Preventive health measures in France

Preventive measures for certain occupational illnesses have been established as a priority by the French government. These include cancers and illness as a result of exposure to asbestos. However, so far, progress has been slow due to economic, technical and sociological reasons.

The prevention of occupational illness such as cancer has been identified as a national priority for the next five years by the CNAMTS (Caisse Nationale d’Assurance Maladie des Travailleurs Salariés - National Health Insurance Fund for Salaried Workers).

Extent of the problem

Of the 270,000 new incidences of cancer reported each year in France, the INVS (Institut National de la Veille Sanitaire - National Institute for Monitoring Health) estimates that 4% to 8.5% (7,000 to 20,000) are caused by occupational hazards (in French). According to the Ligue Contre le Cancer , about 15% of lung cancers, 10% of bladder, skin cancers and leukemia, and more than 50% of male frontal sinus cancers, are a result of working conditions.

It is estimated that, in France, 1.4 to 2.6 million employees are exposed to carcinogens, through physical, chemical or biological means. In 2001, 1,365 incidences of cancer were recognised as being directly due to occupational factors, among which 1,149 were due to asbestos. (Source: [INRS - in French](http://www.inrs.fr/INRS-PUB/inrs01.nsf/IntranetObject-accesParReference/ND 2113/$File/visu.html))

Problem of asbestos

Asbestos, which is responsible for most cancers of the pleura, has only been banned in France since 1997. The enormity of the public health issue became apparent when it was realised that the use of asbestos material in offices and public spaces meant that anybody could be exposed to this risk. Principal actors, health officials, employers and trade unions, had to re-examine how they managed occupational risk prevention.

Since February 2001, legislation on CMR (Cancerogènes, Mutagènes, Reprotoxiques - Carcinogens, Mutagens and Reproductive toxins) requires employers to carry out a risk evaluation. This obligation includes taking an inventory of dangerous substances and establishing comprehensive prevention measures, such as: substituting carcinogens with other less toxic products; providing individual and general protective equipment; setting-up closed system work units; and offering information and training for everyone involved.

Two examples illustrate the scale of the changes. A small company in the wood manufacturing industry - wood dust is the second biggest cause of cancer in the workplace - was faced with problems of allergy, bronchitis, and sinutis, etc. This was managed by installing a vacuum extraction system connected to each machine. In another case, the French National Railway had to provide isolation units for the maintenance of systems containing asbestos.

Implementing legislation

Currently, CMR legislation is still not being systematically applied, particularly in small companies. There are various reasons for this shortfall, such as: the impact of substituting products on supplier and client relationships; the heavy burden financially and technically of protective equipment; and physical discomfort for workers (e.g. having to wear masks). Moreover, people do not yet know whether new products may also be dangerous, and no specific precautions or training measures are being taken in handling them.

In fact, the main difficulty in trying to protect health lies in the scientific uncertainty surrounding chemical substances. Of the 100,000 materials currently used, only a few thousand have been analysed and classified in the three CMR categories defined by the European Union (http://ecb.jrc.it/classification-labelling). For instance, ceramic fibres, considered as an alternative to asbestos, are now also classified among carcinogenic substances.

Another means of preventing occupational cancers is in the development of more thorough medical follow-up procedures for workers during the course of their working life and after they retire. In this regard, France falls behind northern EU countries. This failure seems to be due to several reasons, such as: insufficient awareness by doctors of work-related health problems; the long period between exposure to the substance and actual presenting of the disease; the low level of information on the part of workers regarding the materials they use; and the complex interaction between different toxic substances (e.g. the majority of asbestos-related cancers are observed among plumbers, car mechanics, etc. and not among those working directly with the material).

References

« Réalité Prévention » n° 5, June 2004 - INRS review (Institut national de Recherche et de Sécurité)

« Entreprises et Carrières » n° 728, 7-13 September 2004