towards professional recognition and generalization of the practice? The file of Health in action n°460, June 2022.

Mediation in health was born empirically from needs in the field, but its official recognition is recent and it was little valued until then. The major challenge is therefore to convince of its usefulness so that it is no longer experimental but perpetuated, integrated into common law.
In 2017, the Haute Autorité de Santé (HAS) took a first step in the direction of structuring this practice, by establishing a reference system which defines its scope and its interactions, at the interface of other professions in the socio-sanitary field. . The objective is twofold: 1) to improve access to rights and to curative and preventive care by promoting the autonomy of the most vulnerable and those furthest from the health system and 2) to make health professionals aware of the possible difficulties of patients in carry out their care and prevention pathways. HAS also retains three main ethical principles that should apply to health mediation: confidentiality and professional secrecy; non-judgment (withdrawal posture); respect for people’s will and freedom of choice.

The health mediator in France: a response to social inequalities in health

In the French system, access to health and social rights for the entire population is theoretically guaranteed by law. Although quite rich, this system remains quite complex for the neophyte. There are also major health inequalities within the national territory, at the geographical level and within the population. They are reflected in particular by differences in life expectancy or in the incidence of certain pathologies (cancer, diabetes, obesity, etc.).

At the level of the individual, health professionals also note failures in follow-up and adherence to diagnostic or therapeutic pathways. The causes of these ruptures, often cumulative, relate to all the vulnerabilities of populations far from care. Among the main obstacles identified are pointed out: social and economic precariousness, age, low level of education, language barrier, digital divide, geographical isolation, lack of social support, motor disabilities or psychic, loss of autonomy, mental health disorders, lack of knowledge or control of the health system, cultural representation of the disease, treatment, medication, chronicity and/or the accumulation health issues.
These various vulnerabilities lead to interruptions or renunciations in the course of care, both curative and preventive (how to receive treatment when you are on the street; come to a consultation due to lack of access to public transport in rural areas or money if they exist…). These failures, which cannot be reduced to the language barrier or the cultural dimension, are the source of health inequalities. Moreover, even if the ultimate objective of health mediation is to develop people’s autonomy and ability to act, it must be recognized that it may also be necessary in the long term for certain chronically ill or disabled people. permanent or likely to worsen (elderly or mentally ill).

What jobs, what skills?

In the first part “state of knowledge”, different mediation professions are defined: social mediators, health mediators, “peer health” mediators, transcultural mediators, “relay adults”. Researchers and professionals in the field define mediation, its history (it comes from civil society and particularly from the field of HIV/AIDS in the early 90s), its foundations, its objectives.
They also define skills for this new profession: mastery of the basics of the professions with which the mediator will interface, medical knowledge, knowledge of the basics of psychological support, motivational interviewing, the health system but also access to rights (social assistance), the functioning of health networks, the local associative fabric, sense of otherness (defined as having concern for others), empathy, ability to listen, non-judgment, decentering, etc.

Practice in France and abroad, inside and outside the hospital

The rest of the file is devoted to the state of concrete practices and to the mechanisms and actions of mediation within the hospital or neighborhoods of certain cities. A researcher analyzes the profession of “peer health mediator”, who shares the same experience as the patient, a psychologist describes transcultural consultation, a focus is presented on the specific mediation needs for Travelers, especially during the ” Covid-19 crisis”. Various testimonies from mediators officiating in Public Assistance hospitals in Paris, at the Saint-Laurent du Maroni hospital (Guyana), in Lille or Dunkirk, but also in Germany or Belgium thus illustrate the state of art in the matter. Ultimately, this review of practices in France and abroad demonstrates the usefulness of health mediation.