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PRESS RELEASE
15 May 2024
Communication to the Senate Social Affairs Committee
RESPIRATORY HEALTH
The Chair of the Senate Social Affairs Committee has asked the Court of Accounts to carry
out a survey on "respiratory health". Its aim is to assess the effectiveness of policies to
prevent and combat the main respiratory diseases: chronic obstructive pulmonary disease
(COPD), asthma and lung cancer. These three diseases have been selected because of the
large number of patients suffering from them (10 % of the French have one of these three
diseases) and the consequences in terms of quality of life, health and public spending. In
terms of cost, in 2021 the French health insurance system estimated that the cost of treating
chronic respiratory diseases would be €3.7bn. A further €3bn in health insurance
expenditure must be added for lung cancer, giving a total for all respiratory diseases of €6.7
billion. The survey focused not only on the health system, but also on the objectives set and
the resources mobilised to combat environmental risk factors and their impact on
respiratory health.
Respiratory diseases on the rise despite significant prevention efforts
In France, over 10 % of the population suffers from a respiratory disease, particularly women.
These are mainly chronic diseases, including asthma, which affects four million individuals,
chronic obstructive pulmonary disease (COPD), which affects 3.5 million patients, and lung
cancer, which affects 160,000 patients.
The number of sufferers has been rising for at least two
decades, particularly for lung cancer and COPD, as a result of smoking and population ageing.
Asthma, for its part, has increased as a result of environmental factors.
With regard to tobacco,
despite active policies, consumption is not falling quickly enough, particularly among women
and the lowest income population groups. The fight against airborne pollutants must be
continued and information on the causes of the deterioration in air quality must be improved,
all the more so since as a result of global warming, the weight of environmental factors in
respiratory diseases could increase. As a result of multiple exposures - behavioural,
environmental and socio-economic - and the sometimes long time lag between these
exposures and the onset of a disease, the prevention of respiratory diseases requires
all the
determinants of an individual's health throughout his or her life to be taken into account
.
More effective care pathways, from identification through to support
Public spending on the prevention and treatment of respiratory diseases is increasing: spending
on prevention and treatment by the health insurance system is rising, as is spending on
prevention, which is mainly earmarked for the fight against smoking. The latter has doubled
since 2018 and care expenditure increased by €1.3bn between 2017 and 2021, reaching
€6.7bn. The health impact of this expenditure could be measured using a respiratory health
indicator, which could be developed by the Ministry of Health and included in the French
National Environmental Health Plan (PNSE). Management of chronic respiratory diseases is not
optimal, due to shortcomings in early detection and inadequate local provision. This leads to
costly and potentially avoidable emergency hospitalisations. Lung cancer, on the other hand, is
treated in a more structured way and in specialist institutions, but often not before the disease
has reached an advanced stage. Poorly understood by healthcare professionals and the general
public, COPD is perceived with a degree of fatalism. However, the scientific literature has shown
the benefits of non-drug treatment: therapeutic education and adapted physical activity are
treatments in their own right for respiratory diseases. Although enshrined in law, they are still
not easily accessible to patients close to where they live, and are under-prescribed.
Unclear governance and organisation
France has chosen to innovate in terms of care and funding: the so-called "Article 51"
experiments are paving the way for changes in the healthcare system. In response to the
saturation of primary care services, initiatives have been developed to coordinate
multidisciplinary teams and structure them around comprehensive patient care. But these
developments, like the health insurance system's attempts at disease management
programmes, are not enough.
In the case of diseases where the key to treatment lies in
changing lifestyle habits, input from 'expert patients' is worth considering. Connected tools that
encourage patient autonomy and monitoring also have a role to play, particularly for younger
patients. In addition, the legal framework applicable to the prevention and control of respiratory
diseases comes under the concept of "environmental health", the administrative application of
which is provided for in the French Public Health Code with the implementation of the PNSE.
This is in addition to other plans, under the responsibility of numerous ministries, without there
being any guarantee of coherence between all the objectives. The duality of the administrative
responsibilities involved, between the ministry of health and the ministry of ecological
transition, affects the clarity of the policy pursued and, consequently, its effectiveness,
management and monitoring of the related public expenditure.
To ensure overall coherence,
respiratory health needs to be included in the national health strategy and be consistent with
the National Environmental Health Plan. This plan must be in line with the objectives defined
by the ministry of health and with the roadmap for COPD and asthma, as set out in the French
National Authority for Health (HAS) recommendations.
Read the report
PRESS CONTACTS :
Julie Poissier
Head of Media
T +33 (0)6 87 36 52 21
julie.poissier@ccomptes.fr
Sarah Gay
Press Relations Officer
T
+33 (0)1 42 98 59 94
sarah.gay@ccomptes.fr
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