🏛️💡 Municipal Elections 2026: Mayors are becoming actors in local health again. The Health Institute proposes a democratic departmental governance where local elected officials finally lead prevention and health infrastructure, in the face of a centralised system that is at breaking point.

Source: 📒 Mayors, actors of the last mile of health, the first milestones of health prevention📜🔗LINK 

Consult other proposals to candidates - AND the summary -https://pratiquesensante.odoo.com/blog/politiques-10/tour-dhorizon-des-propositions-aux-candidats-elections-municipales-2026-france-5589

At the heart of the subject 

1. ANALYTICAL SUMMARY

A mobilisation of local elected officials in response to the territorial health emergency

Health is among the top three priorities for voters in the 2026 municipal elections, alongside security and local finances. Faced daily with medical desertification, the closure of emergency services, and the growing anxiety of citizens, mayors are confronted with a paradoxical situation: they have no explicit health competencies, yet remain the primary point of contact for residents. The Health Institute, an independent citizen structure created in 2018, directly addresses the 35,000 French mayors at the AMF Congress in November 2025 to propose a central role in the reformation of the health system, as the municipal elections in March 2026 approach (p. 1).

A proposal for structural reform embedding health in local areas

The document proposes two concrete operational levers for mayors: to participate in territorial management through departmental Health Territorial Groups composed of four colleges, one of which is dedicated to local elected officials, and to become recognised public health actors by addressing non-medical determinants (80% of health factors). This reform aims to replace a system designed in the mid-20th century, which is ill-suited to the three major transitions (ageing, chronicity, innovations), with a democratic departmental governance embedded in a national five-year strategy. The electoral challenge is clear: to transform health competence into a credible campaign argument for 2026 (p. 2-3).

2. KEY POINTS OF THE DOCUMENT

• Identify health as an electoral priority: a La Tribune/IFOP survey ranks health among the top three concerns of the French for the 2026 municipal elections, creating strong expectations towards candidates (p. 1)

• Recognise the obsolescence of the current system: designed in the 20th century, the French system remains focused on curative care and hospitals, ill-suited to ageing, the chronicity of diseases, and technological innovations, which generates medical desertification and territorial inequalities (p. 1-2)

• Create departmental Territorial Health Groups: democratic operational steering bodies composed of four colleges (including one college of local elected officials), replacing the current unreadable structures (GHT, CPTS), with a five-year national strategy voted by Parliament (p. 3)

• Recognise the mayor as a public health actor: 80% of health determinants being non-medical, the mayor oversees health infrastructure, local prevention (nutrition, addictions, mental health), health education, hygiene and public sanitation (p. 3)

• Transform the electoral issue into a pedagogical opportunity: in front of voters who will question access to care, candidates can explain the structural crisis and propose their role in the reform, offering a perspective of hope rather than an argument of incompetence (p. 3)

3. ACTION TRACKS FOR LOCAL ACTORS

Integrate health into the 2026 electoral programmes: prepare an argument explaining the structural causes of the health crisis (excessive centralisation, curative vs preventive approach, unsuitability to demographic transitions) and the future role of mayors in territorial governance, to transform citizen concern into a credible political proposal (p. 3)

Train in territorial health governance: to take ownership of the concept of Departmental Territorial Health Grouping and identify the four colleges that make it up, in order to legitimise the participation of local elected officials in the operational management of health, beyond the simple management of infrastructure (p. 3)

Map the non-medical determinants in its territory: to list the existing municipal levers for action (school nutrition, addiction prevention spaces, sports halls, air quality, sanitation) representing 80% of health factors, in order to structure a coherent local public health policy (p. 3)

Document the unmet local health needs: the document remains silent on intraterritorial inequalities (rural vs urban areas, QPV) and on intercommunal coordination — mayors must therefore locally identify populations with disrupted access to care (isolated elderly, vulnerable individuals, non-native speakers) to adapt national proposals to the realities on the ground (needs identified through cross-sectional analysis)

'4. Other references

ADDITIONAL RESOURCES

5. CROSS-SECTIONAL ANALYSIS — VALUES OF HEALTH PRACTICES

Literacy: The document uses expert language (1996 orders, HPST law 2009, GHT, CPTS) without a glossary or simplification, limiting its accessibility to non-specialised elected officials.

Empowerment: The beneficiaries (citizen-patients) are absent from the design — the reform offers power to elected officials, not to users of the health system.

Participation: No co-construction mechanism is described; governance remains representative (college of elected officials) without citizen participatory devices.

Community health: The collective dimension emerges through non-medical determinants (80%) and territorial anchoring, but without a structured community approach (peer supporters, discussion groups).

Ethics: Cultural and social biases are not mentioned; the term 'social health inequalities' is cited (p. 2) but without intersectional analysis.

Human rights: Territorial equity is aimed for (fighting medical deserts) but the inclusion of vulnerable populations (precarity, disability, migration) is not specified.

