Social and Geographical Healthcare Inequalities in the Greater Paris - Grand Paris -

Questions linked to health rate high among metropolitan issues. The health crisis highlighted the health system’s resilience, but also its fragilities and the enormity of needs on a daily basis. It also revealed existing social and territorial inequalities for those facing illness, which particularly effect the most precarious and those suffering from risk factors (obesity, diabetes, asthma etc.).

Jardin des Grands Explorateurs - Avenue de l’Observatoire, Paris 6th © David Boureau

In order to document these issues a three part study, addressing the social and geographical health inequalities in the Grand Paris Metropolis has been undertaken within the framework of Apur’s 2023 work program.

Couverture - Offre de soins dans le Grand Paris - Volet 1 : Inégalités sociales et territoriales de santé dans le Grand Paris © Apur
Couverture - Recours aux soins et aux dispositifs de prévention - sensibilisation, promotion et prévention - Volet 2 : Inégalités sociales et territoriales de santé dans le Grand Paris © Apur
Couverture - Inégalités sociales et territoriales de santé dans le Grand Paris - vol 3 © Apur


The first part gives consolidated, territorial information about available healthcare provisions in Grand Paris which is analyses on different scales.
The study aims to contribute to the thought process and to accompany the actions of all partners, key players in the field, those involved in healthcare and development, who contribute to improving the healthcare provision and treatment procedures. It provides an overall, updated map of available facilities under different categories: location, density, diversity, accessibility (current and future) and dissemination through the facility and public transport projects underway in Grand Paris. 
Six themes are examined:

  • Hospital facilities
  • Community-based establishments and general practitioners
  • Specialised mental health services and a brief focus on the prevention and fight against addiction
  • Services for women and infants (gynaecology, maternity, child protection) with an additional focus on sexual health prevention
  • Socio-medical services for people with disabilities and the elderly
  • Future prospects for health-care facilities up to 2030, through presenting a number of action levers  and projects.

The illustrative maps shown throughout the study highlight territorial inequalities. They underline the inadequacy of provisions in relation to the needs, which are expected to increase in years to come due to the growth and the ageing of the metropolitan population. Against this backdrop, the study looks back over a certain number of actions which have been carried out to reinforce, rebalance and improve the present services available and opens up a number of avenues to be considered. 

Part two of the study deals with the diminishing use of treatment and preventive schemes available in Grand Paris Metropolis.
The study, based on a statistical and cartographic analysis made in partnership with the French National Health Insurance - Assurance Maladie -,  contributes to characterising the populations and areas in Grand Paris which make the least use of the preventive and healthcare services. It shows that over 7 million members of the metropolitan population are medically insured, 15% of whom have no registered general practitioner. One out of every ten medically insured inhabitant (10.5%) is covered by the Complémentaire Santé Solidaire scheme and less than 2% by State Medical Aide - Aide Médicale d’État -. More than one in ten policyholders in the metropolis have not had medical or dental check-ups for at least two years. Over 17% of the population suffer from a long-term condition.      
The maps show major social inequalities in terms of the use of available schemes, particularly in cancer prevention programmes. The lowest levels of use are among the Metropolis’ lower income municipalities. The last part of the study analyses all the indicators at a neighbourhood level. It compares the results with other demographic and social data, using an ecological approach aimed at characterising areas in which results differ. 

The results show a strong link between a socially disadvantaged situation and less frequent use of healthcare and certain preventive schemes. The availability of health-care seems to play a less important role than social disparities in the dynamic of utilisation.

The third part of the study describes a selection of public health initiatives implemented in Grand Paris.
Promotion and preventive action has and will have an impact on healthcare needs and contributes to the fight against social and territorial healthcare inequalities
A short questionnaire was given to local authorities in Grand Paris and to the Agency’s partners during the summer of 2022.  About forty initiatives were selected and examined in greater depth involving visits and interviews. Based on this information, detailed fact sheets were drawn up for each of the initiatives as well as a cross-referenced analysis being made. They are categorised under three themes : health awareness-raising and promotion, prevention and outreach action, health enhancing urban planning and environmental health.  

These initiatives are found to vary both thematically (maternal and child protection, health in schools, nutrition, organised check-ups, encouraging physical exercise and sports activities, health and sport, sexuel health and education, environmental health, health promoting urban planning and the reduction of environmental risks etc.), their scale (on a metropolitan or smaller scale) and the ways in which they are implemented (health awareness and educational workshops, reports /  check-ups /screening / consultations, outreach schemes, community health-care and health mediation, local strategic documents and action plans, health-enhancing urban planning, recommendations and development operations).

The study contributes to the spread and promotion of these initiatives, it helps to raise awareness of public health issues and encourages wider communication on these challenges.
Add to this panorama ! Local Authorities and those active in Grand Paris, do you have a health-related initiative to share? Don’t hesitate to let us know by filling in the document found via this link.
Your initiative could be included in the next update of this compendium.

These three publications have been the subject of two feedback periods organised in partnership with the Urban Planning School - École Urbaine - and the Health Department of Sciences Po on 18th October and 22nd November 2023.


Documents to download

  • Study

    The healthcare provision in Grand Paris - Part 1: Social and Territorial Healthcare Inequalities in Grand Paris

    Format : pdf, 236 MB
  • Study

    Use of health-care and preventive schemes - awareness-raising, promotion and prevention - Part 2: Social and Territorial Health Inequalities in Grand Paris

    Format : pdf, 36.97 MB
  • Study

    Pubic health-care initiatives: awareness-raising, promotion and prevention - Part 3: Social and Territorial Healthcare Inequalities in Grand Paris

    Format : pdf, 42.14 MB
  • Synthesis

    Social and Territorial Healthcare Inequalities in Grand Paris - Healthcare provision, use of available treatment, and public health schemes

    Format : pdf, 13.31 MB