# New and Emerging Risk Factors in Occupational Health
## 4 Development Prospects  
The studies accepted in this issue trace the lines towards which occupational health can be developed. Individual differences in occupational disease risk, previously considered to be idiopathic, currently seem clearly linked to differing susceptibilities arising from genetic polymorphisms among individuals. The growing understanding of these genetic predispositions and the effect of environmental influences seem to suggest that many occupational disorders share causal roots in gene-environment interactions. Genetics, through the study of polymorphisms and epigenetic variations, may indicate new personalized prevention strategies, with the adoption of more stringent safety measures in favor of hypersensitive workers. Despite the rapid progress in these fields, further work is necessary before gene expression changes can be used to establish safe levels of substance exposure. In the future, we will probably strive to link gene expression changes and pathway perturbations to the phenotype by mapping them to specific adverse outcome pathways [8]. Although no specific genetic assays for routinely testing occupational disease susceptibility have been so far marketed, the rapid pace of research in this field will probably make such assays available in the next years [9]. Some epigenetic mechanisms involving the silencing of tumor suppressor genes and/or the activation of proto-oncogenes, which are considered critical during carcinogenesis, have been observed in many occupational-induced human cancers [10; 11]. Biomarkers could be linked to disease susceptibility and progression, as well as provide a significant tool for identifying the pre-clinical effects of environmental chemical, physical,and biological pollutants. The future target of safety in the workplace will not only be to guarantee the absence of occupational diseases, as it was in the last century, but to demonstrate the absence of epigenetic variations in the exposed workers. From this perspective, telomeres and their interacting proteins [12] and micro RNAs mutations [13] are among the most likely candidates as potential biomarkers for exposure and health response to physical, chemical, or psychosocial occupational stressors, including redox regulatory changes and oxidative stress. Epigenetic investigations with a special focus on gene-environment interactions are currently exploring the relationship of various occupational stressors with internal biological systems, with reference to resilience or susceptibility to stress [14]. The traditional separation between physical-chemical and psychosocial agents is outdated. Workplace interventions of health promotion will probably target the relationship between work-related stress and epigenetic plasticity factors in a holistic view. The new concept of \"Total Worker Health\" (TWH) was developed from this very wide perspective. TWH is articulated into a complex of policies, programs, and practices that integrate protection from work-related safety and health hazards with the promotion of injury and illness prevention efforts to advance worker well-being [15]. This holistic model prioritizes a \"hazard-free work environment for all workers\". The paradigm needs to maximize worker health, safety, and well-being and is based on inclusive physical, social, economic, psychological, and spiritual health components of well-being [16]. This approach needs to continue addressing deadly hazards and risks that may occur in sectors where traditional occupational health and safety practices are still necessary, but also considering non-working origin risk factors that could create a synergy with occupational ones [17]. In the workplace, we have achieved in recent years a progressive and very strong reduction in the levels of chemical and physical pollutants. At the same time, however, in these environments the number of pollutants present in low doses has increased enormously. Furthermore, awareness of the importance of organizational and psychological factors has increased.