Abstract
Based on socio-historical fieldwork in France and the United States, this paper shows the ways in which a body of knowledge that originated in the United States—applied epidemiology—was successfully institutionalized in France initially by means of a private training structure for health professionals, The Institute for the Development of Applied Epidemiology, backed by a coalition that included “marginal actors within the state,” a private foundation, and an American agency. The reform of the French “health state” took on specific features in this case. Its initial model was that of American philanthropic foundations. It then took concrete form as an agency, the National Network for Public Health, which made it possible for knowledge to penetrate public policy decision-making circles. This penetration did not follow a centrifugal logic based on the fragmentation of public administration following the precepts of new public management, but rather a centripetal one. The agency framework allowed for a period of acclimatization of a body of knowledge that was initially seen as new, foreign, and lacking in legitimacy, at the boundaries of the state prior to a more explicit period of institutionalization and bureaucratization in the context of a formal public administrative body: the National Institute for Health Surveillance.