2023-08-01 16:20:13
The recent social mobilizations against the postponement of the legal retirement age have reminded us that professional activity is not always synonymous with good health. On the contrary, the work can be exhausting, mentally and physically, sometimes becoming “unsustainable”.
He can also kill, brutally. Thus, on June 29, 2023, a 46-year-old telecommunications technician died of a fall of around 20 m while working on an electricity pylon, in Arques, in Pas-de-Calais. Six days earlier, André Serena Nunes, 34, a rope access worker on a cliff securing site, lost his life following a 15-meter fall in Oulles, Isère. His name is added to those appearing on the long list of people who, each year, die of their work. Some are very young, like Peter Menanteau, a 17-year-old apprentice who died on July 17, 2023 when he fell with his machine in a quarry, in Essarts-en-Bocage, in Vendée.
An unbearable observation, first and foremost for the families of the victims who, like Benjamin’s mother – who died at the age of 23 falling from a roof on which he was working, in Chinon, in Indre-et-Loire – hears to denounce what is otherwise most often trivialized: “I would so much like the death of my child not to be just a news item from a small provincial newspaper”.
645 people died at work in 2021
In 2021, according to the latest figures published by health insurance, 645 people were victims of a fatal work accident. However, these data only account for part of the phenomenon, since they only concern employees covered by the general scheme: neither civil servants, employees of the agricultural scheme or sea-fishermen, nor self-employed persons and employees posted workers – these forms of employment which have been on the rise in recent years – are not taken into account in these statistics, let alone undocumented and undeclared workers.
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“Controversies” is a new format of The Conversation France. We have chosen to tackle complex subjects which lead to positions that are often opposed, even extreme. In order to reflect in a calmer climate and to advance the public debate, we offer analyzes that call on different research disciplines and combine the approaches.
The “work” series attempts to decipher improbable aspects, sometimes unknown or unthought around this notion currently at the heart of political debates.
Long condemned to be mere miscellaneous facts evoked in the pages of the regional press, most often without their names even being mentioned, these deaths at work have gradually managed to take their place in public debate in recent years, thanks to in particular to the methodical work of review and questioning carried out by the teacher Matthieu Lépine and to the recent mobilizations of the collective Stop à la mort au travail, created on the initiative of the families of victims. In 2022, the reduction of serious and fatal work accidents has thus become a stated priority for the public authorities.
But, with greater indifference, work also kills slowly, through slow contamination or progressive poisoning with toxic substances.
Thousands of professionals exposed to the risk of cancer
We often ignore it, but thousands of people are exposed to carcinogens, legally and in the usual exercise of their profession. This is the case for 11% of employees on average according to the latest SUMER survey, such as “Medical monitoring of employee exposure to occupational risks”.
For example, many of them are still exposed to asbestos, the use of which has been banned since January 1997. Construction workers, electricians or even plumbers, all employees involved in renovation may indeed still be confronted with these fibers in the exercise of their professions. More broadly, in the absence of a precise and exhaustive inventory of asbestos-containing buildings, many employees and users are in contact with asbestos without knowing it, including children in schools.
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But asbestos fibers are not the only cause, far from it. Cutting oils, wood, silica or metal dust, welding fumes, chlorinated solvents, amines in varnishes and colors, cytostatic drugs contained in particular in chemotherapies, diesel engine exhaust gases, ionizing radiation (in the environment medical, the nuclear industry…) and ultraviolet rays (whether natural, in outdoor work, or artificial, in tanning booths), pesticides, formaldehyde, night shift work, etc., the list is long. And studies on the effects of exposure to these products are seriously lacking.
A lack of problematic toxicity data
The International Agency for Research on Cancer (IARC) has so far identified no less than 120 certain carcinogens for the human species and more than 400 probable or possible ones, many of which are present in the professional world. Due to the lack of studies conducted, no data exists regarding the toxicity of hundreds of thousands of other chemical molecules.
Hundreds of new molecules are in fact put into circulation each year, the toxicity of the oldest has not always been studied and, moreover, the pathogenic character of chemical substances can vary, even worsen, when they are found mixed with others.
Molecules which, taken separately, have only a limited effect can thus have much more deleterious effects when they are found in complex mixtures. Studies suggest, for example, that exposure to multiple non-carcinogenic chemical compounds when taken in isolation could lead to the development of cancer. However, this “cocktail effect” is very poorly documented and the regulations most often only concern isolated compounds.
Which employees are most affected?
According to the National Research and Safety Institute for the Prevention of Workplace Accidents and Occupational Diseases (INRS), “all sectors of activity, without exception, are likely to be affected” by the risk of cancer.
However, there is a very unequal distribution of this risk in the world of work, depending on socio-professional category, sector of activity or employment status. Thus, according to the SUMER study already cited, the most exposed are skilled workers (34.5% of them compared to 2.8% of executives and intellectual professions), particularly those in automobile repair (90% of them) or maintenance (60.3%) and, all sectors combined, temporary workers (19.8% of them).
It is sometimes during adolescence that these exposures begin, for example in the beauty trades where apprentice hairdressers and beauticians come into contact with chemical and carcinogenic substances, some of which are also mutagenic and reprotoxic, particularly in the body. nail salon, a rapidly growing and poorly regulated activity.
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To be exposed to these toxins, whatever the level of exposure, is to face the risk of suffering from cancer decades later: the majority of carcinogens have no threshold effect. In other words, there is no threshold below which the risk of contracting cancer does not exist. In the case of asbestos for example, a few fibers can be enough to cause mesothelioma, a formidable cancer of the pleura.
