Tomorrow, what kind of health care system do we want?


We know the opinion of the French on the state of the public hospital: 88% of them consider it to be in "danger" and 94% are in favour of increasing the means. Thus, to improve the operation of the public hospital, 87 % suggest more staff and 77 % more budget. (1). But what do health professionals themselves think? Professionals who are worried and tired but... not resigned. 2250 carers decided to testify, through a survey, to propose initiatives to reinvent the health and medico-social establishments that buy, transport, feed, educate in health, ... on their territories. They are very powerful prescribers of change and educational places. They have a major role to play, starting by becoming exemplary in terms of reducing the environmental and social impacts of their activity. 

Committee teams and specialized agencies (2) observed the management of the VIDOC-19 crisis by health professionals. They were amazed at the power of the medical teams' commitment and inventiveness, and appalled at the risks they were taking, with fear in their stomachs, to carry out their mission. They were amazed at the ability of the health and medical-social facilities to reorganize themselves from floor to ceiling in a matter of days. So they wanted to give them a voice.
Through a survey (2), cealth and addiction professionals were able to express themselves and highlight their desire for exemplary institutions. Environmental impacts, social and societal responsibility: they have the resources to act! What seemed impossible (difficult) yesterday is possible tomorrow. 

At a time when the healthcare system is under strain, 2,250 healthcare professionals, including 62 %s practicing in a facility that welcomes Covid-19 patients, took the time to share their emotions, ideas and expectations. 98 % of the respondents completed the questionnaire in its entirety and filled out the "comment" boxes extensively: 12,000 words and as many ideas were collected.
This questionnaire sought to highlight the strengths of the health system that have enabled it to withstand this pandemic crisis rather than pointing to previously identified fault lines.

Health professionals are worried and tired but not resigned. Their responses show great confidence in their strength and abilities. They feel useful and in their place. Experts in the field, involved and enlightened, they are ready to act and have ideas.
Almost 90 % of the respondents would like health and medico-social institutions to become exemplary in their management of waste, transport, energy consumption, quality of life at work, etc., and as many are in favour of obtaining funding to encourage institutions to respect environmental, social and societal criteria.

Healthcare professionals feel useful and in their place

They have faith in their own strength and are together: 83.2 % of the responding health professionals feel they belong and are helpful. This strong pre-existing sense of usefulness is generally inherent in the choice to practice in health care. It is a fundamental value in human resource policy.

A feeling of usefulness that has not been exacerbated by the crisis, since 65.2 % of the respondents declare that the crisis has not changed the perception of usefulness of their profession. The usefulness of everyone in the care chain is one of the strengths revealed by the crisis, prioritised in the top 3 by 65.9 % of respondents.

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Expectedly, 87.7 % of respondents feel very worried/ somewhat worried about the pandemic. This level of concern is almost the same whether or not the facility has patients with Covid-19.

In descending order, health care professionals felt completely or somewhat tired at 66.3 %, creative at 60.9 %, stressed at 56.7 %, proud at 58 %, powerless at 57.9 %, angry at 48.2 %. It should be noted that 63.6 % of respondents do not feel resigned.

Generally speaking, few differences are noted in the responses by occupation and public/private sector. One body globally in unison.

They know how to cope

Regarding the strengths revealed by the crisis, respondents most frequently cited the collective capacity for reorganization (79 %), mutual aid among colleagues (68.1 %), and the usefulness of each person in the care chain (65.9 %).

This confidence in a collective capacity for reorganization pre-dates the crisis, as 82.3 % of the respondents state that it would have been entirely or moderately possible to set up new organizations in record time. 78.5 % of the respondents describe the help they received from their colleagues or colleagues as exceptional or important.

They want action!

First of all, 81.5 % of the respondents consider that the crisis has blatantly or fairly blatantly revealed the inadequacy of population health education. The vast majority point to this inadequacy as a strong weakness revealed by pandemic crisis management. 58.1 % of respondents consider that a preventive approach to health, rather than a predominantly curative approach as is the case today, would reduce the number of sick people in the event of a future health crisis. Prevention and health education are priority areas of work.

57.6 % of health professionals believe that the crisis will create the conditions for positive change in the health system. 91 % of respondents strongly/somewhat agree that this momentum, including inventiveness, should be maintained during the pandemic.

When asked what the main reasons for your concern were, 24.7 % answered fear that nothing would change after the pandemic, which was cited as the second most important reason, just after fear of the risk of contamination. A very strong call for change!

A desire to reduce the environmental, social and societal impacts of establishments

87.7 % of respondents would like health and medico-social institutions to become exemplary in their management of waste, transport, energy consumption, quality of life at work, etc. 93.7 % want to take action or are already doing so. 2.5 % of respondents agree to take action but later. Only less than 2 % of respondents consider that there are other priorities.

87.3 % of respondents are in favour of obtaining funding to encourage health and medico-social institutions to comply with environmental, social and societal criteria.

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Indeed, we must remember thehe sixth edition of the publication The Future of the Global Environment (Global Environment Outlook). The report, written by 250 scientists and experts from more than 70 countries and published in March 2019, was the most comprehensive and rigorous assessment of the state of the global environment carried out by the United Nations in the last five years: a warning that the damage to the planet is so great that the health of populations will be under increasing threat unless urgent action is taken. The report also warned that due to pollutants in our freshwater systems, antimicrobial resistance will become the leading cause of death by 2050 and that endocrine disrupters will affect the fertility of men and women and the neurological development of children.
Joyce Msuya, Acting Executive Director of UN Environment, said at the time: " The science is clear. The health and prosperity of humanity is directly linked to the state of our environment. This report gives us opportunities for humanity. We're at a crossroads. Will we continue along the current path, which will lead to a bleak future for humanity, or will we adopt a more sustainable development path? This is the choice our political leaders must make now. "

Reinventing ourselves *

The health crisis has revealed many breaking points in the French health system, but it has also highlighted the strength of its players in the field. The crisis has led to great inventiveness: 69.4 % consider that it is the role of professionals to be inventive, and 71.3 % are surprised by so much inventiveness.

