A Rationale for the Cross-Cultural Use of Graphic Symbols in
Occupational and Environmental Health Education
Richard A. Lippin, M.D.
the arts transcend language, their use can be employed effectively
in occupational and environmental
in an increasingly multi-lingual world with workers and the
public who have variable literacy levels. Also, the arts can
be used effectively as a bridge to enhance cross-cultural communication
as well as serving as a bridge to create language literacy.
It is recognized that the material portrayed through the arts
is, by definition, non-specific and often non-detailed; hence,
must not be a substitute for more detailed specific, verbal,
or written occupational and environmental health materials.
However, it has long been
known and efficiently utilized by organizations such as the World Health Organization that the
arts can provide powerful educational messages that often capture
the interest of otherwise uninterested workers and the public.
This paper will explore the above concepts and provide some
specific examples of the potential use of graphics in occupational
and environmental health education and settings.
A specific proposal to utilize ten organ or disease specific
graphics is made by the author.
From the early cave drawings of Southern France
to the present golden arches of the McDonald’s Corporation,
symbols and art have been used to inspire, communicate and educate.
Prior to spoken and written language, symbols and art were
a more important means of communicating, the benefits of which,
for a variety of reasons, have been recently reassessed. The
use of symbols and art in medicine have both assets and liabilities.
Among the assets are:
• The arts, especially visual arts,
music, and dance, transcend language barriers in an increasingly
• Arts which transcend language can be targeted to semiliterate
or illiterate communities as a bridge to increase literacy.
• Art and symbols represent a more rapid form of communication
than written or spoken language.
• Special symbols including a sovereign flag, corporate logo, family
crest, or even a college mascot are easily identified and serve
as an inspirational image around which individuals or groups
The “Sesame Street generation” expects that educational
experiences be entertaining and, hence, incorporate aesthetics.
• Professional educators are increasingly less fearful of incorporating
arts, entertainment, and pleasure into educational experiences.
• Neuroscience will most likely continue to scientifically validate
that educational experiences which incorporate the arts are more
effective educationally than those which do not.
• Incorporating the arts into educational experiences has particular
appeal to youth, an audience which stands to benefit most from
increased health and science education.
• Symbols or art often enhance the aesthetic appeal of a human
Among the liabilities of utilizing symbols or art to communicate
are the following:
• Symbols or art convey a limited amount of often non-specific
• The same symbol may have different meanings in different settings
• Symbols are visual in nature and cannot be spoken or heard.
• Symbols encourage simplistic approaches to often complex problems.
• Excessive emotional response to symbols or arts may interfere
with critical intellectual cognition.
This paper will specifically explore the use of symbols in health
education, especially occupational and environmental health education,
and propose a set of symbols be considered for use in international
occupational and environmental medicine.
In the health area, two historic symbols
and one more modern symbol stand out as powerful examples of
almost universally recognized
symbols. The first is the “skull and crossbones” which
has indicated death and death from poison for at least several
hundred years. The second is the “red cross” which
is officially recognized as the emblem of neutral medical helpers
(Honoring the Swiss whose flag colors it simply reversed who
were exemplary in this area.), and the third is the now well-known “no
smoking” symbol (figures 1,2,3). From a safety education
or use perspective, international traffic signs are among the
best known international symbols. The red octagon of a stop sign
or the yellow triangle of the yield sign are well known examples
(figures 4,5). The symbols for ionizing radiation hazard and
biological hazard have also become wellknown (figures 6,7). Perhaps
the best known safety symbol is the green cross used to designate
safety and hospitals (figure 8). It appears as if the safety
sciences have utilized international symbols more comprehensively
and successfully than the medical sciences to date.
Regarding occupational and environmental
medicine, perse, Thomas Torpy in 1975 published an article
entitled “Graphics Symbols
in an Occupational Health Service” (Journal of Occupational
Medicine, Vol. 17, No. 12, December 1975). Torpy proposed a set
of symbols to designate various functions in an occupational
medical department. He stated in the article that graphics are
more economical than words for they are recognized and remembered
with ease, confusion is reduced, and language barriers are lowered.
Additionally, they provide an aesthetically pleasing compliment
to the design of a health facility. Using representational graphic
symbols, he proposed in this paper 24 symbols designating various
functions within an occupational medical department ranging from
a medical records section, counseling, cardiopulmonary, laboratory,
nurses station, vision testing, physical examination, immunization,
health education, etc.
Illustrated are the symbols for medical
records, audiometry, and health education. Three examples depicting
audiometry, and health education are reproduced (figures 9, 10,
11). He stated that his own staff at the Occupational Health
Service, Department of Personnel, County of Los Angeles, had
greeted the appearance of these signs with enthusiasm and had
offered several suggestions for more holistic designing. He also
encouraged that others, using original graphics or considering
their adoption, deposit specimens copied as he has done with
the Central Symbols Archives in Pasadena, California. While I
certainly would encourage the adoption of Torpy’s symbols
in occupational medical departments, in my personal travels as
a medical director for a multinational chemical company, unfortunately,
I have never seen these graphics comprehensively implemented.
Stimulated by Torpy’s
work and secondary to my recognition that occupational medical
programs are globalizing,
I am proposing
the increased use of symbols and arts in occupational medicine.
Specifically, I designed and am proposing ten symbols depicting
occupational and environmental hazards which could be utilized
in signs, workplace product labels, produce safety bulletins,
and other documents either as a supplement to multilingual translations
or, in some cases, as a substitute for such. I am proposing graphics
for pulmonary hazard, neurological hazard, cancer hazard, fetal
hazard, male reproductive hazard, female reproductive hazard,
skin hazard, eye hazard, hearing hazard, and cardiac hazard.
Using the universally recognized skull and cross-bones and a
relatively simplistic graphic for toxicity to each organ system
or disease, I am offering the graphics for possible consideration
as an adjunct to worker and public occupational health education.
I am seeking the consultation of such organizations as the American
College of Occupational and Environmental Medicine (ACOEM), the
World Health Organization (WHO), the International Labor Organization
(ILO), and other relevant organizations to solicit their reactions,
consultation, and possible endorsement of these symbols.
In summary, symbols and art do not and
should not replace the need for comprehensive occupational
and environmental health
and safety, employee, and public education. However, in our increasingly
multinational world, used appropriately, I believe symbols could
prove to be a useful adjunct in protecting the health of workers
and the public on an international scale. Quoting from D’arcy
Hayman, Arts and Man, “These times when the development,
even the survival, of man demands upon full and successful intercultural
communication, we cannot afford to overlook or ignore any area
of form of communication. The aesthetic level of human interaction
is one which is indispensable in the life of all persons.”
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The Aspen Institute Quarterly, Winter 1992;4
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