[From social medicine to the management of precariousness in health]. / De la médecine sociale à la prise en charge de la précarité en santé.

A review of the history leading from the creation of social medicine to the management of precariousness in the health field. We will define the main concepts (precariousness, poverty, social inequalities in health) and indicate the main barriers to access to care for people in precarious situations. Finally, we will give some guidelines for the healthcare community in order to improve care.

Deservingness: migration and health in social context.

This article brings the social science concept of 'deservingness' to bear on clinical cases of transnational migrant patients. Based on the authors' medical social science research, health delivery practice and clinical work from multiple locations in Africa. Europe and the Americas, the article describes three clinical cases in which assumptions of deservingness have significant implications for the morbidity and mortality of migrant patients. The concept of deservingness allows us to maintain a critical awareness of the often unspoken presumptions of which categories of patients are more or less deserving of access to and quality of care, regardless of their formal legal eligibility. Many transnational migrants with ambiguous legal status who rely on public healthcare experience exclusion from care or poor treatment based on notions of deservingness held by health clinic staff, clinicians and health system planners. The article proposes several implications for clinicians, health professional education, policymaking and advocacy. A critical lens on deservingness can help global health professionals, systems and policymakers confront and change entrenched patterns of unequal access to and differential quality of care for migrant patients. In this way, health professionals can work more effectively for global health equity.

Atendimento hospitalar para populações à margem do sistema de saúde na França: o exemplo dos Permanences d'accès aux soins de santé / The government of groups at the margin of the healthcare system in French public hospital: the example of the department for access to healthcare / La prise en charge par l'hôpital des populations à la marge du système de santé en France: l'exemple des Permanences d'accès aux soins de santé

Résumé Cet article analyse la prise en charge de la pauvreté à l'hôpital public. Il prend l'exemple des Permanences d'accès aux soins de santé (PASS), structure hospitalière qui prend en charge des personnes connaissant des difficultés d'accès aux soins dans le système de santé français. Il s'appuie sur une enquête empirique issue d'un travail de thèse en sociologie. L'enquête mêle observations participantes et entretiens semi-directifs (n=49) et a été réalisée dans 16 PASS différentes. Sur un plan théorique, l'article met en miroir les travaux sur les métamorphoses de la question sociale et une perspective biopolitique d'inspiration foucaldienne. La prise en charge des populations en marge du système de santé par une institution publique (l'hôpital) est considérée comme agissant dans des domaines qui dépassent le strict traitement de la maladie pour entrer dans ceux de la régulation sociale, la protection de la santé publique ou la réalisation de droits humains. Dans le cas des PASS, l'article montre la construction d'une biopolitique de la migration autour d'un bricolage compliqué qui mêle citoyenneté, politiques économiques, politiques de santé publique et accès aux soins. Le mode d'exercice du pouvoir se caractérise par un gouvernement par le bas qui est réalisé par les professionnels de terrain lors des interactions avec les patients et met en scène une économie morale basée sur des représentations de ce qui est bon et mauvais pour la société.

Abstract This article analyses how the modern public hospital handles poverty. To do so it goes from the example of the hospital-based Departments for access to healthcare (Permanences d'accès aux soins de santé - PASS), that is specialized in taking care of patients experiencing difficulties to access healthcare in the French healthcare system. The article relies on an empirical study achieved as part of a PhD work in sociology. The study combines participant observations and interviews (n=49) which have been conducted in 16 different PASS. On a theoretical level, the paper mirrors the work on the metamorphosis of the social question and a biopolitics perspective inspired by Foucault. In this perspective the way the public hospital takes care of individuals situated at the margin of the healthcare system is thought as entering in the areas of social regulation, protection of the public health or realization of human right. In the case of PASS, the article shows the construction of a biopolicy of migration that is a cobbling together of citizenship, economic policies, public health and access to healthcare. The form of power is characterized by a government from the bottom which is realized by street-level healthcare professionals during interaction with the patients and based on a moral economy depicting representations of what is good and bad for the society.

Resumo Este artigo analisa o acesso de pessoas de baixa renda a hospitais públicos. Tomamos como exemplos os Permanences d'Accès aux Soins de Santé (PASS), ou Centros de Acesso à Saúde, estrutura hospitalar que atende pessoas que têm dificuldades para acessar o sistema de saúde francês. Baseada em uma investigação empírica, resultado de uma tese em sociologia, esta investigação junta observações de participantes e entrevistas semidiretivas realizadas em 16 PASS diferentes. Em um plano teórico, o artigo espelha os trabalhos sobre as metamorfoses da questão social e uma perspectiva biopolítica de inspiração foucaultiana. O atendimento de populações à margem do sistema de saúde por uma instituição pública (hospital) é considerada agindo em áreas que sobrepassam o estrito tratamento de doença para entrar em áreas de regulação social, proteção da saúde pública ou a realização de direitos humanos. No caso dos PASS, o artigo mostra a construção de uma biopolítica de migração ao redor de uma montagem complicada que mistura cidadania, políticas econômicas, políticas de saúde pública e acesso à saúde. A maneira de exercer o poder se caracteriza por um governo de base realizado por profissionais de campo em interações com os pacientes e colocando em cena uma economia moral baseada em representações do que é bom ou ruim para a sociedade.

[Access to care for vulnerable populations]. / L'accès aux soins des personnes en situation de précarité.

Accessing hospital care is a privilege for a growing proportion of the population in situations of economic and social precarity. It is therefore important that caregivers understand these difficulties in order to adapt their nursing approach.