Politiques sociales : un enjeu de santé publique ?

Les recherches sur les déterminants sociaux de la santé laissent dans l’ombre les effets des politiques sociales sur les inégalités de santé. Pourtant, le soutien que représentent ces politiques pour une grande partie de la population a pour but, entre autres finalités, de remédier aux inégalités inhérentes aux sociétés capitalistes. Cet article vise à démontrer que les politiques sociales, en l’occurrence les politiques familiales, ont une incidence sur le statut socioéconomique des individus et sur les inégalités sociales de santé.Research on the social determinants of health does not often spotlight social policies’ effects on health inequalities. Yet, the support that such policies provide to a large part of the population is intended, among other things, to reduce the inequalities inherent to capitalist society. This article documents the ways that social policy in general and family policy in particular have consequences for individuals and for social inequalities of health

Intoxication à l'alcool et contraintes psychosociales au travail : l'impact des conditions de travail stressantes et aliénantes

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

Poster Introductions I--Socioeconomic Inequalities in Health and the Welfare State: A Research Synthesis

Research on the social determinants of health and health inequalities has drawn increasingly from the comparative social policy literature. Much of this research relies on one welfare regime typology, but there is a need to systematically review the efficacy of this and alternative approaches if we are to advance research in this area and provide state-of-the-art information to policy makers. Our paper presents the findings of a critical review of the public health literature on socioeconomic inequalities in health and the welfare state. In addition to synthesizing existing research, we identify knowledge gaps, and address the research and policy implications of existing work. Sarah Brennenstuhl is a 2nd year Ph.D. student at the Dalla Lana School of Public Health, University of Toronto. Sarah\u27s general research interests are the structural determinants of women\u27s health. For her dissertation work, Sarah plans to looks at how the structural changes associated with the dominant political ideology of neo-liberalism have impacted uniquely on women\u27s health in Canada. Peggy McDonough is an Associate Professor in the Dalla Lana School of Public Health at the University of Toronto. Her research interests in social inequalities in health and women’s health have led her recently to incorporate a comparative welfare state dimension in her studies. Amélie Quesnel-Vallée, PhD, is Assistant Professor at McGill University, where she holds an Arts and Medicine cross-faculty appointment in the Departments of Sociology and of Epidemiology. She also heads the International Research Infrastructure on Social inequalities in health (IRIS), funded by the Canada Foundation for Innovation Leaders Opportunity Fund. In 2005, she received the American Sociological Association Dissertation Award for her Fulbright-funded doctoral research. She currently studies the impact of public policies on health inequalities in 21 OECD countries. Her work recently appeared in a book she co-edited, Le privé dans la santé : Les discours et les faits (Presses de l’Université de Montréal, 2008

Work and pay in flexible and regulated labor markets: A generalized perspective on institutional evolution and inequality trends in Europe and the US

In den letzten Jahren hat sich eine unified theory aus der Arbeitsökonomik heraus-gebildet, in der die Meinung vorherrscht, dass die Kombination makroökonomi- scher Schocks und flexibler Arbeitsmarktinstitutionen in den USA eine starke Zu-nahme der Lohnungleichheit verursacht habe, während die gleichen Schocks in Europa vor allem für gering qualifizierte Arbeitnehmer eine hohe Arbeitslosigkeit und geringe Beschäftigungsniveaus gebracht hätten als (unerwünschter) Nebeneffekt der durch die strikten institutionellen Regelungen des Arbeitsmarkts in Europa rigiden Löhne. In der vorliegenden Analyse wird hingegen argumentiert, dass Institutionen in Europa eigene Formen der Flexibilität entwickelt hätten, die im Gefolge der in der unified theory beschriebenen Schocks ebenfalls zu einer zunehmenden Un-gleichheit in Europa geführt hätten, aber eben in anderer Gestalt. In Frankreich sei beispielsweise die Ungleichheit bei der Arbeitsplatzsicherheit schneller gewachsen als in den USA. Darüber hinaus hätten Entwicklungen auf dem französischen Ar-beitsmarkt dazu geführt, dass sich gering qualifizierte Arbeitnehmer in unsicheren Beschäftigungsverhältnissen konzentrierten. -- In recent years a unified theory has emerged out of labor economics, which argues that a combination of macroeconomic shocks and flexible labor market institutions in the U.S. has produced strong upward trends in wage inequality, while these same shocks have produced high unemployment and low employment growth in Europe as a side effect of the wage stability preserved by that continents rigid labor market in-stitutions. This paper argues instead that European institutions in fact have evolved their own form of flexibility, which, in combination with the macroeconomic shocks described in the unified theory, have also led to rising inequality in Europe, but of a different form. Taking France as an example, inequality of employment security has risen faster here than in the U.S. Furthermore, trends in the French labor market have led to increased concentration of low-skill workers in these insecure job statuses. These results challenge the view that unemployment is the main mecha-nism through which European labor markets absorbed asymmetric shocks to their demand for labor. They also challenge the view that Europeans have intolerance for inequality, but instead suggest that the main difference between the two sides of the Atlantic concerns the nature of the inequalities that each society is willing to tolerate.

