MSDs Monitoring of exposures and related diseases in France

1. MSDsMonitoring of exposures and related diseases in France European Lighten the Load Summit Bilbao – 26 February 2008 Ministère du travail, des relations sociales et de la solidarité – DARES - DGT

2. What do we know about MSDs in France ? • Number of occupational diseases recognised and compensated on the increase • Regional epidemiological monitoring network puts into context exposures data and clinically observedhealth-related problems • National data on occupational exposure allows estimation of number of workers at risk of MSDs

3. The occupational diseases • The AT-MP section of CNAMTS (social security organisation) recognises some diseases as occupational and compensates. • Criteria for recognition are laid down in a table specifying: • Profession • Agent or hazard • Diagnosed health outcome • Average delay between exposure and diagnosed health outcome. • There are 115 tables. The table linked to upper limb disorders was set up in 1972 and revised in 1991

4. Increase in recognised occupational diseases In 10 years 275 000 cases recognised and compensated Source : Caisse Nationale d’Assurance Maladie des Travailleurs Salariés

5. Trends in major occupational diseases Source : Caisse Nationale d’Assurance Maladie des Travailleurs Salariés

6. Upper limb disordersby localisation in 2000-2004 Source : Caisse Nationale d’Assurance Maladie des Travailleurs Salariés

7. The epidemiological surveillance network of MSDs in Pays de Loire The Institut de Veille Sanitaire, the medical labour inspection service, the University of Angers and occupational physicians have set up a network in the « Pays de Loire » region 80 occupational physicians have participated A sample number of workers have been surveyed for 3 years (2002-2004) about their working conditions and their health problems (pain). Standardised medical testing allows for the diagnosis of MSDs

8. The model used • Based on the SALTSA Consensus (Sluiter et alii – 2001) • The main risk factors assessed are : • Three biomechanical factors • repetitive work, • force application • painful postures • Three psychosocial or organisational factors • insufficient recovery • work load • social support • (following the Karasek model)

9. Model usedDetailed criteria for upper-limb disorders

10. 2002-2003 survey results 2 685 workers surveyed and examined by an occupational physician The number of MSDs diagnosed is 470 for 383 affected workers 13 % of the workers suffer at least one of the 6 major MSDs of upper limbs Men 11,3% Women 15,1% An extrapolation to the general working population would yield more than 3 million cases…

11. 2002-2003 exposure data Depending on the exposures reported by the workers in the questionnaire, the situation is assessed to be of - Weak exposure (0 factors) - Moderate exposure (1 factor) - Strong exposure (2 factors or more) Source  : InVS

12. Exposures and occupations Source  : InVS

13. Relationsbetween outcomes and exposures Trends in health outcomes depending on the number of declared risk factors/exposures in % Source  : InVS

14. The SUMER survey (L’enquête SUrveillance MEdicaliséedes Risques) - Survey organised by the Ministry of Employment (DGT and DARES) - Concept by a group of experts in working conditions and health at work - Carried out by - DARES - medical labour inspection (inspection médicale du travail) - occupational physicians In 1987, 1994, 2002-2003….. and 2008-2009

15. The SUMER survey • The objectives of the SUMER survey are to describe the exposures to working conditions which can affect workers’ health • In 2003, 1 800 occupational physicians, i.e. 20% of the profession, surveyed workers they regularly follow • - Average of 30 questionnaires per occupational physician • A sample of 50 000 workers surveyed • 25 000 auto questionnaires filled in • The population represented is of 6,7 million women and • 9,2 million men

16. The questionnaire filled in by the occupational physician - Enterprise data - Worker data (descriptive) 4 types of exposures • Organisational constraints Refers to average work situation • Physical constraints • Biological agents • Chemical products Refers to the last week worked

17. The self-administered questionnaire(autoquestionnaire) - One in 2 workers fill in the questionnaire Includes : - Karasek questionnaire - Evaluation of reduction in working time (ARTT) (to 35 h, legal requirement in France) - Self assessment of health status - Work satisfaction - Evaluation of link between work and health - Absenteeism by disease or accident - Violence at work, «bullying»

18. Survey methodology • For organisational constraints, • the worker answers alone • For all other exposures, • the worker answers and the occupational physician validates the answer as an expert - For every exposure, we know • the extent in the last week worked • the PPE available to the worker • the level of exposure (for chemical products) • the collective prevention measures (for chemical products)

19. How to use SUMER to evaluate MSD risk With SUMER we can build a « Proxy » of the SALTSA questionnaire and a score Repetitive work with high frequency . . . . . . . . . . . . > 20 hours/week Manual handling of loads . . . . . . . . . . . . . . . . . . . . > 20 hours/week High psychological demand .. . . . . . . . . . . . . . . . . . > 3rd quartile of Karasek Low social support . . . . . . . . . . . . . . . . . . . . . . . . . . < 1st quartile of Karasek Visual (screen work or binoculars, or precision work) . . . . . . . . . . . . . . . . . . . . . . . . . . . > 20 hours/week Elevated arms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > 10 hours/week Use of vibrating tools . . . . . . . . . . . . . . . . . . . . . . . . > 2 hours/week Other painful postures (twisted, squatting) . . . . . . . . > 10 hours/week Exposure to cold . . . . . . . . . . . . . . . .. . . . . . . . . . . . > 20 hours/week

20. Number of risk factors Less items (9/19)  a less sensitive indicator The minimum is 2 factors 27,7% of the workers has a high exposure to MSD risk factors Source : Dares-DGT - SUMER A simple extrapolation to the total population to which SUMER applies would yield a number of 4,8 million workers with high exposure

21. Exposure levels by occupation Source : Dares-DGT - SUMER In red, the proportion of workers highly exposed

22. Age and risk factors With increasing age and beyond the age of 30, the situation of men is improving The situation of women is continuously worsening Source : Dares-DGT - SUMER

23. Main work activity Source : Dares-DGT - SUMER In red, the proportion of workers exposed

24. Which are the factors with highest prevalence? Source : Dares-DGT - SUMER

25. Summary • The number of recognised occupational diseases is increasing, but still the real extent of diseases is significantly underestimated. • A regional network has been set up, and will be extended, which puts into relation exposures and related health outcomes.It allows for detailed results, but the tool is difficult to use, a long questionnaire on exposures and individual health problems. • A large survey allows for observations of a large sample of workers highly exposed to MSD risks.