Occupational medicine versus work medicine: etymological and semantic aspects

The recent piece ‘Time to ditch Occupational Health’ questions the use of the terms ‘occupational physician’ and ‘occupational medicine’ and suggests that they should be replaced with the terms ‘work doctor’ and ‘work medicine’. I would consider the problem by separating the two aspects: (i) the meaning of ‘occupational health’ (i.e. the worker’s health) and (ii) the meaning of ‘occupational physician’ (i.e. the physician whose mission is to protect workers’ health) and of ‘occupational medicine’ (i.e. the discipline studying worker’s health and disease). Therefore, I separately analyse the object of interest (‘occupational health’), the actor (‘occupational physician’) and the discipline (‘occupational medicine’). Firstly, let me begin with the term ‘occupational health’. The starting point should be the well-known definition of health (a state of complete physical, mental and social well-being and not merely the absence of disease or in firmity). However, the definition has been criticized over the past 60 years as being absolute and not measurable. Although redefining health is a complex goal, several proposals have been made for adapting the definition of health to the modern world. Recently, a more flexible and pragmatic definition was proposed: health should be identified as a dynamic attitude based on the ability to adapt to different conditions and to self-manage in the face of social, physical and emotional challenges. The addition of the adjective ‘occupational’ does not substantially change the meaning of the definition. Accordingly, the term ‘occupational health’ should not refer anymore to the obsolete World Health Organization definition. Instead, in a modern vision, ‘occupational health’ might be viewed as the attitude and capacity of workers, aware of their skills and adequately trained, to self-manage and to adapt to different working conditions. On this basis, I think that the term ‘occupational health’ should be maintained. The second point concerns the terms ‘occupational medicine’ and ‘occupational physician’. In this case, you might refer to the equivalent terms used in several European countries. Thus, the term corresponding to ‘occupational medicine’ is ‘Arbeitsmedizin’ (Arbeit, work) in Germany, ‘médecine du travail’ (travail, work) in France, ‘medicina del lavoro’ (lavoro, work) in Italy and ‘medicina del trabajo’ (trabajo, work) in Spain. It is interesting that the Italian ‘lavoro’, the French ‘travail’ and the Spanish ‘trabajo’ derive from different Latin terms. In fact, ‘lavoro’ derives from ‘labor’ (literally fatigue), whereas ‘travail’ and ‘trabajo’ derive from ‘tripalium’ (an instrument of torture involving three stakes). Working was never assumed to be a pleasant activity! Hence, all the terms used in several countries throughout Europe literally correspond to ‘work medicine’ and not to ‘occupational medicine’. The expression ‘occupational physician’ has its equivalent in the ‘Fachartz für Arbeitsmedizin’, ‘médecin du travail’, ‘medico del lavoro’ and ‘medico del trabajo’. These terms are associated with the term ‘work’ in their respective languages, whereas in English-speaking countries, the expression ‘work doctor’ or ‘work physician’ (from old English ‘weorc’ or ‘worc’, something done, action, proceeding, business, military fortification) is uncommon, and the expression ‘occupational physician’ is generally used. It is possible that the adjective ‘occupational’ was chosen for its erudite Latin origin (‘occupare’, the act of occupying and the state of being occupied). Perhaps it was thought that its Latin root could be smarter and more attractive as compared with the too trivial term ‘work’. Finally, I would add that over 100 years ago, it was Luigi Devoto, the founder of the Clinica del Lavoro in Milan, who named ‘medicina del lavoro’ (i.e. ‘work medicine’) the then growing discipline that had the purpose of studying the diseases of the workers. By using this expression, he suggested that the work was ill and as such it needed to be studied and treated.