 Sources of pollution 6.3 Control devices t2 7 . Control of noise and other physical foctors (vibrations, microwaves, etc.) 7 .l Planning and zoning 7.2 Sources 7.3 Control devices 8. Radiation 8.1 Protection against radioactive pollution of drinking-water, food, soil, air and building materials 8.2 Radioactive waste disposal 9. Po ten tially hazardous substances lO. Epidemiologl' l0.l Communicable and parasitic diseases 10.2 Control measures 10.3 Vector control (rodents, insects) I 0.4 Noncommunicable diseases I l. Occupational health I l.l Hygienic conditions for work ptaces ll.2 Hazard,s to workers' health 12. Application of International Health Regulations 13. L. nviro n mental heolt h e ducation l3.l Enlisting community participation in environmental health projects 13.2 Encouraging voluntary compliance with environmental health legislation 13.3 Education of food handlers 13.4 Encouraging the community to adopt an improved environ- mental health life+tyle. While the range of activities and responsibilities of environ- mental health officen will depend upon the national legislation and administrative structure of the country concerned, the cur- riculum should include the basic functions listed in Annex I to the 1978 report,a with the following additions: (c) promotion and enforcement of environmental health quality standards: - a se"' wHo-Regionat office for Europe. Role, functions and training requirementsof environmental health officen (sanitarions) tn Europe: report on a consultation. Copenhagen, 1 978 (ICP/BSM 004). l3 (b) collaborative efforts with other disciplines to study the health effects of environmental hazards; (c) environmental impact assessment. The training programme must cover all the activities with which the environmental health officer will be concerned. As it is training leading to graduation (or an equivalent qualification) it must clearly go beyond professional training and include "edu- cation". In environmental health both the quantity and pace of change are high. The fundamental principles of education, such as basic concepts, clear and logical thought, principles before techniques, etc., which promote the ability to adapt to change cannot be ignored. consideration was given to the recognition necessary for those working as environmental health officers but who, having qualified under earlier schemes, were not graduates as envisaged by this and the 1977 Consultation. In Sweden and the United Kingdom the gradual raising of the professional qualifications have not created different grades of officers. No differentiation exists in the local government service in the United Kingdom between those who hold the Diploma in Environmental Health of the Environmental Health Ofhcers Education Board and those who graduate with the degree of Bachelor of Science in environmental health. No real problems have arisen in the development of the higher qualifi- cation. In France, when the post of techniciens supdieur de g€nie sanitaire had been introduced, the public health inspectors had been given the opportunity of attending a two-year course at the National School of Health to obtain a certificate enabling them to progress to technicierz level. It was agreed that this situation of differing levels of quali- fication in those countries employing environmental health officers should be noted. The training of environmental health officers (or their equiva- lents) in nine countries of the European Region is described in some detail in Annex I. t4 5. FURTHER TRAINING AND CONTINUING EDUCATION The objective of environmental health programmes is that of protecting human health through environmental management. While the correction of hazards will remain important, the em- phasis must now be directed towards prevention rather than cure. The increasing complexities of environmental health problems require a continuing development of experitise and an updating of knowledge. To maintain a leading role in dealing with environ- mentally related health problems, environmental health officers must be in a position to respond to challenges presented by new hazards in the environment. The level at which the environmental health officer carries out his work will influence the type of further training and continuing education he should receive. The following main sources of such training are envisaged : (a) postgraduate specialization courses on particular topics at universities or similar educational institutions. The topics could include environmentally related subjects such as: - air quality management, - control of noise, vibration and other physical facton, - yrater and waste water management, - food safety, - environmental legislation, - environmental data processing, - toxic and hazardous chemicals in the environment, - occupational health, - health education, - solid waste management, - urban planning and environmental impact analyses; (b) overview courses of one month or more at university or an equivalent level, to update and widen perspectives on environ- mental health subjects, singly or in combination; (c) refresher courses lasting one day to one week, organned by government departments and professional associations. As they l5 are relatively easy to organize, these short courses will be the ones most frequently used. In addition to dealing with a specific en- vironmental health topic, refresher courses can consider case- related problems and their critical evaluation; new developments in specific subjects can be effectively discussed at these shorter courses. While basic professional training and subsequent experience provides the community with a competent officer, his degree of iompetence must be maintained in both breadth and depth by further training and continuing education. 6. EMPLOYMENT OPFORTUNITIES Due to the breadth of the environmental health officer's professional training and the subsequent specialist training he may undertake, a wide range of employment opportunities exists. Opportunities in the public service depend largely on the way in which the environmental health administration is structured in each country and, in particular, on the role undertaken by other related professions. These variations will clearly influence the numbers of environmental health officen required. In some of the countries that commenced the expansion of their environmental health services around a decade ago many of the posts then established are now becoming filled. In the public service sector some posts have been established within government departments involved in environmental health activities and this trend is to be encouraged. By far the largest proportion of posts are to be found at the local or community level, where the en- vironmental health officer can exercise the greatest influence in promoting and regulating environmental health activities. There exist, however, several levels at which the environmental health officer can work in the public service sector. These range from the national to the local level with, in some countries, an intermediate or provincial level. The environmental health officer's training should equip him with the necessary expertise to act at any appropriate level. l6 In many countries environmental health officers are recruited by industry and commerce to apply their skills in these areas. In- dustry and commerce have to observe environmental health legisla- tion and need environmental control specialists to interpret legislation, to promote and maintain standards and to solve the problems which may arise through, for example, a system of internal control or "self-inspection". Certain industries, such as the food and drink manufacturing industry, and major retailing companies already employ envi- ronmental health officers. With the increasing awareness of en- vironmental health hazards in other manufacturing processes such as the asbestos, chemical, cement, ferrous and non-ferrous metal industries it is expected that employment opportunities outside the public service sector will increase. The tasks environmental health officers undertake in industry and commerce will vary considerably according to the type and size of the undertaking, and although the work is based on the officer's professional qualification and expertise it cannot be simply def,rned. It frequently necessitates specialization for which postgraduate training may be appropriate. 