Contenu du sommaire : Expériences de la santé en migration

In 2008, National Institute for Demographic Studies (INED) and National Institute for Statistics and Economic Studies (INSEE) realized a questionnaire Trajectories and Origins: survey on the diversity of the populations in France (TeO) comparing migrants and descendants of migrants' social trajectories to those of French people having no immigrant parents. The survey aims to measure the scale of the discriminations linked to origins and their impact on social trajectories. A section is dedicated to the health. A later investigation by interview with persons having declared a poor health status, allowed to redraw their story and to confront the statistical results with the narratives of life. This article is the product of this crossed approach of quantitative and qualitative analyses on the health of immigrants. The data of the questionnaire show that the immigrants in France declare a worse health than the persons of the majority population; an important part of this result is explained by the socioeconomic factors. But narratives show that the systemic discriminations undertaken by origin and sex, exercise a harmful effect which is not, far from it, of lesser importance.

Health coverage only for illegal immigrants, the medical aid (AME) was created in 2000. In this paper, we focus on the consequences of this specificity on access to healthcare for these people in three areas: the law, the organization of health insurance funds, agents and practices of these organizations (both reception staff who receive applicants than service agents investigating cases). The combination of these three angles of approach will give to see the journey made by illegal immigrants and pitfalls encountered. We will see that illegal immigrants confined in their own health care system creates a two-speed system, favouring their reception by the public places separated or differentiated ways and limiting their access to care and structures. We will be particularly attentive to the impact of productivist management on the reception of such persons and the processing of their case: the productiveness imposed on agents and as their lack of training lead them to demand more documents to the applicants, always postponing their access to care.

Two studies on migrants' health and safety measures (OHS) at work are selected to discuss social inequalities in health. The first study documented the trajectories of immigrant workers' compensation victims of occupational injuries (n=104). The results indicate that immigrant workers face more obstacles than Canadian workers during medical and legal consultations, during administrative procedures and during the reinstatement in the work. The trajectories often lead to dismissal. The second study focused on the implementation of OSH measures in small businesses (<50 employees) hiring immigrants (>25%). In these businesses (n=28), immigrant workers are less well trained in OSH, misjudge risks, few declare their injuries, and rarely participate in accident investigation. Many do not wear protective equipment. Immigrant workers who are victims of occupational injuries live with permanent disabilities that impair their productivity and often lead to a dismissal, for which they don't know their appeals. This is a pathway of social inequalities in health.

Care providers, in public maternity hospitals in Paris area, often spoke about “African” women as a category with specific characteristics. This article presents and discusses a research analysing the processes of racial categorisations and their impact on the medical course. Our quantitative research pointed out a high rate of C-sections for the “African” women, when they're migrants, even after correcting other potential influences like state of health. We show that differential medical protocols proposed to reduce inequalities in health do not reach their goal, and sometimes induce discriminations. But we constantly show how sociological analyses help deconstructing medical stereotypes or ideologies that have been embodied by the medical staffs.

This paper analyses the trajectories of cancer patients from non-EU countries in Brittany, at two separate moments: admission to medical care and end-of-life trajectories consequently to treatment failure. At both key moments, patients are confronted with various administrative obstacles according to their migration profile: from asylum seekers – who have conjointly asked for legalization on the basis of their health situation – over undocumented migrants, to foreigners who entered France with a tourist visa and whose cancer may or may not have been diagnosed previously in their country of origin. Providing cancer support services or palliative medical care for foreigners in a precarious social situation confront medical staff with border-line cases that question their practices and norms, and more especially so in Brittany, a region with low levels of immigration. As a consequence, the logics of actors must be understood in relation with the structural context that influence the beginning and the end of care trajectories, as health facilities that face structural organizational and financial constraints encounter those of immigration policies. Indeed, just as identity documents and possibilities of social protection influence the admission to medical care, they are of central importance for end-of-life trajectories.

This article explores certain aspects of the exile trajectories of women living with HIV-AIDS from the African Great Lakes and coming to Canada. If pre- and post-migratory factors can have an impact on their living conditions and health, we will focus rather on the effects of Canadian legislation on access to the territory and to health-care for these migrants. After a brief summary of Canadian legislation governing the entry for sick migrant and especially HIV-positive migrants we will show through the stories of the women interviewed, who mainly fleeing violence and persecution gendered, how these policies affect their trajectory and their health. We will see that Canadian law is a set of constraints for refugees with HIV, while providing a resource available to capture some specific opportunities.

This article questions the rationale underlying non-biomedical health-care use, and discusses the links between health systems and migratory experience. This article steps on a fieldwork that revealed the under-representation of migrants originating from the Indian sub-continent among the users and practitioners, in spite of the growing interest for this medicine in the midst of the general population. Overall, this article deconstructs the (culturalist) idea stating that migrants quite often import and use health-care practices coming from their country of origin.