🏛️🤝 From the commitment charter to project coalitions, this evaluation identifies concrete levers to embed health in all territorial policies.
Summary
🔴🔑AT THE HEART OF THE SUBJECT: Analytical summary, Key points to remember, Action tracks for stakeholders, Additional references
➕🛠️ ADDITIONAL RESOURCES: Cross-sectional analysis, Multiple choice questions, Frequently asked questions, Easy to Read and Understand
Source: 📒 Supporting local authorities in a health-promoting approach: feedback on the evaluation of the ACTeS-7 project📜🔗LINK
At the heart of the subject
Analytical summary
Context, territories and tensions
The ACTeS-77 project supports six voluntary local authorities in Seine-et-Marne, with rural, semi-urban, and urban profiles, in a context of significant social, demographic, and local health policy disparities. It is part of the Health Cities Network 77 led by the Île-de-France ARS, following the Covid-19 crisis which repositioned municipalities as central actors in public health without formal health competencies. The evaluation analyses a three-year framework (2023-2025) combining prefiguration, support, and evaluation, backed by an inter-institutional monitoring committee. It highlights a structural tension between the strong demand for healthcare services, the need to address the social and environmental determinants of health, and the gap between short-term political timelines and the long-term nature of local health policies.
Operational contributions and sustainable levers
Tailored support through double associative pairs has strengthened the capacity of local authorities to clarify their health policy, structure reference trios (political, strategic, operational), and develop projects that are more coherent with health promotion. Inter-site seminars, training, and work on existing projects have supported cultural adaptation, cross-sectoral collaboration, and cooperation between services (urban planning, education, youth, housing, social services, etc.). The evaluation identifies concrete levers: institutionalisation of bodies and tools, articulation of training and support, targeted intersectorality, clarification of expectations and the intervention framework. It concludes on the necessity to embed health promotion within existing strategic frameworks, to stabilise the references, and to sustainably articulate prevention and access to care.
Key points to remember
Position ACTeS-77 as a three-year support mechanism for six voluntary Seine-et-Marne local authorities, integrated into the Health Cities Network 77 (context, objectives, phases) (p.1-2).
Structure an inter-institutional monitoring committee (ARS DD77, ARS IDF, Departmental Council, AMF77, CPAM, prefecture, researchers, elected officials, support structures) to steer and legitimise the project (p.2-3).
Clarify the role of the reference trio (political, strategic, operational) to stabilise internal mobilisation and embed health in the local agenda (p.3).
Enhance acculturation to health promotion through training linked to concrete projects, articulating social and environmental determinants and healthcare provision (p.4).
Develop targeted and contractual intersectoral projects, reconciling local adaptation, common framework, and planned evaluation over time (p.4-5).
Action tracks
Formalise a clearly identified, stable, and recognised political-strategic-operational reference trio to lead the health approach and secure decision-making (p.3).
Establish regular dialogue sessions between elected officials, management, and references (internal committee, steering meetings) to update priorities and adjust the project to political uncertainties (p.3).
Organise health promotion training linked to existing actions, incorporating the issue of healthcare provision as a determinant among others, to enhance ownership by services (p.4).
Build targeted intersectoral project coalitions (a few services and partners around specific objectives), by contracting expectations and roles to clarify support (p.4-5).
Other references
🔍➕ For more information, see the articles referenced by "Health Practices" on the theme of participation ➡️🔗https://pratiquesensante.odoo.com/1-2-participation
ARS Hauts‑de‑France, "Operators: the tools to build and deploy your projects" (updated 2024, operational guide for health prevention-promotion, in French, downloadable):https://www.hauts-de-france.ars.sante.fr/operateurs-les-outils-pour-construire-et-deployer-vos-projets.
CACIS Chair, "Intersectoral collaborations and partnership action, how does it work?" (methodological tool, PDF, 2019 but still updated and supplemented by the 2020 assessment tool; verified URL):https://chairecacis.org/fichiers/intersectorialite_partenariat_2019.pdf.
Praxis / Collectif DS, "Learning and support guide: The ABC of DS" (2024, French manual on partnership action and intersectoral dynamics, with analysis tools):https://praxis.encommun.io/n/Cn8Qli81z0qogQmaszP5Y9YUcSQ/.
