Health democracy in time of COVID-19: a perspective from France
Authors: Eva Brocard, Pascal Mélihan-Cheinin, Emmanuel Rusch
Journal: The Lancet Public Health (2021)

Faced with the unprecedented emergency conditions created by the COVID-19 pandemic, the French Government has relied almost exclusively on scientific expert committees to inform its decisions. Some experts from these committees, such as France's COVID-19 Scientific Council1Atlani-Duault L Chauvin F Yazdanpanah Y et al.France's COVID-19 response: balancing conflicting public health traditions.Lancet. 2020; 396: 219-221Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar and the French Health National Conference (Conférence Nationale de Santé [CNS]), have pointed out the absence of health democracy in the decision making process regarding France's COVID-19 response. The CNS is a consultative body, created in 1996, consisting of 96 independent members, the widest range of stakeholders for health and social sectors. The body includes representatives of patients' organisations, unions, and social protection actors; prevention professionals; researchers; health-care services and products providers; local elected officials; and regional health consultative bodies. The aims of this organisation are to advise France's Minister of Health on the health policies on the agenda, as well as to alert and issue recommendations about specific health issues of the CNS members' choice. In late 2010, during the H1N1 pandemic period, the CNS adopted a series of recommendations on how to consult the population during a health crisis to guarantee effective protection through a democratic process. However, the voices of the patients were barely heard in the early stages of the COVID-19 pandemic. Therefore, in mid-April, the CNS issued a resolution2Conférence Nationale de SantéLa démocratie en santé à l'épreuve de la crise sanitaire du COVID-19.https://solidarites-sante.gouv.fr/IMG/pdf/avis_cns2_150420_cp_revu_er_env_2206_250620_espace.pdfDate: April 15, 2020Date accessed: March 4, 2021Google Scholar calling upon the government to consult civil society and health democracy consultative bodies for the management of the COVID-19 pandemic response. The CNS recommended ensuring the consultation of patient's organisations by hospitals staff, guaranteeing information sharing and communication between regional health democracy bodies and regional departments of the French Health Ministry. The body also requested to be consulted on the public health measures considered by the ministry with regards to the COVID-19 pandemic. In response, the French Government formally committed in July, 2020, to strengthen prerogatives and human resources of the regional health consultative bodies at the local level. At the national level, the French Health Minister has officially consulted the CNS since December, 2020, on the effects of the pandemic on patients. To answer the Health Ministry's solicitation, the body mobilised its members to obtain information on COVID-19 effects on patients' rights (including non-discrimination principles, the respect of medical secrecy, and the right to clear and accurate information), equal access to health care, and the quality of patient care. Members shared more than 100 written contributions, which will provide input for the CNS's upcoming report on patient rights in time of COVID-19. This report, which will be published in June, 2021, will provide key observations on the repercussions of the pandemic on patients' rights and care pathways, as well as recommendations for future health crisis management. The CNS will continue to advocate for greater civil society involvement, not only to strengthen the government response to the COVID-19 pandemic, but also to influence evidence-based policies centred around the needs of patients. EB and PM-C work at the General Secretary of the French Health National Conference, placed within the Ministry of Health and Solidarity. ER is the elected president of the French National Conference and receives no wage for his role. COVID-19 in France: challenges and opportunitiesA year into the pandemic, France has been hit hard by COVID-19. Health-care workers and people in the community are exhausted. There have been 4 million reported cases and 90 000 deaths due to COVID-19, as of March 15. This grim milestone is an opportunity to review what has happened, but it is also an opportunity for France to put equity at the centre of its recovery. Full-Text PDF Open Access