Languedoc-Roussillon, a relatively well-off region on the Mediterranean coast of France, has had some successes in considering the public health impacts of its Structural Fund programmes with regard to inclusion of the disabled and other vulnerable groups. However, regional health authorities report difficulties in understanding and participating in the planning and implementation of Structural Fund programmes, and have indicated that there is room for improvement in terms of communication and early strategic coordination for the 2014 – 2020 period. Furthermore, officials believe there are many health gains implicit in the current programmes which could be better recognised through the monitoring process.

Public health is not given significant consideration under the Languedoc-Roussillon Operational Programmes, as priority is given to economic development and innovation projects. This is line with the EU’s strategic guidelines for Cohesion Policy 2007 – 2013, and also reflects the fact that

the Regional Council has limited competence for health services directly.

France’s national ESF OP adopts a broader approach insofar as it stresses the need to use Structural Funds as a means to protect those social groups that are furthest from the labour market and where barriers might include health risks, social exclusion or disabilities.

Health implications are often considered only implicitlythrough the current indicators and further work may be required to identify the most useful indicator set from the 200-300 indicators used in the four main regional programmes (ERDF, ESF, EFF and EAFRD).

Partnershipsbetween regional planning and regional health authorities are at an early stage and a consideration of best practices from other regions would be very beneficial, and would encourage better communication.

 

 

Background information

Languedoc-Roussillon has a population of 2.5 million inhabitants (2005), which represents an increase of over 1 million inhabitants since 1954.  Two out of three people in Languedoc-Roussillon live less than 30 kilometres from the coast and eight out of ten less than 30 kilometres from the main towns and cities in the region.

The population includes a growing number of foreign nationals, equal to 9% of the region’s population or 205,000 immigrants; the region ranks 4th overall in France in percentage of foreign population. Economic growth is inextricably linked to population dynamics.  The growing population boosts economic development (through increasing consumption, development of construction in particular) but creates new needs (including the need for additional childcare facilities, sanitation, waste etc).

The region has an ageing population of Languedoc-Roussillon which is expected to increase over the next 20 years; the percentage of the population over 75 was 5% in 1990, 9.5% in 1999 and is expected to reach 10.5% in 2015 and 14% in 2030. The proportion of the workforce aged over 50 is projected to rise from 19.5% in 2000 to 24.2% in 2015. This ageing of the population will require upgrading of facilities and equipment, particularly in the health care sectors, but will also open some opportunities for employment and development in areas such as health, personal services, culture, recreation and fitness.

Figure 1: French regions, by Cohesion Policy status, 2007-2013

Source: DG Regional Policy – Inforegio

Table 1: Languedoc Roussillon: the region at-a-glance

Population (inh., 2005)

2.5 m

Surface area (km2)

27 376

GDP per capita in EUR (PPS, 2008)

23,500 

GDP per capita as % of EU 27 (PPS, 2008)

84%

Cohesion Policy status

Regional Competitiveness & Employment

Life expectancy at birth, male (2008)

77.9

Life expectancy at birth, female (2008)

85.1

Sources: Eurostat and Fifth report on economic, social and territorial cohesion

The regional economy relies heavily on traditional sectors related to population growth, including: health and social work (20.8%), public administration (13.6%), the retail trade (9.1%), services to individuals whose hotels and restaurants (8.6%), construction (6.5%). The distribution of employment in these sectors is higher in Languedoc-Roussillon than in the rest of France.

Figure 2: GDP per capita in PPS (EU27 average = 100)

Source: Eurostat; GDP per capita in PPS is Gross Domestic Product in purchasing power standards.

In 2008, life expectancy at birth in Languedoc-Roussillon was 77.9 years for men and 85.1 years for women, which is slightly higher than the EU 27 average of 75.8 (men) and 82 (women).

In terms of overall development, Languedoc-Roussillon scored slightly above the EU average on the EU version of the UN’s Human Development Index (HDI). This index includes healthy life expectancy, household income, and educational attainment levels. Languedoc-Roussillon scored 69.3 out of 100 compared to an average value of 62 for EU regions.