ADDITIONAL RESOURCES
Cross-sectional analysis
The reference points - 📜🔗LINK
CROSS-SECTIONAL ANALYSIS — VALUES OF HEALTH PRACTICES
Literacy: The document simplifies the determinants of health and health promotion with diagrams and explanations accessible to non-specialists in communities (p.1‑2).
Empowerment: Residents are considered as actors in the projects, but the concrete modalities of beneficiary involvement remain poorly detailed in the summary (p.1‑2, 4‑5).
Participation: Participation mainly focuses on professionals, elected officials, and partners through monitoring committees, inter-site seminars, and working groups (p.2‑5).
Community health: The collective dimension is integrated through action in living environments, local policies, and territorial actor coalitions (p.1‑2, 4‑5).
Ethics: The document emphasises adherence to the principles of health promotion, non-hierarchical prescription, and adaptation to local contexts, but does not explicitly mention cultural biases (p.4-5).
Human rights: The approach aims to combat social and territorial health inequalities, without explicit reference to standardised human rights but in line with equity and inclusion (p.1-2, 4-6).
Intersectorality: The text precisely documents cooperation between social services, urban planning, education, youth, funders, and institutions (ARS, CPAM, etc.) (p.2-5).
Partnership: Models of collaboration are outlined through the monitoring committee, support pairs, project coalitions, and the local reference trio (p.2-5).
Combating discrimination: Discrimination is not named as such; the document rather addresses health inequalities and access to resources, with an implicit non-judgmental stance (p.1-2, 4).
Final summary: The document meets the criteria for health promotion and intersectorality well, but remains vague on human rights, discrimination, and resident participation.
EVALUATION OF RESOURCE RELIABILITY
Scientific relevance: The content is based on recognised references (Ottawa Charter, work on health determinants, Urba4, Barton et al., WHO, Vlahov et al.). The data pertains to the recent period (2023-2025) and is up to date for 2026.
Operational relevance: The document offers very concrete recommendations on political mobilization, internal organization, training, targeted intersectorality, and evaluation; it is immediately usable by local teams and support structures (p.3‑5).
Multiple choice questions
PART 1 — MCQ (without answers)
Question 1 (p.1‑2): What is the main objective of the ACTeS‑77 project for the supported communities?
a) To develop municipal health facilities
b) To build a clear local health policy and translate it into concrete actions
c) To fund private practitioners in the area
d) To establish a departmental telemedicine network
Question 2 (p.2): What is the main role of the monitoring committee established in ACTeS‑77?
a) To manage the budget of the reference hospital
b) To ensure the deployment of the project, clarify its implementation, and facilitate links between communities and institutional partners
c) To carry out screening for chronic diseases in the municipalities
d) To validate the recruitment of territorial agents
Question 3 (p.3): Which configuration of referents most strengthens mobilization in the communities?
a) A single volunteer referent per community
b) A clearly identified, stable, and recognised political, strategic, and operational trio
c) An external referent not attached to the community
d) An annual rotation of non-specialised referents
Question 4 (p.4): What approach to health promotion training is considered the most effective in ACTeS-77?
a) Theoretical training disconnected from local projects
b) Training focused solely on individual behaviours
c) Training linked to the support of concrete projects and the priorities of local authorities
d) Training reserved only for health professionals
Question 5 (p.4-5): What type of intersectorality is associated with the most advanced projects in ACTeS-77?
a) A very broad intersectorality, including all services and partners in the area
b) A lack of intersectorality, with each service working in silos
c) A targeted intersectorality, with a limited number of services and partners around clearly defined objectives
d) An intersectorality limited to the health and medico-social sector
(Order of correct answers chosen to comply with the rule: Q1=b, Q2=b, Q3=b, Q4=c, Q5=c.)
PART 2 — Commented correction
Question 1: What is the main objective of the ACTeS-77 project for the supported local authorities?
✅ Correct answer: b) To build a clear local health policy and translate it into concrete actions.
📝 Explanation: The document specifies that ACTeS-77 aims to help local authorities build a clear local health policy and translate it into health promotion projects, strengthening their capacities for design, implementation, and evaluation (p.2). Source: p.2.
Question 2: What is the main role of the monitoring committee established in ACTeS-77?
✅ Correct answer: b) Ensure the deployment of the project, clarify its implementation, and facilitate links between local authorities and institutional partners.
📝 Explanation: The monitoring committee, comprising ARS, the Departmental Council, AMF77, CPAM, the prefecture, researchers, and elected officials, is tasked with monitoring the progress of the system, clarifying its implementation, and facilitating links with partners (p.2‑3). Source: p.2‑3.
