Lippin Papers > A Rationale for the Cross-Cultural Use of Graphic Symbols


A Rationale for the Cross-Cultural Use of Graphic Symbols in Occupational and Environmental Health Education

Richard A. Lippin, M.D.


Because the arts transcend language, their use can be employed effectively in occupational and environmental health education 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 international multilingual world.
• 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 can rally.
• 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 environment.
Among the liabilities of utilizing symbols or art to communicate are the following:
• Symbols or art convey a limited amount of often non-specific information.
• The same symbol may have different meanings in different settings or cultures.
• 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.

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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 medical records, 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.

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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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1. Torpy T: Graphic Symbols in an Occupational Health Service. J Occup Med. 1975;17:756-759.
2. Dreyfus H. Symbol Sourcebook, New York: McGraw-Hill Book Company, 1972; 20
3. Naisbitt J, Aburdence P. Megatrends 2000 Ten New Directions for the 1990’s. New York: Avon Books; 116
4. Harris E: Why Study the Arts-Along With Math and Science? The Aspen Institute Quarterly, Winter 1992;4
5. Hayman D, The arts and man: A world view of the role and function of the arts in society. Englewood Cliffs, NJ: Prentice-Hall, 1969.

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