Entre plan national et initiative locale, l'émergence d'une gouvernance territoriale des risques professionnels ?: Rapport final

A partir du cas des « Réseaux de Veille et de Prévention » des risques professionnels (RVP) mis en place en Provence-Alpes-Côte d'Azur au début des années 2000 dans le cadre du Contrat de Plan Etat-Région 2000-2006, cette recherche s'est efforcé de comprendre comment s'organisait et innovait l'action publique en matière de prévention des risques professionnels. 1. La difficile marche vers une gouvernance territoriale des risques du travail Reprenant les RVP et adopté dès 2005, le Plan régional Santé Travail (PRST) est censé concrétisé un paradigme « épidémiologique » qui, dans une logique de santé publique, vise à décloisonner les différentes composantes de l'action sanitaire. Soucieuse de préserver son autonomie d'action ainsi que le bien fondé d'une régulation tripartite impliquant les partenaires sociaux, la direction régionale du travail (DRTEFP) s'appuie sur la promotion d'un paradigme, alternatif et complémentaire, qualifié d'ergonomique : les atteintes à la santé doivent être mises en relation avec les conditions organisationnelles de l'activité des personnes. Avec ce 2ème paradigme, cette administration de l'Etat redonne du sens à une initiative de la Région, à savoir les accords cadres tripartites de branche couvrant la formation, l'emploi et les conditions de travail. La conclusion et la mise en œuvre de nouveaux accords cadres dans la métallurgie et la chimie-plasturgie, tout comme le renouvellement d'accords antérieurs dans des secteurs clés, tels que le BTP et l'hôtellerie-restauration, constituent des tests probants d'une part, de la capacité de coopération entre acteurs publics et d'autre part, de l'aptitude de ces derniers à mettre sur pied des dispositifs qui puissent intégrer la gouvernance des divers risques du travail (versant emploi : exposition au chômage, obsolescence des qualifications ; versant santé au travail : exposition aux accidents et maladies professionnelles) pour produire plus d'efficacité dans les gestions publiques et privées de ces risques. 2. Action collective et appropriation des démarches préventives par de (très) petites entreprises La finalité de l'action collective étudiée, laquelle relevait initialement des RVP, était double : d'une part, mettre à disposition des entreprises un guide pour l'élaboration du document unique relatif à l'évaluation des risques et, d'autre part, enclencher une action de formation permettant aux entreprises de s'approprier la démarche pour faire de la prévention un investissement durable. Au total, à l'échelle des deux professions –Hôtellerie-restauration, réparation automobile- dans les Alpes Maritimes, l'impact de la démarche reste limité ; d'ailleurs, les entreprises – non touchées par l'action collective - ne semblent pas plus éloignées de la prévention des risques. L'appropriation durable de la méthode d'évaluation des risques par les artisans et leurs employés requiert un service d'accompagnement et de suivi plus conséquent. Cette appropriation est très dépendante des types d'entreprise concernées. On identifie – en prenant l'exemple de la réparation automobile - trois configurations qui dessinent des relations à la main d'œuvre spécifiques et aux normes légales en matière de prévention : la TPE « indépendante » et traditionnelle ; la TPE « managériale » avec un mode de gestion plus industriel, la TPE « entrepreneuriale » qui s'appuie sur une haute maîtrise technique et des prestations annexes de qualité. Plus l'entreprise s'apparente au modèle de l'entreprise indépendante traditionnelle, plus elle met à distance la prévention. Il en ressort qu'une démarche d'intermédiation doit échapper au « confort » d'une approche standardisée des entreprises si elle veut s'adapter à la pluralité des logiques de fonctionnement des TPE visées. 3. La formation à la prévention des risques, une composante de la qualification professionnelle ? Depuis 15 ans, l'investissement politique et cognitif sur l'enseignement à la prévention des risques professionnels en formation initiale a été important. L'objectif est de faire de cet enseignement une dimension reconnue comme telle de la formation professionnelle des jeunes. Au vu des quelques CFA et lycées professionnels visités, nombre de facteurs convergent pour rendre assez abstraite la formation à la prévention des risques. Entreprises et établissements de formation ne coopèrent pas assez pour faire de la prévention une composante reconnue de la qualification professionnelle

The Aids policy cycle in Western Europe: From exceptionalism to normalization

In every Western European country the occurrence of Aids has led to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained not only by the fact that a health catastrophe was feared, but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar exceptionalist alliances consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise signs of fatigue in the exceptionalist alliance and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. The paper elucidates specific aspects of each of the four roughly distinguishable phases in this process: Approx. 1981 - 1986: emergence of exceptionalism. The underlying reasons for exceptionalism are investigated in this paper. Approx. 1986 - 1991: consolidation and performance of exceptionalism. The paper investigates the exceptionalist policy model, more specifically some nationally different factors in the polity and politics that help to explain the different forms of policies. Approx. 1991 - 1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The changes made in the management of HIV and Aids are elucidated using examples from the fields of health care, primary prevention and drug policies. Aids health-policy innovations, and their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with Aids for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which Aids exceptionalism has been institutionalized and the distance of these innovations from medical/therapeutic events. The contribution made by European countries to containing the global Aids crisis is inadequate. --

