7.2 Administration and governance
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Various stakeholders at various levels are involved in the governance of health policies.
- At national level
The State is responsible for improving the population's health, particularly among its youngest citizens. It must do its utmost to ensure equality of people when it comes to health, to improve the quality of care and to promote public health. The National Health Strategy is interdepartmental and thus covers all ministerial portfolios.
Ministry in charge of Health and Prevention
At national level, it is the Ministry i charge of Health and Prevention which “drafts and implements Government policy in terms of solidarity, social cohesion, public health and organisation of the health service”. This Ministry is responsible for organising prevention and medical care. In liaison with the other competent departments, it writes and applies the rules governing the health protection policy.
Directorates of the Ministry for Solidarity and Health
This ministry is composed of several directorates/bodies whose remits may have to do with young people's health (list not exhaustive):
The DGS draws up, assesses and helps to deliver public health policy. With a sub-directorate for population health and chronic disease prevention, the DGS is particularly instrumental in designing children and youth health policy.
It has four main missions:
- Preserving and improving the health of the population.
- Protecting the population from national or international health threats.
- Guaranteeing quality, safety and equality when accessing the health service.
- Coordinating, overseeing and initiating networks of partners of the Ministry for Solidarity and Health.
The DGOS organises the range of available medical care based on health policy objectives and priorities.
- The social security department (DSS) ;
The DSS, which is attached to the Ministry in charge of Health and the Ministry in charge of the Economy, has four main missions:
- The design of public policies and the legal corpus in the field of health, access to care, family benefits and social security;
- Steering of social finances;
- Steering the social security bodies (the various national benefit funds);
- Negotiating and monitoring France's European and international commitments in the field of social security.
The DGCS is tasked with designing, managing and assessing public policy bearing on solidarity, social development and promoting equality. It coordinates 7 thematic public policies:
- Preventing and combating exclusion and poverty, developing social inclusion and the integration of people in vulnerable circumstances.
- Housing and access to housing for homeless or inadequately housed people.
- Independent living for disabled people.
- Independent living for elderly people.
- Family policy and protection of children and vulnerable persons.
- Women's rights and gender equality.
- Promoting innovation and social experimentation, particularly as part of the social and solidarity economy.
- DREES - Department for Research, Studies, Evaluation and Statistics (Direction de la recherche, des études, de l'évaluation et des statistiques)
The DREES is part of the public statistics service. It is tasked with producing and disseminating knowledge about health policy and with guiding research policy. The DREES conducts surveys at regular intervals on young people's health and social conditions.
The IGAS inspects, audits and assesses structures and policies.
- SGMAS (General Secretariat of Ministries of Social Affairs)
See chapter 4. 2 Administration and governance of social inclusion policies.
The General secretariat of ministries in charge of social affairs
The General Secretariat of the Ministries of Social Affairs is responsible for modernising the administration, coordinating services and social public policies. It coordinates the joint work between the ministries and the territorial services, which it leads and steers.
The General Secretariat has authority over the cross-cutting and support functions of the social ministries:
- The Directorate of Finance, Procurement and Services (DFAS),
- the Human Resources Directorate (DRH),
- the Information Systems Directorate (DSI),
- the Legal Affairs Directorate (DAJ),
- the Delegation for European and International Affairs (DAEI), for the fields of solidarity, health and labour
- the Delegation for Information and Communication (DICOM) for the fields of solidarity, health and labour
- the delegation for health information systems strategy (DSSIS) for the solidarity - health field.
The Ministry relies on the Regional Health Agencies (ARS) and the Regional Directorates for the Economy, Employment, Labour and Solidarity (DREETS) for the implementation of policies in the territories.
The Ministry of Solidarity and Health works jointly with various health operators or organisations involved in the development and implementation of health policies for young people. These partners are numerous and have various legal forms (agencies, associations, etc.).
Operators and partners of the Ministry of Solidarity and Health contributing more specifically to the development and implementation of youth policies (non-exhaustive list).
