With access to healthcare and funding for health services having been central issues in both the UK Brexit referendum and the US Presidential elections in 2016, EPHA’s Vice President Catherine Hartmann looks at how health issues have featured in the candidates’ programmes and media coverage for the French Presidential elections so far. The first round of voting in France will take place later this month.

Guest editorial by Catherine Hartmann, Secretary General, European COPD Coalition and EPHA Vice-President

At the beginning of December 2016, the French press relayed the outrage expressed by many, in particular political parties, patients’ associations and representatives of reimbursement funds, about presidential candidate François Fillon’s plan to reimburse only the “big risks” by social security and leave the “small” risks to the “mutuelle” (health mutuals and health insurance) – without providing definitions of what these were.

Observers and health advocates had hoped that this would start an in-depth conversation on the status of healthcare and services in France, plans for the future and a reflection on what French citizens wished for their health from their leaders. Indeed, health ranks systematically high in the French population’s top priorities, together with e.g. tackling unemployment, security, and social rights.

General media regularly report on the state of healthcare in France, often with an electoral perspective, underlining the importance it holds for French citizens, and how pivotal it is for an electoral win. Libération, Le Monde, Le Figaro, France Television, Radio France (and its numerous channels) all report extensively on the major issues both in health care and services: “medical deserts” (part of the territory with too few healthcare professionals), cost of secondary care and of medicines, training of health workforce, rise of certain chronic diseases (obesity and diabetes are key concern), with very little on health promotion and disease prevention. They consistently express the general will for more and better actions to improve the status of health  – even if in a number of fields, portions of the population are quite conservative and just want the status quo, for instance in eHealth, abolition of co-payment, or improved transparency in relations with the pharmaceutical industry.

In a poll published in February 2017, more than three-quarters of the French (77%) say that the proposals made by the candidates in health will have a significant impact on their upcoming vote. A vast majority of the poll respondents think that the quality of the French health system will only decrease. This should be an incentive for politicians to care more for this subject. Yet, 76% of citizens believe that health is quite absent both from the candidates’ programmes and in related public debates.

This is also true at European level: according to this same survey, 66% of citizens from other EU countries answer that health is an element they take into account when voting. Moreover, the European Parliament published results of a Eurobarometer survey last summer revealing that approximately two thirds of EU citizens would like the EU to intervene more in health and social security.

Fillon’s proposal on “small risks” was removed from his final programme, but the debates rapidly fell flat.  Health was back on the agenda in February when five presidential candidates and/or their representatives together presented their health programme at a meeting held at the French Mutuality, speaking to a wide public and benefitting from a large echo in the press. Yet, the broad plans shared at the meeting, the focus on “prevention” announced by most candidates, and the great enthusiasm they demonstrated towards a renewed health system to better deliver healthcare for everyone, did not materialise in their respective programmes published afterwards.

In contrast, the main candidates’ programmes are modest, lack ambition and vision or, on the contrary are far too big to be implementable – they are not a true reflection of what the citizens have expressed again and again towards their beloved health system – there seems to be a real dichotomy between what is wished for by a vast majority, and the politicians’ vision for the future of French health – no big surprise there, one may say – but it is even more obvious in  this presidential election.

Now personal and political scandals overshadow the debates or better presentation of the programmes the citizens sought, there is not much room for discussions, other than “PenelopeGate”, or the tensions between the left-wing parties.

At European level, in March, European Commission President Jean-Claude Juncker presented five scenarios for the future of the European Union, including two proposals to significantly reduce the role of the EU in heath in general – in sheer contradiction with what citizens have expressed in the recent Eurobarometer survey and in France – and omitting the fact that health is in all policies, not only belonging to its one sector.

Yet, if French and EU politicians want support from their fellow citizens restored and their image enhanced, working more and better on health is one clear win.

A full overview of the candidates’ proposals on health is available here

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