“Half of medical time is spent on preventable problems” – Liberation

The Minister of Health claims to want to make it a priority – even adding it to the title of his function – but prevention still does not take hold in France. Its results are even “generally mediocre”, according to a report by the Court of Auditors of December 2021. It could however make it possible to avoid or reduce the number and severity of illnesses and disabilities, while the French healthcare system is suffocating. François Alla, professor of public health and head of the prevention innovation service at the Bordeaux University Hospital, insists on the need to extend it beyond the medical field and to adapt to the needs of the territories.

Why is France behind in terms of prevention?

It’s not really a lack of financial means, nor a lack of will. The problem comes mainly from the organization. If we want prevention to work, the key elements are the systematic identification of pathologies and risk factors, as well as the resulting treatment. The two get stuck. Almost all French people have at least one contact per year with the healthcare system, but health professionals do not systematically ask the question of influenza vaccination, cancer screening, alcohol… These are all opportunities for lost prevention. And even when the question is asked, the available care offer often does not allow downstream care.

Today, because we lack caregivers, we are tightening up on care, and prevention is on the rise. However, the return on human and financial investment is enormous: the factors accessible to prevention, such as obesity, arterial hypertension, tobacco, represent approximately half of the cost of care in France. In other words, half of the drugs, of the hospital beds, of the medical time is spent on preventable problems.

Are some preventive measures more effective than others?

We must first get rid of the received idea that health behaviors are individual choices and a matter of will. If it was enough to spread the good word, no doctor would smoke! The essence of prevention is found in urban planning, living and working environments. Take the use of screens by children: messages to parents are not enough. How do those who live in a small apartment, work staggered hours, for whom the TV also serves as a nanny? Put green spaces, time for professional support, the children, if they have the choice, will spontaneously go for physical activity. The same goes for the elderly: in Nice, an experiment showed that it was not informative messages but the development of suitable spaces that took seniors out of their homes to walk. The major challenge therefore lies in public, national and local policies. Prevention in the care setting is the end of the chain or catching up.

But do caregivers also have a role to play?

Of course, they act through medical prevention – such as vaccination or cancer screening – and remediation of situations generated by the environments. Health professionals are aware that prevention is part of their activity and generally want to do so. At the national level, not much is happening, but locally ideas are teeming. And starting from the field is the right solution.

What should be developed above all is to “go towards” the most vulnerable populations. If we wait for people to approach us, those with the least needs will generally come, especially the most privileged social classes. Not people who are poor, disabled, chronically ill or suffering from mental disorders, homeless, imprisoned… The best thing is to move around, meet them and provide them with prevention ourselves.