[Health and politics in France]

Health is a dual notion. It is individual, singular and intimate. It is also collective, statistical and political. The modern problematic of health relies upon a balance of complex relations between individual and collective acceptances of the notion. You can try to outline the evolutions and the main concepts through a quadruple approach: health and politics, health and its professionals, health and society and in the end, health and the State. The relationships between health and politics in France are affected by the historical delay of France in public health, namely because of a structural weakness of the administrative organization of public health. Nevertheless France developed a dense and well organized care system and a universal social protection against the disease. The creation of the health professions in France was marked by a historical opposition between the doctors and the state which led to a failure of hygienist medicine and a fundamental misunderstanding on health insurance. Medical domination led to the organization of a system based on professional dichotomy and the delegation of the regulation skills to the health care professionals. The role of health issues in the French society was deeply renewed by the development of the medical and epidemiological knowledge. This resulted in a new political responsibility in the management of health risks but also in the confirmation of the patients' rights and the role of their associations in the health systems operations and the piloting of public policies. In this environment, the state has recently and progressively confirmed its dominating role in the health sector. A public hospital service was created In the 60's and 70's, then in the 80's there were recurrent interventions in order to control health spendings and eventually in the 90's health safety devices were set up. More recently, a process of health policies institutionalization confirmed this evolution. In the future, health issues should be regarded as priorities for public actions because of social and humanitarian challenges they represent, but also the new political and bioethical questions they give rise to.