History & Civics Project

World Health Organisation

France
May 2011

Ram Hattikudur
X B, Vidya Shilp Academy
Table Of Contents:

Introduction
Background & Facts
Country Health Profile –
France
Current Challenges facing
WHO in France
WHO Plans for the future in
France & Europe
Summary
References
Introduction:

(a) The UN:

The United Nations (UN) is an international organization whose stated aims are
facilitating cooperation in international law, international security, economic
development, social progress, human rights, and achievement of world peace.

The UN has many organizations and agencies that function to work on particular
issues. Some of the most well-known agencies are the International Atomic Energy
Agency, the Food and Agriculture Organization, UNESCO (United Nations
Educational, Scientific and Cultural Organization), the World Bank and the World
Health Organization.

It is through these agencies that the UN performs most of its humanitarian work.
Examples include mass vaccination programs (through the WHO), the avoidance of
famine and malnutrition (through the work of the WFP) and the protection of
vulnerable and displaced people (for example, by the UNHCR).

The United Nations Charter stipulates that each primary organ of the UN can
establish various

specialized agencies to fulfill its duties.

(b) WHO:

The World Health Organization (WHO) is a specialized agency of the United Nations
(UN) that acts as a coordinating authority on international public health. Established
on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the
mandate and resources of its predecessor, the Health Organization, which was an
agency of the League of Nations.

The WHO's constitution states that its objective "is the attainment by all people of
the highest possible level of health."[2] The flag features the Rod of Asclepius as a
symbol for healing.

The World Health Organization (WHO) is one of the original agencies of the United
Nations, its constitution formally coming into force on the first World Health Day, (7
April 1948), when it was ratified by the 26th member state. Jawaharlal Nehru, the
first prime minister of India, was a big supporter of starting WHO, because India
needed its services.
The epidemiological service of the French Office International d'Hygiène Publique
was incorporated into the Interim Commission of the World Health Organization on 1
January 1947, and this became WHO France.

Regional offices and regions of the WHO:

Africa; HQ: Brazzaville, Congo

Americas; HQ: Washington, D.C., USA
Eastern Med.; HQ: Cairo, Egypt
Europe; HQ: Copenhagen, Denmark
South East Asia; HQ: New Delhi, India
Western Pacific; HQ: Manila, Philippines

France falls within WHO’s European operations, headquartered in Copenhagen. In

addition, two liaison organizations of WHO are in France. These are:

• IARC, International Agency for Research on Cancer (Lyon, France)

• WHO Lyon Office for National Epidemic Preparedness and Response (LYO)
(Lyon, France)
Ms. Zsuzsanna Jakab is the WHO Regional Director for Europe. The head for WHO France
does not seem to be in the public domain.

Background & Facts:

According to the World Health Organization (WHO), France has the best health care
system in the world. It has been reported that the WHO found the French system to
be number 1 while the US is at number 37.

Country Statistics(France)

Total population
61,330,000

Gross national income per capita (PPP international $)

32,240

Life expectancy at birth m/f (years)

77/84

Healthy life expectancy at birth m/f (years, 2003)

69/75

Probability of dying under five (per 1 000 live births) 5

Probability of dying between 15 and 60 years m/f (per 1 000 population)

124/57

WHO rankings actually contain multiple rankings and the numbers generally quoted
are the ranking based on the measure that the WHO calls the OP ranking. OP is said
to measure "overall performance" adjusted to reflect a country's performance based
on how well it theoretically could have performed. When reporting the rankings of 1
for France, 30 for Canada and 37 for the United States, it is the OP ranking being
used.

Why did the French system do so well in the WHO rankings? The French
system excels in 4 areas:

• It provides universal coverage

• It has responsive health care providers
• Patients have freedom of choice
 • The health and longevity of the population

Countries such as India should be looking more closely at the French system
because it is successful, and because it has some similarities with the Indian system

The French system relies on both private insurance and government insurance.
Also, just like in India, people generally get their insurance through their employer.
What is different is that everyone in France has health insurance. Every legal
resident of France has access to health care under the law of universal coverage
called la Couverture maladie universelle.

