Insurance covering occupational diseases is an important pillar of social security. This is particularly true in latency diseases such as cancers, which may occur many years after the occupational exposure.

Appropriate insurance cover for workers should therefore be independent of the existence or economic performance of the employer. It is important for employees that the handling of their work-related health problems is not dependent on litigation or the solvency of their employer.

Regardless of the organization of insurance cover, it is essential to have distinct and transparent criteria for the definition of occupational diseases to distinguish these from diseases of other origin. This applies to the “definition” of the general concept (and for each disease, unless a list of occupational diseases is to be used) and to the criteria to be applied to the recognition of each case, for example to meet the required level of causality/probability.

At the international level, the International Labour Organization (ILO) established the first ILO list of occupational diseases in 1925. Changes in the structure of industries, the development of new chemicals, and advanced national workers’ compensation schemes have led to revisions in the ILO’s list. The current ILO List of Occupational Diseases annexed to Recommendation No. 194 of 2002 is composed of two dimensions (causes and diseases) and subcategories. The European Commission’s current list of occupational diseases is part of Commission Recommendation 2003/670/EC (see also Report on the current situation in relation to occupational diseases’ systems in EU Member States and EFTA/EEA countries, in particular relative to Commission Recommendation 2003/670/EC concerning the European Schedule of Occupational Diseases and gathering of data on relevant related aspects). The relationships between exposure and disease are also having effects on the design of prevention strategies.

The international list of occupational diseases is often adjusted to national needs and realities. However, national lists may not be regularly updated and therefore may not include new occupational diseases such as those related to ergonomic, psychosocial or certain chronic diseases. To address these gaps and to recognize the occupational nature of the disease, national authorities often work with so-called “open systems” that assess the link of a newly-recognized pathology that is not on the list to occupational exposure to the disease.