Nicolas Hervieu – Pluricité February 2014

City Health Networks

in France

(les “Ateliers Santé Ville”)

Nicolas Hervieu – Pluricité February 2014 2

City Health Networks

what is this ? It’s a focus on public health in disadvantaged neighbourhoods

It comes on top of “common law” health prevention policies. It’s rather new in France

Each City Health Network is a small cell

It covers one or a few neighbourhoods

It generally has no team, just 1 pilot (called coordinator – not always on full time) It stems from local willingness, and then get additional state Funds.

They “make people do”

It first builds up a diagnosis share by local partners

It aims to coordinate health services delivered locally

Nicolas Hervieu – Pluricité February 2014

4 8 15

6 16

10 17

52

36

24 15

9

27

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Experimentation (2000 – 2006)

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City Health Networks – how it grew up in France Widespread (2007-…)

They developed with “politique de la ville” (contracts were launched in 2000 and 2006)

Number created each year*

Improving health in disadvantaged neighbourhoods has been one of the priorities of the urban policy

"politique de la ville" which concentrates on critical urban areas with a particularly poor housing and

sanitary situation.

Pilot networks were introduced in two regions in 2001, and got a positive evaluation in 2003.

They came as a standard “health tool” in new contracts in 2006.

*Source : yearly survey led by the french social cohesion and social equality agency (ACSé)

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City Health Networks & Local Health Contracts

No health

contract

(47%)

Discussing

(24%)

Yes,

signed!

(29%)

Relationship as of December 2012

Is there a local health contract onto your perimeter ?

Created in 2009, the development of the local health contract continue.

When there is a local health contract onto the perimeter, most of the city health networks are involved

in the preparation phase of this contract (90%).

More than half of the local health contract are led directly by the coordinator of the city health contract

11% 43%

52% 70%

74%

Others

Shared steering commitee

Local health contract coordination by the coordinator

Involvement of the ASV to the urban policy awareness

Involvement of the ASV in the choice of the field of intervention

What is the involvement of the city health network regarding this contract ?

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City Health Networks & Local Health Contracts – How they complement

Local Health Contracts have a wider territorial coverage

They encompasses one or several cities, when City Health Networks focus on neighbourhoods.

They often share similar thematic range and objectives though

1st approach to generate synergies

When both exist in a city, only one pilot (‘coordinator’) is appointed, and she/he runs both instruments

2nd approach to generate synergies

thematic approach or populationnal approach (according to age, or particular situations: pregnant

women, disabilities…)

prevention (vaccination, nutrition, cancer, diabetis, cardio-vascularies diseases), access to health

care services (first resort care), territorial strategy…) and social-medical (mental health care,

addictions…)

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City Health Networks – each one of a kind

They are born from local will, and designed to suit local needs…and means. So different they are!

From our analysis, we see 3 kinds (personal typology)

1) Local City heath networks

• Proximity, smaller intervention scale

• Direct action : all the actions are initiated, build and led by the ASV (which implies more human resources)

• About 10-20% of ASV

2) Mixed City heath networks

• About 60-70% of Ateliers Santé Ville

• The « typical » ASV – which mix direct and indirect actions

3) City health networks

“coordinator” of health care actions

• Large scale, across several cities

• About 20% of ASV

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City Health Networks – Who backs it ?

More than half of the city health networks are directly initiated and supported by the city.

Mainly, the city health networks are supported by local authorities.

7%

8%

20%

11%

54%

Others

Association

Communal centre for social welfare

Interconnected cities/communities

Cities

Main types of organism initiator of the city health network :

Source : yearly survey led by the french social cohesion and social equality agency (ACSé)

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Organization and actors involved – Where the action takes place ?

7%

42%

85%

83%

69%

89%

11%

2%

3%

15%

4%

47%

13%

14%

16%

0% 20% 40% 60% 80% 100%

Intermunicipalities

Association

Communal centre for social welfare

Municipalities

Overall

Area of intervention of the city health network according to the organism initiator of the action :

Communal Intercommunal Infracommunal

69% of the city health

networks take part at a

municipal/communal scale.

