Country Profile

The French welfare state is based on the principle of “national solidarity” - this commitment is declared in the first article of the French Code of Social Security. It is understood as sharing responsibility and pooling risk overall in society. Recently, additional attention has been given to the most vulnerable groups by introducing a guaranteed minimum income. The income inequalities, as measured by Gini coefficient, have now stabilised and are at a level of 0.327 (United Nations Development Programme, 2004).

The public and political debate on the subject of health inequalities in France tends to focus on social exclusion and accesibility to health care services, rather than on the mechanisms involved in the creation of socio-economic inequalities. Linguistically, these two terms (health inequalities and social exclusion) are often interchanged in both public debate and political thought.

Although already for a long time there has been epidemiological research explaining different health outcomes in terms of socio-economic inequality, the major focus was on allowing access to quality care for all. Only since 1998 has there been an established comprehensive programme against social exclusion, which included a section on health. This referred to specific intervention programmes at a regional level (PRAPS) and measures to enable financial accesibility to care (CMU) or physical/psychological obstacles (PASS in hospitals). Please see policy section for further details.

There has also been a process of revitalising “social ghettos”, which are a result of spatial segregation and inhabited mostly by underprivileged social groups. Health promotion has been considered, but there are no defined objectives. Numerous actions were implemented in the areas of addictive behaviour and high-risk activity prevention, sex education, HIV/AIDS prevention, parental support, etc. Through general measures, the aim was to reduce the vulnerability of populations, and through specific health actions, to provide the information and skills which would reduce risk and enable access to prevention and care.

These policies, referred to generally as urban policies, came up against the multiplicity of systems and the administrative skills at the regional level. This situation hindered the construction of global strategies. It complicated procedures and schedules, ultimately harming the global efficacy of these urban policies. Civic organisations played a very important role in recognising exclusion phenomena, unlike traditional social or political agencies which were reluctant to consider increasing poverty as a major problem. Because of their exemplary and innovative actions, civic organisations also became permanent actors in numerous interventions regarding these populations: social emergency services, syringe exchange programmes, free consultations, food parcels etc.

The background information to this entry was collected by the French project partner - Anne Guichard, Delegate for Health Promotion from the French National Institute of Prevention and Health Education (INPES).
The following persons also contributed either by participating in the roundtable discussion or by providing their comments independently:

• France LERT - Director INSERM U687 - Head of a research team on social determinants in health, INSERM U687 (public health and epidemiology of the social and occupational determinants of health)
• Pierre CHAUVIN - INSERM U707 - Head of a research team on social determinants in health and healthcare utilisation, INSERM U707- Head of a research team on social determinants in health and healthcare utilisation, INSERM U707 (AVENIR team: The social determinants of health and utilisation of care.)
• Catherine RICHARD, DIV (Interministerial Delegation for Cities and Urban Development), Social Cohesion Department
• Nathalie SIMONNOT - Manager, Médecins du Monde
• Nicolas PRISSE - DGS (Directorate General for Health) - Sub-Directorate for Health and Society, Office for Population Health, Poverty and Exclusion
• François-Paul DEBIONNE, DRASS Alsace
• Pierre LARCHER, - DGAS (Directorate General For Social Action) - Sub-Division for Policies in Insertion and the Fight against Exclusion, Office for Prevention, Insertion and Access to Rights

Documents and Publications

This section provides the key documents on health inequalities published on a national level in France in the  past decade.

Key Actors

In this section key actors that are in a position to have an impact on health inequalities policies, such as ministries, state agencies, universities and/or independent institutes are listed.

Key Policy Tools

In this section main tools used to implement and monitor national policies in the field of health inequalities are listed.

National database of good practice

Please click here to learn about the databases where you can find a collection of good practices aiming at reducing health inequalities collected in France.

Strategic Initiatives

In the course of Closing the Gap, participating institutes have developed Strategic Initiatives outlining further steps that can realistically be taken to tackle health inequalities.