Modèle individuel, modèle médical, modèle social : la question du sujet

International audienceTo cite this version: Jean-François Ravaud. Modèle individuel, modèle médical, modèle social : la question du sujet. Handicap Revue de sciences humaines et sociales, CTNERHI 1999, pp.64-75. hal-0226428

PPF PHS – Handicap et sciences sociales

Isabelle Ville, Jean-François Ravaud, directeurs de recherche à l’INSERMEmmanuelle Fillion, maître de conférences à l’Université de Bretagne Occidentale Mobilisations et identités collectives dans le champ du handicap et de la santé Ce séminaire inauguré cette année s’est déroulé à la Maison des sciences sociales du handicap récemment créée. Une traduction en langue des signes était assurée ainsi que l’accessibilité de la salle. Les trois premières séances ont posé le cadre historique et théo..

Handicap et sciences sociales

Jean-François Ravaud, directeur de recherche à l’INSERMIsabelle Ville, chargée de recherche à l’INSERMMyriam Winance, chargée de recherche au CNRS Le handicap : histoire politique, pratiques sociales et expériences intersubjectives Le séminaire a abordé la catégorie contemporaine du handicap en l’inscrivant dans une histoire longue afin d’en dégager les évolutions et les permanences notamment dans les rapports qu’elle entretient avec la pauvreté et l’assistance d’une part, le travail d’autre ..

Frequency of low back pain among men and women aged 30 to 64 years in France. Results of two national surveys.

International audienceINTRODUCTION: In France, most studies of low back pain (LBP) have been carried out among workers or patients. Until very recently, the frequency of LBP in the general population was not known, because National Health Surveys did not include questions on LBP. OBJECTIVE: To estimate the prevalence of LBP in the French population aged 30 to 64 years. MATERIALS AND METHODS: The main data were from the National Health Survey 2002-2003 (n=14,248). LBP was assessed by an accompanying self-administered questionnaire asking details about duration of LBP in the previous 12 months. Weights were used to estimate the prevalence of LBP in the French population, with two definitions of LBP. Additional results dealing with chronic LBP, from another national survey (Handicap, Disability and Dependence), are also briefly presented. RESULTS: More than half of the French population in this age group experienced LBP at least one day in the previous 12 months (LBP1), with 17% experiencing LBP for more than 30 days in the previous 12 months (LBP30); prevalence differed between men and women and that of LBP30 increased with age. DISCUSSION-CONCLUSION: The prevalence of LBP as assessed by the National Health Survey is similar to that found in countries other than France. These estimates can be used as a reference for surveys in specific populations, provided that comparable methodologies are used

Associations of social and material deprivation with tobacco, alcohol, and psychotropic drug use, and gender: a population-based study

International audienceBACKGROUND: The aim was to assess the relationships between social and material deprivation and the use of tobacco, excessive alcohol and psychotropic drugs by both sexes and in various age groups. Greater knowledge concerning these issues may help public health policy-makers design more effective means of preventing substance abuse. METHODS: The sample comprised 6,216 people aged > or 15 years randomly selected from the population in north-eastern France. Subjects completed a post-mailed questionnaire covering socio-demographic characteristics, occupation, employment, income, smoking habit, alcohol abuse and "psychotropic" drug intake (for headache, tiredness, nervousness, anxiety, insomnia). A deprivation score (D) was defined by the cumulative number of: low educational level, manual worker, unemployed, living alone, nationality other than western European, low income, and non-home-ownership. Data were analysed using adjusted odds ratios (ORa) computed with logistic models. RESULTS: Deprivation was common: 37.4% of respondents fell into category D = 1, 21.2% into D = 2, and 10.0% into D > or 3a re men than women reported tobacco use (30.2% vs. 21.9%) and alcohol abuse (12.5% vs. 3.3%), whereas psychotropic drug use was more common among women (23.8% vs. 41.0%). Increasing levels of deprivation were associated with a greater likelihood of tobacco use (ORa vs. D = 0: 1.16 in D = 1, 1.49 in D = 2, and 1.93 in D > or = 3), alcohol abuse (1.19 in D = 1, 1.32 in D = 2, and 1.80 in D > or = 3) and frequent psychotropic drug intake (1.26 in D = 1, 1.51 in D = 2, and 1.91 in D > or = 3). These patterns were observed in working/other non-retired men and women (except for alcohol abuse in women). Among retired people, deprivation was associated with tobacco and psychotropic drug use only in men. CONCLUSION: Preventive measures should be designed to improve work conditions, reduce deprivation, and help deprived populations to be more aware of risk and to find remedial measures

Disability Policies in France: Changes and Tensions between the Category-based, Universalist and Personalized Approaches

In this article, the authors show that the current French disability policy is traversed by conflicts between three different approaches to disability which came about at different periods in history. They begin by looking at the origins of disability policy in France. This policy was developed during the 20th century, from notions of repair, indemnification and compensation through rehabilitation. It became institutionalized in 1975, when two laws were passed, giving it the form of a category-based policy. Between 1970 and 2000, affected by the international situation, this policy came into conflict with a universalist policy. More recently there has been a desire to develop a personalized approach. Finally, the authors use two examples (taken from recent debates on the implementation in France of the new law of 11 February 2005) to show the tensions that have led to the coexistence of these three approaches within current disability policy

Prevalence of impairments, disabilities, handicaps and quality of life in the general population: a review of recent literature