Due to their work, many manual workers do not reach retirement age, or are in poor health. Researchers from the National Institute for Demographic Studies (INED) thus evoke their double penalty, “more years of incapacity within a shorter life”. The main concerned themselves, employees or retirees suffering from cancer, do not usually know that their cancer can find its origin in their past work.
And for good reason, the disease occurs at a distance from the activities that exposed them, most often decades later, up to fifty years in the case of asbestos. They are most often unaware of having been in contact with these toxins. They are then unable to have their cancer recognized as an occupational disease.
Insufficient prevention campaigns
Fewer than 1,650 cases of cancer were thus recognized as an occupational disease in 2021 when, according to epidemiological studies, from 14,000 to 30,000 new cases of cancer each year would be of occupational origin, and undoubtedly much more with regard to the modalities uncertain mathematical construction of these estimates.
Cancer pathology is even identified as the first cause of work-related death in Europe. But while this disease has been in constant progression since the beginning of the XXe century, until today representing the leading cause of death in France, public health prevention campaigns ignore the contribution of work activity to this epidemic.
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On the contrary, they focus on so-called individual behaviors, inviting people to “respect themselves”, in other words to stop smoking, reduce their alcohol consumption, adopt a balanced diet and practice regular physical activity. As if the work did not influence their life and their state of health, as if the workplaces were not also places of life.
Questioning the contribution of work in the occurrence of cancers
For more than 20 years, an interdisciplinary research-action system that I co-direct with Zoé Rollin, the Scientific Interest Group on Occupational Cancers in Seine-Saint-Denis (Giscop93), has given itself ambition to question the contribution of work in the occurrence of cancers and to make it visible with a view to helping to make these diseases avoidable, in the same way as smoker’s cancers.
In this perspective, it has initiated several research projects: on the prevention of apprentices to carcinogenic exposures, on environmental contamination with asbestos, or even on the identification of work activities that cause exposure.
To meet this last objective, partner hospital departments inform the team of researchers of all their patients newly diagnosed with broncho-pulmonary or urinary cancer (bladder and kidney). Those who agree to join this survey are asked to tell their professional story, from when they left school until the onset of their illness.
The team’s investigator, most often a sociologist, invites them to describe as precisely as possible the activities they have carried out, in what context and environment. Reconstructed in this way, these career paths are subject to the expertise of a group made up of occupational physicians and nurses, toxicologists, prevention inspectors, industrial hygienists who will identify or not carcinogens, and qualify them (probability, frequency, intensity, duration), before recommending or not a declaration of occupational disease. Borrowing this survey methodology, a Giscop 84 was created in 2017 in the Vaucluse on the initiative of an oncologist, head of the hematology department at the Avignon hospital. Its first results go in the same direction as those of Giscop93.
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Among these results, which have already been the subject of several publications, some deserve particular attention at a time when the debates on work are relaunched. First of all, the exposure of women is more difficult to document than that of men, the majority in the survey, research on occupational risks having, until recently, essentially focused on male populations.
The recent media coverage around the recognition of breast cancer as an occupational disease in a nurse who worked night shifts, for example, reminds us that far from being a fatality for women, this cancer can also be the result of working conditions. pathogens, such as night work, exposure to ionizing radiation and, according to ANSES, several dozen chemical molecules present in the production space. And that it is, as such, also avoidable, provided that these carcinogenic risks are prevented at their source, at work.
Another observation is that the patients whose pathways were appraised were mainly exposed, during their career, not to a single carcinogen but to several, at the same position or in a succession of different positions and jobs. Those who have worked in the framework of temporary work and subcontracting are particularly concerned. These are the same employment situations that are clearly identified as those where the rules of prevention are the most difficult to apply; subcontracting and outsourcing of activities – often the most exposing, such as maintenance or cleaning – similar to subcontracting and outsourcing of risks. The nuclear sector is a striking example of this, as is agriculture.
But the example of Mr. Boutef, swept away at the age of 34 from a dazzling cancer, testifies to the arbitrations also exercised within large companies like his, a multinational in the aeronautics sector. A worker in a foundry, exposed to nearly a dozen carcinogens, he regularly demanded with his colleagues elected like him, delegates of the Health, Safety and Working Conditions Committee (CHSCT), respect for the labor code which obliges the employer to protect the health of its employees, and in particular the installation of extractor hoods where toxic dust prevented them from breathing. Recorded in black and white in the minutes of one of the meetings, the response from the employer’s representative is enlightening: “We need to pace our investments”.
Even written into the texts, engraved in the law, the preservation of the health of women and men at work does not impose itself on employers as a priority.
Posting policy?
Included in the roadmap of the government and the social partners within the 2021-2025 Occupational Health Plan, and in the ten-year strategy to fight cancer, the prevention of carcinogens in the workplace could remain only a simple display.
The current shortage of occupational physicians and labor inspectors raises fears of the hypothesis. To put an end to this silent epidemic of occupational cancers, there is an urgent need to question the pathogenic working conditions and to demand more restrictive state intervention in the world of work to guarantee the right not to lose his life.
By including safety and health in June 2022 in the fundamental principles and rights at work, the ILO strongly encourages it to do so. The ecological crisis that we are going through also invites us to rethink working conditions and living conditions together, the health of employees and that of the population, so close are the links between the toxic and carcinogenic exposures that take place within companies and those which are present in the environment, most often resulting from industrial overflows.
The recent discovery of the impact of perfluorinated PFAS on human health is a glaring illustration of this: employees are the first to be exposed to these toxic and carcinogenic substances before they are released outside and pollute persistently. , water, soil, air, but also breast milk. The survival of our planet thus depends closely on how work is carried out and under what conditions.
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