[Immigration, work and health--social, cultural and best practices in occupational medicine: the views of union patronage].

Observations from the trade union patronages report that migrants more often that before seek for their assistance, for various reasons, including health and safety at work. We have noticed, besides the "healthy migrant effect" (now decreasing), a certain mobility within occupations, as well as autonomous enterprise developments. Occupational injuries that we see in migrant workers tend to be less serious, potentially because of the greater instability and fear at work (and quick return to work), with informal patterns of health care. Under notification, greater frequency of temporary compensations are also present, likely related to higher vulnerability of migrant worker and to different access and quality of health services. As for the occupational diseases, we have observed an increase in notifications for migrant workers, mainly related to a greater knowledge and exercise of health care and insurance rights and options. Our Patronage experience enables to state that migrants are prone to accept uncomfortable conditions, high rhythm and heavy workloads and that health and safety at work is perceived as a factor not immediately necessary as compared to other issues such as work itself, residence permit, housing. On one side, society at large has to take care of such issues; on the other side, the occupational health system should proceed to a new cultural approach, using also appropriate indicators of process and outcome today available, while integrating the well known motto from Ramazzini, considering questions proper for migrant workers.