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Medical Inspection of Workplaces and Workers in France

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In the 1930s, the application in France of certain clauses of the labour code concerning occupational hygiene demonstrated the value of providing workplace inspectors with access to consulting physicians.

The laws of 17 July 1937 and 10 May 1946 (articles L 611-7 and R 611-4) empowered the Department of Workplace Inspection to order temporary medical interventions. Over time, these interventions, originally conceived of as intermittent, evolved into ongoing activities complementary to and conducted simultaneously with workplace inspection.

The promulgation of the law of 11 October 1946 concerning occupational medicine was soon followed by the establishment of a permanent technical framework for the medical inspection of workplaces and workers. The decree of 16 January 1947 established the context, pay scales, status and functions of medical inspectors of workplaces and workers.

Since 1947, however, technical development in this area has been irregular and sporadic, and the number of medical inspectors has sometimes failed to keep pace with the number of inspection tasks; the latter has also been true of workplace inspections. Thus, while medical departments created in accordance with the law of 11 October 1946 increased in prevalence and importance, the number of medical inspectors was gradually reduced from 44, the number originally called for in 1947, to 21. These contradictory trends partially explain some of the criticism the occupational medicine system has had to face.

However, since 1970, and particularly since 1975, there has been a significant effort to create a Department of Workplace Medical Inspection capable of responding to the needs of the approximately 6,000 physicians responsible for over 12 million workers. In 1980, inspection services were allocated 39 paid positions, of which 36 were actually filled. In 1995, 43 positions were available. Priority Action Plan Number 12 of the VIIth Plan provides for 45 medical inspectors; this will bring staffing levels up to the levels originally envisaged in 1947.

At the same time that French officials were recognizing the necessity of establishing a specialized inspection department responsible for the application of legislative and regulatory directives concerning occupational hygiene and medicine, identical conclusions were being drawn in other countries. In response to this growing consensus, the ILO, in collaboration with the WHO, convened an international colloquium on the medical inspection of workplaces, in Geneva in 1963. Among the noteworthy outcomes of the colloquium were the definition of the responsibilities, duties, and knowledge and training requirements of medical inspectors, and the techniques and methods of medical inspection.

General Organization

The central office of the Department of Workplace and Worker Medical Inspection is part of the Industrial Relations Department and reports directly to the Regional Director of Industrial Relations and Medical Inspection. The Regional Director, in turn, is part of the Regional Labour and Employment Board and reports directly to the Regional Director of Labour and Employment. The number of professionals and workers in France in 1995 were:

  • 12.5 million workers benefiting from general coverage
  • 6,337 physicians, of which 2,500 are full-time
  • 4,000 nurses
  • 1,500 medical departments
  • 90% of workers are followed up by sectoral medical departments.


The number of medical inspectors in each region depends on the number of salaried occupational medicine positions in that region. In general, each regional medical inspector should be responsible for approximately 300,000 workers. This general rule is, however, subject to modification in either direction, depending on the size and geography of each region.


Although many of its clauses are no longer relevant or have lapsed, it is nevertheless useful to review the responsibilities of medical inspectors prescribed by the aforementioned decree of 16 January 1947.

The physician in charge of the department is responsible, among other things, for the coordination of all medical problems in the various departments of the Ministry of Labour and Social Security. His or her functions can be extended by decree.

The Medical Inspector of Workplaces and Workers will:

    1. maintain, with the Technical Committees of the Social Security Credit Unions, direct and permanent contact with the Workplace Inspection Department, and ensure the application of legislation concerning occupational hygiene and the protection of worker health
    2. carry out, on an ongoing basis, activities designed to protect worker health in the workplace; these activities will include, among other things, the supervision of the Occupational Medical Departments established by virtue of the law of 11 October 1946
    3. supervise, in close collaboration with psychotechnical departments, medical examinations aimed at determining workers’ fitness for work, and reclassifying and referring workers who are temporarily unfit for work or physically handicapped to rehabilitation centres
    4. supervise, in collaboration with the Technical Committees of the Social Security Credit Unions, the preparation, compilation and use of statistics concerning the physiopathological characteristics of the workforce.


          The Medical Inspector of Workplaces will communicate information he or she possesses concerning the risk of occupational disease and accidents in different companies to the Technical Committees of the Social Security Credit Unions. The note of 15 September 1976 concerning the organization of Industrial Relations Departments assigns the following responsibilities to the Department of Workplace and Worker Medical Inspection:

          • the investigation of technical aspects of occupational medicine, pathology, work physiology and ergonomics
          • the investigation of questions related to the protection of wor-kers’ health and to work conditions
          • the investigation of medical aspects of work
          • the monitoring of progress in medicine, physiology and erg-onomics
          • the coordination of regional information gathering.


