On February 1 and 2, professionals, experts and institutions from the healthcare and medico-social sectors gathered for the traditional Rencontres de la santé de Nice, the 9th edition of which was held in 2024. Led by founder Didier Haas, the event's original mission was to build bridges between Quebec and France on hospital issues. Ten years on, the Rencontres are still a major forum for public and private players.
The absence of a Minister of Health, appointed six days later (Catherine Vautrin was then responsible for health issues in a broader post), gave the event an unprecedented context. On February 8, the Prime Minister appointed Frédéric Valletoux - former Chairman of the Fédération hospitalière de France - Minister Delegate for Prevention and Health. It was astonishing to discover that Mr. Valletoux performed his ministerial duties as part of a delegation to another minister.
As we are regularly reminded, the progressive decentralization of healthcare has reached its limits; the multiplication of levels and players has made this organization cumbersome and complex. The imbroglio of the French administration leaves us stunned as to the possibility of a constructive evolution. The question then arises as to how we can rethink a healthcare system that can adapt to the different territorial levels needed to deploy policies and understand the needs of beneficiaries and stakeholders. The salvation of the healthcare system could come from two concepts that are emerging as viable possibilities: population responsibility and One Health.
Born in Quebec, population-based responsibility consists in getting all the players in a catchment area to work together towards a triple objective: better health, better care, at a lower cost, in order to build a new model based on maintaining good health. This approach is organized in five stages: selection of the population, assessment of their level of risk or the severity of their pathology, definition of a suitable clinical program, identification of local players and implementation of the program and integration of patients through to follow-up with evaluation indicators. After an experiment, conducted in 2018 in five territories, this principle was enshrined in the law on the organization and transformation of the healthcare system, which stipulates that "all healthcare players in a territory are responsible for improving the health of the population in that territory, as well as for the optimal care of patients in that territory."
The ambition of One Health is to take into account all human, veterinary and environmental health impacts in the design of health policies. Climate change, the animal world and human activity are all factors impacting on human health and encouraging the emergence and spread of diseases (60% of infectious human diseases have an animal origin). Faced with this undeniable fact, each territory becomes a relevant geographical level in which the role of each player, in particular local elected representatives and local authorities, must be re-evaluated to meet health objectives.
Floréal Peix, CEO of Elior Santé, reminded us that "the 'One Health' approach will enable us to act on climate change, improve human conditions and combat the depletion of natural reserves. With a common objective: to deploy a policy of prevention at all levels, vital when we know that 70% of diseases are linked to external factors. All of this will be achieved by coordinating care and treatment paths, taking into account the needs of the medico-social sector.
These ninth and probably last meetings in Nice demonstrated the great conceptual proximity of men and women of good will when they look at the system and show themselves to be lucid and even a little innovative: but Doctor Lorenzo Macieria, President of the CPTS in La Celle Saint Cloud, was unanimously enthusiastic when he described in detail what can be done when the solutions are simple, fully reflect the commitment of professionals and prove to be ideally suited to the territory!
