International Occupational Medicine: Croatia
What work takes place in your country?The Republic of Croatia became independent in 1990 after Yugoslavia was dissolved. There are 4.5 million inhabitants of whom a third are employed. The leading activities are agriculture and forestry, followed by manufacturing industry, which replaced mining after closure of the mines. The construction industry has not only grown significantly after many structures were destroyed during the war but also because of migration from the country into the towns and the inflow of foreign workers. Both the wholesale and retail sectors are growing, with imports surpassing exports and tourism has seen a resurgence. Croatia is a desirable tourist destination with benefits for the economy. Other important activities are the civil service and defence, education, health protection and social care. Sickness absence rates are higher than in the European Union and represent a challenge.
What are the key occupational diseases?
Most common are the harmful effects of noise and vibration. Infectious, parasitological diseases are the next most common together with zoonoses from jobs with contamination risks, in workers employed in the health service and cattle breeding. Other frequent conditions include occupational dermatitis and chronic periathritic changes caused by cumulative trauma. Pneumoconiosis and diseases caused by benzene have declined in frequency.
How is occupational health provided?
At the end of 2007, the Croatian Institute for Health Insurance of Workers’ Health Protection was established. All registered employers are required to register their companies and employees with the Institute, which directs them on the basis of location, to occupational medicine specialists for periodic examination. In that way, all the employed get health protection in the domain of occupational health and safety including industrial injuries and preliminary and periodical examinations.
Who provides the services?
In Croatia, occupational health is provided by occupational medicine specialists working in 148 teams. Forty specialists work in county health centres and 102 are private owners—68 leaseholders and 34 full owners. Two are employed in the Croatian Institute for Health Insurance and four in the Croatian Institute for Occupational Medicine.
How is occupational health represented?
All occupational medicine specialists are members of the professional branch of the Croatian Association of Occupational Medicine with its seat in Zagreb and branches in Rijeka, Split and Osijek. The branches organize permanent education courses and copes with current problems. Professional work is controlled by the Croatian Institute for Occupational Medicine in Zagreb and is responsible for the implementation of legislation along with the new Croatian Institute for Health Insurance, which is responsible for operational functioning.
What legislation do you have that impacts on the provision of occupational health?
Although occupational medicine was founded as long ago as 1925 by Andrija 
tampar, the roots of present-day occupational medicine go back to 1984 when the rules on jobs under special working conditions were published in the People's Gazette. The recent rules regulating the operation of the Croatian Institute for Health Insurance of Workers’ Health Protection were published in the People's Gazettes 85/06, 112/07 and 125/07. The rules specify all the procedures in establishing and recognizing industrial injuries, occupational diseases and carrying out preliminary and preventive examinations.
What about research and education?
Within the medical school in Zagreb (which includes the Andrija tampar School–International centre for Public Health studies), there is an educational centre for postgraduate studies, which is obligatory for future occupational medicine specialists. The occupational medicine course is obligatory in the sixth year of studies at medical schools in Zagreb, Rijeka, Split and Osijek. In Zagreb, there is also the Institute for Occupational Medicine and Medical Research that carries out research on applied toxicology.
What has your country contributed to advancement of the speciality?
While Croatia was still a part of Yugoslavia there were several well-known physicians who contributed to the speciality such as Andrija tampar, not only the founder of social medicine but also the initiator of occupational medicine in these parts. Tihomil Beriti
cooperated with toxicologists abroad solving the pathogenesis of lead anaemia and the academic Marko ari is known for research on pneumoconiosis. Today, the aim is for occupational medicine to be a recognized branch of preventative medicine with involvement in initiatives such as the Matra project (informatics) and the Bologna process for the training of specialists in occupational medicine.
Occupational Medicine, Medical School University Rijeka, Braæe Branchetta 20, Rijeka 51000, Croatia
e-mail: hlalic{at}inet.hr
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