Porcherie Marion, Le Bihan-Youinou Blanche, Pommier Jeanine
Sante Publique. 2018 May-Jun;30(1 Suppl):33-46. doi: 10.3917/spub.184.0033.
This article describes the changing modalities of action designed to address social inequalities in health recommended in France, in the light of WHO and other international guidelines. Content analysis of policy recommendations identified eleven categories of actions and five types of changes as a function of target populations and the resources deployed. Recommendations have evolved from interventions designed to improve access to primary care to interventions on the social determinants of health, from reinforcement of individual capacities to global empowerment, from interventions on target populations to social inclusion of everyone, from promotion of health investments to increased financial regulation, from a favourable public health policies approach to a health approach in all policies.Multiple modalities of action have been proposed in France, but have remained poorly implemented. They have evolved over time, usually in response to international reference texts with a certain time gap. Internationally recommended interventions differ considerably from interventions focussing on individual capacities, while the new public health law in France reintroduced targeted behavioural interventions. These findings raise a number of other questions, especially concerning the way in which research into social inequalities in health influence public decisions and the institutional treatment of health in all policies.
本文根据世界卫生组织(WHO)及其他国际准则,介绍了法国为应对健康方面的社会不平等问题而建议采取的不断变化的行动方式。对政策建议进行的内容分析确定了十一个行动类别以及根据目标人群和所部署资源划分的五种变化类型。建议已从旨在改善初级保健可及性的干预措施,演变为针对健康的社会决定因素的干预措施;从增强个人能力转变为全面赋权;从针对目标人群的干预措施转变为让每个人都融入社会;从促进健康投资转变为加强金融监管;从采取有利的公共卫生政策方法转变为在所有政策中纳入健康方法。法国已提出多种行动方式,但实施情况仍然不佳。它们随着时间推移而演变,通常是在一定时间间隔后响应国际参考文本。国际推荐的干预措施与侧重于个人能力的干预措施有很大不同,而法国新的公共卫生法重新引入了有针对性的行为干预措施。这些发现引发了许多其他问题,特别是关于健康方面社会不平等问题的研究如何影响公共决策以及在所有政策中对健康进行制度性处理的方式。