Daniel Benamouzig

Achieving universal health coverage in France: policy reforms and the challenge of inequalities

Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers and employers organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancets Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France.

Policy Diffusion and Translation: The Case of Health Agencies

After a discussion of the concepts of policy diffusion, policy transfer and policy convergence, we put forward the analytical potential of the translation framework combining three dimensions: the discursive dimension, the actor’s dimension and the institutional dimension. With the case of the shaping of evidence-based bureaucracies using quality evaluation and cost benefit analysis in three western European healthcare systems (uk, France and Germany), we give an example of how this framework can be operationalized and explain why it enables to understand divergent convergence processes.

A Sociological Checklist for Assessing Environmental Health Risks

The contribution of social sciences to risk assessment has often been confined to dimensions of risk perception and communication. This article relates an effort to promote knowledge from the social sciences that addresses other dimensions of risk issues. A sociological checklist produced for ANSES in France helps to identify and analyse social dimensions that should be given attention during the process of risk assessment.

Science réglementaire en santé publique : de quoi parle-t-on ?

Cet article porte un eclairage sur un concept peu connu des acteurs de la sante publique en Franceu2008: la science reglementaire ou regulatory science, utilise pour decrire l’ensemble des activites scientifiques servant a produire les connaissances mobilisees pour appuyer, developper ou adapter les decisions en matiere de politiques publiques. Il s’agit de comprendre comment l’expression apparue au milieu des annees quatre-vingt et formalisee en un concept sociologique sous la plume de l’americaine Sheila Jasasnoff en 1990, s’est progressivement imposee au sein des agences de regulation americaines, japonaises puis europeennes comme une nouvelle discipline scientifique.L’article examine l’evolution du concept et les differentes approches proposees pour definir la science reglementaire. Il met en evidence sa nature hybride et heterogene soulignant ainsi les differentes caracteristiques que l’expression recouvre suivant l’institution qui la formule (FDA, EMA, PMDA) et le champ d’application qu’elle couvre.En s’appuyant sur des exemples concrets d’application des pratiques de science reglementaire dans trois grands domaines du risque sanitaire (la toxicologie environnementale, les maladies infectieuses et la pharmacovigilance), l’article interroge surtout la place de la recherche dans le processus de decision en montrant comment l’apparition de nouvelles methodes destinees a renforcer la capacite des regulateurs a exercer des fonctions de surveillance, de controle ou de reglementation, et le role des communautes academiques associees a cette demarche, contribuent au renforcement des politiques de sante publique en France, comme a l’echelle mondiale.This article sheds light on a concept little known to public health actors in France: regulatory science, used to describe the range of scientific activities used to produce the knowledge mobilized to support, develop or adapt public policy decisions. The objective is to understand how the expression appeared in the mid-1980s and was formalized into a sociological concept by the American writer Sheila Jasanoff in 1990, and has gradually imposed itself in American, Japanese and European regulatory agencies as a new scientific discipline. The article examines the evolution of the concept and the various approaches proposed to define regulatory science. It highlights its hybrid and heterogeneous nature, underlining the different characteristics that the expression covers according to the institution which formulates it (FDA, EMA, PMDA) and the scope of application that it covers. Based on concrete examples of the application of regulatory science practices in three broad areas of health risk, the paper focuses on the role of research in the decision-making process by showing how the emergence of new methods designed to strengthen the regulatory capacities of regulators and the role of academic communities associated with this approach, contribute to the strengthening of public health policies in France and worldwide.

Dessine-moi un périmètre de soins

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