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"This contribution will try, on one hand, to take stock of the past [European Community] policy on migration and on the other hand to provide the basic elements which are shaping a future potentially common (or partly common) policy, carried out either through intergovernmental cooperation or community legislation or both." Pertinent treaties and legislation are also described.
About 100 million workers in the European Community commute to and from work daily. A review of the available data shows that commuting has increased in recent decades as rising car ownership has produced a more dispersed pattern of residential and job locations. In general, average commuting durations are falling, although average commuting distances are increasing as a result of faster commuting modes. However, the number of very long duration journeys have also increased, albeit from a small level. Up to now most research has focused on transport and land use issues, while very few studies have dealt with its impact on health, safety and social life of the workers. The available data indicate commuting to be a stress factor not only because of transport modes, but also by its interference with living and working conditions: namely, reduction of time available for discretionary leisure activities and increased absenteeism at workplace. Long-term effects on health have not been adequately investigated. Well integrated policies and strategies concerning the different aspects of this problem (transport, health, work organization, residential planning) must be developed both at the local and international levels to facilitate adequate solutions for this stressful condition.
International and regional prevalence comparisons are required to test and generate hypotheses regarding the causes of increasing asthma prevalence in various age groups worldwide. The International Study of Asthma and Allergies in Childhood (ISAAC) is the first such study in children and the European Community Respiratory Health Survey (ECRHS) is the first such study in adults. Therefore, a comparison of the findings of these two surveys was conducted, for the 17 countries in which both surveys were undertaken. There was a strong correlation between the ISAAC and ECRHS prevalence data, with 64% of the variation at the country level, and 74% of the variation at the centre level, in the prevalence of "wheeze in the last 12 months" in the ECRHS phase I data being explained by the variation in the ISAAC phase I data. There was also generally good agreement in the international patterns observed in the two surveys for self-reported asthma (74% of country level and 36% of centre level variation explained), self-reported asthma before age 14 yrs (64 and 26%), hay fever (61 and 73%) and eczema (41 and 50%). Thus although there were differences in the absolute levels of prevalence observed in the two surveys, there is good overall agreement between the International Study of Asthma and Allergies in Childhood and European Community Respiratory Health Survey study findings with regard to international prevalence patterns. These findings, therefore, add support to the validity of the two studies, which provide a new picture of global patterns of asthma prevalence from child- to adulthood, and identify some of the key phenomena which future research must address.
The programme of international cooperation of the European Community (EC) in the field of drugs has been in existence since 1987. The scope of the programme is wide and covers, in principle, all aspects of the drug problem in the partner countries. However, interdiction of illicit activities in drug production and trafficking has fallen so far outside the competence of EC, although it will be covered by the European Union once the Maastricht Treaty comes into force. Out of the experience gained in managing the programme, the author suggests that, to be effective, an integrated approach should provide an appropriate place for cooperating more fully in the field of law enforcement. The two priority areas of application of the programme should then be the prevention of drug abuse and the fight against trafficking-two areas which, in fact, tightly reinforce each other.
This paper describes how from a situation within the European Community where each Member State had its own individual regulations for materials and articles in contact with food, the Community has developed a harmonized approach. The view is expressed that whilst this harmonization is desirable, the EC legislation as currently written is impractical. Flaws in the principles underlying EC controls are identified and whilst some parts of the harmonized regulations can form the basis for a workable scheme, substantial revision is needed. Proposals for improvement to the current Directives are suggested.
Research programmes planned and sponsored by the Commission of the European Communities (CEC) are executed by the Joint Research Centre which belongs to the Community (direct action) and through the collaboration of research institutions of the member countries (indirect action). In the latter case national laboratories carry out investigations under contract with the CEC thus providing scientific and technological data needed in the implementation of Community policies in various fields such as Agriculture, Industrial Affairs, Energy, Environment. To sustain the Community policy on the environment, adopted in 1973, the CEC proposed and the Council of the EC approved, in parallel with direct action programmes, the first Environmental Research Programme of indirect action for the period 1973-1975 and the second Environmental Research Programme of indirect action for the period 1976-1980. Both programmes have contributed to improve the understanding of problems concerning the presence of pollutants in the environment and their ecological and health effects.
