The symposium organized at the Hôtel Dupanloup in Orléans on Wednesday 9 and Thursday 10 November offered, in the absence of a miraculous solution to eradicate medical deserts, a vast panel of innovative experiences on French territory in terms of inter-municipal cooperation in the field of health, from 22 metropolis to the communities of rural municipalities.
By Pierre Allorant
Fresh from a global pandemic that has brought back the classic duo of mayor and prefect since the 1800s, the metropolis of Orléans, the surrounding territories of Orléans and their university have benefited in 2022 from unprecedented public decisions in mainland France for half a century. , at a time when the Orleans multidisciplinary research group of the national program POPSU Métropoles was beginning the last phase of its action research work on “the metropolis and the others” focused on health, both access to health that the determinants of health. He wanted to broaden the reflection to other inter-municipalities, thanks to the comparison of the initiatives taken by the hygienists of the nineteenthAnd century to the current metropolis of Lyon, passing through hospitals, proximity and rural intercommunals.
Hygiene and urban planning
Concetta Penutto, who leads the new axis of the MSH Val de Loire “Health in all its states”, retracing the work of the hygienist Le Brun of Le Mans, is attentive to the topography of the city, the environment and the population for a purpose preventive, with an emphasis on “the air, the waters, the places”, but also the vegetation and the animals, in a sort of anticipation of ” A health “, general health. The study of fountains and wells, prisons, butchers, cemeteries and hospitals, places of” compassion and charity “, of welcoming abandoned children and insane people, is linked to the wave of investigative work started since the 18thAnd century before the epizootic to examine social behavior, customs, food, demographics. The doctor thus turns a critical and very contemporary gaze to the administration of hospitals, asking that the organization of care be based on respect for the work of caregivers and attention to the living conditions of patients.
With such an entry into the subject, the “impressionist” approaches have had every chance of unfolding, avoiding the temptation that the hospital does not mock the charity from which it comes. Hospital, did you say hospital, the “sick man” of French public health? Toulouse professor Mathieu Touzeil-Divina showed why ” the local hospital is for health what pedagogy is for the University: an ideal and sometimes a label if not a myth rather than a reality », The objective of proximity by masking nationalization and the risk of relegation to the status of a nursing home, distinct from the nursing hospital since 1840.
The tools of inter-municipal cooperation
Several speakers revisited the tools of inter-municipal cooperation, from the Local Health Agreement, sometimes metropolitan (Nolwenn Duclos) to the Territorial Professional Health Community, through the use of elected officials for the creation of multidisciplinary health centers. The place of community elected representatives in the governance of the public health service remains marginal and little expanded by successive laws until the recent 3DS law which opened experimentation and differentiation. Similarly, the ARS, mistreated during the Covid crisis, has only opened its doors ajar, with the state in the lead. In the answers to medical merits, the increase in the stock of doctors trained by the loosening of the “numerus clausus” alternates with the search for an increase in medical time (Asalee, Nursing in Advanced Practices), and with an implant regulation that points timidly through the 4And college in a deficient area. Meanwhile, the increase in MSPs in rural margins and in peri-urban areas with scarce resources has favored the establishment of young doctors, eager to train in a multidisciplinary team.
Access to treatments and determinants of “health-well-being”: towards hospital metropolises?
But health, as defined by the World Health Organization, is far from being limited to access to treatment only, to include all the determinants of a life in good physical and mental health, well-being and an assured quality of life. With this in mind, urban planning documents as an instrument of environmental and urban planning (Corinne Manson) occupy a prominent place, in particular inter-municipal PLUs that consider habitat, housing, displacements, pollution, risks and weigh for 4/5And the health of a resident. Prevention, school, work, university and potentially inter-municipal medicine are the poor relative of the French system, which is still too hospital and curative. Sport-health seems to be in full development at a time when obesity, diabetes and diseases related to excessive sedentary lifestyle are exploding, especially among young people (70% of adults, 90% of children), making the connection with food essential. project., the travel plan, the educational project, for a sustainable quality of life. The goal of a “hospitable city”, with the foreign models of Ghent and Vancouver, is imposed at the expense of the too famous “attraction” of territorial marketing reduced to advertising slogans.
Reciprocity, solidarity, innovation
Promising instrument of city-countryside solidarity, for example between the metropolis of Tours and the municipalities of Indre-et-Loire, the reciprocity contract (Julien Thomas) still leaves the actors of the territories unsatisfied, such as the president of Loches Sud Touraine, who he hardly sees concrete solidarity arriving, no doubt due to the lack of a sufficient pool of professionals capable of satisfying “collaborative governance” (Nathalie Dubost). Without this contract, the community of municipalities of Les Loges illustrates a political voluntarism that listens to citizens and operators, and resulted in a true health policy until the recent opening of the first regional center of the GIP Pro santé in Jargeau.
Holder of the Chair of Public Health at Sciences Po, Dr. Yann Bourgueil examined the integration of inter-municipal cooperation in the local health care system, recalling the excellence of the model established at the Liberation, then the performance of the dual system conceived by Robert and Michel Debré in the 1958, CHU / liberal medicine clinic, this organization no longer provides the answer to aging and the shortage of professionals and resources.
To crown the research-action in public health
Since the opening, the importance of the question and the work of this research had been marked by the presence in support of the President of the national program, the sociologist of Toulouse Marie-Christine Jaillet, of the Chief Urban Architect of the State Hélène Peskine, Permanent Secretary of the Urban Plan Building Architecture, the First Deputy Mayor of Orléans Florent Montillot and the President of the University, Eric Blond. All noted the originality of this focus of local actors on access to care and its shocking social and territorial inequalities, and the completely unprecedented nature of the impact of a finished publication in the office of former Prime Minister Jean Castex , contributing, with the “sacred union” of regional elected officials and civil society (CESER) to an important political decision: the first creation in mainland France of a university hospital and a medical faculty since 1976, realized between the end of February and 1uh September 2022.
But pending the effects, the next decade promises to be daunting. All the more reason to continue working together, including researchers, elected officials, urban planning agencies, community services. Why in the new “Transitions” program launched in 2023, season 4 of “POPSU metropolis”, opening it to other territories of the Loire and the Loire? With the BRGM, the University-CNRS campus, the OSUC, the competitiveness poles and soon INSERM, Orléans has all the credentials to contribute, without excluding the natural regional partners, to putting an end to the sterile quarrels of its cities Cathedral.
More information otherwise: Young doctors at the congress in Orléans