l^oC^Bo Official ]ournal of th^ European C^ornTnuniti^s 1^.^.^ 
IT 
COMMISSION 
COMMISSION MEMORANDUM 
FIFTH ECSC MEDICAL RESEARCH PROGRAMME 
Protection of workers against risks arising froni work in the coal and steel industries' 
^COA^^^^^^ 
MEMORANDUM 
I INTRODUCTION B 
^. NEED FOR THE PROPOSED PROGRAMME ^ 
3 PROGRAMME ^ 
3.L Occuoational cancels ^ 
3.^. Occupational hvooacusis ^ 
3.3. OccuoationaMesoi^ato^v diseases 10 
3.^. Occuoationaln^uscula^s^eletatcomolaints 10 
3.^. Diseases linked to e^oosu^e to certain chemicals 10 
3.D. Training and inforrnation of those involved in the industries tt 
3.^. Methods fo^ measuring ^vo^e^e^oosu^e It 
^t. COORDINATION OF^OR^ It 
^. RESULTS OFTHE PROGRAMME M 
6. FINANCIALASPECTS AND DURATION OFTHE PROGRAMME t^ 
B5 CONCLUSIONS t^ 
r^^ Official Journal of the European Communities l^ooe^BB 
1. ^^rod^ctio^ 
Thefourth E^C^ medical researchprogrammeon the 
effects on the health of workers of physical and other 
occupational factors at the workplace, adopted pursuant 
to Article^^ of theEC^C Treaty andpuhlishedinthe 
C^c^^r^^^^r^^CA^^ 
of ^ ^o^remher t^t, has expired. The nine million 
units of account made available were used up hy the end 
of the programme. 
The fourth programme was a natural continuation of 
earlier medical programmes dating hack to l^D,which 
examined hasicprohlems such as the aetiopathogenesis 
of pneumoconiosis, chronic bronchitis and emphysema 
andthe^arions aspects of respiratory physiopathology. 
foefinite progress has heen made in the knowledge of the 
respiratory diseases affecting iron^ore and coal miners 
and steel workers,with particular attention heing paid to 
pretention and early detection. 
The research being carried out under the fourth 
programme shows how the scope of the earlier 
programmes has clearly been extended. 
Respiratory diseases are notthe only diseases to strike 
workers in this sector and, in response to the wishes 
expressed by those in^ol^ed in the industries and in ^iew 
of the most recent biological discoveries, the 
programme^se^perimentalandepidemiologicalresearch 
has been extended to include all of the harmful agents in 
the workers^ environment in these industries and indP 
vidualfactorsrelatingtosensitivity. particular attention 
has thus been paid to cancers and the earlydetection of 
cancer by research into the carcinogenic nature of atmoD 
spheric pollutants in the EC^ industries. The 
programme also now includes the development of an 
information and training system for all those responsible 
for the pretention and detection of occupational 
diseases, aimed at improving the methods used by occuD 
pational physicians and safety engineers for the quali 
tativ^e and quantitative evaluationofharmfulagents. 
^here iron and steel works and coking plants are 
concerned, epidemiological, biological and functional 
research takes into account all operations which may 
ha^re harmful effects on health, paying particular 
attentionto certain specific diseases. current work on chronic respiratory diseases is intended 
tofollowupthemany projects conductedunder earlier 
programmes methodically and carefully and to fill any 
gaps in respiratory functiontesting. 
A total of ^D research projects, most of them still in 
progress, ha^e received financial aid under the fourth 
programme. They were selected on the basis of how 
likely they weretoproduceresultswithsomepractical 
application. 
^ome^eryusefulprojects, althoughnot yet completed, 
ha^e already e^aminedthe following subjects^ 
— the harmonization and standardization of lung tests, 
— the evaluation of the health risk presented by the 
action of various metals ^chrome and nickel in 
particulars on iron and steel workers, 
— astudy of the cell populations of the deeplung and 
thebiologicalmechanismsin^ol^ed,usingthebron 
choalveolar lavage technique, 
— the influence of the temperature and humidity of the 
air breathed by workers exposed to climatic stress, 
— the early diagnosis and analysis of the development 
of the various types of respiratory disease, including 
astudy of bronchial hyperreactivity, 
— the pretention of back pain in the mining industry, 
— a study of the physical factors governing the 
depositionof inhaledparticlesinthelungs, 
— aspects of specific skin complaints in miners. 
