Medical Deserts in France

“87% of France is a medical desert,” declared the Deputy Secretary of the French Department of Health and Prevention in December of 2022. Although medical deserts are currently a hot topic in France, the debate has been going on and off the news for decades. In 1979, Simone Veil, then Secretary of Health, affirmed that there were no more medical deserts in France, justifying a reduction of the numerus clausus (annual cap on the number of medical students). The argument was that too many physicians would inflate health care demand and thus cause rising costs, in the context of a country having publicly funded universal coverage.

Today, with an aging population and a growing prevalence of chronic conditions, and after three decades of cost-control strategies, there seems to be a misalignment between supply and demand of care. Yet, there is still no official definition of what a medical desert is. Under which threshold must action be taken? What is the appropriate rate of physicians per population? How much is too long a distance to see a doctor? When do waiting times for an appointment exceed the reasonable? Are allied professions a valid alternative of GPs for primary care? How realistic is it to refer to deserts in a country that is smaller than Texas?

A comprehensive healthcare reform was launched in 2018 by president Macron. It includes efforts in regional coordination of healthcare providers, medical school admission reform, delegation of medical acts, and access to telemedicine. The reform resulted in a major antagonizing of health professions. Medical students oppose the modification of their curriculum, complain about burn-out and mistreatment. General practitioners are out in the street criticizing the government and asking for better pay. Virtually every national media echoes the diagnostic of a healthcare system in crisis. The medical deserts issue thus turn into a perfect case study to analyze the dynamics of health politics in France.

Bio

Dr. Elisa Chelle is Professor of Political Science at the Department of Law and Government at the University Paris Nanterre, France. She also is an affiliate researcher at Sciences Po and has recently been distinguished fellow of the Institut universitaire de France for a research project on medical education reform. She serves as editor of the academic journal Politique Américaine since 2020. She is currently visiting professor at the CUNY Graduate Center.

Her research covers topics in health politics, inequality, and philanthropy, focusing on policy transfers between the United States and France. She has authored or edited four books, including Comprendre la politique de santé aux États-Unis (2019) – that is the first book ever written in French about the American healthcare system –, as well as 30 articles or book chapters. She appeared or was quoted in multiple national media outlets (France Info, France Culture, France 24, Europe 1, Radio France International, Le Figaro, Le Point…).

Prior to joining the University Paris Nanterre, Elisa Chelle taught at Sciences Po Grenoble, France, Sciences Po Rabat, Morocco, University of Lausanne, Switzerland, and University of Lyon-3, France. She was a visiting doctoral fellow at NYU and postdoc at the Canadian Institutes for Health Research. She worked as a policy officer for the French Ministry of Health and Social Affairs and as a consultant for the Council of Europe. Her Ph.D. dissertation on experimental anti-poverty strategies in the US and in France was awarded the Early-Career Research Prize of the Institut de France / Caritas Foundation.

Lund Critical Debate

Democracies worldwide—even many wealthy democracies long considered safely consolidated—are at risk today. Governments, policymakers, and voters face new conflicts over democratic institutions, checks and balances, which citizens can compete for office or deserve representation, and what rules of accountability apply.

This year's Lund debate from the Mario Einaudi Center for International Studies examines the threats democracies around the world are confronting, both from external forces and from within—and what governments and citizens can do to fight back.

Join Thomas Garrett of the Community of Democracies and Damon Wilson of the National Endowment for Democracy for a conversation on democratic backsliding, strategies for resilience, and the conditions and practices that undermine democracy: democracy ... and its opposites.

A reception with refreshments will follow the conversation.

Lund Debate: 5:00–6:30 p.m. | Alice Statler AuditoriumFree ticket required for in-person attendance. Reserve your ticket today! Join the lecture virtually by registering at Cornell.

Reception to follow.

***

Panelists

Thomas E. Garrett is secretary general of the Community of Democracies, a global intergovernmental coalition comprised of the Governing Council member states that support adherence to the Warsaw Declaration's common democratic values and standards. Garrett previously worked for the International Republican Institute for 12 years overseas in Ukraine, Mongolia, and Indonesia, returning to Washington, DC, in 2005 as director of Middle East programs and then as vice president for global programs.

Damon Wilson is president and CEO of the National Endowment for Democracy (NED), a nonprofit grant-making foundation supporting freedom around the world. Prior to joining NED, he helped transform the Atlantic Council into a leading global think tank as its executive vice president. He previously served as special assistant to the president and senior director for European affairs at the National Security Council. Wilson also served at the U.S. Embassy in Baghdad as the executive secretary and chief of staff, where he helped manage one of the largest U.S. embassies during a time of conflict.

Moderator

Rachel Beatty Riedl has served as the Einaudi Center's director since 2019. She is the Einaudi Center's John S. Knight Professor of International Studies and professor in the Department of Government and Cornell Jeb E. Brooks School of Public Policy. Her research interests include institutional development in new democracies, local governance and decentralization, and authoritarian regime legacies in Africa.

***

About the Debate

The Lund Critical Debate is a signature event of the Mario Einaudi Center for International Studies. This year's dialogue is part of Einaudi's work on democratic threats and resilience. Established in 2008, Einaudi's Lund Critical Debate series is made possible by the generosity of Judith Lund Biggs '57.

Faculty and staff are invited to join for an overview and open discussion of the Global Hubs initiative.

Vice Provost Wendy Wolford will explain the purpose of the Global Hubs, and faculty leads for several of the Hubs locations will discuss their experiences with institutional partners and ways for faculty and staff to be involved.

Please bring your questions about the Hubs and join us in person on March 13 at 11:30 a.m. in G10 Biotech.

Moderator:

Wendy Wolford, Vice Provost for International Affairs

Faculty Presenters:

Gustavo Flores-Macias, faculty lead for Tecnológico de Monterrey, MexicoNate Foster, faculty lead for University of Edinburgh, United KingdomYing Hua, director of Cornell China Center, BeijingLee Humphreys, faculty lead for DenmarkTom Pepinsky, faculty lead for National University of Singapore, SingaporeMark Milstein, representative for the Faculty Senate CAPP on the faculty advisory committeeRachel Beatty Riedl, director of the Mario Einaudi Center for International StudiesKen Roberts, faculty lead for Universidad San Francisco de Quito, Ecuador