- EUR-LIVE
- eur-live@u-pec.fr
Vulnerability is neither a single health issue nor a simple social problem, but is linked to multiple factors (health, environmental, social, economic, political and cultural). It depends on their interaction at a given time and during life. For a holistic approach in understanding vulnerability, the EUR LIVE benefits from a privileged relationship with health agencies in France and research organizations such as the INSERM and the CNRS.
Vulnerability has emerged as a key concept underlying the UN Sustainable Development Goals (SDGs), whose vision of a just, equitable, tolerant, open, and socially inclusive world in which the needs of the most vulnerable are meet (Resolution UN General Assembly, 2015).[1]
As a concept, vulnerability is a growing concern for decision-makers, academics, and society. One example of the broadened application of vulnerability is the recent attention paid on health system resilience, a new concept “operationalized by health policymakers such as the Expert Group on Health System Performance Assessment, regarding its capacity to adapt to shocks and structural changes (European Commission, Expert Group HSPA report, 2020)[2]
Vulnerability is particularly important in the field of health and well-being. The EU’s Third Health Program (2014-2020) identified (a)n increasingly challenging demographic context, threatening the sustainability of health systems as a key challenge, and correspondingly, increasing the sustainability of health systems as a key objective (For example, the project VulnerABLE: Improving the health of those in isolated and vulnerable situations, European Commission, 2015). [3]
According to the 2015’s WHO report [4], the study of vulnerability involves many parameters, including:
the status of the individual or the group at riskthe individual life trajectoriesthe socio-economic, cultural and geographic context
The ambition of EUR LIVE is therefore to address the vulnerability in its many facets through teaching programs closely linked to research.
Advancing knowledge on vulnerability thus requires dynamic and multidimensional expertise in health, social and environmental sciences to consider health, environmental stressors, and social/economic inequalities through a life-course perspective.
a permanent structure to carry out multi-scale, multidisciplinary research and teaching on vulnerabilitya clear and solid integration in the health sectora continuum between academic research and « real life » to enable innovation and tackle vulnerabilityThe EUR LIVE is built around 3 pillars, each of which has a longstanding and well-known reputation for excellence:
Health and Biology
The UPEC is a leading institution in France in the field of Biomedical and Health Sciences[5], hosts 7 national Reference Centres for rare diseases.
Three main DHU-Départements Hospitalo Universitaires work on topics in which vulnerability is a key issue :[6]
The FHU ADAPT intends to improve the prognosis of severe mental disorders (mood and psychotic disorders, autism spectrum disorders, etc.) and addictions by identifying potential biomarkers of stratification defining homogeneous entities paving the way for precision psychiatry. To develop precision medicine in psychiatry, the FHU ADAPT is building a cluster of medical teams and researchers around the University of Paris-Est-Créteil and the health center of the University of Paris-Saclay in the south of Paris where all cutting-edge technologies are brought together to encourage innovation through industrial partnerships.
The FHU SENEC aims to:
• Decipher the role of cellular senescence among environmental and genetic factors
• Understand the role of cellular senescence in the propagation of the aging process between organs
• Assess the impact of cellular senescence on health trajectories at different stages of life
• Analyze the harmful effects of cellular senescence on tissue repair processes
• Establish the framework for clinical trials to validate interventions targeting aging
The FHU TRUE aims to:
• Create a transdisciplinary hospital structure (Inflasite) to provide care to patients suffering from dysimmune pathology or receiving hematopoietic stem cells or kidney transplantation and treated with innovative therapies.
• Create a consortium of research structures clinical, translational, and fundamental to assess and identify response mechanisms to innovative therapies.
