CEPEL

Thematic Area No. 1 – Health

The CEPEL-Health thematic cluster builds on the “Health Innovation Cluster” 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," involving both government stakeholders and those engaged in the social appropriation of health.

These three research areas 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 structure, which builds on 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. The development of a new track, “Governance of Health Policies: Actors, Instruments, and Expertise,” is to be implemented for the 2021 academic year, with a focus on law and political science/medicine within the University of Montpellier;
  • In addition, 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 neighborhoods in France is not on the same scale as that found in American cities, it is worth considering the hypothesis that the growing social segregation of neighborhoods is reflected in health outcomes and patterns that cannot be reduced solely to the availability of healthcare or distance from healthcare 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 determinants.

Food and Health

Building on the previous project “Telling the Story of Illness: Cancer and Disadvantaged Neighborhoods,” which explored the unique characteristics of segregated neighborhoods in terms of overall health outcomes, a comparative study of health outcomes in urban areas of the Occitanie region will be launched 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 the 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 conducted in collaboration with a team from the educational sciences and a team from medicine/nutrition.We are therefore shifting 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 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 allow us to specify each of these levels of action. Through this policy, we explore 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 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, a public health physician at 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 healthcare financing models. The specific themes of his research include: (i) analyzing care pathways using advanced data processing methods; (ii) developing tools to objectively measure inequities 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—designed to target specific populations with the aim of better ensuring 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 geographical regions (from the European 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 with the addition of new partners.

Digital Health and Regional 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 is in regular contact, as an expert, with health institutions at the local (ARS), national (Ministry of Health), and international (WHO) levels to expand the project on a larger scale.

Health as a Factor in Socialization

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 the 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 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 university hospital federation (FHU) “Chronic Infections” (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 study, from a comparative perspective, the construction of risk and communication surrounding it. In particular, we will explore the societal determinants of arboviral risk in the broadest sense:

  • the level of risk perception, identification of causal factors, and the acceptability of diagnostic and treatment approaches. It will also involve determining how perceptions of risk are disseminated;
  • This analysis will focus on factors related to 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 Faculty 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 an acute disease model to a chronic disease paradigm, most health issues today have 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) for the revitalization of elementary schools in working-class neighborhoods aligns with 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 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 interface between health, education, and the environment. We are actively pursuing a policy to recruit a CNRS researcher on cross-cutting health-environment issues, which would allow us to contribute to the project’s coherence and strengthen the team in this area. The emergence of this now well-documented theme has made CEPEL the recipient of numerous requests for collaboration from Montpellier-based teams, both in the fields of health and the environment, who wish to add a political dimension to their biological expertise in particular.Recruiting a researcher well-versed in the interdisciplinary nature of these issues will allow us, at the heart of MUSE’s core objectives, to situate the social sciences and humanities dimension within these complex subjects. 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 appropriation 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 thinking, regarding “immunity,” are being called into question.

Health as a Government Priority

This research track builds upon and aims to expand, 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 usually kept separate: the sociology of actors and the analysis of public policies. Typically focused on institutions and/or instruments, the latter has been enriched by the “programmatic approach” of systematic work on the elites responsible for these policies. The securing of 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 systematization of the programmatic approach, now labeled the “Programmatic Action Framework” (hereinafter PAF).ProAcTA proposes, with regard to the U.S., the U.K., 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,” they have competed with other elites espousing an austerity-oriented rhetoric that advocates for 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, 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—shared by both advocates of social protection systems and their opponents—that various austerity-related strategies (budget cuts, privatization, outsourcing, etc.) have necessarily reduced the capacity of public authorities to intervene.The aim of the PAF is to propose an alternative to current interpretive 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 health elites account for them in formulating health insurance reform, it nevertheless aims to expand to encompass all issues related to health system reforms, particularly those concerning the supply of care and public health. This project is specifically intended to address—as the team has begun to do—beyond the issue of sectoral reforms, the broader question of the role of elites in the transformations affecting policy governance in Western democracies on both sides of the North Atlantic. In this context, existing partnerships with American (OPERA) and British colleagues, supplemented by those established since 2017 with German partners under the ProAcTA initiative, are expected to expand to include Canadian researchers.