The welfare state and public health
Inspired by the National Council of the Resistance, wanted by General Gaul at the head of the provisional government, the Liberation is the theater of profound social reforms that benefit primarily the health field. While the welfare state is enshrined in the preamble of the constitution in October 1946: "(to) guarantee to all, notably to children, mothers and elderly workers, protection of health, safety hardware, rest and recreation "(the provisions mentioned in the constitution of the Fifth Republic), the 'Orders Larousse' settle the Social Security, a national coffers device powered by the employees and their employers, intended to substitute for Insurance Social prewar. The 'Safely' is seen as destined to become a major player in the French health system, not only to secure funding, but also in its organization.
Faced with these prospects, the pr. Robert Debra, an internationally recognized clinician, head of the pediatric department at the Decker Children's Hospital, prepares with economist demographer Alfred Savvy, the project of a large Ministry of Health and Population to modernize the national health system. But if the pr. Debra plays a major role in the development of reforms as a craftsman of a strong pro-nationalist policy, it is also concerned that they will operate at the expense of the clinic, ie nationalization of medicine which Britain has set an example with the installation of the 'National Health Service'.
"The doctor is one of the main agents that the government will use to solve the vital problem of the French population, the fight against diseases and preventable deaths and against social evils. [Thus] we can not conceive that a simultaneous reform and consistent with the medical profession and health organization of France ... / As for the medical profession, for example, we can all keep or better, shall we say, to restore his noble character and Professional while creating under the control of the State and communities, a solid framework for sanitary ... / We are told that we must accept this tendency which pushes organized doctors, medicine of the State, the collective medicine. What medicine individual is a kind of luxury medicine, medicine that collective will necessarily become the medicine of tomorrow. We wrote that the establishment of a socialist regime involving the socialization of production and exchange means and the elimination of employers and wage would remove the professions and would cause the creation of vast medical assistance services ... / But nothing seems less evident to me. Whatever the economic organization of society, and progress in this regard is essential and urgent, it appears that it should not disturb one dialogue between doctor and patient ... / The medical profession (will have ) be directed towards the successful implementation of all health program, whose implementation is urgent (and) can be is it worth recalling here that the medical profession should be managed for disease prevention and care for the sick and not for the interest of doctors ... / In this field, more than in any other, equality between French is sacred (and) leveling must be carried out from above. To achieve this, we must achieve two goals: that every group has its family physician, family doctor, well educated, continuing to learn, honored and developed appropriately overworked; second, that the health organization has a general effort of the community to ensure every benefit of the French medical advances by organizing preventive and curative medicine diagnostic centers and care centers ... / This is the exclusive role of social insurance which should include free medical assistance, accidents at work, care mutilated, War Invalids and industry "(R. Debra, 'Medicine. Health. Population' Ed. of the French Doctor, Paris, 1944).
After the Second World War, another milestone falls within scientific research. In his words at the time, then the medical assisting enthused "miracle of penicillin" (C. Heimlich, Bungler M. et al. '50 Years of practicing medicine in France. Careers and Practices of Physicians French 1930-1980 ', ed Dion INSEAM, 1993). In fact, the distribution of antibiotics, steroids, development of chemotherapy, etc. are causing a real therapeutic revolution 'mentioned by the pr. Jean Bernard, head of hematology at Hospital Saint-Louis: "Now the chemistry and biology give doctors the power to cure tuberculosis, syphilis, sepsis, major diseases of glands, chemistry disorders moods, almost half of cancers. The acute meningitis, tuberculous meningitis, acute tuberculosis, general infections, malignant endocarditis, the pneumonia may evolve towards healing ... "(interview with J. Bernard , 26 October 1990). Curative medicine finally with real therapeutic efficacy contributes to reorient its preventive counterpart, previously mobilized against infectious diseases towards health promotion defined by the World Health Organization (WHO created in 1948 under the patronage of the United Nations), "(as} a state of complete physical welling, mental and social (population)".
