Research on methodologies for evaluation of public policies to correct reduce social inequalities in health – EVALISS

Social inequalities in health have been the subject of research in the humane and social sciences for many years. Interdisciplinary research studies have progressively developed, particularly from 2000 onwards. For two years, the development of knowledge in this field has been followed by its appearance on the political agenda. This is reflected in a recent report by the Haut Conseil de la Santé Publique, the Plan Cancer 2 and the missions of the Agences Régionales de Santé. The rapid emergence of this demand for intervention raises new questions.

The question of social inequalities in health is currently seen in terms of social gradient, with reference to mechanisms that act across the whole of society. Such a conception is in opposition to the conception which was expressed in terms of exclusion, precarity and access to rights, whereas the approach to which we must now respond takes in determining factors that relate to the whole economic and social system, going beyond the healthcare system, and concerns the population as a whole.

The question of policy implementation raises the question of how social inequalities in health are represented. The need also arises to have a theoretical basis; lastly, there is a need for an interdisciplinary approach. In the field of public health, the dominant paradigm is based on the superiority of the randomised trial. In reality, the evaluation of interventions and public policies requires a complex approach, and dictates a more relevant framework for policy analysis and evaluation.

The aim of the research project is to develop a general conceptual framework for evaluating interventions and public policies that aim to reduce social inequalities in health. This project calls upon research teams in several disciplines, in close partnership with local and regional authorities. The principal objective is to produce the best possible level of proof that can be used for setting up public policies.
The project is based on several concrete areas of study that exist in the Midi-Pyrénées region: the AAPRISS project (Agir et Apprendre Pour Réduire les Inégalités Sociales de Santé); the Pyrénées Cathares health contract, a local and regional programme of the ARS Midi-Pyrénées; and lastly the evaluation of the impact of new technologies carried out by the e-Health Centre of Toulouse.

The project that we propose consists of four tasks. Task 1: analysis and theorisation of programmes before an intervention is implemented, with development of an analytical grid for actions of preventive health and health promotion. Task 2: concrete evaluations of the different programmes in order to determine the most appropriate association between the various methods of evaluation proposed and the types of intervention; Task 3: study of the ethical and legal implications of interventions to reduce SIH; and Task 4: production, collection and summarizing of interdisciplinary knowledge and development of a general framework of evaluation.

Several teams are participating in this project: some have skills in health promotion (EHESP, INPES, University of Montréal), health economics (IRDES); teams grouped in Toulouse within IFERISS, have skills in sociology, psychosociology, analysis of public policies, psychology, epidemiology, public health, law and ethics. These research teams work in close collaboration with regional authorities (Mairie de Toulouse et Communauté Urbaine), the Agence Régionale de Santé Midi-Pyrénées, Toulouse University Hospital (CHU de Toulouse), the Association de l’Oncopole, and numerous regional actors in prevention.