COVID-19: need of new territorial approaches

Autor(es)

Cédric Arcos

Deputy CEO

Paris Region

IHF Governing Council Member

Even before the appearance of SARS-CoV-2, the fight to ensure our territory’s balanced development of was one of our most important missions. Indeed, the Île-de-France Region is a land of contrasts: it is France's leading economic region, with high standard of living, but also a territory marked by strong social and spatial inequalities, particularly inequalities in access to healthcare. As a result, the Regional Council, as the guarantor of a long-term vision, has taken strong actions to fight against social, health, environmental and educational divides that strike the region. This is the whole purpose of the "Region of Solidarity" programme, which runs for more than three years and which aims to implement policies in order to reduce inequalities and act on behalf of all the populations, whether rural or urban, of the Ile-de-France region.

The arrival of the COVID-19 epidemic has given this mission a new dimension. The aims remain unchanged: support the health system, accompany economic actors, help the most vulnerable and promote ecological transition. However, it has been necessary to thoroughly review modes of action and adapt to this unprecedented crisis: rethinking interventions and processes, demonstrating responsiveness, flexibility and inventiveness. Today, 99% of regional agents are teleworking, which was made possible by a gradually spreading this organization mode since 2017.

Demonstrating such a capacity to adapt was truly essential, as the stakes were so high. Indeed, COVID-19 terribly aggravates vulnerabilities since it first hits the most fragile and precarious. The Region's strong links with the major associations have made it possible to intervene as quickly and as closely as possible to those who need it most. More than 80 tons of food not used by high schools were distributed to associations. Similarly, 800,000 surgical masks were given to frontline volunteers and a dedicated emergency fund for humanitarian associations was set up.

Efforts must continue in this area, given that the epidemic is deeply destabilizing our society by causing great impoverishment among many of our fellow citizens, especially families who are facing increased expenses. Many people in the Ile-de-France region are thus at risk of tipping over from modest to vulnerable status, and it acting to limit this tipping over as much as possible is essential. To help them, in addition to strengthening aid to associations, targeted aid has been mobilised, particularly focused on all families of high school students on scholarships. More broadly, the Regional Council has made job insecurity and the fight against poverty priority objectives for the coming months. This crisis is further undermining an already fragile social cohesion and this is why we need more than ever local solidarity. Moreover, all the initiatives taken to support carers and associations so far demonstrate this thirst for cohesion.

The second major challenge of this crisis was to support the players and the health system through unprecedented actions. Firstly, an emergency fund of ten million euros was set up to support the equipment of urban healthcare professionals to continue their activity, protect themselves and their patients. Another one million euros has been mobilized to finance clinical trials of new drugs launched at the European level, doubling the financial resources allocated to them by the State. In the turmoil caused by the shortage of masks, the Region mobilized to acquire more than 30 million surgical masks directly from China, even going so far as to charter its own planes to secure arrivals. To meet the needs of companies and local authorities and thus enable the resumption of activity, a regional buying group was set up in just a few days, which currently supplies more than 9 million masks, through negotiated and secure markets.

As the issue of human resources is central to the response to the epidemic, nursing students, for whom the Region is responsible, have been mobilized as reinforcements. Thus, so that these students can provide support in the care services, the choice was made to no longer pay them as trainees (200 euros per month) but to pay them as young professionals, between 1,300 and 1,500 euros per month, in order to give due recognition to their commitment. In addition, 10,000 accommodations have been opened in our high schools and leisure centres to house carers close to their places of work as well as vulnerable populations in need of isolation. In addition, the Region participated in financing a home monitoring application for COVID patients. Services to suburban hospitals were strengthened when the rest of public transport traffic was reduced by at least half. The Region decided to provide free shuttles between stations and health centers and finally a concierge service for residents was set up. This project is entirely managed by the Region and it symbolizes more than any other the agility we have been able to demonstrate in these difficult times. In concrete terms, several dozen interns are now housed close to their place of work or have a car at their disposal, all free of charge, thanks to the Region.

This ability to adapt will have to be maintained with the release from confinement, which will mark the start of a new era. From now on, we must ask ourselves how we can be useful to the population, businesses, health, culture, sport and solidarity players. In this new landscape whose contours are still blurred, it is necessary to take a global vision and to think about the territory in all its dimensions. 

In France, the crisis of the COVID-19 epidemic has thus profoundly changed ways of working that seemed to us to have been taken for granted for a long time. From the place of health to our territorial organization, new trends seem to be taking shape in various fields.

Firstly, there is a widespread awareness of the importance of the health sector as a major political issue. In France, the subject was only considered from a technical point of view. For the first time it has become a real political issue, requiring global choices.

This crisis also raises the question of the need to rethink France's industrial policy in order to guarantee its autonomy. A strategy will have to be devised to rebuild a strong healthcare industry in France and Europe, but also and above all a digital strategy capable of giving us full control over our destiny.

The crisis is also leading us to rethink cities’ design. Urban density has shown its limits and new organizational models will undoubtedly be popular, more responsible and less aggressive for the environment.

Relations between territories and the French State, which is highly centralizing, will finally have to be questioned. This crisis shows the importance of the territories in adapting the general strategy and has also confirmed the great maturity of local leaders. New responsibilities will undoubtedly have to be entrusted to them and more forces will have to be added. 

The current crisis shows the best of the French health system (professionals mobilised beyond reason, innovative organisations, an extraordinary capacity to adapt) but should not make us forget that it came at a time when the system was at the end of its rope. It will therefore have to be radically overhauled in order to put solidarity, territoriality and cooperation as a core issue. More fundamentally, the challenge will be to make health a vector of change in our social model, by giving meaning to it and a purpose to organisations.

Paris, 12 June 2020