Within the European Forum of Occupational Accidents and Diseases Insurance, the Working Group “Occupational Diseases” has discussed this topic in several meetings. As a result of these discussions, a review of the national systems of the 10 European Forum members represented in the Working group has been conducted. In this context, it should be noted that the occurrence and recognition of occupational diseases are also influenced by the economic and industrial structures as well as natural resources and environmental conditions prevailing in each country. The results show some similarities but point out fundamental differences in national legal, institutional, and social security systems. Therefore, occupational disease statistics across European countries cannot be directly compared as they are strongly influenced by these different systems. The detailed interpretation and conclusion of the results of this review are presented below, with the aim of supporting an informed discussion regarding feasibility and limitations of harmonising OD statistics at European level.

Setup of the survey and results

The survey is based on a comprehensive questionnaire designed to gather detailed information on national systems for the reporting, recording, notification, and analysis of occupational disease (OD) data. The review is organized into several thematic sections: Institutional Framework and Notification Processes: The initial part of the survey establishes the institutional and geographical context of each participating member. It explores the primary stages of the process, focusing on the stakeholders responsible for notification – including workers, employers, and physicians – and the designated recipients of this information, such as social security institutions or governmental authorities. Furthermore, it examines the mandatory nature of these notifications and the degree of data centralization at the national level. Key Findings: Notification is mandatory in nearly all countries surveyed. The legal obligation to notify typically falls on employers and medical professionals (both general practitioners and occupational doctors). Reports are primarily submitted to national social security institutions or, in some cases, to specific governmental labor authorities.

Data Centralization, Analysis, and Transparency: This section investigates how data is compiled and used. It identifies the key indicators analyzed, such as ICD-11 diagnostic codes, industrial sectors, worker demographics, and costs, while also evaluating the transparency of information regarding public access to raw or aggregated data and the end-use of the data.

Key Findings: Data is widely centralized, often within a unique national database managed by the social security institution responsible for occupational risks. Standardized indicators are used across countries, including ICD diagnostic codes, industrial sectors (NACE/NOGA), and occupations (ISCO). Furthermore, transparency is a common standard, with most countries providing public access to aggregated data through dedicated web portals. Data is mainly used for prevention-activities, scientific research, and the development of new legislation.
Structure of Insurance Funds and Recognition Challenges: The final chapter analyzes the structure and financing of institutions covering occupational diseases, comparing them to systems for occupational accidents or non-professional illnesses. The survey highlights disparities in benefits, such as higher reimbursement rates or access to career transition, and details the decision-making mechanisms for disease recognition. Finally, the survey highlights the major challenges encountered during the recognition process. Key Findings: Financing is predominantly based on employer-funded premiums, though some systems also integrate tax-based funding. Recognition as an occupational disease offers often superior benefits compared to non-professional illnesses, such as higher reimbursement rates, full coverage for medications, and specific vocational reorientation. However, the process remains demanding; the primary challenge identified is establishing a clear causal link, especially for diseases with long latency periods or those resulting from multi-causal factors. Each country has its own framework of conditions and systems that define the possibilities of recognition of a disease as an occupational disease.

Comparative Analysis: Similarities and Disparities

The cross-national analysis reveals a complex landscape where strong procedural alignments coexist with significant structural divergences.

Besides a shared intend for transparency, these findings show that underlying differing mechanisms of notification, recognition and insurance coverage main deeply rooted in national legal frameworks and social security traditions, limiting direct international comparability.

Key Area of Alignment – strong similarities

• Universal Centralization: A notable point of convergence is the data management; most surveyed countries report that OD data is centralized within a unique national database, typically managed by the social security institution responsible for occupational risks.
• Regulatory Compulsion: Notification is mandatory in the majority of participating countries, establishing a legal baseline for the systematic collection of data within each country.
• Data Utilization and Transparency: There is broad consensus on the purpose of data collection, with a primary focus on prevention activities. Data is used as well for scientific research and legislative updates. Most countries maintain a high standard of transparency by providing public access to aggregated data via dedicated web portals.
• Administrative Focus: In general, OD data primarily serves administrative, legal, and compensation purposes.

Key Area of Divergence – significant disparities:

• Notification Responsibility and Legal Obligation: The initial reporting stage shows high variation. Roles differ significantly across borders: some systems rely heavily on medical doctors, others on employers, and a few on the workers themselves. Furthermore, the legal obligation to notify follows no uniform pattern, ranging from systems that mandate employers to those that target doctors, or a combination of both. The importance of underreporting depends on these configurations and has a high impact on statistics.
• Institutional Frameworks: There is no uniformity in how OD systems are organized relative to occupational accidents. The survey shows a split: some countries utilize a single institution for both risks, while others maintain strictly separate bodies.
• Funding, Benefit Structures and Recognition Criteria: Although OD recognition generally offers superior benefits – such as higher reimbursement rates or specialized pensions – Country-specific differences of funding make comparisons uneven.
• The Causality Hurdle: Establishing a clear causal link remains a universal but disparate challenge. Indeed, the settings of the recognition processes vary significantly in the participating countries. Most countries have a mix of different processes: some are based on national medical expertise, others on lists with recognition-criteria or a mix of both. The recognition criteria – either of expertise groups and the list – vary frequently and therefore influence strongly the number of recognized occupational diseases.

The process of evaluation is particularly challenging for diseases with long latency periods or multi-causal factors. Causality depends as well on exposure data that differ, depending on local working conditions and prevention standards.

Conclusion

Occupational disease statistics across European countries show similarities. Yet, fundamentally, they are not comparable. This is because they are produced within different national legal, social security, and institutional frameworks that differ significantly in terms of definitions, recognition criteria, reporting practices, and coverage.

The Working Group Occupational diseases recommend using these statistics as a source of inspiration and mutual understanding and the exchange of experience rather than as a common benchmark.

Any comparative reference at the European level must be handled with great caution, ensuring that national system differences and methodological limitations are clearly described to prevent misinterpretation.

Furthermore, the Group emphasizes that making data accessible to others adds significant value by encouraging continuous improvement and reflection on one’s own national practices.
While each country should remain sovereign over its social security system, highlighting these structural differences serves as an opportunity for countries to learn from one another’s successes and challenges.

In conclusion, due to the fundamental differences in national legal, institutional, and social security systems, occupational disease statistics across European countries cannot be directly compared as they are strongly influenced by these different systems and especially the choice of recognition criteria.

To continue these reflections, the Working Group Occupational Diseases will now take a closer look at the issues related to recognition. We aim to understand better how the member countries of the European Forum constitute their list of occupational diseases and define recognition criteria. ●