Czech Republic

1. Duties of the employer concerning employees' health

   
   In Czech Republic the employers are responsible for a variety of measures concerning employees' health. The present system of occupational Health is based on the Labour Code and on the Public Health Protection Act. It makes obligatory for employers to ensure the safety and protect the health of employees at work especially in relation to risks which may pose a danger to life and health. The employers are responsible for establishing the risk factors and monitoring of their level, minimizing and prevention of job risks. In case when risk at work cannot be eliminated or sufficiently limited by technical means or by reorganization of work, the employer is required to provide his/her employees with personal working protection aids. Employers shall also according to the legislation categorize all jobs according to a degree of work load and possible effects on health, ensure health check - ups for all workers contingent on a job category and special health risks, not allow employees to perform work, which is beyond their ability and which is inappropriate to their state of health; ensure that first aid is available to employees; inform employees about the classification of the work which they are doing, of the health care facility which will provide them with occupational preventive care and with the preventive medical health checks; provide employees with training on the statutory and other regulations related to the safeguarding of safety and protection of health at work, investigate the causes and circumstances of an injury at the work and keep records relating to all injuries at work, which results in employees death or in incapacity to work for more than three calendar days and keep records on all employees suffering from an occupational disease and compensate them for it.

2. Understanding of WHP concept

   The concept of workplace health promotion is understood by the stakeholders in this field firstly as a mixture of traditional occupational health and safety activities enriched by implementation of programmes supporting and facilitating healthy lifestyles of employees and secondly as development of cohesive, coherent and comprehensive internal strategies on health of employees' in enterprises/organisations. The emphasis put on traditional approach is caused by the fact that working conditions are still not at a sufficiently high level in many enterprises, in SMEs in particular. Education in healthy lifestyles is perceived as a tool that helps to change risky behaviours. It should follow after an improvement in working condition. And at the final stage there is room for planning, co-ordinating and evaluating of all health related measures as necessary.
   
   The Czech legislation gives a definition of health promotion and workplace health promotion in several acts.
   
   First of them is the Act no. 258/2000 on public health protection that regulates the rights and obligations of natural and legal persons in the fields of public health protection and Public health protection and promotion are defined in this act as a sum of activities and measures towards the creation and protection of healthy living and working conditions and prevention of the spread of infectious and high prevalence diseases, occupational health risks, occupational diseases and other relevant health disorders and surveillance of maintenance of such conditions.
   
   Another piece of legislation concerning health promotion issues is the Government resolution no. 1046/2002 on the Long-term programme for improvement of the population health in the Czech Republic - Health for All in the 21st Century. It is in fact a national adaptation of the WHO Programme Health for All in the 21st Century. Disease prevention and health promotion are relevant parts of the entire Programme and are integrated into strategies for most goals. Workplace health promotion broadens health protection in enterprises with a new concept of health education; nevertheless, unlike health protection and work safety workplace health promotion is not based on legal regulations and is therefore a sort of voluntary, beyond-standard activity.
   
   Health protection and promotion is also described as a common concern and responsibility of all citizens, organizations, institutions, interest associations and state administration in the Government resolution no. 810: Environmental health action plan that tackles generally the issue of environmental health.
   
   Apart form the term health promotion and workplace health promotion other terms relating to the topic of health at work are used in Czech legislation. In the Government resolution no. 273/1992 related to the national plan of health promotion and restoration and the draft project of mid-term strategies for health promotion and restoration the expression "Healthy enterprise" is used. According to that act healthy enterprise usually focuses on making behavioural change towards healthy lifestyle and workforce regeneration combined with occupational health and work safety. In the Act no. 20/1966 on Public Health Care that concerns health care provided by the society to the public there is a description of "Occupational health care facilities" that according to legislation provide counselling in the issues of health protection and health promotion and social wellness of employees, assess effects of work and workplace conditions on human health, carry out preventive medical check-ups of employees, ensure workplace first aid, cooperate with the competent public health authority and are involved in the training and education in the fields of health protection and health promotion.
   