Institutional operators and actors
- The Santé publique France agency
Santé publique France is the national public health agency under the supervision of the Minister of Health. The agency was created on 27 April 2016 by the law on the modernisation of the health system. Its objective is to ensure the health protection of the French people, through monitoring, epidemiological surveillance and prevention. The agency's objective is to "better understand, explain, preserve, protect and promote the state of health of populations". It acts as a centre of expertise in public health.
The Santé publique France agency was created by merging three public institutions: the Institut de veille sanitaire (InVS), the Établissement de préparation et de réponse aux urgences sanitaires (EPRUS), and the Institut national de prévention et d'éducation pour la santé (INPES).
The Santé publique France agency plays an important role in the development of health policies for young people, by carrying out statistical and qualitative studies and surveys on health.
- The national health insurance fund for salaried workers (Caisse nationale de l’Assurance maladie des Travailleurs Salariés - CNAM)
The CNAM is the head of the French health insurance system. It is a public institution under the supervision of the Ministry in charge of Health and the Ministry in charge of the Economy.
It fulfils the following tasks:
- Definition of the guidelines and principles of its action;
- Implementation of agreements between the health insurance funds and the unions representing health professionals;
- Development of health expenditure control;
- Definition and promotion of the prevention of illness, accidents at work and occupational diseases;
- Definition and management of the activity of the health insurance funds.
- The High Council on Public Health (Haut Conseil de la santé publique - HCSP)
The High Council on Public Health (Haut Conseil de la santé publique - HCSP) was created by the law of 9 August 2004 on public health policy and was set up in 2007. The HCSP can issue opinions and recommendations on the health and well-being of young people. It may be consulted by ministers and by the chairmen of the relevant parliamentary committees.
The HCSP has the following functions :
1. to contribute to the development, annual monitoring and multiannual evaluation of the National Health Strategy
2. to provide the public authorities, in conjunction with the health agencies, with the expertise required for the management of health risks and for the design and evaluation of health prevention and safety policies and strategies
3. to provide the public authorities with forward-looking thinking and advice on public health issues
4. contribute to the development of a comprehensive and concerted child health policy.
- The interministerial mission for the fight against drugs and behaviours of addiction (mission interministérielle de lutte contre les drogues et les conduites addictives - MILDECA)
Reporting to the Prime Minister, the MILDECA leads and coordinates the government's action in the fight against drugs and addictive behaviour. In this capacity, it draws up the government's plan to combat drugs and drug addiction and ensures its implementation. The MILDECA also designs prevention and screening policies for addictive behaviour among young people.
The governance of health policies also takes place at the regional level. Over the past thirty years, several regional bodies have been integrated into the health and care system. This process of regionalisation was reinforced by the law on hospital reform and patients, health and territories, known as "HPST" of 21 July 2009.
- Regional health agencies (Agences régionales de santé – ARS)
The HPST law of 21 July 2009 created the Regional Health Agencies (ARS) which are the authorities responsible for steering the health system at regional level. They are also responsible for: organising the supply of health care according to the needs of the population, ensuring better coordination of care and implementing public health policies at regional level, particularly those aimed at young people. The steering of public health policy in the region comprises three areas of intervention:
1. health monitoring and safety, as well as health observation
2. The definition, financing and evaluation of prevention and health promotion actions;
3. Anticipation and management of health crises.
While they must apply national policies, the ARS can also implement regional projects and action plans for young people, depending on the needs of their populations.
- PAEJ - Drop-in advice centres for young people (Points d'accueil et d'écoute Jeunes)
PAEJs are centres for adolescents and young adults (10-25 year olds) who are struggling socially and mentally vulnerable. They have a preventive role to play by welcoming, listening to, supporting, guiding and carrying out mediation with young people in at-risk situations. These centres must give young people the chance to talk about their problems and concerns and to gain the capacity for personal initiative and action again. They are merely an intermediary between the young person and the general law facilities of the health service (hospitals, child psychiatry, etc.). There are three types of drop-in centres:
- Reception facilities for young people;
- Reception facilities for runaways and housing for minors;
- Reception facilities for vulnerable youths.
- The health sites for young people (espaces Santé jeunes)
The health sites for young people are sites welcoming, listening, guiding and raising awareness for young people from 11 to 25 years-old. Parents and professionals are working with young people towards this objective.