The Aids policy cycle in Western Europe: From exceptionalism to normalization

In every Western European country the occurrence of Aids has led to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained not only by the fact that a health catastrophe was feared, but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar exceptionalist alliances consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise signs of fatigue in the exceptionalist alliance and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. The paper elucidates specific aspects of each of the four roughly distinguishable phases in this process: Approx. 1981 - 1986: emergence of exceptionalism. The underlying reasons for exceptionalism are investigated in this paper. Approx. 1986 - 1991: consolidation and performance of exceptionalism. The paper investigates the exceptionalist policy model, more specifically some nationally different factors in the polity and politics that help to explain the different forms of policies. Approx. 1991 - 1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The changes made in the management of HIV and Aids are elucidated using examples from the fields of health care, primary prevention and drug policies. Aids health-policy innovations, and their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with Aids for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which Aids exceptionalism has been institutionalized and the distance of these innovations from medical/therapeutic events. The contribution made by European countries to containing the global Aids crisis is inadequate

Die Normalisierung von Aids in Westeuropa: Der Politik-Zyklus am Beispiel einer Infektionskrankheit

Das Auftreten von Aids hat in allen westeuropäischen Ländern zu exzeptionellen Innovationen in Prävention, Krankenversorgung, Gesundheitspolitik und Bürgerrechtsfragen geführt. Diese Ausnahmen vom normalen Verlauf der Gesundheitspolitik erklären sich vor allem daraus, daß neben einer gesundheitlichen Katastrophe infolge von Aids auch Zivilisationsbrüche auf dem Gebiet der Bürgerrechte befürchtet wurden. Dies brachte eine trotz großer nationaler Unterschiede im Grundmuster ähnliche „exceptionalist alliance“ aus beteiligten Gesundheitsberufen, sozialen Bewegungen und Betroffenen hervor, die den mangels wirksamer Therapien von der Medizin nicht besetzten Handlungsraum produktiv nutzte. Mit dem Ausbleiben der Katastrophe, Ermüdungserscheinungen der „exceptionalist alliance“ und zunehmenden Therapiemöglichkeiten der Medizin geht der ‘exceptionalism' in Europa jedoch schrittweise zu Ende. In diesem Prozeß werden bei national unterschiedlichen Entwicklungsmustern vier Phasen unterschieden: Circa 1981 - 1986: Entstehung des ‘exceptionalism'. Hierzu werden die Ursachen des ‘exceptionalism' untersucht. Circa 1986 - 1991: Praxis und Konsolidierung des ‘exceptionalism'. Dargestellt werden sowohl das Policy-Modell des ‘exceptionalism' als auch länderspezifische Konfigurationen der Polities und Politics, die zu unterschiedlichen Inhalten der politischen Entscheidungsprozesse (Policies) in bezug auf Aids führten. Circa 1991 - 1996: Auflösung des ‘exceptionalism' und erste Anzeichen der Normalisierung. Untersucht werden die Gründe des Normalisierungsprozesses. Seit 1996: Normalisierung, Normalität. Darstellung des veränderten Umgangs mit HIV und Aids. Dazu werden Beispiele aus den Bereichen Krankenversorgung, Primärprävention und Drogenpolitik betrachtet. Es wird untersucht, welche gesundheitspolitischen Innovationen der ‘Aids-exceptionalism' in Westeuropa hervorbrachte und auf welche Risiken und Chancen diese Innovationen im Zuge der Normalisierung treffen. Es werden drei mögliche Entwicklungspfade identifiziert: Stabilisierung, Generalisierung und Rückwärtsentwicklung. Die Chancen, in Zusammenhang mit Aids entwickelte Innovationen für die Modernisierung der Gesundheitspolitik auch für andere Felder der Prävention und der Krankenversorgung zu nutzen, variieren länderspezifisch. In welchem Umfang ‘Aids-exceptionalism' gesundheitspolitische Innovationen auch in anderen Bereichen anstoßen kann, hängt letztlich vom jeweils erreichten Grad der Institutionalisierung des ‘exceptionalism' und der Entfernung dieser Neuerungen vom konventionellen medizinisch-therapeutischen Geschehen ab. Der Beitrag der europäischen Länder zur Eindämmung der globalen Aids-Krise ist unzureichend.In every Western European country the occurrence of Aids has led to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained not only by the fact that a health catastrophe was feared, but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar "exceptionalist alliances" consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise signs of fatigue in the "exceptionalist alliance" and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. The paper elucidates specific aspects of each of the four roughly distinguishable phases in this process, given nationally different patterns of development: Approx. 1981 - 1986: emergence of exceptionalism. The underlying reasons for exceptionalism are investigated in this paper. Approx. 1986 - 1991: consolidation and performance of exceptionalism. The paper investigates the exceptionalist policy model, more specifically some nationally different factors in the polity and politics that help to explain the different forms of policies. Approx. 1991 - 1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The changes made in the management of HIV and Aids are elucidated using examples from the fields of health care, primary prevention and drug policies. Aids health-policy innovations, and their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with Aids for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which Aids exceptionalism has been institutionalized and the distance of these innovations from medical/therapeutic events. The contribution made by European countries to containing the global Aids crisis is inadequate

