Working conditions have deteriorated recently and exposure to carcinogenic materials has worsened. In France there has been a spate of work-related suicides.
‘Encouraging a person to commit suicide is punishable by three years’ imprisonment and a fine of EUR 45,000 where the encouragement is followed by a suicide or attempted suicide’ (French penal code, article 223-13).
France leads the list of countries where the suicide rate has grown since 1975. The rate among working males reached 11,000 a year by 2000 – ‘more than one every hour’ as the sociologists Christian Baudelot and Roger Establet pointed out. ‘Suicide is invariably the result of major contradictions between the demands of social life and the nature of the individual’ (1). Recent statistics from France’s National Institute for Health and Medical Research (Inserm) indicate that the rate is now stabilising at around 12,000 a year.
There are no figures to indicate whether any of this is work-related. Suicide at work, like any act of self-harm, is an enigma. It is not new: in 1995 the CGT trade union noted eight suicides among subcontracted maintenance workers at the Electricité de France (EDF) nuclear power station at Chinon, near Tours. The media were not interested (2).
Deaths that mattered
Maintenance work at Chinon involved radioactive materials. The managers of French nuclear facilities have to observe legal limits for individual exposure to radiation. Rather than reduce exposure, they prefer to rotate large numbers of subcontracted and temporary workers. This practice is known as job management by dose (gestion de l’emploi par la dose): when individual workers have absorbed an acceptable amount of radiation, they lose their jobs.
While the nuclear industry maintained its public image, claiming to respect ‘threshold limit value ceilings’, contract workers had a choice between staying in work and keeping healthy. The 25,000-35,000 outside workers brought into radiation risk areas to do maintenance (50% of those studied) suffered 80% of total collective exposure to radiation within the industry. The media were still not interested.
But a series of suicides, just months apart, at two monuments of capitalism – the Renault Technocentre at Guyancourt, just outside Paris, and the nuclear plant at Chinon – were a different matter. Eight highly-qualified managers and technicians killed themselves at work, or blamed work for their suicides. This time the world took notice. Four suicides in May, among workers at Peugeot Citröen in Mulhouse, worsened anxiety.
In October 2006 an engineer threw himself off the fifth floor of the Technocentre where Renault builds its latest models. His family managed to get his suicide recognised as a workplace accident and will claim that the company was responsible. After two more suicides, in December 2006 and February 2007, the unions went public on working conditions in the company. The Renault Contract 2009 has created an impossible contradiction by transforming the obligation to work into a duty to produce results. It was dreamed up by Renault’s CEO, Carlos Ghosn, who, committed to raising shareholder dividends by 250%, set ambitious production targets: an increase in sales of 800,000 vehicles between 2005 and 2009, and the launch of 26 new models in three years. Every worker has to make a personal commitment: any who refuse to sign a transcript of the meeting during which they set personal targets with their manager will receive a recorded-delivery letter listing targets and warning they must be met. This exerts constant pressure, but allows no opportunity to discuss the problems created by the challenge.
There is a similar target-driven culture at the Chinon plant. But maintenance workers also have to uphold nuclear safety standards under the pressure of job insecurity. Two suicides there were the result of the heavy responsibilities on executives, one in maintenance, one responsible for the running of the facility.
When Valery Legasov, one of the former Soviet Union’s leading specialists in nuclear safety killed himself after the 1986 Chernobyl disaster, he left a memoir criticising failings in safety throughout the industry (3). He emphasised three points: the sacrifice of safety standards to productivity; the lack of a critical response among engineers to repeated anomalies in the functioning of power stations; and the unpreparedness of personnel and the authorities (nuclear and civil) for any serious malfunction.
All these suicides were work accidents as defined by article L.411-1 of the French social security code, since they ‘took place in the workplace or during work’. The problems these workers had to confront were the result of organisational decisions by senior managers who made workers responsible for resolving contradictions, but denied them the means to do so. Article 223-13 of the penal code implies an indictment of whoever was responsible. Surely company directors should be legally required to back up their denials that these suicides were work-related?
