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Social and Regional Health Inequalities

Health inequalities affect the entire population across the country and across the social spectrum, and can emerge at a very young age. Measures that promote equal opportunities for everyone—including vulnerable populations—could help prevent them.

Our missions

  • To measure social and regional inequalities and their impact on health and the underlying mechanisms, in collaboration with researchers in this field

  • Documenting the social determinants that influence the health status of the population

  • Identify tools and levers for action to guide public policies and initiatives toward greater health equity

  • Promote and contribute to the evaluation of effective and promising interventions aimed at reducing health inequalities

What We Do

Social and Regional Health Inequalities: Our Approach

Addressing social and territorial health inequalities (ISTS) is a major priority for Santé publique France. The ISTS program aims to generate knowledge and provide expert advice to inform public policy. This involves, in particular:

  • integrating a population- and territorial-based approach into the design of our studies, which allows us to obtain data on socially disadvantaged populations and to better document social determinants—particularly structural ones—in our surveys and major national studies;

  • promoting access for the entire population to prevention and health promotion through a proportionate universal approach;

  • prioritizing targeted partnerships to better combat health inequalities and develop advocacy for equitable health.

Two populations particularly vulnerable to social health inequalities are taken into account: young children and people in socially vulnerable situations and/or who are geographically distant from health services.

Incorporating social determinants into surveys

Santé publique France incorporates social determinants into its major surveys of the general population, with the support of research partnerships (CERPOP UMR1295, University of Toulouse; INED; IRIS, Campus Condorcet Aubervilliers; EHESS). For example:

  • the systematic collection of data on social status, such as gender, origin, educational level, employment, and resources;

  • the inclusion and development of thematic modules on social inequalities in health in line with the surveys’ objectives (food insecurity, discrimination, social support, health literacy, environment and housing, use of health services).

  • The Santé publique France Barometers: providing insights into the knowledge, attitudes, beliefs, and health practices of the French population. The 2024 edition includes specific modules on ethnic background, food insecurity, and discrimination.

  • The EVANE study on the determinants of the experiences and parenting practices of parents of children aged 0 to 2, conducted in mainland France, includes indicators on working and housing conditions, neighborhood of residence, and social support.

  • The Francim network study on the influence of the social environment on the survival of cancer patients in France.

  • The Albane study (environment, biomonitoring, physical activity, and nutrition) on the influence of social inequalities on physical activity, nutrition, and the health status of the general population, including detailed modules on housing and the housing environment.

  • The Enabee study on indicators of well-being and mental health among children aged 3 to 11, as well as associated factors, from the perspective of social health inequalities, with an overrepresentation of REPs (priority education networks).

  • The Entred study on the characteristics and health status of people with diabetes, as well as the impact of socioeconomic and geographic inequalities on health status and healthcare utilization.

  • The study “Estimation of Morbidity Due to Air Pollution and Its Economic Costs for the Period 2016–2019 - Case studies in mainland France, the Hauts-de-France region, and the Greater Paris metropolitan area” conducted as part of the WHO’s EMAPEC project, in which the quantitative assessment of the health impact of air pollution on morbidity was broken down by groups of municipalities defined according to their level of social deprivation.

  • Body mass index surveys in CE1-CE2 conducted in 2000, 2006, and 2016.

  • The Epifane study on infant feeding during the first year of life in 2012 and 2021.

Certain studies have highlighted the significance of social health inequalities during the pandemic:

  • The Confeado study on the impact of lockdown on children and adolescents.

  • The Prévac study on vaccination coverage and access to COVID-19 vaccination among vulnerable populations.

  • The CoviPrev study on mental health and the adoption of preventive behaviors during the COVID-19 pandemic.

  • The Santé publique France Health Barometers – DROM Section

  • The Unono Wa Maore study on the health status of the population of Mayotte aims to assess the prevalence of major diseases (chronic and infectious) and to describe health behaviors and their determinants among the population of Mayotte.

  • The Nutrimay study, focusing on dietary habits, physical activity, and nutritional status in Mayotte, concentrated particularly on young children under 5 years of age and women of childbearing age.

  • The Kannari2 study on exposure levels to chlordecone and other environmental pollutants among the Caribbean population, with a focus on more vulnerable groups (children and women of childbearing age) and those with higher exposure (agricultural workers, fishermen, and residents of contaminated areas). This study followed the Calbas and Escal studies conducted in 2003–2004 in Guadeloupe and Martinique, respectively, and the first edition of Kannari conducted in 2013–2014.

  • The Entred 3 study—DROM component—on the specific characteristics of diabetes in the DROMs in terms of demographics, health status, and use of health services.

