The aim of this proposal is to fund the preparation of a book manuscript that will reconstruct in detail the social processes that led from the "disaster" represented by France's experience of HIV-contamination of the blood supply to the transformation of public health from a relatively neglected backwater to a central concern of the French state and a primary target for innovation and social change. The discovery that a single blood transfusion-not to speak of the repeated injections of blood products required by hemophiliacs-could transmit AIDS was regarded in most developed countries as a public health crisis. Only in France, however, was it construed as a national disaster and followed by significant changes in the meaning of public health and in its social and political organization, changes that have not ceased to play themselves out. The book's authors, Constance A. Nathanson and Henri Bergeron, will undertake a detailed reconstruction of this event and its consequences as they have unfolded over the decade and a half from 1990-2005 (focusing most heavily on the period, 1991-94). The data on which they will draw include primary French government documents, the media, and oral history interviews with key actors, complemented by a large secondary source literature on France's response to several perceived recent "crises" in health care and public health. These materials will allow them to describe and interpret multiple changes that include: the reframing of public health from a matter of disease prevention and health promotion to one of national security;the passage and implementation of a vast new body of laws relative to public health institutions and the regulation of public health;the creation of new public health agencies;the emergence of new public health actors and new career opportunities in public health;and the emergence of patient associations as a new political force. Not only in France but in other developed countries as well, the prestige and influence of public health declined over the twentieth century. This book will address the question, under what circumstances does public health become a serious interest of state? We will be submitting the completed manuscript to Oxford University Press, which has notified us of its "strong interest" in considering it for publication.
Major crises entailing substantial loss of human life are hardly an infrequent occurrence in the modern world. We believe there is much to learn from the French experience about when, how, and why public health institutions and ideologies become reshaped in response to major threats. A more profound understanding and reflection on this experience will add to our knowledge of the range of potential responses to such crises and of the circumstances that facilitate responses that are more, or less, effective in containing the crisis and crafting a constructive response.