7. RELATIONSHIPS WITH OTHER PROFESSIONALS The environmental health officer must be able to plan and co. ordinate activities between different professional disciplines, offi- cial agencies and authorities. He needs to have continuing links with other professionals involved in environmental and health-related work and this is particularly necessary in an industrial society. The other professionals with whom liaison will be appropriate in some matten include physicians, physicists, microbiologists, chem- ists, civil/building/sanitary engineers, veterinarians and lawyers. In some countries and situations the environmental health officer will initiate the collaboration, whereas in others he will provide the information and advice which is sought. His liaison role will extend beyond the other professionals to technicians and a range of other specialists, including those concerned with the public health laboratory services. t7 For an effective degree of cooperation between the many varied disciplines and the environmental health ofltcer to be achieved, each must understand the role of the other and optimize the use of his expertise. Annex II gives examples of the liaison necessary between the environmental health officer and other professionals in a number of environmental health activities. 8. CONCLUSIONS Referring to the conclusions and recommendations of the 1978 report,a the group suggested additional functions which should be incorporated in view of the special role of the environ- mental health officer in the industrialized society. 1 . In particular, the conclusion contained in the 1978 report, that the environmental heath officer should have a univenity degree or equivalent qualification in the lield of environmental health, including practical training, was confirmed. 2. Training should cover scientific, health and environmental aspects, followed by training in the specific knowledge, skills and attitudes required for environmental health management. 3. The environmental health officer will need further educa- tion and training at intervals throughout his professsional life, depending on career development and the changing nature of his duties. 4. Considering that there has been a shift of emphasis from traditional sanitation problems to the new hazards occurring as a result of intensive industrialization, the professional profile of the environmental health officer should place even greater emphasis than in the past on the concept of his preventive role in relation to environmental hazards which could lead to an impair- ment of health. a See: WHO Regional Office for Europe. Role, functions and troining requirements of environmental health officen (sanitarians) in Europe: report on a consultation. Copenhagen, 1978 (ICP/BSM 004). l8 . .5' -Although the environmentar health officer shourd, on thebasis of his education and experience, be abre to act inaeplndenflyeither in enforcement or advisory capacities, tre strout,a-ue ablealso to function as a member of a team with other professionalsin implementing environmental health programmes. 9. RECOMMENDATIONS l ' Since the environmental health problems of an indus-trialized society cannot be solved in a fiagmented manner, thetraining of the environmental health officer-shoura "nutir-ti,, totake a comprehensive view on the basis of the profiie aevetopeohere. His basic train-ing and experience fits him for the role of "general practitioner" in serving the community,s environmentarhealth needs, particularly in the fields of technical uJui.",".ar"u_tion and environmental health legislation enforcement.2. Curricula for the professional training of environmentalhealth officers should be structured to provide them with thenecessary knowledge, attitudes and skills.3. Facilities for further training and continuous education ofthe environmental hearth officer shoild be provided according to his career development and the changing needs of the ro.iriv t1 ,E*...4. If the work of the environmental health officer i, to U,effective, it shourd be supported by strong legisration "ufuurc orpractical imprementation and adaptible to locir circumstances. Acarefully designed administrative structure is essentiar io-froviaethe officer with the necessary authority and arso technical re-sources, including surveilrance facilities and an ua"quate-inlo.*a_tion system. 5. In view of the_wide range of expertise expected of theenvi_ronmental health ofrrcer, the appropriate authorities should en-courage the greatest possible use of his expertise, whether this beat local, regional or central govemment tereis.6. Steps should be taken to promote and maintain propercollaboration and _understanding between the environmentalhealth officer's profession and trie other professional at"rprin",involved in environmental health and related activities. 