          Management of medical inspectors involves:

          • the coordination of regional medical inspectors
          • the development and application of reports, technical studies and research conducted regionally or transregionally, and ulti-mately, of specialized work groups
          • the organization of meetings which provide members of the Department of Workplace and Worker Medical Inspection with an opportunity to compare experiences and define consistent approaches to new problems
          • the preparation of recruitment and training procedures for medical inspectors of workplaces and workers
          • the continuing education of all regional medical inspectors.


          In addition to these core activities, the Department of Workplace and Worker Medical Inspection also collaborates with industrial relations and human resources departments in all cases involving medical aspects of work (especially those involving handicapped workers, candidates for continuing education and job applicants) and is responsible for managing, coordinating, recruiting and training regional medical inspectors and ensuring their continuing technical education. Finally, the central office of the Department also engages in consulting activities and is the government’s official representative in matters concerning occupational medicine.

          The Department of Labour’s central or regional Departments of Workplace and Worker Medical Inspection may be called upon to intervene when other governmental departments without their own medical inspection services (most notably the Department of Health and Social Security) find themselves faced with problems related to the prevention or correction of occupational health hazards; these departments of the Department of Labour may also assist in the establishment of a department of medical prevention. Except in cases where the requesting party is another governmental work-inspection service, the Department’s role is usually limited to an advisory one.

          From 7 to 10 June 1994, almost 1,500 people attended the XIIIth Journées nationales de médecine du travail (the 23rd National Occupational Medicine Conference) organized by the Société et l’Institut de médecine du travail et d’ergonomie de Franche-Comté (the Society and Institute of Occupational Medicine and Ergonomics of Franche-Comté). The following subjects were discussed:

          • neurotoxicity of low-level solvent exposure
          • health and the precariousness of health and work
          • stress and strain of contemporary work—the role of the occup-ational physician.


          The Department is the government’s representative in medicosocial, scientific and professional agencies or institutions in the field of occupational medicine. These include the Conseil National de l’Ordre des Médecins (the National Council of the Order of Physicians), le Haut Comité d’Études et d’Information contre l’alcoolisme (the High Commission for Alcoholism Research and Information) and various university and scientific institutions. In addition, the central Department of Workplace and Worker Medical Inspection is frequently called upon to present the French government’s position on medical questions to the European Economic Community, the WHO and the ILO. Regional departments have similar responsibilities, in accordance with Circular DRT No. 18-79, of 6 July 1979, on the role of cooperation between workplace inspectors and medical inspectors of workplaces in the prevention of occupational hazards. The circular identifies orientation, informational, supervisory, management and intervention activities to be carried out, as needed, in collaboration with the regional, departmental or local workplace inspection departments.

          Although both workplace inspectors and medical inspectors share common goals—the prevention of occupational health ha-zards—their specific interventions may differ, depending on the technical expertise required. Other circumstances may, on the other hand, require their collaboration.

          Proposed New Circular

          A circular in preparation reiterates and updates the clauses of the circular of 6 July 1979. It should be noted that on 1 January 1995, the Departments of Occupational Training assumed the responsibilities of the regional Departments of Labour and Employment. The function, role and mission of medical inspectors of workplaces must therefore be reviewed.

          In summary, we can say that by 1980, medical inspection departments had, for all intents and purposes, regained the role and functions originally foreseen for them in the period 1946-47. The most likely next step in medical inspection is towards increasing emphasis on promotion, management and research in workplaces. This evolution, it should be noted, parallels that of occupational medicine itself. Following a long period of development and implementation that may now be considered practically completed, occupational medicine must now embark upon a new era of qualitative improvement and scientific advance.



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          Occupational Health Services References

          Association of Occupational and Environmental Clinics (AOEC). 1995. Membership Directory. Washington, DC: AOEC.

          Basic law on labour protection. 1993. Rossijskaja Gazeta (Moscow), 1 September.

          Bencko, V and G Ungváry. 1994. Risk assessment and environmental concerns of industrialization: A central European experience. In Occupational Health and National Development, edited by J Jeyaratnam and KS Chia. Singapore: World Science.

          Bird, FE and GL Germain. 1990. Practical Loss Control Leadership. Georgia: Institute Publishing Division of the International Loss Control Institute.

          Bunn, WB. 1985. Industrial Medical Surveillance Programmes. Atlanta: Centers for Disease Control (CDC).

