The concealment of occupational diseases is still a serious, unresolved health problem affecting workers worldwide, in spite of the technical, scientific, and legal advances in the last decades. If we take into account statistics from international organizations, such as ILO or WHO, or national agencies, there should be no reason to worry, since both global and percentage figures show that the prevalence of these conditions is very limited. Therefore, we would come to the conclusion that working conditions and environment are under control and no great effort is needed to improve prevention. Yet, we all know that this is a big lie that has been said over and over again and that hides a world of pain and deprivation, with a high death, disease and disability rate.

Development

We could think that concealing occupational diseases is a typical problem of developing countries, where working conditions are precarious, and regulations and controls, insufficient. However, the phenomenon being analyzed is also observed in the most developed countries. Comparing rates between different countries is very hard due to the disparity in the criteria to define occupational diseases, even within countries in the same European Community. In my country, Argentina, a developing country, the incidence rate of occupational diseases in 2009 was 1.8 per thousand workers, not far away from Spain’s rate. But in Argentina, the official rate, apart from being a debatable value, reflects only the universe of registered workers, which is barely 50% of the country’s workforce. A European workers survey revealed that 8.6% declared to have been affected by a work-related disease. It is estimated that 80% or more work-related diseases are concealed, and the European Agency for Safety and Health at Work estimates that in the European Union, for each deadly injury, there are eighteen more deaths caused by occupational diseases. This data is just shocking, and shows a serious moral flaw of society in general and occupational health in particular. Unlike occupational injury, which is easily defined and registered as such, identifying occupational diseases is highly confusing, particularly when its concept is based on the traditional medical-legal thinking. The dividing line between occupational disease and work-related disease is very fine, to the point that, scientifically and ethically, it is more and more difficult to accept this division, a situation that turns critical when the register system is that of a closed list.

The causes for concealing these conditions and their effect on the individual and the society are being analyzed, and solutions are being proposed. The causes are basically underdiagnosis and underreporting. Underdiagnosis is a phenomenon determined by several factors, among which it is worth mentioning the physician’s ignorance about the role of work as a determining factor behind the health-disease process, which prevents physicians from thinking of the work origin when facing a particular pathology. In my country, for instance, occupational cancer, due to the long latent period in the clinical onset of the tumors, is identified by physicians from the social services for retired people, which assist 6 million members—physicians who do not have any kind of training in relating cancer with the history of occupational exposure. This difficulty is stressed when the clinic and the pathology of the occupational disease are not distinguished from those of a disease that is not occupational. A lung cancer caused by nicotine poisoning is not distinguished from a lung cancer caused by occupational exposure to carcinogenic substances. At the other end, general practitioners are not trained either in recognizing the early stage of some occupational diseases, such as neurobehavioral disorders in workers exposed to solvents, thus missing the opportunity for early diagnosis and measure-taking to prevent evolution towards chronicity.

If the person responsible for the underdiagnosis is the occupational physician, we are before a serious case of lack of skill or negligence. For the occupational health specialist physician, knowledge gained during his or her original training is not enough—he or she must keep up to date on a permanent basis on issues such as onset of new occupational diseases and screening and early diagnosis methods for the traditional ones.

Underreporting of occupational diseases’ main cause is not reporting them, which makes it a situation that verges upon serious issues such as failure to comply with the law and codes of medical ethics. Employers try to avoid administrative or judicial claims that may make them invest money in absenteeism, treatment, rehab, and payment of damages, as well as the possibility of investing in working conditions improvements. In addition to this, in some countries, such as Argentina, the increase in occupational morbidity means higher costs in mandatory purchase of occupational injury and disease insurance, and difficulty in obtaining or maintaining international quality certifications. If the worker must take part in reporting the injury, there is always a possibility of not reporting it for fear of losing his or her job.

Occupational diseases underdiagnosis and underreporting consequences lead to what could be called “underassistance” and “undercompensation”. The affected worker wanders around public and private services without finding the right person to relate his or her affection with the working conditions, thus wandering away from the timely and proper therapy. This is why huge expenses caused by these diseases are added to the already high costs of each country's welfare system. From the point of view of prevention, ignoring the existence of occupational diseases may lead to taking wrong prevention measures. Finally, since the worker has not found a satisfactory response in the system that has allowed the outbreak of the disease, it usually ends up in a suit that increases the cost of Justice Management.

Conclusions

Measures proposed to avoid concealment of occupational diseases are varied, but emphasis is placed on proper training of physicians, both at undergraduate and graduate levels, so that they are capable of identifying such diseases, on informing the workers themselves on their rights, on the extension of occupational health coverage to all the country’s mass of workers with no exclusions, on preparation and maintenance of a record of these affections, on the role of the state in inspecting compliance with regulations on this matter, etc. But nothing will be enough unless there is an occupational physician who carries out his or her specific job of watching and protecting the workers' health in full compliance with the ethical principles. In this regard, ICOH's International Code of Ethics for Occupational Health Professionals is very clear in its article 22: “Occupational injuries and work-related diseases must be reported to the competent authority according to national laws and regulations.”