Include socially disadvantaged individuals in initiatives targeting the general population or through targeted initiatives

To change people’s knowledge, attitudes, and behaviors, Santé publique France implements social marketing initiatives, combined with remote support services. The agency also develops websites dedicated to prevention and health promotion, which it continuously updates to meet user expectations. These initiatives are part of a proportionate universalism approach, aimed at tailoring prevention efforts to the specific needs of different populations.

  • The “Moi(s) sans tabac” campaign reaches socioeconomically disadvantaged populations through community-based outreach, a proactive approach, targeted media outreach, and pre- and post-tests that take into account the needs of the target audience.

  • The “Quitting Smoking Is Possible” campaign targets smokers who are most vulnerable socio-economically. It incorporates accessibility (literacy, comprehension, readability) and media targeting, and relies on key strategies to reach disadvantaged individuals. This is complemented by community-based outreach in the workplace and a multichannel approach. To view testimonials from the campaign: Quitting Smoking Is Possible.

  • The “Eat-Move” campaign takes into account the economic and time constraints of its target audiences.

  • The Covid Vaccination campaign was designed in partnership with Africa Radio for French-speaking populations from sub-Saharan Africa living in France to support decision-making by highlighting the choices of opinion leaders.

  • The Onsexprime.fr website, aimed at young people with questions about sexuality and love, is designed to help teenagers approach their sexual lives in a positive and responsible way. It addresses the widespread use of the Internet in sexual socialization among adolescents. The variety of content and tools offered caters to a range of profiles and levels of digital literacy.

  • The website 1000-premiers-jours.fr, aimed at expectant parents and parents of young children, is designed to provide information—in a manner as accessible as possible to the general public—on the influence, during pregnancy, of environmental factors in all their dimensions (chemical, physical, emotional, social, etc.) on their health and that of their child.

  • The manger-bouger.fr website (menu builder) is designed to help people of all ages and at every stage of life eat a varied and balanced diet day by day by offering menu ideas, recipes, and even generating a shopping list.

  • Remote healthcare support services: a vital link in users’ healthcare journey

Santé publique France operates or subsidizes some twenty remote healthcare support services through in-house programs and a policy of subsidizing partner organizations. These programs offer personalized support combining helplines with websites featuring interactive Q&A services, chats, and forums. Through the variety of contact channels made available to the general public, they help break down barriers to accessing health support in various areas: addiction, sexual health, mental health, youth health, and environmental health and air pollution. They offer an alternative to anyone who might feel isolated when facing questions, needing help, or seeking guidance, with a guarantee of free access and confidentiality. These services can play a role in supporting the most socially disadvantaged by providing access to simple, practical information, thereby facilitating their access to care services.

  • In the field of addiction, Santé publique France offers services accessible to all (alcool-info-service.fr, drogues-info-service.fr, tabac-info-service.fr, and joueurs-info-service.fr) aimed at helping individuals directly affected by addiction, as well as their loved ones, in finding information or specialized addiction treatment facilities, and supporting them in their efforts to reduce or stop substance use or excessive gambling. These resources provide universal access to information and appropriate care services and support public health promotion and prevention campaigns, both for the general public and through individualized support.

Evaluating interventions to reduce health inequalities from an early age

In France, the population’s health status is characterized by good health on average, but by particularly marked health inequalities beginning in childhood that persist throughout life (Source: Better Integrating Social Determinants into the Promotion of Children’s Health in France | Caim-info).

Santé publique France evaluates and supports the implementation of interventions aimed at reducing health inequalities starting in early childhood in order to identify and support those that prove effective.

  • Panjo: an early prevention program designed to foster the development of secure attachments between newborns and their parents. It is offered to expectant parents living in adverse psychosocial and economic circumstances.

  • PSFP: The Family and Parenting Support Program is designed for families with children aged 3 to 6 and 6 to 11. Its goal is to strengthen parenting skills and develop children’s psychosocial skills. The program primarily targets families living in priority neighborhoods within the city. It is based on educational techniques, such as role-playing and simulated scenarios.

  • Unplugged: a European universal prevention program against psychoactive substance use in schools that aims to reduce experimentation with and consumption of psychoactive substances (tobacco, alcohol, cannabis) among middle school students aged 11 to 14.

  • ICAPS (Intervention Focused on Physical Activity and Sedentary Behavior) is part of a socio-ecological approach that targets young people in their daily environment and takes into account barriers to physical activity, with the goal of increasing their regular physical activity and preventing excessive weight gain among adolescents. Since 2019, the National Center for Support in Physical Activity Deployment and the Fight Against Sedentary Lifestyles (CNDAPS), an organization accredited by Santé publique France, has been responsible for advocacy, training, and evaluation of Icaps projects at the national level.

  • PRomotion of Nutrition and Physical Activity - Health Inequalities (PRALIMAP-INÈS) is a program showing early evidence of effectiveness in screening for overweight and obesity among adolescents in school settings, linking the intervention to school-based care in coordination with the healthcare system.