          —. 1995. The scope of international occupational medical practice. Occup Med . In press.

          Bureau of National Affairs (BNA). 1991. Workers’ Compensation Report. Vol. 2. Washington, DC: BNA.

          —. 1994. Workers’ Compensation Report. Vol. 5. Washington, DC: BNA.
          China Daily. 1994a. New sectors opened to lure foreign investment. 18 May.

          —. 1994b. Foreign investors reap advantages of policy changes. 18 May.

          Council of the European Communities (CEC). 1989. Council Directive On the Introduction of Measures to Encourage Improvements in the Safety and Health of Workers At Work. Brussels: CEC.

          Constitution of the Russian Federation. 1993. Izvestija (Moscow), No. 215, 10 November.

          Czech and Slovak Federal Republic. 1991a. The health sector: Issues and priorities. Human Resources Operations Division, Central and Eastern European Department. Europe, Middle East and North Africa Region, World Bank.

          —. 1991b. Joint environmental study.

          Equal Employment Opportunity Commission (EEOC) and Department of Justice. 1991. Americans with Disabilities Act Handbook. EEOC-BK-19, P.1. 1, 2, October.

          European Commission (EC). 1994. Europe for Safety and Health At Work. Luxembourg: EC.

          Felton, JS. 1976. 200 years of occupational medicine in the US. J Occup Med 18:800.

          Goelzer, B. 1993. Guidelines on control of chemical and physical hazards in small industries. Working document for the Inter-Regional Task Group on health protection and health promotion of workers in small-scale enterprises, 1-3 November, Bangkok, Thailand. Bangkok: ILO.

          Hasle, P, S Samathakorn, C Veeradejkriengkrai, C Chavalitnitikul, and J Takala. 1986. Survey of working conditions and environment in small-scale enterprises in Thailand, NICE project. Technical Report, No. 12. Bangkok: NICE/UNDP/ILO.

          Hauss, F. 1992. Health promotion for the crafts. Dortmund: Forschung FB 656.

          He, JS. 1993. Working report on national occupational health. Speech on the National Occupational Health Conference. Beijing, China: Ministry of Public Health (MOPH).

          Health Standards Office.1993. Proceedings of National Diagnostic Criteria and Principles of Management of Occupational Diseases. Beijing, China: Chinese Standardization Press.

          Huuskonen, M and K Rantala. 1985. Work Environment in Small Enterprises in 1981. Helsinki: Kansaneläkelaitos.

          Improving working conditions and environment: An International Programme (PIACT). The evaluation of the International Programme for the Improvement of Working Conditions and Environment (PIACT). 1984. Report to the 70th session of the International Labour Conference. Geneva: ILO.

          Institute of Medicine (IOM). 1993. Environmental Medicine and the Medical School Curriculum. Washington, DC: National Academy Press.

          Institute of Occupational Health (IOH). 1979. Translation of the Occupational Health Care Act and the Council of the State Decree No. 1009, Finland. Finland: IOH.

          Institute of Occupational Medicine.1987. Methods for Monitoring and Analysis of Chemical Hazards in Air of Workplace. Beijing, China: People’s Health Press.

          International Commission on Occupational Health (ICOH). 1992. International Code of Ethics for Occupational Health Professionals. Geneva: ICOH.

          International Labour Organization (ILO). 1959. Occupational Health Services Recommendation, 1959 (No. 112). Geneva: ILO.

          —. 1964. Employment Injury Benefits Convention, 1964 (No.121). Geneva: ILO.

          —. 1981a. Occupational Safety and Health Convention, 1981 (No. 155). Geneva: ILO.

          —. 1981b. Occupational Safety and Health Recommendation, 1981 (No. 164). Geneva: ILO.

          —. 1984. Resolution Concerning Improvement of Working Conditions and Environment. Geneva: ILO.

          —. 1985a. Occupational Health Services Convention, 1985 (No. 161). Geneva: ILO

          —. 1985b. Occupational Health Services Recommendation, 1985 (No. 171). Geneva: ILO.

          —. 1986. The Promotion of Small and Medium-Sized Enterprises. International Labour Conference, 72nd session. Report VI. Geneva: ILO.

          International Social Security Association (ISSA). 1995. Prevention Concept “Safety Worldwide”. Geneva: ILO.

          Jeyaratnam, J. 1992. Occupational health services and developing nations. In Occupational Health in Developing Countries, edited by J Jeyaratnam. Oxford: OUP.