 

Policy and institutional overview

Cohesion Policy

During the 2007-13 period, France will benefit from around €14.3 billion from the total budget of Structural Funds. Of this, €3.2 billion will be allocated for the Convergence objective, €10.3 billion for the Regional Competitiveness and Employment objective, and €860 million for the European Territorial Cooperation objective. There are 36 operational programmes in France. Of these, 31 will be supported by the ERDF and five by the ESF.

The regional Operational Programme (OP) for Languedoc-Roussillon comes under the Regional Competitiveness and Employment objective and has a total budget of about €817 million. It is funded through the European Regional Development Fund (ERDF). Total EU funding for this programme amounts to some €270 million, representing about 1.9% of overall Cohesion Policy funding for France for 2007-2013. France’s national contribution for the Languedoc-Roussillon programme amounts to €547 million and may partly consist of loans granted by the European Investment Bank (EIB) and other loan instruments. The Region of Languedoc-Roussillon is the Managing Authority for the regional ERDF programme; the ESF programme is a national-level programme.

In France there are two important phases which affect the programming process for Structural Fund programmes. In the first phase, the competent national ministries prepare their National Strategic Reference Framework via a top-down process, based on the EU regulations and guidelines.  For the 2007-2013 funding periods, these documents have placed a significant emphasis on innovation and sustainable development.  In the second phase, the Prefectures (national government representatives in the regions) from France’s 22 regions initiate discussions with the regional authorities on the preparation of the regional ERDF investment programmes.

Priorities in the Operational Programme are developed in consultation and on the basis of a SWOT analysis that considers the pre-defined themes identified by the EU and the national government. For the 2007-13 period innovation, competitiveness and sustainable development have been the top-down focus for the EU Cohesion Policy. Funds are earmarked to these priorities, which are based on the EUs overarching strategies of Lisbon and Gothenburg. 

Health sector

Overview of institutions

Regional-level government in France has limited competence in the field of public health. Similar to all 22 regions in France, Languedoc-Roussillon has an Agence du Santé Regionale, (ARS, part of the national government) whose tasks are to: tackle issues which lead to chronic diseases; promote behaviour conducive to reducing childhood obesity; maintain immunisation; prevent addictions (including smoking, alcohol and substance abuse); tackle Alzheimer's; and reduce health risks linked to environmental factors. The ARS in Languedoc-Roussillon is currently consulting on its draft strategy.


Table 2: Healthcare in Languedoc-Roussillon: main figures

€29,654,623  Health budget (2010)

387 Principle primary care centres (PCC) and 1,113 Local PCC.

37 Public hospitals (level I)

16 Transfusion centres

12,113 Healthcare professionals (2008)

Overview of public health policies and objectives

Overall the Region of Languedoc-Roussillon seeks to reduce health inequalities, prevent health problems and educate the population about health care. Whilst health is not compulsory competence for the regional government, it is an important demographic challenge for the region, which recognises the need to act proactively in anticipation of future needs.

The region has five areas of priority action:

1.      The health of young people aged 15 to 25 years with a focus on risk prevention and health education;

2.       The health of senior citizens;

3.       Disabled people: to improve daily life and access to public services

4.       Access to health care for people in all areas

5.      Support to regional hospitals and teaching hospitals

 

 

Health in the Structural Fund programmes

A review of the two Operational Programmes that affect Languedoc-Roussillon – the ERDF programme for the region and the national ESF programme for France - shows that the majority of references to and consideration of health occur in cases where the health sector can be considered a driver for economic development. This includes support for the biomedical and pharmaceutical sectors, and improvement of access to health care services, through information and communication technology (ICT). As the broad programme priorities of innovation, competitiveness and sustainable development were pre-determined at the EU and national levels, the regional programme does not directly consider health as a priority.

Nevertheless, in the ERDF programme, the impact of non-health investments on health gains is given some consideration in the strategic analysis of the region, and in some of the specific investment priorities. Main priorities in the ERDF are rural services, access to ICT infrastructure and the importance of environmental infrastructure in the region.


