Biological monitoring and medical screening at the workplace in the EC countries.

Health surveillance in the work environment involves continuous biological monitoring and medical screening, with the purpose of primary and secondary prophylaxis of work-related diseases. Is this screening activity governed by a rationale based on knowledge of dangerous exposure and the availability of valid tests? In the USA, where health surveillance programmes are used extensively, a study has found screening activity to be associated more with plant size than which relevant exposure. This study was done to elucidate the character and extent of use of health surveillance in the work environment in the EC countries with the aid of a questionnaire survey. The chief medical officers of the National Labour Inspectorates supplied information on substances covered by health surveillance programme in the EC member states, together with the legislative status and numbers of exposed workers. Belgium, France, Italy and the former Federal Republic of Germany made extensive use of health surveillance programmes in cases of known exposure to metals, organic solvents, carcinogenic and genotoxic substances, mineral dust, ionizing radiation, and biological agents. Denmark and Holland ran national programmes only for substances covered by EC directives, while England, Ireland, Spain, and Portugal comprised an intermediate user group. The result suggest that the use of health surveillance is related more to the national choice of standard regulatory instruments than to relevant exposure.