title: Social care and changes in occupational accidents and diseases - the situation in Eastern Europe in general and for skin diseases in particular.
abstract: BACKGROUND
  As a consequence of the disintegration of the state systems and the expansion of the European Union, there have been marked changes in the political and social affiliations of the countries of Eastern Europe. Of the 22 countries in Northeastern, Centraleastern, Southeastern and Eastern Europe, 12 are now members and 10 are "new" neighbours of the European Union. The accident insurance systems and changes in occupational accidents and occupational diseases in eastern European countries are described. Changes since EU and visible differences from non-EU countries are analysed. Special emphasis is given to occupational skin diseases.
  
  
  METHODS
  The available data from the European Union (MISSOC and MISSCEEC Studies on the Social Protection Systems), the database "Social Security Worldwide" (SSW) of the International Social Security Association (ISSA), the International Labour Office Database (LABORSTA), the World Health Organization (WHO) and the annual statistical reports of the different countries were analysed with respect to changes in occupational accidents and occupational diseases. To find missing data, 128 ministries and authorities in the 22 countries in eastern Europe were researched and 165 persons contacted.
  
  
  RESULTS
  The social insurance systems were very different in the different countries and some were better established than others. Moreover, not all data were available. For these reasons, detailed comparison was not always possible. The occupational accident rates are decreasing in more than half the countries. In contrast, the fatal accident rates have increased in half the countries. The number of newly registered occupational diseases is decreasing in more than half the countries. The rates for occupational skin diseases in 2006 were particularly high in the Czech Republic, Poland and Slovakia. In half the countries (four out of eight), the number of occupational skin diseases is decreasing. A reliable analysis of any correlation between EU membership and the rates of occupational accidents and occupational diseases was not possible, because of missing current data.
  
  
  CONCLUSIONS
  Comparison of the social insurance systems and changes in occupational accidents and occupational diseases in 22 countries in eastern Europe makes it clear that further effort is needed to develop registration and notification procedures. Only then will it be possible to analyse changes, to map successes and problems and perhaps to initiate necessary improvements. Standardisation of the documents must also be improved, to allow international comparisons between the systems.
authors.affiliation: Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany. rika.hirschberg@gmx.net
authors.forename: Kathrin R
authors.initials: KR
authors.lastname: von Hirschberg
authors.forename: Björn
authors.initials: B
authors.lastname: Kähler
authors.forename: Albert
authors.initials: A
authors.lastname: Nienhaus