To facilitate the decisions of all healthcare system professionals, it is essential to analyze all health determinants.
Three dimensions should be taken into consideration:
Some of these analyses call for cohort studies to be carried out on a large section of the population (statistically representative of the analysis subject). For example, the ELFE cohort will take account of 20,000 children born in 2010 in France and follow them up from birth to adulthood using a multidisciplinary approach. This type of epidemiological survey is an invaluable source of information that might guide public health policy decisions.
Which scientific strategy should be followed?
A recent analysis of the research potential has revealed a certain number of French public health and clinical research strengths, including multidisciplinary development, close interface between production of knowledge and intervention, undeniable qualities of expertise in the teams.
By contrast, this analysis has also highlighted clearly identified weaknesses: the relative dispersion of teams which is hampering not just the national and international visibility of their research findings but also their capacity to take action on emerging health risks, and still not enough interaction between fundamental and clinical approaches in human and social sciences and public health, despite its necessity for an integrated understanding of the different factors involved in the population’s health.
The Institute of Public Health has made supporting the development of what we now call “large research infrastructures" its first priority in the field of public health research and clinical practice. These infrastructures are a powerful incentive for research teams to group together.
The Institute is responsible for stimulating the development of research in three fields in particular:
France is in fourth place in terms of life expectancy at birth (78 years on average) and first place for life expectancy at 65 (16 years for men and 20 for women). It has the lowest rates of cardiovascular deaths. The death rate in the under 15s is also very low, and infant mortality in particular has been cut in half over the last seven years.
Over the long term, positive trends are observed: steady decline in deaths from cardiovascular diseases, falls in elderly people, AIDS (thanks to tritherapies) and cot deaths. The quality of life among the elderly has also improved. This progress is partly thanks to significant funding devoted to health (10% of GDP).
Weaknesses are appearing in our health situation alongside these positive results, however, particularly the number of avoidable premature deaths (in the under 65s) which is high compared with our neighbors. This premature death rate reduces the overall life expectancy and highlights the issue of inadequate primary prevention in our country. Lastly, despite social and political choices being focused on equal access to health care, health inequalities within the population are still evident between sexes, regions and professions.
These phenomena can be explained by various factors, some of which have been taken on board in the strategies of the public health policy which views treatment as the almost exclusive pillar of our healthcare system, to the detriment of prevention initiatives - a mere 7% of our health expenditure. Moreover, the health inequalities observed concern unequal access to prevention more than unequal access to treatment.
Directors : Corinne Alberti and Daniel Benamouzig