Urban health

Devolving power in Paris, France

21 April 2021

3 min read

In Paris, we saw how they enabled people across the city to make decisions about how public money is spent to improve urban health.

This city profile is part of a series of ten, exploring how cities around the world are addressing health inequalities. Read the full report and sign up to receive more insights from us.

About Paris

The Greater Paris Region accommodates a population of 12.1 million, making it the most populous metropolitan region in Europe, even though the Ville de Paris (the City of Paris) had just under 2.2 million residents, roughly a quarter of London’s population in 2019.

Today, Paris is the second most multicultural city in Europe, Its racial diversity is more challenging to quantify due to French law, which prohibits distinguishing between people on the basis of race or religion. This ‘colour-blind’ model of public policy largely limits policies targeted at racial or ethnic groups, as well as research into population differences and disparities.

The city is highly segregated by both race and income. The western neighbourhoods are inhabited by affluent French-Parisians or international elites, while the southern and north-eastern suburbs (banlieues) are home to a high proportion of residents of foreign origin, and also have high levels of crime, unemployment and social deprivation.

Healthcare in France is well-regarded and designed to provide accessible medical treatment to all through scaled government reimbursements for healthcare costs. Nevertheless, state bureaucracy and the system of co-payments can ostracise the more deprived residents and recent immigrants. Additionally, healthcare providers have increasingly concentrated in more affluent sections of the city, requiring poorer residents to travel greater distances to receive specialised care.

Paris in numbers

12.1m

people living in Paris

20%

of the population of Paris were born outside of France

150+

nationalities are represented within the wider city

Devolving power through participatory budgeting

One of Paris’s approaches to addressing urban health is devolving power. The city does this by enabling people across the city to make decisions about how public money is spent. We saw that the city chose to support projects focused on health improvements, not only in their own neighbourhoods, but city-wide.

Between 2014 and 2020, the City of Paris committed 500 million euros of public money (about 5% of the city’s capital fund) to be spent on projects chosen by the city’s residents. Participatory budgeting is open to everybody in Paris, regardless of age, nationality or documentation. It enables people to make decisions on how public money is spent, to develop proposals for their city and to communicate with the administration and municipal service experts.

Each of Paris’s twenty Districts decide on local projects, as well as one city-wide initiative. There is also a commitment to direct 30 million euros into working-class neighbourhoods in the city.

How has this approach supported improvements in health?

Analysis of the projects shows that they are spread over the entire territory of Paris, with a high concentration in the lower income areas of central Paris and fewer projects in affluent neighbourhoods of West Paris.

Successful health related projects include:

3000 survival and health kits distributed to the homeless
Establishing a refuge shelter for migrants
New public gardens and pedestrian areas
More co-working spaces and sports facilities

Political leadership was key to this initiative’s success. The Mayor of Paris was a strong advocate of the approach, throwing weight behind it and enabling those delivering it to push the boundaries. The City realised it was important not only to inform people about the initiative, but to engage them at every stage, so they used existing community networks to provide clear feedback about the chosen projects.

A key reflection of this project was that, when given the choice, people often direct resources to neighbourhoods with the greatest levels of need. People voted for projects even if they didn’t live there. They didn’t want to just improve their own street; they want to improve the whole city.

We worked with a community-based organisation who became our ambassadors in the field. We were committed to answering everybody...it’s important that you let people know that new things in the city are thanks to them.

Julien Antelin Formerly chief of staff for the Deputy Mayor of Paris

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