Contenu du sommaire : Risques de santé en sociétés

This article discusses the interactions between the concepts of risk and health, from a social sciences and humanities perspective. It provides a broad overview of the interdisciplinary literature, published in both French and English. However, given the breadth of the task, the main focus of the article is on the ‘spatiality' and the unequal configuration of risks for health. This is supported by diverse examples, to better understand the different spatial scales, from the local to the global, at which hazards and uncertainties are constructed, perceived and amplified. To situate the processes at play within a ‘social' context, the authors draw on two types of complementary, but often viewed as distinct, explanations: the spatio-epidemiological approach of spaces of risk and the cultural approach to risk in societies. The relationship between these two approaches contributes to a better understanding of the issues, necessary to inform and orient public health actions and interventions.

 Between Spaces at Risk and Mobilities : Appreciation of the Inequalities and Risk Management Dengue fever, transmitted by the aedes vector, is most prevalent in urban environments because of the ecological requirements of its vectors that reproduce in the multiple water collections generated by the city and its inhabitants. However the diversity of urban landscapes seems to determine the heterogeneous distribution of the disease across the urban landscape. Across the world, the diffusion of the disease is due in part to urban development, especially to uncontrolled development, and on the acceleration of population displacements. This study explores whether these large-scale processes are also at play at a more local scale, using the city of Santa Cruz de la Sierra, in Bolivia, as a case study. This city of a million and half of inhabitants is rapidly growing and is at the crossroads of circulation ; it is the epicentre of the disease in Bolivia. We examine the interaction between the various levels of risk factors influencing the disease and inequalities in its distribution. We discuss implications of the results for the development and implementation of urban policies, highlighting the importance of considering health hazards in their formulation.

As part of a global fight against emerging diseases, the quality of disease surveillance system often determines the effectiveness of responses. By directing the policies and areas of actions, effective supervision will optimize actions for the control of infectious diseases. In many countries, this surveillance fails to represent the reality of epidemics ; the unreliability of the monitoring system leads to a chronic under-registration of infectious diseases and to unequal territorial surveillance. Through the study of dengue in India, this article examines the challenges of introducing means to control epidemics on a territory without previous diagnostic of the surveillance system.

Access to health care, as a determinant of health, became unequally distributed in China as a result of continued pursuit of the market-oriented reforms introduced the late 1970s. Increasing urban-rural socio-economic disparities jeopardized the equity in social welfare and particularly the equity of access to health care, which has been widely considered a key objective of health care policies, in turn putting the disadvantaged communities in especially vulnerable position by increasing their health risks. Using the household survey data from the China Health and Nutrition Survey (CHNS), changes in the accessibility of health care are herein examined at the household level across socioeconomic groups in nine provinces of China over the 1989-2004 period. First, we describe the access to health care over the 15 years of survey, and then using a multivariate regression we analyze the determinants of access in 2004. We find that the geographic accessibility gap between hospitals and clinics has decreased from 1989 to 2004, while the gap in financial accessibility has increased, making urban hospitals the least accessible facilities. This study concludes a strong correlation between the geographic factors (method of travel, region, and availability of infrastructure in the province of residence) and the quality of access received. Overall, patients who are able to reach the facilities on foot enjoy better access than those who can not. Similarly, residents of the West along with the provinces with higher availability of health care facilities also tend to have a better potential access than their counterparts. Understanding of health care utilization patterns and access issues is essential for informing public decision- and policy-making aimed at improving living conditions and building a harmonious society.

Since 1996, the French public health policy seeks to establish uniform health coverage, for all types of care, throughout the country. From databases and statistical analysis, this research shows that this coverage exists for liver transplantation, but that great disparities also exist. The collective determinants alone do not explain the distribution of patients in the territory.

