Lhe interaction between the health system and the social organization reminds us, violently. At the forefront of the difficulties encountered by the health system are of course logics specific to the health field: the deleterious effects of years of numerus clausus, staff shortages and the overall organization of patient care – and especially those in social difficulty – are all issues that cannot be denied.
But these dynamics – in a way endogenous – should not hide equally powerful exogenous mechanisms. The Covid-19 epidemic had shown those who would have forgotten that the state of health of a population, including in its most acute crises, and in the violence of inequalities in mortality, was essentially related to social determinants. Although no direct time measurement can quantify it, it is very likely that the inegalitarian effects described on this occasion are still at work today. They multiply the risks for poor or modest people, weakened both by more frequent chronic diseases and more exposing living conditions – poor quality or overcrowded housing, constrained transport and degraded themselves, impossibility of leaving precarious work. –, and undoubtedly contribute, once again, to the development of epidemics and the flow of patients to emergency departments or medical beds.
The situation of extreme tension experienced by hospitals also highlights another dimension of the play of reflections between the health system and the rest of the questions posed to society.
Stuck in beds
Christmas week in Ile-de-France – within a panel of twenty-two maternity wards –, forty-six women, including twelve pregnant and thirty-four who had recently given birth, accompanied by newborns and sometimes siblings, were kept in hospital for no medical reason, but for lack of downstream accommodation. While they vary from week to week, these numbers are still high. The same week, many patients were also stuck in hospital beds, while their condition only required nursing care, which was better suited to home care. They were, for example, about seventy at the Assistance Publique-Hôpitaux de Paris, and seventy-four in the non-university hospitals of Seine-Saint-Denis. Here again, it was the absence of housing or accommodation that imposed itself on the hospitals and the patients concerned.
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