The issue of taking vulnerability into account in the healthcare system and in healthcare policies is unavoidable if we want to promote greater health equity and reverse the continuing trend of increasing social, territorial, and environmental inequalities in health (ISTS).

Given the multiplicity of aspects of vulnerability and the lack of a common language on what vulnerability in health means, the HCSP took up the subject in October 2023 and entrusted the permanent ISTS working group with reflecting on this theme. This led to the present report, which is the result of expert work, based on hearings, analysis of contributions, and a review of the literature, on how the vulnerability of individuals, populations, and territories is and should be taken into account by the health system.

It thus highlights that vulnerability is not an intrinsic state, but a contextual situation linking an individual or group with certain characteristics living in a physical, social, cultural and legal environment with certain exposures that pose health risks.

The report gives an overview of the current situation. The analysis of actions carried out in France to address people in situations of vulnerability still shows the scale of unmet needs, as well as the lack of coordination between the many actors involved and the funding invested, and the lack of data from studies and research.

Based on these findings, several recommendations are made :

• Act according to several core principles : combine equity in health and solidarity, combine the One Health approach and primordial prevention, combine universality, and proportionate universalism, combine the population-based and territorial approaches ;
• Act on several levels adressing both environmental factors, individuals or communities, by using mutiple levers at the same time : health promotion, empowerment of those concerned and community health, destigmatization, prevention and health in all policies, social health, intersectorality, training, and research ;
• Develop strategies and proposals aimed at strengthening equity in health : strengthen proven schemes, overhaul certain existing measures, innovate and experiment, develop diagnostic and evaluation tools, adapt the financing of useful actions, and adjust the law.

Then, taking into account vulnerability in all its dimensions in public health’s actions and in all public policies is an urgent and collective challenge. To meet it, it should be a cross-cutting priority in the national health strategy and all public health policies for the next decade.