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Created: Tuesday 22 June 2021 12:00
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Written by Morgane ROLAND
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On May 7, 2021, the Ministry of Ecological Transition and that of Solidarity and Health, launched the 4th National Environmental Health Plan (PNSE 4) which will apply in France until 2025. A look back at this major event which will positively impact, we hope, the health of all French people.
The impact of the environment and the living environment on the health of inhabitants is no longer a secret: the World Health Organization (WHO) believes that 14% of mortality in France (i.e. 84,000 deaths each year) is of environmental origin. Globally, 23% of deaths and 25% of chronic conditions are attributed to environmental factors; cancers, diabetes, obesity, respiratory diseases, allergies, asthma, cardiovascular diseases … The cost of inaction is enormous. Today, health appears as the criterion of balance between humans and their environment.
To respond to these very strong challenges, and to a growing civic concern, France has been engaged since 2004 in an active dynamic in terms of environmental health, thanks in particular to the implementation of three National Health Environment Plans, which are followed by PNSE 4. These plans are also implemented at the regional level by Regional Health and Environment Plans (PRSE).
The objective of a PNSE is to prevent health risks linked to environmental degradation (indoor air quality, exposure to chemicals, waves, noise, etc.) and allow everyone, citizen, elected official, professional, researcher, to act for an environment favorable to health. These plans are co-piloted by the Ministries of Ecological Transition and Health, and are drawn up under the direction of the Environment and Health Group (GSE). The plans are submitted to public opinion during a 6-week consultation phase, then amended according to the feedback received. Their programming, every five years, is enshrined in the Public Health Code.
The 4th National Health and Environment Plan displays the ambition of « better understand the risks to which everyone is exposed in order to better protect themselves and their environment ». It is intended to be more operational and concrete than the 3 previous plans, in order to be suitable for all French people, citizens, health professionals, business leaders, elected officials, etc. The plan is broken down into 4 strategic axes and 20 actions:
- Learn, train and inform about the state of our environment and the right actions to adopt (7 actions): a first strategic orientation focused on prevention and access to information, in particular through digital tools.
- Reduce environmental exposures affecting human health and that of ecosystems (8 actions): actions relating to the reduction of exposure to electromagnetic waves, noise, artificial light, soil pollution, etc.
- Multiply the concrete actions carried out by local authorities in the territories (2 actions): the creation of a collaborative platform for communities, to pool and share knowledge and feedback.
- Better understand the exposure and the effects of the environment on the health of populations and on ecosystems (3 actions): a final axis advocating research and data analysis in order to better understand the mechanisms between health and the environment.
In addition, the health crisis we are going through having raised questions about our relationship with living things, the PNSE 4 wished to be part of the more global “One Health” approach. This is what marks the evolution of the PNSE in its 4th version.
The concept of « One Health », “one health” in French, was developed in the 2000s in response to several scientific studies showing that 60% of known human infectious diseases and 75% of emerging human diseases are of animal origin (or even zoonotic). The repeated health crises (avian flu, H1N1 flu, and today Covid-19) have generated tremendous interest from health authorities, research organizations and associations for this “One Health” approach.
The process is then defined as “a collaborative, multisectoral and transdisciplinary approach, with work being done locally, regionally, nationally and globally, to achieve optimal health and well-being outcomes, while recognizing the interconnections between people, animals, plants and their shared environment ”(One Health Commission, 2019). It is a question of going beyond the simple recognition of the link between health and the environment, and of considering the health of the environment, humans and animals as one and the same problem.
Diagram “One health”, Vizea
The process requires a bringing together several disciplines : the medical, veterinary, human, animal and environmental sciences sector all come together around the “One Health” concept. It is then a question of review the modes of governance of environmental health, favored by the tripartite alliance established since 2010 between the World Health Organization (WHO), the World Organization for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations.
“One health” promotes a systemic approach to environmental health issues today. The PNSE4 wishes to accelerate the taking into account of this concept for the next five years.
The National Health and Environment Plan is available at the regional level in the form of ” Regional Health Environment Plans “(PRSE). The objective of these plans is to localize the policies defined in the fields of health and the environment. They will be able to answer several questions that remain unanswered after reading the PNSE 4.
First of all, the Regional Plans will be responsible for specify, quantify and temporize the major strategic orientations fixed by the National Plan, adapting them to the characteristics of their territories.
Regional Plans may also provide details on budgetary resources and mobilizable human resources to respond to the issues raised.
Finally, the Regional Plans will have to register in consistency with other public policies carried out in the territories, in connection both with the theme of health (Social Security Financing Law, National Objective, thematic plans by pathologies, etc.) and with that of the environment (for example within the framework of Plans Air Territoriaux), which, as we have understood, are closely linked!
Next step: the operational and local implementation of the National Health and Environment Plan at the level of the regions of France.
And to go further …
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