[Italy: a national health service with a tumultuous history]. / L'italie: un service sanitaire national a l'histoire tumultueuse.

During the 70's, various political forces succeeded to combine their efforts and launched a health reform. The system based on sickness insurance funds each serving a specific social or occupational group was replaced by a universal system covering all the citizens. During the 80's, the reformist context disappeared, the basic units of the new system (U.S.L.) became extremely politicized, resources subsidized by the State became scarce, the people frustrated. At the beginning of the 90's, a new reform was launched, aimed at raising the management level of the USL (ambulatory care) and the large hospitals. At the same time, more financial and managerial responsibilities were transferred to the regions. During these decades, the Italian reform attempted to implement several foreign models. But a long time was wasted in debates and discussions. When the implementation started, these models became outdated and the authors inspiring the reform disappeared themselves from the stage.

[Social situations and health care of immigrant foreign populations in France over the course of the last 5 decades]. / Situations sociales et besoins de santé des populations étrangères immigrées en France au cours des 5 dernières décennies.

The goal of this study is to define possible characteristics in social and medical needs with immigrant foreigners who arrived in France during the last fifty years; and because of the grave situation, it should be necessary to take appropriate and special action. Except identical needs related to similar social and economic situations shared by french and foreign people, the immigration introduces new risk factors: related to ethnologic expression of the illness and cultural breaking, a special assistance is claimed; ethnopsychiatry is one of many possible solutions.

[The Italian experience: from a national health system to diversified forms of taking charges of patients]. / L'expérience italienne: d'un système sanitaire national à des formes différenciées de prise en charge.

The Italian health system was reorganized in 1978 on the basis of the British NHS. During the 80's, scarcity of resources, organizational bottlenecks and discontent of the consumers have led to various contemplated reforms in view of a better management of the public sector and an enlarged competition of both sectors, public and private. The article unveils the economic rationale of past and on-going developments and underlines some pre-requisites for implementing the reform launched in 1992-1993.

[Multidisciplinarity in public health: the global approach and territorial dimensions]. / Pluridisciplinarité en santé publique: approche globale et dimension territoriale.

The GRES 31 is a small study group which was established in 1982 in Toulouse, France. Its aims are to promote health among underprivileged groups such as gypsies, immigrants from North Africa... in the local communities. The local community is envisaged as an area where the social structure which has become pathogenic (bad work conditions, destruction of human links...) can be reshaped for a healthy life. The approach of GRES 31 is "global": the health problems of an individual cannot be separated from the overall life context of his group. The ethnic culture and collective behaviour of the group is closely related to the demand for care and the health outcome. On such a pre-requisite, the social scientist has to play his role together with the health professionals. The term of "research" (i.e. "social research") is to be supplemented by that of "experiment". Moreover, health promotion cannot merely imply guidance from the outside but primarily participation from inside the local communities. Such an approach is not a novelty: as a matter of fact, the works of the French hygienists in the 19th century paved the way for a pluri-disciplinary perspective in health work. In some circumstances, the "researchers-experimenters" cannot avoid certain conflicts among themselves: for example when an ill child is endangered by the observance of the ethnic traditions of his own group. More generally, efforts to reduce "clinical imperialism", "State interventionism", "local bureaucracy"... could be of light weight when dealing with "macro-problems" such as nuclear risk, AIDS, or health cost containment.