[Health equity: an often misused concept]. / Équité en santé : un concept souvent galvaudé.

The use of the concept "health equity" is more and more widespread. It is often considered as a major objective in health policies aimed at improving healthcare for populations in a vulnerable situation. However, the understanding of "health equity" is often subject to confusion and it can be misinterpreted with the concept of "health equality". Although it may seem trivial at first sight, such confusion may lead to serious consequences for health policies and their implementation with the target populations. This article aims to provide a clarification of the concept of "health equity", while proposing definitions that are more suitable to the needs of professionals and their audience.

L'usage du concept « équité en santé ¼ est de plus en plus répandu. Il est souvent intégré dans les politiques de santé en tant qu'objectif majeur dans les processus visant à améliorer la qualité des soins, en particulier auprès des populations en situation de grande vulnérabilité. Néanmoins, la compréhension de ce terme est souvent confuse et sa définition peut être confondue avec celle de l'« égalité ¼. Bien que pouvant paraître anodine au premier abord, une telle confusion peut avoir de lourdes conséquences sur les politiques de santé et leur mise en œuvre auprès des publics cibles. Cet article vise à proposer une clarification du concept d'« équité en santé ¼, tout en fournissant des définitions adaptables aux besoins des professionnels et de leur audience.

[Teaching health equity in the French-speaking part of Switzerland : inventory in 2023]. / Enseignements sur l'équité en santé en Suisse romande : état des lieux en 2023.

The theme of health equity was for a long time absent or little addressed in the pre- and postgraduate teaching programs of universities and training university hospitals in Switzerland. This gap has gradually been filled by the development and provision of structured teaching on health equity, adapted to the needs of their target audiences. This article aims to highlight a selection of teachings that have emerged in recent years in the French-speaking part of Switzerland.

La thématique de l'équité en santé a été pendant longtemps absente ou peu abordée dans les programmes d'enseignement pré et post-gradué des universités et établissements hospitaliers de formation en Suisse. Cette lacune a été progressivement comblée par le développement et la mise à disposition de formations structurées portant sur l'équité en santé, adaptées aux besoins de leurs publics cibles. Cet article vise à mettre en avant une sélection d'enseignements qui ont vu le jour ces dernières années en Suisse romande.

Case Management may Reduce Emergency Department Frequent use in a Universal Health Coverage System: a Randomized Controlled Trial.

BACKGROUND: Frequent emergency department (ED) users account for a disproportionately high number of ED visits. Studies on case management (CM) interventions to reduce frequent ED use have shown mixed results, and few studies have been conducted within a universal health coverage system. OBJECTIVE: To determine whether a CM intervention-compared to standard emergency care-reduces ED attendance. DESIGN: Randomized controlled trial. PARTICIPANTS: Two hundred fifty frequent ED users (5 or more visits in the prior 12 months) who visited a public urban ED at the Lausanne University Hospital between May 2012 and July 2013 were allocated to either an intervention (n = 125) or control (n = 125) group, and monitored for 12 months. INTERVENTIONS: An individualized CM intervention consisting of concrete assistance in obtaining income entitlements, referral to primary or specialty medical care, access to mental health care or substance abuse treatment, and counseling on at-risk behaviors and health care utilization (in addition to standard care) at baseline and 1, 3, and 5 months. MAIN MEASURES: We used a generalized linear model for count data (negative binomial distribution) to compare the number of ED visits during the 12-month follow-up between CM and usual care, from an intention-to-treat perspective. KEY RESULTS: At 12 months, there were 2.71 (±0.23) ED visits in the intervention group versus 3.35 (±0.32) visits among controls (ratio = 0.81, 95 % CI = 0.63; 1.02). In the multivariate model, the effect of the CM intervention on the number of ED visits approached statistical significance (b = -0.219, p = 0.075). The presence of poor social determinants of health was a significant predictor of ED use in the multivariate model (b = 0.280, p = 0.048). CONCLUSIONS: CM may reduce ED use by frequent users through an improved orientation to the health care system. Poor social determinants of health significantly increase use of the ED by frequent users.

[Patients forgoing health care for economic reasons: how to identify this in a primary care setting?]. / Renoncement aux soins: comment appréhender cette réalité en médecine de premier recours?

Although the performance of the Swiss health system is high, one out of ten patients in general practitioner's (GP) office declares having foregone care in the previous twelve months for economic reasons. Reasons for foregoing care are several and include a lack of knowledge of existing social aids in getting health insurance, unavailability of GPs and long waiting lists for various types of care. Although long term knowledge of patients or a psychosocial history of deprivation or poverty may help identify individuals at risk of foregoing care, many may remain undetected. We propose then a few instruments to help GPs to identify, in a simple and structured approach, patients at risk of forgoing care for economic reasons; these patients are frequently deprived and sometimes poor.

[Social medicine: does it still make sense in 2013?]. / Médecine sociate en 2013: quand la précarité précède la pauvrete.

Social medicine is a medicine that seeks to understand the impact of socio-economic conditions on human health and diseases in order to improve the health of a society and its individuals. In this field of medicine, determining the socio-economic status of individuals is generally not sufficient to explain and/or understand the underlying mechanisms leading to social inequalities in health. Other factors must be considered such as environmental, psychosocial, behavioral and biological factors that, together, can lead to more or less permanent damages to the health of the individuals in a society. In a time where considerable progresses have been made in the field of the biomedicine, does the practice of social medicine in a primary care setting still make sense?