Strategy for the primary and secondary prevention of occupational diseases in the German Democratic Republic.

BACHM ANN W. Strategy for the primary and secondary prevention of occupational diseases in the German Democratic Republic. Scand J Work Environ Health 14 (1988) 273-279. This review explains the German Democratic Republic's strategy for preventing occupational diseases, which is considered one of the primary purposes of public health. It is a complex challenge that is being tackled through close cooperation between enterprise-linked occupational health services, the inspectorates of industrial hygiene, public health centers, and trade unions. In primary prevention , planning is based on results obtained in thorough analyses of all the relevant parameters, such as work conditions, industrial accidents, occupa tional diseases, morb idity records, and the quality of social services, and a complex work analysis has been developed to provide comprehensive and measurable information on health hazards due to harmful physical and chemical factors, dust, and job-related physical and neuropsychic stresses. Primary preven tion is realized mainly through the elimination of health hazard s and the improvement of work condi tions, both based on a comprehensive framework of legislation. At the level of secondary prevention, company-linked occupational health services are a part of the national health service. Altogether, approx imately 75 "/0 of the work force is covered by occupational health services. A nationwide information system consists of compatible components for primary and secondary prevention, thus enabling control of exposure-effect relationships and the optimization of health policy.

The improvement of occupational health and individual effic iency are major components of economic and social policies pursued in the German Democratic Republic (GDR). All important aspects of occupational health, including responsibilities, demand s, rights, and dut ies, are forma lly stated in legislation (5,7,8,9,10,12,15).
The persistent containment of occupational diseases has been formulated as the prime purpose o f publi c health (16). Hence particular att ention is given to the most common and the severest occupational diseases. This is a complex challenge which is being tackled in close cooperation by enterprise-linked occupational health services, inspectorates of industrial hygiene, public health centers, and trade un ions. Teamwork between all of them is ensur ed at all levels of man agement and is guid ed by the prin ciple that an y case of occupational disease should be a good reaSOn for a critical appraisal of existing work conditions and for occup ational health monitoring.
Mo re ef fective ad vantage ou ght to be taken of all so rts of facilities for prim ary and secondary prevention, and new approaches should be devised for the high-continuity impro vement of occupational health care. The annual rat e of certified occup ational disea ses is showing a declining trend in all industries of the GDR because of th e planned and concentrated technologi cal, organizational, medical , and social measures being taken at the company level. By 1987, the incidence of occupational diseases had decrea sed by abou t 40 % from the approximate 12 300 cases registered in 1976. Severity, too, has been mitigated. The rat e of notifi able industrial accidents decreased by about 25 % in the same period. It should be emphasized in this context that overall labor productivity in the GDR nation al econom y incre ased by rou ghly 60 % from 1976 to 1987. This positive balance is likely to demonstrate the great importance attributed to occupational health and the firm integration of occupational health with management at the ministerial, cor poration, and compan y levels. For the elimination of unnece ssar y jobrelated difficulties and hazards to health , COncrete and detail ed measures are formally pro vided in company plan ning, abo ve all scientifi c and techni cal measures and plan components for work ing and living cond ition s. Potentially concerned company departments, shopfloor section s, technologies, and workplaces ar e explicitly named in the plan components, together with the number of work ers involved.
In our country, with its mix of indu stries, planning is based on result s obtained in pro found anal yses o f all relevant parameters, such as work conditions, industri al accidents, occupational diseases, morbidity records, and the qualit y of social services. Labor safety 273 specialists, medical officers, and union representatives are involved in the planning discussions, and they take an active part in the drafting of priority tasks for forthcoming planning periods. The company manager is held fully responsible for providing adequate occupational health conditions in the company concerned. In this context, the manager must provide an account to the company work force and union bodies at regular intervals.
It is an established policy guideline that any measure of socialist intensification for higher productivity and company effectiveness must be combined with action to improve work conditions for the labor involved. However, technoscientific progress does not automatically produce health-adjusted and personality-building characteristics of work. The design of equipment and production sites and the planning of technologies require due consideration not only of technological and economic criteria, but of aspects related to occupational science, occupational medicine, and social conditions as well. It is as early as the preparatory phases for production that decisions are actually made concerning the nature and conditions of future work, that is, concerning the tasks, role, and position of the individual worker in the process of production in society. Belated modification of inadequately designed work conditions is usually not economical and thus is unsatisfactory.
