The objectives of public health research are to understand the influence of factors that determine population health and propose interventions and health policies based on scientific knowledge and evidence. These actions serve to improve health and well-being and reduce health inequalities. At Inserm, over 110 teams are dedicated to public health research.
Public health researchers study population health, well-being, disability, and loss of autonomy, as well as the factors that determine these states (referred to as « determinants of health »), whether biological, behavioral, social, or environmental. These data enable them to develop and assess interventions to improve population health, prevent disease, and compensate for disabilities and loss of autonomy. The researchers also produce innovations in terms of the organization of health services, social services, and medical/social services.
Public health research is characterized by its multidisciplinary and cross-cutting approach. It draws on:
- human and social sciences applied to health
- toxicology, etc.
It usually entails the analysis of data on population samples, on varying scales, depending on the purpose of the research. Hence, the main « instruments » used by public health research scientists are:
- cohort studies
- case-control studies
- cross-cutting studies
- morbidity registries
- medical-administrative databases
These involve monitoring, over time, a group of individuals that share a number of common characteristics, so as to identify the occurrence of a given health event (disease or physical dysfunction). Individual monitoring makes it possible to identify risk factors or protective factors for the health event studied.
For example, the E3N-Générations study looks at people from the same family, with a shared genetic predisposition and environment, to understand the relationship between health, environment, and modern lifestyle. E3N-Générations will ultimately bring together three generations: the women in the E3N cohort and the fathers of their children constitute the first generation, their children the second generation, and their grandchildren, the third generation. All in all, the study is expected to involve around 200,000 individuals.
A cohort study is based on compliance with a pre-defined protocol, on data collection and (active or passive) participant follow-up procedures, which make it possible to identify the onset of the health events being studied.
Cohorts are one of the reference instruments for epidemiological and public health research. The French Ministry of Higher Education and Research has identified them as research infrastructures, thus recognizing their utility to the public health research community and, more broadly, to biomedical research in general. Inserm sponsors or manages the organization of more than 70 cohorts.
Find out more about Inserm cohorts:
|3 Cités||Explore the relationship between vascular risk factors and dementia in people aged 65 and older|
|CANTO||Improve the quality of life of women with breast cancer|
|CKD-REIN||Improve the management of chronic kidney disease through the follow-up of 3,000 patients over 5 years|
|COBLAnce||Identify predictive biomarkers of bladder cancer|
|Constances||A « generalist » cohort designed to study a wide range of topics using health information from 200,000 « representative » adults between the ages of 18 and 69|
|Elfe||Monitor, from birth to adulthood, the development of 18,000 children born in 2011|
|Epipage 2||Learn more about the outcomes of premature infants|
|i‑SHARE||10-year follow-up of the health of 30,000 students|
|MAVIE||Study the causes and circumstances of everyday accidents over the long term|
|NutriNet Santé||Decipher nutrition-health relationships in adults|
|OFSEP||Multiple sclerosis observatory|
|RADICO||Program bringing together several cohorts in the field of rare diseases|
National Cohort Coordination Unit (CCNC)
Since March 2009, Inserm has been running a National Cohort Coordination Unit (CCNC) within the Aviesan alliance Multi-Organization Theme-Based Institute on Public Health, led in partnership with the French Institute for Public Health Research (Iresp). This unit aims to provide services (methodological support, legal assistance, working groups, etc.) to publicly funded cohorts, and to facilitate shared access to data from these cohorts for all scientific communities to which this may be of interest.
These involve recruiting individuals presenting the health event being studied and control subjects not presenting this event. Data are collected on all participants in the two groups, with the aim of highlighting risk factors or protective factors for the health event studied.
Hence, the EGEA study aims to identify genetic and environmental factors associated with asthma, bronchial hyperresponsiveness and atopy, with a view to developing preventive measures and new treatments for patients. This study is based on the analysis of data relating to nearly 400 asthmatic patients and their families, together with 415 non-asthmatic controls.
These observational studies serve to describe the characteristics and exposure concerning a population, at the time of recruitment into the study. These may be repeated over time, so as to compare the data obtained and thus analyze their changes over time.
For instance, national perinatal surveys are regularly conducted in France, to determine the main indicators for maternal and neonatal health, medical practices during pregnancy and childbirth, together with the associated risk factors. This information notably serves as guidance for public health decisions and for evaluation of health actions in the perinatal field (public measures, professional recommendations). Surveys have been held in 1995, 1998, 2003, 2010, 2016 and in March 2021. In practical terms, each survey entails the collection of data on all births registered in France over the equivalent of one week.
These are exhaustive databases, relating to one or more health events occurring in a geographically defined population. They are compiled for epidemiological and public health research purposes by a team with the appropriate skills. A number of registries exist in France, relating to cancer, cardiovascular and neurovascular disease, congenital abnormalities, rare diseases, etc.
The morbidity registries are overseen by two committees: the Strategic Registry Committee (SRC), responsible for decision-making in terms of guiding registry policy (for instance, concerning priority for coverage or funding) and the Registry Evaluation Committee (REC), an independent committee responsible for the scientific evaluation of the registries. Inserm is a stakeholder in these two committees.
Created for non-research purposes, these databases are of particular interest to public health research scientists. For instance, the Caisse nationale d’assurance vieillesse (CNAV, national pension fund) database sheds light on individuals’ career paths, and thus provides information on occupational exposure, and potential risk factors. The vast Assurance maladie (national health insurance scheme) database, which comprises all reimbursed procedures (medicines, hospital admissions, etc.), notably enables scientists to examine the patients’ care pathways.
Inserm and the national health data system
The health system reform law namely led to the creation of the Système national des données de santé (SNDS, national health data system). This system notably consists of:
- national health insurance scheme data (SNIIRAM)
- hospital data (PMSI database)
- medical causes of death (CépiDc-Inserm)
- data on disability (sourced from the MDPH – CNSA data)
- a sample of data sourced from top-up health insurance organizations
The only one of its kind in Europe, or indeed the world, the SNDS represents a major step forward: these data, covering practically the whole French population, represent an immense opportunity in terms of health research. Any individual or public/private, for-profit/non-profit organization may, in 2017, have access to SNDS data further to authorization from the CNIL, with a view to conducting a study, research or evaluation of public interest.
Governance of this system is expected to include data producers, including Inserm. In more practical terms, the Centre d’épidémiologie sur les causes médicales de décès (CépiDc, epidemiology center on medical causes of death), an Inserm Service Unit, is responsible for extracting and supplying data for research. For more information, visit the SNDS website
Epidemiology-France portal, French health data catalog
Implemented at the Aviesan alliance Multi-Organization Theme-Based Institute on Public Health, the Epidemiology-France portal provides an online catalog of the main French-sourced individual health databases, beneficial in the development of research and expertise in public health (excluding clinical trials).
This instrument is part of a scientific data sharing movement aimed at allowing all scientists to get the most out of the available data, and thus accelerate the generation of new knowledge.