CBOne of the programmers major achievements was the 
updating of the EC^ questionnaire on chronic bron 
chitis and pulmonary emphysema drawn up in t^DB. This 
wasnecessary totake account of scientific progress, to 
make the questionnairemoremanageableandto ensure 
comparableresults wereobtained.Thenew^ersionwill 
be useful in the fifth programme for obtaining truly 
comparable data fromthe^arious^iember states. 
Theresults of thefourthprogramme willbecollected, 
assessed and combined, and will be made available to 
interested parties atasymposiumdue to beheld during 
1^. widespread circulation of the results will assist 
their implementation inthe industries concerned,one of 
the aims of the fifth programme too. 
No C 47/8 Official Journal of the European Communities 19. 2. 88 
2. Need for the proposed programme 
Despite the remarkable progress made during earlier 
programmes and the wide scope of the fourth 
programme, workers in the coal and steel industries are 
still being exposed to major health hazards and even to 
unforeseen risks arising from, for example, the intro­
duction of new processes and technologies and the use 
of new chemicals. 
Respiratory diseases are certainly still widespread in the 
industries, but only certain specific aspects of pneumoco­
niosis, chronic bronchitis and emphysema require further 
study. It is highly likely that when the research projects 
initiated during the fourth programme are completed 
and evaluated, a huge quantity of information will 
become available and only in certain specific cases will 
more detailed examination be needed. This is true in 
particular of the epidemiological projects, most of which 
will be completed in 1987, which will provide new infor­
mation on the frequency and different types of respi­
ratory diseases in miners and iron and steel workers, and 
in particular on the prevalence of the radiological and 
respiratory function anomalies associated with 
emphysema, and on the influence of smoking and 
various environmental factors. 
The results of the projects will then have to be put into 
practice in the prevention of disease in the industries. 
Likewise, the work carried out during the last two 
programmes on standardizing respiratory function tests 
should enable simple, reliable techniques to be 
implemented at the workplace. 
Only if the results can be incorporated into the short and 
medium-term preventive measures taken in the industries 
concerned, will the respiratory element of the fourth 
programme be successful. 
Furthermore, it is an accepted fact that other conditions 
may be responsible for diseases in the two sectors in 
question and that it is therefore necessary to take a 
broader view of the diseases contracted by iron and steel 
workers, coking plant workers and iron-ore and coal 
miners. Examples include occupational cancers, which 
are very serious, and osteo-articular diseases which are 
very common. 
In this context it must be remembered that: 
— there are certain Council Directives on the protection 
of workers against the risks of exposure to certain 
agents at the workplace, the provisions of which apply likewise to the ECSC sector and which come 
under the broader framework of the Council Resol­
utions on Community programmes on safety and 
health at work, 
— a Community action programme is being launched 
against cancer and contains a number of measures for 
the prevention of occupational cancer including 
defining and coordinating topics for practical 
research at the workplace. 
Furthermore, an ILO recommendation and convention 
on the organization of health services at work were 
adopted in 1985, reconsidering the question of how 
occupational medical services should be structured and 
funded. A detailed examination of the potential effects of 
this proposal in the coal and steel industries would be 
useful. 
In view of the above and at the request of the industries 
concerned, it is proposed to introduce a fifth medical 
research programme with the following objectives: 
(1) to respond to workers' needs by improving the 
physical and psychological conditions in which they 
work; 
(2) to help protect the health of workers, including 
preventing all types of occupational disease; 
(3) to help the ECSC industries to implement preventive 
measures and in particular to comply with 
Community objectives, including EC Directives, in 
relation to health at the workplace; 
(4) to promote projects to use the results of earlier 
programmes to fulfil the objectives described above. 
3. Programme 
An analysis of the proposals put forward by national 
experts on the advisory committees and in the Working 
Party on Industrial Medical Services — Coal and Steel 
indicates that the fifth programme should concentrate 
mainly on priorities, but should not overlook certain 
lesser aspects about which the various bodies are 
concerned. 