In the early 1950, the Ministry of Health is finally provided with budgetary resources that allow it to install large operational departments, as a General Directorate of Health '(DGS) entrusted to dr. Eugene Aleut. Simultaneously, the National School of Public Health '(NPHS) is open, while a National Center of demographic and social health education' (CNESDS) illustrates the willingness of governments to place health education under their leadership . This is to promote vaccination (compulsory BCG, vaccine DT-cock-polio) or launch campaigns of alcohol control, etc. DGS is involved in the installation of the National Blood Transfusion Center (CNTS) where practical screening for syphilis or Rhesus factor determination (severe immunological incompatibility factor) is, that of the International Children's Center (CIE) and development of maternal and child protection (PMI), while actively participating in the development of the university hospital reform (the Debra reform) finally endorsed by the 1958 Ordinances.
At the National Institute of Hygiene, the new director appointed in 1946, Louis Barnard a polytechnic doctor wants to put the body in the prospects opened up by research and public health benefits.
"If for centuries there was concern to improve the conditions of human life, the discovery of the germ theory, the notion of contagion that resulted and the possibility of creating immunity to governments have imposed the concept for more accountability in the health sector. National health services have therefore created and developed in each country of the world "(L. Barnard symposium of Caen, 1956, arch. Inseam).
To support research, INH develops a device scholarships to send the US domestic interested in research in order to upgrade their technical training. The Institute is supported by a 'Committee of Health Studies Social Security' to fund research for the prevention, for example compare the efficacy of BCG vaccine and streptomycin in tuberculosis control. But in 1956, penalized by its limited budgetary resources in part due to competition from the DGS, the Institute makes an agreement with the Association Claude Bernard 'charge to install laboratories in hospitals of the Paris Public Assistance (these will become the first Inseam research units some years later, see below). Because of the interest Barnard to medical physics (he was a member of the scientific board of the Commissariat a energizer Atomize), including risks due to fallout from atomic explosions in the atmosphere, INH Launches' Service central protection against ionizing radiation '(SCPRI).
Prevent or cure the hegemony of medical research
In the wake of molecular biology, this new discipline upsetting the life sciences, the emergence of a 'bio medical' looks set to announce next victory over all forms of diseases and even eventually allow the indefinite extension of human life. An admittedly Utopian hope for observers hands, but that seems to be relegated to a secondary position the earth more immediate concerns on land and in health prevention.
By focusing on scientific research, the Fifth Republic wanted to give a new impulse to modernization. Following the proposals of an inter-ministerial committee led by Robert Debra and his younger Russet, an order of 30 December 1958 merges the faculty and the clinic in university hospital centers (CHU) to strengthen the 'scientific' studies medical. The following year, a General Delegation for Scientific and Technical Research (DGRST) promotes research policy based on concerted actions' intended to fill the areas where the country suffers from a delay, such as molecular biology and Cancer. But the delegation is also concerned about the functioning of scientific institutions and INH finds himself under fire for its organizational shortcomings, including its inability to resolve the overlapping of functions between medical practice and research laboratory. An administrative reform commission recommends its dismemberment, from his research activity is devoted to the CNRS, public health in the eponymous department. On the advice of the oncologist Georges Mathew, at the instigation of the Minister of Health, the organization's integrity is maintained but it is transformed into National Institute of Health and Medical Research (Inseam), the registered budget in major budget options in the Fifth Plan (1966-1970), its direction is entrusted to seeing the former Director General of Health, dr. Aleut. The priorities now granted to bio medical research are reflected in the organization of its scientific committees, the first being dedicated to "cellular and tissue pathologist", the last (and thirteenth) to "epidemiology and preventive medicine."
