National models of policy adaptation: facing an epidemic in France, Great Britain, Germany, Italy.

The aids epidemic has confronted the health systems with problems for which they were badly-prepared, thus explaining the controversy over the role of the State and the public intervention methods. In the European welfare sta tes, only medical treatment could be adequately catered for by the existing institutional structures. Prevention, however, required the development of new structures and approaches, taking into account the lateral coordinatio n of policies, the specific situation of socially underprivileged populatio ns and the border line between what was considered as private and what as p ublic issues. This article analyses how the different health systems in Eur ope responded to the challenge of the epidemic. It elaborates the national models of institutional change, which emerged with the epidemic but whose o bjectives reach beyond it to aim at sustainable public health policies.