{"id":267877,"date":"2020-02-04T11:31:55","date_gmt":"2020-02-04T16:31:55","guid":{"rendered":"https:\/\/policyoptions.irpp.org\/issues\/les-inegalites-sociales-de-sante\/"},"modified":"2025-10-07T22:49:13","modified_gmt":"2025-10-08T02:49:13","slug":"les-inegalites-sociales-de-sante","status":"publish","type":"issues","link":"https:\/\/policyoptions.irpp.org\/fr\/2020\/02\/les-inegalites-sociales-de-sante\/","title":{"rendered":"Les in\u00e9galit\u00e9s sociales de sant\u00e9
Chronique<\/em>"},"content":{"rendered":"

En 2006-2008, l\u2019esp\u00e9rance de vie sur le territoire du CLSC Hochelaga-Maisonneuve \u00e0 Montr\u00e9al \u00e9tait de 74,2 ans, comparativement \u00e0 85 ans pour le territoire<\/span> plus favoris\u00e9<\/span> du CLSC Saint-Laurent. <\/span>Onze ann\u00e9es de vie<\/span><\/a> s\u00e9paraient les citoyens des deux territoires. Depuis lors, <\/span>il est peu probable que <\/span>la situation <\/span>ait<\/span> beaucoup chang\u00e9, car ces \u00e9carts dans les conditions de vie ont la vie dure.<\/span>\u00a0<\/span><\/p>\n

Les sp\u00e9cialistes de la sant\u00e9 publique parlent d\u2019in\u00e9galit\u00e9s sociales de sant\u00e9 (ISS) pour d\u00e9crire<\/span> de tel<\/span>s ph\u00e9nom\u00e8nes<\/span>, que l\u2019on retrouve <\/span>aussi ailleurs dans le monde<\/span>. Bien s\u00fbr, la pauvret\u00e9 est en jeu\u202f: partout, les personnes en situation de pauvret\u00e9 <\/span>courent plus de risques<\/span> que les mieux nantis <\/span>d\u2019avoir des probl\u00e8mes de sant\u00e9 et de mourir pr\u00e9matur\u00e9ment. Mais il ne s\u2019agit pas que de pauvret\u00e9. <\/span>Chaque fois que l\u2019on gravit un \u00e9chelon dans la hi\u00e9rarchie des revenus et des statuts sociaux, la sant\u00e9 s\u2019am\u00e9liore. La sant\u00e9 des uns et des autres refl\u00e8te leur situation sociale, selon ce que les \u00e9pid\u00e9miologistes appellent un \u00ab\u202fgradient social\u202f\u00bb. Les chances <\/span>de vivre en<\/span> sant\u00e9 <\/span>traduisent<\/span> ainsi<\/span> l<\/span>es in\u00e9galit\u00e9s sociales. <\/span>Comme on dit souvent, i<\/span>l vaut mieux <\/span>\u00eatre<\/span> riche et en sant\u00e9 que pauvre et malade.<\/span>\u00a0<\/span><\/p>\n

Compte tenu de ce lien entre<\/span> statut socio\u00e9conomique<\/span> et sant\u00e9<\/span>, qui fait consensus parmi les chercheurs depuis quelques d\u00e9cennies, on pourrait penser que la cl\u00e9 consiste \u00e0 r\u00e9duire <\/span>la pauvret\u00e9 et <\/span>les in\u00e9galit\u00e9s. C\u2019est en partie vrai, mais la situation n\u2019est pas si simple.<\/span>\u00a0<\/span><\/p>\n

En principe,<\/span> s\u2019il suffisait de <\/span>s\u2019attaquer aux<\/span> in\u00e9galit\u00e9s<\/span> de revenu ou de statut social<\/span>, les pays plus \u00e9galitaires devraient obtenir de meilleurs r\u00e9sultats. <\/span>Or les pays nordiques, champions de l\u2019\u00e9galit\u00e9, ne r\u00e9ussissent pas<\/span> davantage<\/span> \u00e0<\/span> contrer les ISS. C\u2019est ce que plusieurs appellent <\/span>le <\/span>\u00ab\u202fpuzzle\u202f\u00bb de la sant\u00e9 publique<\/span><\/a>.<\/span>\u00a0<\/span>\u00a0<\/span><\/p>\n

