Reduced access to care, medical history, lifestyles, income levels… The working classes are not only more exposed to Covid-19, but also more likely to die from it. The heightened vulnerability of “first responders” living in overcrowded housing in a priority urban policy district, such as unprotected freelancers living in the isolated countryside, will by no means surprise elected officials who tirelessly warn of the extent of medical desertification. If there have never been so many doctors in France, their very unequal distribution in France produces very concrete health consequences, which these political leaders know very well.
“Among populations residing in medical deserts, we observe delays in the management of acute pathologies (stroke, heart attack), lack of screening and follow-up of certain cancers, but also and above all of chronic diseases (diabetes, hypertension) – which require supportive care. paramedics (physiotherapy, speech therapy) who are also less available. And, in the end, more abandonment of care: when you have significant delays before seeing a health professional, or many kilometers to travel, you tend to get discouraged more quickly”, lists Dr. Hélène Colombani, director of the Department of Health of the city of Nanterre and president of the National Federation of Health Centers.
Palliative solutions… that have shown their limits
And yet nothing helps! In the country of equality, the illusion that health status and life expectancy would be homogeneous –in all strata of the population, from Cluses to Vannes passing through Cannes, Lens or Neuilly-sur-Seine– has the skin hard. Although the health crisis has revealed an unexpected capacity for adaptation and territorial anchoring of the CPAM, of the departmental delegations of certain ARS as well as of health professionals, it has also implicitly revealed the extreme centralization of French health in normal times… And he highlighted a certain number of dysfunctions attributable sometimes to the negligence of high officials of the Ministry of Health, sometimes to the passivity of the National Health Insurance Fund and sometimes to the rapacity of the College of Doctors. Before the issue fell -again- into oblivion during the presidential campaign…
How much longer will communities agree to write checks with their eyes closed in the face of failed ARS directors and practicing liberals with a roaring appetite? Will they continue to ask for a long time, wisely, the right to put bandages in a hospital whose services, starting with the Emergency Department, are closing one after another, especially given the deterioration of the working conditions of caregivers? And put Band-Aids on half-staff care in the city, accentuating competition and territorial inequalities without remedying the shortage of doctors? Until when will the deputy mayors of health and the elected doctors shout, without being heard, to denounce the lack of prevention and the errors produced by the too weak coordination between hospital and municipal medicine?
Tired of having to put up with orders and counter-orders from the State in times of crisis while providing logistical help and medical supplies to its operators, tired of having to plug the gaps more or less effectively the rest of the time, some opted for Los officials call for a more comprehensive rethink of the French health system.
Towards a change of course for the State, its allies and its operators?
Without ignoring the more than legitimate role of the State, nor the -timid- attempt of some of its operators to take into account the health and socioeconomic characteristics or even the cultural differences of certain patients, the communities increase the pressure on the ARS and the personnel national politician. Objective of the profound transformation to which some elected officials in the matter point: to bring about and consolidate a territorial approach to health, still embryonic today, better adapted to the needs and problems of the inhabitants. To do this, they no longer hesitate to bring up the issues that bother them – from the deterioration of the working conditions of caregivers, synonymous with the deterioration of the reception conditions for patients, fueling the unattractiveness of certain hospitals to the loss confidence of certain vulnerable patients regarding conventional medicine through the disconnection of certain technocrats.
In the “next world”, the associations of elected officials dream that public health will no longer be the exclusive prerogative of the Cnam and the Ministry of Health, the two official protagonists behind whom Bercy often hides. That the corporation of doctors and the deans of the universities also make their aggiornamento… If they took advantage of the presidential campaign to start the debate on the unthinkable of the current organization of the health system and identify some ways forward, raise the resistance of each one of these actors will take time. The battle is not won in advance. Away from.
For the chosen ones, the hardest remains to be done
Nothing says that local authorities will actually manage to revive democracy in health and establish themselves as operational actors in public health in the last mile in the near future. Nor that they are going to give their opinion on the health planning of the territory, the structural difficulties of the public hospital, the guidelines of the PLFSS 2023 or that they are going to be able to do more in terms of prevention, in exchange for the abandonment by the central State of a form of “ Sanitary Jacobinism”. But one thing is certain: the fight to put the health system at the service of the greatest number deserves to be waged. Because the Ministry of Health, like the doctors, will not be able to favor its undifferentiated approach forever, whatever the social group or the territory in question… Just as Emmanuel Macron will no longer be able to return to the balance of financial accounts, he will only cover medical and health policies, but must manage to articulate it with the improvement of the health status of the population.
The new executive, who has confirmed that he wants to make health one of his main priorities after purchasing power, has been warned. No more patches placed without much coherence according to decrees and laws as loquacious as they are technical! Together with a series of structural reforms -imbalances in hospital geography, financing of hospitals and Social Security, prevention of conflicts of interest, review of medical studies-, the President of the Republic and Brigitte Bourguignon, her new Minister of Health and Prevention, sooner or later it will have to learn lessons from the crisis management of the Covid-19 epidemic, which has only revealed all the previous dysfunctions. And they will have no choice but to engage local authorities and localize much more health and medical policy in the near future if they hope to reduce inequalities in access to care, illness and death.