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 states, 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 coordination of policies, the specific situation of socially underprivileged populations and the border line between what was considered as private and what as public issues. This article analyses how the different health systems in Europe responded to the challenge of the epidemic. It elaborates the national models of institutional change, which emerged with the epidemic but whose objectives reach beyond it to aim at sustainable public health policies.