The ERDF programme also funds many environmental projects that will have an impact on public health. These include cycle routes, trams and electric canal barges and reducing congestion and access of heavy goods vehicles in towns. All have varying effects on longer term public health. The coastal dyke that has been constructed between Montpellier and Sete is a key example.  Funded on the basis of its contribution to the economy and the environment, the dyke is widely used by walkers and cyclists and will have a measurable impact on public health over the next few years.

The ERDF programme contains a number of indicators related to carbon reduction, emission reductions and sustainability.  Projects, beneficiaries and institutions are increasingly being asked to measure their carbon footprint and the benefits have a direct impact on the future of health gains.

The ESF programme, which is managed at the national level and contains provisions for each of the regions, considered occupational work and safety, equal opportunities in access to employment-related initiatives, and integration of disadvantage groups (including the mentally and physically disabled) into the labour market.

Tables 4 and 5 below summarise the key priorities and intervention areas of both OPs, as well as their correlation with the proposed briefing sheet topics. Whenever applicable, the tables also show how health is considered within each priority.

Tables 4 and 5: Overview of Languedoc-Roussillon’s OPs

Operational Programme for the European Regional Development Fund Languedoc-Roussillon

MA: Conseil Régionale du  Languedoc-Roussillon

Total EU allocation: €270 million

Priority Axis

Funds (€)

Percent of total OP

Content of priority

Briefing Sheet topic(s)

Health considerations in the priority

Developing innovation and the knowledge-based economy as factors of growth and competitiveness

110,000,000

42.4%

•foster concerted encouragement of innovation

•SME competitiveness

•use regional research as a basis for encouraging the competitiveness of firms

RTD

Priority is given to research and innovation around the region’s biomedical and pharmaceutical sectors with a growth potential

Reducing the vulnerability of the region, ensuring its appeal and the quality of the environment and curbing greenhouse gas emissions

92,420,027

32.3%

•prevent risks to the population and economic activities

•protect the coastline and restore iconic sites

•promote energy efficiency and the development of renewable energy sources

•help cut greenhouse gas emissions

•preserve the quality of water and aquatic environments

•ensure the sustainable management of water resources

•ensure that species, sites of great natural value and the countryside are protected and properly exploited

Climate change

Energy

Water

Biodiversity

Support to projects to prevent/minimise noise levels, luminous pollution and air pollution. OP recognises the need to promote alternatives to road transport with traffic densities and emissions of air pollutants

 representing a real threat to people in the region. Target values of 25 days per year above 120μg / m³ VOC and / or NOx) are routinely exceeded. Consequently, alternatives to road transport need promotion. The problem of pesticides and nitrates in urban water is also referenced in the priority.

Encourage accessibility (information and communication technologies and infrastructure) and balanced regional development

62,000,000

24.1%

•strengthen ICT networks and infrastructure

•develop innovative uses of information and communication technologies

•promote and develop alternatives to road transport

 

 

Health-related services can be improved off the back of ICT, broadband initiatives that include rural areas.

Technical assistance and strengthening of institutional capacity

6,000,000

1.2%

 

 

 

 

Operational Programme for the European Social Fund – France 

MA: Ministry of Economy, Industry and Employment

Total EU allocation: €156.62 million (share allocated to Languedoc-Roussillon)

Priority Axis

Funds (€)

Percent of total OP

Content of priority

Briefing Sheet topic(s)

Health considerations in the priority

Adaptation of workers and firms to economic change

56,000,000

35.7%

Developing employment and skills

 

Employment

Education and training

 

Index of work-related accidents per 1000 insured workers is associated to the axis.

Access to employment for job seekers

41,000,000


26.1%

Helping people to find jobs and remain in work

Employment

Contribution to equal opportunities in access to employment. The ageing population can present an opportunity for additional employment in the health sector.

Strengthening social cohesion  and fighting discrimination arising from social exclusion


50,500,000


32.24%

Based on specific programmes prepared by the regions

Employment

Social inclusion

 

 

Investing in human capital and Innovative transnational and inter-regional action for employment and social inclusion


700,000


1.6%%

Human resource measures
 

Education and training

Institutional capacity

RTD

Learning from other regions across a range of revenue based activities related to social exclusion, equalities and the integration of disadvantaged and migrant target groups, outreach, mentoring and innovative approaches for the integration of the disabled into the labour market.