Roughly 230 000 workplaces are annually renewed or redesigned along with the modernization of shopfloor sections and complete plants and through the translation of findings obtained from scientifically substantiated work organization into practice. A general improvement in work conditions is the result. Health hazards and stress caused by hard physical work are completely eliminated for 25 000 to 30 000 workers every year.
Practice in the majority of enterprises has been characterized by the following situations: (i) occupational health is planned, implemented, and followed by company management in cooperation with the shopsteward's committee and other union bodies, (ii) priorities for modernizing production facilities and sanitation projects are formulated with due consideration of information obtained on occupational hygiene in the company concerned, (iii) conditions for self-control in terms of the occupational hygiene of job-related difficulties and health risks are established and expanded in terms of personnel and equipment, (iv) designers of machines, technological processes, and buildings have to produce evidence for thorough consideration in the design of occupational health requirements, (v) inventors and innovators are motivated to work on lessening health risks and easing work, and (vi) demands for order, safety, and discipline have been made challenge items of socialist competition programs for high-quality performance.
Skilled personnel are available in 15 inspectorates of industrial hygiene at the regional level and in 220 274 inspectorates at the district level to support company management and union officials in carrying out their responsibilities in occupational health (II). These inspectorates are flanked by 10 industry-related centers of industrial hygiene. The inspectorates and centers are controlled and guided by the GDR Ministry of Health, the Division of Company-Linked Occupational Health and the inspect orates of industrial hygiene. They are technically subordinate to the regional or district medical officers in charge of the area in which they are situated.
Approximately 2 200 workers are employed in the inspectorates and centers and work under the guidance of specialists in occupational medicine. Included are physicians, engineers, physicists, chemists, psychologists, and other professionals for guidance, counseling, and follow-up in all fields of company-linked industrial hygiene.
Scientifically substantiated rules and regulations, codes of practice, and projects have proved to be of great importance to occupational health at the company level. They reflect the preventive orientation of GDR health policy. They serve as legal instruments to ensure that in all GDR industries machines, systems, technologies, and shopfloor structures are designed and completed with a view to avoiding or at least minimizing occupational health risks and unnecessary jobrelated difficulties (8,9).
GDR standards (TGL) with exposure limits and measuring methods were introduced in 1969 for the purpose of adequate industrial hygiene (14). Such standards are issued by the National Agency for Standardisation, Measurement, and Product Testing, following consultation with government authorities under the GDR Ministry of Health. They are scientifically prepared and formulated at the GDR Central Institute of Occupational Medicine (ZAM) in cooperation with competent partners.
In the meantime, 110 GDR standards on industrial hygiene have come into force. They concern noise, whole-body and local vibration, chemical agents (220 maximum acceptable concentrations), nontoxic fibrogenic and nonfibrogenic dusts, microclimate, lighting, electromagnetic fields, and the dimensioning of standing and seated workstations. Additional rules and regulations have been adopted and introduced regarding occupational activities of women and adolescents (6), together with specific recommendations for the evaluation and limitation of hard physical work with reference to age and sex (I, 2).
The industrial hygiene standards are used as criteria for the analysis, evaluation, and structuring of work. They are norms for the qualitative and quantitative characterization of major parameters of work conditions and tools for the purpose of optimizing occupational activities. They establish the properties and features by which tools, processes, organizational patterns, and environmental conditions are to be charac-terized for health-oriented, stimulating, and personality-develop ing occupational activity.
Enterpr ise management in the GDR is legally bound to compliance with the sta ndar ds and exposure limits which have actually result ed fro m research in all fields of occupatio nal medicine and co nsideration o f international findings. Hen ce the regul at ion s ar e all medically substantiated and formulat ed so tha t, with their observ ance and on the basis of an 8-h workday, occupational dama ge to health can be prevented throu ghout occupa tional life.
Complia nce with the demand s has often proved to be somewha t difficult for certa in ente rprises, prim arily those of smaller size or with outda ted techn ologies not yet modernized for economic reasons and a shortage o f funds . Compromise solutions have to be implemented in such cases. Personal protective equipment has to be used to compensate for the lack o f sufficient primary protection, and medical monitoring has to be inten sified . Yet, even new mach in es and imported installations are sometimes found to fall short of the industrial hygiene criteria so that modific ation and resetting may be required.