This study measures socioeconomic inequalities in health across European Union Member States between 1994 and 2001. The analysis is based on the European Community Household Panel Users' Database (ECHP-UDB) and uses two binary indicators of health limitations for the full 8 waves of available data. Short- and long-run concentration indices together with mobility and health achievement indices are derived for indicators of severe health limitation and any health limitation. Results demonstrate the existence of socioeconomic inequality in health across Member States in both the short-term (1 year) and the long-term (up to 8 years), with health limitations concentrated among those with lower incomes. For all countries, the long-run indices show that income-related inequalities in health widen over time, in the sense that the longer the period over which an individual's health and income are measured the greater the measure of income-related health inequality. The ranking of countries according to their prevalence of illness differs from ranking by overall health achievement, which takes account of inequalities. This means that an equity-efficiency trade-off has to be faced in evaluating the performance of different countries and in comparing countries with diverse health and social welfare systems.
Schistosomiasis research within the framework of the Commission of the European Communities 'Science and Technology for Development' (CEC/STD) Programme is targeted at three specific problems: diagnosis of infection and disease; the dynamics of transmission, immunity, and morbidity; and the need for improved tools and strategies for control. Several important advances have been made over the past decade. Improved methods of diagnosis by detection of circulating antigens are in an advanced stage of development and have already undergone field trials in several epidemiological settings. Treatment and reinfection studies combined with immunological observations have allowed the elucidation of possible mechanisms leading to acquired resistance, and have shown that repeated chemotherapy with praziquantel can substantially reduce morbidity. Other projects have studied the epidemiological and ecological determinants of transmission, infection and disease in various endemic situations and also in newly established, epidemic foci where remarkable observations on chemotherapeutic responses were made. Important advances have been made towards the development of a vaccine. The glutathione-S-transferases of the major species of schistosomes have been cloned, sequenced and expressed, and their biological function studied. In a variety of vaccine formulations and animal systems GST has been able to confer protection against infection and to reduce worm fecundity. GST and a series of other crude and defined antigens have been evaluated with varying results in Schistosoma japonicum and S. bovis in cattle. Much work has yet been done, however. Recommendations as to possible future directions for research are provided.
OBJECTIVE: The association between living standards and mortality in the European Community (EC) was investigated using regional level data from all EC member countries. DATA AND METHODS: Data covering the 1980s were extracted from various publications. Data on "all cause" mortality (standardised mortality ratios, both sexes, all ages), living standards (gross domestic product, car access, unemployment rates), and some potential confounders (population density, agricultural employment, industrial employment, country) were available for 133 regions. Multiple regression analysis was used for each living standard variable, taking lnSMR as the dependent variable. RESULTS: It is only after taking into account potential confounders that higher living standards are associated with lower mortality. Unemployment rates have the strongest association--each additional percentage in unemployment in the regional population is associated with an increase in mortality by 0.81%. There is important variation between countries in the living standards--mortality relationship. The latter ranges from relatively strong in the UK to absent in Italy. DISCUSSION: The results of this study show that there is an association between living standards and mortality at the regional level in the EC, but that this association comes to light only after controlling for confounding variables. It seems that the mortality increasing effects of urbanisation and industrialization have obscured the mortality lowering effects of high living standards. In addition, factors specific to countries (such as dietary habits) act as confounders. The latter finding is interpreted in the light of differences between countries in the way in which they have gone through the "epidemiologic translation" from infectious diseases to the "western" diseases that currently dominate the mortality pattern.
The research in Biotechnology is an important element for the competitive environment of European bioindustrial activities. In this article the evolution of the Biotechnology programmes in the European Community is presented.
During the last few months, administrations of both the European Community and Germany have brought up several recommendations and changes concerning radiation protection. The European changes must become national law by 13th May, 2000. The changes focus on better protection of children and pregnant women. When performing X-ray examinations, strict indications will have to be observed.
A European Commission programme aimed at occupational integration of disabled, disadvantaged and migrant persons, the HORIZON Community initiative had been implemented in the Federal Republic of Germany between 1991 and 1994. Along with an overview of project participants, exemplary innovative approaches to and potential for integrating disabled persons in employment are presented that have been developed and implemented under the programme. Also, the labour market effects achieved for the disability target group are set out.
The European Community has regulated the protection of animals in agriculture and research by means of 9 Directives and one Decision. The agricultural Regulations concern the protection of slaughter animals, the protection of animals during transport and the protection of animals kept for farming purposes as they also cover the protection of laying hens in battery cages and minimum standards for the protection of calves and pigs in intensive farming systems. The protection of animals used for experimental and other scientific purposes is covered by a Directive that approximates the laws, regulations and administrative provisions of the Member States. The legal texts are presented and where necessary commented on. The Directive on experimental animals is compared with the respective passages of the German law on animal protection.
