Contenu du sommaire : Les outre-mer français : conditions de vie, santé et protection sociale

The French West Indies became a French département in 1946. Prior to this, the status of “old French colonies” (Guadeloupe, Martinique, Guyana and Reunion Island) prevented them from fully benefitting from social protection measures introduced into mainland France at the time of the Popular Front. As Aimé Césaire, one of the founding fathers of integration (départmentalisation) put it, the inclusion of the French West Indies in France and the subsequent extension of the French social legislation regime to its overseas regions was primarily intended to eradicate inequality. However, the introduction of this regime into the overseas départements was subject to certain conditions. One of these related to payment of social welfare benefits, which was introduced by degrees over an extended period of time. This in fact served to perpetuate inequalities between mainland France and its overseas regions. This discrepancy persists today and is the proof that integration from a legal point of view is by no means a guarantee of social assimilation. Despite a gradual narrowing of the gap in terms of social equality, differences still exist in comparison with mainland France.

Living conditions, poverty and social protection in Mayotte – inequality viewed from two different angles. On 31st March 2011, Mayotte – a small island with a surface area of 374 km² situated in the Mozambique canal – became France's 101th French département and its 5th overseas département. At the same time, due to the structure of its local economy, the island also became the poorest département. To this day, the principle of social equality and the introduction of common law into this new département have remained tentative. As a result, support at family and local level have taken on the crucial role of social buffer. This article will describe how the integration process has contributed to both regulating and creating inequalities and the challenges this poses. For this purpose, we have chosen to approach the question from two different angles: we shall firstly deal with “internal” social inequalities in Mayotte (based on “ethnicity”, gender, generation and class). We shall then consider Mayotte within the context of its geo-political environment. The fact that the island is situated at a migratory crossroads highlights inequalities in terms of social protection systems between Mayotte and its neighbouring territories.

Public Housing in Mayotte: public policy in difficulty in the fifth French overseas département. This article will review the public housing policy reform introduced into Mayotte from the mid-2000's onwards. This reform, which was part of the integration or départementalisation process, made financing arrangements and access to public housing more complex. In parallel with a public policy standardisation process, the decision to maintain specific aspects of the former social welfare system on the island until 2014 would appear to be a contradiction in administrative terms. Public action is further hampered by scarcity of building land, lack of social intermediation structures and the state of existing private housing. As a result, the number of potential beneficiaries of housing benefits has been reduced. All these administrative changes are implemented at local level but the State has nonetheless the central role when it comes to defining eligibility for social assistance.

Territorial integration – changing health concerns in Mayotte: focus on the state of health of the population of the 101st French département. Mayotte, a French territory in the Comoros Archipelago, became the 101st French département in 2011. The integration process initiated in the 1990's entailed significant work on infrastructures, health and education. This was followed by the institutional alignment of the island with Mainland France and the overhaul of the social, political and cultural pillars of the Mayotte territory. At the same time, this rapid and sudden shift in the social landscape, combined with living conditions in Mayotte affected the health of the population, placing this issue at the centre of the underlying conflict and tension resulting from the territory's preparation for its new status. Findings of a social geography study conducted in Mayotte in 2010 provide insight into the key issues of the island's territorial integration into France and allows to analyse the relation links between Mayotte's new political status and the setting up of the current health system on the island. It also aims to understand the repercussions of the integration process on access and accessibility to health care. Finally, these results viewed through the lens of the island's epidemiological characteristics, show the indirect consequences of past and present territorial restructuration.

Exclusion and social measures in the Pacific overseas territories – focus on street prostitution in French Polynesia. Research carried out in 2009 into street prostitution in the urban agglomeration of Tahiti (French Polynesia) threw light upon the precarious living conditions and coping strategies adopted by the different individuals concerned. These men, women and transgenders or Rae Rae face exclusion and stigma, a situation, which is further, compounded by the culturally determined essentialist vision of local traditions. We shall go beyond the cultural dimension and focus on the normative construction process of social relations in French Polynesia, its incorporation by different groups and individuals and its influence on types of individual action and socialisation. The question of normative typification will be tackled by analysing Polynesian attitudes to regulatory health measures and practices on one hand, and the attitudes of local individuals who are responsible for implementing the appropriate social policy on the other.

High unemployment in French overseas territories: a problem with multiple causes. Consistently high unemployment figures in the French overseas departments where certain categories of the population have been severely hit – young people and women in particular – has cast doubt upon the effectiveness of the public policy response to unemployment in overseas regions. This article will review theoretical and applied research into the causes of unemployment in the overseas departments and regions. This will be supported by statistical data derived from indicators, making it possible to assess the current state of the job market. Whereas the first wave of findings tended to point more towards an excess supply of labour and socio-demographic factors, more recent analyses tend to focus on economic factors governing insufficient labour demand. The coexistence of high unemployment and difficulties recruiting would also suggest that supply and demand are poorly matched. These points have not been fully explored but clearly they help explain the high rate of unemployment overseas. There is certainly a wide range of factors that need to be taken into account in order to fully understand the persistence of unemployment overseas – a situation that has significant ramifications for employment policy in the French overseas départements (DOM).

Working spaces for nurses in France and Japan: elements for a conventionalist interpretation. Based on original case studies, this article will attempt to describe what a “working space” represents for nurses in both France and in Japan. It shows how and why these professional spaces are structured differently in terms of history and socio-economics. The idea of “conventions” – seen here as a reciprocal system of expectations – provides the key for interpretation. In Japan, this space corresponds to the “domestic world”, where proximity, multitasking and care prevail, whereas in France this space is seen as belonging to the “industrial world”, thereby explaining the priority given to technical specialisation associated with longer hospital stays. Analysis of the private practice sector in both countries confirms the existence of these two very different worlds. However, studies show that in Japan, the decision to opt for a liberal profession involving visits to patients' homes, goes hand in hand with a change of approach, more are less permanent, to the time/work equation. Thus current and recent events must be taken into account when interpreting career breaks in the nursing profession (frequent and long in Japan, rare and brief in France) In the case, of Japan, this can be partially explained by the after-effects of the Fukushima catastrophe.

Pay-for-performance and conditional price setting of drug prices. When a drug is put on the market, it may not perform exactly the same way as it did at prior to obtaining market authorisation (namely, at the clinical research stage or during the pricing negotiation). This risk is now covered by a “conditional contract”. A quick agreement on the price is granted provided pharmaceutical companies undertake to partially or fully refund the sum initially negotiated should the treatment be less effective than originally stated. Using a framework setting out application guidelines, we shall analyse these market access contracts for reimbursable products under the Social Security system. For the most part, these conditional contracts are drawn up on the strength of descriptive or normative studies without a control group. This means that the therapeutic impact of the drug cannot be measured. In such a context, price fixing for drugs may be jeopardised by the scanty quality of evidence. In order to address this issue, we suggest setting up comparative observational studies and comparing groups with the appropriate micro-econometric studies.