Proportionate universalism: Towards “real equality” of prevention in France

Although their design may feature a considerable amount of universalism, prevention strategies often produce results that are socially and/or spatially differentiated. This differentiation process can induce social or territorial gradients of access to and/or effectiveness of prevention and, in turn, worsen health inequalities. This process also accentuates the gap between the principles of certain public policies and their practical implementation, raising the question of the real benefit of these policies for beneficiaries. Although Sir Marmot considers proportionate universalism to be a strategy to tackle health inequalities, the practical modalities of implementation of this principle have been rarely described in the literature until very recently. This pragmatic paper therefore presents a causal analysis of differentiation processes, underlines the need for self-reflexive prevention strategies, and investigates practical implications of proportionate universalism.