France

Country profile

The French Republic is a unitary semi-presidential republic in Western Europe with a population of over 65 million inhabitants. France is one of the world's most developed countries, possessing the world's fifth largest economy measured by GDP, the ninth-largest economy measured by purchasing power parity and is Europe's second largest economy by nominal GDP. It is the wealthiest European (and the world's 4th) nation in aggregate household wealth. France enjoys a high standard of living as well as a high public education level, and has also one of the world's highest life expectancies. France has been listed as the world's "best overall health care" provider by the World Health Organization whilst average life expectancy at birth is 77 years for men and 84 years for women, one of the highest of the European Union

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 public and political debate on the subject of health inequalities in France tends to focus on social exclusion and accessibility 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.

Policy responses

The issue of health inequalities has only really appeared on the political agenda in recent years, however it is being afforded increasing attention in debates around the issue.

Policy responses are devised at a national level with priorities and frameworks being established. It is then the responsibility of the Regional Health Agencies to create specific plans within these frameworks that are tailored to their own needs and that explicitly address health inequalities.

An overview of policy responses addressing health inequalities in can be found in our Policy Database.

Good practices

Key actors

Please find below an overview of key actors in France working on health inequality issues:

• Agence Nationale pour la cohésion sociale et l'égalité des chances (ACSE) - National Agency for Social Cohesion and the Equality of Opportunities. The ACSE contributes to actions for people facing difficulties of social or professional integration

• Comité national de santé publique (CNSP) - National Committee for Public Health. The CNSP was created in 2004 to function as a cross government group to improve coordination and information among the main ministries whose policies may have a health impact.

• Conférence nationale de santé - National Health Conference. Acting as a forum for dialogue on health issues, the national conference of health is an advisory authority to the Minister of Health. It allows the actors of the health system to express their points of view on health policies and to communicate requests and expectations of the population. It fosters dialogue between health system users and professionals, other actors and policy makers. The work program of the conference for the period 2011-2014 addresses health inequalities as an overall orientation.

• Haut conseil de la santé publique (HCSP) - High Council for Public Health

• Institut national de prévention et d'éducation pour la santé (INPES) - National Institute for Health Prevention and Education

• Ministère du Travail, de l'Emploi et de la Santé - Ministry of Employment and Health

• Observatoire des inégalités - Observatory on Inequalities

• Société française de santé publique (SFSP) - French Association of Public Health. The SFSP provides various actors within the health system a frame and means for collective reflection based upon the critical analysis of scientific evidence and professional practices. It formulates propositions to assist decision-makers and to inform public opinion regarding the strengths and weaknesses of public health policies. It is strongly involved in addressing social determinants of health and health inequalities.

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Key resources

Please find below an overview of relevant documents addressing health inequality issues in France. Further publications can be found in our Publications Database.

• Éléments de réflexion pour une politique de santé 2011 - 2025 (2011).  Position Paper for a health politics 2011 – 2025

• Réduire les inégalités sociales de santé (2010) - Reducing social inequalities of health.

• National Strategy Report on Social Protection and Social Inclusion 2008-2011 (2008)
  

Are you aware of any other key resources that should be added to this list?
Please let us know!