[Health mediation: A social innovation? Obstacles, formations and needs]. / La médiation en santé : une innovation sociale ? Obstacles, formations et besoins.

Our study focuses on health mediation as an answer to the challenges of reducing social inequalities in health, a key goal of the 2016 Health System Modernization Act. Mediation in health requires that two "Social worlds", the health professions and social action, sometimes distant from one another, meet each other and collaborate. Assuming that training would be a lever to facilitate their collaboration, the aim of the research is to characterize the current offer of training in the sphere of social and health mediation, to identify unmet needs and social innovation proposals that can respond to them. Our methods of investigation are based on a three-fold collection of quantitative and qualitative data: a first-hand literature review, an inventory of trainings in the national territory, focus groups and interviews with mediators and institutions working in this domain. Our results show that a certain number of obstacles tend to keep partitions between the health and social "worlds" including a strong asymmetry of the supply of training to the benefit of the social sector, an unequal territorial distribution and a heterogeneity of their contents. The expressed needs make it possible to advance a certain number of consensual principles related to social innovation to consolidate cooperation between social and health professionals.

A health equity impact assessment umbrella program (AAPRISS) to tackle social inequalities in health: program description.

BACKGROUND: The failure to simultaneously address two objectives (increasing the average health of the population and reducing health inequalities) may have led to what has been observed in France so far: an overall decrease in mortality and increase in inequality. OBJECTIVE: The Apprendre et Agir pour Réduire les Inégalités Sociales de Santé (AAPRISS) methodology is to analyze and modify interventions that are already underway in terms of their potential impact on health inequalities. It relies on partnership between researchers and actors in the health field, as well as policy makers. In this paper, we describe the program and discuss its feasibility and acceptability. METHODS: This program is not a single intervention, but a process aiming at assessing and reshaping existing health programs, therefore acting as a kind of meta-intervention. The program develops scientific and methodological support stemming from co-construction methods aimed at increasing equity within the programs. Stakeholders from prevention policy-making and the health care system, as well as researchers, collaborate in defining interventions, monitoring their progress, and choosing indicators, methods and evaluation procedures. The target population is mainly the population of the greater Toulouse area. The steps of the process are described: (1) establishment of AAPRISS governance and partnerships; (2) inclusion of projects; and (3) the projects' process. DISCUSSION: Many partners have rallied around this program, which has been shown to be feasible and acceptable by partners and health actors. A major challenge is understanding each partner's expectations in terms of temporality of interventions, expected outcomes, assessment methods and indicators. Analyzing the projects has been quite feasible, and some modifications have been implemented in them in order to take inequalities in health into account.

[An intervention research program (AAPRISS) to reduce social inequalities in health: methods and validation]. / Un programme de recherche interventionnelle (AAPRISS) visant à réduire les inégalités sociales de santé : méthodes et validation.

OBJECTIVE: The AAPRISS intervention-research program (Apprendre et Agir Pour Réduire les Inégalités Sociales de Santé) aims to change prevention projects to improve the extent to which they take health inequalities into account. The goal is to assess a project's feasibility and its acceptability, from the viewpoint of the sponsors of the project in question, and to present its tools and potentially-transferable elements. PARTICIPANTS: Five cancer-prevention projects focused on nutrition have been included in the AAPRISS program: two projects conducted in school, one community-health project conducted in a disadvantaged neighbourhood and two hospital therapeutic-education programes. For each one, a workgroup was created bringing together the project sponsors and their team as well as researchers from various disciplines. LOCATION: The study involves projects currently underway in the Midi- Pyrénées region of France. INTERVENTION: AAPRISS is based on the exchange of knowledge among project sponsors and researchers and the co-construction of the analysis, reorientations and the assessment of the prevention projects included in the program. The validation of the program and its feasibility from the project sponsors' point of view is based on a questionnaire and presentations carried out during a symposium that took place in May 2014 in Toulouse. RESULTS: Twelve key program functions have been described. They have been shown to be feasible and acceptable and concrete project modifications towards a better consideration of social inequalities of health (SIH) have been realized in most of the projects. Co-construction among the stakeholders raises many issues and difficulties that could have been overcome by the establishment of a relationship of trust between project sponsors and researchers. CONCLUSION: The complexity of the determinants leading to SIH calls for programs that revisit existing projects rather than a new intervention aimed at reducing them.

[Territorial translation of the National Health and Nutrition Program in Midi-Pyrénées, France]. / La traduction rerritoriale du Programme national nutrition santé (PNNS) en Midi-Pyrénées, France.

Inspired by the Hygienist Movement, which associates good health with regular, moderate exercise, the National Health and Nutrition Program identifies a lack of physical activity as a risk factor for many chronic diseases. As such, the Program encourages people to take care of their bodies by inciting a moral obligation to develop a physically active lifestyle and follow a healthy diet. With the overall goal of improving the health of the population by acting on nutrition, the Program focuses on primary prevention, screening and early treatment of conditions like heart disease, cancer, obesity, osteoporosis and diabetes. As an incentive program developed in keeping with the biopolitical views of the 1970s that saw education as an alternative means to hospitals for achieving good health, the Program is also a good public action tool for controlling costs.