CEPEL

Thematic cluster 1 - Health

The CEPEL-Santé thematic cluster is a continuation of the "Innovative cluster : Santé" launched during the previous five-year contract, consolidating and broadening its perspectives. It is now based on three lines of research nurtured by a comparative and territorial approach:

  • interdisciplinary (social sciences, biology, immunology, public policy, environmental sciences, information sciences, etc.);
  • cross-sectoral (education, food, environment, etc.);
  • invested in the issue of "health democracy", involving both government players and those involved in the social appropriation of health.

These three lines of research are already supported by project funding (ACTER [Occitanie Region], ArboSUD [I-site Muse], ProAcTA [ANR Franco-German program]. The cluster is also supported by two cross-disciplinary activities:

  • on the one hand, the dynamic teaching of a Master's degree with an existing Master's degree, the Health Master's degree and its SHS (healthcare, humanities and society) course run by the Faculty of Medicine. All the researchers involved in this thematic cluster contribute to the Master's program. The development of a new course entitled "Health policy government: players, instruments, expertise" is scheduled for the start of the 2021 academic year, with the University of Montpellier taking the lead in law and political science/medicine;
  • involvement in the "Humanités médicales" international research network (IRN, formerly GDRI). CEPEL is a founding member of this network and actively contributes to its influence.

Health as an issue of social cohesion

For several decades, numerous American studies have focused on theneighborhood effects of health. While the separation of French neighborhoods is not of the same order as that which prevails in American cities, the hypothesis that the growing social specialization of neighborhoods is reflected in levels and forms of health, which cannot be reduced to the mere availability of care or distance to care, is worth exploring. The question of "neighborhood effects" on health will then appear as an object in its own right, and not just as the result of determinants.

Food and health

Following on from the "Raconter la maladie : Cancer et quartiers précarisés" project carried out in the previous period, which explored the specificity of segregated neighborhoods in terms of overall health production, from 2019 onwards, a comparative approach to health production in urban territories in the Occitanie region will be developed.The ACTER program (Collective food in urban territories: health - sustainability - ethics. Regional funding of €170,000) constitutes the first stone of this program in 2019 and 2020 and aims to explore the ways in which collective food policies are differentiated according to the social composition of territories (three CEPEL tenured researchers are involved in this program: Laurent Visier, Professor of Sociology at the Faculty of Medicine, Geneviève Zoïa, Professor of Anthropology at the Faculty of Education and Gilles Moutot, Senior Lecturer in Philosophy. The research, coordinated by CEPEL, is being carried out in collaboration with a team of educational scientists and a medical/nutritional team, so we are moving from a fixed focus on disadvantaged areas to a comparative approach that we will broaden in the next phase (international comparisons). The choice of school food is intended to take charge of a "day-to-day" policy that potentially affects all age-group populations. Examination of policies at municipal (schools), departmental (middle schools) and regional (high schools) levels should enable us to specify each of these levels of action. Here, we explore the cross-cutting nature of education, health and environmental issues (see below).

Inequalities in access to healthcare

The period ahead should enable us to explore new and emerging issues in the field of public health. Research efforts will focus in particular on the following questions:

  • Socioeconomic determinants of access to healthcare: Grégoire Mercier, PH in public health at Montpellier University Hospital, and 2018-2019 recipient of a Harkness Fellowship at Harvard Medical School (Health Care Policy Department) is working on how to take socioeconomic determinants of healthcare into account in the context of new healthcare financing models. More specific areas of investigation include: (i) the analysis of care pathways using advanced data processing methods; (ii) the development of tools to objectify inequities in access to care; (iii) the evaluation of care coordination and complex interventions designed to improve it.
  • Social innovation and access to medical care: Marc Smyrl understands "social innovation" to mean programs, most often the fruit of public/private partnerships, aimed at targeting specific populations to better ensure their economic and social integration through the use of participatory instruments. A central element of this research project is the attention paid to the translation of ideas and instruments both between sectors (from technological innovation and economic development to social and health policies) and between political and geographical regions (from the European to the local level, or between European and non-European countries). With regard to the latter, Turkey is currently the focus of our comparative research, but this scope is set to expand with the accession of new partners.

Digital health and territorial cohesion: Nicolas Giraudeau (MCU-PH, University of Montpellier) will continue his research into connected health. Since 2012, he has been in charge of the "E-dent" oral telemedicine project for people with limited access to dentists. As an expert in this field, he is in regular contact with local (ARS), national (Ministry of Health) and international (WHO) health authorities, with a view to extending the project to a larger scale.

Health as a social issue

Health risks and crops

Under the aegis of the FHU, CEPEL is responsible for the SHS part of the ArboSUD program ("Le risque arboviral en Camargue et au Burkina Faso : déterminants environnementaux, humains et sociétaux"). Since January 2019, an international cross-disciplinary approach has been developed with infectiology and virology colleagues, focusing on the prevention and management of infectious scourges in southern countries. As part of the WHO's "One World, One Health" multi-sectoral approach, we helped set up the "Chronic Infections" hospital-university federation (FHU) (Muse, CHU, UM, etc.), of which CEPEL is a founding member and one of the nine constituent teams. This program looks at mosquito-borne infection in Camargue and Burkina Faso. From a comparative perspective, we will study the politics of risk construction and risk communication. In particular, we will explore the wider societal determinants of arboviral risk:

  • the level of risk perception, determination of causality, acceptability of diagnostic and treatment approaches. The aim is also to determine how risk perception is disseminated;
  • the determinants of gender, social and cultural capital, and level of urbanization will be given priority in this analysis.

