CEPEL

Thematic Area No. 1 – Health

The CEPEL-Health thematic cluster builds on the “Innovative Cluster: Health” launched during the previous five-year contract, consolidating and expanding its scope. It is now based on three lines of research informed by an approach that is both comparative and region-specific, aiming to:

  • interdisciplinary (social sciences, biology, immunology, public policy, environmental sciences, information sciences, etc.);
  • cross-sectoral (education, food, environment, etc.);
  • committed to addressing the issue of “health democracy,” which involves both government actors and those involved in the social appropriation of health.

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

  • On the one hand, the Master’s program is integrated with an existing Master’s degree—the Master’s in Health and its Social Sciences, Humanities, and Society (SHS) track—administered by the School of Medicine. All researchers involved in this thematic cluster contribute to the Master’s program. A new track, “The Governance of Health Policies: Actors, Instruments, and Expertise,” is to be launched for the 2021 academic year, with the Law and Political Science/Medicine departments at the University of Montpellier serving as the lead departments;
  • On the other hand, its involvement in the international research network (IRN, formerly GDRI) “Medical Humanities.” CEPEL is a founding member of this network and actively contributes to its influence.

Health as a Factor in Social Cohesion

For several decades, numerous American studies have focused onthe neighborhood effects on health. While the segregation of French neighborhoods is not of the same nature as that found in American cities, it is worth considering the hypothesis that the growing social specialization of neighborhoods is reflected in levels and patterns of health that cannot be reduced solely to the availability of health care or distance from health care facilities. The issue of “neighborhood effects” on health will thus emerge as a subject in its own right and not merely as the result of other determinants.

Food and Health

Building on the project “Telling the Story of Illness: Cancer and Disadvantaged Neighborhoods,” carried out during the previous period—which explored the specific characteristics of segregated neighborhoods in terms of overall health outcomes—a comparative approach to health outcomes in urban areas of the Occitanie region will be developed starting in 2019.The ACTER program (Collective Food Services in Urban Areas: Health – Sustainability – Ethics; regional funding of €170,000) serves as the cornerstone of this initiative in 2019 and 2020 and aims to explore how collective food service policies differ based on the social composition of these areas (Three tenured researchers from CEPEL 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, associate professor of philosophy. The research, coordinated by CEPEL, is being conducted in collaboration with a team from the field of education sciences and a team from the fields of medicine and nutrition.We are therefore shifting from a narrow focus on disadvantaged areas to a comparative approach that we will expand in the next phase (international comparisons). The choice of school meals aims to address a “day-to-day” policy that potentially affects all populations within a given age group. An examination of policies at the municipal (elementary schools), departmental (middle schools), and regional (high schools) levels should enable us to specify each of these levels of action. Through this policy, we are exploring the cross-cutting nature of issues related to education, health, and the environment (see below).

Inequalities in Access to Health Care

The coming period should provide an opportunity 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 Health Care: Grégoire Mercier, a public health physician at the Montpellier University Hospital, who received a Harkness Fellowship at Harvard Medical School (Department of Health Care Policy) in 2018–2019, is working on incorporating socioeconomic determinants of health into new health care financing models. The specific areas of his research include: (i) analyzing care pathways using advanced data processing methods; (ii) developing tools to objectively measure inequities in access to care; and (iii) evaluating the coordination of care and complex interventions designed to improve it.
  • Social Innovation and Access to Medical Care: Marc Smyrl defines “social innovation” as programs—most often the result of public-private partnerships—aimed at targeting specific populations to better ensure their economic and social integration through the use of participatory tools. A central element of this research project is the focus on the transfer of ideas and tools both across sectors (from technological innovation and economic development to social and health policies) and across political and geographic regions (from the European level to the local level, or between European and non-European countries). Regarding this last point, Turkey is currently the primary focus of our comparative studies, but this scope is set to expand as new partners join the project.

Digital Health and Territorial Cohesion: Nicolas Giraudeau (MCU-PH, University of Montpellier) will continue his research on connected health. Since 2012, he has led the “E-dent” project, a telemedicine initiative focused on oral health for people who have difficulty accessing dental surgeons. In this capacity, he maintains regular contact—as an expert—with health institutions at the local level (ARS), national level (Ministry of Health), and international level (WHO) to expand the project on a larger scale.

Health as a Factor in Socialization

Health Risks and Crops

CEPEL is responsible for the social and human sciences component—under the auspices of the FHU—of the ArboSUD program (“Arboviral Risk in the Camargue and Burkina Faso: Environmental, Human, and Societal Determinants”). Since January 2019, an international, cross-disciplinary approach has been developed in collaboration with colleagues specializing in infectious diseases and virology, focusing on the prevention and management of infectious diseases in the Global South. This initiative aligns with the WHO’s multisectoral “One Health” framework.In this vein, we have participated in the establishment of the “Chronic Infections” University Hospital Federation (FHU) (Muse, CHU, UM…), of which CEPEL is a founding member and one of the nine constituent teams. This program focuses on mosquito-borne infections in the Camargue and Burkina Faso. We will conduct a comparative study of the construction of risk and the communication surrounding it. In particular, we will explore the societal determinants—in the broadest sense—of arboviral risk:

  • the level of risk perception, the identification of causal factors, and the acceptability of diagnostic and treatment approaches. The study will also seek to determine the ways in which risk perception is disseminated;
  • This analysis will focus on the determinants of gender, social and cultural capital, and the level of urbanization.