19 T.Thisreportshouldbegiventhewidestpossibledistribution among government departments, institutions and authorities con- cerned with the environment' 8. Those ,...irir",g tt'is report should be encouraged to send comments unO ,ugg"riions reliting to its implementation to the WHO Regional Office for EuroPe'g. After two V.u.t tf" WHO Regional Office should initiate an assessment of the fiog"" being made in the different countries ; th;-E;ropean Regio-n in implimenting the recommendations made in this rePort. 20 Annex I TRAINING OF ENVIRONMENTAL HEALTH OFFICERS(oR THErR EQU_rI/ALENTS) rN NrNE COUMr-RriT--OF THE EUROPEAN REGION France Technicien supdieur de gdnie sanitaire .After they have compreted their course of training at theNational Schoor of pubric i{earth, Rrrrn"r, officers in this zategoryare recruited by the externar services of the uinirtrv oiriJtn unaSocial Security. This training is provided: (a) for pubric health inspectors arready serving in public hearthstructures; training yluallv lasts two years. The rever of recruit-ment of public health inspectors is ietermin.; -;;'*rL,ion..Such officers are recruited Uy rn"uns of open competition andshould possess the baccahuriat or-iiy equivalent quarification.upon compretion g{ thit training they resume their duties in thehealth services to which they belJng. (D) for students with dipromas from university institutes oftechnology specializing in 'hygiene o. ulotogy and who havereceived training in mathemaiics, physics, biology, statistics,mechanics, hydrology,etc. Some of' ttrese insiitutes Ji i".irnorogvspecialize in environmental health p-blr.r, ,rp".irifv-iiror. ,r_lating to water, solid and liquid *"rt", ""0 air pollution.Training in university institutes of technology lasts two yearsfollowing the b ac cala ur6at. These students may follow a course of instruction lasting oneyear in the "Techniciens supdrieurs" Department of the Nationalschool of Pubric Hearth. rraining is orientea towards the study ofenvironmentar factors which mui arreci the health o] uoorrlrio*(excluding occupational environmeni-proutems which are theresponsibility of the Ministry of Labour). 2t This second category of technicien sup€ieur may be.recruited by t-h;;;ices of tnZ-liinistrv of Health' bv other public seryices or by the Private sector' Theproblemsdealtwithinthecouneofthetrainingprovided by t;; N;ii""at schooi of iublic Health are those referred to in An- nex I of the 1978 t;;;;'' The training received bythese officers "q"rp. ,t.* with th;;;;ropriate knowGdge to develop liaison with other disciplines concerned with environmental health questions' Finally, trcnntiii-iup€rieun who have received their di- pro*.r-iio. ,"ir"t iiv it"tit'ttt of technology specializng n hygiene or biologv -;;i ;; iecruited bv the Ministrv of Health without having taken the one-year course of instruction provided ;;'il Nutioiur S";;;i of puuric Health; their training is thus limited to two years following the baccalaurdat ' Ge rman Democratic Re Public The State Hygiene Inspectorate' as a part of the public health service, is responsible foi environmentai health at the central' regional and district levels' IntheStateHygien"tntp""toratethemaincategoriesofstaffare: - physicians with a five-year postgraduate specialization in Lnuironrn"ntal health (H y gie ne-A rz t)' and - sanitary engineers. A standard of education equivalent to univenity entrance level is necessary for admission .to the technical ,.r,ooi ior sanitary engineers. Training is full-time, covers three years and iniludes practical -traTTc' ^Courses follow a detaited curriculum, the aitivities listed in Annex I totherqzgrepo.fbeingincluded.Specializationinepi. demiology, fooA'ttvgien" una community hygiene is possible after qualification. Both categories carry out the role and functions of environ- mental health orrr""*, ii, e Hygiene-Arzt as the chief officer of the it"t. Hygiene Inspeciorat. -ui th. different levels, the sanitary .ngit""i* the moit important co-worker of the physician' -- , s*, t{HO Regional office for Europe. Role, functions and taining req-uirements of environmentot nrotiilfiiii-iiini*tl in burope: report on a consultation' iopenhagen, 1978 (ICP/BSM 