Definitions of prevention in occupational dermatology and statutory accident insurance

There is no consistent definition of prevention, either in occupational medicine or in a legal context pertaining to social insurance. Both fields refer to terms such as behavioural prevention and situational prevention, primary, secondary and tertiary prevention, as well as individual and general prevention. These expressions are neither self-explanatory nor used with any degree of consistency. This paper aims to derive an approach for categorising and describing the terminology from the perspectives of occupational dermatology and statutory accident insurance. To do this, it is first helpful to clarify which question to use when addressing prevention from a situational perspective. Depending on the issue at hand, various juxtapositions arise, which could provide answers to the different questions. Where prevention approaches the question of the group of people to be protected, one comes to the juxtaposition of general versus individual prevention. However, in addressing the question of whether the preventive measures are to address working conditions or the avoidance of risky behaviours, one comes to the juxtaposition of situational versus behavioural prevention. Finally, the question may also arise as to the degree of individual manifestation of a work-related risk at which prevention should be applied to in order to avoid (further) injury to health. Answering these questions leads to a differentiation between primary, secondary and tertiary prevention. The juxtapositions described are not opposites but should rather be seen as different answers to the question at hand. In practice, combinations of different types of prevention often arise. For example, in statutory accident insurance, there are programmes for secondary individual prevention to counter the occurrence or worsening of an occupational illness. These programmes address situations in the workplace but also work towards establishing health-conscious behaviours of the employees affected.