Health Inequalities Among Older Adults In Developed Countries: Reconciling Theories and Policy Approaches

Policies that are meant to support older people in Canada might worsen inequalities. Increasingly privatized pension schemes and lack of subsidized support services disproportionately reward those with the most social and economic means in old age. Those who benefit generally experience better health than those who are disadvantaged. Canada has opportunity to guard against such a skewed impact of programs for the elderly by drawing on approaches developed by the World Health Organization, international examples, and sociological theory and research. These approaches can to help design policies that transcend existing inequalities in older people, fostering more equitable health outcomes

Policy Brief No. 23 - Health Inequalities Among Older Adults: Reconciling Theories and Policy Approaches

Despite universal access to healthcare, there are disparities in older people’s health status in developed countries. These inequalities are rooted in lifelong differences in social and economic status. Government policies to assist older people may end up reinforcing these inequalities if they fail to create a buffer against their effects. However, best case practices and WHO guidance show that policies can also mitigate against the effects of lifelong disadvantage in older age. There is opportunity to design initiatives for older people in Canada that lessen the disparities in health outcomes that we currently see

Income and economic exclusion: do they measure the same concept?

<p>Abstract</p> <p>Introduction</p> <p>In this paper, we create an index of economic exclusion based on validated questionnaires of economic hardship and material deprivation, and examine its association with health in Canada. The main study objective is to determine the extent to which income and this index of economic exclusion index are overlapping measurements of the same concept.</p> <p>Methods</p> <p>We used the Canadian Household Panel Survey Pilot and performed multilevel analysis using a sample of 1588 individuals aged 25 to 64, nested within 975 households.</p> <p>Results</p> <p>While economic exclusion is inversely correlated with both individual and household income, these are not perfectly overlapping constructs. Indeed, not only these indicators weakly correlated, but they also point to slightly different sociodemographic groups at risk of low income and economic exclusion. Furthermore, the respective associations with health are of comparable magnitude, but when these income and economic exclusion indicators are included together in the same model, they point to independent and cumulative, not redundant effects.</p> <p>Conclusions</p> <p>We explicitly distinguish, both conceptually and empirically, between income and economic exclusion, one of the main dimensions of social exclusion. Our results suggest that the economic exclusion index we use measures additional aspects of material deprivation that are not captured by income, such as the effective hardship or level of economic 'well-being'.</p

Work and pay in flexible and regulated labor markets: a generalized perspective on institutional evolution and inequality trends in Europe and the U.S.

"In recent years a 'unified theory' has emerged out of labor economics, which argues that a combination of 'macroeconomic shocks' and flexible labor market institutions in the U.S. has produced strong upward trends in wage inequality, while these same shocks have produced high unemployment and low employment growth in Europe as a side effect of the wage stability preserved by that continent's rigid labor market institutions. This paper argues instead that European institutions in fact have evolved their own form of flexibility, which, in combination with the macroeconomic shocks described in the unified theory, have also led to rising inequality in Europe, but of a different form. Taking France as an example, inequality of employment security has risen faster here than in the U.S. Furthermore, trends in the French labor market have led to increased concentration of low-skill workers in these insecure job statuses. These results challenge the view that unemployment is the main mechanism through which European labor markets absorbed asymmetric shocks to their demand for labor. They also challenge the view that Europeans have intolerance for inequality, but instead suggest that the main difference between the two sides of the Atlantic concerns the nature of the inequalities that each society is willing to tolerate." (author's abstract)"In den letzten Jahren hat sich eine 'unified theory' aus der Arbeitsökonomik herausgebildet, in der die Meinung vorherrscht, dass die Kombination makroökonomischer Schocks und flexibler Arbeitsmarktinstitutionen in den USA eine starke Zunahme der Lohnungleichheit verursacht habe, während die gleichen Schocks in Europa vor allem für gering qualifizierte Arbeitnehmer eine hohe Arbeitslosigkeit und geringe Beschäftigungsniveaus gebracht hätten als (unerwünschter) Nebeneffekt der durch die strikten institutionellen Regelungen des Arbeitsmarkts in Europa rigiden Löhne. In der vorliegenden Analyse wird hingegen argumentiert, dass Institutionen in Europa eigene Formen der Flexibilität entwickelt hätten, die - im Gefolge der in der 'unified theory' beschriebenen Schocks - ebenfalls zu einer zunehmenden Ungleichheit in Europa geführt hätten, aber eben in anderer Gestalt. In Frankreich sei beispielsweise die Ungleichheit bei der Arbeitsplatzsicherheit schneller gewachsen als in den USA. Darüber hinaus hätten Entwicklungen auf dem französischen Arbeitsmarkt dazu geführt, dass sich gering qualifizierte Arbeitnehmer in unsicheren Beschäftigungsverhältnissen konzentrierten. Diese Ergebnisse stellen eine Herausforderung an die Sichtweise dar, dass Arbeitslosigkeit der Hauptmechanismus sei, durch den die europäischen Arbeitsmärkte asymmetrische Schocks auf der Arbeitsnachfrageseite absorbierten. Ebenso wird in Frage gestellt, dass Europa nicht bereit sei, Ungleichheit zu tolerieren; vielmehr wird die Annahme gestützt, dass der Hauptunterschied auf den beiden Seiten des Atlantiks in dem Typus von Ungleichheiten liegt, den die jeweiligen Gesellschaften zu tolerieren bereit sind." (Autorenreferat

