[Methodological approaches to the evaluation of Local Health Contracts and their capacity to reduce social inequalities in health].

INTRODUCTION

Local health contracts are a promising tool to reduce social and geographical inequalities in health. They are optimally effective when they are designed to mobilize the resources of various sectors to target the essential, upstream determinants of inequalities.

METHODS

We propose a checklist of their capacities to achieve this goal, comprising two parts.

RESULTS

the targets and objectives of each action (what needs to be changed to achieve what long-term results?); and the strategies and modalities of intervention to address the issue of how to act. An example of application to a sample of first-generation contracts in the Ile-de-France region is presented, showing the importance attributed to the health system rather than to the inhabitants' living conditions.

DISCUSSION

The authors discuss the limits of a working tool that does not address either the conditions of implementing actions according to territories or regional governance.