Nearly all employees affected by cumulative occupational exposure

To better describe the reality of multiple exposure situations among employees in France and identify the occupational sectors particularly affected, a study was conducted jointly by ANSES, Santé publique France, and DARES based on the results of the 2016–2017 SUMER survey. Conducted as part of the 3rd Occupational Health Plan 2016–2020 (PST 3), it follows a review of the main actions taken regarding multiple exposures, both in France and abroad, published in 2018.

This analysis reveals that nearly all (97%) of the 25 million employees in the public and private sectors are multi-exposed, meaning they are exposed to at least two stressors—whether of the same category or not—during their professional careers. These occupational stressors fall into five categories:

• chemical—potentially hazardous substances;

• biological—bacteria, viruses, or mold;

• physical—noise pollution, postural or thermal stress, exposure to radiation;

• organizational—work schedules, lack of material and/or human resources, work intensity and pace, limited autonomy, etc.;

• relational—high pressure, low recognition at work, hostility from colleagues or management, tensions, etc.

A dozen cumulative exposure profiles identified

A statistical analysis grouped employees into 12 profiles describing the most common cumulative exposure situations.
Some profiles may be associated with one or more specific occupational fields, such as healthcare professionals, those in agriculture, the navy, and fishing.

Others describe a situation of multiple exposure common to several sectors of activity. This is particularly the case for employees engaged in office work, in fields as varied as public administration, education, or banking and insurance.

Organizational constraints affect all sectors of activity

While known exposures to chemical, physical, or biological stressors are specific to the professional activity performed, all profiles of multiple exposure, however, highlight exposures to organizational and relational stressors. Often less well-documented, these stressors are in fact inherent to any salaried activity, as they are specific to the organization of work and cooperation with other workers, as well as to interactions with clients or users.

Many healthcare professionals are exposed to all categories of stressors

Healthcare professionals—nurses, midwives, nursing assistants, paramedical professionals, physicians, and similar roles—appear to be a professional group particularly affected by multiple exposures. They experience characteristic exposures across all five categories of stressors. They are thus potentially exposed to human-derived biological agents, often combined with exposure to chemical substances, particularly through medications. They also face stressful situations, scheduling constraints such as night shifts, a demanding work pace, and a lack of material and human resources, compounded by physical stressors such as ionizing radiation or difficult physical postures.

An original framework to guide prevention and research on multiple exposures

This comprehensive approach based on multiple-exposure profiles represents a significant step forward in shedding light on multiple exposures, enabling them to be better addressed. It provides a framework for reflection, encouraging us to no longer consider the stresses faced by employees in isolation but as a whole, potentially highlighting the associated occupational risks. It offers an initial identification of the sectors affected by these multiple exposures.

Following this work, a more precise characterization of professions particularly prone to multiple exposures should be conducted, such as for healthcare workers. Ongoing studies have already been initiated regarding the working conditions of cleaning and sanitation workers and their impacts on health, as well as the health risks for workers involved in the collection, sorting, and processing of household waste.

It would also be useful to strengthen research to better understand how the interaction between certain stressors can lead to an exacerbation of health effects for workers. This will contribute to progress in implementing the exposome concept, which aims to account for cumulative exposures: accumulation over time, accumulation across exposure factors—to which this report contributes—and, beyond that, accumulation between exposures in the workplace and in daily life.