Since the start of the epidemic, the voice of political and health officials has been abundant.
Yet the prevalence of the epidemic among people with an immigrant background is absent from speeches, spots and official publications.
And this, despite a striking observation: while excess mortality was 8.5% in 2020 compared to 2019, it was “only” 7.7% among people born in France and 14, 9% among those born abroad.
Behind the scenes, health authorities, associations and local elected officials have seen the wave rise.
In the absence of figures, studies were hastily commissioned.
Their results and the signals from the field confirmed their intuition "We will have to put in place specific devices, dedicated to these audiences", it was said, from March 2020, to the ARS Ile-de-France.
Objective: to limit a disaster that cannot be read in the curves, but is already visible in many priority neighborhoods.
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Studies, translations, messages on community radios, telephone canvassing, mobilization of neighborhood associations, targeted screening, training, tailor-made contracts ... A range of projects is gradually emerging, mobilizing dozens of structures, both public and associative .
No figures, but a long experience in the field
Even before the confinement, in February 2020, Luc Ginot, director of public health, at the ARS of Ile-de-France was well aware that in the event of an explosion of the epidemic, the working-class neighborhoods would go also, to be on the front line.
"We have been following health issues for decades in the region, our job is to work with hospitals, but also with associations to reach people who do not go there" specifies the ARS.
In the absence of figures, a study was ordered in March from the Regional Health Observatory (ORS).
Published in May 2020, it outlines a probable link between contamination, dense housing, working-class neighborhoods, co-morbidities and occupational exposure.
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At the same time, acts of stigmatization against the Chinese community are recorded here and there in the region.
The ARS mobilizes a network of around fifteen diaspora associations established in France, as well as a community radio station.
Two watchwords: raise awareness and reassure.
The foundations are laid for a public and health policy adapted to people of foreign origin.
Translate to speak better, meet to listen better
The system is gaining momentum in the heart of summer.
Santé publique France translates its prevention brochures into more than twenty languages: English, Spanish, Romanian, but also Arabic, Dari, Urdu, Bambara, Wolof, Soninke, Somali, Tamil ... “These brochures were distributed in health establishments and with associations that we have identified ”recalls Luc Ginot.
“Some piled up in hospital stocks, others were really useful.
As evidenced by the many returns from associations, pointing to approximations on the form or shortcomings in the substance, quickly corrected ”, we remember at the ARS.
“It's important to have brochures to talk to everyone, but more importantly, they start a dialogue.
It also allowed us to listen, ”notes Luc Ginot.
Prevention poster published by Public Health France for Tamil audiences.
Stanislas de Livonnière
At the end of the summer, over 900 people had been trained to relay messages and actions from health authorities.
Among them, associations, social landlords, building guards, household managers… “I have worked a lot with the Banlieue Santé association, which carries out preventive actions aimed at the most isolated populations, through the translation of health instructions. or even the delivery of hygiene packages ”, testifies the deputy of Val-d'Oise Fiona Lazar, elected from one of the departments most concerned by the excess mortality of people of immigrant origin.
“They also conducted massive test campaigns at the foot of towers, in stations, to reach people on the front line and often immigrants,” continues the elected.
Stéphane Troussel, president of the departmental council of Seine-Saint-Denis, is “not surprised”, either, by the presentation of our figures.
His department is one of those with the largest excess mortality gap between people born in France or elsewhere.
“We must not only strengthen the healthcare offer, but also have differentiated actions according to the territories in order to reach these populations,” he underlines.
However, the prevention messages disseminated by the government and health authorities do not always seem appropriate.
“This kind of communication is not necessarily immediately accessible.
This first and foremost involves proximity, the field, neighborhood players, etc.
It's like vaccination: given the digital divide, it is not enough to go to Doctolib to add slots, you have to adapt to the realities of Seine-Saint-Denis, ”the elected official still slips.
At the national level, Public Health France financially supports several associations: "The Committee for the health of exiles (Comede) was thus able to offer face-to-face or remote consultations with interpreters".
This is the case with other structures "working with populations of sub-Saharan, Asian or Latin American origin".
A partnership has also been established with Africa Radio to broadcast prevention messages on the airwaves and on social networks.
An undeniable impact during the second wave
According to our calculations, the excess mortality in France of people born abroad was 33% during the first wave and 26% during the second.
"A harvest effect has undoubtedly taken place", analyzes Patrick Simon, of the National Institute of Demographic Studies (INED).
"The weakest people were swept away by the first wave, they were no longer there to increase the figures for the second," he explains.
For ARS Ile-de-France, this phenomenon is not enough to explain everything.
"The reduction in winter pathologies, such as influenza or gastrointestinal illness, clearly shows that the messages have passed and that behaviors have been modified" it is argued.
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The map of France will divide in the fall.
The excess mortality of immigrants remains comparable or even higher in spring in the North, the Rhône, the Isère ... but it is falling below that of people born in France in the Ain, Meuse, Nièvre or Jura.
In Paris, between October and December 2020, there are hardly any differences in excess mortality between those born in France or elsewhere.
Awareness-raising, screening ... there has therefore been no lack of fighting in recent months to bring those most excluded from the care process closer together.
Other fronts are added and reinforce what appears in places to be a priority: mental health and vaccination problems, in particular.
A very special injection center has just opened in Bobigny (93).
"It is dedicated to beneficiaries of State Medical Aid (AME), of complementary health solidarity (C2S) or to those who have not taken out their vital card for a while" we detail at the ARS.
Others, smaller, are being deployed in Nanterre (92), Grigny (91), Saint-Maur or Choisy (94) "The objective is to have one system per department".
A bus in Seine-Saint-Denis
Health insurance provides invaluable help to “reach out to these audiences”, they underline.
“In particular, it identifies people who have not signaled to them for more than six months.
It takes eleven phone calls to reserve a slot.
You have to convince.
Thanks to these procedures, more than 1000 vaccination appointments were made per week in Bobigny ”notes the ARS.
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“For this project, we are not specifically targeting people born abroad.
But from the moment we target people who are vulnerable and remote from the healthcare system, we will necessarily help people with an immigrant background, ”specifies the Ile-de-France health authority.
Tuesday February 16, 2021, Seine-Saint-Denis deployed its first itinerant bus, supposed to cross the territory of the department in 21 stages over a month.
The goal?
"Answer all the questions the public has about vaccination and allow the most vulnerable populations who cannot get vaccinated to find a solution", replied Marie Pastor, head of the prevention and health action department at department.
And there is an emergency: as of March 31, 2021, only 8.4% of the inhabitants of Seine-Saint-Denis had been vaccinated, the lowest rate in metropolitan France (12.7% nationally), according to Public Health France .
Yes
vaccine coverage is among the best among people aged 75 or over, it will now be necessary to gradually reach the other categories.