Background ‘Health2020’ highlights the role of institutions for tackling the social inequalities in health. In France, the Regional Health Agencies manage the health and social care sector and the prevention and health promotion programs and policies. Since 2009, they are assigned to tackle the social inequalities in health. This communication explores how actors from these Agencies and local consultative assemblies see the role and action of their institution on the social inequalities in health. It presents the first results of an exploratory study conducted in an Agency (area of 3 300 000 inhabitants). Method A qualitative study, using a documentation content analyses and semi-directive interviews with 35 actors selected on the basis of a convenience sample has been conducted in 2014–15. They were chosen to reflect on the organization of the institution (health care, social care, public health, general and strategic affairs, assembly), at the regional and local levels. Content analyses were conducted with the NVivo10 software. Results As shown by the documents content analysis, actors differently positioned in the Agency and their assemblies take the social inequalities in health into account when they edict a policy document. However, interviews analyses show that actors have various visions of reality and definition of social inequalities in health. The main levers of action are considered to be the health professionals and the actors of the health system. Thus, it does also involve material and non-material incentives aiming at reorienting the health care system by using prevention and health promotion as indirect levers of action. Conclusion Although the social inequalities in health seem to concern the actors, their conceptions of actions tackling the social inequalities in health are much contrasted. But, the levers described during this study show a consistent and shared political vision which puts forward the notion of equity through innovative programs.