          —. and KS Chia (eds.). 1994. Occupational Health and National Development. Singapore: World Science.

          Joint ILO/WHO Committee on Occupational Health. 1950. Report of the First Meeting, 28 August-2 September 1950. Geneva: ILO.

          —. 1992. Eleventh Session, Document No. GB.254/11/11. Geneva: ILO.

          —. 1995a. Definition of Occupational Health. Geneva: ILO.

          —. 1995b. Twelfth Session, Document No. GB.264/STM/11. Geneva: ILO.

          Kalimo, E, A Karisto, T Klaukkla, R Lehtonen, K Nyman, and R Raitasalo. 1989. Occupational Health Services in Finland in the Mid-1980s. Helsinki: Kansaneläkelaitos.

          Kogi, K, WO Phoon, and JE Thurman. 1988. Low Cost Ways of Improving Working Conditions: 100 Examples from Asia. Geneva: ILO.

          Kroon, PJ and MA Overeynder. 1991. Occupational Health Services in Six Member States of the EC. Amsterdam: Studiecentrum Arbeid & Gezonheid, Univ. of Amsterdam.

          Labour Code of the Russian Federation. 1993. Zakon, Suppl. to Izvestija (Moscow), June: 5-41.

          McCunney, RJ. 1994. Occupational medical services. In A Practical Guide to Occupational and Environmental Medicine, edited by RJ McCunney. Boston: Little, Brown & Co.

          —. 1995. A Manager’s Guide to Occupational Health Services. Boston: OEM Press and American College of Occupational and Environmental Medicine.

          Ministry of Health of the Czech Republic. 1992. The National Programme of Health Restoration and Promotion in the Czech Republic. Prague: National Centre for Health Promotion.

          Ministry of Public Health (MOPH). 1957. Recommendation on Establishing and Staffing Medical and Health Institutions in Industrial Enterprises. Beijing, China: MOPH.

          —. 1979. State Committee of Construction, State Planning Committee, State Economic Committee, Ministry of Labour: The Hygienic Standards for Design of Industrial Premises. Beijing, China: MOPH.

          —. 1984. Administrative Rule of Occupational Disease Diagnosis. Document No. 16. Beijing, China: MOPH.

          —. 1985. Methods of Airborne Dust Measurement in Workplace. Document No. GB5748-85. Beijing, China: MOPH.

          —. 1987. Ministry of Public Health, Ministry of Labour, Ministry of Finance, All-China Federation of Trade Union: Administrative Rule of Occupational Disease List and Care of the Sufferers. Document No. l60. Beijing, China: MOPH.

          —. 1991a. Administrative Rule of Health Inspection Statistics. Document No. 25. Beijing, China: MOPH.

          —. 1991b. Guideline of Occupational Health Service and Inspection. Beijing, China: MOPH.

          —. 1992. Proceedings of National Survey on Pneumoconioses. Beijing, China: Beijing Medical Univ Press.

          —. 1994 Annual Statistic Reports of Health Inspection in 1988-1994. Beijing, China: Department of Health Inspection, MOPH.

          Ministry of Social Affairs and Employment. 1994. Measures to Reduce Sick Leave and Improve Labour Conditions. Den Haag, The Netherlands: Ministry of Social Affairs and Employment.

          National Centre of Occupational Health Reporting (NCOHR). 1994. Annual Reports of Occupational Health Situation in 1987-1994. Beijing, China: NCOHR.

          National Health Systems. 1992. Market and Feasibility Study. Oak Brook, Ill: National Health Systems.

          National Statistics Bureau. 1993. National Statistics Yearbook of the People’s Republic of China. Beijing, China: National Statistic Bureau.

          Neal, AC and FB Wright. 1992. The European Communities’ Health and Safety Legislation. London: Chapman & Hall.

          Newkirk, WL. 1993. Occupational Health Services. Chicago: American Hospital Publishing.

          Niemi, J and V Notkola. 1991. Occupational health and safety in small enterprises: Attitudes, knowledge and behaviour of the entrepreneurs. Työ ja ihminen 5:345-360.

          Niemi, J, J Heikkonen, V Notkola, and K Husman. 1991. An intervention programme to promote improvements of the work environment in small enterprises: Functional adequacy and effectiveness of the intervention model. Työ ja ihminen 5:361-379.

          Paoli, P. First European Survey On the Work Environment, 1991-1992. Dublin: European Foundation for the Improvement of Living and Working Conditions.

          Pelclová, D, CH Weinstein, and J Vejlupková. 1994. Occupational Health in the Czech Republic: Old and New Solutions.