These spaces can carry out collective prevention actions, and are brought together within the Fédération des Espaces Santé Jeunes. They work in coordination with all structures dealing with young people (relevant ministries, judicial protection of youth, municipal services, hospitals, etc.).
The website « Carto Santé Jeunes » lists and geolocates the PAEJ and health sites for young people.
- SSE - University Student Health Service (Service Universitaire de Santé Etudiante)
The SSE is a free university medical service available across all higher education institutions .
The purpose of these centers is to ensure the physical well-being of students throughout their studies. In addition to the medical check-up stipulated in the Decree of 7 October 2008, its remit covers the whole of the prevention spectrum. In this respect, the SSE conducts and organises health promotion, prevention and information campaigns with the focus on developing them jointly with students.
Students can come in on a one-to-one basis for advice and information, to check they are up-to-date with their jabs or to get a medical certificate. The service can also arrange specialist (smoking, diet) and psychologist appointments.
It is placed under the authority of university bodies (Boards of Trustees, Vice-Chancellor of universities). The SUMPPS mainly gets its funding from the State (Minister for Higher Education) and through the fees paid by students enrolled at the university, included in their tuition fees.
Since the end of 2022, these services have been open to young people studying at university, but also to all young people in higher education, including those outside university (schools, private training). 8.2 million in 2023 to increase the number of salaries and strengthen the centres' operating resources.
Local and regional level
Bodies under local (« département) authority
Sexual health centres
Sexual health centres (former planification and familial education centres) are public etablishments funded by the departement’s council. They are managed either by the Departmental Council or, by delegation, by a hospital or a commune.
They are a place to receive, listen to, discuss and advise on sexuality, fertility, sexually transmitted infections and voluntary termination of pregnancy. These centres are staffed by doctors, midwives and marriage counsellors.
The free information, screening and diagnosis centres (Centres gratuits d’information, de dépistage et de diagnostic - CeGIDD)
Since 2015, health establishments, centres, NGOs, and public health services and bodies can be affected as « CeGIDD » and thus offer screenings, treatments and free consultations regarding sexuality and sexually transmitted infections.
Associations specialising in young people's health and well-being
Associations working to prevent risk behaviours and educate in health as well as medical-social facilities for young people play an instrumental role in governing youth health policy. Among these stakeholders, Centres for adolescents (Maisons des adolescents) and Family Planning (Planning familial) help to welcome and support the most vulnerable youths. (Non-exhaustive list)
- Centres for adolescents
Some medical-social facilities have been set up specifically to address youth well-being, one example being Centres for adolescents (See 4.7 Social Inclusion: Youth work providers in the field of social inclusion for young people). These public facilities belong to the National Association of Centres for Adolescents (Association nationale des maisons des adolescents) and are committed to: "welcoming, listening to, informing and guiding socially struggling and mentally vulnerable youths". Some of them also provide medical care and appointments for adolescents, such as the Maison de Solenn in Paris, which is part of a hospital group and has a medical research centre specialising in common adolescent problems. Centres for adolescents are on the frontline when it comes to applying youth mental health policies.
- Family planning
Founded in 1956 initially as "La maternité heureuse", the association, which in 1960 became the "Mouvement Français pour Le Planning Familial" (MFPF), more commonly known as "Le Planning Familial", is a longstanding advocacy movement which "takes on board all sexual orientations and champions the right to contraception, abortion and sexuality education". Accredited by the Ministry of Education, the association is a highly reputed partner that campaigns in secondary schools and sixth-form colleges (lycées). Pursuant to its framework agreement signed with the aforementioned Ministry, the association is tasked, among other things, with:
- "Delivering, in partnership with Education staff, sexuality education and information sessions in schools;
- Developing programmes aimed at preventing sexist and sexual violence in schools by delving into the theme of relationships between girls and boys;
- Offering gynaecological appointments, contraception prescriptions, guidance, one-to-one sessions and monitoring on abortions and preventing STIs;
- Putting on training programmes on sexuality and gender-related issues for professionals in the health, social and educational sectors. This association is a member of the International Planned Parenthood Federation (IPPF).