Thematic file

Health and Insecurity in France

The Foundation brainstorms with its partners

How can access to care be improved for people at risk of dire poverty in France? On November 20, 2014, the Sanofi Espoir Foundation organized a roundtable at the Economic, Social and Environmental Council with four of its partners to discuss the fight against health inequalities. The goal was to formulate proposals that could change public practices and policies.

Today, 8.5 million people are living below the poverty line in France*. Insecurity and disease continue to gain ground. Overwhelmed by the difficulties of their daily lives, more and more women, men and children give up searching for the healthcare they still need. For thousands of them, this quest is an insurmountable obstacle race. Faced with this unacceptable conclusion and determined to work together to find solutions to improve the situation, the Sanofi Espoir Foundation brought together its most committed partners in France - the French Red Cross, Médecins du Monde, Paris Samusocial and Solipam, which supports pregnant women and their babies up to 3 months old in dire need of help.

*Source INSEE 2014

We live in a society on the brink of social breakdown. We must be careful that desperate people do not sink into the sort of violence that could undermine us all.

Jean-Paul Delevoye , President of the French Economic, Social and Environmental Council

When in 1986 it opened its first care center for the homeless in France, Médecins du Monde (MDM) thought it would be able to close it down a year later. However, in 32 cities in France, MDM today supports a constantly growing population of women, men and children living each day in extreme distress. In 2013 almost 30 000 people pushed open the door of its care centers (CASO), 97% of them living below the poverty line, a third of them lagging behind in their healthcare coverage, and one in five who have given up taking care of themselves in the last twelve months.



Like MDM, the French Red Cross, Samusocial of Paris and Solipam are all finding that health inequalities are worsening: in France today: the poorer the person, the sicker they are and the younger they die. According to the French Red Cross, life expectancy among the poorest in France stands at no more than 45 years.

Couples, seniors, women and children: the new faces of extreme poverty

When Samusocial was created twenty years ago, it was mainly targeted at those living in extreme difficulty. Today, there are more families living in the Ile-de-France region in special social hotels, emergency shelters or centers for asylum seekers. The number of emergency phone calls from seniors and single women on the streets is increasing. And when they do have a roof over their head, 86% of families put up in hotels are hungry - a new phenomenon. Every second mother and one in three children are anemic, and this has a significant impact on their health. The number of unaccompanied minors has also increased steadily since 2007. There are four times more minors aged over 10 living alone without their family than in 2011, mainly because of their difficulties in being taken into care by the relevant services.

of families aided
by Médecins du Monde experience
food insecurity


Chronic disease and mental disorder are the pathologies of exclusion

Pathologies are mostly related to difficult living conditions and cover respiratory, digestive, musculoskeletal, skin, and mouth problems (11% of the poor people suffer from caries compared with 6% for the rest of the population). Not does this demographic have much access to prevention: two thirds of the children attending the MDM CASOs are behind with their vaccinations and most patients do not know their HIV or hepatitis status. In six cases out of ten they have chronic diseases. For these people living in dire poverty, "the accumulation of difficulties also causes mental disorders that gradually lead to a loss of interest in personal presentation and hygiene. People lose their self-esteem and no longer take care of their health," said Patrice Dallem, Director of Social Action at the French Red Cross. “Currently, psychological suffering is the major health symptom of extreme insecurity. We cannot ignore its importance when setting up medical and social care systems.”

isolated homeless people
in the Ile-de-France present
severe psychiatric disorders

of mothers cared for by Samusocial
suffer from depression. One in every two children
is suspected of having mental disorders


For those in deepest poverty, access to care is an obstacle race

On top of the countless daily difficulties (lack of resources, lack of stable housing, remoteness from care centers, the language barrier, etc.) ignorance of administrative circuits and the complexity of the steps needed to access entitlements create even more problems. 88% of patients that arrive in the Médecins du Monde centers have no health coverage at their first consultation, while nearly three-quarters are in fact entitled to it! The association also stigmatizes the difficulties in accessing State Medical Assistance (EMA) due to the red tape and institutional malfunctions that, by dint of discouraging applicants, encourage them to give up treating themselves. One in four children cared for by Médecins du Monde staff has never consulted a general practitioner or pediatrician.

of people do not have
any current entitlement to health insurance.

of patients are already too late
to access care services



By sharing their in-field experiences and their convictions, the Foundation's partners also analyzed the malfunctions that tend to marginalize the most vulnerable, impact their health and undermine social equilibrium in general. The following are their proposals for improving these issues.

Administrative simplification

Abandoning the care process is strongly associated with lack of health coverage. It is therefore vital to ensure access to entitlements and care for the extremely poor. Voluntary associations would like to merge State Medical Assistance (AME) into the CMU (universal health insurance) system, raise the levels of the AME and CMU, and provide better support during the registration process.

For pregnant women in dire situations, Solipam suggests creating an inter-PASS (Permanent Access to Care) card, so as to simplify and facilitate access to these currently highly-sectored schemes.

Everyone stressed the importance of strengthening partnerships between voluntary associations and institutions. There must also be a comprehensive circuit that takes into account the social, educational and health aspects of these highly marginalized communities.

By virtue of their abusive practices, some administrations bar access entitlements to the extremely vulnerable.

Marielle Chapuis , Project Manager at the Access to Care Observatory
Medécins du Monde

Stabilize the accommodation process

Vagrancy and the unhealthy condition of much accommodation affect the health of the extremely vulnerable. All speakers emphasized that by stabilizing the accommodation of families, pregnant women and homeless children, it will be easier to integrate them into a course of healthcare and a rehabilitation project. This means finding alternatives to emergency accommodation, and improving the quality of hotel lodgings. For shelters that are better suited to family life, accommodation in a shared apartment with a shared kitchen offers an interesting and no more expensive alternative to the use of hotels.

By adapting our accommodation and integration facilities, we could make very concrete progress in finding alternatives to social hotels.

Paule Herschkorn-Barnu
Director Solipam network

Stepping up prevention

For people who cannot or do not want to sign up for fixed care facilities, it is important to maintain and develop mobile outreach. The goal is to reach out towards and work with the people in question in order to gain a better grasp of their difficulties and needs.

By stabilizing people in accommodation, we can also stabilize their health.
This is demonstrated by our "housing first" project for the homeless suffering from severe mental illness.

Martine Wonner
Medical Director at Paris Samusocial

You offer a repair service for society’s failures and you are committed to heal the wounds of a society that is not working properly.

Jean-Paul Delevoye
President of the French Economic, Social and Environmental Council




There are an increasing number of homeless families, but we know almost nothing about them. With the support of the Sanofi Espoir Foundation, Samusocial has published the results of a three-year research action that for the first time provides an inventory of family poverty in Ile-de-France.



Five children are born every day in emergency accommodation facilities in the Ile-de-France (Source: ENFAMS survey), making 2,000 births out of the 180,000 births reported annually in this area. Very often their mothers give birth without being monitored during pregnancy The Solipam network (Solidarity Paris Mamam) seeks to limit the health risks faced by these vagrant women and their babies.