Origines et évolution de la formation à la prévention des risques « gestes et postures » en France

La prévention traditionnelle des risques musculo-squelettiques du travail est orientée selon deux axes quasi indépendants : l’axe technique et l’axe humain. Les limites de ces approches sont actuellement reconnues par les ergonomes et certains professionnels de la prévention qui tentent ensemble d’instaurer une troisième voie. Il s’agit de concilier les orientations techniques et humaines à partir de la compréhension de l’activité de travail et de concevoir, en particulier, des programmes de formation à la prévention des risques qui développent à la fois la capacité de réflexion de tous les acteurs de la prévention sur leur propre activité de travail et leur pouvoir d’action sur les aspects techniques ou organisationnels du travail. Cet article propose une brève analyse de l’histoire des idées et des pratiques de la formation institutionnelle dans ce domaine particulier des risques musculo-squelettiques qui restent un enjeu d’importance malgré les « modernisations » du travail.Prevention of occupational health hazards, in France, has traditionally been practiced within the framework of two separate, almost independent approaches. The first is a technically-oriented approach focused on the design and/or layout of the work space, machines and equipment, and on protecting individual “safety,” usually according to a priori notions of security, irrespective of concrete working conditions. The second approach is human-oriented, with an emphasis on worker training and accountability. It involves imposing rules on workers, impressing upon them knowledge that will supposedly motivate their adoption of a priori “safe behaviours” (e.g. proper procedures and postures), irregardless of the type of work activity or its context. These approaches are based on long-standing more or less implicit models of the work, the worker, prevention and training, which we must become familiar with and discuss in order to gain a better understanding of certain obstacles to changing work conditions.Thus, our goal in this article was to identify influences that have shaped the formalization of training in the area of occupational hazard prevention (in particular, material handling training). This field has become increasingly more structured in France over the past fifty years, beginning with the creation of the Sécurité sociale (Caisse nationale d’assurance maladie des travailleurs salariés — CNAMTS) after World War II (1946), and various services related to workplace hazard prevention that came along with it, in particular the Institut national de sécurité, now known as the Institut national de recherche et de sécurité (the equivalent of the Institut de recherche en santé et en sécurité du travail du Québec [Quebec Occupational Health and Safety Research Institute]). Various institutions have participated in, and influenced the development of the concepts upon which it was based. These training activities have been impacted by a variety of wide-ranging schools of thought that over time have led to interactions and the development of new disciplines, such as ergonomics, which in turn, have played a role in this evolution.Initially, fifty years ago, the common thread running through occupational hazard prevention efforts was an endeavour to adapt ideas and techniques developed in the sports world, to the workplace. The athlete was viewed as a role model of achievement, both physically and morally. The implicit references are the model of manual labour and values of virility that corresponded to the conventional image of salaried employment in that era—the physical work of male labourers involved in heavy industry, mining, transportation and construction. Many trades in this industry sector explicitly required handling heavy loads, as masse mechanization in France only dates back some twenty-five years. The work carried out by women would only be taken into account starting in the 1970s, with the advent of mass production industries and support operations. The ideal worker model was that of the “industrial athlete,” the end product of harmonious physical development and physical training that should be encouraged—a continuous process starting with initial training in professional schools followed by “procedures and postures” training for employed individuals—through the practice of physical exercise, based on “natural” activities of the noble savage, which also happens to be the preferred method for training young military recruits (“obstacle course” type).In fact, applying athletic practices to the civilian business world was part of a much earlier attempt dating back to the sanitation trend of the nineteenth century, when public health concerns led to initiatives for countering the harmful effects of industrialization on worker health. In times of war, these workers would prove to be poor soldiers. Among the solutions adopted, was the implementation of athletic education programs in the late nineteenth century, in the hope of achieving harmonious physical development among the male population. This period was one of significant growth in the sectors of accessible sporting goods and systematic athletic training, aimed initially at academic institutions, the general public and later the workplace. The soldier, “noble savage,” athlete and worker models were closely interrelated and would remain so for a good thirty years, implicitly shaping formalized training in the field of musculoskeletal disorder prevention.In both the workplace and the occupational science community, the operative model was that of “man’s adaptation to work” via screening and employment training. The first INS “operating procedures and working postures” training instructors were military personnel and top athletes. Thus, their teaching approach was authoritarian, inspired by conditioning theories and delivered through orders and “proper procedure and posture” drills, which supposedly would become unconditional reflex behaviours under all circumstances. The postures and movements are only considered from the perspective of biomechanics, without any relation to the work.This training intended to reduce occupational accidents initially involved a corps of prevention instructors formed in the late 1950s. These “company manual labour coaches” were recruited from among ordinary labour volunteers who agreed to deliver this training to their co-workers, after receiving training themselves. The results, however, are less than conclusive.The training delivered by the Social Security Agency has since evolved. The “manual labour” style has been replaced by “security operating procedures and working postures,” significantly broadening the point of view. The targeted population base has also expanded. The Social Security Agency has gradually evolved by and through institutional prevention technicians, some of whom have been receiving ergonomic training for several years. The result of all these factors taken together is that the process itself is currently undergoing changes brought on by contradictory influences. The internal debate has been fuelled by the considerable recent escalation in the number of musculoskeletal disorder cases.The limits of traditional training approaches are now recognized by both ergonomists and some prevention professionals who are currently attempting to introduce a third avenue. This proposed method involves striking a balance between the technical and human orientations on the basis of understanding the actual work. Particular emphasis would be placed on developing safety training programmes designed to develop the reflective thinking skills of all prevention players with respect to their actual work, as well as their latitude for changing technical and/or organizational aspects of the work. The goal is to deal with the source of the hazard, while maintaining favourable working conditions and promoting good health. Our training-action experiments conducted in recent years with a view to promoting an ergonomic analysis of work as a “tool of, by and for action” in the workplace, has led us to question especially the historical ideas and practices of formalized training in the field of musculoskeletal hazards, which continues to be an important issue, despite the “modernization” of work. A brief analysis is presented herein.La prevención tradicional de riesgos musculo-esqueleticos relacionados al trabajo está orientada según dos ejes casi independientes : el eje tecnico y el eje humano. Los límites de estos enfoques son actualmente reconocidos por los ergonomistas y ciertos profesionales de la prevención que, conjuntamente, intentan instaurar una tercera vía. Se trata de conciliar las orientaciones tecnicas y humanas a partir de la comprensión de la actividad de trabajo y de concebir, en particular, programas de formación en prevención de riesgos que desarrollen a la vez la capacidad de reflexión de todos los actores de la prevención sobre su propia actividad de trabajo y su respectivo poder de acción sobre los aspectos tecnicos u organizacionales del trabajo. Este articulo propone un breve analisis de la historia de las ideas y practicas de la formación institucional en el campo particular de los riesgos musculo-esqueleticos que siguen siendo un problema crucial a pesar de las « modernizaciones » del trabajo