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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. Several government departments play a part in drawing up and rolling out health policies: those responsible for health as well as labour, the economy and the budget.
Ministry for Solidarity and Health
At national level, it is the Ministry for Solidarity and Health 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 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 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)
The General Secretariat of the Ministries of Social Affairs is responsible for the coordination of services and social public policies. It coordinates the joint work between the ministries and the territorial administrative services : (Regional Health Agency (ARS), Regional Directorate of Youth, Sports and Social Cohesion (DRJSCS) and Regional Directorates businesses, competition, consumption, labor and employment (DIRECCTE).
The General Secretariat is organized into four directorates, three delegations and an office. It has authority over the cross-cutting functions:
- The Finance, Purchasing and Services Department (DFAS),
- the Human Resources Department (HRD),
- the information systems department (DSI),
- the Directorate of Legal Affairs (DAJ),
- the Delegation for European and International Affairs (DAEI), for the fields solidarity - health and work
- the Delegation to information and communication (DICOM) for the solidarity - health and work fields
- the Office of Communication of Youth and Sports (BCOMJS) for the sports field
- the Delegation to the health information systems strategy (DSSIS) for the solidarity - health field.
The Ministry for Solidarity and Health undertakes partnerships with different operators and structures dedicated to health which play a part in crafting and delivering youth health policies. These operators take diverse legal forms (Agencies, associations, etc.).
Operators of the Ministry for Solidarity and Health contributing more specifically to the drafting and implementation of youth-oriented policies (non-exhaustive lists).
- The agency Santé publique France
Santé publique France is France's national public health agency, whose supervising Minister is the Minister for Solidarity and Health. The Agency was set up on 27 April 2016 by the Law for modernising the health service. Its purpose is to protect the health of French citizens through epidemiological surveillance, general surveillance and prevention. It seeks to "know, explain, safeguard, protect and promote the population's health better" and has the status of being a centre of expertise in public health.
The Santé publique France agency came about through the merging of 3 public institutions: InVS - the French Institute for Public Health Surveillance (Institut de veille sanitaire), EPRUS - the French Establishment for Public Health Emergency Preparedness and Response (Établissement de préparation et de réponse aux urgences sanitaires) and INPES - the French Institute for Health Education and Prevention (Institut national de prévention et d’éducation pour la santé).
It plays a key role in the planning stages of youth health policy by conducting studies and statistical qualitative surveys on youth health, among them "the youth health survey" (baromètre santé jeunes) which sheds light on the health of young French citizens (See 7.1 General context).
- HCSP - French High Council for Public Health (Haut Conseil de la santé publique)
The HCSP was founded by the Law of 9 August 2004 on public health policy, set up in 2007. It is able to issue opinions and recommendations on young people's health and well-being. It may be consulted by ministers and the chairpeople of Parliament's competent commissions.
The HCSP is tasked with:
- "contributing to the drafting, annual monitoring and multiannual assessment of the National Health Strategy;
- providing the public authorities, in liaison with the health agencies, with the necessary expertise for managing health risks and designing and assessing health security and prevention strategies and policies;
- providing the public authorities with foresight and advice on public health issues;
- helping to craft a comprehensive and concerted children's health policy".
- MILDECA - Cross-government mission for combating drugs and addictive behaviours (Mission interministérielle de lutte contre les drogues et les conduites addictives)
Reporting to the Prime Minister, the MILDECA oversees and coordinates the Government's action on combating drugs and addictive behaviours. In this regard it shapes the Government's action plan against drugs and drug addiction and keeps an eye on its implementation. The MILDECA also devises schemes and policies for preventing and screening for addictive behaviours in young people.
- 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.
- SUMPPS - University Health Promotion and Preventive Medicine Service (Service Universitaires de Médecine Préventive et de Promotion de la Santé)
The SUMPPS is a free university medical service available across all higher education institutions and open to all students.
Its purpose 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 SUMPPS 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.
- At regional level
Health policies are also governed at regional level. Over the past thirty years, several regional bodies have joined the healthcare system. This regionalisation process has been shored up by the Law on reforming hospitals and on patients, health and local areas of 21 July 2009, known as the "HPST" Law.
- ARS - Regional health agencies (Agences régionales de santé)
The HPST Law of 21 July 2009 created ARS - Regional Health Agencies, which are the authorities with overall responsibility for the health service at regional level. They are also tasked with: organising the range of available medical care in line with the population's needs, improving the coordination of care and setting up public health policies at regional level – particularly those aimed at young people. There are three activity strands involved in managing public health policy at regional level:
- "Health security and surveillance, as well as health observation;
- Defining, financing and assessing health promotion and prevention initiatives;
- Anticipating and managing health emergencies.
Although they are required to implement national policy, ARSs can also, depending on the needs of their local populations, carry out regional projects and action plans for the benefit of young people.
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 National 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 National 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).
A range of different stakeholders are involved in the public health sphere: agencies, health insurance, health watchdog and private-practising professionals.
Implementation of youth health policy is therefore reliant on intersectorial and interministerial cooperation between the Ministry for Solidarity and Health and the other sectorial ministries, such public operators as Santé publique France, devolved ministerial departments, local authorities, associations and health facilities, as well as other partners. This cooperation can take official form by way of signed agreements between stakeholders (State and associations) for example and/or participation in workgroups.
The key role played by the Ministry of Sport in crafting policy aimed at promoting physical well-being must be highlighted, but the Ministry of National Education is also instrumental in this interministerial partnership and the roll-out of youth health policy. Law No. 2016-41 of 26 January 2016 on modernising the French health service underscores the role that schools and higher education institutions play in youth health policy by maintaining that: "[The mission of promoting health in schools] is carried out, across all educational institutions, … by the local education authorities in liaison with the regional health agencies… " (Article 3)".
The DJEPVA - Department for Youth, Non-Formal Education and Voluntary Organisations (Direction de la jeunesse, de l’éducation populaire et de la vie associative) (See 1.3 National Youth Strategy), currently under the Ministry of National Education's authority helps to develop information for young people on health matters via its Youth Information (Information Jeunesse) network.
Other institutions, like the Regional health agencies (see above 7.2 Governance) can also put specific health policies into practice which call on the various stakeholders operating in their local area.
Moreover, territorial authorities (Regions, Départements and municipalities) also take action as regards public health through projects as well as medical-social facilities, health centres and community clinics or partnership-based platforms, one example being the City-Health Workshops (Ateliers santé ville), which bring together diverse health operators.These Workshops are local public initiatives seeking to reduce social and territorial health inequalities and to improve the health of residents living in deprived urban neighbourhoods, by facilitating the involvement and coordination of different stakeholders (associations, etc.) through the setup of medical social networks. Underpinning them is a partnership between the State, local authorities and Regional Health Agencies.