Counting the casualties
Work-related deaths, injuries and sickness are underestimated. Every day in France, accidents kill two people, asbestos kills eight, and 2.5 million workers are exposed to carcinogenic substances. Millions are pushed to the limits of physical and mental endurance (4). Recent studies of conditions show that workers are vulnerable to traditional risks, to pressures to meet deadlines and to hierarchical constraints (5).
After 30 years of stability, recognised and compensated occupational illnesses rose from an average 4,000 during the 1980s to 40,000 in 2005. Almost 90% of this increase is due to repetitive strain injury and asbestos-related illnesses (6). And it is officially recognised that these figures are just the tip of the iceberg: every year, France’s labour accidents fund (Fonds des accidents du travail) pays the general health insurance scheme (Régime Général d’Assurance Maladie) compensation for the unnecessary costs that it has to meet for work-related injuries not declared as such and therefore not indemnified.
The annual number of new cancer cases rose from 150,000 in 1980 to 280,000 in 2000. French men are the most likely in Europe to suffer from cancer before the age of 65; between the ages of 45 and 54, a blue-collar worker is four times more likely to die of cancer than a senior manager. Despite this, a professor of epidemiology, Richard Doll, and many scientists around the world have exculpated the asbestos, chemical and nuclear industries from any responsibility, insisting that the only causes of cancer are tobacco, alcohol and eating habits (7). Doll’s 1981 estimate that occupational cancers represented only 4% of the total is arbitrary and has been contested, but it remains the reference norm among specialists and doctors. Overall, according to the estimate of France’s leading public health institution, the Institut de veille sanitaire, asbestos is responsible for less than 1% of all cancers. But in France in 2005, out of 1,795 work-related cases of cancer and 325 deaths, more than 85% were linked to asbestos (8).
A sinister lottery
The nature of the illness offers considerable freedom of interpretation. Cancer does not obey any simple law of cause and effect. It is a process during which the human body, at a particular time in life and in a particular state of health, encounters carcinogens at work or in the general environment. It may be decades before symptoms appear. Some exposed individuals succumb; others do not. There can be no certainty. And industry exploits the unpredictable nature of this sinister lottery to deny or underestimate the evidence of risks for as long as possible.
Articles L.461-1 and L.462-2 of the social security code specify that the victims of designated industrial diseases should not have to prove that they are work-related (9). Only 20 substances appear on this register of carcinogens; and there is no documentation on the effects of exposure to more than one. But since 1993 there has been a complementary system that allows for the recognition of non-designated diseases if a doctor can establish a ‘direct and essential link’ with the victim’s job. Since 2002 the victims of asbestos-related cancers have been entitled to extra compensation from a special social security fund.
A five-year research study of occupational cancers in Seine-Saint-Denis, a suburb of Paris, has questioned the prevailing interpretation of the factors responsible and what constitutes an occupational disease (10). Close study of the work histories of 650 patients showed that more than 80% suffered long-term multiple exposure to a number of known carcinogens not included in the official register. Most of the men were blue-collar workers, half of them under 60, in industries like construction, metalworking, car repair, printing, maintenance and cleaning. Only one in six has received recognition and compensation.
Many of the patients were employed in building and public works. But few, apart from those exposed to asbestos, had their condition recognised as an occupational disease. This was especially true of painters, electricians or tar-spreaders. Their carcinogens do not appear in the register; and because they moved from job to job it was impossible to demonstrate a ‘direct and essential link’ between their occupations and their cancers. Many of the women worked as cleaners (housemaids, ancillary staff in nursery schools, nursing auxiliaries). The carcinogens implicated may have been in products, like solvents, that do not appear in the official list, or may have been present in the workplace itself.
Preventative networks
Among men in the study, unskilled labourers were most at risk: maintenance workers, packers, delivery drivers and heavy plant drivers, particularly exposed to polycyclic aromatic hydrocarbons (compounds produced by combustion or present in some road-surfacing materials), benzene, diesel and petrol, and also to other carcinogens used in servicing, maintenance and cleaning. One case involved a sub-contracted worker stripping paint from planes at Charles de Gaulle airport outside Paris, who died in 2006, at the age of 53, from cancer of the sinuses. His illness was not recognised as work-related, although he used caustic products in a process that generated paint dust containing carcinogenic compounds. From the manufacture of aeroplanes to their maintenance, most risks are borne by contract workers, whose work histories seldom meet the legal criteria for their cancers to be recognised as occupational.
