The time of cities and territories: tribune
By Renaud Epstein, professor of sociology at Sciences-Po Saint-Germain-en-Laye.
How to reconcile metropolises and countryside, outskirts and city centers, ecology and housing. At a time of ecological transition, in partnership with the Urban Projects and Strategies Observation Platform (Popsu)immersed in projects and initiatives that improve urban policies.
In France, 310 municipalities with less than 5,000 inhabitants have a hospital establishment on their territory. In these small towns and the rural living areas they serve, the hospital is the central facility around which the organization of care policies are organized and professional territorial health communities are structured, bringing together all the actors. health and medico-social around health projects defined collectively. This structuring character is expressed with particular force in low-density areas where the population is aging and which are particularly affected by medical desertification.
Beyond this health function, the hospital is a key player in local development and social cohesion in small towns confronted with the dynamics of multifaceted decline. It is often the first employer in the territory, with highly qualified employees and others who are less so, whose local roots are crucial for maintaining commercial activity and public services in cities whose functions centrality are weakened and frequently suffer from low attractiveness.
The ferment of territorial hospitality
Maintaining the hospital supply is therefore a key issue for the future of these cities, many of which are struggling to maintain their population and attract new residents. The hospital remains in this the ferment of territorial hospitality, a beautiful notion that historically refers to a double function of temporary reception of pilgrims, soldiers and peddlers, and of permanent reception of the sick, the elderly and the destitute. It was for this purpose, and not for care, that the medieval towns of the Christian West were equipped with hospitals. And it is with a view to strengthening a weakened centrality and asserting their hospitality that the elected representatives of small towns have been mobilizing for a few years for their hospital, as well as to guarantee access to care.
Because small towns have been particularly affected by the hospital restructuring policies conducted since the beginning of the 2000s, with their procession of closures and downgrading of small hospitals from health to medico-social. These policies, guided by objectives of budgetary rationalization – and often justified on the register of health security – have fueled a dynamic of desertification which has accelerated over time, as well as a feeling of abandonment which feeds a resentment whose we measure the risks it poses every day. The future of hospitals in small towns cannot therefore be considered solely through the prism of the organization of care and its cost; It is certainly a health issue but also, inseparably, an urban, economic, social and political issue.