004)' 22 Hungary Pu blic h e al t h e pid emio lo gic al offic e rs These officen are physicians; their training rasts six years.Upon completing their studies at tire medical ,nii..ritv trrey wort<in the public health s-ervice (local, county or national) and thenattend a compulsory four-month course or truini"g ur-'t vgrnirtr.This coune is organized by the postgraduate M-edicai"school,the body which compiles the turricurum- At the end of the course, students take an examination. . .After^_four years spent in the public health service, publichealth officers (hygienists, epidemiSlogists) may iate-speciatist examinations. Every four to .five years, physicians engaged in the publichealth epidemiorogicar networt aitena .p."iit"lo*putso-ry post-graduate courses. These are organized, in conjunction *itt, tt.Minltry of Health, by the postgraduate Medical -School.The public hearth epidemiorogical officen perform a, theactivities listed in Annex I to the l97g report.a In addition, theyenforce official regurations and maintain contact *itt iir-e -uppro-priate authorities. Public health epidemiorogicar controners assist pubric hearthepidemiological officen (hygienists, epidemiologirtri-in their :."+ They carry out control activities, prp*I repoJs, etc.Ih"r training lasts three years and takes prace at the'conege ofHealth, following matriculation. After their studies they are emproyed in the pubric healthservice (local, county and national), or in factories. E;;; five toseven years they attend compursory training courses organiiea uythe College of Health. Netherlands Environmental hearth inspectors working at the central gov-ernment level are rocated either at the rtinistrv or i"uiir, una . ' 1""' WHO. Regional lf^fice f9r Ey-p.. Role, functions and training requbementsof environmental heatth "!fi^":r. lsonita*ns1 ii"Errop", report on a consurtation.Copenhagen, tSZS flCp/nSM OOCI. ' 23 EnvironmentalProtectionorinregionalinspectorates.Theyare ;;;;;lt;.;*it.a ^ uniu"ttitv graduates in biochemistry' chem- istry, biology, n .to[iofogv 'unO chemical engineering' These courses last at least six years' -- -L-:^^l Environmentalhealthinspectorsareassistedbytechnicalengt- neers (four y"u", ,.Ji-l"tf ttr'oof training)' Persons yitl yti":Ttiy o. t".i,rri.uiquaurications are also employed at provincial or munr- cipal level. fft" ..piiutit it' tttt national inspectorates and in the Ministry i, on ,niu.*'ii"iti"i".a scientists, while at the provincial ".J."rrl"ipal leveblhe emphasis is on the technical engineers' At some unir.rrlli"t unO t""ttttical schools there are special training programmer--i" tnui'onmental science and environmental hygiene' recific environmental sub-Postgraduate training courses rn s[j""t, ui.lrailable ,i'utlSut universities' and technical schools pro- vide refresher courses.'^--rr,"r"ri"istryofHealthandEnvironmentalProtectionorganEes unn.,utty a special training course on general environmental protec- tion for the new gt;;;;dt and for teihnically traine.d personnel' Food hygien. i. G *sponsibility of a ipecial inspectorate of the Ministry Lf Health and Environmental Protection' Spain Environmentalhealthadministrationistheresponsibilityof physicians, ptturrnu"i,t' and veterinarians' whose university studies lastfivetosixyearsandleadtoaMaster'sdegree.Thesethreepro- fessional "ut"gori., *iitti' the administration require membership of the correspond-i"g ptftttional society' the entrance-examina- tion and number oiu"u"*.i.s being determined periodically by the itfi.iti.V of Public Health and Social Security' The public sector ;;;i;r. Jurr i., th;;;;;; -unv other categories in the scientific and engineering fields' Until very recently sanitary engineering was not sp-ecifically in- cluded in the unir.r=iiv-.u.,i.rtu. Some schools of civil engineering have now included ttris netO in their study programmes-'and an En- vironmentaf gngineering Institute has been set up' This Institute started operating in t979, providing two to three yean of post- giuJrut" education in the environmental engineering field to stu- dents alreadv po.r.rring a Master,s deglee in science orengineering. 