Contenu du sommaire

The rationalization of medical practices and its political dimensions Political dimensions of medical practices' rationalization need more empirical works. In this controversy, the French paediatric oncology community, which has adopted evidence-based medicine as a medical model for practices, is at odds with a single service, which has adopted a different and critical model. The study of this controversy shows that patients' attitudes are ambiguous towards this process of medical rationalization and that information by some other actors like the media and physicians is of poor help to them. But this study stresses that changes inside the medical profession are actually the main current impact: evidence based medicine is changing the nature of practices' legitimacy and is becoming a tool for physicians to judge and classify each other.

Women's involvement in market-gardening and the resort to health care in West African savannahs Since the 1980s, women have been at the heart of rural development projects in Sub-Saharan Africa. They often make up the majority of the actors involved in what the Strategic Documents for Reducing Poverty rather laconically refer to as IGA (Income-Generating Activities). Such institutional recognition goes with the acknoweldgement of the major part played by women in catering for basic food and health needs. However, African women still hardly resort to first-aid units. More than men, they turn to traditional or informal modes of care first, if not exclusively. Given their increased financial autonomy thanks to their activities, their limited access to care-units cannot be explained in terms of cost alone. The study of the Senufo women's involvement in market-gardening on either side of the border between Ivory Coast and Burkina Faso raises the question of their contribution to improving sanitary conditions for families — children especially — , as well as of its consequences on therapeutic pathways and the various modal ities of resorting to primary care.

The universal medical coverage: a range of social impacts This article put the law setting up the « universal medical coverage » (CMU) in view to the framework of social protection in France, including its most recent evolutions. The author shows that the choice made of a principle of « positive discrimination » — a specific and targeted measure — involves social effects such as pointing out if not stigmatising the persons concerned. She discusses the kind of use the beneficiaries do of the CMU. They are many to take effectively benefit of it, regarding health care access. However, some do not use it at ail (they do not apply), or have only a limited benefit of it (because of care déniai by some professionals). The article then discusses the consequences of this law, which aims at bringing more equity, on the actual social inequalities regarding health in France.