The importance of environmental health in local health contracts Contrats locaux de santé : quelle place pour la santé-environnement En Fr

Résumé En Fr

Context: Among the mechanisms of public health territorialization, regional health authorities and local authorities can draw up Local Health Contracts (CLS). The French statute governing hospitals, patients, health, and territories presents a framework of concerted actions between ARS (regional health authorities) and communities in response to the public's needs for prevention and health promotion. The environment, with its effects on the risk of chronic diseases, can incite territories to work on prevention. Objective: To examine how CLS integrate the environmental determinants of health and determine the priority health issues. The CLoterreS research project provides a first insight into the place of environmental health in the actions undertaken in the territories within the CLS framework. Method We reviewed the scientific literature on CLS to estimate the value of these approaches by the community of researchers, health professionals, and public policy makers. We examined a collection of official documents related to CLS (preliminary diagnoses/assessments and contracts signed since 2010), focusing particularly on Brittany, and we interviewed local actors to measure the extent to which contracts have taken environmental health into account. Results: A significant sample (comparison of 75 CLS among 305 nationwide, then a comparison of 7 CLS in Brittany) presented a very contrasting balance since 2010 of environmental health actions and priority themes. Discussion: The evolution of CLS between 2010 and 2017 highlights notable themes (e.g., indoor air quality and housing quality) in the actions undertaken. But the territories lack health diagnoses and the knowledge and evidence that would help them to understand the issues and thereby lead to more useful actions. Added to this, compartmentalized organizations and a lack of resources hinder the emergence of these cross-cutting projects.

Parmi les outils de territorialisation des politiques publiques de santé existants, les acteurs publics (agences régionales de santé [ARS], collectivités locales) peuvent décliner un contrat local de santé (CLS). La loi HPST (hôpital patients santé territoires) présente un cadre d’action concerté entre ARS et collectivités en réponse aux besoins des publics pour la prévention et promotion en santé. L’environnement, déterminant de santé contribuant aux risques de maladies chroniques, peut mobiliser des territoires sur des actions de prévention. La recherche CLoterreS consiste à observer les actions qu’intègrent les CLS en matière de prévention et promotion de santé. Dans ce cadre de recherche, la place qu’occupe le champ spécifique de la santé-environnement dans ces contrats a fait l’objet d’un focus particulier.