Le esperienze recenti di Santé Publique France

Pierre Arwidson, MD

25 maggio 2015

Seminario satellite

L’epidemiologia nella riorganizzazione del Servizio Sanitario Nazionale

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C O N V E G N O D I P R I M A V E R A 2 0 1 5

L'epidemiologia a supporto delle politiche del Servizio Sanitario

25 e 26 maggio 2015

Centro Congressi Auditorium al Duomo Via de Cerretani 54/r, Firenze

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3 influences

• Major French public health organization evolutions

• IANPHI : an international inspiration

• 2015 law of modernisation of the health system

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Major French evolutions in the organization of public health

• Creation of health agencies in the nineties : need of more expertise, evidence-based approaches, risk assessment, epidemiology, etc.

• Decentralisation :

• Regional hospitalization agencies in 1996 (ARH)

• Regional health agencies in 2009 (ARS)

• Health democracy and the rights of patients (Kouchner law, 2002) : national and regional health conferences

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Health agencies : after a phase of expansion now a phase of concentration

(10 -> 8)Health products based agencies• French National Agency in Biomedicine (safety of reproduction and transplantation

medicine) - ABM• French National Agency for Medicines and Health Products Safety - ANSM• French Agency for Food, Environmental and Occupational Health & Safety (the first

merger of the new process : AFSSA (food safety) & AFSSET (environmental and occupational health and safety) - ANSES

• French National Blood Service - EFS• French Institute for radiological protection and nuclear safety - IRSN

Population-based agencies• Health Emergency Preparedness and Response Agency (1998) - EPRUS• French National Institute for Prevention and Health Education (2002) - INPES• French Institute for Public Health Surveillance (2007) - INVS

Other kind of agencies• French National Authority for health HAS (≃ English NICE)• French National institute on Cancer INCA (≃ US NCI)

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• Reinforce the efficiency of our administrative organizations

• Reduce the dispersion of means and efforts

• Necessity to have a sufficient critical size

• There is a logic of continuity between surveillance and intervention

Marisol Touraine, Minister of Health 19 june 2014

Par ailleurs, il nous faut renforcer l’efficacité de nos structures administratives. Nos moyens sont trop éclatés et les efforts trop dispersés. Je veux donc doter la France d’un Institut pour la prévention, la veille et l’intervention en santé publique, qui disposera d’une taille critique suffisante. Une concertation sera conduite avec l’ensemble des équipes concernées, dont je salue le professionnalisme.

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3 influences

• Major French public health organization evolutions

• IANPHI : an international inspiration

• 2015 law of modernisation of the health system

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I N T E R N A T I O N A L A S S O C I A T I O N O F N A T I O N A L P U B L I C H E A L T H I N S T I T U T E S

CORE NPHI FUNCTIONS These functions help countries organize and conduct their public health services. They are based on the Essential Public Health Functions framework, which has been in use for more than a decade. Of the Core Functions, three are very important for NPHIs: Core Functions 1, 2, and 10.

1 Evaluation and analysis of health status Collect data to understand the health status of the population, set priorities, and suggest interventions. Gather or have access to data on vital statistics, potential threats to health, risk factors for disease and injury, and access to and use of personal health services. Use the data to guide policies and programs.

2 Public health surveillance, problem investigation, and control of risks and threats to public health Collect data on an ongoing basis to monitor for public health problems, and, when problems are identified, take action to control them. Conduct ongoing monitoring for outbreaks and other public health problems Make sure that samples can be tested for organisms or chemicals that cause public health problems Investigate outbreaks or other public health problems, and make sure that interventions are put in place to address them

A national public health institute (NPHI) is a government agency, or closely networked group of agencies, that provides science-based leadership, expertise, and coordination for a country’s public health activities. An NPHI is defined by its Core Functions and Core Attributes.

www.ianphi.org

3 Prevention programs and health promotion Take action to create the conditions that promote health in the population. Inform and educate people about how to improve their health Support legislation and regulations to promote health Support environmental changes to promote health

4 Social participation in health Strengthen the power of the community to play an active role in public health. Involve the community in developing and designing programs to promote health Provide assistance and information to organizations that work to promote health

5 Planning and management Develop and implement a strategic plan, policies, and programs for the NPHI, as well as systems to ensure efficient operations. Have a clear vision and mission statement Conduct periodic strategic planning, using data to identify priorities and set measurable goals Employ staff who are trained in the systems needed for efficient functioning of an NPHI

6 Regulation and enforcement Ensure that regulations and rules that support public health are passed and enforced. Provide data to help regulators make evidence-based decisions Evaluate the impact of regulations and rules on public health

7 Evaluation and promotion of equitable access to necessary health services In close collaboration with government and nongovernment agencies: Monitor access to health care, including access for vulnerable populations Identify barriers to care and strategies to overcome barriers