Comment favoriser la communication thérapeutique avec une population vulnérable ? Des approches et des outils pour les professionnels prenant en charge les mineurs non accompagnés

En France, les mineurs non accompagnés (MNA) rencontrent de multiples obstacles qui peuvent avoir des effets négatifs sur leur santé mentale. Les professionnels de la santé et du social qui participent à leur prise en charge doivent développer et mettre en œuvre des approches et outils adaptés aux réalités des MNA et qui leur offrent un espace d’interactions le plus ouvert possible. À partir d’une revue de littérature, nous proposons dans cet article de dresser un état des lieux de la santé mentale des MNA, et d’identifier les approches et les outils développés et mis en œuvre par les professionnels qui visent à favoriser la communication et l’expression des MNA (notamment : approche interculturelle, travail en interdisciplinarité, art-thérapie). Nous formulons en conclusion plusieurs pistes de réflexion à l’endroit des professionnels et des pouvoirs publics.In France, unaccompanied minors (UMs) encounter several obstacles that can have negative effects on their mental health. Health and social workers must develop and implement approaches and tools that are adapted to the realities of UMs, and that encourage a space to foster discussions. Based on a review of the literature, this article explores the mental health status and needs of UMs and highlights the approaches and tools developed and implemented by professionals to encourage communication with UMs (e.g., intercultural approach, interdisciplinary work, art therapy). Based on results from the review, we suggest recommendations for professionals and public authorities

Effect of Family Medicine Groups on Visits to the Emergency Department among Diabetics in Quebec between 2000 and 2011: A Population-Based Segmented Regression Analysis of an Interrupted Time Series

Poster Presentation Background: Family Medicine Groups (FMG) were introduced in Quebec in 2002 to reorganize primary care practices and encourage team-based and inter-professional approaches to service delivery. We measured the effect of this reform on the rate of emergency department (ED) visits among patients diagnosed with diabetes. Methods: Administrative databases were used to derive the weekly rate of ED visits between April 1, 2000 and March 31, 2012. We performed an interrupted segmented regression analysis to derive the estimated and extrapolated rates of visits in the years following the initial reform implementation. We employed an outcome control series of diabetics visiting the ED to treat appendicitis to strengthen the study’s internal validity. Results: A gradual decline in the rate of visits was observed for short term diabetes related complications and total ED visits. After 9 years of reform implementation, we observed a reduction of 1.42 and 1.70 ED visits per 10,000 diabetics to treat short term complications in urban and rural areas, respectively. A steady decrease was also observed in the total rate of ED visits in urban areas where we observed a reduction of 6.72 visits per 10,000 diabetics 9 years following the reform. Visits coded for appendicitis showed no clinically relevant changes over the study period. Interpretation: Our results suggest that the decreases in the rate of ED visits are attributed to the implementation of the FMG model across the province. The steady decline in the rate of total ED visits in urban areas is of particular relevance where overutilization of the ED is a problem. Evidence of these decreases despite the low-intensity nature of the FMG reform suggests the potential for this model to act as a future platform for implementing comprehensive care models for chronic disease management