   On the practical level mainly three topics are currently considered important elements of workplace health promotion. The first one is the issue of motivation of employers - that is how to convince management that the benefits from workplace health promotion could be higher than its costs; the second is the motivation of health insurance companies - to support health promotion activities at workplaces and the third area of interest is proper education of specialists and other workers in the field of health prevention. Research in this field causes no big problems, participants in the studies are usually well motivated. The key challenge is the implementation of workplace health promotion on a large scale due to low interest among companies, especially small and medium size ones.

3. Monitoring of conditions and professional training for WHP

   There are several very interesting research projects, mainly epidemiological studies, carried out in Czech Republic that can be applied to the workplace health promotion development.
   
   One of them is the longitudinal study of health state and life- and work style of intellectual workers conducted by a group of researchers: Frantík, E., Horváth, M. Kožená L. from the Centre for Occupational Medicine, National Institute of Health in Prague. Its aims were to find predictors of health and performance deterioration and to design screening procedure for health risk factors. For 20 years (1973 - 1993) researchers have been following the examined group of 675 middle-aged workers (39 women) in 7 technical applied research institutes performing clinical, biochemical, psychological examinations. In the result of the research a screening questionnaire with PC program for complex evaluation of health risks - method since used in many following studies and health programs - has been developed.
   
   Another important research concerned the health state and cardiovascular response to work stress in the Prague ambulance workers. It was conducted in 2000 - 2001 by Kožená, L. and Frantík, E. from the Centre for Occupational Medicine, National Institute of Public Health in Prague and consisted of a screening questionnaire and 24 hour monitoring of heart rate and blood pressure. It was performed on the group of 80 workers of emergency ambulance service (drivers-paramedics, nurses, control-room dispatchers, doctors). It clearly shown that there is a significant rise of blood pressure in situations described as stressful and that there is a lower blood pressure response to stress in drivers-paramedics qualified as nurses when compared to drivers without this qualification.
   
   As far as the training in the workplace health promotion is concerned there are professional groups obliged to undergo preparation for this sort of activities (occupational health physician, occupational health nurse, public health physician, psychologist working in public health, public health assistant).
   
   There are also additional possibilities of acquiring know - how and education in WHP at the courses at National Institute of Public Health. Courses are certificated in the system of medical education in the Czech Republic, each person interested in WHP can participate.

4. Activities and Models of Good Practice in the field of WHP

   Czech Republic is very active in the field of dissemination of workplace health promotion concept. Since 2000 several major events popularizing this idea took place in the country. One of the most important was a series of annual conferences on Workplace Health Promotion that took place froem 2001 till 2003. The 3rd National Conference on WHP in Brno was at the same time the 1st general assembly of the National Forum of Health Promoting Organizations. In 2004 Workshop on the Methodology and Assessment of Worksite Health Promotion took place.
   
   There were also successful projects propagating the workplace health promotion such as introduction of Section Workplace Health Promotion on National Institute of Public Health pages in 2005. It included Kriteria kvality podpory zdraví na pracovišti - edition of the Czech translation of Quality Criteria for Workplace Health Promotion. A seminar for public health physicians and occupational health physicians was organised and the competition in WHP for the title of Health Promoting Enterprise of the year was organised in 2005 for the 1st time. Since 2006 - courses in Workplace Health Promotion will start and the competition for the title of Health Promoting Enterprise of the year will be held.
   
   All those activities and developments can be brought to life thanks to the financial support of the Ministry of Health provided via initiatives such as the National Program of Health Promotion-Projects of Health Promotion. Each Czech legal entity can apply for this grant. There are 14 thematic sections in this project that include: nutrition improvement; smoking cessation; stress reduction; reproductive health improvement; reduction of alcohol consumption; physical activity optimization; disease prevention; prevention of injuries, poisonings and violence. There are also setting approach projects funded within this framework that include: health promotion in the village, town, region, and action plans for health and environment; health promotion in schools and, of course, health promoting enterprises.
   