Health and safety at work has been one of the most important topics in the European Union's social policy agenda for several years now. In particular stress has been recognised as the main emerging work-related health problem. Causes are hardly ever limited to one single reason or factor in the workplace. An ad hoc module focussing on workplace health and safety was integrated in the Labour Force Survey of 2007. This module collects a range of information including, among others, the presence of work-related illnesses and exposure to risk factors that can adversely affect workers' health. Using data from this module, this paper presents results of a descriptive analysis which indicate that a significant portion of Italian workers are affected by work-related stress. Work-related stress is associated with exposure to psychological risk factors such as time pressure and overload of work, harassment, bullying and discrimination, violence and threats of violence in the work environment. This is further supported by results of logistic regression models indicating significant associations between work-related stress and work characteristics (professional position, economic activity, duration of contract, evening and night work, etc.) and exposure to psychological risk factors, independent of workers' demographic backgrounds (gender, geographic area, age and education). These results show that workers reporting being exposed to risk factors are also more likely to report health problems as a result of work-related stress. Workers who are subjected to time pressure or overload of work suffer from stress-related illness five times more compared those who are not. Workers declaring harassment, bullying or discrimination problems are four times more likely to report health problems whereas workers reporting violence or threats of violence are twice as likely to suffer from stress-related health problems compared to those who do not experience these phenomena.

This article aims to explore the links between health risks and immigration, and more specifically the situation of immigrant agricultural workers in the Almeria area (Andalusia, Spain). First we synthesise the contemporary migratory dynamics in Spain, characterised by the recent arrival of extremely different immigrant populations (immigrant workers in precarious situation and retired people from Northern Europe) in the Mediterranean coastline. Then we analyse the risks faced by immigrant workers. In addition to the conditions of immigration, precarious administrative status or working and housing conditions, the article addresses the question of spatial segregation, which exposes these workers not only to health risks (distance from healthcare services) but also to social risk (social isolation and vulnerability). Finally, we propose a critical analysis of health and social public policies implemented to limit health risks. Indeed, national and regional policies comprise different objectives, mostly based on culturalist presuppositions, appearing to be completely out of phase with local realities. This has lead local administrative and sanitary entities to set up healthcare structures adapted to the increasing number of immigrants. However, measures targeting health risks are still lacking.

According to definition, data bases used and variables considered, it is estimated that between 5 % and 30 % of cancers are due to environmental exposures. In this article, we inventory perceived and actual risks relative to interactions between environmental exposures and cancer. We emphasize methodological challenges of environmental epidemiology studies, central to scientific inquiry and discussion, given the numerous doubts associated with this topic. We then examine how risks' perception motivates people to appropriate this research domain, traditionally reserved to experts. Finally, we demonstrate that risk perception depends on its quality (known vs. unknown, preferred vs. suffered, high vs. low), its visibility and its proximity to populations.

Recreational shellfish gathering is a traditional and popular activity that has been little studied by the social sciences. Yet it has drawn increasing attention as an environmental and public health concern. This article shows how mussel gathering in the outer zone of the Seine estuary came to be seen as a public health risk by government authorities and how this risk was ignored or discredited by the gatherers themselves. The body of data includes 389 questionnaire responses as well as data from interviews, field observation and the logbooks of those concerned. The work of authorities who constructed shellfish gathering as a public health risk was first identified. Then we examined the measures for prevention and monitoring that were taken and observed differences in how the estuary territory is managed, therefore constructing different indifferences or deviations. Although some sites are policed, the most attractive shellfish gathering sites are not controlled and remain, despite their prohibited status, among the most highly frequented. What are the rationales for actions of the populations most “exposed” to risk ? To understand the practices of all concerned, it is important to account for the divergent interests that are manifested within this territory.

The Russian Arctic is the most populated and the most industrial region of the circumpolar region. Although the geographical diversity of the region makes an overall approach difficult, the inhabitants share exposure to extremely harsh natural conditions and experience of a socioeconomic environment recently entered into modernity. This article proposes a discussion on health risk in the Russian Arctic, focussing on three concepts of risk : physical determinism, vulnerability and resilience. The health status of polar populations is lower than the health status enjoyed by non-polar populations. However, the health transition observed suggest that health status is not solely determined by physical conditions. The multilevel Russian crisis has weakened both individuals and groups, and has damaged their health. These effects are amplified by characteristics associated with northerness, namely lower temperature, lower population densities and remoteness. Would high latitudes exacerbate health risks of modern society ? The boreal economy relies heavily on industrial sector, whose development will continue in future. Occupational health therefore appears as a major health issue in Russia, namely as a result of the incoming of workers from the south, not used to the conditions of the north, and of the safety of workplaces that is often below standards. Finally, exposure to, and ingestion of, pollutants as well as hazardous substance use (drug and alcohol) are other major issues of environmental health ; in addition, the indirect health effects of exposure to cold weather are poorly known.