A shift takes place in the 1970s when the Sixth Plan (1971-1975) wants to change the health costs of a logic of demand, characteristic of the welfare state established in the postwar period, the benefit a care package included in a market economy booming (see Daniel Bigamous, 'Health in the mirror of the economy', PUF, 2006). Following him, the Seventh Plan (1976-1980) calls for the re balancing of the health budget between the research laboratory and preventive health campaigns: "before the significant increase in health spending, it is logical that political power questioned their meaning. Are they tangible translation of the Cartesian optimism [rationalism which now seems steeped in medical research, nes] or are they the expression of a myth involving excess as stated Ivan Ilyich and protesters society services and consumption? " (Preparation of the Seventh Plan, research, life sciences, health report subgroup). Moreover, the president of the National Center for demographic and social health education '(CNESDS), dr. Bertrand, draws the attention of governments on certain realities of the day:
"Although usually run by doctors, health education should not be locked into the classic issues of hygiene and public health. Instead, it should open on the most new social problems, including those of old age, the social reintegration of disabled people, mental health, sexual health, food hygiene, etc. [In fact] the increase in life expectancy at birth has led to an increase in the prevalence degenerative patients in the elderly, whereby the majority of health spending is now devoted to caring for individuals with past forty years and threatened by the progressive deterioration of their bodies. But if contemporary medicine is unable to cure most of these cases, it can delay the progression, that is to say, in practice, postpone retirement death and especially delay the entry into permanent disability, action that has an obvious economic value "(dr . Bertrand, IGAS report, in 1974, arch. Inseam).
The trade-offs between health prevention measures provide material for discussion. It noted the widespread hesitations between checkups, the 'check up' to the US, and the establishment of a systematic screening for major chronic diseases (cardiovascular diseases, cancers, etc.). Screening is recommended by dr. Lucien Rapporteur, director of the medical department of social medicine (DRMS) Inseam, which emphasizes that the individual nature of the health check involves a cost as "... it is limited to 'VIPs' the big trusts, anxious to protect their brain capital "(L. Rapporteur, Mr. Chichi, Preventive medicine -.. checkups Foreign Experiences, arch Inseam). As for vaccination, it seems far from having lost its interest pr argues Francois Hermite to the High Medical Committee of Social Security.:
By Navakeyo
Inspired by the National Council of the Resistance, wanted by General Gaul at the head of the provisional government, the Liberation is the theater of profound social reforms that benefit primarily the health field. While the welfare state is enshrined in the preamble of the constitution in October 1946: "(to) guarantee to all, notably to children, mothers and elderly workers, protection of health, safety hardware, rest and recreation "(the provisions mentioned in the constitution of the Fifth Republic), the 'Orders Larousse' settle the Social Security, a national coffers device powered by the employees and their employers, intended to substitute for Insurance Social prewar. The 'Safely' is seen as destined to become a major player in the French health system, not only to secure funding, but also in its organization.
Faced with these prospects, the pr. Robert Debra, an internationally recognized clinician, head of the pediatric department at the Decker Children's Hospital, prepares with economist demographer Alfred Savvy, the project of a large Ministry of Health and Population to modernize the national health system. But if the pr. Debra plays a major role in the development of reforms as a craftsman of a strong pro-nationalist policy, it is also concerned that they will operate at the expense of the clinic, ie nationalization of medicine which Britain has set an example with the installation of the 'National Health Service'.
"The doctor is one of the main agents that the government will use to solve the vital problem of the French population, the fight against diseases and preventable deaths and against social evils. [Thus] we can not conceive that a simultaneous reform and consistent with the medical profession and health organization of France ... / As for the medical profession, for example, we can all keep or better, shall we say, to restore his noble character and Professional while creating under the control of the State and communities, a solid framework for sanitary ... / We are told that we must accept this tendency which pushes organized doctors, medicine of the State, the collective medicine. What medicine individual is a kind of luxury medicine, medicine that collective will necessarily become the medicine of tomorrow. We wrote that the establishment of a socialist regime involving the socialization of production and exchange means and the elimination of employers and wage would remove the professions and would cause the creation of vast medical assistance services ... / But nothing seems less evident to me. Whatever the economic organization of society, and progress in this regard is essential and urgent, it appears that it should not disturb one dialogue between doctor and patient ... / The medical profession (will have ) be directed towards the successful implementation of all health program, whose implementation is urgent (and) can be is it worth recalling here that the medical profession should be managed for disease prevention and care for the sick and not for the interest of doctors ... / In this field, more than in any other, equality between French is sacred (and) leveling must be carried out from above. To achieve this, we must achieve two goals: that every group has its family physician, family doctor, well educated, continuing to learn, honored and developed appropriately overworked; second, that the health organization has a general effort of the community to ensure every benefit of the French medical advances by organizing preventive and curative medicine diagnostic centers and care centers ... / This is the exclusive role of social insurance which should include free medical assistance, accidents at work, care mutilated, War Invalids and industry "(R. Debra, 'Medicine. Health. Population' Ed. of the French Doctor, Paris, 1944).