In line with the resolution of the ECSC Consultative 
Committee of 23 March 1984 (OJ No C 114 of 28 April 
19. 2. 88 Official Journal of the European Communities No C 47/9 
1984, page 3), the projects involved in the research will 
be of specific practical value to the sectors concerned, 
and will be initiated and directed by industrial medical 
officers or hospital and university doctors working in 
close contact with the industries concerned. 
This will encourage the pooling of research at 
Community level by giving priority to projects involving 
cooperation between two or more Member States. 
In addition, care will be taken to ensure that projects are 
undertaken by a particular sector known to observe 
Community standards relating to the environment, 
health and industrial safety. 
The particular subjects selected for the programme are as 
follows. 
3.1. Occupational cancers 
Within the overall framework of the resolution of 
the Council and representatives of the Governments 
of the Member States of 7 July 1986 on a 
programme of action of the European Communities 
against cancer (OJ No C 184 of 23 July 1986), 
research will continue in order to define and assess 
the risks presented by recognized or suspected 
carcinogenic agents found at workplaces in these 
industries, with a view to establishing a specific 
policy of prevention. 
Research has already been carried out during earlier 
programmes in specific sectors — iron-ore mines and 
coking plants — which were found to have an 
increased risk of lung cancer. Other projects are in 
progress to assess the risk of cancer as a result of 
exposure to high concentrations of nickel and 
chrome compounds in the fumes released during the 
welding of stainless steel or in the production of 
special steels. 
In addition to these questions, which may require 
further study, it will be necessary to encourage 
research aimed at identifying carcinogenic chemicals 
and assessing them at both epidemiological and 
laboratory level, with appropriate mutagenicity and 
carcinogenicity tests. In view of the lack of reliable methods of measuring 
levels of past exposure, at epidemiological level 
priority should be given to exploratory studies. A 
prevalence of stomach cancer in miners and cancer 
of the lung and larynx in steel workers has been 
noted which merits specialized research. 
It must also be remembered that there has been 
growing scientific speculation over a number of 
years about the possible link between exposure to 
silica dust and the occurrence of lung cancer; conse­
quently it would seem necessary to provide for 
research in this field taking care to allow for the 
possibility that other carcinogenic substances may 
also be present. 
Looking at the problem generally, consideration 
should be given to promoting research in areas such 
as the early detection of cancer and the devel­
opment of a system to educate and inform workers 
about recognized carcinogenic agents. Furthermore, 
it will be necessary to prepare morbidity and 
mortality statistics which are comparable at 
Community level. 
3.2. Occupational hypoacusis 
The Council Directive on the protection of workers 
from the risks related to exposure to noise at work 
was adopted in 1986 (OJ No L 137 of 24 May 
1986). It contains a series of measures to afford 
workers the highest level of protection, and 
guidelines for monitoring the hearing of those 
exposed. 
Although several projects have already been carried 
out during earlier programmes, noise still poses a 
considerable health problem in the ECSC industries. 
At the present time hearing protection and preser­
vation depend mainly on technical measures to 
reduce noise at source. However, the results of 
these measures can be evaluated only by 
audiometric screening and monitoring by means of 
specific longitudinal studies. 
For this reason there must be close cooperation 
between the medical research carried out in this 
sector and other ECSC programmes dealing with 
ergonomics or technical noise control. 
Once the provisions of the Council Directive are 
implemented, the industries will have stricter 
responsibilities than in the past. Research in this 
field could therefore lead to the development of 
suitable systems for protecting workers' safety and 
health from the effects of noise on the hearing and 
other areas. 
No C 47/10 Official Journal of the European Communities 19. 2. 88 
3.3. Occupational respiratory diseases 
Although much attention has been devoted in earlier 
programmes to respiratory diseases such as pneumo­
coniosis, chronic bronchitis and emphysema, 
allowing remarkable progress to be made in the 
prevention of these diseases, it cannot be denied 
that specific, well-defined research is still needed in 
this field. 
