[Young people, a key target]. / Les jeunes, une cible déterminante.

Health determinants, whether direct (e.g. behavior) or indirect (e.g. environment), have an impact on the health status of the population. In this article, we look at the influence of some of these parameters on young people, a key target group for the future.

[Social inequalities in health]. / Déterminants sociaux et accès aux services de santé.

In France, the health status of the population is marked by a paradox: good health on average, but significant health inequalities from childhood and throughout life. Social inequalities in health result from unequal distribution of social determinants, which refer to the social, political, economic, cultural and environmental factors that shape the living conditions in which people are born, grow up, live and age.

[Social inequalities in health]. / Les inégalités sociales de santé.

Social inequalities in health include all the impacts caused by the different social characteristics of individuals on their health. They strongly influence the health status of the French population. Socio-professional category, gender and ethnic origin are all determining factors in the health of people who, however, are not dependent on the healthcare system. Action in the healthcare field will therefore focus on the effects of these inequalities, to limit the number of people who forego healthcare, and to promote collective and individual health.

[The nursing role in the face of health inequalities]. / Le rôle infirmier face aux inégalités de santé.

Social inequalities in health refer to differences in health status between people or groups of people, linked to factors that are particularly social, unequal and considered morally or ethically unacceptable. These may be major differences in life expectancy, or in the greater likelihood of being a carrier of disease, depending on the social group to which one belongs or the territory in which one lives. Accentuated during a health crisis, they are, however, avoidable.

[Health promotion]. / La promotion de la santé.

In 1986, the Ottawa Charter established health promotion as a central objective of governments in order to reduce health inequalities. It is a key concept that forms an integral part of nurses' training and missions.

[The current state of healthcare provision: Between inequalities in access to care and new systemic measures]. / État des lieux de l'offre de soins : entre inégalités d'accès aux soins et nouvelles mesures systémiques.

Although France's healthcare system is rich in multi-faceted skills, both in the community and in hospitals, and implemented by a range of medical, paramedical and medico-social professionals, it is no longer able to meet the health needs of all. Today, these social inequalities in health require us to rethink our policies and redesign existing systems, in order to develop new alternatives that will make quality care and health maintenance accessible to all.

[Territorial health inequalities]. / Inégalités territoriales de santé.

Whether positively or negatively, an individual's geographical location has an impact on his or her state of health. Often described as a "catchword", the notion of territory is complex to define. To better understand its influence, we'll be looking at the different territorial scales, as well as the responses of populations to these issues. With this in mind, we'll take a look at how healthcare professionals are changing their practices.

[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.

Open Secrets: Silence, Suppression, and Memory in the History of Canada's 1918-20 Influenza Pandemic.

For several decades, the 1918-20 global influenza outbreak has been called "the forgotten pandemic." Although recent scholarly and public interest in the pandemic has complicated the narrative of forgetting, the label has stuck. Highlighting historical evidence of influenza's long-term impact upon survivors, family, and community in Canada, the flu stories presented here, diverse in form and content, verify that a key question in pandemic influenza history is not whether the pandemic was forgotten or remembered, but by whom, and in what ways, it has been suppressed - or foregrounded. By moving beyond the classic epidemic plot line, with beginning, middle, and end, historians can find new methodologies and evidence with which to more fully understand the influenza pandemic's unfolding intersection with colonialism, war, social inequality, and labour struggles in the 20th century.

[Socio-professional life after cancer]. / La vie socioprofessionnelle après un cancer.

The occurrence of cancer can create or increase social inequalities, particularly because of its consequences on employment. The first results of a large French prospective cohort on the return to work of women after breast cancer show the importance of the support of these patients by health professionals, and in particular by nurses.

[Work, family, resources and unequal levels of psychological distress between working men and working women : vulnerability or gendered expression of stress?] / Inégalité de détresse psychologique entre les hommes et les femmes en emploi : vulnérabilité ou expression genrée du stress?

INTRODUCTION: This study aims to compare the vulnerability hypothesis and the expression hypothesis to explain a greater level of psychological distress among working women than among working men. METHOD: The two hypotheses were contrasted by integrating work stressors, family stressors, work-family conflicts and psychosocial resources. The conceptual models were tested by using multilevel path analyses on 2026 employees in Quebec (Canada) based in 63 work establishments. RESULTS: Results partially supported both hypotheses. According to the vulnerability hypothesis, single parenting, child-related problems and self-esteem were indirectly involved in the variation of psychological distress among women through family-to-work, otherwise known as work-family conflict. According to the expression hypothesis, although family-to-work conflict was closely associated with more psychological distress among women, this stressor was also closely associated with higher at-risk alcohol consumption among men. Couple-related problems and a sense of control likewise played a role in the expression mechanism through family-to-work conflict. CONCLUSION: These results underline the importance of considering that gender contributes to mental health inequalities through multiple mechanisms. They also call for a distinction between the two directions of work-family conflict as gendered mediators.

[Cognitive aging apart from dementia]. / Le vieillissement cognitif en dehors de la démence.

