L'universalisme proportionné, un outil pour améliorer la santé des minorités LGBTI.

The design of health policies must be guided by the imperative of sex and gender inclusiveness in order to advance the health of all. Classically conceived from the idea of universalism, the French conception of health policies is however often categorical when it comes to questions linked to sex and gender, even though health topics are rarely specificaccount. This article examines this tension in the design of public policies that can improve the health of sexual and gender minorities, between "neutral" or "universal" policies and categorical, "sexed" or "gendered" policies. The report Sex, Gender and Health published by the HAS in 2020 bears this conviction that concerning sex, gender and health, the principle of proportionate universalism is the most suitable for improving the health of all, without prejudice but also without privilege, nor for the general population, nor for the minorities that compose it. The authors question the design of public health policies with regard to sexual and gender minorities, seeking the relation between the preservation of the general interest and special interests. It is therefore a question of using the concepts of "sex" and "gender" as levers for improving the health of all, and not as tools for defining categorical policies.

Collecter des données pour la santé des populations LGBTI : pourquoi, comment, avec qui ?

INTRODUCTION: Data collection and its appropriate exploitation contributes to the detection of differences in needs or health outcomes between different sub-groups of the population. These enable improvements in knowledge, and then treatment and health policies. METHOD: Our study is part of a prospective analysis of the health and social support system. Several issues were defined, linked to sex, gender and health relationships. One of them was "when and how the collection of sexed data about health could contribute to improve population health?". Particular issues were identified regarding LGBTI minorities. A narrative review was conducted, centered on this subject. The authors' own expertise and testimonials from users of the health system were also used. RESULTS: First, the analysis highlighted the lack of available data on the health of LGBTI people, and more broadly the lack of inclusiveness of sexed/gendered data collected from the general population. Then, three work leads were identified: (1) the tension between the benefits and the risks of having data on minorities (at the individual and collective level), (2) particular questions asked by Big data, and (3) the methodological difficulties to solve. For each of these work leads, the authors lay the foundations for a constructive reflection in order to encourage further work. DISCUSSION: Authors invite the actors, in concertation with the involved communities (and perhaps on their own initiative) to enter now into this reflection in order to move it forward and to promote health together.

How to strengthen the presence of patients in health technology assessments conducted by the health authorities.

The constant development of health technologies, combined with the increase in the cost of treatment, means that States must continually make choices about the introduction of new technologies into their healthcare system and how they are to be funded. In France, the systematic participation of patients in these processes is one of the targets to be met in terms of healthcare democracy. Although, on an international level, patient involvement in these assessments is constantly growing, it is difficult to define due to the presence of unstabilised elements in terms of both terminology and assessment methods. As a result, patient and public involvement in health technology assessments varies considerably from one country to the next, from one field to the next and even from one type of technology to the next. Several types of involvement exist, ranging from studies conducted to collect patient "insight" (experience, perception, needs, preferences, attitudes to treatment and health, etc.) to processes aimed at including patients in assessments (as individuals, as representatives of associations, etc.). Given the scope and complexity of the subject, and the difficulty involved in understanding all the different aspects of health technologies and innovations, the members of the Round Table chose to concentrate on health technology assessments (medicinal products and medical devices) to develop national recommendations on all possible types of patient involvement in the health technology assessment processes conducted by the health authorities in France.

[The regionalization of health: an opportunity for health democracy?]. / La régionalisation de la santé : une chance pour la démocratie sanitaire ?

Health democracy in France has consisted in recognizing individual and collective rights attributed to users of the health system and in making decision-making procedures in health more contradictory. However, this movement has encountered a number of obstacles and barriers since the adoption of the law of March 4, 2002. Seven years later, the recent Act of July 21, 2009, aims to renovate a more vigorous health democracy, including restoring regional conferences on health and governance with the autonomous powers that were conferred to them in the 2002 Act. However, nothing is yet secured; vigilance is essential and should remain high on the agenda.

[The pathway approach and the coordination of care]. / Logique de parcours et coordination des soins.

The pathway approach is promoted by health authorities but is still limited by highly technical professional practices and partitioned organisations. Effective coordination requires professionals to put it into practice and the authorities in charge of delivering healthcare to allow it. This evolution must also be combined with closer collaboration with the patient.

[The healthcare democracy]. / La démocratie sanitaire.

Thirteen years after the law of 4th March 2002, known as the "Kouchner law", what is the situation regarding the much talked about healthcare democracy? Individual and collective rights have been granted to the users of the health care system. In addition, a series of actions have been promoted in order to exert them. Finally, a number of places and processes favouring consultation have been put in place.

[Telemedicine and patients, for the traceability of data exchanges]. / Télémédecine et patients, pour une traçabilité des echanges de données.

The computerisation of healthcare data in France is protected by a legal framework, which professional practices sometimes overlook. With the arrival of telemedicine, the patient's express consent is required, the purpose and consequences of which need to be explained. While restricting, this consent is essential for the social acceptance of the computerisation of healthcare date, which offers advantages but which also harbours certain dangers.