The metamorphoses of occupational health services between occupational health and public health

Health and security at work, occupational risk prevention (road risk, psychosocial risks), intensification of labour conditions... A number of questions that the enterprise has to take into account. Answering them assumes a variety of points of view and skills. Occupational health services, that have the exclusive mission to prevent any worker health alteration occurring from their work, contribute to this debate. Due to their unique position, as a field actor, they should be the master piece of the occupational health system ; these services are, however, victim of a collective disaffection. The delicate combination of the "medical fitness for work" concept and the occupational risk prevention concept contributes to this disaffection. Since 1942, the institution has seen deep metamorphoses, a number of them appearing from the combination (sometimes being a cause for tension) of the labour law and the public health law. After the Liberation, the incorporation of the institution to the Ministry of Labour, sealed a long domination of the Labour law. The growing power of the Public Health has been jeopardizing progressively this domination. The reform dated 20th July 2011 illustrates this change of balance. The analysis of the links between the Labour Law and the Public Health Law suggests to propose a new paradigm for the sake of the workers' health, based upon the idea - which is also a fact - that the occupational health service cannot be compared to other providers : this service contributes to the general interest.