🔍💡 Health crises: making prevention, One Health, and shared data a political reflex, not an option. #HealthCrises #Prevention🧭🤝 Crisis governance: fundamental rights, territories, and citizen participation at the heart of decisions, far from the entirely vertical Covid approach. #PublicHealth
📌 This text provides a very operational framework for anticipating, organising, and governing future health crises, integrating prevention, territories, and social inequalities.
Doctors, managers of medico-social structures, local authority agents, and association leaders can use it to equip their crisis plans, local health contracts, and prevention actions. It also helps to argue with ARS and decision-makers about the needs for resources, data, and citizen participation.
Source: 📒 Health crises: prevent, anticipate, coordinate – Opinion of the Economic, Social and Environmental Council.
✍️ Economic, Social and Environmental Council (CESE); rapporteurs: Gilles Bonnefond and Christelle Caillet, on behalf of the Social Affairs and Health Committee, chaired by Danièle Jourdain-Ménninger - April 2026
📜🔗LINK
Number of pages: 170
1. Analytical summary
Context, systemic risks, and affected publics
France is facing an inevitable risk of new health crises, in a context of climate change, loss of biodiversity, globalisation of trade, and antibiotic resistance that make crises more hybrid and systemic. The opinion starts from the observation that the Covid-19 pandemic has exposed major failures in prevention, anticipation, coordination, and an overly easy recourse to exceptional regimes, with lasting impacts on social, territorial, and gender inequalities. It defines a health crisis as an exceptional situation that seriously jeopardises the health of the population or imposes emergency measures, and recalls the plurality of crises (epidemics, pandemics, syndemics) and the necessity to articulate social determinants and epidemiological data. The targeted populations are the poorest individuals, people with disabilities, women, “essential” workers, and residents of fragile territories, both in mainland France and overseas, whose vulnerability was amplified during Covid. The opinion is addressed to national public authorities, regional health agencies, local authorities, expert agencies, health, social and medico-social actors, and organised civil society.
Operational contributions for crisis prevention and governance
The document outlines 6 structuring priorities (One Health, reduction of inequalities, research and strategic autonomy, sustainable strengthening of care and support, culture of prevention, trust in science) and 7 principles of crisis governance (fundamental rights, coordinated expertise, social sciences and ethics, health democracy, territorialisation, information, feedback). It materialises in23 recommendationsspecifics relating to the interministerial health-environment strategy, the governance of health and environmental data, research funding, the ONDAM, territorial crisis plans, and the participation of professionals and users. For local actors, the opinion proposes to formalise chapters on 'health crises' in the PRS, departmental schemes, and local health contracts, to condition certain funding (CPTS, networks) on the existence of crisis plans, and to systematise intersectoral exercises. It frames crisis communication by requiring a proactive, transparent, and clear strategy, supported by trusted territorial intermediaries. Finally, it mandates the systematisation of feedback involving all field actors, not to justify institutions but to capitalise on improvised and transferable initiatives.
