The proliferation of reforms in public administration based on the principles and instruments of the "New Public Management" (NPM) have triggered protest from and collective action by many professional groups in various sectors (healthcare, education, justice, social work, research.. .) and raised questions about the future of professionals working in the public service, particularly as concerns their autonomy. However, after analyzing the situation, it seems that the opposition between NPM and certain professional groups is not the last word in the debate. Should changes be seen as the decline of professional groups and of their autonomy or as a transformation of professional models, an overhaul of professionalism, etc.? Such questions, which current events in France and Europe have brought to the fore, are food for ongoing sociological thought. They are broached here empirically, from the field, applying varied levels of analysis and research. The contributors to this dossier explore the different forms of tension existing between professional groups and NPM.

Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France.

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The shielding of older individuals has been proposed to limit COVID-19 hospitalizations while relaxing general social distancing in the absence of vaccines. Evaluating such approaches requires a deep understanding of transmission dynamics across ages. Here, we use detailed age-specific case and hospitalization data to model the rebound in the French epidemic in summer 2020, characterize age-specific transmission dynamics and critically evaluate different age-targeted intervention measures in the absence of vaccines. We find that while the rebound started in young adults, it reached individuals aged ≥80 y.o. after 4 weeks, despite substantial contact reductions, indicating substantial transmission flows across ages. We derive the contribution of each age group to transmission. While shielding older individuals reduces mortality, it is insufficient to allow major relaxations of social distancing. When the epidemic remains manageable (R close to 1), targeting those most contributing to transmission is better than shielding at-risk individuals. Pandemic control requires an effort from all age groups.

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RésuméLa création d'agences sanitaires en France a singulièrement renouvelé l'action publique en matière de gestion des risques et des crises. Les agences sanitaires ne constituent pas de simples dispositifs techniques créés pour répondre aux crises sanitaires. Ce sont des formes politiques qui résultent de transformations sociales et politiques plus profondes de l'administration, de l'expertise scientifique et de la médecine. Elles s'inscrivent dans un triple mouvement d'ouverture des espaces administratif, scientifique et médical : elles apparaissent comme le produit des transformations de l'administration sous l'effet des théories de la nouvelle gestion publique, d'une ouverture de l'expertise scientifique à des exigences de transparence et du développement de la santé publique. Pourtant, ces processus sont paradoxaux et favorisent l'apparition de nouvelles « bureaucraties techniques » posant la question de leur responsabilité politique. Là où les agences devaient réduire la bureaucratie, elles élargissent son périmètre et renforcent ses structures, en constituant un espace intermédiaire où apparaissent des tensions entre elles et leurs tutelles. Cet agencement transforme singulièrement l'équilibre des pou-voirs politiques et administratifs. -Numéro spécial : Les nouveaux formats de l'institution. * Auteur correspondant.Adresse e-mail : benamouz@vjf.cnrs.fr (D. Benamouzig). AbstractThe creation of health agencies in France has stimulated public interventions in the managing of risks and emergencies. Health agencies are not mere technical organizations set up in response to a particular health crisis. They are political forms stemming from deeper social and political changes in public administration, scientific expertise and medicine. Part of a threefold trend toward opening administrative, scientific and medical doors, they have emerged out of the transformation of the public administration under the impact of theories about: new public management, the transparency of scientific expertise, and the development of public health. These processes are paradoxical however. They tend to favor the growth of new technical bureaucracies, whence questions about the latter's political responsibility. While agencies were supposed to reduce bureaucracy, they have broadened its borders and reinforced its structures. They constitute an intermediary space, where appear tensions between them and their supervisors. This arangement does singularly transform the balance between administrative and political powers. -Special issue: New patterns of institutions.