An y man agement findin g itself inca pable o f complying with the mandatory rules on industrial hygiene is legally bound to appl y for a special perm it (14) befo re it deviat es from the regulations. Such situations may develop in cases in which valid expos ure limits ar e grea tly surpassed for temporar ily inevitable reasons or many workers are affected or occupational diseases ha ve already developed. Appli cation s are to be submitted to the proper inspectorate o f industrial hygiene at the regional level and must includ e shortterm, medium-term, and long-term pro gram s for remedial action in the form of engineering, technology, orga nization, and medical care. The programs have to be presented by th e company manager in person . A time-limited permit may be gra nted aft er scrutiny that is usually accompanied by on -the-spot inspection, and it is often hinged on conditio ns to be met by the recipient of the permit. Should an application be made against the background of a particularly critical situation, the National Expert Committee on Industrial Hygiene wiII intervene to pass on the appli cation and compl ementary information and recomm endations to the GDR Minister of Health for the final decision making.
Plann ed action on job layout for the primary prevention of occupational diseases depends on informa tion abo ut current conditions. One ca nnot simp ly rely on sporadic workplace anal ysis and accidenta l checking on whatever harm ful factor. A system of methods for complex workplace anal ysis in the context of good industrial hygiene has, therefore, been devised in occupation al medicin e and has been thoroughly tested in all industries for several years. This complex workplace analysis was elevated to legal sta tus in 198I and is now bind ing for enterprise mana gement and the inspectorates of industrial hygiene (3). It covers all job-related requirements, expo sures, and stress factor s. Management of all ent erp rises, according to the valid labor sa fety sta tutes (9), ar e obliged to present detailed report s annually on their health-risk work places with explicit reference to the noxiou s agents and stress factor s implied.
Th e compl ex work anal ysis has been formul at ed to pro vide comprehensive and measurable information on health hazard s du e to harmful physical and chemical factors, indu strial dust , and job-related physical and neuropsychic stresses. A full-scale methodology for anal ysis and evaluation has been worked out for each of the factors involved. Health risks and occupation al stresses are rat ed against a general reference which is based on all the industrial hygiene regulations and mandatory exposure limits. The principle for this procedure may be seen from the following, highly simplified list: 1.0 = no exposure to noxious agents 0.8 =exposure always below the exposure limit 0.6 =perfo rmance and individual comfort affected by wor k condition s 0.5 = expos ure ident ical to the expo sure limit 0. 2 = exposure drastically abo ve the exposure limit 0.0 = exposure limit sur passed by several magnitud es Such a gradu ated list has proved to be advantageous, as it has eliminated the need for dealing with a multitude o f single pieces of information. The stress profile of a given workplace may be seen at first glance from its rating. Additional data on specific act ivities and on an enterprise as a whole are available in the form of computerized documentation. If the assumption is made that the mandatory regulati on s and exposure limits are of sufficient validity and reliabilit y, these rat ings may be assumed to characterize the probabiliti es of health damage.
Th e aforementioned compulsory ent erpr ise reporting on indu strial hygiene at workplaces is based on this methodology. Reports have to be submitt ed by the management of companies with ten work ers or more. They are checked and supplemented for regional analysis by the prop er inspectorate of industrial hygiene at the regional level and are forwarded to the GDR Central Institute o f Occupational Med icine for computerized evaluation.
Comprehensive data on the indu strial hygiene condition s of about 7.3 million wor kers have been stored in the indu strial hygiene information system. The usefulness of the system in terms of health policy and practice has been clearly demonstrated from the very beginning, as it makes essential dat a con tinuously available to the Council of Ministers, specialized ministries, the Nat ional Executi ve of the Confederation of Free German Trade Union s, indu strial union s, corporat ion and company man agement , and regional authorities for the fo llowing pu rpo ses: (i) the assessment of industrial hygiene by industries; (ii) the plann ing of priority action to alleviate health risks and other job-relat-ed problems; (iii) the verificatio n o f effe ctiveness of previous measures ta ken to improve work conditions; and (iv) the planning and enforcement of extended care in occupational medicine.
Analyses of industrial accidents and occupational diseases, together with anal yses of th e genera l situation in indu strial hygiene, are annua lly on the agenda of joint discussion s of the Council of Ministers with the National Execut ive of the Co nfederatio n of Free German Trade Union s. The conclusions resulting from such meetin gs are incorporated in planning at the indu str ial , corporation , and co mpa ny levels.
Th e elimination of hazards and unn ecessary difficulties from production pr ocesses and work conditions has continued to be the major approach to the prevention of occupational disea ses. Effective contributions can be made to primary prevention by the national health service and health institution s in the form of scientifically substantiated indices and guidelines, practical methods for analysis, and reali stic information on existing situations.