Intersectorality: The proposal values intersectorality (infrastructure, prevention, education, hygiene) without precisely identifying the partners to mobilise (schools, employers, funders).

Partnership: No formalised model of collaboration between elected officials, health professionals, and other actors is detailed in this advocacy document.

Fight against discrimination: The document remains silent on health discrimination (related to origin, gender, sexual orientation); non-judgment and diversity are not mentioned.

Summary: Strategic document focused on governance and the power of elected officials to act, with a promising territorialised approach but lacking in citizen participation, inclusion of vulnerable populations, and concrete community mechanisms.

6. EVALUATION OF THE RELIABILITY OF THE RESOURCE

Scientific relevance: The structural analysis of the French healthcare system is based on verifiable references (Juppé ordinances 1996, HPST law 2009, AMF Congress 2025, La Tribune/IFOP survey November 2025). The observation of the three transitions (ageing, chronicity, innovations) is documented in the academic literature. However, the statement “80% of health determinants are not medical” (p. 3), while consistent with the work of the WHO, would benefit from an explicit source. The proposals are part of the current debates on territorialisation and health decentralisation.

Operational relevance: The distinction between two concrete levers (territorial management via departmental groups + public health role for mayors) provides clear entry points for action. 

7. MCQ — 5 QUESTIONS 

PART 1 — Presentation of the MCQ

Question 1: According to the La Tribune/IFOP survey cited in the document, what are the three main concerns of the French for the municipal elections of 2026?

a) Health, education, environment

b) Health, security, local finances

c) Employment, housing, health

d) Security, transport, taxation

Question 2: What are the three major transitions to which the current French healthcare system is not adapted?

a) Digitalisation, globalisation, privatisation

b) Urbanisation, precarisation, judicialisation

c) Ageing population, chronicity of diseases, rise of technological innovations

d) Feminisation of professions, shortage of doctors, rising costs

Question 3: What territorial governance structure does the Health Institute propose to create to replace the current GHTs and CPTSs?

a) Strengthened Regional Health Agencies

b) Municipal Health Councils

c) Departmental Territorial Health Groups

d) Digital Health Coordination Platforms

Question 4: What percentage of health determinants are not medical, according to the document?

a) 50%

b) 65%

c) 75%

d) 80%

Question 5: Among the following areas, which are part of the proposed public health role for mayors?

a) Prescription of medication and teleconsultation

b) Organisation of health infrastructure and local prevention actions

c) Management of public hospitals and recruitment of doctors

d) Regulation of professional orders and validation of qualifications

PART 2 — Commented correction

Question 1: According to the La Tribune/IFOP survey cited in the document, what are the three main concerns of the French for the municipal elections of 2026?

✅ Correct answer: b) Health, security, local finances

📝 Explanation: The document explicitly cites this survey conducted in November 2025, which places health on the same level as security and local finances, justifying the urgency for municipal candidates to develop a credible argument on this subject. This hierarchy of concerns explains why the Health Institute is addressing mayors at the time of the AMF Congress. —Source: p. 1

Question 2: What are the three major transitions to which the current French healthcare system is not adapted?

✅ Correct answer: c) Ageing population, chronicisation of pathologies, rise of technological innovations

📝 Explanation: These three transitions are presented as the major upheavals not integrated by a system designed in the mid-20th century. They structurally explain why the centralised curative and hospital-based approach can no longer meet current needs, necessitating a systemic overhaul that includes prevention and territorialisation. —Source: p. 1

Question 3: What territorial governance structure does the Health Institute propose to create to replace the current GHTs and CPTSs?

✅ Correct answer: c) Departmental Territorial Health Groups

📝 Explanation: This departmental democratic body, composed of four colleges including one dedicated to local elected officials, aims to replace the multiple current structures deemed incomprehensible to citizens. The departmental level is chosen because it is the territory known to all, from which the decentralised public social protection services are already managed. —Source: p. 3

Question 4: What percentage of health determinants are not medical, according to the document?

✅ Correct answer: d) 80%

📝 Explanation: This fundamental data justifies the central role proposed for mayors in global health policy. It legitimises municipal intervention in infrastructure, prevention (nutrition, addictions, mental health), health education, and hygiene, areas that traditionally fall under local competencies but are rarely considered as components of health policy. —Source: p. 3

Question 5: Among the following areas, which are part of the proposed public health role for mayors?

✅ Correct answer: b) Organisation of health infrastructure and local prevention actions

📝 Explanation: The document precisely lists four areas of intervention for mayors: organisation and investment in health infrastructure, local prevention actions (nutrition, addictions, mental health), health education (school and work), and public hygiene/sanitation. These competencies mobilise traditional municipal levers by explicitly incorporating them into a global health policy. —Source: p. 3

8. FAQ 

1. Why is health becoming a major electoral issue for the 2026 municipal elections when it is not a municipal competency?