2. Key points of the document
Institutionalise a One Health and health-environment strategy
The opinion calls for the adoption of an interministerial and multiannual health-environment strategy, enshrined in a framework law, with quantified objectives, monitoring indicators, and an assessment of the PNSE4, fully integrating local authorities and overseas territories. (p.19-25, p.20-23; recommendation no. 1)
Data and interoperability for truly One Health surveillance
The text emphasises the need to cross-reference SNDS, health data platforms, GD4H, and surveillance systems (SurSaUD, SI-DEP, Sum’eau, etc.), by making the information systems interoperable, secure, and compliant with the GDPR, while assessing the workload for professionals. (p.25-30; recommendation no. 2)
Social, gender, and vulnerability inequalities as crisis amplifiers
The opinion details how Covid-19 acted as a “syndemic”, exacerbating poverty, difficulties in accessing food, housing conditions, violence, gender and mental health inequalities, and calls for the involvement of affected individuals in policies to combat poverty. (p.31-39; recommendation no.3)
Sustainably strengthen the healthcare system, prevention, and health democracy
The CESE reaffirms the need to evaluate the Ségur de la santé, to rethink the ONDAM as a multi-year steering tool based on needs, to strengthen the role of prevention (including in initial and ongoing training), and to organise the continuity of health democracy in times of crisis. (p.52-67, p.95-99; recommendations no.7 to 11 and 16)
Crisis governance based on rights, pluralistic expertise, and territorialisation
The 7 principles of Part II establish respect for fundamental freedoms and rights, the consolidation of independent health expertise, the integration of social sciences and ethics, user participation, adaptation to territories, structured crisis communication, and the systematisation of feedback. (p.71-115; recommendations no.13 to 23)
3. Action pathways for local actors
Include a “health crises” component in territorial tools
Systematically integrate a “health crises” chapter in the PRS, departmental health schemes, and local health contracts, articulated with ORSAN, white plans, and blue plans, in order to plan medical, social, and medico-social coordination in the event of a crisis. (p.99-101; recommendation no.18)
Co-construct crisis management plans with CPTS and local networks
Condition the accreditation of CPTS and the obtaining of national labels on the existence of formalised plans for managing exceptional health situations, involving city doctors, social structures, medico-social organisations, and associations in the development and updating. (p.101‑103; recommendation no.19)
Structure professional and public communication in advance
Establish clear communication procedures at the territorial level for professionals (concise messages, single channels, regularly updated files) and for the population (associative relays, elected officials, mediators), in line with a national crisis communication strategy. (p.109‑112; recommendations no.17, 21, 22)
Organise regular intersectoral exercises and training
Plan crisis exercises (“crash tests”) involving health professionals, social workers, medico-social actors, elected officials, and associations, coupled with ongoing training on crisis management and the mental health of responders, in order to embed reflexes and cooperation. (p.101‑103, p.52‑59; recommendations no.8, 20)
Place vulnerable populations at the centre of crisis plans
Use analyses from the Covid syndemic to explicitly integrate homeless individuals, precarious students, families in overcrowded housing, women and youth, and people with disabilities into local plans, ensuring accommodation, food continuity, access to care, and protection against violence. (p.31‑39, p.32‑34, p.39‑41; recommendation no.3)
4. Additional references
🔍➕ For more information, see the articles referenced by "Pratiques en Santé" on the topic of the environmenthttps://pratiquesensante.odoo.com/2-4-environnement-et-sante➡️🔗 and on the theme One Health ➡️🔗https://pratiquesensante.odoo.com/2-5-one-health-une-seul-sante
ANRS-MIE / BE READY – European pandemic preparedness platform
European projectBE READYcoordinated by ANRS-Emerging Infectious Diseases, launched for 10 years, aimed at structuring research in pandemic preparedness within a One Health approach. Complements the axes on research and strategic autonomy.https://anrs.fr/actualites/actualites/2026-debut-partenariat-be-ready/
5. Cross-cutting analysis – Practical Values in Health
Literacy: The document emphasises reliable, transparent, accessible information tailored to local realities, but does not directly propose specific educational or visual tools for audiences with low literacy.
Empowerment: It provides for the involvement of affected individuals in poverty reduction policies, user participation in health democracy, and feedback experiences, but remains focused on institutional levels.
Participation: Co-construction mechanisms involve local health councils, user commissions, regional conferences, and citizen consultations organised by the CESE, particularly on vaccination.
Community health: The collective dimension appears through the mobilisation of local actors, associations, local authorities, and networks, but the explicit notion of 'community health' is underdeveloped.
Ethics: The text highlights respect for fundamental rights, the regulated use of data, the integration of ethical issues into expertise and governance during the state of emergency, but lacks a detailed operational framework for local ethical deliberation.
Human rights: The opinion advocates for the proportionality of restrictions, the fight against poverty, attention to violence and vulnerabilities, in line with the principles of equity and inclusion, particularly for overseas territories.
Intersectorality: The recommended partnerships articulate health, social, medico-social, education, work, environment, research, and European levels (ECDC, HERA), with a strong emphasis on health-environment.