Secondary prevention of occupational diseases
Company-linked occup ational health services in the GDR ar e part of the nat ional health service. The y are in cha rge of the medi cal car e of wor kers in their occup ational environment and ha ve to ensure the seconda ry prevent ion of occupational di seases. Rou ghly 13 000 med ical offi cers and nur ses are ava ilable in 137 company-linked outpatient clinics, 334 company-linked do ctor -staffed med ical units, I 953 docto r-sta ffed compan y-linked medical outposts, a nd I 330 outposts staffed with nurses. Sixty-five percent of the work force in the GDR is under th e direct care of company-linked occupational health services. Th is to tal, for all practical purposes, is further increased to 75 lIJo when the services rendered by occupational health personnel affiliated with other institutions of public health are included. A very high degree of occupational health services is available close to the work places in areas of high indu stri al concentration .
Med ical offic ers at th e workplace level in the GDR carry o ut their dut ies und er the assumption that prevention, diagnosis, therapy, and aft er care form one unit y (4). Th ey are independent o f company man agement in terms of career promotion and finance and, the refore, can live up to their responsibilities witho ut constra int. Company-linked occupational health services are technically subordinate to the district medical officer but are under the pr ofession al guida nce and control of the inspectorate of indu str ial hygiene in cha rge o f th eir area.
Med ical officer s at the work place level can be specialists in genera l pra ctice, internal medicine, dermatol ogy, orthopedics, ophtha lmology , gyneco logy, otorhinolaryngolog y, dentistry, a nd occupational 276 medicine . These medical officers ha ve a wide-ranging scope of responsibilities in th e secondary prevention of occupational diseases, including first aid to cas ua lties of indu strial accidents, outpati ent t reat ment of workers and their familie s, periodic examina tions and screening, extended medical supervision of selected group s of workers, participation in the job assignment of conva lescents under rehabilitation schemes, shopfloor visits to inspect work co nditio ns, and th e counseling of man agement on all issues of occup ati on al health . Genera l hygiene in facto ry canteens, common rooms, and sanitary installations, as well as health education of man agement and labo r, arc ad ditiona l respon sibilities. The rat io of preventive to cura tive services is 30 to 70 on the average. Medical officers at the work place level are stron gly involved in prim ary medical care but are usually in a better position to offer their skilled services on account of their tho rough knowledge of patients' jobs and work conditions and perm anent cont act with the patients ' occupational enviro nment.
The first contac t between a medical officer at the workplace level and a worker is made during the preemplo yment examination , befo re an employment contract is signed . Suc h a med ical check-up may lead to therap eutic measures or aft er care . Othe r legal dut ies of th e med ical officer include regular fitness and mon itorin g checks of workers with part icular occupational exposures to no xiou s agent s and stress; occupational guida nce for ado lescents ; specific health care for women, shift workers, and elderly emplo yees; rehabilitation ; a nd advice o n the allo cati on of protected jo bs to workers with occupational health problems.
Fitness screening an d monit orin g checks of workers potent ially exposed to occupat ion al health risks a re amo ng the most substantial meth ods used by th e nationa l health service in the early detection of occupation al effects o n human health, th e prevention of occupation al diseases, and the redu ction of indu strial accident rat es and invalidity. They constit ute a highly compl ex model of extended occupation al health care.
A prog ra m of methods (13) came into fo rce in 1981 to ensure health-adjusted employment even at workplaces with inevitable health risks and other jo b-related difficult ies. Th e program pro vides for the compulsory medical exam inat ion of defined grou ps of wor kers prior to emp loyment o r at regula r intervals or before transfer to ano ther job within the same enterprise. Occupational fitness and monit orin g checks are compulsory for the following categories of wor kers: (i) adolescents up to th eir 18th birthday; (ii) people with ha rd ph ysical work; (iii) workers exposed to harm ful ph ysical factors, chemica l agents, and du sts; (iv) workers exposed to sources of inf ection; (v) workers invo lved in high-risk activ ities, such as night shifts , wor k at visual display units, work with risk of falling, the handling of explosives, work on high-voltage insta llatio ns, work with resp ira to rs, and th e ope ration o f co nveying an d hoisting equipment; and (vi) wor kers with so-cial considerations, including women with several children and individuals close to retirement. Provisions of the following nature apply to each group of workers under compulsory health monitoring: (i) informative definition of workplaces, typical activities, requirements, stress factors, potential hazards, and other jobrelated difficulties; (ii) detailed specification of methods to be used in the medical examinations; (iii) medical check-up intervals; and (iv) definition of functional disorders and diseases imposing limitations on or ruling out a certain activity under work conditions currently prevalent in the enterprise concerned.
