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Émilie Bérard and Emmanuel Vigneron continue their deliberations on medical deserts in France, a topic first broached in our two previous issues. After a first instalment illustrating the notion of medical desert over a long timescale, and a second one offering a topography of the French medical desert, their aim now is to identify the underlying factors. How did we get to this point in France—both historically and more recently? How has the dimension of local provision, ess­ential for an effective care pathway, come to be neglected to this extent?Given the evidence of how health care provision has deteriorated over time, what are the conceptual failings we must address to remedy the situation—and what strategy should be adopted? The authors identify at least five conceptual failings. 1) The doctor must no longer stand alone at the centre of the system; health is everyone’s business. 2) Not all health provision can be present everywhere in sufficient quality; there is, then, an issue of access and regional planning that is central to the battle against medical deserts. 3) Prevention isn’t something that occurs naturally; it needs to be encouraged and extended wherever possible. 4) Health information and education services need to be bolstered. 5) The medical world needs to master, and commit to, the use of new technologies. Émilie Bérard and Emmanuel Vigneron identify three major levers with which to address these five strategic subject heads: cultivating the scientific spirit; establishing a graduated system of care combined with effective patient flow; and developing health education generally throughout the population.