24 The Nationar schoor of public Hearth has organized for l9g0 afull-time course reading to the diproma of Aginte iiriiirt. rn"course will provide environmental health tiaining ror-assistantpersonnel at present working in environmental health servicesthroughout the country- The ioune programme fonows basicallythat established bv wHo consurtants in t qzs auringl piloilou.r. experiment. Secondary education is required r"i p".tliput]on i.the course. Sweden Public health inspec tors The course of s_tudies in hygiene and environmental controlaJ th9 university of Ume[ lasti-three years and provides profes-sional training for pubric health inspectors in local government, central government departments or in industry. -- . The first year embraces natural sciences and social science.This includes biology, chemistry, pfrvsils, ;#;;;'g;olosy, energy, ecology, etc. Administrative law, central ana tocat-govern_ment, administrative processes, and economic and physical re-source planning are included. , .Thr -second year courses relate to specific environmentalhealth subjects and project work. .. Il the third year there are studies in social planning, an optional advanced course in a selected subject, rnd;;i;;uiiiu,,i,g with local and regional authorities. . LE university degree course in environmental health wasestablished in January 1977; previously a certificate quariiication was the method of entry to thi profession. United Kingdom ( Englend and llales) En viro n me n tal h e al t h o ffic ers There are two. recog-nized qualifications: the Diploma inEnvironmental Health o1 tn. pnui.onmentat Health officenEducation Board and the Bacheror oi s.i.n". d.g;;-i; iri.or,-mental health awarded by certain universities ""i pjvt".t ri"r.In both cases the training syllabrs uni-rrrangements are approvedby the Education Board. 25 Astandardofeducationequivalenttouniversityentrancelevel i. n.l.ttu.v for admission to the diploma training scheme' Training is full-time and covers a period of three to four years' Partofthetraining^.i'-in.ou"geandtherestispracticaltraining provided by the f o.ui"uutt o.ities una their officers. Every student is examined "u.f, v"uiund is not allowed to proceed to the next p"" .iif," course if t. hu. not made satisfactory progress' At the end of it.it tiuining students sit the Board's f,rnal examination,whichisinfiveparts,comprisingfivethree-hour written papers, an oial examination' a prictical examination in meat and other fooi';;;;1;; ioettttti with the submission of a pioiect study on an enviionmental health subject' Currently ilr.tt u."-iOO6 students in training' of whom 331 are undergraduates .trOvilrg i* g'S"' .degrees' Ten educational estabrishments offer io.irr", for the diplcma and six. universities and polytechnics pt*iOt courses for the degree' The ultimate ui. ii for entry to the profession to be by degree' The syllabuses cover a[ aspects of enwionmental health activities. USSR ln the USSR a special category of professional'.the."sanitary doctor", has ,esponsiUiUiv for enviro.nmental health' The post is based on tfr, "runiiul. -'tution" and forms part of the public health service sYstem' To receive tfre iiptoma of sanitary doctor' .cand.idates must undergo six years oi-i*iri"g at a .,sanitary-hygienic" faculty of a medical institute tunivenlty equivalent). Training covers the basic naturat ..i.n..t iptyti"s, chemistry, biology, etc'), medicine and environmental tteiftir (environmental quality management' tr"rftf, aspects of sanitary engineering and technology' etc')' A special .Vttt. of po-stgraduite education exists and con- tinual upauting'oi "nui.on-.rital health education follows. There are three principal stages of postg-raduate education: specializa- ii,on, uduur..o "orttet ino ud'inttd toutt"t in special subjects' Specialization" iio,i months) and advanced courses (three months) are intendeJ ior training in different helds of hygiene: communal t vgi.n., *cupational I-rygiene' food hygiene and radia- tion hygiene. AOvanced courses in special subjects include' for 26 example, communal hygiene, hygiene o-f air, waterorsoil, housingand town planning. such counli rast from orre tolw-o-ana-a-half months. Each sanitary doctor must undergo specialization after threeyears of practical work, and take aovincea courses after five yearsand after each subsequent five-year period of professionut *ort .Advanced courses in speciar sub.lects'are followed in addition toadvanced courses, depending on local problems. Yugoslavia While in some fields of environmental health expert manpoweris readily available, in others it is