   There are many stakeholders active in the field of WHP in Czech Republic besides Ministry of Health. These include:
   
   
   • Centre of Occupational Health, National Institute of Public Health, designated as WHO Collaborating Centre for Occupational Medicine. Its main area of competence is applied research and development of new methods, reference activities for regional public health authorities and their supervision, participation in the legislation process concerning health in work issues, harmonization with EU requirements, international collaboration with institutions as WHO, ILO, OECD, UNEP, US NIOSH etc. This Institute works in the field of workplace health providing advisory and educational activities such as: research concerning workload, health state and health risks associated with the particular work conditions and suitable preventive and compensating measures, recently focusing on the professions with high psychological load; organization of courses, seminars and workshops on planning and implementing health promotion programs; implementation of WHP projects in the enterprises; counselling for organizers of workplace health promotion. NIPH conducted many projects tackling with WHP. Since year 2000 it carried out many initiatives, especially health promoting programs in particular organizations, namely in: Power and Ecological Engineering Company in Brno in 2002; the Office of Regional Authority of Central Bohemia in Prague in 2003; the 3 enterprises in the West Bohemia - cooperation with the General Health Insurance Company in 2004; schools participating in the project Healthy School - cooperation with the Centre of Health and Environment, NIPH in 2005. Currently they are working developing the health promotion programmes in the Opera House - designed for singers in the Opera chorus and players in the orchestra - 2005- 2006; Siemens Elektromotory Mohelnice (1800 employees); the building company SMO Otrokovice (200 employees).
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   • Institute of Public Health based in Prague ; contributory organization of the Ministry of Health of the Czech Republic. It is a health care facility providing extensive activities in the areas of laboratory analyses, public health services and counselling in health promotion. It includes public health centres (occupational health department, traveller vaccination), public health laboratories, microbiological laboratories including parasitology and virology, toxicological laboratories and laboratories for outdoor and indoor air quality assessment. The Institute focuses on health education and health promotion. It has been involved in creation, launching, organization, coordination and implementation of health protection and health promotion programmes not only for the adult economically active population but also for children, adolescents and seniors. It provides counselling in healthy lifestyles, drug use prevention and prevention of infectious diseases, in particular HIV/AIDS. It ensures primary and partly also secondary disease prevention. Special attention is paid to the monitoring of population health, trends in the incidence of diseases, health effects of environmental factors, healthy living and workplace conditions and causes of work disability. In cooperation with enterprises and organizations the Institute focuses on health promotion programmes targeting prevention of diseases leading either to early death or work disability such as heart and vascular diseases, tumors, diabetes, osteoporosis, locomotory system diseases, obesity, etc. Special attention is paid to prevention of prolonged excessive stress, stress control and stress management programmes. All of these are intervention programmes. Apart from laboratory and clinical examination, disease risk factors and effective intervention measures are determined and risk level assessment is carried out. Each participant is given information on why and how risk factors develop and what to do to limit or eliminate their effects. In this field, counselling, lectures, workshops and discussions are organized. Health education also includes distribution of health education materials and teaching aids. Institute carries out within particular programmes specific and highly specialised examinations such as e.g.: for prevention of heart and vascular diseases: internal examination, nutrition status assessment, anthropometric examination, bicycle ergometry testing, psychological examination and biochemical analyses. Comprehensive intervention targeting major risk factors or for cancer prevention: oncological examination, biochemical and hematological analyses and screening for selected markers of malignancy depending on the participant's condition. Intervention targeting major risk factors.
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   • Institute of Public Health based in Jihlava specialises in preventive medicine; it also performs comprehensive occupational health services such as measurement and assessment of physical and chemical factors in the community and occupational environment;; laboratory services in public health protection; occupational health care; counselling and consulting services for both employees and employers, counselling centre for healthy workplace conditions, preventive check-ups, organization of and training in workplace first aid, implementation of health promotion programmes in enterprises. They participate annually in the health promotion project: Highland Healthy Enterprise.
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   • Regional Institute of Public Health placed in Brno with its Department of Promotion of Health provides a variety of services aiming at improvement of knowledge of health lifestyle (health education activities for schools, companies, public); prevention of obesity; nutritional consulting service, prophylactic check ups (blood pressure, cholesterol level, body mass index, Bodystat, lungs' capacity, prevention of cancer etc.) and expert services in these topics; support in implementation of healthy lifestyle of employees; co-operation with companies - therapeutic or rehabilitation services offered by employer to employees; professional experience in improvement of work safety and work conditions and expert services in work-related stress factors. The most important task of Health Promotion Department is check-up of health status of individuals and improvement of health in the general public, with emphasis on all activities regarding improvement of healthy lifestyle (programmes for schools, for companies, community programmes etc.). The Institute recently started developing co-operation with organizations with the objective to implement the strategy of promotion of the health for employees. This new alliances resulted in realisation of many projects:
     • Non-smoking Organization - movement headed by RIPH from the year 2002. It associates 43 organisations in Brno that are committed to implementation of non-smoking workplaces policy - expert services supporting employees that want to quit smoking
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     • Healthy Company as a Bonus for Life- expert services in health promotion. This project developed by Bartlova in 2003 - consisted of : application of programme Non-smoking Organization; nutrition consulting services; prophylactic check ups (blood pressure, cholesterol level, body mass index, prevention of cancer etc.) and expert services; programme for management - stress coping, communicative techniques, leadership, tests of personality). Company that cooperates in this activity is: ŽS Brno, a.s.,- Railway Buildings Plant
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     • Noise the Killer - special community health promotion project by the Ministry of Health - developed by Zidková in 2005 - consisted of activities for public edification in noise reduction. Cooperating organization selected were restaurants in Brno City, activities were aimed at reduction of loud or anoying music
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     • Workplace Health Organization - expert services in project proposed by NIPH (National Institute of Public Healh) - in the year 2005 - cooperating organization was PENAM a.s., Brno
     
