What’s Occupational Health like in Germany?

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This is what I thought to myself when I once again woke up at 4am. So in a slightly jet-lagged state I set about to find out the answer.

The WHO reported in 2012 that Germany had a total workforce of over 40 million (nearly half were reported to be women!), the majority (approx.. 60%) of which, were employed by small and medium-sized enterprises (SMEs).

As I understand it, Germany’s OSH legislation is harmonized with EU directives, with health and safety at work administered by the Ministries for Labour and Social Affairs.

In terms of occupational hygienists – specialised training in occupational hygiene is available for medical specialists only (usually occupational physicians), with postgraduate occupational hygiene courses no longer in existence (how terrible!)..

Employers by law are obliged to seek the advice of specialists in occupational health and safety. This may include occupational physicians and safety professionals – who may be internal to the company (in large organisations), or alternatively contracted in by the hour. The overall responsibility for H&S rests with the employer, with legislation enforcement provided by over 6500 government inspectors.

The most common occupational disease in Germany recorded in 2010 was reported to be noise induced hearing loss (> 5,700 cases), followed by asbestosis and silicosis. That looks pretty similar to the situation we have in Australia. Also similar is that health surveillance is obligatory for employees exposed to hazardous substances, with employers also obliged to measure exposure, assess risk, and take preventative measures to avoid or reduce the risk of the hazard eg: noise and vibration.

When the EU Framework Directive was adopted, Germany apparently experienced a paradigm shift with the way that health and safety was managed. The Directive sought a holistic and risk-based approach to ensure the health and safety of workers.

So there are a few similarities between our health and safety systems. The differences become apparent however, when I started to delve into the details surrounding hazardous substances and carcinogens.

The German equivalent of the Australian workplace exposure standards (WES) are the AGW (Arbeitsplatzgrenzwerte). The differences between the WES and the AGW however are huge. Australian WES’s are designed to protect ‘nearly all workers’, which by definition means that some risk still remains. Our WES also include both carcinogenic and non-carcinogenic chemicals. By contrast, the AGW are health-based limit values which are used to regulate non-carcinogenic substances only. It is stated that if the AGW limits are met, then no health risks are expected. Coming from a risk-based background I think it’s brave to say ‘no-risk’, but who am I to criticise the Germans!

Germany used to have technical guidance concentrations (technische Richt-Konzentrationen, ‘TRKs’), to regulate carcinogenic substances, although these were abolished in 2005. TRKs were determined in accordance with the ‘best available’ technology or ‘state of the art’ and only marginally reflected health criteria. They reported to provide no information about the extent of the residual risk or about the probability of incurring cancer through exposure at the workplace, thus according to the Germans, they lacked transparency.

The new approach (although still in its trial period as I understand it), is the ‘Risk Concept for Carcinogenic Substances’, commonly known as the Risk Concept. This is a graduated approach where the higher the level of exposure to a carcinogen, the higher the pressure to minimise exposure.

risk concept

(picture courtesy of, ‘The risk-based concept for carcinogenic substances developed by the Committee for Hazardous Substances’ (BAuA, 2013)

The ‘acceptable risk’ (where the green ends) relates to the point where statistically 4 out of 10,000 persons exposed to that substance throughout their working life will develop cancer. That number corresponds to the risk of cancer outside of the workplace. The result is that the ‘tolerable limit’ is very very low. Therefore I wonder if this practical given the technology we have today?

John Cherrie commented on this late last year when he asked the question, ‘this sounds like a good idea but it does produce limits that are much lower than can probably currently be achieved…is this a practical approach? Will it promote greater reduction in exposures in the future? The answers I’m sure will come in good time.

What does seem like a positive approach within this Risk Concept, is the idea of ‘individual measures’, which are obligatory to be applied, dependant on the respective risk area. These measures are classified into 5 categories (administration, technology, organisation, occupational medicine, and substitution)…similar in a way to our hierarchy of controls. So in a sense – this Risk Concept is both based on risk, but then has mandatory elements that follow that must be applied in certain situations. In a way this is similar to some aspects of Australian legislation (eg: a risk assessment must be performed, but in the case of asbestos there are mandatory elements that must be applied upon discovery of that hazardous substance).

In the end, the real test of whether legislation has a positive effect on occupational hygiene issues is to follow the numbers of reported occupational illness and disease over time (I’m going to assume that it’s reported accurately…which is probably a discussion for a separate blog post!).

Disclaimer: This blog post was written whist jet-lagged and has used thisthis, this, and this reference to provide a commentary on a very complicated topic!

2 thoughts on “What’s Occupational Health like in Germany?

    jane said:
    March 30, 2014 at 10:08 pm

    I love it that you’re still studying eve whilst on a jaunt!!!

    Liz said:
    March 24, 2016 at 10:09 pm

    Hi. I stumbled over this article today. I love it. I usually don’t leave comments but here I had to. I have just finished my training as an occupational health physician in Germany, planning to re-locate to New Zealand or Australia.
    I always wondered about how comparable the systems are and how difficult the transition might be from what I know here in Germany to the NZ/AUS way. I do feel that Australia has more legislations in place, more comparable to Germany, while it’seems all a very small niche in New Zealand. I might be completely wrong though and just haven’the found the right information yet.
    Anyway. Thank you for your article and for the Australian perspective.

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