« Ils sont terrifiés par la médecine occidentale »

Les discours accusatoires sont une dynamique récurrente dans l’histoire des épidémies. Si les études sur le sujet ont tendance à recenser des figures du blâme et montrer en quoi leur accusation renforce des enjeux sociaux préexistants, cette recherche ajoute une perspective complémentaire à ce corpus d’écrits en analysant le travail rhétorique de la production du blâme. À partir du concept de cadres, elle s’intéresse aux logiques argumentatives sous-jacentes aux accusations déployées dans le débat thanatologique lors de l’épidémie Ebola 2013-2016. Notre analyse des commentaires sur Facebook et Twitter indique que cinq cadres accusatoires justifient le déploiement de discours entourant les pratiques funéraires traditionnelles : l’opposition religion – science; l’inaction et l’irresponsabilité; les cultures locales/africaines; la corruption; et la pauvreté. Ces cadres sont appuyés par les autorités sanitaires et les médias, dont les discours sont remis en circulation par les usagers de médias sociaux afin de justifier leurs arguments accusatoires. L’analyse montre que l’usage de ces schèmes et le choix de figures du blâme privilégiées varient selon l’ancrage géographique des usagers de médias sociaux. Une lecture transversale des résultats indique que les cadres accusatoires mobilisent l’« irrationalité » des accusés, et qu’ils ciblent des figures récurrentes, notamment le continent africain et ses habitants. Nous émettons l’hypothèse que ces discours réarticulent des normes et craintes qui vont au-delà de la peur de la maladie et de l’Autre. Ils sont aussi ancrés dans des frustrations préexistantes et réarticulent une préoccupation contemporaine à l’égard de la « désinformation ». En guise de conclusion, nous suggérons des pistes de réflexion pour les stratégies de communication en ligne.Accusatory discourses are a recurring dynamic in the history of epidemics. Previous studies tend to explore figures of blame and show how their accusation reinforces social issues. This research adds a complementary perspective to this body of work by analysing the rhetorical work associated with the production of blame. Drawing on the concept of frames, it is interested in the argumentative logics underlying the accusations circulating in the thanatological debate during the 2013-2016 Ebola epidemic. Our analysis of comments published on Facebook and Twitter indicates that five accusatory frames justified the use of accusatory discourses surrounding traditional funeral practices: a religion-science opposition; inaction and irresponsibility; local/African cultures; corruption; and poverty. These frames are sustained by health authorities and the media, because social media users share and rely on both institutions’ discourses to justify their accusatory arguments. Our analysis shows that the use of these frames and the chosen figures of blame vary according to social media users’ geographical ties. A transversal reading of the results indicates that the accusatory frames argue the “irrationality” of the accused, and that they target recurring figures of blame, namely the African continent and its inhabitants. We postulate that these discourses rearticulate norms and preoccupations that are beyond the fear of the disease and of the Other. They are also situated in pre-existing frustrations and rearticulate a contemporary preoccupation relating to “disinformation”. In conclusion, we present points for reflection to improve online communication strategies

A salutogenic approach to disaster recovery: the case of the Lac-Mégantic rail disaster

In July 2013, a train carrying crude oil derailed in Lac-Mégantic (Canada). This disaster provoked a major fire, 47 deaths, the destruction of 44 buildings, a massive evacuation, and an unparalleled oil spill. Since 2013, Public Health has undertaken several actions to address this challenging situation, using both quantitative and qualitative methods. Community-based surveys were conducted in Lac-Mégantic in 2014, 2015 and 2018. The first two surveys showed persistent and widespread health needs. Inspired by a salutogenic approach, Public Health has shifted its focus from health protection to health promotion. In 2016, a Day of Reflection was organized during which a map of community assets and an action plan for the community recovery were co-constructed with local stakeholders. The creation of an Outreach Team is an important outcome of this collective reflection. This team aims to enhance resilience and adaptive capacity. Several promising initiatives arose from the action plan—all of which greatly contributed to mobilize the community. Interestingly, the 2018 survey suggests that the situation is now evolving positively. This case study stresses the importance of recognizing community members as assets, rather than victims, and seeking a better balance between health protection and health promotion approaches

The “Lac-Mégantic tragedy” seen through the lens of the EnRiCH community resilience framework for high-risk populations

