PThe first concern of the French for municipal elections, well being is included within the elections of March 15 and 22. Debates on well being decentralization are resurfacing, and a recurring temptation is to search for the “right administrative level” to restore a well being system underneath pressure. Worn by the Prime Minister, the France Santé label [dispositif conçu pour améliorer l’accès aux soins] and the strengthening of the position of the departments bear witness to this quest.
Recent historical past, nonetheless, requires warning. There is normal settlement that the departmental stage has hardly confirmed itself by way of getting older or maternal and youngster safety. At the identical time, native authorities – metropolises, intermunicipalities, municipalities – specific their curiosity within the well being of their inhabitants and are already performing on this course.
These developments happen in a context of lasting budgetary restrictions and in a second of democratic fragility. Majorities can’t be discovered, ministers of well being observe each other, structuring texts are uncommon, and legislative proposals proliferate with out coherence. In this unsure panorama, a steady motion is asserting itself: the strengthening of the native stage, significantly municipal. Since the Covid-19 disaster, communities have been actively known as upon to supply concrete responses to the difficulties of accessing care. This transfer is just not trivial. It displays a change of democratic expectations: we flip to the mayor greater than we flip to central administrations, that are out of attain.
The decisive query of means
However, in issues of well being, the contribution of native authorities goes far past the only real query of care, which stays primarily a nationwide competence. The actual energy of communities lies elsewhere: of their skill to advertise well being “in all policies”in line with the method lengthy defended by the World Health Organization. Because well being is just not solely at stake within the physician’s workplace or within the hospital. It is made in housing, transport, city planning, entry to inexperienced areas and even alternatives for bodily exercise. Communities can act on the determinants of well being, that are primarily positioned exterior the healthcare system.
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