Public health: the urgency of a collective approach

Public health the urgency of a collective approach

From 2020, once the first wave subsided, it was possible to choose a different angle of approach. I’empowerment (1) is a strong public health lever. But developing the collective and individual power to act requires prerequisites: better access to information, the development of skills necessary for its understanding and its appropriation, involvement in the decision-making process – including being able to raise the needs and requests. This also implies a change of positioning: we must recognize the population’s organizational and decision-making capacities, no longer think of ourselves as only experts but on the contrary as companions.

This is what our rulers did not do. I’empowerment is dangerous: it requires giving the faculty to act against inequalities, to tolerate self-determination, to let go of power, and this is not in the spirit of the times.

The promotion of so-called individual responsibility without any of these conditions being met was doomed to failure: the population was deprived of its capacity for accountability. By giving false information, by disregarding her abilities, but also by dividing her into different groups as if they were independent of each other: We had to lock up the elderly and people with comorbidities, shout down the disrespectful young people, consider that the magical French children risked nothing while others had to toil somehow. Similarly, the heroization of caregivers has placed them outside any community group, in a dangerous and surreal denial of their privacy. Everything has been put in place to make the slightest empowerment.

The current chaos, between denial, mistrust and fake news, is the result of what has not been done. Today the state of our healthcare system urgently requires, even outside Covid, an appropriation of health by the population.

From 2020, it would have been necessary:

● Communicate the right information with humility. Recognize that society, whether civil, scientific or medical, still had to learn, and that it was possible to move forward together.

● Recognize that the error was possible and the information subject to change. The best example remains the absence of communication on the transmission by aerosols of the virus, only relayed by a few scientists and activists with the hashtag #CovidIsAirborne.

● Provide access to basic scientific culture to understand the situation. Rather than listing the dead every evening on TV, explain the characteristics of viruses, their modes of transmission and the evolution of the state of knowledge on Covid-19, to lay the foundations for localized and adapted access to information.

● Flee divisive discourse to encourage awareness of diversity, of our need to act and exist collectively. Forget, therefore, the meritocracy and individualism of rigor in recent years.

● Explain the various possible options, the foreseeable consequences and the part of the unknown. Accept fears, criticisms and questions without minimizing them. Provide benchmarks. Allow everyone to have a satisfactory level of alert, individual or collective.

● Do not make science a matter of opinion. To accept that the facts are not yet sure or known is not to accept that the proven facts are subject to debate. The earth is not flat.

● Promote, by any means, the development of social activities despite the health context, to rely on collective strength: invent places configured to minimize transmission, allow professionals to practice there and the public to be there citizen.

● Provide material means of defense and prevention, in all the fields necessary and adapted to the specificities of the territory.

● Get out of all-medical (or all-hospital). Health should not be thought of only in medical terms: it is a component of daily life and influences the possibility of people to take full part of their citizenship, to study, to work, to have fun, to find housing, to be autonomous.

“We will not make up for the lives lost”

Only by understanding this can we do better. Preventive behaviors are followed only if they garner support. The more active and involved the participation in decision-making, the more membership is important and promotes prevention. Representing the current pandemic on the one hand and the challenges to come on the other hand without a global thought excludes from the outset the possibility of thinking about a health that would be public.

The main difficulty ofempowerment, and by extension health prevention, is that the effects are not immediate. Emergency measures were difficult to avoid in March 2020. What followed was and remains catastrophic. The refusal to project oneself differently leads to death, disability or more generally a deteriorated quality of life, including in the field of mental health, which has also been damaged by government mistreatment. We will not make up for the lives lost, nor those damaged by the Covid Long, and each passing day brings others. Each denial added to the previous one also reinforces the consequences of the discrimination suffered by vulnerable people – lack of access to care, to social life, to civic participation.

We can never go back, but we could still go forward. The question is: how much death and suffering, drama, challenges and disasters will it take? Are we able to learn from our mistakes and do better in the future? This is the urgent question to which we must respond collectively, governments and citizens.

(1). Process by which a person, or a social group, acquires mastery of the means that allow them to become aware, to reinforce their potential and to transform themselves with a view to improving their living conditions and their environment.

Natica BARTKOWIAK, Social Worker

Elisa ZENO, Research Engineer, co-founder of School and Forgotten Families

Louis LEBRUN, Medical specialist in public health

Dominique COSTAGLIOLA, Emeritus Research Director INSERM

Yvanie CAILLE, founder of Renaloo

Cathie ERISSY, Secretary General of the APPI Association for the Promotion of the Nursing Profession

Jérôme MARTY, UFMLS President

Thierry AMOUROUX, spokesperson for the National Union of Nursing Professionals SNPI

Cristina MAS, Long Pediatric Covid Collective

Céline CASTERA, Association #ApresJ20 Covid Long France

Julie GRASSET President association Coeurvide19

Gwen FAUCHOIS, health activist, former Vice-President of Act Up-Paris

Michaël ROCHOY, General practitioner, co-founder of Stop-Postillons

Matthieu CALAFIORE, General Practitioner, Director of the General Medicine Department of Lille

Cécile PHILIPPE, Molinari Economic Institute

Marie-Aude VISINE, FPE executive, ambassador of the ComPaRe covidlong cohort, expert patient

Arnaud MERCIER, Professor at the University of Paris Panthéon-Assas

Pauline NEXON

Michela FRIGIOLINI, Former member of Act Up-Paris (1992-1996)

Christian LEHMANN, general practitioner, writer

Matthieu PICCOLI, Hospital doctor, geriatrician

Dr Florent TETARD, Lecturer, LSPM CNRS, Sorbonne Paris Nord University

Corinne DEPAGNE, Pulmonologist

Philippe BORREL, Author and director of documentary films

Raphaëlle LAPOTRE, Curator of Libraries, School and Forgotten Family

Isabelle BAUTHIAN – Writer, science popularizer

Matthieu CHAUVEAU, Certified Professor

Solenn TANGUY, Educational Writer, Winslow Public Health Collective

Marion PONSOT, Research team assistant

Nathalie PIAT, iOS Developer

Dr. Christophe LEFEVRE, Doctor (no, I have no connection with o. Véran and God forbid!

Valérie REVERT, Parent of students

Alexander SAMUEL, Teacher

Solenn LESVEN, Parent of students

Valentin THERY, Technician in the pharmaceutical industry

Armelle VAUTROT, Academic and therapist, activist for empowerment in mental health (psychoeducation and psychosocial rehabilitation in particular)

Maëe SÉBILLE, Graphic designer

Christophe PONSOT, Engineer

Sandrine GLAIZAL, Higher education education staff

Davide BENEVENTI, Researcher

Benoit Hallinger

Laure SOULE, parent

Dominique LANG, Nurse in infection prevention and control

Igor AURIANT intensive care physician

Arthur BABET, IT developer

Yannick FREYMANN, doctor

Marie-Anne PANET, Doctor, member of the NoFakemed collective

Denis AVIGNON, student

Priscillia FAUTRAT, Winslow Collective

Emilie TRAN – Forgotten Schools and Families

Corinne PLANTE, Shopkeeper

Emmanuel CAILLET, architect

Stéphanie EVEILLARD, stay-at-home mother

Franck CLAROT, radiologist, pathologist

Lonni BESANÇON, researcher

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