Occupational health: aiming to take better account of multiple exposure

Workers can potentially be exposed to numerous health risk factors through their occupations. The question of multiple exposure is a major challenge for all those active in the field of occupational health, safety and prevention. As part of the 2016-2020 National Occupational Health Plan, a review of the measures taken by the main players to address the question of multiple exposure in France and abroad is being published today. This work has helped determine the state of knowledge and the issues surrounding this problem.


Throughout their professional careers, workers are exposed simultaneously to chemical, biological or physical hazards through various routes such as inhalation, ingestion or skin contact. This exposure, combined with psychosocial risk factors related to issues of work organisation and management, can lead to the occurrence of short- or long-term diseases and make working conditions more difficult.

Occupational factors likely to increase health risks are frequently studied separately from each other and current approaches rarely integrate this issue of multiple exposure, despite it reflecting the reality of work situations.

As part of the third National Occupational Health Plan (PST3) adopted by the Ministry of Labour in late 2015, a specific action aims to improve how multiple exposure is taken into account and identify certain occupational sectors that are particularly exposed to cumulative risks. To this end, an initial review has listed the main measures taken in this area at institutional level in France and in other countries in Europe and North America.

The work involved collecting and analysing the available studies, practices and guidelines on the question of multiple exposure. It emphasised that the most advanced work and actions in the field relate to chemical exposure, although workers' knowledge of these risks remains insufficient. Concerning other risk factors such as physical or biological ones, the analysis reflected the limited investment in these subjects. On the other hand, work on organisational and psychosocial constraints is growing strongly. The survey also identified some prevention tools, and information and training initiatives that have been implemented to take better account of the multiple exposure aspects.

This review has enabled some initial lessons to be drawn, which will help identify, in a subsequent analysis phase, the occupational sectors particularly exposed to cumulative risks and, more generally, foster efforts to take better account of multiple exposure in the assessment and prevention of risks in the workplace.

The National Occupational Health Plan (PST3) sets out the government's occupational health orientations for the period 2016 to 2020. Action 1.11, which concerns the question of multiple exposure, is being implemented by several partners, including the National Agency for the Improvement of Working Conditions (ANACT), the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), the National Health Insurance Fund (CNAM), the Directorate for Research, Studies and Statistics (DARES), the General Directorate for Labour (DGT), the General Directorate for Risk Prevention (DGPR), the General Directorate for Health (DGS), the National Research and Safety Institute (INRS) and the French Public Health Agency (SPF).