Reorganization for greater efficiency, according to the government; political takeover at the expense of scientific independence, according to health actors: the announcement of a "strategic refocusing" of Public Health France, which would lose control over prevention campaigns, is causing concern.
This "strategic refocusing" of the public health agency has been decided, with two main developments: "the management of strategic stocks and the health reserve" will depend directly on the Minister of Health, and national public health communication campaigns will be "transferred" to the ministry and the National Health Insurance Fund, Stéphanie Rist's office told AFP.
According to France Inter, which broke the story, this reform was decided at an interministerial meeting, approved by Prime Minister Sébastien Lecornu and announced Thursday to staff by SpF's Director General, Caroline Semaille.
Nearly a year ago, the ministers then in charge of health, Catherine Vautrin and Yannick Neuder, asked the General Inspectorate of Social Affairs (IGAS) for a "review" of the missions and "human, financial, and technical resources" of SpF, raising initial concerns about the agency's future. This report has not been made public.
Born from the merger of several public bodies (InVS, Inpes, Eprus, Adalis), Santé publique France was created in 2014 to provide France, like the United States or England, with an establishment bringing together missions of prevention and health promotion, alerts and surveillance, intervention.
The removal of stock management and the health reserve from SpF aims to "shorten the chain of command" and "strengthen decision-making capacity," the ministry told AFP.
As for the transfer of communication campaigns, starting from "early 2027", it aims to produce "clearer messages" because a "multiplication of campaign bearers" has "may have blurred the readability of public discourse on health", according to Ms. Rist's office, ruling out any search for "savings".
The government is considering approximately two billion euros in additional savings on state agencies and operators, the Minister for Public Action and Accounts, Amélie de Montchalin, indicated in mid-January.
– “Impression of regaining control” –
Not opposed to "recentralizing a bit, to have a single master on board" and promoting prevention, a health system expert told AFP, under the condition of anonymity, that "a major reorganization is underway between the Ministry of Health and various agencies."
But against a backdrop of persistent tensions over the state budget and health and environmental issues, the announced restructuring of SpF caused a stir on Friday.
The agency is "under the control of the State but, scientifically, it has independent expertise," Dr. François Bourdillon told AFP, expressing his concern about a "dismantling" of the agency he created and led until 2019. "Putting public health campaigns back under the Ministry of Health really gives the impression of a takeover."
"Why is she being attacked when she is fully carrying out her duties and there is so much to be done in healthcare?" he asked, suggesting the influence of lobbyists.
Pointing to an "unreadable logic", Bernard Basset, honorary president of the Addictions France network and former deputy director of Inpes, wonders "if there is not a political calculation on the control of information on health subjects where lobbies are active: alcohol and nutrition".
Hendrik Davi, Green Party MP and SpF administrator, also fears "a major risk of censorship on campaigns that are nevertheless essential: tobacco, alcohol, drugs, pollution, sexual health…"
According to Professor Serge Hercberg, one of the designers of Nutri-Score, "neither political ideology nor economic interests should prevail over science."
"In many international contexts, the weakening of the role of independent scientific agencies has led" to (...) "a lasting loss of public trust in public discourse," the French Society of Public Health also warned in a statement.
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