National Public Health InstitutesCore Functions & Attributes

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11 core functions of NPHI

• Evaluation and analysis of health status • Public health surveillance, problem investigation, and control of risks and

threats to public health • Prevention programs and health promotion • Social participation in health • Planning and management • Regulation and enforcement • Evaluation and promotion of coverage and access to health services • Human resource development and training • Quality assurance in personal and population-based health services • Public health research • Reduction of the impact of emergencies and disasters on health

FOLIOFramework for the Creation and Development of National Public Health Institutes

I N T E R N A T I O N A L A S S O C I A T I O N O F N A T I O N A L P U B L I C H E A L T H I N S T I T U T E S

A Series of Technical and Policy Briefs Number 1 2007

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9 Core attributes of NPHI

• National scope of influence• National recognition• Limitations on political influence• Scientific basis for programs and policies• Focus on the major public health problems affecting the

country • Adequate human and financial resources• Adequate infrastructure support• Linkages and networks• Accountability

FOLIOFramework for the Creation and Development of National Public Health Institutes

I N T E R N A T I O N A L A S S O C I A T I O N O F N A T I O N A L P U B L I C H E A L T H I N S T I T U T E S

A Series of Technical and Policy Briefs Number 1 2007

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3 influences

• Major French public health organization evolutions

• IANPHI : an international inspiration

• 2015 Law for the modernisation of the French health system

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Why a health law ?

Rise of life expectancy 1/5 of the population will be 75+ in 2040

Development of chronic diseases+5,4% of type 2 diabetes each year from

2005 to 2015

Persistance of health inequalities> 1/2 unemployed smoke vs 1/3 employed

children of blue collars 10 x more obese than white collars

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What is in the health law ?

Reinforce prevention

Refocus the health system on local primary health care

Give new rights to the patients

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avec les acteurs de santéConcertations

Contributions et rapports

600 heuresde réflexion et d’échange

Des remontées productives :Des centaines de constats, bonnes pratiques et propositions d’actions

Près de 200 débats organisés à l’échelon régional, départemental et local

Présentation des orientationsde la loi de santé

Juin 2014

> Prévention> Parcours de santé > Innovation> Gouvernance et démocratie sanitaire

Début 2015Examen du projet de loi au Parlement

De la stratégie nationale de santé à la loi de santé

Septembre 2013Remise du rapport Cordier et présentation

de la stratégie nationale de santé par Marisol Touraine

Rapports parlementaires

Débats régionaux

25 000personnesmobilisées

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Pacte de confiance avec l'hôpital, E. Couty, 03/2013

Gouvernance et utilisation des données de santé, P-L. Bras (IGAS), A. Loth, 09/2013

La santé mentale et l'avenir de la psychiatrie, D. Robillard, 12/2013

Coopérations entre professionnels, C. Genisson, A. Millon, 01/2014

Pour l'an II de la démocratie sanitaire, C.Compagnon, V. Ghadi, 02/2014

Les domaines d'action prioritaire de la stratégie nationale de santé, HCSP, 02/2014

Le service territorial de santé, le service public hospitalier, B. Devictor, 04/2014

Ressources humaines et projet régional de santé, C. de Singly, 06/2014

L'emploi médical temporaire à l'hôpital, O.Véran, 12/2013

Accès aux soins pour les personnes en situation de précarité, A. Archambault, 09/2013

Synthèse des débats régionaux, IGAS, mai 2014

Reports

Consultation process

Regional debates

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CHAPITRE III

Réformer le système d’agences sanitaires

Article 42

2°D’instituer un nouvel établissement public, dénommé «Agence nationale de santé publique » et autorisé à employer dans sa communication nationale et internationale l’appellation « Santé publique France », reprenant l’ensemble des missions, compétences et pouvoirs exercés par l’Institut de veille sanitaire mentionné à l’article L. 1413-2 du code de la santé publique, par l’Institut national de prévention et d’éducation à la santé mentionné à l’article L. 1417-1 du même code et par l’Établissement de préparation et de réponse aux urgences sanitaires mentionné à l’article L. 3135-1 dudit code, ainsi que les biens, personnels, droits et obligations de ces instituts, notamment les obligations de l’employeur à l’égard des personnels.

Pour assurer la cohérence du système de surveillance et de veille et pour améliorer la pertinence des actions dans son champ de compétence, l’établissement dispose, sous son autorité, de cellules d’intervention en région, placées auprès des directeurs des agences régionales de santé ;

• Creation of Public Health France (French national agency for Public Health)

• the coherence of the health surveillance system and pertinence of its action, the agency has regional intervention teams at the regional level (in Regional Health Agencies)

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Challenges - opened questions - no definitive answers yet

• Interaction with research (subsidies, direct contracts with research teams, fluidity of work force between research institutions and health agencies, cross collaborations)

• Interaction with regional agencies (connection of the national and regional surveillance systems : Regional intervention cells, subsidiarity principle)

• Borders with the health care system (who is in charge of measuring the quality of care ? who is in charge of patient education ?) 15