CEPEL

Thematic area No. 1 – Health

The CEPEL-Health thematic cluster is a continuation of the "Innovative Cluster: Health" launched during the previous five-year contract, consolidating and broadening its scope. It is now based on three lines of research informed by a comparative and territorialized approach that aims to:

  • 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 actors 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 thematic cluster is also backed by two cross-disciplinary activities:

  • On the one hand, the momentum of master's degree teaching with an existing master's degree, the master's degree in Health and its SHS (humanities and society) course offered by the Faculty of Medicine. All researchers involved in this thematic cluster contribute to the master's program. The development of a new track, "The Governance of Health Policies: Actors, Instruments, Expertise," is to be implemented for the start of the 2021 academic year, with a focus on law and political science/medicine at the University of Montpellier.
  • On the other hand, 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 of health. While the segregation of French neighborhoods is not on the same scale as that found in American cities, it is worth considering the hypothesis that the growing social specialization of neighborhoods is reflected in health levels and patterns that cannot be reduced solely to the availability of healthcare or distance to healthcare facilities. The question of "neighborhood effects" on health will therefore appear as a subject in its own right and not merely as the result of other determinants.

Food and health

Following on from the previous project, "Raconter la maladie : Cancer et quartiers précarisés" (Talking about illness: Cancer and disadvantaged neighborhoods), which explored the specific characteristics of segregated neighborhoods in terms of overall health outcomes, a comparative approach to health outcomes in urban areas in the Occitanie region will be developed starting in 2019.The ACTER program (Collective Food Supply in Urban Areas: Health – Sustainability – Ethics. Regional funding of €170,000) is the cornerstone of this program in 2019 and 2020 and aims to explore the ways in which collective food policies differ according to the social composition of the areas (Three CEPEL 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 education scientists and a team of medicine/nutrition specialists.We are therefore moving from a fixed 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 an "everyday" policy that potentially affects all populations of a given age group. The examination of policies at the municipal (elementary schools), departmental (middle schools), and regional (high schools) levels should make it possible to specify each of these levels of action. Through this policy, we are exploring the cross-cutting nature of education, health, and environmental issues (see below).

Inequalities in access to healthcare

The coming period should provide an opportunity to explore new emerging issues in the field of public health. Research efforts will focus in particular on the following questions:

  • The socioeconomic determinants of access to healthcare: Grégoire Mercier, a public health physician at Montpellier University Hospital, who received a Harkness Fellowship at Harvard Medical School (Health Care Policy Department) in 2018-2019, is working on incorporating socioeconomic determinants of health into new healthcare financing models. The specific topics of his research include: (i) analyzing care pathways using advanced data processing methods; (ii) developing tools to objectively measure inequalities in access to care; (iii) evaluating the coordination of care and complex interventions designed to improve it.
  • Social innovation and access to healthcare: Marc Smyrl defines "social innovation" as programs, most often the result of public/private partnerships, that aim to target specific populations in order 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 translating 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 level to the local level, or between European and non-European countries). On this last point, Turkey is currently the main focus of our comparative studies, but this scope is set to expand with the addition of new partners.

Digital health and territorial cohesion: Nicolas Giraudeau (MCU-PH, University of Montpellier) will continue his research on connected health. Since 2012, he has been leading the "E-dent" oral telemedicine project for people with limited access to dental surgeons. In this capacity, he is in regular contact, as an expert, with local (ARS), national (Ministry of Health), and international (WHO) health institutions to expand the project on a larger scale.

