2024-04-17 12:00:15
Prevention seems to be acquiring a new status in thinking about the health needs of our country. No strategy is formulated anymore that does not recall its importance for the future of the healthcare system or the expected savings. Major programs have been launched, such as free vaccination at colleges against human papillomavirus infections or the My Prevention Report project.
New local authorities are taking on these issues. Health Insurance is strengthening its intervention in this area, including structurally in conventional negotiations. In short, the lines are moving. But we can think that three issues remain to be better addressed: they revolve around social inequalities in health, which the prevention approach should reduce.
On the one hand, we know that, isolated, individual preventive approaches have a spontaneous tendency to aggravate these social inequalities in health: the mechanisms, identified, relate both to the healthcare system itself and to the best appropriation of the systems. by the most educated and the weight of the difficulties of daily life borne by the less advantaged categories.
The power of intervention of non-health actors
On the other hand, a prevention program built around the healthcare system thus presents a risk of social differences in its results, even when preventive practice (screening, vaccination) is free, a fortiori when it is not. (adapted sport, for example). Let us add that the emergence of efficient predictive devices and the development of digital or biological innovations around an individualization of prevention considered as a Holy Grail can, if they free themselves from this concern, have real aggravating effects.
This situation requires thinking about the issue of inequalities from the genesis of programs through a territorial approach – proactive strengthening of actions in the poorest neighborhoods – and methodological – implementation of tools adapted to the constraints of these social categories. Stated in a general way, this principle must become the essential criterion for validating actions. As a mirror, a second question arises: that of the expansion of public health practices.
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Let us repeat that health promotion is not reduced to medicalized or individual prevention. The Covid-19 crisis had shown the power of intervention of non-health actors, such as HLM landlords, social workers, neighborhood associations, community associations and, sometimes, unions. Today, their mobilization in public health seems less sought after: their words seem less audible, their actions are too little valued.
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