Cognitive aging apart dementia results from different genetic programming, different according to individuals. The aging of the various cognitive and very heterogeneous cognitive functions largely depends on the life course of each person. Social factors, in particular the environment in which a person lives, may or may not accelerate the processes of cognitive aging. The slower processing speeds of information from the environment, practical or strategic new acquisitions, and the difficult management of multiple tasks, reflect an age-related hypofrontality. Physical and mental health, social and relational well-being participate in good cognitive aging. Exploration of the different facets of cognitive aging shows its complexity.

Economic impacts of chronic conditions in a country with high levels of population health coverage: lessons from Mongolia.

OBJECTIVE: To analyse the impact of non-communicable diseases (NCDs) on household out-of-pocket (OOP) expenses, catastrophic health payments and medical impoverishment in Mongolia, a middle-income country with a high population health insurance coverage rate. METHODS: Secondary data analysis of the Mongolian Household Socioeconomic Survey with 12 840 households, including information on standard of living, OOP spending, and health conditions of household members. Measures of catastrophic spending and medical impoverishment were constructed for Mongolia. The association of medical impoverishment and catastrophic spending with a range of socioeconomic and demographic covariates and health conditions was assessed using multiple regression models. RESULTS: OOP health spending contributed to an 8% increase in the incidence of poverty in Mongolia. The impoverishment associated with medical expenses is concentrated in the poorer quintiles, indicating some deepening of poverty among the already poor. Households with a member affected by NCDs and with multiple morbidities were more likely to experience catastrophic spending and medical impoverishment than those with infectious diseases. The main drivers of the financial distress were expenditures incurred for outpatient services, including for diagnostics and drugs. CONCLUSION: Despite high rates of population health insurance coverage, health expenditures have substantial impoverishing effects in Mongolia, with the impacts being greater among households containing individuals with chronic conditions. Addressing the goal of universal health coverage (UHC) in Mongolia needs attention to the depth of coverage, especially for expenditures on outpatient care and medicines, and targeting the poor effectively.

OBJECTIF: Analyser l'impact des maladies non transmissibles (MNT) sur les dépenses directes des ménages, les paiements de santé catastrophiques et l'appauvrissement médical en Mongolie, un pays à revenu intermédiaire avec un taux élevé de couverture d'assurance santé de sa population. MÉTHODES: Analyse secondaire des données de l'enquête socioéconomique sur les ménages mongols auprès de 12.840 ménages, y compris des informations sur le niveau de vie, les dépenses directes et les conditions de santé des membres du ménage. Des mesures des dépenses catastrophiques et de l'appauvrissement médical ont été élaborées pour la Mongolie. L'association entre l'appauvrissement médical et les dépenses catastrophiques à une gamme de covariables socioéconomiques et démographiques et de conditions de santé a été évaluée à l'aide de modèles de régression multiple. RÉSULTATS: Les dépenses directes de santé contribuaient à une augmentation de 8% de l'incidence de la pauvreté en Mongolie. L'appauvrissement associé aux dépenses médicales est concentré dans les quintiles les plus pauvres, ce qui indique une aggravation de la pauvreté chez ceux déjà pauvres. Les ménages avec un des membres atteint de MNT et avec des morbidités multiples sont plus susceptibles de connaître des dépenses catastrophiques et un appauvrissement médical que ceux souffrant de maladies infectieuses. Les principales causes de la crise financière étaient les dépenses engagées pour les services ambulatoires, notamment les diagnostics et les médicaments. CONCLUSION: Malgré des taux élevés de couverture de l'assurance santé de la population, les dépenses de santé ont des effets appauvrissants considérables en Mongolie, les impacts étant plus importants pour les ménages comptant des personnes atteintes de maladies chroniques. Pour atteindre l'objectif de la couverture santé universelle (CSU) en Mongolie, il est nécessaire de porter une attention particulière à l'étendue de la couverture, en particulier pour les dépenses en soins ambulatoires et en médicaments, et cibler efficacement les pauvres.

[Nursing students, key players in health services]. / Les étudiants en soins infirmiers, acteurs clés du service sanitaire.

The health service, which came into effect in September 2018, concerns all health-care students. Nursing students were among the first to get involved in nursing fields in a variety of settings where the population could get involved in raising awareness of healthy behaviours. A group of nursing students from a school in Île-de-France attests to their involvement in this innovation.

[Racism, between representations of the 'other' and nursing practices]. / Racisme, entre représentations de "l'autre" et pratiques soignantes.

The care environment, renowned for being humanistic and egalitarian, has long remained impenetrable to sociological studies. Surveys, however, reveal another side, where prejudices, unequal treatment and racism in care are expressed. Medicine is itself built on racial categories which still pervade epidemiology and genetics.

[Community health and interculturality]. / Santé communautaire et interculturalité.

An interventional research study in public health was carried out with populations originating from sub-Saharan Africa living in France. With the aim of acting on health inequalities through health education, the researchers focused notably on the links between intercultural relationships and the improvement of health promotion actions.

[Social determinants of contraceptive use in Tunisia]. / Les déterminants sociaux de l'utilisation des méthodes contraceptives en Tunisie.

