Digital health technologies in the face of social and territorial inequalities: a sociology of comparative public action.

Summary The links between digital health and social and territorial inequalities are rarely studied. On these two markers of health systems and on the digital-inequality coupling, the policies of Western health systems have been even less studied, despite international injunctions to adopt "health (and equity) in all policies" strategies. This thesis studied the actions of governments and other actors involved in this digital-inequity coupling. Rooted in intervention research and political science, it relies on a mainly qualitative methodology of sociology of public action. The comparative analysis of public action between sub-territories in four countries (France, Canada, Spain and England), since 2015, is based on documentary study (official and stakeholder sources) and on interviews with key actors in the fields of digitalization and social inequalities in health. Health digitization policy has become institutionalized to varying degrees, in the four countries studied. However, equity in digital health has not been placed on the political agenda, despite the fact that digital health has the potential to increase inequalities in access, understanding and appropriation of ICT. In the four territories, when it is (rarely) addressed, digital inclusion is done so through a combination of instruments and groups of actors from various forums that co-produce public interventions on digital, inequalities and digital inclusion. Each mode of public action instrumentation varies across territories and is affected by existing local institutions, interests and actors' perceptions of them. This thesis proposes a conceptual framework for public action and policy implementation in digital health and equity in four territories. It is designed to provide keys for policy analysis in other contexts and to suggest strategies that could be implemented in the field.