Tribune. Our health system is organized around a central concept: as soon as a health care offer is available and Social Security makes it financially accessible, each citizen is supposed to benefit from it equally. In other words, if some are poorly treated and health inequalities are large and continue to grow, three causes are considered: either the supply of care is insufficient, as in medical deserts, or it is not really financially accessible. because of the sums remaining payable by the patient, that is to say, again, it is a problem of information and it must be better publicized.
The Covid crisis has shown us that this reading is not enough. Almost unconstrained access to all the measures successively deployed during the crisis was not enough to avoid the strong inequalities in the face of the disease. The very wide accessibility of means of prevention or screening, completely free care or even widely used vaccination have not reduced health inequalities.
Factors of inequality
The reasons for renouncing prevention or care are more complex than just geographic or financial access to the health system. Worse, limiting the analysis of health inequalities to these obstacles collectively exempts us from any action on the other reasons for giving up care.
Because other factors are also decisive: the representation for each of the state of good health, the even intuitive understanding of the severity of the symptoms, the fact of relativizing a pain or suffering in the light of that of his relatives. Access to quality information made even more unequal by these “bubbles” of social networks around convictions or beliefs is also a major factor of inequality.
Our goal for the next decades cannot be just a limited improvement in average health, backed by the marginal increase in life expectancy for those who are already living the longest. The aim must be to reduce the gaps between those who experience the best health and live the oldest and those who, faced with disease or disability, die younger.
In Marseille, depending on the neighborhood, life expectancy varies by almost ten years. We must therefore first improve the state of health of those who are the most distant from our health care system, and move towards a “population responsibility” of health actors, that is to say a responsibility for the health sector. regard to an identified population.
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