Policy case study. France. The TMS Pros programme and other initiatives to tackle MSDs.

Similarly to other European countries, the prevalence of musculoskeletal disorders (MSDs) in France is very high and MSDs are recognised as one of the leading causes of occupational disease. The national occupational safety and health (OSH) strategy, which has been laid out over nearly 20 years through a series of work health plans (Plans santé au travail — PSTs), has identified the tackling of MSDs as a priority in three consecutive plans. During the last decade the problem of MSDs has been addressed in France through a series of initiatives by various stakeholders taking a variety of different approaches, including through research, awareness raising, support schemes, sectoral plans, guidance and other materials.
in 2014, the TMS (Troubles musculo-squelettiques) Pros programme was set up by the Health Insurance
— Occupational Risks (Assurance maladie — risques professionnels) section of the French National Health Insurance Fund for Salaried Workers (Caisse nationale de l’assurance maladie des travailleurs salaries — CNAMTS) with the collaboration of the French National Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (Institut national de recherche et de sécurité – INRS). The programme offers businesses support to prevent work-related MSDs. TMS Pros targets enterprises affected by a high rate of occupational MSDs. Enterprises registered in the TMS Pros programme can benefit from assistance for MSDs prevention tailored to their needs, provided by the regional offices Pension Insurance and Occupational Health Fund (Caisse assurance retraite et santé au travail — CARSAT), and Regional Health Insurance Fund (Caisse régionale d’assurance maladie — CRAM). Since
2016, the initiative has also provided financial support to small and medium-sized enterprises (SMEs). The first phase of the TMS Pros programme targeted 8,000 companies. The objectives for the second phase anticipate an increase in the percentage of companies that will adhere to the TMS Pros scheme and set up a plan of action from 20 % in 2019 to 80 % by 2022.To improve the epidemiological surveillance of occupational risks in France, the CONSTANCES ‘general purpose’ population-based epidemiological cohort was launched in 2012, aimed at contributing to the development of epidemiological research and to provide public health information. It is designed as a research infrastructure to support the public health objectives of the French National Health Insurance Fund for Salaried Workers (CNAMTS) and of the national government, consisting of the collection of highly diverse data from multiple sources based on a representative sample. The data also cover the epidemiological surveillance of occupational hazards. Previously, in 2010, the COSET programme (Cohortes pour la surveillance épidémiologique en lien avec le travail, Cohorts for epidemiological monitoring of work-related health problems), a system for monitoring work-related health problems, was set up with the aim of better understanding the links between occupational factors and the occurrence of health problems. COSET monitors developments in the health and careers of workers from two social security platforms, the insurance scheme for the agricultural sector (Mutualité sociale agricole – MSA), and the insurance scheme for self-employed or independent workers (Régime social des indépendants – RSI). The data from these cohorts provide a better understanding of causes of and risk factors for different health outcomes, including MSDs, and a strong evidence base for policy decisions. For the active members of the general scheme CNAMTS, the COSET programme relies on the data collected from the CONSTANCES cohort.The sector-specific Organisation for the Prevention of Occupational Hazards in the Construction Industry (L’Organisme professionnel de prévention du bâtiment et des travaux publics — OPPBTP) provides guidance and assistance on the prevention of occupational risks in general in the construction sector through a network of 200 prevention counsellors within its regional structure. The aim is to reduce accidents and occupational diseases related to physical activity by involving employees in the process of developing and implementing prevention measures.