Technical assistance

5,620,000

3.58%

 

 

 

 

 

 

Integrating health in the programmes

This section reviews how health issues have been integrated into the planning, implementation and monitoring of the Structural Fund programmes in Languedoc-Roussillon. It is based primarily on interviews with managers and experts in the Structural Funds Managing Authority, the Regional Council’s health department and the central government agency for health in the region. A list of interviews conducted is contained in the References section of this report.

The Regional Council’s health department is not regularly consulted with a view to the integration of health in the programmes, as health is not perceived as a primary objective for the programmes. Currently the ERDF programme is driven by innovation, competitiveness and economic development; these priorities stem from the National Strategic Reference Framework which is in turn based on the Cohesion Policy guidelines and the Lisbon and Gothenburg Agendas.

In general, the health department struggles to mainstream the integration of public health considerations into the Structural Funds planning process and, consequently, into the implementation of projects. One reason for this is a lack of understanding of the overall process, which can prevent health professionals from accessing information on the programme including the sorts of projects which are eligible for funding.

The only priorities readily recognised in the programme for wider public health issues are barriers to employment, (such as social exclusion or disabilities, which can prevent individuals from finding work).  Good contacts cross border between Languedoc-Roussillon and Cataluña have also helped the exchange of best practices on the application of the Structural Funds to the environment and health as drivers for regional development.

Many of the indicators designated for monitoring both the ERDF and ESF programmes in Languedoc-Roussillon are in the fields of environment, sustainability, carbon reduction and social inclusion and have an indirect link to wider public health gains. For the 2014 - 20 period, health officials underlined the importance of progress in this area and that it would be essential to measure the impact of future projects and programmes on health.

Project Example 

Maison de Santé: an innovative rural health and economic development initiative - ERDF support has been awarded to two rural health centres (maisons de santé) where a number of rural services have been set up together. The objective of the centres is to keep health professionals located in clusters at the heart of rural territories. Public health services have benefitted as the funding has supported the project through the provision of next generation broadband that facilitates virtual health services and the transfer of detailed dossiers to big hospital centres in the region or elsewhere in France.  The benefits to public health have been two-fold: 1) To ensure a continued presence of specialist health services alongside other essential economic and social services in rural areas, and 2) to provide a broadband service capable of supporting sophisticated virtual health services normally available to larger urban centres.

Further Needs

While there is an expectation that public health will feature somewhere in Cohesion Policy for 2014 – 2020, it is fully expected that the EU 2020 agenda will drive the planning process through smart, innovative and sustainable development priorities. 

Languedoc-Roussillon has no systematic approach to the integration of public health issues.  Dialogue, explanation and better timing with the programming process, combined with effective publicity and explanations to potential beneficiaries on how eligibility works are key issues for any cross-cutting theme.  The Managing Authority representatives underlined that while formal consultation processes exist, they are somewhat cumbersome and might be better compensated by innovative communication techniques where virtual and timely information can be refined and better targeted to ensure that public health stakeholders are engaged at different levels.

 

 

References

Print sources

Programme Operationnel Competitivité Regionale et Emploi (2007 – 2013) Languedoc-Roussillon, September 2007

http://www.languedoc-roussillon.eu/fonds/doc_fonds/po_feder2007sept18strat.pdf

Programme opérationnel national Fonds social européen France, June 2007

http://www.languedoc-roussillon.eu/fonds/doc_fonds/po_fse2007v18juin2007...

Interviews

Interviews with regional health department

Beatrice Rougy - Directrice de la Santé au Conseil Régional du Languedoc Roussillon

Interviews/coordination with Brussels office
Julie MARAVAL, Directrice, Maison du Languedoc-Roussillon

Interviews with the intermediate body for Structural Funds programmes:

Jean-Philippe BROSSARD, Directeur des Politiques Internationales Européennes et Contractuelles

Conseil Régional Languedoc-Roussillon

Interviews with other regional stakeholders
Didier DURAFFOURG, Secretaire General (President of UDITE) – Mairie de Sete
Nathalie SANSELME, Directrice pour la Communication, Mairie de Sete