You don’t need to live in Africa but just down the road in France to have a life expectancy of just 50 years. Nearly one in every four French people feels vulnerable and this sense of fragility involves not just health, but housing, employment and education. And the only aid to address this state of affairs appears to be fragmented and over-compartmentalized. That’s why on June 19 the Sanofi Espoir Foundation organized a seminar on Vulnerabilities and Life Paths in France. The aim was to imagine global solutions to rebuild some of those shattered lives, alert the authorities by drafting a white paper, and create an Institute to monitor these expressions of vulnerability in France.
Crowning eight years of work by the Sanofi Espoir Foundation, this event held under the sign of "the vital need to break down silos" was not simply intended to review the situation, but, to use the Foundation’s President Xavier Darcos’ expression of engagement, to “build a launch pad".
Six workshops for collective construction
Gentilly - June 19 - 10 am ... Like 150 other members of associations and foundations, social workers, researchers and the general public, Thierry left the large auditorium where Xavier Darcos, President of the Sanofi Espoir Foundation had launched the Vulnerabilities Symposium and joined one of the day’s six co-construction workshops. As the director of a social residence for the Apprentis d’Auteuil that every year houses 150 young people aged 16 to 25 years with backgrounds as fragile as their health, Thierry chose to testify about health as a pillar of social insertion. He explained to the 25 participants in his workshop how his Foundation gradually fives these young people renewed confidence so that one day they can get a job. He was greeted by a hail of questions. Which partners does he work with? What kind of results? What obstacles did he have to overcome? People started discussing and new solutions began to emerge. A facilitator noted these on post-its and stuck them on a large board. It’s the same scenario two floors above, where some thirty people were working on "Go to" in healthcare, starting with several personal testimonies including Charlotte’s . She’s in charge of patrols for ADSF (Association for the Development of Women's Health), and explained how her organization aids young Nigerian women prostitutes in the Bois de Vincennes (Paris), how they deal with the most urgent problems such as STDs and unwanted pregnancies, and especially how she helps them escape from the violence. There was an equally studious atmosphere in the rooms next door where four groups were working on other topics: The Overall Approach to Care and De-siloing, Socio-cultural Mediation, Territorial Continuity of Healthcare Provision and Transferring Innovation in the Law. It is 11 a.m. and the boards are covered in post-its, so now it’s time to group them and identify emergent projects that the Foundation will support starting in 2019.
A global approach to individual care
"These six themes were identified by the associations themselves as priorities,” says Valerie Faillat, Head of the Foundation. “We had expected other, more finely-focused ideas, but these were eliminated six months ago. The message was clear: to prepare for this conference, we had to act in a horizontal, collaborative way. So 30 working sessions and 100 hours later, we are still doing that."
Once again people have been very enthusiastic about working and discussing together today, which shows that de-siloing our work is essential. "It’s no longer enough to take a highly technical, compartmentalized approach to fighting inequalities separately in health, housing, education and employment. To win the battle against all these linked sources of vulnerability, we must not only break down the dividing walls and put people back at the center of our concerns, but also cross-reference our own experiences and work more closely together."
A round table to shed light on our action
Resolutely action-focused, the Vulnerabilities Conference was also intended to “shed light on this action," as Xavier Darcos put it. This was the purpose of a one-hour roundtable for speakers chosen both for their complementary areas of expertise and their openness, moderated by Marie Drucker and introduced by Xavier Darcos.
Recalling, with supporting figures, why older models of silo-based care were not functioning, he stressed the need to break down dividing walls. This was echoed by Jean-Michel Blanquer, the French Minister of Education, when he commented on government measures in favor of a global vision of children. The school medical examination, that nearly one in two children no longer benefits from today due to the lack of doctors, forms part of these measures in the form of an inter-ministerial action plan that will involve local doctors starting in 2019. Another measure is the Homework Support scheme established since September 2017 that sets up new links between school and families, and helps reduce difficulties surrounding this topic for the poorest families in France.
Dr. Isabelle Chabin-Gibert, Head of the Social Insecurity Department at the Ile-de-France Regional Health Agency, reiterated that the fight against social inequality was an integral part of her regional health project. This is a major challenge, given that life expectancy can vary between 7 and 10 years depending on the place of residence and social status. Ensuring food security for families living in social hostels does not sound like a very “medical” measure, but it helps improves health, as today three out of every four children in this sort of accommodation suffer from dietary deficiencies. In the same way, ensuring stable housing for pregnant women improves their health as they can benefit from gynecological check-ups.
Asked about the need for a one-stop shop or single major Ministry for Social Action, Benoist Apparut, former Housing Minister and Chairman of the Board of in'li (alternative accommodation), preferred to emphasize how urgent it is to fix the scope of Ministries so that public policy can take a long-term view and enable local actors to gain greater visibility. Their task is to work together by breaking down silos at a local level.
The closing words came from Alain Ehrenberg, the sociologist and Emeritus Director of Research at CNRS (the French National Research Center). Regretting that segmenting public policy tends to penalize citizens who define themselves more by their life paths than their social status, he alerted the symposium to the need to change our model of social protection. In a society that no longer protects people by virtue of their status but teaches them to protect themselves, it is urgent not only to clarify what is meant by responsibility and autonomy, but also to develop a capacity for emotional intelligence to avoid the complete neglect of those in need.