As part of the FHU, we are also collaborating on the International One Health Master’s Program in Infectious Diseases, which will launch in 2020 at the School of Medicine and bridges the gap between the biological aspects of infections and the policies implemented.

Health Education

As part of the epidemiological transition marking the shift from a paradigm of acute diseases to one of chronic diseases, the majority of health issues today include an educational dimension. The multifaceted relationships between education and health constitute an important area of research. The involvement of G. Zoïa and L. Visier in two action-research programs with the cities of Nîmes (30) and Clichy-sous-bois (93) aimed at revitalizing elementary schools in working-class neighborhoods reflects the view that health and well-being are central educational values. Here, research is directly linked to programs for the design and construction of school facilities. It relies, in particular, on the production of sociological audiovisual materials. Furthermore, the coordination of health services by members of the research cluster at the Faculty of Medicine, in collaboration with the Faculty of Education, can serve as a foundation for research programs.The ACTER program (see above) analyzes the intersection of health, education, and the environment. We are actively pursuing a policy to recruit a CNRS researcher focused on cross-cutting health-environment issues, which would enable us to ensure the project’s coherence and strengthen the team in this area. The emergence of this now well-documented research area has led to CEPEL receiving numerous requests for collaboration from teams in Montpellier—in both the health and environmental fields—who wish to incorporate a political dimension into their biological expertise, in particular.Recruiting a researcher well-versed in the interdisciplinary nature of these types of issues will enable us, in line with MUSE’s core objectives, to integrate the social sciences and humanities (SSH) dimension into these complex research topics. This focus also aligns with the perspectives opened up by the ongoing exchanges between the IRIM (Montpellier Institute for Infectious Disease Research, Nathalie Chazal and Jean-Michel Mesnard), the Alexandre Koyré Center at EHESS (Alexis Zimmer), and the department (Gilles Moutot) on issues concerning new modes of engagement and collaboration between the social sciences and humanities and biology—modes necessitated by the way in which, today, concepts and knowledge in immunology, and by extension all thinking—including political thought—on “immunity” are being called into question.

Health as a Government Priority

This research track builds upon and aims to further advance—specifically within the field of health policy—the research effort undertaken on the United States in the areas of defense and health through the OPERA project (“Operationalizing Programmatic Elite Research in America, 1988–2008”), funded by the ANR.The originality of this research—which involves Farid Boussama, Saïd Darviche, and Marc Smyrl at CEPEL—lies in combining two approaches to public life that are typically kept separate: the sociology of actors and public policy analysis. While the latter is typically centered on institutions and/or policy instruments, it has been enriched by the “programmatic approach”—a systematic study of the elites responsible for these policies. The project secured significant funding (ANR DGF: Proacta “Programmatic Action in Times of Austerity. Competition Among Elites and Governance of the Health Sector in France, Germany, the United Kingdom (England), and the United States (2008–2018) ” / (ANR-17-FRAL-0008-01) (DFG BA 1912/3-1) has made it possible, since April 2018, to lay the groundwork for a systematized programmatic approach now known as the “Programmatic Action Framework” (hereinafter PAF).ProAcTA proposes, with regard to the United States, the United Kingdom, Germany, and France over the period from 2008 to 2018, to test the following counterintuitive hypothesis: In our democracies, fiscal austerity in the health policy sector has had the effect of creating specialized sectoral elites that favor maintaining or even strengthening the state’s regulatory capacity. Acting as “guardians of state policies,” these elites have competed with other elites—the “austerity advocates”—who promote a reduction in public spending. “Guardians” and “austerity advocates” are examples of “programmatic actors,” whose characteristics are defined in detail in this research project. Building on this, ProAcTA will test the broader hypothesis that competition for power among programmatic actors generates both an endogenous dynamic of policy change and a necessary explanation of policy content. The research will consist of evaluating and identifying functional equivalents across national systems, with reference to both the composition of elites and their strategies. We will seek to move beyond the usual typology of social protection systems and the distinction between “liberal” and “statist” programs. To this end, we will empirically reexamine the assumption—held by both advocates of social protection systems and their opponents—that various austerity-related strategies (budget cuts, privatization, outsourcing, etc.) have necessarily reduced the government’s capacity to intervene.The aim of the PAF is to propose an alternative to current interpretive models in the field of public policy. Its focus on actors distinguishes it from approaches centered on institutions or instruments; the organic link between actors and programs marks a significant difference from network analysis. Finally, the selection of actors directly involved in program design represents an important complement to agenda-setting studies or the advocacy coalition framework.While the project focuses on the issue of budgetary constraints and how health elites take them into account when formulating health insurance reforms, it nevertheless aims to expand to encompass all issues related to health system reforms, particularly those concerning the provision of care and public health. In particular, this project aims to address—as the team has already begun to do—not only the issue of sector-specific reforms but also the broader question of the role of elites in the transformations affecting policy governance in Western democracies on both sides of the North Atlantic. With this in mind, existing partnerships with American (OPERA) and British colleagues—along with those established since 2017 with German partners under the ProAcTA initiative—are expected to expand to include Canadian researchers.