• Support health and research through a hospital immunopathology platform specializing in cross-phenotyping of patients exposed to innovative therapies
Prof. Sophie HUE, MD, PhD
sophie.hue@aphp.frProf. Pascale FANEN, MD, PhD
pascale.fanen@u-pec.fr
Health Economics and Public Health
Vulnerability is a key topic of the Clinical Research Unit in Health Economics (URC-ECO, Pr. Durand- Zaleski) and the ERUDITE team (e.g. Ministry of Health project, project Disability – Pr. Barnay). Both work with the MGEN Public Health foundation and the National Health Insurance Body (CNAM) to study methodological issues (such as measuring and identifying vulnerability and health inequalities) and apply empirical approaches by implementing clinical research, econometrics analyses and medico- economic evaluations (assessment of new technologies) based on panel and cohort data. They also study specific features of vulnerability such as health inequalities (health insurance, income, risky behaviours, care trajectories), bidirectional relationships between health and work, health vulnerability related to old age as well as vulnerability and care provision (comparative perspective on healthcare system, primary care, management, prevention, etc.).
The CEpiA research team (EA 7376, S Bastuji-Garin) focuses on frailty and geriatric clinical epidemiology at the hospital level and in primary care settings. The CEpiA has created new frailty and vulnerability classifications of older patients with cancer, developed new screening tools to select vulnerable patients, built large multicentre interventional clinical studies to prevent morbi-mortality in vulnerable patients (CEpiA Study, EGESOR, IMPROVED). CepiA coordinates an international network to develop an international Geriatric Database and co-coordinates the national platform for research in geriatric oncology.
EpiDermE (EA 7379) works on therapeutic assessment and strategy for chronic inflammatory skin disorders, focusing on vulnerable persons and populations. This research group includes clinical and methodological experts using data (phenotype, co-morbidities and vulnerability, severity of skin diseases) from national academic cohorts (COMPARE, CONSTANCE, PSOBIOTEQ (n>3000), Henri Mondor Clinical Investigation Centre CIC), and has strong collaborations (Cochrane-France, Cochrane skin group, ANSM, CNAMTS-SNDS, European dermato-epidemiology committee). EpiDermE has a convention with the CNMATs-SNDS, allowing direct access to the health insurance database (>60,000,000 French people).
The RESUS+ project (Living Lab and health observatory, Pr. E. Audureau) aims to measure the state of health and quality of life of students and staff and to improve access to care (and care management) for vulnerable populations.
Prof. Florence CANOUI-POITRINE
florence.canoui-poitrine@aphp.frProf. Thomas BARNAY
barnay@u-pec.frProf. Yann Videau
yann.videau@u-pec.fr
Health and Environnement
Air pollution is now recognized as the single largest environmental-health risk factor but the interaction between atmospheres and vulnerable subjects remains poorly understood. The “POLLU-RISK” project gathers complementary expertise (physics, chemistry, engineering, environmental & biological science, developmental biology, psychiatric disorders, cardiovascular & respiratory pathophysiology and bioinformatics) in a “Pollution Service Platform” with the ambition i) to model the health impact of air pollution, ii) to decipher the molecular mechanisms underlying health effects of air pollution, iii) to develop tools for personalized monitoring of vulnerable populations, and finally iv) to interact with industrial companies, policy-makers and health agencies to assess the risks associated with current and future pollution agents in order to improve the protection of vulnerable populations.
The LISA[7] is recognized for its expertise in air quality modelling and for the implementation of numerical predictive approaches to assess pollutant exposure for decision support in environmental policies. As a leading partner of the European atmospheric simulation chamber community (Eurochamp Consortium, EU grant), it is one of the 20 best laboratories in the world to develop exposure protocols to investigate the adverse effects of air pollution on health, thanks to two large high- performance atmospheric simulation chambers. [8]
Prof. Geneviève DERUMEAUX
genevieve.derumeaux@inserm.frProf. Isabelle COLL
isabelle.coll@u-pec.fr[1] https://sdgs.un.org/2030agenda
[2] https://health.ec.europa.eu/system/files/2021-10/2020_resilience_en_0.pdf
[3] https://ec.europa.eu/health/social_determinants/projects/ep_funded_projects_en
[4] WHO Report State of Inequality 2015: https://www.who.int/data/inequality-monitor/publications/report_2015_rmnch
[5] CWTS Leiden 2018 (14th in Europe and 38th worldwide).
[6] All three’s excellence has been recognised by a jury of international experts (HCERES 2017).
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