A Multisectoral Approach to Prevention of Lead Poisoning in Hungary: Lessons Learned and Potential for Replicability Elsewhere

Hungarian and American occupational and environmental health professionals are collaborating in a research and demonstration project designed to prevent lead poisoning in Hungary. Using a multisectoral approach, the project has three phases: data collection and review, risk communication, and facilitation of program and policy development. First, the project team reviewed relevant data of many types through a workshop at which commissioned papers were presented, key-informant interviews, and a survey of knowledge, attitudes, and practices. The team then conducted a multifaceted risk-communication program to disseminate information about lead hazards in general and what had been learned about lead exposures and lead poisoning in Hungary. It presented training workshops for workers exposed to lead at work and for groups serving as "mediators" who could affect others' behavior, such as nongovernmental organizations, labor unions, public health nurses, pediatricians, teachers and students, and coordinators of the Hungarian Healthy Cities Project. It also conducted a campaign of "concentrated action," using a variety of communication approaches directed to car owners, pregnant women, mothers of small children, and others, in order to convey knowledge and change attitudes, emphasizing emotional appeals. Project leaders will organize a multisectoral working group to develop, coordinate, and implement an overall activity plan aiming to reduce lead pollution. The approach developed and used in this project provides a model for preventing lead poisoning that may be transferrable or adaptable for use for preventing lead poisoning and other environmental health problems elsewhere.

Working on reform. How workers' compensation medical care is affected by health care reform

The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?