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For the past two decades, prevention has been considered an absolute priority in the French health system reforms. However, the process has been slow. Striking social inequalities in health is still a characteristic of the “French paradox”: good medical care and high social inequalities.. Prevention in the health sector cannot be simply decreed. It requires articulation between the local and the national levels, strong incentives for both users and health professionals and must be based on evaluations. However, the standardization of institutional and scientific evaluation procedures has encouraged the use of “ex post” approaches and has prevented the “ex ante” option. This article suggests a wider use of that method in order to choose efficient methods able to reduce health inequalities. JEL Codes: I11, I12.