Under the French system, health insurance is a branch of Social Security or the
Sécurité Sociale. The system is funded primarily by taxing the salaries of workers.
An employee in France will pay about 20% of their salary to fund the Sécurité
Sociale. These taxes represent about 60% of the cost of the health insurance plan.

The balance of the funding comes from the self employed, who pay more than
salaried workers, and by indirect taxes on alcohol and tobacco. Finally, additional
taxes are levied against other income, both direct and indirect.

The French share the same distaste for restrictions on patient choice as American
do. The French system relies on autonomous private practitioners rather than a
British-style national health service. The French are very dismissive of the British
system which they call "socialized medicine." Virtually all physicians in France
participate in the nation's public health insurance, Sécurité Sociale.

Perhaps it's time for us to take a closer look at French ideas about health care
reform.

Country Health Profile:

Highlights on health give an overview of a country’s health status, describing recent

data on mortality, morbidity and exposure to key risk factors along with trends over
time. The reports link country findings to public health policy considerations
developed by the WHO Regional Office for Europe and by other relevant agencies.
Highlights on health are developed in collaboration with Member States and do not
constitute a formal statistical publication.

Each report also compares a country, when possible, to a reference group. This
report uses the 27 countries with very low child mortality and very low adult
mortality, designated Eur-A by WHO, as the reference group. Eur-A comprises
Andorra, Austria, Belgium, Croatia, Cyprus, the Czech Republic, Denmark, Germany,
Greece, Finland, France, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco,
the Netherlands, Norway, Portugal, San Marino, Slovenia, Spain, Sweden,
Switzerland and the United Kingdom.

To make the comparisons as valid as possible, data, as a rule, are taken from one
source to ensure that they have been harmonized in a reasonably consistent way.
Unless otherwise noted, the source of data in the reports is the European health for
all database of the WHO Regional Office for Europe. Other data and information are
referenced accordingly.

The above statistics show that the country currently has a robust and self sufficient
health care system.

But this was not always the case. Most of the country’s infrastructure was destroyed
due to World War II. While Paris itself was spared bombing by both the Allies as well
as Axis forces, key battles raged across France in both 1939-40, when the Germans
invaded, as well as in 1944-45 during the Allied counter-offensive.

World Health Organisation was instrumental in building up the country’s health

infrastructure & more importantly, in helping the government to devise a public
health structure that is now ranked amongst the best in the world.
France falls within WHO’s European area. Even within the European system, the
French public health system is being studied carefully for best practices. In its 2000
assessment of world health care systems, the World Health Organization found that
France provided the "best overall health care" in the world. In 2005, France spent
11.2% of GDP on health care, or US$3,926 per capita. Of that, approximately 80%
was government expenditure.
 Physician Healthcare
Life Infant Nurses Per capita %of government
s per costs as a %of health costs
Country expectan mortality per 1000 expenditure on revenue spent on
1000 percent of paid by government
cy rate people health (USD) health
people GDP

Australia 81.4 4.2 2.8 9.7 3,137 8.7 17.7 67.7

Canada 81.3 5 2.2 9 3,895 10.1 16.7 69.8
France 81 4 3.4 7.7 3,601 11 14.2 79
Germany 79.8 3.8 3.5 9.9 3,588 10.4 17.6 76.9
Japan 82.6 2.6 2.1 9.4 2,581 8.1 16.8 81.3
Norway 80 3 3.8 16.2 5,910 9 17.9 83.6
Sweden 81 2.5 3.6 10.8 3,323 9.2 13.6 81.7
UK 79.1 4.8 2.5 10 2,992 8.4 15.8 81.7
USA 78.1 6.7 2.4 10.6 7,290 16 18.5 45.4

WHO France: Current Challenges:

WHO faces entirely different challenges in developed countries like France, which
are very different from those it faces in sub-Saharan Africa or East Asia.
Nevertheless, there are challenges and WHO has programs in place to address
these.

(a) Lifestyle-related issues:

France, with a population of nearly sixty million people, has a high health ranking by
the World Health Organization, taking into account healthy life expectancy (without
disability or incapacity), child and adult mortality rates, among other indicators.
Although some of the data show a relatively healthy population in France, other
core health indicators reveal a high rate of premature mortality, primariy lamong
males, as a result of tobacco and alcohol
consumption and accidental deaths.

