The hidden injuries of work: Institutional invisibility, precarity, and the recognition of occupational harm. A scoping review.

Work-related injuries and occupational illnesses constitute a substantial but unevenly recognised burden on workers and health systems. While work can provide income, social protection, and social integration, it can also expose workers to physical, psychosocial, and organisational hazards, and the resulting harm remains unevenly documented within occupational health and safety (OHS) systems. Growing evidence indicates that official statistics and compensation and surveillance systems incompletely capture work-related harm, including among workers in precarious or temporary employment and migrant workers. This scoping review examines how work-related injuries and illnesses become institutionally invisible within systems of reporting, recognition, compensation, and surveillance. Drawing on 59 peer-reviewed publications conducted in or including middle- and high-income settings and published between 2015 and April 2026, the review synthesises evidence on the mechanisms through which occupational harm is underreported, misclassified, suppressed, or excluded from institutional records. The review followed PRISMA-ScR guidelines, with findings synthesised using a thematic, multilevel analytical approach. Across the literature, institutional invisibility may emerge through cumulative processes of invisibilisation rather than isolated reporting failures. These mechanisms include constraints on reporting, organisational practices such as claim suppression and incomplete recordkeeping, and institutional filters involving classification, compensation, surveillance, and regulation. They intersect with employment precarity and stratified protection, contributing to uneven institutional visibility among differently positioned groups of workers. Beyond surveillance bias, invisibility may also have downstream clinical and occupational consequences, including delayed access to care, compensation, rehabilitation, and return-to-work support. By proposing an integrative framework for understanding how occupational harm becomes institutionally invisible, this review contributes to debates in public health and health systems research on evidence production, risk governance, and health equity. It underscores the importance of incorporating occupational recognition into health equity agendas and addressing the institutional processes that shape whether work-related harm becomes visible and actionable.