          Pokrovsky, VI. 1993. The environment, occupational conditions and their effect on the health of the population of Russia. Presented at International Conference Human Health and the Environment in Eastern and Central Europe, April 1993, Prague.

          Rantanen, J. 1989. Guidelines on organization and operation of occupation health services. Paper presented at ILO Asian subregional seminar on the Organization of Occupational Health Services, 2-5 May, Manila.

          —. 1990. Occupational Health Services. European Series, No. 26. Copenhagen: WHO Regional Publications

          —. 1991. Guidelines on the organization and operation of occupational health services in the light of the ILO Occupational Health Services Convention No. 161 and Recommendation No. 171. Paper presented at the African sub-regional workshop on occupational health services, 23-26 April, Mombasa.

          —. 1992. How to organize plant-level collaboration for workplace actions. Afr Newslttr Occup Health Safety 2 Suppl. 2:80-87.

          —. 1994. Health Protection and Health Promotion in Small-Scale Enterprises. Helsinki: Finnish Institute of Occupational Health.

          —, S Lehtinen, and M Mikheev. 1994. Health Promotion and Health Protection in Small-Scale Enterprises. Geneva: WHO.

          —,—, R Kalimo, H Nordman, E Vainio, and Viikari-Juntura. 1994. New epidemics in occupational health. People and Work. Research reports No. l. Helsinki: Finnish Institute of Occupational Health.

          Resnick, R. 1992. Managed care comes to Workers’ Compensation. Bus Health (September):34.

          Reverente, BR. 1992. Occupational health services for small-scale industries. In Occupational Health in Developing Countries, edited by J Jeyaratnam. Oxford: OUP.

          Rosenstock, L, W Daniell, and S Barnhart. 1992. The 10-year experience of an academically affiliated occupational and environmental medicine clinic. Western J Med 157:425-429.

          —. and N Heyer. 1982. Emergence of occupational medical services outside the workplace. Am J Ind Med 3:217-223.

          Statistical Abstract of the United States. 1994. 114th edition:438.

          Tweed, V. 1994. Moving toward 24-hour care. Bus Health (September):55.

          United Nations Conference on Environment and Development (UNCED). 1992. Rio De Janeiro.

          Urban, P, L Hamsová, and R. Nemecek. 1993. Overview of Occupational Diseases Acknowledged in the Czech Republic in the Year 1992. Prague: National Institute of Public Health.

          US Department of Labor. 1995. Employment and Earnings. 42(1):214.

          World Health Organization (WHO). 1981. Global Strategy for Health for All by Year 2000.
          Health for All, No. 3. Geneva: WHO.

          —. 1982. Evaluation of Occupational Health and Industrial Hygiene Services. Report of the Working Group. EURO Reports and Studies No. 56. Copenhagen: WHO Regional Office for Europe.

          —. 1987. Eighth General Programme of Work Covering the Period 1990-1995. Health for All, No.10. Geneva: WHO.

          —. 1989a. Consultation On Occupational Health Services, Helsinki, 22-24 May 1989. Geneva: WHO.

          —. 1989b. Final Report of Consultation On Occupational Health Services, Helsinki 22-24 May 1989. Publication No. ICP/OCH 134. Copenhagen: WHO Regional Office for Europe.

          —. 1989c. Report of the WHO Planning Meeting On the Development of Supporting Model Legislation for Primary Health Care in the Workplace. 7 October 1989, Helsinki, Finland. Geneva: WHO.

          —. 1990. Occupational Health Services. Country reports. EUR/HFA target 25. Copenhagen: WHO Regional Office for Europe.

          —. 1992. Our Planet: Our Health. Geneva: WHO.

          —. 1993. WHO Global Strategy for Health and Environment. Geneva: WHO.

          —. 1995a. Concern for Europe’s tomorrow. Chap. 15 in Occupational Health. Copenhagen: WHO Regional Office for Europe.

          —. 1995b. Global Strategy On Occupational Health for All. The Way to Health At Work: Recommendation of the Second Meeting of the WHO Collaborating Centres in Occupational Health, 11-14 October 1994 Beijing, China. Geneva: WHO.

          —. 1995c. Reviewing the Health-For-All Strategy. Geneva: WHO.

          World Summit for Social Development. 1995. Declaration and Programme of Action. Copenhagen: World Summit for Social Development.

          Zaldman, B. 1990. Industrial strength medicine. J Worker Comp :21.
          Zhu, G. 1990. Historical Experiences of Preventive Medical Practice in New China. Beijing, China: People’s Health Press.