In any medical check-up for occupational fitness assessment, the medical officer must refer to all documentation available from complex industrial hygiene analyses of the workplace in question. A medical examination becomes compulsory as soon as a workplace rating is 0.5 or lower (0.2, 0.0). Management is not only obliged to document workplace ratings but also to give a verbal description of the peculiarities of exposures in agreement with preset classifications. Rating 0.5, for example, stands for noise levels between 85 and 90 dB (A). Code number 76.1 must be added to describe "constant noise" or 76.2 for "variable noise without pulsed components," and 76.3 for "impulse noise". An alphabetic and systematic list has been issued on harmful chemical substances and dusts from which irritative, allergenic, fibrogenic, hematotoxic, hepatotoxic, neurotoxic, and carcinogenic qualities of substances can be derived. Medical officers at the workplace level are furnished in the GDR with comprehensive information on exposures and other stress profiles and are thus in a good position to make an informed assessment of all aspects relevant to specific work conditions and the individual health of the worker, as well as to undertake a profound diagnosis of fitness for a concrete job and, if necessary, initiate adequate medical action. Medical decision making on occupational fitness, consequently, is based on parameters of individual disposition and concrete workplace-related exposures. Emphasis must be placed on determining whether an existing congenital or chronic disease may be adversely affected by harmful occupational factors and stresses and may thus cause deterioration of the individual's health condition.
In the past, medical action had to be taken without such basic information on stress-related diagnosis, therapy, and after care. The company-linked occupational health services have been elevated to higher quality standards owing to this highly differentiated program of methods for fitness and monitoring examinations in occupational medicine. Highly accurate information on health risks and job-related difficulties is of particular interest to the general practitioner or medical specialist involved in occupational health but not personally affiliated with a specific enterprise and thus not in regular contact with his or her patients' real work conditions. Both management and the worker concerned will be informed about diagnostic findings by the medical officer. This practice ensures job assignment according to health. Limited fitness has been recorded over an extended period of time for 6 to 8 0J0 of all workers. In such cases, current jobs may be continued if provided with additional protection at the organizational, social, and medical levels. Preventive changes at a workplace may be recommended under certain circumstances. Unfitness has been recorded for 0.8 to 1.6 070 of the workers. Such medical findings will necessarily entail a change of job. The workers concerned have to be given health-adjusted jobs within their present enterprise, however, without any social disadvantage.
Roughly 1.2 million workers are annually involved in fitness and montoring checks by company-linked occupational health services. About 20 0J0 of these checks are made by medical specialists affiliated with institutions outside occupational health. Large-scale introduction of the program of fitness and monitoring examinations has clearly shown, on the other hand, that many medical decisions are still taken on the basis of expert opinion, say, individual discretion. Hence fitness criteria need further improvement. Too much room is still left for individualistic judgement. More basic knowledge has to be accumulated on the multifactorial etiology of numerous diseases and on the role played by individual disposition in the pathogenesis of occupational health disorders. Fitness criteria have so far rarely been subjects of research efforts in occupational medicine. It is, nevertheless, estimated that even with the instruments currently available the early detection of occupational effects on health is possible, and an effective contribution can be made to the prevention of occupational diseases. The assumption can be made that, in the long run, for workers with medically certified unfitness or limited fitness the probability for developing an occupational disease would have been much greater without the early detection of such occupational effects on health.
Important results obtained from medical examinations, just as the data recorded in complex workplace analyses, are entered into computer-adjusted files. Combined statistical evaluations of the workplace and health data have opened up unprecedented sources of epidemiologic information with great relevance to health policy orientation and research. The data compiled from fitness and monitoring checks in occupational medicine have provided the basis for the information system, which has been developed for occupational medicine since 1982.
