Study title
Barriers to health systems and exclusion: A comparative study of the strategies developed to reduce health care barriers and combat social deprivation in European urban contexts
Ref study 8472
Study language English
Contributing institutions
  • Public health
  • Social policies
Geographical space
Malmö (Sweden), Bradford (UK), München (Germany), Marseille (France), Geneva (Switzerland), Reggio Emilia (Italie)
This project explores the different responses that have been developed to reduce barriers to the access of health care system. These barriers represent an important factor for exclusion, especially in urban regions and constitute one of the main focal points of current health policies.
Over the last decade, issues linked to pauperization and exclusion have gained in importance in the field of health policies. Segregation and exclusion related to inequalities in health and the "health gap" have become a central phenomenon linked to socio-economic status, employment, gender, etc. Barriers to health systems are also related to general conceptions that underlie the health systems. These systems have developed locally differentiated strategies through regional or urban health planning initiatives that crystallise some characteristics of the change of modern welfare states.
The aim of this research project is to investigate and illustrate - based on the standpoint that social deprivation is a dynamic process - the strategies that have been adopted and implemented in different European contexts to bridge the health gap, what specific actions have been set up and by means of what actors they have been advocated. Another aim of this research is to set off a learning process and to enrich the current debate on social exclusion and health in Switzerland. This project is based on the comparative method and six cases will be compared and typologized. Documentary research and semi-structured interviews will be the main tool to collect information.
The significance of this study is theoretical as well as practical: Firstly, the comparative approach reveals country/urban public health responses to specific problems and gives a catalogue of possible interventions in relation to the national framework and health insurance patterns. Secondly, the developed strategies can are put in perspective with Swiss urban public health responses to show what issues are critical and what measures could be implemented. Thirdly, case studies will explore adequation with perceived needs, as well as the social acceptance of measures. These aspects are then placed in the current debate of the elaboration of future public health strategies and measures in Switzerland. The research findings can also be used as a guide to policy makers.
Methods (description)
The project is based on the research instruments of the comparative approach. Documentary research and semi-structured interviews will be the main tool to collect information. Before embarking in the collection of information, an analytical framework was set up for the empirical part (conceptualisation). This framework is based on the one hand on monographies by topic and context and on the other hand by comparative literature on public health systems and social deprivation.
Documentary analysis: Review of current government reports and monographies as well as comparative studies in the field of health inequalities and barriers to health care/state interventions. Analysis of local reports, annual reports, political statements, etc. Contact with local experts for literature.
Case studies: We work with six cases to insure a sufficient differentiation and possibility to compare and typologise (small n strategy). For the analysis we selected urban contexts in six European countries. The selection of the urban contexts is dictated by the similarity from social, demographic and economic viewpoints, but also by the difference in the organisational logic and experience. In addition we will select urban contexts that are sensitive to questions of social exclusion and health. The last criterion of choice was the existence of experiences and instruments aiming to remove barriers to enter in contact with the health system for marginalised people.

Methods (instruments)
Replicated study No
  • Renschler, Isabelle; Cattacin, Sandro. 2004. Unterschiede integrieren statt Abweichungen wahrnehmen. In: Tangram: Bulletin de la Commission fédérale contre le racisme(16), 2004.
Financed by
Ethical approval No
Study type
Data availability
Source (Updates) Web
Date created 31.01.2006
Date modified 31.01.2006
Start - End date 01.03.2003 - 28.03.2006