After the Second World War, another milestone falls within scientific research. In his words at the time, then the medical assisting enthused "miracle of penicillin" (C. Heimlich, Bungler M. et al. '50 Years of practicing medicine in France. Careers and Practices of Physicians French 1930-1980 ', ed Dion INSEAM, 1993). In fact, the distribution of antibiotics, steroids, development of chemotherapy, etc. are causing a real therapeutic revolution 'mentioned by the pr. Jean Bernard, head of hematology at Hospital Saint-Louis: "Now the chemistry and biology give doctors the power to cure tuberculosis, syphilis, sepsis, major diseases of glands, chemistry disorders moods, almost half of cancers. The acute meningitis, tuberculous meningitis, acute tuberculosis, general infections, malignant endocarditis, the pneumonia may evolve towards healing ... "(interview with J. Bernard , 26 October 1990). Curative medicine finally with real therapeutic efficacy contributes to reorient its preventive counterpart, previously mobilized against infectious diseases towards health promotion defined by the World Health Organization (WHO created in 1948 under the patronage of the United Nations), "(as} a state of complete physical welling, mental and social (population)".
In the early 1950, the Ministry of Health is finally provided with budgetary resources that allow it to install large operational departments, as a General Directorate of Health '(DGS) entrusted to dr. Eugene Aleut. Simultaneously, the National School of Public Health '(NPHS) is open, while a National Center of demographic and social health education' (CNESDS) illustrates the willingness of governments to place health education under their leadership . This is to promote vaccination (compulsory BCG, vaccine DT-cock-polio) or launch campaigns of alcohol control, etc. DGS is involved in the installation of the National Blood Transfusion Center (CNTS) where practical screening for syphilis or Rhesus factor determination (severe immunological incompatibility factor) is, that of the International Children's Center (CIE) and development of maternal and child protection (PMI), while actively participating in the development of the university hospital reform (the Debra reform) finally endorsed by the 1958 Ordinances.
At the National Institute of Hygiene, the new director appointed in 1946, Louis Barnard a polytechnic doctor wants to put the body in the prospects opened up by research and public health benefits.
"If for centuries there was concern to improve the conditions of human life, the discovery of the germ theory, the notion of contagion that resulted and the possibility of creating immunity to governments have imposed the concept for more accountability in the health sector. National health services have therefore created and developed in each country of the world "(L. Barnard symposium of Caen, 1956, arch. Inseam).
To support research, INH develops a device scholarships to send the US domestic interested in research in order to upgrade their technical training. The Institute is supported by a 'Committee of Health Studies Social Security' to fund research for the prevention, for example compare the efficacy of BCG vaccine and streptomycin in tuberculosis control. But in 1956, penalized by its limited budgetary resources in part due to competition from the DGS, the Institute makes an agreement with the Association Claude Bernard 'charge to install laboratories in hospitals of the Paris Public Assistance (these will become the first Inseam research units some years later, see below). Because of the interest Barnard to medical physics (he was a member of the scientific board of the Commissariat a energizer Atomize), including risks due to fallout from atomic explosions in the atmosphere, INH Launches' Service central protection against ionizing radiation '(SCPRI).
