Based on the assertion that humanity is united, which requires unified action on public health at a global level, the “world health” or “global health” approach now often incorporates a second type of unity, that of the living world and health determinants, viewing man in his environment through the lens of the “one health” concept. In view of the growing importance of this scientific and political issue, the mission’s assessment of the current situation in France is that there is a lack of ownership of the concept of global health, a lack of visibility of that which does exist and some very serious shortcomings.
First of all, from an academic perspective, global health is not a university discipline listed in the various sections of the National University Council (CNU). There was no master’s degree in this field in 2020-2021 (one has been offered by both the School of Public Health of the University of Bordeaux and Claude Bernard University Lyon 1 since 2022). Only a few higher education institutions offer courses in “global health” that are not just part a multidisciplinary program, which is most commonly the case. The institutions that advertise their courses using this term are not involved in medical or public health training (Sciences Po, Institut Pasteur-CNAM, in particular). Only one medical school (Rouen) offered elective training in global health in 2018. Recently, however, the development of transdisciplinary training programs backed up by research capacities and supported by the Université Paris-Saclay and Université Paris Cité, both of which are either members of or co-lead alliances (groupings of European universities), has illustrated the growing level of awareness surrounding global health.
The same can be said of research. Several research institutions are developing global health research activities and programs in cooperation with partner countries (French National Research Agency for AIDS - Emerging Infectious Diseases (ANRS-MIE), Institut Pasteur (IPP)). For some of them, this is part of their mission, while others have seized upon the concept (Research Institute for Development (IRD)). The current COVID pandemic has certainly helped to increase awareness of global health issues.
Lastly, the mission found that there was a lack of programming or support dedicated to research activities in the field of global health, particularly in terms of funding capacity, as well as measures to bring structure to what is a potentially important community.
This finding was confirmed by the mission’s comparison of the situation in different countries (Germany, United Kingdom, Northern European countries, United States and Canada) with respect to global health. The analysis of foreign systems and policies (see appendices 4 to 8), based on information collected from embassies’ scientific departments, as well as during interviews conducted by the mission, has helped to highlight France’s major weaknesses. In particular, it should be noted that this was only made a priority at a late stage, as the national global health strategy was only set out in 2017. There is a lack of political leadership and its resources are spread too thinly, all of which are detrimental to its impact.
Nevertheless, the main conclusion of this exercise is that the delay in taking global health into account, far from being a insurmountable obstacle, should instead be seen as an invitation and an opportunity to design, coordinate and roll out a pro-active policy in this area – a matter of great importance for the future – and to do so by relying on the few, but valuable assets that France has at its disposal.
In this respect, the COVID-19 pandemic has amplified awareness of the “globalization” of health, among both citizens and researchers. In the broader context of environmental issues and global warming, the One Health approach has become increasingly relevant. It therefore seems like a particularly opportune moment to think about how an academic field in global health in France should be structured. This will require coordination between the various actors involved in the comprising disciplines and fields of global health. If there is a clear desire to develop a global health training and research ecosystem in France, this should be incorporated into France’s next global health strategy (2022-2026), which is currently being developed, and should be based, in particular, on restoring our country’s influence in the French-speaking world in partnership with the Association of Francophone Universities (AUF).
This future structure must also take into account the challenge of training a new generation of young researchers and other professionals in global health issues and the transdisciplinary work that this entails through an integrative approach. This transdisciplinary work would help to improve public health, which has always been historically poor in France ; an issue that is still relevant today.
France has a number of assets, including a renewed commitment in recent years to official development assistance, a clear policy framework and an increase in its contributions to various multilateral assistance funds. Collaborations and partner sites of research institutions abroad are recognized, valuable assets for undertaking work in research and training in partnership with others. These should be the subject of ongoing focus and strengthened further. However, there are two obstacles that must be taken into account. The first is the persisting view, for a number of researchers from low-income countries, that there is a certain degree of neo-colonialism at play in the world of science, whereby in most cases, it is funding and publications from northern countries that address health issues that affect the Global South. The second is France’s limited involvement in international global health networks. The mission makes recommendations in regard to this point to improve the visibility of France’s work within these networks.
With this in mind, the mission wishes to highlight to six of its ten recommendations, which are as follows :
• Following the example of the United States in formally indicating a new political goal by creating, at the highest level (President of the Republic, Prime Minister), a high commissioner or interministerial delegate for “global health” ;
• Putting in place governance capable of coordinating all actors and stakeholders and their involvement in the project to bring structure to the academic field, as has been done in Germany ;
• Making efforts to rapidly consolidate 3 research and teaching clusters in global health from among the main sites identified in the report by bringing together actors who are already involved or interested in such work ;
• Supporting the development of recognized training programs in global health to create a new generation of practitioners, teachers, researchers and future experts in the field.
• Selecting a small number of structuring priorities in global health by prioritizing a transdisciplinary approach with the aim of setting out a collaborative work agenda, using a PEPR to achieve this ;
• Investigating the possibility of public health being granted its own section by the CNU, bringing together physicians and non-physicians specializing in global health and allowing for the inclusion of professors from academic disciplines involved in global health.
ABBREVIATIONS & ACRONYMS
|ANR :||Agence nationale de la recherche (French National Research Agency)|
|AUF :||Agence universitaire de la francophonie (Association of Francophone Universities)|
|CNAM :||Conservatoire national des arts et métiers (French National Conservatory of Arts and Trades)|
|CNU :||Conseil national des universités (National University Council)|
|IP or IPP :||Institut Pasteur|
|IRD :||Institut de recherche pour le développement (Research Institute for Development)|
|PEPR :||Programme et équipement prioritaires de recherche (Priority research program and infrastructure)|