Individuals living near or with the potential to be affected by the large transportation extensions were invited to a series of focus groups by the Plaine Commune in Paris. The initiative was successful in identifying the wishes and health concerns of the Commune's population.
Problems and Purpose
Plaine Commune, an agglomeration of municipal districts, is situated to the north of Paris and is a mix of disused industrial sites and modern office buildings. As early as 1984, plans to expand and improve the area's infrastructure and public transportation were discussed as a way to improve and revitalize the area’s economy and prestige. A Health Impact Assessment (HIA) was undertaken by the Commune Government and the Regional Health Authority to identify the potential harms imposed by the planned expansions. The HIA was designed to include all affected parties: those most susceptable to negative health outcomes as well as the political marginalized such as immigrants and low-income individuals. The HIA also presented an opportunity to collect feedback on residents' most commonly used forms of transportation.
Background History and Context
The nine communes which together make up Plaine Commune are situated in Seine-Saint-Denis, a department located north of Paris. Traditionally, Plaine Commune has a significant heritage of being a working class suburb. It is defined by its young population and the diversity of their background. Furthermore, a significant part of the population are/were experiencing various social difficulties and the region suffers from a great gap in development between the north and the south of Plaine Commune.
In contrast to this, however, Plaine Commune is considered to be “one of the local areas with the strongest potential for growth and development in the Paris metropolitan area.” It is a part of the Local Area Development Contract (LADC), Contrat de Développement Territorial (CDT) in French, which is associated with the Grand Paris project. One of the LADC’s stated goals is to improve journeys across the local area, and to improve connections to and from Paris. As such, three objectives were set up to achieve that goal: improving the offer and quality of existing public transport and develop new inter-suburb transport networks; decreases the usage of cars in the area; and finally, render the whole area more accessible to cyclists, pedestrians, and public transport users.
This stated goal of the LADC comes against a background of general discontent by the population with the, at the time, current state of public transport. When asked about it, participants described the available means of public transport as insufficient. Access to schools, universities, shops, and other various services were perceived to be difficult by the public. Women in particular did not feel at ease with using public transport late at night on their way home. All participants further raised the point that the costs of public transport were too high. All this had for consequence that people were reduced in their mobility. Improvements of the modes of transport available were thus greatly needed.
Organizing, Supporting, and Funding Entities
The decision to conduct a HIA of the planned projects was taken by Plaine Commune and by the Île-de-France Regional Health Agency (ARS in French), although each had different motivations for supporting the Assessmnet. Plaine Commune wanted transportation development to align with the needs of its citizen. At the time, the Commune was set to become a major transport nexus in the Grand Paris project, undergoing a significant growth in its transport network capabilities. The Commune was concerned that the needs of metropolitans would outweigh those of its citizens and thus saw the HIA as a way to ensure its residents were heard, their voices and concerns reflected and addressed in the final designs. For its part, the Ile-de-France Regional Health Agency (ARS), supported the undertaking of the HIA as part of its general mission to develop advocacy tools to ensure the inclusion of health into considerations regarding urban planning projects and public policies. The HIA presented the Agency with an effective way to reduce social and territorial health inequalities. Both being government organizations, the Plaine Commune and the ARS would have used government and public funds, most likely granted by higher-level bodies.
Participant Recruitment and Selection
As its name implies, a Health Impact Assessment is undertaken to identify the potential health impacts of a project on the immediate population. More specifically, focus is generally put on those at most risk to adverse affects such as youth, elderly, and those living close to the projects under scrutiny. In this case, Plain Commue also sought to involve those who would otherwise not get the opportunity to have their voice heard. In the end, the target populations included: young people, job seekers, immigrants, the elderly, the handicapped, poor households, and lastly, single parents households. These different groups were considered vulnerable for various different reasons, ranging from bad access to educational and sportive facilities, to language and economic difficulties.
