13/12/2007
"Can company doctors do their job independently?" queries the business supplement of France’s Le Monde newspaper for 4 December. The heavyweight daily offers a bleak analysis of how occupational health services are organized in France, singling out the "unsafe links between occupational health services and bosses".

The recent revelations about the slush fund kept by the metallurgical industry employers' association has loosened some tongues to blow the whistle on other questionable goings-on that strike at the very heart of how occupational health is managed in France.

Health monitoring for 93% of employees is handled by intercompany occupational health services (SISTs). These are organizations to which companies with no in-house occupational health service outsource their employees’ health surveillance. These bodies are paid for entirely by the employers who hold two-thirds of the seats on their management boards, the other third being set aside for workers' reps since 2004. That is offset to some extent by workers’ reps holding most of the seats on the supervisory committees that exercise oversight on how SISTs are run. The problem is - as the industry-watchers including the trade unions interviewed by Le Monde admit - that lack of effective participation by employee representatives tends to make this a hollow gain.

The lack of trade union control and balancing force seems to have left the field open to what might be described as "incestuous" links between some SISTs and Medef, the French employers’ lobby. Practices like SIST managers who actually work for Medef, SISTs paying the rent on the building where the local employers' association has its offices, and other kickbacks like company cars paid for out of health and safety at work funds, are all being looked into by French law enforcement.

Along with these breaches of the law, Le Monde inveighs against the pressure put on SISTs to shunt company doctors who are too concerned about workers' health out of the way, citing the example of a company doctor at an IBM regional main office who was recently "replaced" for speaking out about the harm done to workers' health by overwork and the staff appraisal system.

The newspaper also paints a stark picture of the structural future of France’s occupational health service, estimating that 1 700 company doctors will be lost to retirement within the next five years, with barely even 400 set to replace them.

Source: Les liaisons dangereuses de la médecine du travail et du patronat, Le Monde, supplément Economie, 4 December 2007.