Available from the developed information system are data on the incidence of findings and diagnoses subdivided by categories of activities, and these data can be processed to generate information by age, sex, industry, and company. An account is given in table I of findings by main groups of diagnosis (according to the International Classification of Diseases) for

Information system in occupational medicine
The structures and prerequisites in GDR society have enabled centralized planning and control at the company, regional, industrial, and national levels for action to enhance work conditions and to reduce job-workers who have undergone occupational health checks in our country. The rates of incidence represent findings typical of GDR morbidity. It is, however, permissible to draw some conclusions as to the general health situation, since all the workers included are employed full-time. For example, the figures can be assumed to represent the percentage contributions of fitness-limiting findings to main groups of diagnosis, with particular reference to activities and their associated exposures and other stress conditions. The relevance of selected findings to fitness is given for a small group of construction equipment operators in table 2. Data filed in the information system developed for occupational medicine may provide information on a wide range of important aspects, including the effectiveness of action taken for the primary prevention of occupational diseases, the quality of preventive occupational health checks, the general validity of industrial hygiene standards and exposure limits, and the effects of work conditions on general morbidity. Insights into such relations and implications are likely to strengthen the scientific basis for the exploration and implementation of more efficient forms of primary and secondary prevention. related difficulties and health risks. A specific information system was devised for this purpose in the GDR more than a decade ago. It has been tested and introduced into practice. It has made possible the identification of priority problems against the background of national health policy and national economy, and it facilitates both decision making at various levels and the assessment of efficiency. The information system is based on systematic periodic analyses of the following issues: (i) the industrial hygiene situation across the national economy, (ii) the incidence of occupational diseases, and (iii) the results recorded from fitness and monitoring examinations in occupational medicine. Each of these three items has been structured as a computer-supported system. System quality has been achieved through the implementation of compatibility of all the codes used and the many different possibilities of coupling the stored data.

Industrial hygiene situation
A methodology has been developed at the GDR Central Institute of Occupational Medicine for complex industrial hygiene analyses and assessment criteria. It has been introduced in all industries and is used by enterprises to report annually on health hazards due to potentially harmful factors and stresses. Reporting is compulsory, as mentioned earlier, for enterprises employing 10 workers or more. Detailed information has thus become available on the types and dimensions of job-related difficulties and health hazards for the workplaces of about 8.3 million people.

Occupational diseases
The incidence of officially recognized and registered occupational diseases has been annually evaluated for the entire GDR for a number of years. Reported suspicion, harmful factors, length of exposure, activity, age, sex, type of occupational disease, severity of physical damage, measures initiated for sanitation and rehabilitation, and the name of the enterprise, industry, region, etc, are among the data recorded for statistical and epidemiologic analysis.

Preventiv e examinations
The new program of methods for fitness and monitoring examinations in occupational medicine has been ext re me ly help ful in expa ndi ng possibilities fo r th e adequate as sessmen t of th e ge ne ra l health sit ua tio n of the wo r king population . In fo rmation not accessible in th e past on ge nera l a nd activity-rela ted morbid ity ha s now become a vailab le from the combined stati stical evaluation o f workp lace data and health data. The processing of d at a recorded from a bo ut 1.2 p eriod ic chec ks a t regular interval s during the ye ar provide s in formation o n th e incidence of fin di ngs a nd diagnoses a nd their rel evance to occupationa l fit ness by groups of acti vity, age, and sex for enterprises, industries, a nd regions. Resulting medical ac tio n , a t the sa m e ti me, be comes o ver seeable under the presented as pects of evalua ti o n, for exa m p le, th e prescription o f shelte re d jobs, th e co ntin ua tio n of treatment, exte nde d me dical care o r change of workplace. Ninety relevant diag n o ses are now open to activity-related evalua tio n , according to th e in ternational cla ssificat ion o f d iseas es of the ner vous, ca rd iovascular, re spiratory, di gesti ve, a nd mu scul oskeletal systems , sensory organ s, ski n, and so me a d di tio na l ca teg ories .
The information system in o ccupational medicine h a s become an instrument o f su bstantive importan ce to man agement, planning , a nd foll ow-up fo r th e G D R C o u n cil o f M ini st er s , t he Natio nal Executive of the Con fed era tio n of Free German Trade Unions, and all a ffil ia te d ind ustrial unions, ministr ies , co r pora tio ns , enterp rises, and local authorities . Information has proved to b e obtainable fro m the sys tem in the fo llo win g co nt exts: (i) effectiveness of mea su res taken to improve work conditions ; (ii) unresol ved pr oblem s a nd thus priorities in ind us t ria l hygiene that o ug ht to be ta ckled in the sanitation a nd modernization program; (iii) types , magnitudes , and distribution patterns of job -related health d isorders , in the co ntext o f real incide nce ; (iv) a cti vit y-related, ag e-related, and sexrelated ge nera l morbidit y; (v) current positi on in occupa tional med icine and necessary input; (vi) va lidi ty and dependabilit y of industrial hy giene standards a nd exposure limits; and (vii) health-related co m po ne n ts o f the la bor p ot enti al in society .