Challenges for an NPI to monitor national public health priority indicators in a context of regionalization: the example of France

(February 29, 2012) Public health priorities were embedded in the first public health law in France in 2004. To monitor progress made in the upcoming four-year period 100 objectives with associated indicators in the different areas of public health were chosen. An evaluation of this first public health law was undertaken while indicators continue to be updated. 

Many of these priorities were translated into national multi-annual plans although five of them were already set in 2004 in the public health law (quality of life of patients with chronic diseases; environmental health; cancer; violence, risky behaviors and addictions; rare diseases). Other plans have been set up since then such as the Alzheimer’s disease national plan, and the occupational health national plan. Some of them are already in their second or third renewal. Among the most recent are the national plan HIV/AIDS and sexually transmitted diseases (2010-2014) and the third national plan on antibiotics (2011-2014). 

More specific actions are triggered with regards to vaccine preventable diseases to increase the vaccination coverage in the French population (influenza and measles in particular in 2011).

Reducing the social and geographical health inequalities has been given a greater priority further to several reports (see also: http://www.invs.sante.fr/beh/2007/02_03/beh_02_03_2007.pdf). 

Among its legal missions, the French Institute for Public Health Surveillance (InVS) has the mandate to monitor the health status of the population. Beside its mandate on early warning, threat detection and alert, the institute is therefore responsible for the provision and analysis of many health indicators to monitor the public health law (among the 100 objectives to be monitored, 34 were provided by InVS in 2010). The Ministry of Health publishes each year a health status report with the updated indicators. 

The health data and indicators provided by InVS from a wide-range of surveillance systems and available databases contribute to the evaluation of the national health plans and specific prevention programs (i.e., cancer screening and immunization programs). 

One of the most challenging programs to be launched by InVS in 2012 is the first national biomonitoring program combined with a heath examination survey.

All the national plans quoted above require close collaboration between the different specialised health agencies and ministries at stake in fulfilling their objectives.

In 2010, health regional agencies were established by law with the perspective of an increased efficiency of the health care system and the reduction of health inequalities. The new law grants also some autonomy and more responsibility for the implementation of the national public health strategy in their region. This “regionalization” process which is new for France is a major challenge of the French health policy. This has a major impact for a national public health Institute like InVS: surveillance systems and production of health indicators will have to take much more into account than before the regional and district scales with a particular need to address social and territorial health inequities. 

– By Anne-Catherine Viso, Coordinator/Director of International Affairs, InVS