Occupational diseases remain largely underreported

Cancer, asthma, diseases of the musculoskeletal system, skin diseases, hearing loss, mental difficulties… Sometimes work makes you sick. However, the recognition of the professional nature of the health problem is not systematic. The illness must be certified to Social Security by an occupational physician, general practitioner, or specialist, and Health Insurance must establish that the problem is attributable to the work performed, justifying compensation. A system that has its flaws. The latest surveillance data from Public Health France published on Tuesday shows an increase in reports of suspected occupational diseases. However, under-declaration, which has long been known, remains at a very high level.

In the studied period (2007-2018), the indicator of the report is generally increasing. 4.9% to 7.1% of patients seen by professional physicians among men and 6.2% to 11.4% among women. A sharp increase was observed, in particular, in the years 2016-2018, by 1.4 in the first case, and by 1.5 in the second.

Among men, the highest reporting rates were recorded in the construction and industry sectors; for women, in transport, industry, human health, accommodation and food. Half of the pathologies reported by men are disorders of the locomotor system, and about a third are related to psychological suffering or psychosocial risks (difficulties related to relationships, problems related to organization or workload, unrecognizability, etc.). The share of mental suffering by women increased continuously from 42% to 52% in 2012-2018. MSDs have taken second place since 2013, while remaining significant (40%).

The increase in reports may be related to some deterioration in working conditions, particularly increased productivity.

Prof. Jean-Francois Guéhanon, Professor of Occupational Medicine at the University Hospital of Rouen.

“The increase in reports may be associated with some worsening of working conditions, particularly increased productivity, as well as increased psychosocial risk factors, less decision-making autonomy, and increased fear of losing one’s job.”, analyzes Professor Jean-Francois Gehanot, Professor of Occupational Medicine at the University Hospital of Rouen. Parallelly, “Physical working conditions have not necessarily worsened, but they have not improved either. he believes. In the increase in reports, we can also see a bias caused by the reorganization of occupational medicine in France, which led to the delegation of part of the activity to nurses. Professional doctors, on whose statements the Public Health France study is based, now see proportionally more people with problems.

Unfinished business

This study by Jean-Francois Guéhanno, as well as Sophie Fanton Quinton, president of the French Society for Occupational Health and professor at the University Hospital of Lille, first and foremost reminds us of the challenge of correcting the underreporting of illnesses related to social security. to work Remember that the worker is obliged to make a statement to Sécu and not to the doctor. The latter, however, must confirm a preliminary medical certificate explaining the observed symptoms and why they can be attributed to the exercise of the profession. But in reality, some doctors don’t complete the process, preferring, for example, to refer the person to their current doctor.

The issue of underreporting is not new, so since 1999, Social Security’s Industrial Accident-Occupational Disease Branch has made significant annual returns to the overall system.

Sophie Fanton Quinton, President of the French Society of Occupational Health and Professor at the University Hospital of Lille.

Even when the pathology is identified by the practitioner, very often the statement is not made for various reasons. Thus, for musculoskeletal disorders (carpal tunnel syndrome, tendinopathy, osteoarthritis, etc.), three-quarters of those reported by a physician as possibly related to an occupational disease were not the subject of a Social Security claim. , to SPF research. in the case of 35.4%, due to lack of knowledge of the administrative process to be carried out by the employee. In 28.5% of cases, the diagnostic assessment to complete the initial report of the occupational physician was insufficient. After all, in 1 out of 5 cases, the employee did not want to declare (for fear of losing his job for half of the people concerned). Similarly, 8 out of 10 hearing disorders can be considered occupational diseases, but only 10% are declared.

“The issue of underreporting is not new, and that’s why since 1999, Social Security’s Industrial Accident-Occupational Disease Branch has made significant annual returns to the overall system.”, – recalls Quinton of Sophie Fanton. He advocates that doctors and other occupational health professionals be more proactive. On the one hand, taking the time to investigate, to “dig” the topic with their hired employees, even when they come to another subject. On the other hand, ensuring that the declaration process and consequences for the employee are properly understood. Finally, involving themselves more directly. “The more doctors themselves report on occupational diseases, which is all the more ethically binding on them, since it is about writing a medico-legal reference, the more the idea will spread that this is their role.”, he pleads. Another beneficial effect is highlighting new occupational pathologies that might otherwise go under the radar.