Tribune. The story repeats itself. Only crises change the health system. This is particularly true for public health, where the mad cow, contaminated blood or drug crises have led successive governments to create health security agencies: the National Public Health Agency, the National food, environmental and occupational health safety and the National Agency for the Safety of Medicines and Health Products.
In this period of crisis linked to the Covid-19 pandemic, forums and reports follow one another to “design the public health of tomorrow”, “give it new life” or even “revolutionize public health”. It is surprising to note that the proposals are very centered on the mechanics of these structures in order to strengthen expertise, research or training, at the risk of adding a new layer to the current millefeuille. We must be right: strengthening the means of the existing organization would make it possible to respond to the needs identified during the last crises.
What should be taken into account above all is prevention, which can be considered, in France, as very devastated. It needs expertise, players and funding.
Investment returns
The stakes are considerable. All the scientific and evaluation data conclude that there are very significant returns on investment in this area, which would make it possible to significantly increase life expectancy, and especially life expectancy in good health. Thus, for example, 41% of cancers can be avoided by preventive measures, by acting on tobacco and alcohol consumption, on nutrition, by fighting against environmental pollution, by fighting against a sedentary lifestyle, by vaccinating, etc.
To carry out prevention, it is necessary, first of all, to rely on research and expertise: knowing the impact of health determinants is fundamental, especially social factors, the source of very strong health inequalities. But that is not enough.
It is also necessary to evaluate the programs and actions in the field, in order to promote those that have demonstrated their effectiveness and thus finance effective operational programs.
It is then necessary to support those involved in prevention. They are multiple:
- The voluntary sector is the only one able to ensure the function of “going to”, which we became aware of during the Covid-19 epidemic, to reach the most isolated populations. During the AIDS epidemic, without the help of associations, it would not have been possible to reach certain communities accustomed to risky or particularly vulnerable practices.
- We must not forget the many public structures present throughout the territory, which constitute a network for the protection of children and, sometimes, a safety net for the most vulnerable populations because they are free: networks of perinatal care, mother and child protection centres, child psychiatry services, school health. All of these structures have been considerably weakened by all the previous governments, even though their missions are crucial, both in terms of protecting and promoting health. The support of all these structures is the only way to build the territorialization that prevention needs to be effective.
- Finally, it is necessary to rely on teachers to develop health education, guaranteeing favorable future behaviours; and health at work, going beyond the individual logic necessary but not sufficient. This would make it possible to take into account the exposures to which the workers are subjected.
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