HEADS is designed as a lever for an integrative dynamic, which will contribute to Bordeaux’s influence as an innovative health cluster. HEADS is conceived as a program that aims to create interfaces, discussion spaces between academic disciplines, and between academic disciplines and professional actors in health.
Taking strength from the University of Bordeaux’s specialists in various academic domains and areas of expertise, breaking barriers between health and social sciences, we seek to generate and promote research excellence characterized by a new way of approaching research objects and questions. Thus HEADS is to meet two watchwords: transversality and internationalization in research and training regarding health.
A focus on the social determinants of health
Health problems and policies constitute the core set of issues tackled by this program, the emphasis being placed upon the social aspects of health.
This means referring to pathogenic factors (biological, environmental, socio-economic, etc.). It is also referring to the different social fields that are involved in the definition and implementation of therapies, not only the health system, which according to WHO definition, "includes all organizations, institutions and resources whose purpose is to improve health" but all researchers, practitioners, industrialists involved in translational processes.
This perspective is fruitful because it allows to produce data and interpretationson the effects of individuals’ social characteristics (such as age, sex, or wealth) upon their health, but also study the impact social organisation or beliefs, upon individuals and their behaviour.
A holistic approach to decision-making
Our perspective also entails a holistic approach to health decision-making, at different scales, from the individual level to the one of non-governmental organisations, and from the cradle to the grave.
Within any society, decisions pertaining to health are constantly being made at a wide range of scales. Individuals make health decisions whenever they eat, drink or exercise. Doctors decide, individually but also in hospitals or even as a profession, what a pathology is, who suffers from it and how it should be treated. Administrators of health service providers decide who should have access to this treatment. Ministers and civil servants working for health ministries decide what the public purse will or will not pay for. If the list of what constitutes a health decision is endless, there are nevertheless major analytical advantages in studying them systematically.
We assume that one cannot fully understand any decision if one focuses purely upon its announcement, at the D moment. Treating a decision as an identifiable event –the D moment – is of course a frequent feature of everyday speech. But when transposed to research, we must look at all the processes that have occurred before the D moment, as well as those that happen thereafter during its implementation.
Thus, approaches to decision-making must focus upon three major aspects:
- problems definition: why an issue related to people’s health is thought of (or not) as a collective problem that should be dealt with by society and its political system? What values, what standards, what institutions are involved and mobilised in this process?
- instrumentation: what are the measures adopted for dealing with the problem that has been defined? Or in other words, what instruments are used to solve the problem? These can range from subsidies for cleaning water supplies to the categories used to measure the incidence of obesity. Questions related to their cost and legality have of course to be addressed.
- legitimation: within any society, problems and instruments are not just the consequence of technical debates or utilitarian calculation: symbols and emotions – ie values – also have a major impact, because they provide institutions and decision-makers with justifications and entails social acceptance of public policies. So what are the processes of explanation and justification that make a policy legitimate for populations?
In short, framing decision-making in this way leads research to encompass the whole process. In so doing, it also encourages the production of new data about the range of actors –eg. biological scientists, physicians, economists, public authorities, etc.- who participate in problematization, instrumentation and legitimation.
Our thematic framework
- Changing population health: how have the social, economic and political changes of the last few decades modified the way individuals decide about their health? Meanwhile, how have changes in health systems impacted upon the health of individuals (i.e. presence of risk factors, pre-clinical disease, psychosocial burden, biological marker of health, etc.) and the decisions they take?
- Evolving health systems: how have these legitimized sets of problems, and instruments adapted to external and externally imposed changes (be they local, national or global)? How have actors within each system made decisions regarding the financial or legal dimensions of these challenges?
- Regulating health technology and service providers: how has the interface between public and private bodies been managed in each polity? How has the development of longstanding technologies such as medicines, but also newer ones (e.g. interventional radiology), been encouraged and controlled?
- Communicating over health: how has this been undertaken and channelled during debates to formulate public problems and instruments? What publicity has been given to research results and evaluations regarding population health? What impact does health communication have on societal initiatives?