Question 3: Which configuration of referents most strengthens mobilisation in local authorities?
✅ Correct answer: b) A clearly identified, stable, and recognised political, strategic, and operational trio.
📝 Explanation: The evaluation highlights that when the political, strategic, and operational trio is well identified and stable, the dynamics are stronger and health is better integrated into the local agenda (p.3). Source: p.3.
Question 4: Which approach to health promotion training is considered the most effective in ACTeS‑77?
✅ Correct answer: c) Training linked to the support of concrete projects and the priorities of local authorities.
📝 Explanation: Training is considered more effective when it is based on the real projects of local authorities and articulates concepts and support, rather than remaining abstract or focused solely on individual behaviours (p.4). Source: p.4.
Question 5: What type of intersectorality is associated with the most advanced projects in ACTeS‑77?
✅ Correct answer: c) A targeted intersectorality, with a limited number of services and partners around clearly defined objectives.
📝 Explanation: The evaluation shows that the most successful projects rely on targeted intersectorality, rather than on a broad mobilisation that is difficult to coordinate, which allows for more effective cooperation (p.4‑5). Source: p.4‑5.
FREQUENTLY ASKED QUESTIONS (FAQ) — 7 QUESTIONS
Frequently asked questions
Who is leading the ACTeS‑77 project and what is the duration of the project?
Answer: The project is led by Promotion Santé Île‑de‑France and Pas de Côté en Santé, at the request of the ARS Île‑de‑France, and supports six local authorities in Seine‑et‑Marne over three years (2023‑2025), with an evaluation extending to 2026 (phases of prefiguration, support, evaluation). Source: p.1‑2.
What types of local authorities participate in ACTeS‑77?
Answer: Six voluntary local authorities, representing rural, semi-urban, and urban areas of Seine‑et‑Marne, characterised by diverse socio-economic conditions according to the HDI-2 index and heterogeneous levels of public health culture. Source: p.2.
What does the support offered to local authorities actually consist of?
Answer: Each local authority benefits from tailored support provided by a duo of facilitators from the two associations, combining expertise in health promotion, project methodology, training, local intervention, and adaptation to local dynamics (diagnosis, acculturation, project support). Source: p.2‑3.
What is the interest of the monitoring committee for field actors?
Answer: The monitoring committee, composed of institutions, elected officials, researchers, and support structures, provides a broad consultation framework that legitimises the approach, facilitates links between local authorities and partners, and validates the main orientations, contributing to securing the work of local professionals. Source: p.2-3.
How does ACTeS-77 address the issue of access to care in relation to health promotion?
Answer: The project does not separate access to care and health promotion, but seeks to articulate them by treating the provision of care as one determinant among others, in order to move beyond the exclusive focus on medical shortages and to legitimise action on social and environmental determinants. Source: p.4.
What are the main barriers identified to maintain long-term mobilisation?
Answer: The evaluation highlights the fluctuation of mobilisation after the prefiguration phase, linked to changes in political priorities, team turnover, external events, and the fragility of support if the reference trio is not stabilised (p.3). Source: p.3.
What concrete results has ACTeS-77 produced within local authorities?
Answer: The main effects are organisational and relational: increased visibility of health as a cross-cutting issue, structuring of reference teams, improvement of intersectoral cooperation, and dissemination of a common culture of health promotion; the effects on actions are more heterogeneous, dependent on local contexts. Source: p.5-6.
Easy to read and understand
1. Context and issues
Health also depends on housing, work, and the environment.
After Covid-19, local authorities have provided a lot of support for health.
However, they do not have health as an official competency.
In Seine-et-Marne, six local authorities have joined the ACTeS-77 project.
These areas are different: urban, rural, mixed zones.
The project aims to help better organise health for everyone.
2. Operational contributions
Expert teams support each local authority on-site.
They help to write a clear local health policy.
They transform this policy into concrete projects.
Training sessions simply explain health promotion.
Services work more collaboratively: social, urban planning, youth.
Health becomes a shared topic within the community.
Key points FALC
Six volunteer local authorities in Seine-et-Marne are being supported.
A monitoring committee brings together major institutions and elected officials.
A trio of referents carries health: elected official, management, operational.
Training links theory to existing projects.
The projects bring together several services around simple objectives.