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Context

The research project ‘Geographical equity and decentralised policies: which statistical indicators and which normative frameworks of interpretation should be used to evaluate public policy aimed at elderly people in need of care? ’ aims to examine geographical equity in the management of care for loss of independence in France.

Recent research highlights the existence of significant differences between departments in many aspects of care provision for older people with reduced independence. The existence of inter-departmental differences is not unexpected. The scope for manoeuvre afforded by the national legislative framework, combined with the ‘lead’ role entrusted to departmental councils, effectively leads them to develop local policy objectives, paving the way for differing outcomes of public policy. Furthermore, the departments face varying external constraints – whether demographic, epidemiological or economic – all of which constitute potential sources of variation in terms of outcomes relating to access to care services. Whilst these geographical differences regularly raise questions in public debate regarding the equity of public policy towards dependent older people, it is nevertheless the case that the underlying standard of equity is rarely made explicit, making it difficult to assess and measure which geographical inequalities would be unacceptable and should therefore be eliminated.

Presentation

In this context, the project has three objectives:

  • to produce a normative framework for analysing geographical inequalities and interpreting them in terms of acceptable and unacceptable inequalities, depending on the standard one sets;
  • to produce enriched databases so as to be able to estimate, for the French context, indicators of geographical inequalities in support for independent living that can be interpreted in terms of inequity;
  • to estimate certain indicators of geographical inequalities in support for independent living.

Research Team

This project is led by the pole Health and autonomy.

Method and Data

  • For the theoretical framework, the researchers adopt a systematic approach consisting of identifying four typical forms of political organisation (total centralisation; weak, strong and total decentralisation) and, for each of these, they will examine the form taken by the criterion of geographical equity, depending on the meaning given to the adjective ‘geographical’ and on the theory of distributive justice applied. They will then be able to identify the geographical equalities to be guaranteed for each principle of equity and the indicators to be calculated to verify whether these equalities are met.
  • To calculate these inequality indicators, the researchers will produce databases combining individual-level data (RI, CARE, VQS) with contextual data providing information on the provision of accessible services and on the characteristics of the departmental policy on support for independent living
  • To estimate the proportion of geographical inequalities that may be considered inequitable, the researchers will employ econometric methods for decomposing income inequalities and multilevel models.

Partners

Institut pour la Recherche en Santé Publique

This research programme is funded by the Institute for Public Health Research (IReSP) through the 2021 ‘Blanc’ call for proposals.

Last modified: July 20, 2026