International audienc

Knee Arthroplasty: Disabilities in Comparison to the General Population and to Hip Arthroplasty Using a French National Longitudinal Survey

International audienceBACKGROUND: Knee arthroplasty is increasing exponentially due to the aging of the population and to the broadening of indications. We aimed to compare physical disability and its evolution over two years in people with knee arthroplasty to that in the general population. A secondary objective was to compare the level of disabilities of people with knee to people with hip arthroplasty. METHODOLOGY/PRINCIPAL FINDINGS: 16,945 people representative of the French population were selected in 1999 from the French census and interviewed about their level of disability. This sample included 815 people with lower limb arthroplasty. In 2001, 608 of them were re-interviewed, among whom 134 had knee arthroplasty. Among the other participants re-interviewed, we identified 68 who had undergone knee arthroplasty and 145 hip arthroplasty within the last two years (recent arthroplasty). People with knee arthroplasty reported significantly greater difficulties than the general population with bending forward (odds ratio [OR] = 4.7; 95% confidence interval [CI]: 1.7, 12.6), walking more than 500 meters (OR = 6.0; 95% CI: 1.5, 24.7) and carrying 5 kg kilograms for 10 meters (OR = 4.6; 95% CI: 1.3, 16.4). However, the two years evolution in disability was similar to that in the general population for most activities. The level of mobility was similar between people with recent knee arthroplasty and those with recent hip arthroplasty. Nevertheless, people with recent knee arthroplasty reported a lower level of disability than the other group for washing and bending forward (OR = 0.3; 95% CI: 0.1, 0.6 and OR = 0.4; 95% CI: 0.1, 0.9, respectively). CONCLUSIONS/SIGNIFICANCE: People with knee arthroplasty reported a higher risk of disability than the general population for common activities of daily living but a similar evolution. There was no relevant difference between recent knee and hip arthroplasties for mobility

3 questions à Jean-François Ravaud sur ALTER (Société Européenne de Recherche sur le Handicap/European Society of Disability Research)

https://www.cfhe.org/3-questions-a-jean-francois-ravaud/Pouvez-vous présenter ALTER, l'association et ses activités (revue, conférence) ? L'association Alter est une société savante créée à Paris en 1989 sous l'impulsion d'Henri-Jacques STIKER. Ce terme latin avait été choisi pour englober différentes approches de l'altérité, de la vulnérabilité, de la marginalité et reflétait la polysémie de notions voisines à une époque où la thématique du handicap ne s'était pas encore imposée dans le champ académique. L'importance de la perspective historique était affirmée dans le titre Société Internationale pour l'Histoire des infirmités, déficiences, inadaptations, handicaps, etc… et cette énumération de termes qui le composait. Alter avait pour objet de créer un espace pour étudier l'histoire des altérités. Après avoir organisé un certain nombre de rencontres et d'événements scientifiques en France, en particulier dans le champ de l'histoire, et réalisé plusieurs publications 1. Alter a pris une dimension internationale et fait évoluer ses missions

Définition, classification et épidémiologie du handicap

International audienceHow can we define disability and handicap? What are their different forms? What are the figures for the persons concerned? This paper reviews the key conceptual advances and classification developments as well as new French nationwide surveys on disability. Any attempt at defining what is handicap gives rise to heated debates. This layman word initially originating from the turf language has been prevailing in the medico-social field for the last fifty years. The French 2005 Law on disability has now provided a legal definition inspired by the recommendations of the World Health Organization (WHO). For thirty years, following the pioneering work of Wood, international classifications of disability have been an important activity within the WHO, thus revealing a growing interest for the consequences of health conditions. Following the ICIDH in 1980, WHO has moved towards an interactive model with ICF in 2001. Finally, disability issues open to new directions for epidemiology. In France, the investigations of the INSEE (National Institute on Statistics and Economic Studies), the HID survey "Disabilities-Impairments-Dependence", and tomorrow's "Disability-Health survey, bring issues of disabilities and loss of autonomy at the core of their concerns and allow for a better epidemiologic knowledge of the many faces of the disabled population.Qu'est-ce que le handicap ? Quelles en sont les différentes formes ? Combien sont les personnes concernées ? Cet article fait le point sur les principales avancées conceptuelles et classificatoires ainsi que sur les nouvelles enquêtes nationales sur le handicap. Définir le handicap suscite des débats intenses. Terme du langage courant issu du turf, son usage s'est imposé dans le domaine médicosocial depuis 50 ans. La loi de 2005 lui apporte depuis peu une définition légale s'inspirant des recommandations de l'Organisation mondiale de la santé (OMS), Depuis 30 ans, suite aux travaux de Wood, les classifications internationales du handicap ont fait l'objet d'une activité importante au sein de l'OMS, marquant un intérêt croissant pour les conséquences des problèmes de santé. Après la Classification internationale des déficiences, incapacités et handicaps (CIDIH) en 1980, l'OMS a évolué vers un modèle interactif, avec la Classification internationale du fonctionnement, du handicap et de la santé (CIF) en 2001. Enfin, les questions de handicap ouvrent à des orientations nouvelles pour l'épidémiologie. En France, les enquêtes Handicaps-Incapacités-Dépendance et demain l'enquête Handicap-Santé de l'Institut national de la statistique et des études économiques (INSEE) mettent les questions des incapacités et de la perte d'autonomie au centre de leurs préoccupations et permettent une meilleure connaissance épidémiologique des multiples visages de la population handicapée