     
     The Institute in Brno carries out many health promoting activities for employees, such as educational programme 'Days for Health' aimed at prevention of obesity, abuse of substances (smoking, alcohol and other addictions); 'Stop the Noise!'; prevention of musculoskeletal disorders - educational programme aimed at ergonomic aspects of workplace or prevention of work-related stress . It also participates in research projects, e.g.: Ergonomics in monotonous work - analysis of jobs with repetitive work, arrangement of workplaces, optimal work regime, psychosocial factors of workload; Subjective evaluation of impact of monotony on mental health and somatic disorders at workers with repetitive work
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   • PREMEDIS, s.r.o., Liberec, Limited Liability Company deals with disease prevention - work related especially; ergonomics; physiology of work; health promotion and workplace health promotion. It takes part in implementation projects, specialises in services for medium -sized enterprises and consulting. Also carries out training - for groups and individuals. Since 2000 undertook various activities in the field of work health risks prevention; active self-care about health; prevention of obesity and stress at work.
   
   
   Many companies and organizations in Czech Republic develop their own health promoting policies that can be considered models of good practice in this field. Some of them have been identified and characterized for the purpose of this publication.
   
   GLAVERBEL CZECH a.s. Plant Kryry (http://www.glaverbel-czech.com/en/index.cfm) is is the leading manufacturer of float glass and its applications in Central and Eastern Europe. The sole owner of all shares of the company is the world's second largest manufacturer of float glass in Europe - Glaverbel group. The latter is part of Asahi Glass Co. Ltd., which is the world's dominant glass manufacturer.
   
   The company constantly strives to be open and helpful towards the public. It is successful and financially strong company that wants to participate in the economic, social and ecological development of the town and region where it is located. The company hires 1241 employees in 6 plants. It has 28 daughter and distribution companies.
   
   The health promotion project within the company was carried out by the Lázně Teplice a.s. (Spa Teplice) (http://www.lazneteplice.cz/en/); Klinika CLT Teplice (CLT Clinic, Ltd.) (http://www.lazneteplice.cz/en/index_clt.htm) and Premedis s.r.o. Liberec. The main objective of the project was to: evaluate and check out the current state of the health-care plan and take necessary measures to strengthen it; to suggest a blueprint for health care for staff members; to back health care for staff members, reduce fatigue and help each member of staff find contentment in their work; to minimize undesirable effects of work on health and reduce the number of employees on sick leave; to accord with the relevant legislation in the EC and the Czech Republic ; to preparethe implementation of the health-improving measures and put them into practice; monitoring their effectiveness continuously; to make use of the input documents and the outcomes of the pilot project for further cooperation with the company Glaverbel a.s. and the 'Klinika CLT' clinic and, finally, to form a team of internal and external partners who have a role in securing health care for staff members.
   
