CONVEGNO DI PRIMAVERA 2015 L'epidemiologia a supporto delle politiche del Servizio Sanitario Le esperienze recenti Centro Congressi Auditorium al Duomo Via de Cerretani 54/r, Firenze di Santé Publique France 25 e 26 maggio 2015 1 Pierre Arwidson, MD 25 maggio 2015 Seminario satellite L epidemiologia nella riorganizzazione del Servizio Sanitario Nazionale 1
3 influences Major French public health organization evolutions IANPHI : an international inspiration 2015 law of modernisation of the health system 2
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 3
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) 4
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. 5
3 influences Major French public health organization evolutions IANPHI : an international inspiration 2015 law of modernisation of the health system 6
Core Functions & Attr 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. CORE NPHI FUNCTIONS These functions help countries organize and conduct their public health services. They are based on the Essential Public Health Functions 7
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 FOLIO A Series of Technical and Policy Briefs Number 1 2007 Framework for the Creation and Development of National Public Health Institutes 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 8
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 FOLIO A Series of Technical and Policy Briefs Number 1 2007 Framework for the Creation and Development of National Public Health Institutes 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 9
3 influences Major French public health organization evolutions IANPHI : an international inspiration 2015 Law for the modernisation of the French health system 10
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 11
What is in the health law? Reinforce prevention Refocus the health system on local primary health care Give new rights to the patients 12
4 De la stratégie nationale de santé à la loi de santé Septembre 2013 Remise du rapport Cordier et présentation de la stratégie nationale de santé par Marisol Touraine Contributions et rapports 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 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 Débats régionaux Près de 200 débats organisés à l échelon régional, départemental et local 25 000 personnes mobilisées Reports Rapports parlementaires 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 Accès aux soins pour les personnes en situation de précarité, A. Archambault, 09/2013 L'emploi médical temporaire à l'hôpital, O.Véran, 12/2013 La santé mentale et l'avenir de la psychiatrie, D. Robillard, 12/2013 Juin 2014 Présentation des orientations de la loi de santé > Prévention > Parcours de santé > Innovation > Gouvernance et démocratie sanitaire 600 heures de réflexion et d échange Des remontées productives : Des centaines de constats, bonnes pratiques et propositions d actions Regional debates Coopérations entre professionnels, C. Genisson, A. Millon, 01/2014 Synthèse des débats régionaux, IGAS, mai 2014 Concertations avec les acteurs de santé Début 2015 Examen du projet de loi au Parlement Consultation process 13
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) 14
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