Learn more: Effective or Promising Interventions in Health Prevention and Promotion

Promoting participatory population-based approaches and informing advocacy efforts to guide decision-makers

Santé publique France aims to promote health in all settings and seeks to improve its interaction with lawmakers to prioritize health in all public policies. To make advocacy more effective, two strategies have been employed: involving disadvantaged populations in research studies and partnering with organizations that work with vulnerable populations.

Since 2021, disadvantaged groups have participated in certain agency initiatives, and partnerships have been established with organizations representing these groups. For instance, the work conducted with Travellers has facilitated discussions with organizations such as the National Federation of Solidarity Associations for Action with Gypsies and Travellers (Fnasat) and the Interministerial Delegation for Shelter and Access to Housing for the Homeless or Inadequately Housed (Dihal) on the health consequences of the location of reception areas.

In 2023, Santé publique France contributed its expertise to UNICEF’s (United Nations Children’s Fund) advocacy efforts to better address child poverty in public policies (whether in air pollution reduction plans or in housing policies to adapt them to the specific needs of homeless children). This advocacy effort generated significant media attention and helped bring these critical issues to the attention of decision-makers (the National Assembly). Collaboration with these stakeholders—whether at the local, regional, or national level—is a prerequisite for any initiative, as is engagement with service users and organizations dedicated to these issues.

Learn more:

To better address the needs and living conditions of people excluded from the healthcare system and combat health inequalities, Santé publique France relies on three key areas of action:

Understanding health-related information requires a variety of skills, including research, reading, analysis, comparison, and applying that information to daily life. This is referred to as health literacy. It is defined as an individual’s ability to access, understand, evaluate, and use information to take care of their health. The Health Literacy Survey France 2020-2021 estimates that 44% of adults in France do not have sufficient health literacy.

Santé publique France is implementing several initiatives in the area of health literacy, which is considered a potential lever for reducing social health inequalities:

  • Tools designed for audiences who have difficulty accessing information in the “Information Accessible to All” section, and, more generally, consideration of all literacy levels in the development of public communication initiatives.

  • A guide titled “Communicating for All” with recommendations for developing information accessible to all audiences.

  • Participation in the European Health Literacy Survey alongside 16 other European countries. This work is based on a partnership with the research unit “Economic and Social Sciences of Health and Medical Information Processing ” (Sesstim, from Aix-Marseille University, Inserm, and IRD) and the Action Network on Measuring Population and Organizational Health Literacy (M-POHL), under the auspices of the WHO. See the results of the 2020–2021 survey.

  • Support for researchers through the Reflis Network (Francophone Network for Research on Health Literacy).

Health mediation aims to restore equal access to preventive care and treatment for people with one or more factors of social vulnerability. These factors include: geographic, family, or social isolation; health-risk practices or behaviors; a legal and healthcare environment that is detrimental to health; economic or administrative insecurity; lack of familiarity with the French healthcare system; difficulties related to the French language barrier or digital access; low levels of health literacy; and discrimination.

It relies on “health mediators” working in the field, who are close to the most vulnerable populations and serve as local liaisons to facilitate their access to rights, prevention, and care, as well as to raise awareness among healthcare system stakeholders about the barriers these populations face in accessing healthcare.

Learn more about the National Health Mediation Program (PNMS), the practice of health mediation, its regulatory framework, and the requirements for this initiative.

See also:

The goal is to bring together the experiential knowledge of frontline workers and decision-makers with the scientific expertise of researchers in order to collectively develop courses of action. This approach relies on a collective network of stakeholders to precisely identify priority issues, thereby enabling the joint development and implementation of the most effective response. It allows for the creation of strategic recommendations and tools that meet the needs of stakeholders and beneficiaries. This approach also leads to research projects, in partnership with grassroots organizations, to collect data that enables the adaptation of prevention and promotion efforts to socially excluded populations who are not captured by Santé publique France’s surveillance and prevention systems.

During the COVID-19 pandemic, Santé publique France implemented this approach to better address the needs of socially excluded populations, first regarding testing strategies and then vaccination.

Learn more:

  • Combating COVID-19 among highly vulnerable populations in France: knowledge sharing on testing strategies (Santé publique France).

  • Combating COVID-19 among highly vulnerable populations in France: knowledge sharing on vaccination strategies (Santé publique France).

The invisibility of socially excluded individuals has collective (spread) and individual (lack of care) consequences on their health and well-being. To enhance the capabilities and skills of frontline workers serving people in precarious situations, an information initiative was launched through a monthly Q&A newsletter, co-developed by Santé publique France, stakeholders, and decision-makers.

Learn more about the MobCo initiative.