D<\/span>iverses explications ont \u00e9t\u00e9 avanc\u00e9es pour r\u00e9soudre ce puzzle, mais la plus plausible, <\/span>propos\u00e9e notamment par le chercheur su\u00e9dois Olle Lundberg<\/span><\/a>, rappelle que la mesure des in\u00e9galit\u00e9s de sant\u00e9 est aussi influenc\u00e9e par ce qui se passe en haut de la hi\u00e9rarchie sociale. En b\u00e9n\u00e9ficiant \u00e0 tous, les programmes sociaux universalistes des pays nordiques ont contribu\u00e9 \u00e0 am\u00e9liorer la sant\u00e9 de l\u2019ensemble des citoyens, mais ils ont, proportionnellement, b\u00e9n\u00e9fici\u00e9 davantage aux plus favoris\u00e9s, augmentant de ce fait les in\u00e9galit\u00e9s sociales de sant\u00e9. Mais peut-on d\u00e9plorer, demande <\/span>Lundberg<\/span>, ce qui constitue tout de m\u00eame un succ\u00e8s de sant\u00e9 publique ?<\/span>\u00a0<\/span><\/p>\n

Un sc\u00e9nario un peu semblable s\u2019est <\/span>produit<\/span> au Qu\u00e9bec.<\/span> Selon un <\/span>rapport de l\u2019Institut <\/span>national de sant\u00e9 publique du Qu\u00e9bec<\/span><\/a>, la mortalit\u00e9 pr\u00e9matur\u00e9e (avant 75 ans) a diminu\u00e9 significativement entre 1989 et 2013, et ce<\/span>,<\/span> pour toutes les cat\u00e9gories de la population, faisant du Qu\u00e9bec une des provinces canadiennes ayant les taux<\/span> les plus bas<\/span>. Mais <\/span>la diminution a<\/span> \u00e9t\u00e9 plus prononc\u00e9<\/span>e<\/span> chez les plus favoris\u00e9s, ce qui se traduit par une hausse des in\u00e9galit\u00e9s sociales de sant\u00e9. Il y a bien s\u00fbr un probl\u00e8me d\u2019\u00e9quit\u00e9, mais faut-il y voir un \u00e9chec<\/span> ?<\/span> Tous les Qu\u00e9b\u00e9cois vivent plus longtemps qu\u2019avant.<\/span>\u00a0<\/span><\/p>\n

Les choix \u00e0 faire entre des politiques qui am\u00e9liorent la sant\u00e9 de tous et des politiques qui visent directement les plus pauvres pour att\u00e9nuer les ISS <\/span>posent<\/span> donc <\/span>des questions difficiles<\/span><\/a>, d\u2019autant plus que l\u2019on conna\u00eet assez mal les <\/span>liens<\/span> entre les politiques publiques et la sant\u00e9. Comme le soulignent <\/span>Lundberg<\/span> et ses collaborateurs dans une <\/span>\u00e9tude r\u00e9cente<\/span><\/a>,<\/span> il <\/span>faut une \u00e9valuation fine des diff\u00e9rentes dispositions d\u2019une politique pour pouvoir mesurer son<\/span> succ\u00e8s.<\/span>\u00a0<\/span><\/p>\n

Une bonne compr\u00e9hension des m\u00e9canismes \u00e0 l\u2019<\/span>\u0153uvre <\/span>est d\u2019autant plus importante qu\u2019un accent trop exclusif sur les in\u00e9galit\u00e9s sociales de sant\u00e9 peut faire perdre de <\/span>vue <\/span>l<\/span>\u2019ensemble <\/span>de<\/span> la protection sociale. Dans un livre <\/span>r\u00e9cent<\/span> \u2015 <\/span>Regimes<\/span><\/i> of <\/span><\/i>Inequality<\/span><\/i>: The <\/span><\/i>Political<\/span><\/i> Economy of Health and <\/span><\/i>Wealth<\/span><\/i><\/a> \u2015,<\/span> Julia<\/span> Lynch,<\/span> politologue <\/span>\u00e0<\/span> l\u2019<\/span>U<\/span>niversit\u00e9 de <\/span>la <\/span>Pennsylvanie<\/span>,<\/span> montre<\/span> de fa\u00e7on convaincante<\/span> comment<\/span>, dans les ann\u00e9es 2000,<\/span> le discours sur la r\u00e9duction des <\/span>ISS<\/span> a souvent servi \u00e0 masquer le peu d\u2019efforts faits pour soutenir la redistribution et les services publics.<\/span>\u00a0<\/span><\/p>\n