In the pneumoconiosis sector there are still problems 
to be solved, such as: 
— the limit values for mixed dusts; 
— variations in the frequency of pneumoconiosis 
between coalfields with the same percentage of 
quartz, and therefore the interaction of quartz 
with other dusts; 
— intermittent dust; 
— aggravating co-factors; 
— new methods of diagnosis. 
In addition to 'classic' pneumoconiosis attention 
should also be given to the risk presented by metal­
lurgical graphite in steelworks, which seems to have 
attracted particular interest recently. 
As far as chronic bronchitis and emphysema are 
concerned, research in progress under the Fourth 
programme may produce comprehensive results or 
may leave some areas for further investigation, such 
as the definition of dust limit values or the role of 
coal dust or silicate suspensions during continuous 
casting in iron and steel works. It may also be 
necessary to study the relationship between these 
diseases and problems affecting the upper airways, 
as well as occupational asthma. 
This research may also cover the adverse effects of 
unfavourable climatic conditions, including a study 
of the use of protective breathing apparatus in 
relation to airway resistance and type of exposure. 
The final aspect is to provide for the application and 
assessment at the workplace of simple, reliable res­
piratory function tests and of the revised version of 
the ECSC questionnaire on respiratory symptoms. 
3.4. Occupational muscular-skeletal complaints 
Muscular-skeletal complaints in general and lumbar 
complaints in particular continue to be a major 
cause of absence from work in the ECSC industries. A project on the epidemiology of low back pain in 
coal mines is being carried out under the Fourth 
programme, but a greater effort is required at 
Community level to standardize techniques for 
assessing the prevalence of low back pain in various 
working conditions. 
It now seems an appropriate time to carry out 
experiments to draw up aptitude criteria for ac­
tivities which are particularly stressfull for the 
vertebral column. 
The results of the research taken together with the 
recommendations of the ad hoc committee on risks 
to the lower back at work will enable objective 
criteria to be drawn up for direct application in the 
ECSC industries. 
Furthermore, it must be remembered that other 
diseases in this field have been found in the ECSC 
industries and require careful investigation. There 
are, for example, knee diseases such as chronic 
meniscosis, chondritis, etc. and elbow diseases 
(epicondylitis). 
An analysis of this area must also include meticulous 
identification of the causes of these complaints and 
the role played by factors such as vibration. 
3.5. Diseases linked to exposure to certain chemicals 
In addition to certain chemicals which cause cancer 
(see 3.1), there are many other agents which are 
acknowledged or suspected to have a harmful effect 
on workers. Moreover, detailed toxicity assessments 
are rare or non-existent for many chemicals. 
Particular attention should therefore be given to the 
risks of skin disease (including allergies) and renal, 
hepatic, cardiovascular and neurological diseases 
arising from exposure to substances such as: 
— isocyanates (used in adhesives and resins), 
— solvents and detergents (used in electro­
mechanical maintenance), 
— cutting oils and used oils, whether natural or 
synthetic (used in particular in cold reduction 
mills and roll adjustment), 
— additives derived from hydrocarbons (used in 
steel production), 
19. 2. 88 Official Journal of the European Communities No C 47/11 
— organic phosphorous compounds (present in 
hydraulic transmission fluids). 
This is not an exhaustive list in that any substance 
suspected of having a harmful effect on workers 
could be the subject of research. 
3.6. Training and information of those involved in the 
industries the industrial sector in consultation with worker-rep­
resentatives. The Committee of Producers' and Workers' 
on Industrial Safety and Medicine, and more specifically 
its subcommittee, will subsequently inform the 
Commission of the opinions of management and workers 
on the various projects. Finally, a committee of 
government experts comprising appropriately qualified 
senior civil servants nominated by the Member States 
will submit its opinion on the projects, taking into 
account the policies and experience of the Member 
States. 
If the safety and health protection of workers is to 
be improved, it is necessary to promote and develop 
the transfer of knowledge acquired in pure, physio­
logical and clinical research to the practical 
measures designed to bring about this improvement. 