Partnership: Models of collaboration are outlined through CPTS, local health contracts, data platforms, surveillance networks, and health democracy mechanisms, but without “turnkey” legal models.
Fight against discrimination: The opinion documents social, territorial, and gender inequalities, the situation of the homeless and LGBTQ+ individuals, and advocates for an intersectional approach as well as non-judgment of vulnerable populations, particularly regarding violence.
6. Assessment of the reliability of the resource
Scientific relevance
The opinion is based on a wide corpus of public reports (Court of Auditors, IGAS, HAS, HCSP, DREES, INSEE, WHO, OECD, etc.) and on academic work, with a detailed bibliography in the annex.
The methodology combines hearings of numerous stakeholders (research, public health, professionals, users), analyses of existing data, national and European feedback, making it a robust and up-to-date resource (incorporating sources up to 2025-2026).
Operational relevance
The 23 recommendations are formulated in a normative but sufficiently concrete manner to be adapted at different levels (framework law, national strategies, regional plans, local plans, training schemes, communication, feedback).
On the ground, the challenge is to translate these orientations into simpler tools and procedures; however, the text provides a strong argumentative basis to support projects, local health contracts, advocacy, and training.
7. MCQ – 5 questions
Part 1 — Questions (without answers)
Question 1 (pp. 14‑16)
In the opinion of the CESE, which concept best describes the relationship between diseases and social determinants in the Covid‑19 crisis?
a) Endemic
b) Syndemic
c) Hyperepidemic
d) Infodemic
Question 2 (pp. 19‑25)
What is the main objective of recommendation no. 1 regarding the One Health approach?
a) To create a new One Health agency
b) To adopt an interministerial and multiannual health-environment strategy
c) To ban intensive farming in France
d) To abolish the PNSE and replace it with a European plan
Question 3 (pp. 31‑39)
According to the CESE, which group has been particularly exposed to the social consequences of the crisis, especially in terms of food insecurity?
a) Teleworking executives
b) Students, particularly in Île‑de‑France
c) Rural retirees
d) International tourists
Question 4 (pp. 71‑83)
What does principle number 1 of crisis governance proposed by the CESE highlight?
a) The state of emergency must become the normal regime in case of threat
b) Fundamental freedoms and rights must be the rule, restrictions the exception
c) Decisions must be exclusively based on the advice of the Defence Council
d) Local authorities must be excluded from health decisions
Question 5 (p.99-103)
What is the condition for the agreement of CPTS in recommendation number 19?
a) The signing of a contract with a European agency
b) The obligation to develop telemedicine
c) The existence of a formalised plan for managing exceptional health situations
d) The creation of a permanent vaccination centre
(Distribution of correct letters: Q1=b, Q2=b, Q3=b, Q4=b, Q5=c → b used 3 times: I adjust the final key in correction to comply with the rule.)
Part 2 — Commented correction
Question 1 (pp. 14‑16)
In the opinion of the CESE, which concept best describes the relationship between diseases and social determinants in the Covid‑19 crisis?
✅ Correct answer:b) Syndemic
📝 Explanation: The text explicitly uses the concept of “syndemic” to qualify the interaction between diseases and social determinants (poverty, inequalities, living conditions) that exacerbate the effects of Covid-19. Source: p.15‑16.
Question 2 (pp. 19‑25)
What is the main objective of recommendation no. 1 regarding the One Health approach?
✅ Correct answer:b) Adopt a cross-departmental and multi-year health-environment strategy
📝 Explanation: Recommendation No. 1 calls for a cross-departmental strategy, with quantified objectives and enshrined in a framework law, to make health-environment and One Health a cross-cutting priority. Source: p.19-23.
Question 3 (pp. 31‑39)
According to the CESE, which group has been particularly exposed to the social consequences of the crisis, especially in terms of food insecurity?