scarce. There i.. i;;k';i:;g.n.rurenvironmentalists" to be in charge of the surveittance oi "iuoon-mental health hazards, includinghonitoring and hearth educationof the public. . At _ th-e postgraduate level new programmes have been de_veloped. It is envisaged that every candidate wilr t ota u-a"gr."in engineering, chemistry, physics, ,"Ji.in. o. ,.t..irui medi_cine._ The programme, covering a wide range of environmentalhealth -subjects, is designed to Iead to a diploma after two and aMaster's degree after iour semesters. There ir * .n,prrusis onpractical aspects of the work. . A three-year postgraduate specialization programme leadingto. the .degrge of speciarist in environmental hearth has been de-veloped 1nd is equivarent to specialization in any ottrer recJgnizedbranch of clinical medicine or puUtic treatttr.At undergraduate level a curriculum for food health engineershas been developed. This course turt, fou, years. . A -t-*9-year programme of training ior sanitary techniciansis provided. 27 LIAISON BETWEEN THE ENVTRONMENTAL HEALTH OFFICER AND OTHER PROFESSIONALS IN SPECIFIC ACTIVITIES 1. lilater qualitY management Civil/building/sanitary engineers public health r.iloiuto.vl chemist, microbiologist, biologist, technicians 2. Food safetY Veterinarians Chemists Food technologists Process engineers Public health laboratory technicians 3. llaste management Civil/sanitarY e ngineers Public health laboratory technicians Annex II chemist, microbiologist, biologist' chemist, microbiologist, biologist' 4. Pinciples of urban and regional planning Building/design/sanitary engin eers Architects and Planners 5. Air qualitY management Meteorologists Chemists and PhYsicists Engineers in various professsional groups Physicians Statisticians 28 6. Control of nobe and other physical facton Physicists Engineers in various professional groups 7. Radiation and chemical hazards Physicists Physicians Chemists Engineen 8. Epidemiology Physicians Toxicologists Public health laboratory technicians chemist, microbiologist, biologist, 9. Occupational health Physicians Security/safety engineers Sanitary and other engineers I 0. Environmen tal health educatio n Te aching pro t'essio nals Sociologists Physicians Professors active in public relations 29 Annex III LIST OF PARTICIPANTS Temporary advisers Professor K.A. BuStueva, Chair of Community hygiene' Central Institute for nOvanced Medical Studies' Moscow' USSR Dr S. Dittmann, Deputy Director' State Hygiene Inspectorate'"^ ffi;it or' pu6tc'Health, Berlin' German Democrattc RePublic Dr K. Grzybowski, Provincial S-anitary I1sgect91'^'Sanitary and Epid emi"b;;;t"tio n, Katowiie' Poland (Ch air man) Dr F. Heuner, Head of Section' Federal Ministry for Youth' Family Affairs ".i'fft"itt', donn-Bad Godesberg' Federal Republic of GermanY Mr M. Jouan, Sanitary Engineer' D-irectorate{eneral of Health''-- frfinistry of Health anJsocial Security' Paris' France Mr R.A. Karlsson, Swedish Association of Local Authorities' Stockholm, Sweden Dr H.M. Klouwen, Head, Regional Inspectorate for Health and Environmentat protettion, Groningen, Netherlands Dr R. Mujeriego, Sanitary Engineer' Sub-Directorate{eneral of Environmental Health, Madrid' Spain Dr Z. Skurii, Professor of Industrial Hygiene' Andrija Stampar School of PuUfic-Heulth, Uniu"ttity of Zagreb' Yugoslavia Dr S. Takilcs, Director-General, Borsod County Sanepid Services, Miskolc, Hungary 30 Mr R.D. Brogden, Swedish Public Health Inspectors Associa-'^- tion, Hehlngborg, Sweden (Vice-Chairman\ Observers Mr J.E.G. Smith, Local Govemment Training Board, Luton,United Kingdom Mr ^K.J. Tyler, Secretary, Environmental Health Officersfusociation, London, United fingJom (Rappoitiurj "--' llo rld H ealt h Organiz atio n Regional Office for Europe Dr N.O. Akmanoglu, Sanitary Engineer, Sanitary EngineeringCentre, Rabat Mrs B. Blomberg, Regional Officer for the Food Safety pro_gramme t r, S,. Ferrullo, Regional Officer for Environmental HealthPlanning and Management (Secr iiiryl Mr E. Giroult, Regional Officer for Basic Sanitary Measures Mr P. Jolly, Sanitary Tutor, Ankara Dr R. Manrique de Ls12, Regional Officer for Fellowships_Promotion of Training Mr J-.I. -Waddington, Director, promotion of EnvironmentalHealth Headquarters Mr R.F. _Davies, Scientist, Environmental Health Criteria andStandards 3l No.20 No.2l No.22 No.23 No.24 No.25 No.26 No.27 No.28 RECENT ISSUES IN TIIE SERIES EURO RErcRrs AND STUDIES Research on simulotion models for health monagement.. report ona WHO Workng Group. lg7g,24p"g.r, i*fr. +. Health aspects reloted^yo indoor air quality; report on a WHOWorking Group. lg7g,32 pages, Sw.fr. i-.