[Rethinking aging, autonomy and disability in France: A University-driven, territory-based, and prevention-oriented transformation of the health system - Position of the French Conference of Deans of Medical Faculties].

Abstract

Population ageing, the increasing burden of chronic diseases, and the growing prevalence of disability are major challenges for the French health system. These trends expose the limitations of a model that remains largely organized around disease and dependency, with fragmented coordination between healthcare, social care, and community services. This fragmentation results in disrupted care pathways, delayed identification of functional decline, territorial inequalities, and an increasing burden on patients, caregivers, and health professionals. This position paper presents the vision of the French Conference of Deans of Medical Schools for transforming the French health system through a paradigm shift: moving from the late management of dependency towards the preservation, maintenance, and restoration of functioning throughout the life course. This approach is consistent with the World Health Organization's framework on Healthy Ageing, the International Classification of Functioning, Disability and Health, and the Rehabilitation 2030 initiative. It places functioning, autonomy, participation, and environmental factors at the core of health policy and healthcare organization. Three strategic priorities are proposed: developing integrated territorial organizations to support autonomy; making the prevention of functional decline and the preservation of functioning the foundation of the health system; and strengthening the attractiveness, education, and career pathways of professionals working in the fields of autonomy, geriatrics, physical and rehabilitation medicine, rehabilitation professions, and long-term care. Drawing on their missions in education, research, healthcare, and regional engagement, universities should play a pivotal role in supporting this transformation. Establishing a national academic plan for ageing, autonomy, functioning, and rehabilitation would provide a coherent framework to coordinate existing initiatives, strengthen education, translational and health services research, and support the sustainable transformation of the French health system to better address the challenges of ageing, disability, and loss of autonomy.