[Job retention and health issues: an example of personalized assistance in northern France]

"Santé Emploi Info Service" (Health and Employment Information Service) is a regional information service aimed at providing support and assistance to people who are struggling to perform their job effectively or to return to work as a result of a health problem. Through personalized assistance and follow-up, the service aims to help individuals to avoid professional exclusion, to provide accessible information, and to encourage networking between healthcare professionals and services specializing in job retention and vocational rehabilitation. In total, 1,392 calls have been received since the service opened in 2006, with most calls dealing with employment, income and legal matters and a range of psychological counseling issues. More than half of the proposed solutions have proved successful. The regional service (a unique initiative in France) is supported by Lille Regional Hospital and helps individuals suffering from health problems to overcome obstacles to job retention and vocational rehabilitation. The service also provides specifically-tailored information about legal procedures relating to professional integration and vocational rehabilitation.

The traceability of carcinogenic occupational risks: state of progress in France compared with other European countries

Occupational risks are constantly evolving. The complexification of these occupational risks, the context of the flexibility with the new forms of organization, the new conditions of use and the increase in occupational mobility are accentuating the difficulties of assessment of the deferred risks for the health of employees. In point of fact, if on the one hand the immediate risk (accidental, corrosive, caustic, explosive...) is properly taken into account, on the other hand this is far from the case for the deferred risk, in particular the carcinogenic risk. Now, the liability of employers (especially with regard to cancers due to asbestos) is incurred more and more often. It is they in fact who bear the brunt of the prevention of occupational risks in France. Since 2002, the French employer has thus a veritable safety performance obligation in terms of preserving the health of the employees. Now, one of the vital keys to the prevention of deferred occupational risks resides in the traceability of the exposures that the employees have undergone throughout their working lives, in particular carcinogenic. In this context, the follow-up of the exposure of the employees to carcinogenic risks then becomes a necessity. The awareness of the necessity of setting in place an occupational exposure follow-up tool is not recent. Traceability procedures exist moreover in a certain number of countries, but so far in France we have only seen ad hoc experiments of a very limited nature for the identification and storage of occupational exposure. These are not of an exhaustive nature or only relate to mainly medical data. There is no systematic tool for the follow-up of carcinogenic exposure. This is due, on the one hand to the technical difficulties of setting in place standardized tools for exposure data collation, and on the other hand to the fact that the traceability of the personal information collated may raise ethical issues of reconciling the right to health of the employees with their right to work and the observing of their individual liberties; lastly, because the amassing of such information may raise issues of liability, in particular for the employer exposing its employees to carcinogens. Such issues transcend frontiers and have to be taken into consideration in order for progress to be made in the area of traceability of occupational exposure. Very few studies have been devoted to this subject so crucial to the prevention of occupational diseases. We propose, initially, to define traceability and the issues involved. Next, we will consider the current regulatory obligations on employers in France that may contribute to the traceability of occupational exposure and their limits. Then we will examine the brakes--the legal, ethical and technical difficulties that explain why France is lagging behind in this field. Finally, we will study the French perspectives with regard to the European advances in the traceability area.

Illicit drugs, testing, prevention and work in France: ethical and legal issues

The use of illicit drugs in the workplace raises issues pertaining to prevention and safety and the responsibility of the various members of staff. It also brings into question the interface between work and private life. If employees are in theory responsible for their own safety and risk heavy penalties in the event of the consumption of illicit drugs in the workplace, such behaviour has to be proved. In reality, the worker can only be partially and marginally held liable, given the fact that the employer is prohibited from infringing on their rights and liberties (restrictions on the searching of their personal belongings and lockers as well as on the carrying out of breath testing and saliva testing under restrictive conditions). Employers have for their part a broader range of responsibilities and, above all, an absolute obligation to achieve specific goals in terms of health and safety resulting in the need to take action. In accordance with the International Labour Organization recommendations, European and national legislation, the employer has to implement a suitable preventive policy. However, where is the balance between prevention and repression? Very few studies have raised these issues and our aim is to precisely situate the place of drug testing in the employer's repressive arsenal in France and to try to answer the legal and ethical issues raised. Thus, for example, repression can only be acceptable when it deals with moderate and non-addicted users, or it could be tantamount to discrimination.