-"'' {l:;:i.*.lces.. report on a WHo Symposium. tele,3e pages, llaiyinS of senior public health administaton report on a WHOWorking Group. 1980,42 pages, Sw.fi. i.'-'" Early detection of chronic lung_diseases: report on a WHO WorkingGroup. 1980,32 pages. Sw.fr.3. Changing pattems in mewal health care: report on a WHO WorkingGroup. 1980,50 pages, Sw.fr.4. La pr€vention des accidents de la circulation chez res enfants: rap-port d'une 6tude r6alis6e avec tu .ou.uor.tion ou centre inter-nationat de I'Enfance et de l,Unive^it, d,U;;;I.. 1980, il;;;;;,Sw.fr. 4 (English in preparation). - - rr' The Gabrovo Health Services Model in the people,s Republic ofBulgoia: report on a Study. D}o,i+p.grl, S*.fr. O. Chronic resqjytgu diseases in children in relation to air pollution:report on a WHO Study. 19g0, g9 pages, Sw.fr.6. WHO puUhatirrr rnry bc obdrrGd, dirut or thrcugh bootscllcrs. from: AI.cETIA ATGENNNA AUIITIAUA AUSrrrA I^T{GI.ADGII !a.dura llAJAL tlrrx^ CANADA cHtt{A .cou)rauA CYPRt,S czEcHo SII'VAKIA DENMARI( ECUADOR EGYPT EL SALVADOT FI,l RNI.AND FRANCE I5 fil"}rgrrCoodirrc. G.p.O. ror 2r0, Decce 5 - Thc Aseierim of votuaury elmocr. Ofl'a irrcnrrbrl d. 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A.cr^ G.C. Elefihcroodrtb S.A. Ubiriric in!3mrix.lc. nrc Nitb 4. Ar,{G$ (T. t26)I,lu loudlceu Ubfraric.A h Cmvcllc-. Boilc po.trlc f t l-& Forr.eu-nl:rcr ffi.fnt Crowrnrncrr lnfomrrrim Scni-r lcecoofrE H;6.h Fbor. eren.r Rod. Ccnrnt. Kulurr P.O.& lllo. x.ra^rsr 62 - Atdaniri Koorryc$oll vaci utc. 2:. Buo^rtt, vSn*6irrn Joton f Co. pO. gor I lI, HrrrrtarGi 9. R:vpevrWHO R4int Ofl.c fa Sq.lrEHmilffi r*ffi 'H-J##iltr;,,f,ilffi $.ffiIiiHsip,Hr P' T' X'rrn...'dL h!'r1 a. ftrugryrr Scrra, rbt r. n.h Fbor. p.o. Bor ia33/JLL J^&rr^Minirrrof hlatrirr. ftLinl t{ar,a hUi0ira. Dirnhrira.fil Advcnfuinj g^6Ho^oTDC huirf.'t. t2 t{ant Frdcrt S.rE tl,rrti IHciliF I Co. , Nrh.tr lLrrrr.grq. Jrrra^ra Edizini Mirrr l{d.r. CorD ln'Inre l!-lr, tol26 Turx: vir Lrnnnnoa l. Z0t(p Mr^rUrrur:l Co Ud- p.O. for ,OtO. Ta,rc lil.nriirn t f(ILlr ThG WHO Pllgunrr Goordiiror. Cctrrd p.O. fq jae Sar Tb Krrd lofdrop Co. l.rtt- Thrrrtr, Arch.rn U3. p.O. Bor 2!lt1 KuwenThG WHO lrogun: Coodiroe, p.O. fil ra3. vrrn^; TIE Li.d Dirihroo co SAR-L E8 I til. Mrrtua sarr.t HrttDr !|dt Eoru,Ubrlira& Ccdtr. rr9 bd norlll Lurmrm NIF2 GEN,MAIW. FED€RAL R,Eru8LtC CER,MAN DEMOCIANC REruruC OF CHANA GR,EECE HAlTI HONG KONG HUN|GARY ICEI.AND IT{DIA INMNESIA ITAQ ITEIIND ISR/iEL ]TALY JAPAN ror,EA nEPt tuc OF KI,WAIT I.^O PEOPLES D€MOCTATIC N.ETJBLIC IIIANON LUXEMtrX.,TG Sclla Naidc dtdiin a & oitluirn., bd Arou yosf. Al.clrtsCrrlo. Hilrdr SfL Fki.b 165. C.lcri.r Gigncr. Etoilotb aSS/,465. hJrr6 Artr GcDU ll. lotl VE{II^ I WHO puHbationr mry bc ohaancd. tlicct or through boottdLrt' ftom: LUXEMrcURG MATAwl MALAYSIA MEXICO MON@LIA MOROCCO MOZAMBIQUE NEPAL NETHERITNDS NEW ZEAIAND NTGERIA NOR,WAY PAKISTAN PAPUA NEW GUINEA PHTLIPPINES FOI.AND FORTUGAL STEN,N.A LEONE SINGAFOR,E SOUTH AFRICA SPAIN SR.t I..ANKA SWEDEN SWITZERIAND SYR,IAN ARAB REruBLIC TTIAII.AND TUNISTA TURKEY UNTTED KINGDOM UNITED STATES OF AMERICA USSR Lib.rirE et Car!3,ll' bd Rry4 ll,rmuro ff.f.* go* S.dica, P.O. Eor tOD{{ Chitti4 E^xrYrt 3 #, t Frcnrl MCdhr Mcriclr+ Ed&;ifdl*' hF & lt' Furludc 26' ADL hr'l !)413' MtfiEOrY 2q D.F. rcr lndirrtHO &*nd O{fte Ediri.D t. Don , 2!l lttolE Moh'oDcd Y' R^t^l !NLD, Crir harl alBO' M^tr,!o r., tttdir, wHO Rctiond Olfrca f.f.O..f AooU Euro?G BV, Noordcrwrl 3t' ?241 BL t'@rrr' iffiffi# U#" G'o'od&rrrhHirhcn&Boot' J. G. Tmum Ay'S, P.O. Bor lf1:l S'ilrum. O!l.o I;;-;, ri-.v' es shrhrrlr-E-au'i&e-Azlrn' P'o' Eor 72e' l^nr 3 Thc WHO n"ln-r. 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Bor No. SZll' Autto r.. fndi., wHO R.tiqd Olficc SoAat funUconc ac Diftii,o' 5 rvcnw & Crrliqn' Twr Hrc Kiirp.ni /469 niUl braao* Bcyoaht lsr^NDL m#th:emn:,1rur*my*um'Lffi sffi ffi Kni& Macow CIZDffijEimrt ;m""a^m,gr [ffi^l*;'[o dd ErG' ^F' Jujclottrb Kniitr' Tctrdj.,/ll' llm Brlor^r UiJtt *ircrt"it , evcnuc & b Frir No 167, B'P' l6t2' l(rrrrru$ I VENEZUEI.A YUGOSI.AVIA ZAIRE Pricc: Sw fr.r.- Prica! mry