The results of this survey show that they are worried and tired but ready to "reinvent themselves". They have just demonstrated an immense capacity for change and the majority say they want to take immediate action to transform their institution towards a more sustainable model.

Nevertheless, communication actions will be necessary among health professionals to remind them that 65 % of infectious diseases are zoonoses, i.e. pathogens transmitted from animals to humans, 72 % of which originate in the wild. New studies point to the responsibility of human activity and the destruction of biodiversity in the appearance of new viruses from the animal world, such as coronavirus. 

The President of the Republic Emmanuel Macron said in an interview with the Financial Times on 16 April: " I say to all developed countries, don't wait for the climate awakening [that will make us] experience what we are experiencing in terms of health.« . While "some" Very deep, very brutal choices" are made to save lives, it must be "the same" with the climate risk. Because Covid-19 makes us experience our own vulnerability.« The results of this study are a strong incentive to change the model to achieve resilience. The president is convinced that, in the aftermath of the crisis, " no one will accept to breathe polluted air any more ".

87.3 % of respondents are in favour of obtaining funding to encourage health and medico-social institutions to comply with environmental, social and societal criteria. While individual health professionals are willing to commit, only 18.8 %s expect a collective commitment such as the one shown against the pandemic to combat climate change; 44.7 %s are undecided and 18.4 %s do not expect it at all.

However, it is reasonable to believe that the management of this health crisis has accelerated the awareness of individual and collective responsibility, and its corollary, a desire to act to reduce the environmental, social and societal impacts of health organisations.
Providing their e-mail address in 87 % of the cases, the respondents do not want to stop there and are waiting for a follow-up.

First three proposals

Initiative n°1: immediately promote multiple-use protective equipment manufactured on our territory at a time when establishments are unable to manage the colossal increase in waste with infectious risks.

Initiative n°2: according to a precise timetable, decarbonise the health and dependency sector: develop short circuits and favour the circular economy, rethink transport, optimise waste, etc.

Initiative n°3: fight against multi-resistant bacteria: 38 % of antibiotics and 73 % of antimicrobial products in the world are intended for farm animals. The WHO estimates that antibiotic resistance could kill 10 million humans every year, if nothing is done, by 2050, whereas it already causes 12,500 deaths per year in France.

This call joins the many voices that are rising to urge the government to respond simultaneously and immediately to the two economic and environmental issues at hand. My Health 2022" is a thing of the past and needs to be rewritten in light of the National Health and Environment Plan (PNSE 4).

What do they want to learn from the crisis? Among the hundreds of comments...

"The recurring lack of equipment. »

"You can't do it alone. »

"Couple of caregivers, in the field and exposed, with two very young children, we feel exhausted and afraid of what will happen if we get sick at the same time. Who will take care of our children? »

"The social divide and inequalities, the lack of decisions on our consumption patterns and the protection of the environment. »

"Recognition through thanks instead of improved working conditions. »

"My own health and that of my loved ones. »

"The tremendous solidarity, the availability of personnel, the ability to reorganize in record time. »

"Dare to be new... Think of the patient first before thinking about the institution's political strategy. »

"Lack of solidarity. Seeing that each instance opens its umbrella and covers itself, to the detriment of those on the front line. »

"Exemplary mobilization of the world of health and the need to develop CSR. »

"An opportunity to accelerate awareness of the urgent need to put health and prevention back at the heart of society in an eco-responsible and supportive manner. »

"That another world is possible, we simply need to collectively choose to change it and change ourselves. »

"That our health care system that I was so proud of (before) doesn't work anymore. That money governs too much and that this has an impact on ethics and caring. That has to change! »

"A team that is very invested, supportive, that has been able to adapt to many changes, and that has put many things in place to reassure the residents. There will be an "after Covid" in our EHPAD. »

"An extraordinary team cohesion (nurses, doctor, manager, ASH). »

"One click to initiate the necessary changes. »

"A panic. »

"That the hospital system is the first patient to be treated urgently. »

"That this crisis fundamentally changes our priorities in life and refocuses us on what is essential. »

"Never again. »

"That this is probably just the beginning. But if it could change the way we look at the world, I'm willing to stay positive. »

"Where there's a will, there's a way. And together we are stronger. »

"Awareness that every one of our actions has consequences. »

"Possibility to quickly and collectively implement actions that would reduce our impact on the environment, and the desire to believe that this will be implemented following the crisis. »

"Maybe it's time to change careers. »

"That change is possible and it's already happening. »

"That fear is a powerful mobilizing factor. »

"Now we have the proof that human beings can adapt to all situations, we must be ready to be all more citizens like today so that our planet no longer makes us pay for our unconsciousness and selfishness. »

"It shows how fragile we were when we thought we were invincible. It is time to develop true solidarity, to respect our environment and to protect the living world. »





*President of the Republic Emmanuel Macron invited during his television speech on April 14 to "reinvent himself".

(1) Study conducted by the French Hospital Federation (FHF) March 2019
(2) The Comité pour le développement durable en santé (C2DS), the Primum Non Nocere agency and BVM communication work with a thousand health and medico-social establishments. From 17 to 27 April, 2,250 healthcare professionals took the floor.

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