Public Health Plan Preparations

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: Health Policy Developments 1/2003

Abstract

In June 2003 the government drafted a bill to clarify the missions of the institutions that are responsible for public health and to define public health objectives for the next five years.

Purpose of health policy or idea

The government wants to present a bill to the Parliament in June 2003 to define public health objectives for the next five years. A set of health related issues will be identified as priorities to improve the health status of the population. For each of these health issues, the bill will set:

• clear and realistic goals that must achieved within 5 years;
• public health strategies in order to achieve them;
• a set of indicators to evaluate the achievements on a yearly basis.

The future law is also expected to clarify the missions of the many institutions that are responsible for public health (national vs. regional level, state vs. parapublic - for instance health insurance funds).

Main points

Main objectives

Improvement of health status by public health intervention.

Degree of Innovation	traditional		innovative
Degree of Controversy	consensual		highly controversial
Public Visibility	very low		very high
Transferability	strongly system-dependent		system-neutral

Political and economic background

Historically, the French health care system has always been oriented towards curative care rather than preventive care. Since the beginning of the 90's, efforts have been made to improve public health policy.

The High Level Committee on Public Health (HCSP), created in 1991, undertakes regular overviews of the population's health status, provides guidance, and assists in decision-making regarding public health problems. Its first contribution, published in 1994, identified a set of priorities for France.

Based on the HSPC's annual report and reports from Regional Health Conferences, a National Health Conference (CNS) takes place once a year to propose priorities and suggest policy directions to the government and parliament (since 1996).

The CNS proposals are taken into account in the yearly Social Security Funding Act, in the appendix drafting "orientations of health and social security policy"

In reality, the impact of these procedures on national public health policies has been relatively low. Until now, the most effective tools for public health policy have been:

the Regional Health Plans, which define priorities at the regional level and pluriannual strategies;

Public Health Plans drafted by the Ministry of Health (16 plans in 2001-2002, related to asthma, diabetes, use of antibiotics, nutrition, Alzheimer disease, breast cancer, etc.)

On the whole, prevention and health promotion suffer from the multiplicity of financers, the dilution of responsibilities and the fragmentation of actors, which impairs their global efficacy.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

These measures were announced in July 2002 by the Minister of Health Jean-François Matteï when he presented his strategy a few weeks after his nomination. This law is expected to give more consistence and more importance to public health policy.

All public health actors have been supporting and promoting this project, in particular: the High Committee on Public Health, the French Society in Public Health, the National Institute for Prevention and Health Education, the National Academy of Medicine, etc.

Stakeholder positions

In October 2002, a national technical group of about 80 experts was set up to assist the General Director of Health. The missions of this group were:

• to propose alternative strategies and criteria for choosing health priorities for the law;
• for each possible priority, to identify the determinants, and among them, those open for interventions;
• to propose operational quantified goals to achieve;
• to propose interventions and indicators to evaluate periodically whether they are achieved and, finally,
• to identify stakeholders that should be mobilized and possible factors of failure or success.

This group was composed of representatives of government services, of health sector agencies, of research and statistical institutes and of experts.

This group submitted a draft version of its report at the beginning of March to the General Director of Health.

Influences in policy making and legislation

A bill will be presented to the Parliament in June 2003.

Adoption and implementation

The adoption process is not clearly defined yet and the law is expected to define mechanisms to implement to achieve health related goals. The General Directorate of Health will certainly play a central role in the implementation of the law. But the law is also supposed to redefine precisely the missions of the different actors.

Monitoring and evaluation

The law itself is expected to indicate means to evaluate the degree of achievement of health goals. As far as we know, no mechanism if foreseen to regularly review the overall appropriateness of the objectives of the law.

Expected outcome

It is difficult to say now if this health policy is going to achieve its objectives, and also difficult to imagine what kind of undesirable effects it could produce. It is expected to increase the quality of the health system and particularly of public health and also to improve equity.

References

Author/s and/or contributors to this survey

Valérie Paris

Suggested citation for this online article

Valérie Paris. "Public Health Plan Preparations". Health Policy Monitor, April 2003. Available at http://www.hpm.org/survey/fr/a1/3