Die Normalisierung von Aids in Westeuropa: Der Politik-Zyklus am Beispiel einer Infektionskrankheit

Das Auftreten von Aids hat in allen westeuropäischen Ländern zu exzeptionellen Innovationen in Prävention, Krankenversorgung, Gesundheitspolitik und Bürgerrechtsfragen geführt. Diese Ausnahmen vom normalen Verlauf der Gesundheitspolitik erklären sich vor allem daraus, daß neben einer gesundheitlichen Katastrophe infolge von Aids auch Zivilisationsbrüche auf dem Gebiet der Bürgerrechte befürchtet wurden. Dies brachte eine trotz großer nationaler Unterschiede im Grundmuster ähnliche „exceptionalist alliance“ aus beteiligten Gesundheitsberufen, sozialen Bewegungen und Betroffenen hervor, die den mangels wirksamer Therapien von der Medizin nicht besetzten Handlungsraum produktiv nutzte. Mit dem Ausbleiben der Katastrophe, Ermüdungserscheinungen der „exceptionalist alliance“ und zunehmenden Therapiemöglichkeiten der Medizin geht der ‘exceptionalism' in Europa jedoch schrittweise zu Ende. In diesem Prozeß werden bei national unterschiedlichen Entwicklungsmustern vier Phasen unterschieden: Circa 1981 - 1986: Entstehung des ‘exceptionalism'. Hierzu werden die Ursachen des ‘exceptionalism' untersucht. Circa 1986 - 1991: Praxis und Konsolidierung des ‘exceptionalism'. Dargestellt werden sowohl das Policy-Modell des ‘exceptionalism' als auch länderspezifische Konfigurationen der Polities und Politics, die zu unterschiedlichen Inhalten der politischen Entscheidungsprozesse (Policies) in bezug auf Aids führten. Circa 1991 - 1996: Auflösung des ‘exceptionalism' und erste Anzeichen der Normalisierung. Untersucht werden die Gründe des Normalisierungsprozesses. Seit 1996: Normalisierung, Normalität. Darstellung des veränderten Umgangs mit HIV und Aids. Dazu werden Beispiele aus den Bereichen Krankenversorgung, Primärprävention und Drogenpolitik betrachtet. Es wird untersucht, welche gesundheitspolitischen Innovationen der ‘Aids-exceptionalism' in Westeuropa hervorbrachte und auf welche Risiken und Chancen diese Innovationen im Zuge der Normalisierung treffen. Es werden drei mögliche Entwicklungspfade identifiziert: Stabilisierung, Generalisierung und Rückwärtsentwicklung. Die Chancen, in Zusammenhang mit Aids entwickelte Innovationen für die Modernisierung der Gesundheitspolitik auch für andere Felder der Prävention und der Krankenversorgung zu nutzen, variieren länderspezifisch. In welchem Umfang ‘Aids-exceptionalism' gesundheitspolitische Innovationen auch in anderen Bereichen anstoßen kann, hängt letztlich vom jeweils erreichten Grad der Institutionalisierung des ‘exceptionalism' und der Entfernung dieser Neuerungen vom konventionellen medizinisch-therapeutischen Geschehen ab. Der Beitrag der europäischen Länder zur Eindämmung der globalen Aids-Krise ist unzureichend. -- In every Western European country the occurrence of Aids has led to exceptional innovations in prevention, patient care, health policy and questions of civil rights. This exception can be explained not only by the fact that a health catastrophe was feared, but also civilizational harm in the field of civil rights. Despite national differences, this brought about similar "exceptionalist alliances" consisting of health professionals, social movements and those affected. With the failure of a catastrophe to arise signs of fatigue in the "exceptionalist alliance" and increasing possibilities of medical treatment, exceptionalism in Europe is drawing to a close. The paper elucidates specific aspects of each of the four roughly distinguishable phases in this process, given nationally different patterns of development: Approx. 1981 - 1986: emergence of exceptionalism. The underlying reasons for exceptionalism are investigated in this paper. Approx. 1986 - 1991: consolidation and performance of exceptionalism. The paper investigates the exceptionalist policy model, more specifically some nationally different factors in the polity and politics that help to explain the different forms of policies. Approx. 1991 - 1996: exceptionalism crumbling, steps toward normalization. The forces driving the process of normalization are investigated. Since 1996: normalization, normality. The changes made in the management of HIV and Aids are elucidated using examples from the fields of health care, primary prevention and drug policies. Aids health-policy innovations, and their risks and opportunities in the course of normalization are investigated. Three possible paths of development are identified: stabilization, generalization and retreat. The chances of utilizing innovations developed in connection with Aids for the modernization of health policy in other fields of prevention and patient care vary from country to country with the degree to which Aids exceptionalism has been institutionalized and the distance of these innovations from medical/therapeutic events. The contribution made by European countries to containing the global Aids crisis is inadequate.