Programmes must therefore be devised for trans­
ferring such knowledge, including training and 
information schemes for specific groups such as 
young people or those in key positions in their 
undertakings. In accordance with the resolution of the ECSC Consul­
tative Committee of 23 March 1984, the Commission 
will be assisted for the first time in the course of the 
medical research programmes by national groups mainly 
comprising senior occupational physicians from under­
takings in the coal and steel industries. The groups will 
form a compulsory link with the Commission and its 
advisory committees for selecting research projects and 
fixing priorities at national level. When the Commission 
accepts a project it will conclude a contract with the 
party concerned which makes it compulsory to submit 
technical reports on the work carried out. 
3.7. Methods for measuring workers' exposure 
Controlling harmful agents at the workplace 
requires precise knowledge of the pollution levels 
caused by the agents concerned, in order to evaluate 
precisely the dose/effect ratio. 
A considerable amount of work has already been 
done in this field in both medical research and 
research on industrial hygiene, but there are still 
many untouched areas to be investigated. 
Appropriate monitoring methods must be tested for 
measuring regular exposure, whether or not 
accidental, so that the samples taken are represen­
tative of workers' individual exposure. The reports will be examined and discussed by the 
committee of scientific experts, which will also coor­
dinate the research programme by setting up working 
parties for the various subjects; the working parties will 
also have direct contact with the researchers at meetings 
to be held mainly in Luxembourg. 
5. Results of the programme 
Concise final reports on the projects and, where appro­
priate, combined reports on groups of projects will be 
drawn up and distributed in the relevant sectors of the 
industries. 
As little is still known about some harmful 
substances, it would also seem necessary to devote 
more research to establishing biological limits so 
that pollution levels at the workplace may be 
assessed. The network of national groups and the committee of 
scientific experts could be an effective way of keeping 
the various sectors in touch with progress and devel­
opments as they arise in the programme. 
4. Coordination of work 
As in earlier programmes, the Commission will be 
advised on the scientific aspects of research projects by a 
committee of scientific experts comprising a maximum of 
two experts from each of the Member States, which will 
consult persons qualified in the various fields involved. 
These experts will be nominated to the Commission by To ensure that information on the launching of the 
programme and the research undertaken reaches a wide 
public, details will be published in Euro-Abstracts. 
Copies of complete final reports will be provided by the 
Commission on request for any interested parties. 
No C 47/12 Official Journal of the European Communities 19. 2. 88 
The results of the projects may be included in conference 
presentations and/or published in scientific journals of 
recognized status and with a large readership. 
When the programme expires, the results will be made 
available to those concerned in the coal and steel 
industries at symposium. 
6. Financial aspects and duration of the programme 
All of the earlier medical research programmes ran for 
five years, which proved sufficient for obtaining positive 
results. 
It is therefore proposed that the fifth programme should 
have the same duration. 
The funds to be allocated to the programme must 
include not only the financial aid for the projects, but 
also the related costs of implementing the programme 
and disseminating the results, fees paid to experts 
consulted, the costs of publication, translation, typing, 
conferences, etc. 
In assessing the funds required, account was taken of the 
cost of previous projects, average cost increases, the 
annual budget for social research in the coal and steel 
sector, the equipment required by institutions and the 
staff needed for the satisfactory organization of the 
programme. 
In view of the above and the fact that the financial aid 
granted by the Commission is usually no more than 
60 % of the total cost, it is considered that, to ensure the success of the programme and to provide an effective 
contribution to improving the health of workers in the 
ECSC industries, a research appropriation of 12 million 
ECU must be provided, spread over five years from 1988 
onwards. 
7. Conclusions 
The Commission of the European Communities: 
— in view of the need to encourage medical research 
dealing with the protection of workers against risks 
at the workplace in ECSC undertakings and to 
improve health, hygiene and well-being in these 
undertakings, 
— account being taken too of the favourable opinions, 
approval and views expressed by the advisory 
committees of experts and the professional and 
government representatives, 
— having regard to Article 55 of the Treaty establishing 
the European Coal and Steel Community, 
proposes a total appropriation, depending on the budget 
funds available, of 12 million ECU for the implemen­
tation over a period of five years from 1988 of the fifth 
medical research programme on the protection of 
workers against risks arising from work in the coal and 
steel industries. 
In the light of the above and given the importance of the 
programme of action of the European Communities 
against cancer, the Commission also proposes that 
approximately one third of this budget be devoted to the 
part of the programme concerning occupational cancers.