Associations intervene

generally at a smaller scale.

Source : yearly survey led by the french social cohesion and social equality agency (ACSé)

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Organization and actors involved – the coordinator

Source : yearly survey led by the french social cohesion and social equality agency (ACSé)

4%

3%

55%

22%

16%

More than 2 coordinators

From 1 and 2 coordinator

1 coordinator

From 0,5 to 1 coordinator

Less than 0,5 coordinator

Distribution of coodinators involved in the city health network on 12/31/2012 (full-time equivalents) :

One main actor : the coordinator (dedicated fully or partly to this function)

55% of city health networks are managed by one full-time equivalent

The city health networks supported by several full-time coordinators are generally located

in the largest areas.

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Fields and services provided

Source : yearly survey led by the french social cohesion and social equality agency (ACSé)

501

45

49

75

77

86

97

107

136

220

262

303

306

330

352

367

950

Other themes

Facing health care refusal

Other chronical diseases

Traumatism and violences

Improvement of health care …

Environment

Tuberculosis and vaccinations

Mother and child health care

HIV / AIDS / STD / Hepatitis

Dental health care

Cancer (including screening)

Youth health

Addictive practices and at risk …

Access to sanitaries and social rights

Mental health care

Nutrition

Total number of actions implemented by fields in 2012

The three main topics were in 2012 nutrition, mental health care and access to sanitaries

and social rights.

84355

2421

4018

4807

5072

5837

9153

10660

11620

28631

35318

41822

42777

44313

45333

84804

144935

Other themes

Improvement of health care professionals …

Facing health care refusal

Alzheimer and other aging related diseases

Traumatism and violences

Other chronical diseases

Mother and child health care

Environment

Tuberculosis and vaccinations

Cancer (including screening)

Mental health care

Dental health care

Access to sanitaries and social rights

Youth health

HIV / AIDS / STD / Hepatitis

Addictive practices and at risk (including …

Nutrition

Total number of beneficiaries by fields in 2012

The figures presented above include the indirect beneficiaries (e.g beneficiaries of

communication actions on prevention, awareness campaign…)

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Shared diagnosis and action plan Targeted groups prevention

Even a Web TV !

Short link : http://url.pluricite.fr/ASV-TV

Long link : http://www.ville-

armentieres.fr/fr/actu/webtv.php?type=video&id=641&emission=Atelier_sante_ville&page=1

Thematic prevention

City Health Networks – What they do

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Partnerships

Source : yearly survey led by the french social cohesion and social equality agency (ACSé)

The State is the main

contributor to the city health

network through the social

cohesion and social

opportunities agency with

93% of the city health

networks financed (and

representing 45% of the total

budget), followed by the

municipality or

intermunicipality (45% of the

total budget), and the

regional health agency.

On average, a city health

network is financed by 3

different organisms.

5%

8%

13%

18%

41%

82%

93%

95%

92%

87%

82%

59%

18%

7%

Other fundings

Regional council

Communal centre for social welfare

County Council

Regional health agency

Cities/interconnected cities/municipalities

Social cohesion and social opportunities

agency (ACSé)

Main contributors to the city health networks

City health networks financed City health networks not financed

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Long term sustainability

Today, some organisms might hesitate to develop these networks because they think

that the State's financial commitment is not sufficient to sustain this policy in the long

run. For health care providers, health networks raise the question of how to situate local

health actions with respect to the national policy (local problems may not be in line with

national priorities).

However, city health networks are well integrated. For most of the municipalities, health

networks are an appreciated tool to improve local health policy.

Also, as we saw, city health networks are really adaptable to the territory of intervention

(neighbourhood, communal, intercommunal…), with appropriate means.

Nicolas Hervieu – Pluricité February 2014

Thank you for your attention

More details about city health networks are available here :

Enquête annuelle de suivi 2013 des ateliers santé ville

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