Improving Public Health in France. The Local Political Mobilization in the Nineteenth Century

ith hindsight one of the achievements of the rich countries has been to reconcile tremendous social changes with remarkable improvements in health. For instance, the life-expectancy for French women has increased from 35 years to 83 years since the eve of the French Revolution (Appendix table 1). Despite industrialisation, urbanisation and rural de-population, which have changed the conditions of living, the environment and the economic origin of the family means, the improvement has been incredible. But this does not imply that there has been a smooth evolutionary improvement for the whole population. On the contrary, during several decades, the first industrialization led to increases in mortality (and probably increasing morbidity) among the workers and the urban poor population, especially the children. In fact, to appreciate the links between social change and health, scholars have to pay attention to different analysis scales. The chronological scale first, because the social change effects on health improvement have not been immediate, regular or constant – an increase of the mortality can even be the first consequence of a social change. The geographical scale is also important because the economic and social change occurred first at a local level, and surveys at a national or regional scale can immerse these changes. Taking into account the social scale is fundamental because specific categories, new industrial workers or women or children have been more exposed than the others, and were, at least during a first phase, the main losers of the evolution. The three dimensions, the three scales, have to be connected to each other. I propose here, after a global perspective on life-expectancies, to focus first, at a local level, on an example of the consequences for mortality and health of the 19 century industrialization. The ways in which the industrial and urban penalties have