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                <title level="j">Lien social et Politiques</title>
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                <term xml:lang="fr">Politique de santé</term>
                <term xml:lang="fr">Politique territoriale de santé</term>
                <term xml:lang="fr">Territoires</term>
                <term xml:lang="fr">Médecine libérale</term>
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              <p>The framework for health policy in France is now place-based, and the regional level is considered the most relevant for implementing policies. After 10 years, the principal challenge for the years to come seems to be the integration of all relevant actors of the health system, and particularly the doctors, into the health policy of each region. An analysis of the locational strategies of family doctors shows that they have an individual approach to care with no geographical dimension. In the future, then, only an alteration in models of professionalism will lead to the successful involvement of doctors in place-based health policies. An analysis of the working of health networks reveals collective learning developing within them as well as the difficulties of getting beyond existing notions of professionalism when no alternative model exists.</p>
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              <p>L’approche territoriale est devenue en France le cadre de mise en oeuvre des politiques de santé, et l’échelon régional est considéré comme le plus pertinent pour le pilotage des dispositifs. L’enjeu majeur pour l’avenir, qui se dégage après plus de dix ans d’expérience, est d’associer tous les acteurs de santé, et particulièrement la médecine libérale, au sein d’une politique de santé adaptée à un territoire. Or les médecins ont une approche curative individuelle qui ne donne pas sens à la notion de territoire, comme le prouve l’analyse des stratégies d’installation des généralistes. Dès lors, un déplacement du référentiel d’action professionnel devient la condition nécessaire à l’implication des médecins libéraux dans les politiques territoriales de santé. L’étude du fonctionnement des réseaux de santé met en lumière l’apprentissage collectif qui s’y développe et les difficultés à dépasser un modèle professionnel en l’absence d’un référentiel alternatif. Les territoires peuvent-ils être les outils d’une acculturation à une approche de santé publique ?</p>
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