The Paradoxical Restructuring of the French Health State

Just as education, health is subject to major changes. The author shows how gradual and incremental changes have steered welfare states away from their path dependencies. Financial deficits and mass unemployment have led French senior civil servants to take a reflexive look back at the options taken in 1945 and to draw their inspiration from abroad for the major French sanitary transformation. Budget cuts in health insurance is inspired by Germany while the establishment in 1992 of the national network of public health bears the mark of the US model which puts epidemiology in the service of public health. However, the ideas of Americanisation or marketisation of public health are misleading. Empirical analyses emphasise that the transnational dissemination of new government knowledge (health economy and management, New Public management, field epidemiology) contributed to the reconstruction in France of the sanitary State through the transformation of the social, academic and state fields. This evolution of the French health policy is combined with new principles of justice based on choice and individual responsibility.