Setting : On July 6, 2013, a train carrying oil derailed in downtown Lac-Mégantic (Quebec, Canada), causing major human, environmental, and economic impacts. We aim to describe, and learn from, public health strategies developed to enhance community resilience following the train derailment though the lens of the EnRiCH Community Resilience Framework for High-Risk Populations. Intervention : Annual population-level surveys were conducted in Lac-Mégantic and surrounding areas to assess the long-term impacts of the disaster. Findings suggested that a solid upstream investment towards the development of adaptive capacity was needed. A “Day of Reflection” bringing together local stakeholders and citizens was organized, inspiring the elaboration of an innovative action plan. Leaders advocated for funding to support its implementation, leading to a substantial investment from the provincial government. Through a wide range of actions, the plan aims to bring psychosocial services closer to people, stay connected with the community, and foster community engagement. Outcomes : Several lessons have been identified. After a disaster, there needs to be a balanced focus between the gaps/needs and strengths/capacities of a community. Moreover, public health actors must collaborate closely, all along the continuum of the upstream-downstream paradigm, with local organizations and citizens. Implications : This unique experience, supported by an empirically-based framework, suggests that three vital ingredients are required for success in recovering from a disaster: (1) fostering community strengths and valuing citizen participation, (2) a strong political commitment to support upstream actions, and (3) a public health team able to support these actions. Contexte : Le 6 juillet 2013, un train transportant du pétrole déraillait au centre-ville de Lac-Mégantic (Québec, Canada), causant des impacts majeurs sur le plan humain, environnemental et économique. Notre objectif est de décrire les stratégies de santé publique développées pour favoriser la résilience communautaire suivant la tragédie ferroviaire et d’en tirer des leçons, à travers la lentille du « EnRiCH Community Resilience Framework for High-Risk Populations ». Intervention : Des enquêtes populationnelles ont été réalisées annuellement à Lac-Mégantic et les environs pour examiner les conséquences à long terme de la catastrophe. Les résultats suggèrent qu’un important effort en amont était nécessaire afin de développer la capacité d’adaptation. Une journée de réflexion rassemblant des partenaires locaux et des citoyens a été organisée, inspirant l’élaboration d’un plan d’action innovant. Les leaders ont plaidé pour l’obtention d’un financement afin de soutenir son implantation, ce qui a mené à un investissement substantiel du gouvernement du Québec. À travers un large éventail d’actions, le plan vise à rapprocher les services psychosociaux de la population, rester connecté avec la communauté et promouvoir la mobilisation communautaire. Retombées : Plusieurs leçons ont été tirées. Après une catastrophe, on doit porter une attention à la fois sur les lacunes/besoins et les forces/capacités de la communauté. De plus, les acteurs de santé publique doivent collaborer étroitement, autant en amont qu’en aval, avec les organisations locales et les citoyens. Implications : Cette expérience unique, soutenue par un cadre fondé sur des données empiriques, suggère que trois composantes sont essentielles au succès du rétablissement post-catastrophe: (1) la valorisation des forces de la communauté et de la participation citoyenne, (2) un engagement politique fort pour soutenir les actions en amont, et (3) une équipe de santé publique capable de soutenir ces actions

Associations between resilience, community belonging, and social participation among community-dwelling older adults: results from the Eastern Townships Population Health Survey

Objective : To examine the associations between resilience, community belonging, and social participation, and the moderating effect of resilience on the association between community belonging and social participation among community-dwelling older adults. Design : Cross-sectional; secondary analyses of the Eastern Townships Population Health Survey. Setting : Community. Participants : A sample (N=4541) of women (n=2485) and men (n=2056) aged ≥60 years was randomly selected according to area. Most participants had <14 years of schooling, owned their dwelling, were retired, had 1 or 2 chronic conditions, and did not have depressive symptoms. Interventions : Not applicable. Main Outcome Measures : Self-reported data on age, education, depressive symptoms, social participation, community belonging, and resilience were collected by phone interviewer–administered questionnaire. A social participation scale measured frequency of participation in 8 community activities. A 4-point Likert scale ranging from “very strong” to “very weak” estimated sense of belonging to the local community. Social participation and sense of belonging questions came from Statistics Canada surveys. Resilience was assessed with the 10-item Connor-Davidson Resilience Scale, capturing the ability to cope with adversity. Results : Controlling for age, education, and psychological distress, greater resilience and community belonging were associated with greater social participation among women (R2=.13; P<.001) and men (R2=.09; P<.001). The association between community belonging and social participation varied as a function of resilience, especially in men. Greater community belonging further enhanced social participation, especially among women (P=.03) and men (P<.01) with greater resilience (moderator effect). Conclusions : Resilience moderates the association between community belonging and social participation among community-dwelling older women and, especially, men. Interventions targeting social participation should consider the potential impact of resilience on improving community belonging. Future studies should investigate why resilience moderates associations between community belonging and social participation, and how to enhance resilience among older adults