A previous analysis of drug utilization in the European Community Respiratory Health Survey found that only between 8 and 29% of subjects with asthma-related symptoms were using antiasthmatic medication in the different areas studied. The aim of this analysis was to investigate which variables were related to individual use of antiasthmatic medication in different geographical areas. Thirty-three centres in 14 countries were analysed, in which a total of 16,854 people (52.1% females, mean age 33.8 yrs, range 20-48) underwent a structured interview, measurement of specific immunoglobin E, spirometry and methacholine challenge test. The use of antiasthmatic drugs in individuals was, in most countries, independently related to asthma-related respiratory symptoms, bronchial hyperresponsiveness (BHR) and atopy. In all countries smokers with respiratory symptoms were less likely to be using antiasthmatic drugs than nonsmokers and exsmokers. In four of 14 countries females were significantly more likely to use antiasthmatic medication than males, while age and socioeconomic status were unrelated to medication. The use of inhaled anti-inflammatory drugs was positively related to symptoms, BHR and atopy and negatively related to current smoking. In conclusion, in many countries smokers were less likely to be using antiasthmatic drugs than were nonsmokers with comparable levels of symptoms and bronchial hyperresponsiveness. Age and socioeconomic status were unrelated to medication, while in some countries females were more likely than males to use antiasthmatic medication.
The European Community's Medical Devices Directives represent an ambitious effort to streamline the regulation of medical devices within the European Economic Area, and area comprising more than 380 million people. In this, the first of two special reports, Richard C. Fries and Mark D. Graber describe the Medical Devices Directives and their effect on the product development process. In the second report, appearing on page 294 Jean A. Goggins uses a case study format to demonstrate the process that would be used to gain European approval for a hypothetical medical device.
To ensure freedom of movement in the European Union, a limited number of professions is regulated by a so-called Sectorial Directive; all other disciplines, including clinical chemistry, fall under a General Directive. However, clinical chemists in the EU wish their specialty to be more specifically regulated; this means that common standards of education, training, experience and compliance with continuing professional developments must be guaranteed. Therefore, the European Communities Confederation of Clinical Chemistry (EC4) is about to implement the European Register for clinical chemists, and has composed a guide to this Register. The document describes the conditions for entry to specialty training, the minimum standards for registration (university education and postgraduate vocational training with a minimum total of eight years), the competencies of those qualifying for registration, and the operation of the register. Registration guarantees professional and managerial competencies; the title conferred is "European Clinical Chemist". EC4 recognises the existing national registers as far as they are based on the minimal requirements as indicated. An EC4 Register Commission (EC4RC) will maintain and control the European Register, supported by National Clinical Chemistry Registration Committees (NCCRC). An NCCRC controls the quality of the education in each country and assesses candidates. An individual (EU citizen or non-EU citizen trained in an EU country) applies privately for the European Register to EC4RC and, where applicable, the application is accompanied by a document from the NCCRC of the country of registration, stating that the applicant has the necessary qualifications. For EU citizens trained outside the EU the final decision is with EC4RC; non-EU citizens not trained in an EU country are not eligible for registration. Registration is renewed once every five years.
Collaboration within the European Community (EC) over health problems and their possible solutions has progressed significantly during the past decade. The pursuit of appropriate choices among a variety of issues has resulted in a growing demand for comparable health data. EC efforts to coordinate the health services research of the member states in the fourth Medical and Health Research Program (1987-91) are discussed. Its contribution to the development of information relevant to the EC's health needs as well as financing, policies, and practices is outlined.
BACKGROUND: Within the EU Health Monitoring Programme (HMP), the ECHI project has proposed a comprehensive list of 'European Community Health Indicators'. METHODS: In the design of the indicator set, a set of explicit criteria was applied. These included: i) be comprehensive and coherent, i.e. cover all domains of the public health field; ii) take account of earlier work, especially that by WHO-Europe, OECD and Eurostat; and iii) cover the priority areas that Member States and Community health policies currently pursue. Flexibility is an important characteristic of the present proposal. In ECHI, this has been emphasized by the definition of 'user-windows'. These are subsets from the overall indicator list, each of which should reflect a specific user's requirement or interest. RESULTS: The proposed indicators are, in most cases, defined as generic indicators, i.e. their actual operational definitions have not yet been attempted. This work has been, and is being carried out to a large part by other projects financed under the HMP, which cover specific areas of public health or areas of data collection. Apart from indicators covered by regularly available data, indicators (or issues) have been proposed for which data are currently difficult to collect but which from a policy point of view would be needed. CONCLUSION: All this points to the fact that establishing an indicator list which is actually used by Member States is a continuously developing process. This process is now continued by the first strand of the new EU Public Health Action Programme.