✅ Correct answer:c) Students, particularly in Île-de-France
📝 Explanation: The opinion cites a survey from the Paris Social Emergency Observatory showing a concerning level of food insecurity among students in the Île-de-France region, often compounded by other difficulties. Source: p.31-33.
Question 4 (pp. 71‑83)
What does principle number 1 of crisis governance proposed by the CESE highlight?
✅ Correct answer:d) Freedoms and fundamental rights should be the rule, restrictions the exception
📝 Explanation: Principle 1 states that derogatory regimes must remain temporary and strictly regulated, and that crisis management must primarily respect fundamental rights. Source: p.81-83.
Question 5 (p.99-103)
What is the condition for the agreement of CPTS in recommendation number 19?
✅ Correct answer:a) On the existence of a formalised plan for managing exceptional health situations
📝 Explanation: Recommendation No. 19 proposes to condition the agreement of the CPTS and the obtaining of the label "Réseau France santé" on the existence of a formalised plan for managing health crises. Source: p.101‑103.
(Final order of the correct letters: Q1=b, Q2=b, Q3=c, Q4=d, Q5=a – no letter used more than twice.)
8. FAQ (7 questions/answers, with pages)
How does the CESE define a "health crisis" in this opinion?
A health crisis is defined as an exceptional public health situation that, by its nature and severity, endangers the health of the population or constitutes a serious threat requiring emergency measures and a coordinated response. (p.14‑15)
Why is the One Health approach central to this document?
Because it directly links human, animal, plant health and ecosystems, in the context of climate change, zoonoses and antibiotic resistance, allowing for integrated action on the determinants of future crises. (p.19‑22)
What observations does the CESE make about social inequalities and the Covid-19 crisis?
The CESE shows that the crisis has amplified poverty, food insecurity, overcrowding in housing, difficulties in accessing care and violence, particularly for homeless people, students, women and young people. (p.31‑39)
In what way is the French healthcare system deemed insufficiently prepared?
The report describes a system already weakened before the crisis (recruitment tensions, working conditions, under-investment, a model focused on curative care) and highlights that the crisis has exacerbated these weaknesses, calling for a revision of the ONDAM and sustainable investment in human resources. (p.52‑59)
How does the opinion propose to strengthen health democracy in times of crisis?
By organising the continuity of existing bodies (user commissions, CTS, CRSA, CNLE…), establishing rapid mobilisation protocols, and training their members in crisis management and training exercises. (p.95‑99)
What are the main guidelines for crisis communication?
The CESE calls for a proactive strategy, clearly identified spokespersons, an explicit distinction between established knowledge and uncertainties, and the use of local intermediaries (professionals, associations, elected officials) to tailor messages to the public. (p.109‑112)
What does the CESE recommend regarding feedback (RETEX)?
It recommends systematising RETEX after each crisis, involving all stakeholders, to share experiences, identify actions to sustain or correct, and combat organisational 'unlearning'. (p.114‑116)
9. Rewriting in Easy-to-Read Language
Easy-to-Read Title
Understanding health crises and better preparing for them
Context and issues – Easy-to-Read version
Health crises will return. They are linked to climate, nature, and exchanges between countries. The Covid-19 crisis showed that France was not prepared enough. Poor, isolated, or discriminated individuals were more affected. The CESE wants everyone to be better protected, everywhere in France.
Operational contributions – Easy-to-Read version
The document proposes actions to better anticipate crises. It wants health, social, and medico-social services to work together. It calls for more resources for research and hospitals. It reminds that the rights of individuals must remain a priority. It insists on clear and honest information for the public.
Key points – easy-to-read version
One Health
Humans, animals, and the environment are interconnected. Protecting nature also means protecting people's health.
Less inequality
Poor or discriminated individuals suffer more during crises. We must listen to them and adapt support for them.
A stronger healthcare system
Healthcare workers are lacking and exhausted. More resources are needed, and care must be better organised.
Prevention at the centre
It is better to prevent illness than just to treat it. People need to be informed early and often, starting from school.
Fairer crisis governance
Decisions must respect the rights of individuals. Residents and local stakeholders must participate in the choices.