Health mediation refers to the interface between people who are underserved by the healthcare system and the professionals involved in addressing their issues (social workers, healthcare professionals, government agencies, elected officials, etc.). It aims to facilitate access to prevention and care for people with one or more factors of social vulnerability: geographical, family, or social isolation; practices or behaviors that put health at risk; legal or personal situations unfavorable to health; economic or administrative insecurity; lack of knowledge of the French health system; language or technology barriers; low health literacy; or being a victim of discrimination.

It coordinates individual and/or collective actions centered on information, education, and communication (i.e., “Doing with”) and navigating the health system (i.e., “Reaching out” and “Bringing in”), and also includes a mediation component that supports active mobilization, commitment, and collaboration among local stakeholders themselves, as well as between communities and these stakeholders.

Health mediators may or may not come from the population being supported, but they will have gained legitimacy through detailed knowledge of their territory, of the problems faced by the population, and of local stakeholders.

Health mediation serves to strengthen people’s capacities and support them in overcoming obstacles by empowering them to take action regarding their care pathway. It can also help identify unmet social needs and the shortcomings of a system that is not adapted to everyone, and bring these to the attention of institutions and stakeholders so that health programs can be tailored to suit the specific characteristics of these populations. Finally, it enables the development of access schemes (rights, housing, employment, education) and helps to combat inequalities in access to care and prevention, as well as discrimination and social exclusion.

Health mediation is a promising approach in which health mediators play a pivotal role, using their knowledge of the health system to ensure the health rights of people in vulnerable situations.

Health mediation practices take many forms, despite the common ground for intervention that serves as a reference framework within the National Health Authority (HAS, Haute autorité de santé). The approach must integrate various practices in order to adapt to different populations and shifts in the social context. It is an interventional system.² Based on this systemic approach, we have mapped the conditions for the success and feasibility of health mediation within a conceptual framework of interrelationships.

In the first version of the health mediation conceptual framework, the contextual conditions for success and feasibility (i.e., factors external to the mediation intervention that drive it) form the macro-system. These include political and financial commitment, the ability to influence structural and intermediate determinants of health, and the health mediator’s professional security in their work.

The specific conditions for the intervention’s success and feasibility are the principles of otherness, universalism with a holistic vision of health, interfacing functions, and intersectorality within a locally anchored network. Next comes the process of formalizing actions into plans with adequate resources and health mediation schemes that align with the ethical principles of all mediation according to Faget J.³: reaching out/bringing in, doing with, being together, and doing together.

The qualities required of the health mediator include a benevolent, attentive attitude, great mental flexibility, perseverance while remaining true to oneself, a position of trust, non-judgment, and power sharing, and the ability to provide positive feedback, as well as a strong interdependence between the health mediator, local stakeholders, and the community.

The next steps to enable the implementation of health mediation are crucial because health mediation is a cyclical process that combines the transmission of knowledge and empowerment, from the individual to the societal level. These interventions are carried out among people who feel they have limited control over their environment, with the aim of building their capacity to act; mediation must therefore address the structural determinants of health in order to be effective, particularly among those underserved by the health system. Addressing access to rights, access to and maintenance of housing, healthy food, education, and employment are all levers that facilitate the use of care and prevention.

There are still many steps to take to facilitate the implementation of mediation on a large scale. An important step is evaluation, i.e., identifying and funding promising interventions for evaluation, promoting research into evaluations that use effectiveness criteria, and accompanying and supporting research in this area. A second key step is to establish the professional framework for health mediators. Funding and job security for health mediators are crucial to ensuring the recognition and legitimacy of this profession among other professionals in the social and health sectors. A recognized training framework that promotes professionalization and incorporates the effectiveness criteria highlighted in research would lead to greater recognition of the practices and actions carried out by health mediators.

Santé publique France has initiated and supported research on health mediation in collaboration with the University of Bordeaux. A special feature in the journal La Santé en action is available to professionals; it contains numerous contributions from researchers and practitioners sharing their knowledge and experience in this field. The agency also supports and finances initiatives to develop skills and share best practices across the mediator network, such as within the framework of the national health mediation program led by the FNASAT, as well as health mediation evaluations (IKAMBERE project). At the regional level, in June 2022, the Provence-Alpes-Côte d’Azur Regional Health Agency (ARS PACA) decided to support a pilot health mediation project carried out by two associations, Sept and Corhesan, working in the most disadvantaged neighborhoods of Marseille (see box).