There were no more than 350 scientists, on Tuesday, April 7, in Paris, protesting in front of the National Assembly to denounce a restructuring project of Santé Publique France (SPF), which they describe as a “dismantling” – 350 out of the 650 employees who have been working since 2016 to observe and analyze the health of the French. The agency, divided into 16 regional cells in France, was created following the merger of several organizations to bring together the missions of health promotion, prevention, epidemic surveillance, and health event alert. It is based on the scientific work of SPF teams that the government and regions launch information and communication campaigns.
The reform proposed by the Ministry of Health speaks of a “strategic realignment.” In Nouvelle-Aquitaine, the SPF team, like everywhere else in the country, feels directly threatened. The dozen scientists, doctors, and epidemiologists based in the offices of the regional health agency (ARS) of Nouvelle-Aquitaine in Bordeaux monitor the health of 6 million inhabitants in 12 departments, and respond to 140 requests from the state each year to know the evolution of recurring or unexpected health situations.
“Improving the Efficiency of the State”
“Without forgetting all the daily monitoring work,” says a Bordeaux agent. “We can respond in real-time to the number of hospitalizations, emergency room visits, consultations with SOS Doctors, we monitor epidemics – flu, gastroenteritis, Covid, dengue, chikungunya, bronchiolitis – but also domestic accidents, falls in the elderly, drownings. We measure the impact on human health of exceptional climatic situations, such as heatwaves, cold, floods, storms. We work on unexpected investigations, such as food poisoning. And in Nouvelle-Aquitaine, avian flu is closely monitored.”
“In reality, the Ministry of Health wants a little less science so that politicians have more elbow room”
So why is the state considering giving up on this excellent tool, a tool that it itself set up ten years ago? Benoît Elleboode, director general of ARS Nouvelle-Aquitaine, tries to calm the anger of SPF agents by explaining the government’s strategy: “The issue is not so much about abolishing the agency as it is about improving the efficiency of the state, reflecting on a simplification of the division of tasks with its operators, to, on the one hand, save money, and on the other hand, save time. In short, to better use public funds.” He mentions Covid, lengthy administrative procedures leading to a loss of time, particularly regarding the management of mask stocks.
Indeed, the famous “strategic realignment” envisaged by the reform officially includes the “management of strategic stocks and health reserves”. But not only that, according to the employees of Santé Publique France. “In reality, the Ministry of Health wants a little less science so that politicians have more elbow room,” laments an SPF epidemiologist. However, weakening the National Health Surveillance Agency for populations and prevention would be a regression.
A Dominant Neutrality?
Among the missions of Santé Publique France that the state wants to take back are the national public health communication campaigns, which, from now on – if the reform passes – should be handled by the ministry and the National Health Insurance Fund (Cnam), as early as 2027. According to the state, too many messages kill the messages, and thus, it will now be the only one to deliver “the good news” in public health.
“Weakening or fragmenting the national tool for monitoring population health and prevention would be a regression.”
This makes scientists angry. “The public health campaigns led by SPF were based on statistics, fundamental scientific neutrality. The state has already asked us to reduce campaigns on the impact of alcohol on health, for example, despite epidemiological studies with undeniable results!” protests an agent. This legitimate fear of scientists is dismissed by Benoît Elleboode: “The ARS works every day with Santé Publique France, but I did not understand that this project was aimed at their scientific expertise. But to ensure public health prevention campaigns, does it require three, the ministry, the Cnam, and SPF? The agency provides expertise and evaluation, it can consider recommendations, but it is not necessarily there to implement actions.”
This “reorganization project” is not going unnoticed in the scientific community, let alone in public health in France. The French Society of Public Health expressed its concern in a statement at the end of February, noting that the health of the population is “a common good”. “Weakening or fragmenting the national tool for monitoring population health and prevention would be a regression.” In Bordeaux, Santé Publique France employees lament “a return to thirty years ago.”
“The state wants to keep control”
Thirty years ago, the first French school in the field was founded in Bordeaux, the Institute of Public Health, Epidemiology, and Development (Isped), initiated, among others, by Professor Roger Salamon, supported by the university and the Bordeaux University Hospital. It is the only institute of its kind in France and one of the largest in Europe, with its 1,000 students every year in medicine, economics, humanities, etc., and its ten research teams.
Roger Salamon now looks at the government project with a critical eye: “When I was president of the High Council of Public Health, I noticed the minister of health’s reluctance towards independent scientific structures: the state wants to keep control,” he dares. A strange paradox when we know that Santé Publique France depends on the Directorate General of Health. To explain this project, the state claims to streamline processes, but what about the obstacles it has shown regarding pesticides or alcohol? Yes, I also fear a real dismantling of scientific agencies.”
