From individual to collective ethics. Various historical round-ups of public health. Which practices and issues?

In France advances in medicine have addressed more clinical services than p ublic health or sanitary conditions. However, relationships induced between organization of life in society and health expenditures should be consider ed. Public policies have favoured verification, obligations and sanctions i n the field of public health. Sanitary sanctions have prevailed over preven tive medicine. Prevention, however, while essential for individuals, also b enefits the community. Active help and solidarity usurp the logic of the ri ght to have access to health care. The current trends of aid and solidarity undermine the logic of the right to health; this tendancy may work to bene fit insurance systems and reinforce the risks of exclusion. Clinicians have a commitment to means, while public health physicians have a commitment to results. However, to obtain results the latter may have to rely on informa tion issued from social and medical data that sometimes conflict with confi dentiality. In order to optimize management of medical and social data, dev elopment of information systems is in progress. Collective needs gradually leave aside personal interests and confidentiality. Consequently, databases are potential sources of data files truly related to social exclusion, and at the very least are questionable with regard to individual liberty. Publ ic health was successful in its fight against great epidemics. II has also identified and decreased morbidity factors, but has been, however, unable t o reduce disparities in the access. to health care.