Population response to the risk of vector-borne diseases: lessons learned from socio-behavioural research during large-scale outbreaks

Vector-borne infectious diseases, such as malaria, dengue, chikungunya, and West Nile fevers are increasingly identified as major global human health threats in developing and developed countries. The success or failure of vector control rests mainly on the nature and scale of the behavioural response of exposed populations. Large-scale adoption of recommended protective behaviour represents a critical challenge that cannot be addressed without a better understanding of how individuals perceive and react to the risk of infection. Recently, French overseas territories faced large-scale outbreaks: an epidemic of chikungunya fever in La Re′ union and Mayotte (2005–2006) and four successive outbreaks of dengue fever in one Caribbean island, Martinique (1995–2007). To assess how these populations perceived and responded to the risk, and how the nature and scale of protection affected their clinical status, socio-epidemiological surveys were conducted on each island during the outbreaks. These surveys address three crucial and interconnected questions relevant to the period after persons infected by the virus were identified: which factors shape the risk of acquiring disease? Which socio- demographic characteristics and living conditions induce a higher likelihood of infection? What is the impact of risk perception on protective behaviours adopted against mosquito bites? Grounded on the results of these surveys, a general framework is proposed to help draw out the knowledge needed to reveal the factors associated with higher probability of infection as an outbreak emerges. The lessons learnt can inform health authorities’ efforts to improve risk communication programmes, both in terms of the target and content of messages, so as to explore new strategies for ensuring sustainable protective behaviour. The authors compare three epidemics of vector-borne diseases to elucidate psychosocial factors that determine how populations perceive and respond to the risk of infectious disease

Food scares in an uncertain world

This is the accepted version of the following article: Food scares in an uncertain world. Journal of the European Economic Association, Volume 11, Issue 6, pages 1432–1456, December 2013, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jeea.12057/abstrac

Trust and food modernity in Vietnam

The authors detail the deep transformation of the Vietnamese food system during the last decades, in relation with the industrialization of food production and the extension of the food market chains. The consequences are a growing food anxiety among consumers and an evolution in the process of trust building: the urban consumers still rely on their own know-how to keep their home as a safe place to eat as well as on their day-to-day personal relations with their usual retailers. But trust building has also evolved to include the trust in some stakeholders such as supermarkets rather than in public control. This diversity in the ways of building trust in food can be seen as a characteristic of modernity in emerging Asian economies

Food scares in an uncertain world

This is the accepted version of the following article: Food scares in an uncertain world. Journal of the European Economic Association, Volume 11, Issue 6, pages 1432–1456, December 2013, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jeea.12057/abstrac

Social sciences research in neglected tropical diseases 2: A bibliographic analysis

The official published version of the article can be found at the link below.Background There are strong arguments for social science and interdisciplinary research in the neglected tropical diseases. These diseases represent a rich and dynamic interplay between vector, host, and pathogen which occurs within social, physical and biological contexts. The overwhelming sense, however, is that neglected tropical diseases research is a biomedical endeavour largely excluding the social sciences. The purpose of this review is to provide a baseline for discussing the quantum and nature of the science that is being conducted, and the extent to which the social sciences are a part of that. Methods A bibliographic analysis was conducted of neglected tropical diseases related research papers published over the past 10 years in biomedical and social sciences. The analysis had textual and bibliometric facets, and focussed on chikungunya, dengue, visceral leishmaniasis, and onchocerciasis. Results There is substantial variation in the number of publications associated with each disease. The proportion of the research that is social science based appears remarkably consistent (<4%). A textual analysis, however, reveals a degree of misclassification by the abstracting service where a surprising proportion of the "social sciences" research was pure clinical research. Much of the social sciences research also tends to be "hand maiden" research focused on the implementation of biomedical solutions. Conclusion There is little evidence that scientists pay any attention to the complex social, cultural, biological, and environmental dynamic involved in human pathogenesis. There is little investigator driven social science and a poor presence of interdisciplinary science. The research needs more sophisticated funders and priority setters who are not beguiled by uncritical biomedical promises