BACKGROUND: In Tunisia, the "Revolution" of January 2011 highlighted significant regional disparities and social inequalities in access to health care, including reproductive health services. The purpose of this study was to analyze the social determinants of the use of contraception in Tunisia. METHODS: A cross-sectional national study conducted in 2012; on a sample of 15 to 49-year married women (n=4374) drawn by a two levels random sampling. Prevalence of contraception and its association factors were assessed. Logistic regression was used to evaluate the variation of contraception prevalence with area of residence, age, level of education, number of children and household income. RESULTS: The prevalence of contraception was 66.4 %. Eighty-two percent of women used a modern contraceptive method. The use of contraceptive methods was significantly dependent on the age (P<0.001), area of residence (P=0.008), education (P<0.001). The prevalence of contraception was higher in North West (OR=1.1 [0.81-1.5]; P<0.001), among multiparous women (OR=4.49 [3.57-5.66]; P<0.001), among the youngest women (OR=1.4 [0.9-2,19]; P<0.001) and among those with higher levels of education (OR=1.62 [1.19-2.21]; P=0.008). CONCLUSION: Tunisia, precursor Arab country in family planning, is recording a slowdown in the use of contraception in comparison with other countries of North Africa. Social determinants, such as, age, living conditions, area of residence and level of education are indicators to consider when targeting interventions.

Socio-economic differences in HIV/AIDS mortality in South Africa.

OBJECTIVES: To quantify socio-economic differences in the risk of HIV/AIDS mortality in South Africa for different measures of socio-economic status. METHODS: Systematic literature search in Web of Knowledge and PubMed. Measures of relative risk (RR) were pooled separately for education, income, assets score and employment status as measures of socio-economic status, using inverse-variance weighted DerSimonian-Laird random effects meta-analyses. RESULTS: Ten studies were eligible for inclusion comprising over 175 000 participants and 6700 deaths. For income (RR 1.55, 95% confidence interval (CI) 1.15-2.09), assets score (RR 1.63, 95% CI 1.12-2.36) and employment status (RR 1.52, 95% CI 1.21-1.92), persons of low socio-economic status had an over 50% higher risk of dying from HIV/AIDS. The RR of 1.10 for education was not significant (95% CI 0.74-1.65). CONCLUSIONS: Future research should identify effective strategies to reduce HIV/AIDS mortality and alleviate the consequences of HIV/AIDS deaths, particularly for poorer households.

Socio-economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana.

OBJECTIVES: To assess the extent of socio-economic inequity in coverage and timeliness of key childhood immunisations in Ghana. METHODS: Secondary analysis of vaccination card data collected from babies born between January 2008 and January 2010 who were registered in the surveillance system supporting the ObaapaVita and Newhints Trials was carried out. 20 251 babies had 6 weeks' follow-up, 16 652 had 26 weeks' follow-up, and 5568 had 1 year's follow-up. We performed a descriptive analysis of coverage and timeliness of vaccinations by indicators for urban/rural status, wealth and educational attainment. The association of coverage with socio-economic indicators was tested using a chi-square-test and the association with timeliness using Cox regression. RESULTS: Overall coverage at 1 year of age was high (>95%) for Bacillus Calmette-Guérin (BCG), all three pentavalent diphtheria-pertussis-tetanus-haemophilus influenzae B-hepatitis B (DPTHH) doses and all polio doses except polio at birth (63%). Coverage against measles and yellow fever was 85%. Median delay for BCG was 1.7 weeks. For polio at birth, the median delay was 5 days; all other vaccine doses had median delays of 2-4 weeks. We found substantial health inequity across all socio-economic indicators for all vaccines in terms of timeliness, but not coverage at 1 year. For example, for the last DPTHH dose, the proportion of children delayed more than 8 weeks were 27% for urban children and 31% for rural children (P < 0.001), 21% in the wealthiest quintile and 41% in the poorest quintile (P < 0.001), and 9% in the most educated group and 39% in the least educated group (P < 0.001). However, 1-year coverage of the same dose remained above 90% for all levels of all socio-economic indicators. CONCLUSIONS: Ghana has substantial health inequity across urban/rural, socio-economic and educational divides. While overall coverage was high, most vaccines suffered from poor timeliness. We suggest that countries achieving high coverage should include timeliness indicators in their surveillance systems.

Systemic Racism in Canadian Occupational Therapy: A Qualitative Study with Therapists.

Background. Research on racism within occupational therapy is scant, though there are hints that racialized therapists struggle. Purpose. This paper examines experiences of racism in occupational therapy, including coping strategies and resistance. Method. Ten therapists from racialized groups (not including Indigenous peoples) were recruited for cross-Canada, in-person or telephone interviews. Transcripts were coded and inductively analysed, with data thematically organized by types of racism and responses. Findings. Interpersonal racism involving clients, students, colleagues and managers is supported by institutional racism when incidents of racism are met with inaction, and racialized therapists are rarely in leadership roles. Structural racism means the experiences of racialized people are negated within the profession. Cognitive sense-making becomes a key coping strategy, especially when resistance is costly. Implications. Peer supports and community building among racialized therapists may be beneficial, but dismantling structures of racism demands interrogating how whiteness is built into business-as-usual in occupational therapy.