(b) The financial burdens of longevity, unemployment, and new therapies

France, like many other Western countries, is facing difficulties in sustaining a

healthcare infrastructure that is under growing pressure from increasing
expenditures, with no guarantees of additional funding. Approximately ten million
persons in France are sixty-five years or older, representing a growing segment of
the population that often requires long-term healthcare. In contrast, the total birth
rate in France is comparatively low . Additional burdens on the healthcare system
are increasing levels of unemployment and increased health costs for new
therapies.

Both the above issues are addressed in WHO’s plan via Millenium Development
Goals (or MDGs)

WHO Plans for the future in France & Europe:

To quantify and objectivise its future plans, WHO has drawn up a set of parameters
on which it measures itself from time to time. These 8 parameters are called
Millenium Development Goals (or MDGs). The MDGs are the highest-profile
articulation of internationally agreed development goals. They are the world’s
quantified, time-bound targets for addressing extreme poverty, hunger and disease,
and for promoting gender equality, education, environmental sustainability and a
global partnership for development. Most importantly, the MDGs are an expression
of basic human rights.

These are:

Part I. MDGs on health

MDG 4 – Reduce child mortality
MDG 5 – Improve maternal health
MDG 6 – Combat HIV/AIDS, malaria and other diseases [including TB]

Part II. MDGs on key determinants of health

MDG 1 – Eradicate extreme poverty and hunger
MDG 2 – Achieve universal primary education
MDG 3 – Promote gender equality and empower women
MDG 7 – Ensure environmental responsibility
MDG 8 – Develop a global partnership for development

The Millennium Development Goals (MDGs) are a historic framework providing focus
and accountability in addressing some of the world’s most pressing development
challenges. The 53 Member States in the WHO European Region, including France
have made some significant advances in meeting the MDG. Nevertheless, action
has stagnated in some areas and inequities in progress persist between and within
countries, primarily because Europe, though largely developed economies, has had
its own challenges during the economic downturn and also due to poorer and lesser
developed countries like Albania, Bosnia etc.

Strong health systems are crucial for maintaining and scaling up progress towards
the MDGs on health. Achievement of health targets depends on equitable access to
a health system that delivers high-quality services, including the stewardship of
cooperation with other sectors and at cross-government levels to address the
determinants of health and health inequities. The values and principles of primary
health care – including equity, solidarity, social justice, universal access to services,
multisectoral action, transparency, accountability, decentralization, and community
participation and empowerment – provide a basis for strengthening health systems
to ensure improved progress towards the MDGs.

These same principles are vital for tackling other health challenges in France & the
European Region, such as adult morbidity and mortality linked to non-
communicable diseases and external causes. While the configuration of health
systems depends on country contexts, in all cases MDG progress requires:
• strong national capacities for adequate financing with pooling of risk;
• a well-trained and adequately remunerated workforce;
• information on which to base policy and management decisions;
• logistics that get medicines and vaccines to where they are needed;
• well-maintained facilities organized as part of a referral network; and
• leadership that provides clear direction and harnesses the energies of all
stakeholders, including communities.

Scaling up progress towards MDG targets will be among the challenges addressed
by the new European health policy, which Member States and the WHO Regional
Office for Europe are developing with input from partners. The policy will promote
the Region’s values and aims for health, provide a coherent and integrated
framework and roadmap for health action, and specify ways through which health
systems can be strengthened and the wider determinants of health and health
inequities can be tackled.

Summary:

(Ram to complete this)

References:

1. World Health Organisation website, www.who.int/countries/fra/en

2. World Health Organization. (2000). World Health Report 2000 - Health
systems: improving performance. Geneva, WHO
3. WHO Statistical Information System". World Health Organization
4. http://en.wikipedia.org/wiki/Health_in_France
5. Businessweek article:
http://www.businessweek.com/magazine/content/07_28/b4042070.htm
6. http://en.wikipedia.org/wiki/World_Health_Organization
7. WHO Millenium Development Goals for Europe:
http://www.euro.who.int/__data/assets/pdf_file/0006/95595/E93723.pdf
8. http://www.vhpb.org/files/html/meetings_and_publications/viral_hepatit
is_newsletters/vhv13n2.pdf