These focus groups were recruited through various different organisations and institutions, such as community centres, neighbourhood councils, etc. In Ville de Stains, young girls in the age bracket of 14 to 18 were recruited from a health educational association called ‘Femmes dans la Cité’ (Women in the City). Likewise, another group consisting of women of varying ages and backgrounds were also recruited through ‘Femmes dans la Cité’. In Ville de Villetaneuse, cooperation with the mayor’s office permitted the recruitment of two vulnerable groups, young ones through local youth organizations, and job seekers by refereeing to the employment centre. Further, the decision was also made recruit students from the University of Villetaneuse. Within that group emphasis was put on students who did not live in the local area, found through the student housing organisation ‘Crous’.
The locations of the meeting points for the various focus groups were situated as close as possible to the participants, often in the location of the association they had been recruited through. In this way, travel for the participants was minimized and their participation facilitated.
Methods and Tools Used
The Health Impact Assessment was carried out primarily through focus groups or interviews with dedicated facilitators overseeing discussions, question and answer periods, and feedback and opinion collection. Participants were recruited through a variety of community organizations, each of whom often dedicated a member of its staff to the meetings to act as a 'person of confidence' or mediator between participants (who may not have felt comfortable expressing their opinions or who did not have French as their first language) and facilitators. At least one member of the government and three members of the HIA evaluation team were present to present the transportation plans and their potential impacts and to answer participant questions.
What Went On: Process, Interaction, and Participation
The focus groups consisted of around ten people. In some cases, interviews were held rather that focus groups, according to the number of participants. Participants and the group facilitators were seated in circles or around tables. The number of observers were kept to a minimum; however, those responsible for recruiting the participants, such as leaders of community associations or stakeholder groups, were present at all meetings. Their role was to intervene when necessary and to be a person of confidence for the participators. A member of the local government was also present either at the beginning or throughout the meetings to present the HIA's objective and, ostensibly, to answer questions.
Members of the HIA evaluation team were also present during the meeting. Usually this team consisted of three people; one to lead the debate, and two who were responsible for note taking. All meetings, with the authorisation of the participants, were recorded. This recordings were all destroyed at the end of the study.
Influence, Outcomes, and Effects
In the end, various recommendations were made, factoring in the data results from the inhabitants’ participation. The different focus groups were also revisited after the study to further allow them the opportunity to put in their recommendations. The three different public transport expansions were all given the green light to go through, so the local population’s participation lead to real world consequences in their local communities. Further, all recommendations were marked with an ‘O’ or ‘N’ (‘Oui’/’Non’, ‘Yes’/’No’ in French) to show whether these were recommendations which had been made with the involvement of the participants (see the tables on pp. 218-256). Interesting to note is also that some of these recommendations have been able to be put to use in other projects of a similar type, both elsewhere in France and abroad.
Analysis and Lessons Learned
Seemingly, the whole process and the participatory inclusion of the habitants of Plaine Ville seems to have been a success. Multiple recommendations were made and not only were the participants’ opinions included, it was further pointed which recommendations had been made with or without them, emphasizing the importance of their inclusion. Their inclusion further allowed the stakeholders to be informed of the opinions and situations of some of the most vulnerable members of society, in addition to identifying them in the first place. The various needs of these vulnerable groups served to alter certain recommendations as appropriate.
Further, the HIA has initiated a greater process of empowerment. Through the associations of the participants, they were given the chance to make their voice heard and to discuss and deliberate with other societal groups, which they normally may not have much contact with.
According to Pateman, democracy is essentially a process belonging to the people. That is to say, they are the main actors in it. Within this framing, the HIA conducted by Plaine Commune seems like a good example of that. The people concerned were consulted and their opinions were seriously taken to heart. What’s interesting here is to put it against the background of general French politics. With a great emphasis on representational democracy, its role is often seen as protecting the general interest against that of individuals and groups. Often the involvement of societal groups in decision-making is seen as encroaching on public power for the benefit of only certain parts of the public. As such, Plaine Commune’s decision only to target certain groups, rather than an average of the habitants, could be seen as a confirmation of this fear. However, France is not foreign to direct participatory democracy. A number of laws from the 1990s invited and made compulsory the consultation of affected citizens when it comes to infrastructure projects.