Prevent or cure the hegemony of medical research
In the wake of molecular biology, this new discipline upsetting the life sciences, the emergence of a 'bio medical' looks set to announce next victory over all forms of diseases and even eventually allow the indefinite extension of human life. An admittedly Utopian hope for observers hands, but that seems to be relegated to a secondary position the earth more immediate concerns on land and in health prevention.
By focusing on scientific research, the Fifth Republic wanted to give a new impulse to modernization. Following the proposals of an inter-ministerial committee led by Robert Debra and his younger Russet, an order of 30 December 1958 merges the faculty and the clinic in university hospital centers (CHU) to strengthen the 'scientific' studies medical. The following year, a General Delegation for Scientific and Technical Research (DGRST) promotes research policy based on concerted actions' intended to fill the areas where the country suffers from a delay, such as molecular biology and Cancer. But the delegation is also concerned about the functioning of scientific institutions and INH finds himself under fire for its organizational shortcomings, including its inability to resolve the overlapping of functions between medical practice and research laboratory. An administrative reform commission recommends its dismemberment, from his research activity is devoted to the CNRS, public health in the eponymous department. On the advice of the oncologist Georges Mathew, at the instigation of the Minister of Health, the organization's integrity is maintained but it is transformed into National Institute of Health and Medical Research (Inseam), the registered budget in major budget options in the Fifth Plan (1966-1970), its direction is entrusted to seeing the former Director General of Health, dr. Aleut. The priorities now granted to bio medical research are reflected in the organization of its scientific committees, the first being dedicated to "cellular and tissue pathologist", the last (and thirteenth) to "epidemiology and preventive medicine."
A shift takes place in the 1970s when the Sixth Plan (1971-1975) wants to change the health costs of a logic of demand, characteristic of the welfare state established in the postwar period, the benefit a care package included in a market economy booming (see Daniel Bigamous, 'Health in the mirror of the economy', PUF, 2006). Following him, the Seventh Plan (1976-1980) calls for the re balancing of the health budget between the research laboratory and preventive health campaigns: "before the significant increase in health spending, it is logical that political power questioned their meaning. Are they tangible translation of the Cartesian optimism [rationalism which now seems steeped in medical research, nes] or are they the expression of a myth involving excess as stated Ivan Ilyich and protesters society services and consumption? " (Preparation of the Seventh Plan, research, life sciences, health report subgroup). Moreover, the president of the National Center for demographic and social health education '(CNESDS), dr. Bertrand, draws the attention of governments on certain realities of the day:
"Although usually run by doctors, health education should not be locked into the classic issues of hygiene and public health. Instead, it should open on the most new social problems, including those of old age, the social reintegration of disabled people, mental health, sexual health, food hygiene, etc. [In fact] the increase in life expectancy at birth has led to an increase in the prevalence degenerative patients in the elderly, whereby the majority of health spending is now devoted to caring for individuals with past forty years and threatened by the progressive deterioration of their bodies. But if contemporary medicine is unable to cure most of these cases, it can delay the progression, that is to say, in practice, postpone retirement death and especially delay the entry into permanent disability, action that has an obvious economic value "(dr . Bertrand, IGAS report, in 1974, arch. Inseam).
The trade-offs between health prevention measures provide material for discussion. It noted the widespread hesitations between checkups, the 'check up' to the US, and the establishment of a systematic screening for major chronic diseases (cardiovascular diseases, cancers, etc.). Screening is recommended by dr. Lucien Rapporteur, director of the medical department of social medicine (DRMS) Inseam, which emphasizes that the individual nature of the health check involves a cost as "... it is limited to 'VIPs' the big trusts, anxious to protect their brain capital "(L. Rapporteur, Mr. Chichi, Preventive medicine -.. checkups Foreign Experiences, arch Inseam). As for vaccination, it seems far from having lost its interest pr argues Francois Hermite to the High Medical Committee of Social Security.:
By Navakeyo
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