Why carry out independent collective expert appraisals for the recognition of occupational diseases?
In France, occupational disease tables are the cornerstones of the system for the recognition of work-related illnesses. Their creation and modification are important processes that require scientific knowledge for establishing causal relationships between exposure or working conditions on the one hand and diseases on the other. However, these relationships are neither simple nor direct. So far, the creation and modification of these tables have largely resulted from negotiations between social partners, where scientific considerations were debated in parallel with other political-social and economic aspects.
That said, it has been demonstrated that there is a large gap between, firstly, the state of knowledge on the effects of a number of occupational risk factors and, secondly, how this knowledge is taken into account by the table system. This gap contributes to the structural under-recognition of occupational diseases. To be able to improve this recognition, based on advances in scientific knowledge and professional practices, it seemed necessary to turn to independent, collective scientific expert appraisals. That is why, in 2018, the government decided to separate the expert appraisal stage from the negotiation stage of the procedure for creating or revising occupational disease tables and draw on ANSES's expertise in particular.
Can you please describe the methodology developed by ANSES? Also, what will the Agency's initial appraisals focus on?
It should first and foremost be noted that this methodology was produced through a collective expert appraisal conducted by a dedicated working group made up of experts in various fields including epidemiology, medicine, toxicology, sociology, exposure assessment, ergonomics and social legislation.
The aim of this methodology is to define a framework for collecting and analysing scientific data. The Agency's assessments of these data will enable the public authorities to decide whether it is appropriate to create or revise a table, after consulting the occupational disease committees in which social partners are members. This methodology therefore covers all of the steps that need to be taken to meet this objective, such as the definition of diagnostic criteria for diseases, the description of potentially related occupational exposure, and above all the establishment of causal relationships between the two. It also includes a human and social sciences component, enabling various issues, especially sociological and legal issues, to be taken into account.
Our first appraisal consisted in evaluating the link between exposure to pesticides, in particular chlordecone, and prostate cancer. This appraisal was recently submitted to the competent ministries and will soon be presented to occupational disease committees (CS4 and Cosmap). Next, we will study the link between occupational exposure to asbestos and ovarian, laryngeal, pharyngeal, stomach and colorectal cancers.
What is the intended impact of ANSES's expert appraisals on the system for the recognition of occupational diseases?
By turning to independent, collective and multidisciplinary scientific expert appraisals, the reorganisation requested by the public authorities aims to more effectively tackle the problem of occupational diseases being under-recognised. The goal in particular is to improve the recognition system's ability to take into account advances in scientific knowledge and professional practices. However, it is important to stress that access to more robust and independent scientific expertise cannot itself guarantee any improvement in the current system's ability to achieve its recognition and prevention objectives.
In addition to producing expert appraisals that will benefit reflections on the creation or revision of occupational disease tables, we think that the public nature of our work will more broadly help promote the activation of social rights. The current tables and the arguments that led them to be adopted are not always known and can be interpreted differently by the various stakeholders in the system for the recognition of occupational diseases: these include workers exposed to risk factors who develop a disease and wish to initiate a claim for recognition; doctors who are supposed to assist them to that end by drawing up certificates attesting to their state of health; social insurance funds responsible for the medical-administrative management of claims; and employers receiving occupational disease declarations. It is therefore important that the Agency's work provide all stakeholders involved in procedures related to the recognition of occupational diseases with access to solid scientific data enabling them to defend their positions.