   In February and March 2005 a broad analysis of factors affecting health of staff members was carried out. The results included data on health care for staff members and recommendations for possible improvement. These results formed also the basis for future monitoring and evaluating of the effects of the particular measures. Based on survey a proposal was primarily submitted in order to change the categorization of jobs. It involved reduction in the number of high-risk groups (i.e. performing jobs involving some kind of risk) by 53 persons, also those with high physical strain factor by 16 persons and, finally, those with the local muscular strain factor. All this meant a considerable contribution to health care and welfare of the plant. In June, the "Health promotion" training was carried out. The participants appreciated the significance of this seminar and are now determined to carry on health promotion. On the basis of an agreement with the plant management and in cooperation with the project team, the ergonomics of work were improved and the measures approved were gradually put into practice.
   
   In the course of the second half of the year, the so-called Catalogue Sheets were drawn up. Their main purpose is to describe the operations in individual workplaces, detect the high-risk factors and define the necessary health-improving measures. The Catalogue Sheets will form the main part of the 'Health Care Manual', which will be drawn up by the end of March 2006. While the Catalogue Sheets were being drawn up, staff training was realized in the form of on-the-job training. Individual working activities were monitored, bad habits were pointed out, and possible improvements were demonstrated. Thanks to these schemes, staff members acquired better knowledge of ergonomics, working operations were optimized and negative impact on health was reduced. So, the key outcome is an improvement in dealing with the workload, better conditions for good performance and, last but not least, matters settled to staff's satisfaction.
   
   Based on the outcomes of the certified measurements, suggestions for health-improving measures in several selected workplaces were prepared (high physical strain and local muscular strain reduction, noise level reduction, etc.). These measures will also form a part of the Catalogue Sheets.
   
   In October, staff training called 'Active participation in health" was organized. Practically all the participants continue to be interested in the improvement of the health care. In cooperation with the 'Klinika CLT' clinic, screening was prepared for white-collar employees, followed by focused counseling based on the results of the examination.
   
   The key outcome of the project is not only better awareness and motivation of all employees for health care and promoting health, but also staff's cooperation on putting the health-improving measures into practice. Among the main outcomes are documents (i.e. the Catalogue Sheets) meant to be a basis for creating a system of health care for staff members. Another important outcome is the gradual process of meeting the requirements of the legislation of the EU and of the Czech Republic and the following recommendations for reducing health risks.
   
   There already exist a detailed timetable of activities that will be conducted in 2006. These activities include training, ergonomic changes on the production lines, guidelines and standards for workers, management and health professionals that work with the company.
   
   ČESKÁ RAFINÉRSKÁ a.s., Litvínov, Kralupy nad Vltavou is a company hiring 700 people. It is a chemical industry company. The health promoting project in the company was coordinated by dip.eng. Ivo Hamacek, Petr Bucek M.D.
   
   Main objectives of workplace health promotion programme in this organization included the following: minimizing risk factors of the work- and lifestyle and reduction of the number of employees on sick leave; improved health status and increase in job and life satisfaction of employees.
   
   The programme was carried out in several stages and included such activities as: permanent supervision over working condition and safety; permanent improving of working condition and safety; evaluation and monitoring of the current state of the health - above-standard preventive check ups; informational campaigns on special health topics and risk factors; support of sport and physical activities - swimming, skating, squash, tennis, exercising, matches, sport competitions, tournaments; implementation of better ergonomics at the workplace - project Health and safety in the office; smoking reduction - project PROBETA: competition Stop and win (cooperation with Czech coalition against tobacco); overweight reduction - project NEVA: informational campaign, weight reduction under medical supervision, competition; stress reduction-training in stress management; osteoporosis screening; screening of cardiovascular risk factors; flu vaccination and immunization; massage.
   
