7.6 Mechanisms of early detection and signposting of young people facing health risks
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Policy framework
Youth health policies harnessing mechanisms of early detection and signposting of mental problems or illness primarily concern children which, over the first six years of their life, benefit from compulsory prevention examinations that are paid for by the French health insurance system (Assurance Maladie). The results of these examinations are recorded in the personal health record (carnet de santé) which is issued free of charge to all children when their birth is registered so as to keep track of their medical follow-up. Some of these compulsory examinations are organised at school (infant, primary or secondary school) with nurses, doctors, teachers and school counsellors working together.
In France, there are a total of twenty so-called 'compulsory' health examinations, including one at the age of 11-13 and one at the age of 15-16, which are fully covered and without advance payment, according to Article L. 541-1 of the Education Code.
Health review: at age 6
When pupils turn 6, they must attend a medical check-up that tests for and diagnoses anything which might impact their learning capacity (cognitive, physical, linguistic or mental problems). This compulsory examination is stipulated in the Public Health Code (Code de la santé publique) and in the Law of 5 March 2007 on child protection.
Health review: at age 12
The screening appointment in the child's twelfth year (by the nurse) includes:
- An interview with the adolescent particularly about his or her living conditions, perceived health, any difficulties, mental suffering and his or her pubertal development;
- Consideration of any comments gathered from parents and teachers;
- Verification that the child is up-to-date with his or her jabs;
- A growth & development examination;
- Screening of any sight problems;
- Screening of any hearing problems;
- Oral & dental health check;
- Recommendations and advice for the child, tailored depending on his or her questions and the examination's data.
Health review: for students
During their studies at a higher education institution, students may be asked to attend a compulsory prevention appointment organised by the SSEs - University Student Health Services (Service Universitaires de Santé étudiante) at their institution, in accordance with the law. Organisation of this check-up, which covers medical, psychological and social aspects, is not systematic but depends on higher education institutions.
Stakeholders
A great many stakeholders are involved in youth screening and appointment programmes and they usually work together through partnerships. Among the institutions and organisations, it would be worth highlighting the role played by the PMI - Mother & Child Protection (Protection maternelle et infantile) services, by school medical teams and preventive medical teams in higher education institutions (governed by the Ministry of National Education and the Ministry of Higher Education) and by the prevention associations with support from the regional health agencies, which set up measures for screening and signposting mental problems and illness.
The PMI - Mother & Child Protection services
The PMI was created by the Order of 2 November 1945 to combat maternal and infant mortality. Its services can be found in each département, managed by the local authority, the General Council (Conseil général). They deliver health protection for mothers and infants up to 6 years of age and can provide advice to future parents.
Medical care at school
The remit of National Education doctors is defined in Circular no. 2001-013 of 12-01-2001. They organise individual prevention through health reviews as well as monitoring of school children with special needs. They provide advice about the schooling of disabled children.
Preventive medicine in higher education establishments
Health protection, screening and appointments for students are all carried out by the SSEs (see 7.2 Cross-sectorial cooperation) and help in particular to identify students with disabilities, enabling them to be offered assistance where necessary.
Regional health agencies and associations
Regional health agencies play a role in screening and signposting illness by rolling out national health plans across the regions as well as by supporting and financing prevention associations which promote and organise screenings. One such association in France is Sida info service, which provides advice and information about sexual health, the risks and protection methods.
Local missions (missions locales)
Local missions are community-based public service centres. They are committed to helping 16 to 25 year olds integrate professionally and socially. These structures are recognised by the Law of 26 January 2016 on modernising the French health service as playing a role in identifying young people in particular need of support. Local missions must advance access to social rights, prevention and health care.
These structures are gathered within the National Union of Local Missions (UNML) whose mission is to represent the national network and to form the union of employers of the branch of Local Missions, reception centers, Information and Guidance (PAIO) and other social inclusion organizations.
National health insurance funds
In addition to their recurrent actions (see chapter 4), the CNAMs offer a fully paid preventive health examination for 16-25 year olds.
Guidance to stakeholders
The public authorities carrying out youth advocacy missions produce an array of tools and guides for youth public health stakeholders, similar to the tools of the agency Santé publique France, such as the website Fil santé jeunes and its Youth health portal which provide answers to any health questions young people might ask. The portal brings together practical advice, useful addresses and telephone numbers enabling young people to talk anonymously with professionals, some examples being "Ecoute Cannabis", "Ecoute Alcool" and "Suicide écoute" – hotlines to discuss cannabis, alcohol or suicide concerns respectively.
The Youth health portal also refers to all of the institutional health and well-being promotion and education websites designed particularly for young people, including "Drogue info Service" (drugs) or "Onsexprime" (sexuality).
What is more, the agency Santé publique France also helps to develop associations' communication and promotion tools by subsidising some of their websites - "Sida info service" for example.
The Youth Compass
In order to facilitate young people's access to their rights and public services, the Government has formally launched in 2018 to develop the "The Youth Compass", a digital platform that will eventually enable young people to know the different rights and services available to them, social devices they can claim in their (geographical) environment.
The purpose of this tool is to inform and encourage young people to use their rights and the services, including health services intended for them. The Compass is being deployed throughout the territory. The Health theme is officially deployed in about fifteen Youth Compasses. It is also expected to be deployed in about twenty other Compass centres in 2023.
Target groups
The compulsory health reviews and screenings delivered by the public authorities are for all children and young people attending school, even if more regular attention and monitoring are ensured for children suffering from chronic diseases and young people with disabilities. Screening for sexually transmitted infections is offered to young prisoners because of their increased vulnerability, especially since several Santé publique France epidemiological reports show that the prevalence of such infections seems to be higher among young prisoners than in the general population.
Funding
State-run public health policies are financed by a ministerial budget that has to pass through Parliament. This is the "health safety and prevention" programme overseen by the General Directorate of Health. Health policy funding is mainly provided by health insurance, the State and local authorities including the Département (county-level), which is instrumental in financing screening and consultation actions for children.
The three areas of the "health security and prevention" programme to which funding is allocated are:
- Population health: reimbursement of contraception, support for national associations working to improve the health of the most vulnerable groups of people, etc.;
- Prevention of chronic diseases and quality of life of patients: tackling addictive practices, youth mental health policies, support for sick children, etc.;
- Prevention of environmental risks: nutrition, preventing hearing loss or lead poisoning for example.
Every year the regional health agencies (ARSs) launch a campaign for drawing up contracts and funding prevention action plans fronted by a variety of operators (associations, public institutions, local authorities, etc.). The ARSs allocate their resources chiefly to action plans that are geared towards priority target groups on the wrong side of the inequalities regarding access to medical care and health.
*Source: Document de politique transversal. Projet de loi de finance