Worth noting is that in Southern Europe, including France, democratic participation is more developed on the local rather than at the national level, and that on the local level it is often the initiative of left-wing local governments. This fits well with Paris, and France, voting for the French Socialist party in the 2012 election. Accordingly, Plaine Commune would have been under a socialist government in 2014 when the HIA was made. Further, Plaine Communes’ use of democratic participation fits into the narrative of participation being used to strengthen local communities and increasing solidarity within the area. It would also have served to empower an low-income district, as recommended by many French experts in urban policy.
Lastly, the whole project was mentioned in the newspaper Le Parisien. Their article also presents the HIA as having done well, focusing on the great role health has taken in urban planning.
Q&A With Experts and Officials
 Laporte, Anne, and Muriel Dubreuil. Health Impact Assessment Of Transport Projects For Plaine Commune (Summary). Ebook. Paris: Agence Régionale de Santé (ARS – Regional Health Agency) Île-de-France, Observatoire Régional de la Santé (ORS – Regional Health Observatory) Île-de-France, 2014. http://healthimpactassessment.blogspot.co.uk/2015/07/hia-of-transport-projects-for-plaine.html. 26-27.
 Ibid, p. 1.
 Laporte, Anne, and Muriel Dubreuil. Évaluation Des Impacts Sur La Santé De Projets Transport De Plaine Commune. Ebook. Paris: Agence régionale de santé (ARS) Île-de-France, Observatoire régional de la santé (ORS) Île-de-France, 2014. https://www.iledefrance.ars.sante.fr/sites/default/files/2017-02/EIS-plaine-commune-rapport-integral.pdf. 17.
 Laporte and Dubreuil, Health Impact Assessment Of Transport Projects For Plaine Commune (Summary), p. 27.
 Laporte and Dubreuil, Évaluation Des Impacts Sur La Santé De Projets Transport De Plaine Commune, p. 17.
 Laporte and Dubreuil, Évaluation Des Impacts Sur La Santé De Projets Transport De Plaine Commune, pp. 100-102.
 Laporte and Dubreuil, Health Impact Assessment Of Transport Projects For Plaine Commune (Summary), p. 19.
 Laporte and Dubreuil, Évaluation Des Impacts Sur La Santé De Projets Transport De Plaine Commune, p. 288.
 Ibid, p. 288.
 Ibid, p. 286.
 Ibid, p. 286.
 Ibid, p. 286.
 Laporte and Dubreuil, Health Impact Assessment Of Transport Projects For Plaine Commune (Summary), p. 19.
 Laporte and Dubreuil, Évaluation Des Impacts Sur La Santé De Projets Transport De Plaine Commune, p. 217.
 Ibid, p. 264.
 Ibid, p. 264.
 Pateman, Carole. Participation And Democratic Theory. Cambridge: Cambridge University Press, 1970.
 Saurugger, Sabine. "Democratic ‘Misfit’? Conceptions Of Civil Society Participation In France And The European Union". Political Studies 55, no. 2 (2007): 384-404. doi:10.1111/j.1467-9248.2007.00662.x.
 Ibid, pp. 393-394.
 della Porta, Donatella, Yves Sintomer, and Joan Font. Participatory Democracy In Southern Europe: Causes, Characteristics And Consequences. London: Rowman and Littlefield International, 2014.
 "Résultats De L'élection Présidentielle 2012". Http://Www.Interieur.Gouv.Fr/Elections/Les-Resultats/Presidentielles/Elecresult__PR2012, 2017. https://www.interieur.gouv.fr/Elections/Les-resultats/Presidentielles/elecresult__PR2012/(path)/PR2012/011/011.html.
 della Porta, Sintomer and Font, Participatory Democracy In Southern Europe, p. 28.
 Talpin, Julien. Mobilizing People In Low-Income Neighbourhoods: The Virtues And Ambiguities Of Community Organizing. Ebook. Books and Ideas, 2015. http://www.booksandideas.net/Mobilizing-People-in-Low-Income-Neighbourhoods.html.
 "Ces Projets De Transports Sont-Ils Bons Pour La Santé ?". Leparisien.Fr, 2014. http://www.leparisien.fr/espace-premium/seine-saint-denis-93/ces-projets-de-transports-sont-ils-bons-pour-la-sante-19-11-2014-4302869.php.