   As a result of the activities implemented in the company there was a significant decrease in number of sickness leave in period 1998-2004. The company introduced a tobacco policy that resulted in establishing of the Smoke free Company. Employees actively participated in all programs. In 2005- the company won the 1st place in the competition "Health Promoting Enterprise of the year 2005".

5. Development of structures and policies for WHP

   There are several alliances and stakeholders cooperating with each other in Czech Republic for development of WHP.
   
   One of the key player in this field is the Ministry of Health. It participates in organization of the competition "Health Promoting Enterprise of the Year" and is responsible for workplace health promotion management at national level. It also supports the activities and projects of the National Contact Office for European Network for Workplace Health Promotion on Czech Republic.
   
   Another important ministry in that respect is the Ministry of Labour and Social Affairs that also participates in many joint activities with NCO and with Occupational Safety Research Institute. The cooperation between these bodies allows for exchange of information and experiences
   
   The regional Institutes of Public Health form a strong coalition that jointly are engaged in dissemination of information; WHP projects realization and supporting of the competition "Health Promoting Enterprise of the Year".
   
   There exists a national Forum of Health Promoting Organizations in the Czech Republic that is mainly a platform for exchange of experiences.

6. Future perspectives for workplace health

   The development of workplace health promotion activities in Czech Republic in the nearest few years will require taking better advantage of the existing potential. The challenge is to built up an operational network of regional cooperating centres - partners: regional Institutes of Public Health. The factor that would contribute greatly to improvement of quality of WHP would be incorporation of the concept in educational system of the Czech Republic. This would allow to train new specialists on WHP at universities and secondary schools.
   
   In the nearest future the competition "Health Promoting Enterprise of the Year" will be organised with the support from Ministry of Health and Institutes of Public Health. The National Institute of Public Health has a plan to concentrate on the dissemination of WHP especially in SMEs. This activity will be performed with cooperation of Ministry of Health, Institutes of Public Health and Forum of Health Promoting Organizations. NIPH in the next few years will also: extend the number of health promoting enterprises- partners: Ministry of Health, Institutes of Public Health, Forum of Health Promoting Organizations; improve cooperation with the Forum of Health Promoting Organizations and publish new materials on WHP in Czech language.
   
   Other stakeholders plan to continue the existing programmes with emphasis being put on education of employees and employers in order to enhance their willingness to implement health promotion programmes. They have concrete project and sources of financing which looks very promising.
   
   WHP may become more attractive for the employers in the future as the new act on sickness insurance obliges employers to pay sickness benefits for the first 14 days of employee illness. All sickness benefits were paid by the state up to the present time. Changes that are proposed by the stakeholders to boost the implementation of WHP programmes include introduction of benefits for employers implementing health promotion projects e.g. from the accident insurance system, legislative support of such services. The activity that would facilitate development of WHP programmes is preparation of trained specialists and consultation or guidance by well experienced health promotion practitioners at specialised centres of education. The staff implementing WHP in companies needs methodical advice of NIPH. For the public interest governmental support and official media campaigns would make a lot of difference.
   
   The issues that influence development of WHP in a negative way include instability of the economic system - frequent changes in ownership, bankruptcies and indebtedness of enterprises, frequent changes in legislation and delays in implementation of new law on occupational health care and prophylactic check ups, and on institution for insurance of work accidents and professional diseases. Another hindering factor is also a lack of benefits for workplace health promoting organizations. There is a lack of interest among employees, motivation related problems, lack of interest among managers of small and medium Czech enterprises, inadequate legislative support for these activities, difficulty in cost justification, shortage of adequately skilled and trained staff interested in these activities. As till now official support from the economic institutions (Ministry of Health, Ministry of Industry etc.) and the media is still insufficient. Health supporting efforts are not publicized by official recommendations of economical subjects - Economic Chamber, Business Papers, internet presentation and no auxiliary recommendation or norms are created for organisations for easy implementation of health promotion activities.