Dans le Royaume-Uni de Tony Blair et de Gordon Brown, l\u2019int\u00e9r\u00eat pour les ISS a surtout servi \u00e0 donner un vernis progressiste au gouvernement travailliste, alors m\u00eame qu\u2019il faisait de la redistribution un v\u00e9ritable tabou.<\/span>\u00a0<\/span><\/p><\/blockquote>\n

Dans <\/span>le Royaume-Uni<\/span> de Tony Blair<\/span> (1997-2007)<\/span> et <\/span>de <\/span>Gordon Brown<\/span> (2007-2010)<\/span>, par exemple, <\/span>l\u2019int\u00e9r\u00eat pour les ISS a surtout servi \u00e0 donner un vernis progressiste au<\/span> gouvernement<\/span> t<\/span>ravailliste, alors m\u00eame q<\/span>u\u2019il<\/span> faisait de la redistribution un v\u00e9ritable tabou<\/span> pour ne pas s\u2019ali\u00e9ner<\/span> la<\/span> classe moyenne et <\/span>pour <\/span>s\u2019imposer comme alternative<\/span> cr\u00e9dible<\/span> face aux conservateurs<\/span>.<\/span>\u00a0<\/span><\/p>\n

Faute de parler de hausses d\u2019imp\u00f4t ou de transferts plus g\u00e9n\u00e9reux (sauf pour les plus pauvres et les enfants), les travaillistes se sont tourn\u00e9s vers les ISS<\/span> et ont cherch\u00e9<\/span> \u00e0 d\u00e9finir des solutions administratives multisectorielles et cibl\u00e9es touchant les diff\u00e9rents d\u00e9terminants de la sant\u00e9. Cette \u00ab\u202fm\u00e9dicalisation\u202f\u00bb de la redistribution a finalement <\/span>donn\u00e9 peu de r\u00e9sultats et a <\/span>d\u00e9bouch\u00e9 sur de<\/span> simple<\/span>s<\/span> encouragements<\/span> \u00e0 adopter des comportements individuels plus sains.<\/span>\u00a0<\/span><\/p>\n

En France, d<\/span>e fa\u00e7on similaire, l\u2019int\u00e9r\u00eat d<\/span>es socialistes pour les <\/span>ISS<\/span> leur a permis de p<\/span>r\u00f4n<\/span>er <\/span>l<\/span>\u2019am\u00e9lior<\/span>ation de<\/span> la sant\u00e9 des citoyens sans d\u00e9penser davantage<\/span> \u2015<\/span> ou m\u00eame en d\u00e9pensant <\/span>moins<\/span> \u2015<\/span> pour les soins de sant\u00e9. Le tabou politique, dans ce cas, c\u2019\u00e9tait moins la redistribution que l\u2019id\u00e9e d\u2019augmenter les d\u00e9penses publiques. En Finlande, <\/span>l\u2019enjeu des <\/span>ISS<\/span> a \u00e9galement <\/span>d\u00e9tourn\u00e9 le gouvernement de ses<\/span> pr\u00e9occupations plus traditionnelles <\/span>de<\/span> redistribution et <\/span>de<\/span> r\u00e9glementation des march\u00e9s<\/span>, mises \u00e0 mal par l\u2019inflexion n\u00e9olib\u00e9rale des politiques publiques.<\/span>\u00a0<\/span><\/p>\n

Partout, l\u2019accent sur la r\u00e9duction des ISS a contribu\u00e9 \u00e0 m\u00e9dicaliser et \u00e0 bureaucratiser la qu\u00eate de justice sociale<\/span>,<\/span> e<\/span>n<\/span> \u00e9loign<\/span>ant<\/span> la redistribution et <\/span>le d\u00e9veloppement<\/span> des services publics de l\u2019ordre du jour.<\/span>\u00a0<\/span><\/p>\n