As part of the FHU, we are also collaborating on the One Health International Master's program in Infectious Diseases, due to open in 2020 at the Faculty of Medicine, which will provide a link between the biological aspects of infections and the policies implemented.

Health education

As part of the epidemiological transition from the acute disease regime to the chronic disease paradigm, the majority of health issues today include an educational dimension. The relationship between education and health, in its many forms, is an important area of research. The involvement of G. Zoïa and L. Visier in two research-action programs with the towns of Nîmes (30) and Clichy-sous-bois (93), aimed at redesigning elementary schools in working-class neighborhoods, is a clear indication that health and well-being are central educational values. Here, research is directly associated with school design and construction programs. In particular, it is supported by sociological audio-visual productions. The ACTER program (see above) analyzes the interface between health, education and the environment. We are actively pursuing a policy of recruiting a CNRS researcher in cross-disciplinary health-environment issues, which would enable us to contribute to the coherence of the project and strengthen the team in this field. The emergence of this theme, which is now well documented, means that CEPEL is the recipient of numerous requests for collaboration from Montpellier-based teams, both in the health and environment fields, wishing to add a political dimension to their biological skills in particular. The recruitment of a researcher experienced in the transversality of this type of issue will enable us, at the heart of MUSE's lines of force, to situate the SHS dimension in these complex objects. Such a preoccupation is in line with the prospects opened up by the exchanges already underway between the IRIM (Montpellier Infectious Diseases Research Institute, Nathalie Chazal and Jean-Michel Mesnard), the Alexandre Koyré Center at EHESS (Alexis Zimmer) and the department (Gilles Moutot) on questions concerning new modes of appropriation and collaboration between SHS and biology, which are called for by the way in which, today, concepts and knowledge in immunology, and by the same token all thinking, including political thinking, about "immunity" are being called into question.

Health as a government issue

The OPERA project ("Operationalizing Programmatic Elite Research in America, 1988-2008"), funded by the French National Research Agency (ANR), is a further development of the research effort undertaken in the United States in the fields of defense and health policy. The originality of this research - which involves Farid Boussama, Saïd Darviche and Marc Smyrl at CEPEL - lies in the cross-fertilization of two usually separate approaches to public life: the sociology of actors and the analysis of public policy. The latter, usually focused on institutions and/or instruments, has been enriched by the "programmatic approach", which systematically examines the elites in charge of these policies.The receipt of substantial funding (ANR DGF: Proacta "L'Action Programmatique en Temps d'Austérité. Competition between elites and governance of the healthcare sector in France, Germany, United Kingdom (England), United States (2008-2018)" / (ANR-17-FRAL-0008-01) (DFG BA 1912/3-1) has, since April 2018, laid the foundations for a systematization of the programmatic approach now labelled "Programmatic Action Framework" (hereafterPAF).In the USA, Great Britain, Germany and France over the period 2008 to 2018, ProAcTA proposes to test the following counter-intuitive hypothesis: in our democracies, budgetary austerity has had the effect of creating specialized sectoral elites in the healthcare policy sector who are in favor of maintaining or even strengthening the State's regulatory capacity. Acting as "guardians of state policies", they competed with other elites whose austeritarian rhetoric advocated a reduction in public spending. "Guardians" and "austeritarians" are examples of "programmatic actors" whose characteristics are defined in detail in this research project. On this basis, ProAcTA will test the more general hypothesis that competition for power between programmatic actors generates both an endogenous dynamic of change in policies and a necessary explanation of their content.The research will involve assessing and establishing functional equivalents across national systems, referring to both the composition of elites and their strategies. The aim is to go beyond the usual typology of social protection systems and the distinction between "liberal" and "statist" programs. To this end, we will empirically re-interrogate the presupposition - found among both defenders and opponents of social protection systems - that the various strategies associated with austerity (budget cuts, privatization, outsourcing, etc.) have necessarily reduced the capacity of public power to intervene.The challenge of the PAF is to propose an alternative to current interpretative models in the field of public policy. The centrality of actors distinguishes it from approaches based on institutions or instruments; the organic link between actors and programs marks an important difference from network analysis. Finally, the selection of actors directly involved in program design represents an important complement to agenda-setting studies and advocacy coalition frameworks. While the project focuses on the issue of budgetary constraints and how they are taken into account by healthcare elites in the formulation of health insurance reforms, it nevertheless has the prospect of extending to all issues relating to healthcare system reforms, particularly those concerning the supply of care and public health. As the team has already begun to do, the project is intended to go beyond the question of sectoral reforms, and address the more general question of the role of elites in the transformations affecting political government in Western democracies on both sides of the North Atlantic. With this in mind, existing partnerships with American (OPERA) and English colleagues, augmented by those forged since 2017 with German partners under ProAcTA, should be extended to Canadian researchers.