“France needs renovated territorial capacities in public health, well beyond the sole context of the Covid-19 epidemic”

Tribune. In France, epidemics have often strengthened the health skills of local authorities. The Covid-19 epidemic is no exception to the rule. It highlighted the importance and the limits of the action of local authorities in health. Lessons should be learned by strengthening, in particular, the powers of municipalities and inter-municipal authorities in this area.

From a legal standpoint, the municipalities already have health police powers, which have long been shared with the prefects. They can intervene more broadly under their general jurisdiction clause. In recent years, these skills have evolved under the effect of the territorialization of health policies. Blamed during the epidemic, the regional health agencies (ARS) played a key role in the coordination of critical care and in the organization of vaccination as close as possible to the territories, in particular the most disadvantaged.

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Elected officials and local actors had to multiply the calls and proposals to these state agencies, responsible for supporting the reorganization of care and the medico-social sector, supporting preventive actions and fighting against inequalities. of health, with varying degrees of success. At the same time, the departmental councils, which intervene in the medico-social field, in particular in favor of the elderly and in matters of maternal and child protection, also support the provision of local care.

Health homes

If the territorialization of health policies is at work, the epidemic has revealed a glaring weakness of the local levels: the territorial public health operators have failed at critical moments. Few in local authorities, they could not be deployed to support the testing and isolation strategy after the first wave. They could not be mobilized for the “tracing” and information of contact cases and sometimes had difficulty paying for vaccination, especially for the elderly or precarious.

To carry out these missions, France turned to healthcare players: doctors, liberal nurses or social security organizations – responsible for reimbursing city care – have thus transformed themselves into public health players. Poverty alleviation associations have also played an essential role. In an emergency, this collective redeployment towards public health has experienced varying degrees of success depending on the territory. It was implemented thanks to the commitment of thousands of professionals, public officials and volunteers. It will not be able to continue without disrupting their usual missions, which are not primarily a matter of public health. France needs renewed territorial capacities in public health, well beyond the only epidemic context which has served as revealing.

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