Les in\u00e9galit\u00e9s sociales de sant\u00e9, conclut Lynch, font partie des \u00ab\u202fprobl\u00e8mes pernicieux\u202f\u00bb<\/span>\u202f: <\/span>on ne r\u00e9ussit <\/span>ni<\/span> \u00e0 s\u2019entendre sur les objectifs<\/span> des politiques <\/span>pour les combattre<\/span>, ni \u00e0 <\/span>\u00e9liminer l\u2019in<\/span>certitude <\/span>quant aux causes et aux solutions.<\/span> Il ne s\u2019agit pas d<\/span>\u2019<\/span>ignorer<\/span> ces in\u00e9galit\u00e9s, qui <\/span>demeure<\/span>nt injustes<\/span>, m<\/span>ais c\u2019est une erreur d<\/span>\u2019en<\/span> faire l\u2019alpha et l\u2019om<\/span>\u00e9<\/span>ga des politiques sociales. \u00c0 tout prendre, il vaut mieux miser sur des politiques<\/span> connues<\/span> de redistribution et de<\/span> d\u00e9veloppement des<\/span> services publics<\/span>,<\/span> qui am\u00e9liorent<\/span> directement<\/span> les conditions de vie et<\/span> la sant\u00e9 de l\u2019ensemble de la population, <\/span>tout <\/span>en demeurant vigilant afin de minimiser les in\u00e9galit\u00e9s<\/span> sociales<\/span> de sant\u00e9<\/span> qui persistent.<\/span>\u00a0<\/span><\/p>\n

Photo : Shutterstock<\/span><\/span> \/ <\/span><\/span>Laiotz<\/span><\/span><\/span><\/p>\n

\n

Souhaitez-vous r\u00e9agir \u00e0 cet article ? Joignez-vous aux d\u00e9bats d\u2019<\/em>Options politiques\u00a0et soumettez-nous votre texte en suivant ces\u00a0<\/em>directives<\/em><\/a>. | Do you have something to say about the article you just read? Be part of the\u00a0<\/em>Policy Options\u00a0discussion, and send in your own submission.\u00a0Here is a\u00a0<\/em>link<\/em><\/a>\u00a0on how to do it.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

En 2006-2008, l\u2019esp\u00e9rance de vie sur le territoire du CLSC Hochelaga-Maisonneuve \u00e0 Montr\u00e9al \u00e9tait de 74,2 ans, comparativement \u00e0 85 ans pour le territoire plus favoris\u00e9 du CLSC Saint-Laurent. Onze ann\u00e9es de vie s\u00e9paraient les citoyens des deux territoires. Depuis lors, il est peu probable que la situation ait beaucoup chang\u00e9, car ces \u00e9carts dans […]<\/p>\n","protected":false},"featured_media":276864,"template":"","meta":{"_acf_changed":false,"content-type":"","ep_exclude_from_search":false,"apple_news_api_created_at":"2025-10-08T02:49:16Z","apple_news_api_id":"6a28aa3d-5085-4941-8f3b-0b45d12a0b45","apple_news_api_modified_at":"2025-10-08T02:49:16Z","apple_news_api_revision":"AAAAAAAAAAD\/\/\/\/\/\/\/\/\/\/w==","apple_news_api_share_url":"https:\/\/apple.news\/AaiiqPVCFSUGPOwtF0SoLRQ","apple_news_cover_media_provider":"image","apple_news_coverimage":0,"apple_news_coverimage_caption":"","apple_news_cover_video_id":0,"apple_news_cover_video_url":"","apple_news_cover_embedwebvideo_url":"","apple_news_is_hidden":"","apple_news_is_paid":"","apple_news_is_preview":"","apple_news_is_sponsored":"","apple_news_maturity_rating":"","apple_news_metadata":"\"\"","apple_news_pullquote":"","apple_news_pullquote_position":"","apple_news_slug":"","apple_news_sections":[],"apple_news_suppress_video_url":false,"apple_news_use_image_component":false},"categories":[9357,9372,9377],"tags":[9095,9183],"article-status":[],"irpp-category":[4277,4251,4286],"section":[],"irpp-tag":[],"class_list":["post-267877","issues","type-issues","status-publish","has-post-thumbnail","hentry","category-politiques-sociales","category-recent-stories-fr","category-sante","tag-inegalites","tag-soins-de-sante","irpp-category-discrimination-fr","irpp-category-politique-sociale","irpp-category-sante"],"acf":[],"apple_news_notices":[],"yoast_head":"\nLes in\u00e9galit\u00e9s sociales de sant\u00e9Chronique<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/policyoptions.irpp.org\/fr\/2020\/02\/les-inegalites-sociales-de-sante\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Les in\u00e9galit\u00e9s sociales de sant\u00e9Chronique\" \/>\n<meta property=\"og:description\" content=\"En 2006-2008, l\u2019esp\u00e9rance de vie sur le territoire du CLSC Hochelaga-Maisonneuve \u00e0 Montr\u00e9al \u00e9tait de 74,2 ans, comparativement \u00e0 85 ans pour le territoire plus favoris\u00e9 du CLSC Saint-Laurent. 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