Health as a socialization issue

Health risks and crops

CEPEL is responsible for the social sciences and humanities component, under the auspices of the FHU, of the ArboSUD program ("Arboviral risk in Camargue and Burkina Faso: environmental, human, and societal determinants"). Since January 2019, an international cross-disciplinary approach has been developed with colleagues in infectious diseases and virology, focusing on the prevention and management of infectious diseases in southern countries. This approach is part of the WHO's multisectoral "One World, One Health" initiative.In this context, we have participated in the creation of the university hospital federation (FHU) "Chronic Infections" (Muse, CHU, UM, etc.), of which CEPEL is a founding member and one of nine constituent teams. This program focuses on mosquito-borne infections in Camargue and Burkina Faso. We will study, from a comparative perspective, the policy of risk construction and communication around it. In particular, we will explore the societal determinants of arboviral risk in the broadest sense:

  • the level of risk perception, determination of causality, acceptability of diagnostic and treatment approaches. It will also be necessary to determine the modes of dissemination of risk perception;
  • The determinants of gender, social and cultural capital, and level of urbanization will be prioritized in this analysis.

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

Health education

As part of the epidemiological transition from acute diseases to chronic diseases, most health issues now have an educational dimension. The multifaceted relationship between education and health is 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) for the overhaul of elementary schools in working-class neighborhoods is in line with the consideration of health and well-being issues as core educational values. Here, research is directly linked to school design and construction programs. It relies in particular on the production of sociological audiovisual materials. In addition, the coordination of the health service by members of the center at the Faculty of Medicine in conjunction with the Faculty of Education can serve as a basis for research programs.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 on cross-cutting health and environment issues, which would enable us to contribute to the coherence of the project and strengthen the team in this area. The emergence of this now well-documented theme has led to CEPEL receiving numerous requests for collaboration from teams in Montpellier, both in the field of health and the environment, who wish to add a political dimension to their biological expertise in particular.Recruiting a researcher experienced in the cross-disciplinary nature of this type of issue will enable us, at the heart of MUSE's main lines of research, to situate the social sciences and humanities dimension within these complex subjects. This concern is in line with the perspectives opened up by the exchanges already underway between 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 related to new modes of appropriation and collaboration between the social sciences and humanities and biology, which are prompted by the way in which concepts and knowledge in immunology, and by extension all thinking, including political thinking, about "immunity" are being called into question today.

Health as a government issue

This research area builds on and further develops, in the field of health policy alone, the research undertaken on the United States in the areas of defense and health with the OPERA project ("Operationalizing Programmatic Elite Research in America, 1988-2008") funded by the ANR.The originality of this research—involving Farid Boussama, Saïd Darviche, and Marc Smyrl at CEPEL—lies in combining two approaches to public life that are usually separate: the sociology of actors and the analysis of public policies. The latter, which usually focuses on institutions and/or instruments, has been enriched by the "programmatic approach" of systematic work on the elites in charge of these policies. Significant funding has been obtained (ANR DGF: Proacta "Programmatic Action in Times of Austerity. Competition between 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 to lay the foundations, since April 2018, for a systematization of the programmatic approach, now known as the "Programmatic Action Framework" (hereinafter PAF).ProAcTA proposes to test the following counterintuitive hypothesis for the United States, Great Britain, Germany, and France over the period 2008 to 2018: 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," they have entered into competition with other elites advocating austerity and a reduction in public spending. "Guardians" and "austerity advocates" 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 policy change and a necessary explanation of their content. The research will consist of evaluating and establishing functional equivalents across national systems, referring both to 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 re-examine the assumption—found among both defenders and opponents of social protection systems—that the various strategies linked to austerity (budget cuts, privatization, outsourcing, etc.) have necessarily reduced the capacity of public authorities to intervene.The challenge for 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 or the advocacy coalition framework.While the project focuses on the issue of budgetary constraints and how they are taken into account by health elites in the formulation of health insurance reform, it nevertheless has the potential to be extended to all issues relating to health system reforms, in particular those concerning healthcare provision and public health. In particular, this project aims to respond, as the team has already begun to do, to the more general question of the role of elites in the transformations affecting policy governance in Western democracies on both sides of the North Atlantic, beyond the issue of sectoral reforms. With this in mind, existing partnerships with American (OPERA) and British colleagues, supplemented by those established since 2017 with German partners under ProAcTA, are expected to be extended to include Canadian researchers.