Tackling health inequalities: explaining variations in national health strategies in France, Portugal, and Switzerland

Chloé Bérut |

Dr Chloé Bérut is a postdoctoral researcher in political science (Research program on risk assessment and uncertainties, Sciences Po). Subsidised by EUHealthGov, Chloé participated in the 2022 annual conference of the University Association for Contemporary European Studies (UACES). Below, she summarises the core argument made in her presentation, which addressed the consideration of health inequalities in national health strategies.

During the conference, I presented the results of research conducted in the context of the evaluation of the 2018-2022 French National Health strategy. The study compares the national health strategies of three countries (France, Portugal, and Switzerland). More specifically, it explores to what extent the topic of health inequalities was addressed by these strategies. While France, Portugal, and Switzerland all experience social and geographical health inequalities to a certain extent, the thematic qualitative analysis conducted on their health strategies shows that the way these inequalities are dealt with differs largely. While health inequalities appear to be a topic of importance in the French and the Portuguese strategies, this subject is far less prominent in the Swiss case. To explain these similarities and differences, interviews were conducted with the actors in charge of the writing of the national health strategies and with other relevant policy actors. The results suggest that two interrelated factors may explain the differentiated attention dedicated to this topic in the three countries: the presence of a strong network of academics and experts (an ‘epistemic community’) with a privileged access to decision-makers, and a health system whose principles could accommodate with the idea of health inequalities. While these two elements could be observed in the French and the Portuguese cases, Swiss offered a contrasting picture, in which the ‘individual responsibility’ frame seemed to preclude any greater focus on health inequality issues.