Although health is not an explicit competence of the municipality, residents systematically turn to mayors when access to care deteriorates (medical desertification, closure of emergency services). A La Tribune/IFOP survey from November 2025 ranks health among the top three concerns of voters, alongside security and local finances. Candidates can no longer oppose the formal absence of competence in the face of such a strong citizen demand — they must propose a vision of their role in the overhaul of the system.Source: p. 1

2. What are the structural dysfunctions of the French health system identified by the Health Institute?

The current system, designed in the mid-20th century, has not integrated three major transitions: the ageing population, the chronicisation of pathologies, and the rise of technological innovations. It remains focused on a curative, hospital-based, and fragmented approach (city/hospital/medico-social/home). Excessive centralisation, short-term management of resources, and insufficient exploitation of innovations exacerbate the difficulties. Thirty years of technocratic reforms (1996 ordinances, HPST law 2009) have reached their limit without systemic reform.Source: p. 1-2

3. What is a Departmental Territorial Health Group and how does it work?

It is a departmental democratic instance for operational steering, composed of four colleges (including one college dedicated to local elected officials). It replaces the current structures that are not very clear (GHT, CPTS) and is part of a five-year national health strategy voted by Parliament. The departmental level is chosen because it is the territory known to all citizens, from which the decentralised public social protection services are already managed. This territorialisation aims to make health governance democratic and understandable.Source: p. 3

4. Specifically, what levers can mayors act upon in public health?

The document identifies four areas of intervention: (1) organisation and investment in health infrastructure, (2) local prevention actions (nutrition, addictions, mental health), (3) health education (in schools and at work), (4) public hygiene and sanitation. This legitimacy is based on the fact that 80% of health determinants are not medical. Mayors thus mobilise traditional municipal levers (urban planning, environment, education) by explicitly incorporating them into a comprehensive health policy.Source: p. 3

5. How can we effectively combat medical deserts according to the proposed approach?

The Health Institute criticises the standards imposed by the State that discourage local initiatives. The fight against medical deserts will be all the more effective if local elected officials and health professionals are co-responsible for the remédicalisation of municipalities, rather than being subjected to vertical regulation. The model proposes territorial co-responsibility rather than centralised technocratic management, relying on the legitimacy and proximity of mayors to the population. The crisis of public hospitals shows the limits of vertical management.Source: p. 3

6. What argument can candidates for the 2026 municipal elections present to voters who question them about access to healthcare?

Opposing the lack of health competence may not be sufficient in the face of residents' anxiety. The candidate who can clearly explain the current crisis, its structural reasons (the system's inadequacy to demographic and technological transitions) and the role they will play in the upcoming reform (territorial management, action on non-medical determinants) will offer a perspective of hope. They thus transform a fear into a credible political proposal on a fundamental issue for the quality of life and the attractiveness of territories.Source: p. 3

7. What is the proposed timeline for implementing this reform?

The document specifies that a reforming budget is possible as early as 2026, criticising the 2026 social security funding bill (PLFSS) for its lack of reforming ambition. The national health strategy would be included in a five-year programming law defined by a reformed health state and voted on by Parliament. However, no specific timetable for the implementation of departmental Territorial Health Groups is detailed — the document is a plea rather than an action plan with a timeline.Source: pp. 2-3

9. REWRITING IN EASY TO READ LANGUAGE

Why this document speaks to mayors

Health concerns the French

In 2026, the French will vote to elect their mayor.

They are very worried about three things:

• Safety

• The town's finances

• Health

Health has become a major problem.

Residents can no longer find a doctor.

Emergency services are closing.

People are scared.

Mayors are not responsible for health

Normally, it is not the mayor's job to deal with health.

But residents still come to see the mayor.

They ask him for help.

Many mayors do not know what to do.

They feel abandoned by the state.

An outdated health system

Our health system was created 70 years ago.

Today, the situation has changed a lot:

• People are living longer.

• People have long-lasting illnesses

• There are new technologies

The system is no longer suitable.

It needs to be completely changed.

What the Health Institute proposes to mayors

Proposal 1: Participate in health management

The Health Institute proposes to create groups at the departmental level.

These groups are called Territorial Health Groups.

In these groups, there are 4 teams.

One team is made up of local elected officials, such as mayors.

Mayors will thus be able to decide on the health of their territory.

Proposal 2: Act on everyday health

80% of health does not depend on doctors.

Health also depends on:

• What we eat

• Whether we exercise

• Whether the air is clean

• Whether the streets are clean

The mayor can act on all of this.

It is already part of their job.

But it should be seen as a health job.

What candidates can say during elections

During the campaign, residents will ask questions about health.

Saying "it's not my job" is no longer enough.

The candidate can explain:

• Why the health system has problems

• How they will help to fix it

• What they can do as mayor

This gives hope to residents.

Health is important for living well in one's community.