Medium-term effects of a train derailment on the physical and psychological health of men

In July 2013, the derailment of a train caused the death of 47 people and the destruction of Lac-Mégantic’s downtown area (Canada). Three years after this event, a population survey was conducted among a representative sample of 800 adults, including 282 men. Several significant differences were observed among respondents of a survey based on their level of exposure to this tragedy, including their physical (changes in physical health) and psychological health (post-traumatic stress disorder, mood and anxiety disorders, psychological distress, signs of depression, consultation of social workers and psychologists) as well as their use of prescribed (anxiolytics and antidepressants) and nonprescribed drugs. Such results can be explained by the nature, magnitude, and cause of the event

Post-disaster health status of train derailment victims with posttraumatic growth

In July 2013, a train derailment causing explosions and a fire in downtown Lac-Mégantic (Municipalité Régionale de Comté du Granit, Quebec, Canada) resulted in the death of 47 people and the destruction of many homes and other buildings. This article compares the physical and psychological health of 624 adults from the Granit area exposed to this disaster three years after the tragedy, comparing based on the presence or absence of posttraumatic growth. Women, people with high levels of social support, lower levels of education, and with lower incomes were more likely to show posttraumatic growth. For psychological health, the presence of post-traumatic stress symptoms and the use of antidepressants were positively related to posttraumatic growth. Our study demonstrates that, over time, many people managed to initiate a recovery process and to see benefits from this disaster

Looking for capacities rather than vulnerabilities: the moderating effect of health assets on the associations between adverse social position and health

To increase capacities and control over health, it is necessary to foster assets (i.e. factors enhancing abilities of individuals or communities). Acting as a buffer, assets build foundations for overcoming adverse conditions and improving health. However, little is known about the distribution of assets and their associations with social position and health. In this study, we documented the distribution of health assets and examined whether these assets moderate associations between adverse social position and self-reported health. A representative population-based cross-sectional survey of adults in the Eastern Townships, Quebec, Canada (n = 8737) was conducted in 2014. Measures included assets (i.e. resilience, sense of community belonging, positive mental health, social participation), self-reported health (i.e. perceived health, psychological distress), and indicators of social position. Distribution of assets was studied in relation to gender and social position. Logistic regressions examined whether each asset moderated associations between adverse social position and self-reported health. Different distributions of assets were observed with different social positions. Women were more likely to participate in social activities while men were more resilient. Resilience and social participation were moderators of associations between adverse social position (i.e. living alone, lower household income) and self-reported health. Having assets contributes to better health by increasing capacities. Interventions that foster assets and complement current public health services are needed, especially for people in unfavorable situations. Health and social services decision-makers and practitioners could use these findings to increase capacities and resources rather than focusing primarily on preventing diseases and reducing risk factors

The public health response during and after the Lac-Mégantic train derailment tragedy: a case study

On July 6th 2013, a train derailment occurred in the small town of Lac-Mégantic, Quebec, Canada, causing a major human and environmental disaster. In this case study, we comprehensively describe and analyze actions taken by the Public Health Department of the Eastern Townships, in close collaboration with community-based organizations, during both the impact phase emergency response and the post-impact recovery operations that continued for months. Due to the complexity of the event, public health actions needed to be broadly diversified. Preventive measures targeted chemical, physical, biological, and psychosocial hazards in the short-, medium- and long-term. Our analyses yielded valuable lessons that will improve and inform our response to future events while serving as a basis for developing a conceptual framework for public health emergency preparedness

Universal Measures of Support Are Needed: A Cross-Sectional Study of Health Literacy in Patients with Dupuytren’s Disease

Health literacy represents the degree to which patients can understand and act upon health information and is highly relevant to surgical care. This cross-sectional study sought to determine the prevalence and the independent predictors of limited health literacy in patients with Dupuytren’s disease. The Newest Vital Sign, a validated and reliable tool, was selected to measure health literacy. An exploratory multivariable logistic regression model was used to identify the predictors of limited health literacy. Almost half (44%) of eligible patients (n=185) had limited health literacy. Having a lower household income or being an immigrant led to an increased in the odds of having limited health literacy by nearly 5 and 4-fold respectively. Considering the high prevalence of limited health literacy and the challenge in identifying predictors in the clinical setting, universal measures of support, such as tools aimed to facilitate communication with all patients, would be of high value.M.Sc