Health and politics in France

Discussion
By Didier Tabuteau
English

Health is a dual notion. It is individual, singular, and intimate. It is also collective, statistical, and political. The modern problematic of health relies upon a balance of complex relations between individual and collective acceptances of the notion. One can outline the developments and the main concepts of health through a quadruple approach: health and politics, health and its professionals, health and society and in the end, and health and the state. The relationship between health and politics in France is affected by France’s historic delay over matters of public health, caused by structural weakness in the administrative organization of public health. Nevertheless France developed a dense and well-organized care system and a universal social protection against disease. The creation of the health professions in France was marked by a historical opposition between doctors and the state, which led to a failure of hygienist medicine and a fundamental misunderstanding of health insurance. Medical domination led to the organization of a system based on professional dichotomy and the delegation of regulation skills to health care professionals. The role of health issues in French society was given new life by the development of medical and epidemiological knowledge. This resulted in new political responsibility for the management of health risks, but also in the confirmation of patients’ rights and the role of their associations in the health systems operations and the piloting of public policies. In this environment, the state has recently and progressively confirmed its dominating role in the health sector. A public hospital service was created in the 1960’s and 1970’s. In the 1980’s, there were recurrent interventions in order to control health spending, and eventually, in the 1990’s, health safety systems were set up. More recently, a process of health policy institutionalization reinforced this development. In the future, health issues should be regarded as priorities for public actions because of the social and humanitarian challenges they represent, but also the new political and bioethical questions they give rise to.

Keywords

  • health
  • public health
  • health insurance
  • health safety
  • health professions
  • patients’ rights
  • public service
  • state
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