We constantly develop new molecules whose toxic properties are not evident when they are first produced. To wait 10 or 40 years – even a century, as with asbestos – for mainstream science to acknowledge a statistically significant relationship between a toxic product and a particular cancer amounts to experimenting on humans.
Job insecurity is eroding the right of workers to be protected from and compensated for risks. This is the main reason for the invisibility of occupational cancers in society and the lack of statistical analysis.
In the battle for health in the workplace, the principle of compensation has obvious limits. The principle underpinning the right to reparations, as defined by the 1898 legislation on workplace accidents and that of 1919 on industrial diseases, is insurance. As a result, compensation for workplace victims is not a legal issue, but an aspect of pay negotiations, dependant upon the balance of power between workers and management – in other words on the good will of the employers’ organisation Medef (Mouvement des entreprises de France). Occupational health has been removed from public health’s field of research and action. Manufacturers and employers can determine the organisation and conditions of work with impunity.
No compensation can be adequate reparation for the massive damage done by occupational diseases, especially cancers. This is underlined by a 2007 study by the European Trade Union Institute: unions at least are waking up to the issue (11).
We must not let the health of workers be the exclusive preserve of a few scientific and medical specialists from unions or grass-roots organisations. Over the past 15 years a number of networks have begun to publicise harm in the workplace, the contracting-out of risky procedures, and the off-shoring of work-related fatalities. These include the international Ban Asbestos network (12), which is spreading awareness of the number of victims and naming those responsible.
An alliance of social activists, scientists, health professionals, lawyers, journalists and documentary-makers could shatter the impunity that has protected the manufacturers and shareholders responsible for all this damage. Hence the urgency of creating an occupational international criminal court, before which those who have knowingly caused death in workplace can be called to account. We must return to the basic rights that underpin democracy by forbidding all attacks upon the integrity of individuals. ________________________________________________________
Annie Thébaud-Mony is a sociologist and director of research at France’s National Institute for Health and Medical Research (Inserm). She is the author of Travailler peut nuire gravement à votre santé (Working can damage your health) (La Découverte, Paris, 2007)
(1) Christian Baudelot and Roger Establet, Suicide. L’envers de notre monde (Seuil, Paris, 2006).
(2) See L’Industrie nucléaire: sous-traitance et servitude, from the series ‘Questions en santé publique’, Inserm-EDK, Paris, 2000.
(3) See Bella and Roger Belbéoch, Tchernobyl. Une catastrophe (Allia, Paris, 1993).
(4) Official figures from the French government departments of health insurance and labour.
(5) Ministry of labour, Direction de l’animation et de la recherche, des études et des statistiques (Dares), ‘Premières informations, premières synthèses’, Paris, January 2007.
(6) See François Malye, Amiante: 100 000 morts à venir (Le Cherche Midi, Paris, 2004).
(7) See Annie Thébaud-Mony, op cit; also David Egilman and Susannah Rankin Bohme ‘Over a barrel: Corporate corruption of science and its effects on world environment’ (PDF), International Journal of Occupational and Environmental Health (IJOEH), Burlington, North Carolina, Oct-Dec 2005.
(8) www.risquesprofessionnels.ameli.fr
(9) If the disease and job appear on a list of designated occupational diseases, there is no need to prove a causal link.
(10) Réseau SCOP 93 (Annie Thébaud-Mony et al), ‘Occupational cancer in a Paris suburb: First results of a proactive research study in Seine-Saint-Denis’ (PDF), IJOEH, July-Sept 2005.
(11) Marie-Anne Mengeot, ‘Occupational cancers. The Cinderella disease’, European Trade Union Institute, Brussels, 2007.
(12) See www.ban-asbestos-france.com and www.ibas.btinternet.co.uk
Translated by Donald Hounam
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