🧭📋 Barriers, levers, examples of governance, diagnosis and evaluation, and six recommendations addressed to local authorities and regional and national stakeholders.
This document is aimed at coordinators of local health contracts (CLS), elected officials and local authority services who want to make their CLS a lever for Health in All Policies (SdTP). Based on three case studies, it identifies the main barriers, levers and conditions that enable CLS to contribute to this approach at the local level (p. 6). It compares several ways to organise a CLS: its place in health policy, the steering committee, the technical committee, working groups and coordination. For each, it presents the strengths and limitations according to the local context, without designating one model as better than another (p. 7, 18-22). It also shows how to articulate the CLS with other plans, such as the Territorial Climate-Air-Energy Plan (p. 24), and how to evaluate a CLS beyond the simple assessment of actions (p. 25-27). It illustrates each point with examples from Poitiers, Villeurbanne and Thionville Fensch, and concludes with six recommendations, each with its intended recipients (p. 28-33).
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1️⃣ Summary
Created by the HPST law of 2009, the Local Health Contract (CLS) is a contract signed by the ARS and a municipality or a grouping of municipalities (p. 5). According to the document, it was not originally designed as an explicit instrument for implementing Health in All Policies (SdTP), but it has the potential to play this role (Diallo, Le Bodo and Breton 2022) (p. 6). The study analyses under what conditions it can effectively become so, based on three local authorities that are members of the French Network of Health Cities (RfVS): Poitiers, Villeurbanne and Thionville Fensch Agglomeration (p. 6).
The method combines an analysis of the documents of each CLS and nine semi-structured interviews conducted with CLS coordinators, health elected officials and agents from other services (p. 6). The document analysis is based on a framework developed by the RfVS within an international working group of the JA PreventNCD project (p. 6). The study does not aim for a representative sample (p. 6).
The results focus on planning, resources (funding, data and time), governance, equity, coordination with other plans and systems, and evaluation (p. 7-27). The six recommendations are addressed to local authorities as well as to regional and national actors who support, fund and structure the CLS (p. 28).
2️⃣ What to remember
1️⃣ The CLS is not in itself a SdTP approach. It can become a structuring lever when it serves as a framework for governance, intersectoral coordination and collective mobilisation (p. 28). Non-binding, it gains in scope with the political backing (p. 8) and the articulation with policies endowed with a regulatory or strategic framework: PCAET, PLU/PLUi, city contract (p. 9).
2️⃣ Funding that is not very clear and insufficient data (findings). The three local authorities make the same observation: the financial resources of the CLS are gradually losing clarity and stability, as recent contracts are detailing less and less the contributions of each (p. 15). The main funding from the ARS and the local authority remains relatively stable, but it mainly covers the position of coordinator and the Local Health Diagnosis. Most actions have no earmarked funding at the time of their registration, and the coordinators must then seek funds through calls for projects or grants (p. 16). Health data at the intra-communal level is described as insufficiently available or accessible, which limits the objectification of social and territorial health inequalities (ISTS), prioritisation and evaluation (French Network Cities-Health 2023) (p. 17).
3️⃣ Two tools developed locally (existing in the studied local authorities). In Villeurbanne, an analysis grid with a score, filled out for each action sheet, estimates the supposed impacts on social health inequalities; the document specifies that it is not an impact assessment (p. 23). In Thionville Fensch, the coordinators of the CLS and the PCAET have identified common indicators (p. 26).
3️⃣ To act
1️⃣ Build a common culture of health by creating interdepartmental exchange spaces (action requested by the document, recommendation 2; recipients: general management, municipal services). These spaces can be interdepartmental groups, cross-cutting commissions or health committees. They allow agents to get to know each other, to understand how their projects impact health determinants and to identify opportunities for collaboration (p. 29). Example: in Poitiers, the cross-cutting health commission brings together all departments to share ongoing projects, identify synergies and develop joint actions. Services now proactively seek out the health hub, but this dynamic must be maintained continuously (p. 13).
2️⃣ Make the Local Health Diagnosis a process of collective mobilisation (action requested by the document, recommendation 4; recipients: local authorities, ARS, ORS, data producers), by mobilising municipal services, local partners and residents (p. 31). Example: in Villeurbanne, the DLS was presented to about twenty municipal departments (p. 10).
3️⃣ Draw inspiration from the analysis grid of social health inequalities in Villeurbanne (existing tool cited by the document). Criteria: relevant determinants, participation of residents, vulnerable groups, cooperation between sectors (p. 23). The document does not specify whether the grid is disseminated. Suggestion Practices in Health: inquire with the City to see if it can be shared.
4️⃣ 3 practical questions
1️⃣ Is a Technical Committee (COTECH) mandatory?
No. According to the document, the COTECH can become superfluous when the COPIL is broad or directly linked to the action holders; it becomes an essential link when the COPIL needs to remain tight or when the community seeks to strengthen its internal transversality (p. 21). Poitiers operates without COTECH (p. 19); in Villeurbanne, the COTECH, composed exclusively of municipal agents, is the operational steering body (p. 20).
2️⃣ Can actions be added to the CLS after its signature?
Yes, in more flexible CLS, which allow for the integration of action sheets after the signature (p. 24). In Thionville Fensch, several environmental health actions were added after the signature, following the participation of the CLS coordination in the PCAET bodies (p. 24).
3️⃣ How to evaluate a CLS beyond the assessment of actions?
Some CLS broaden the evaluation to encompass all territorial and partnership health dynamics (p. 26); Poitiers evaluates the CLS through governance and coordination rather than the results of each action (p. 27). The document specifies that the coordinators find the tools, methods, and indicators still insufficient (p. 26).
5️⃣ To go further
Blog Health Practices : no article on the Local Health Contract or Health in All Policies could be identified and verified (searches on pratiquesensante.com and pratiquesensante.odoo.com; the site blocks automated consultation). To be completed and verified manually before publication.
External resource (external source) : ARS Normandy, Regional guide to the local health contract (CLS) for the teams responsible for coordinating a local health contract, February 2025 edition. Practical sheets on governance and coordination, coordination missions, local diagnosis, the action plan and evaluation indicators. Complementary to recommendations 3 to 5 of the document; Norman context, to be transposed. URL opened and verified on 9 October 2026.
6️⃣ #️⃣ Hashtags
#healthpractices #HealthInAllPolicies #LocalHealthContract #HealthPromotion #Intersectorality #HealthSocialInequalities #HealthCities #PublicHealth
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