Search

Les différences de mortalité entre garçons et filles dans l’enfance dépendent à la fois de facteurs biologiques et socioculturels. Du côté biologique, les faits sont relativement clairs (Vallin, 2002) : les garçons sont dans l’ensemble moins résistants et donc plus vulnérables à nombre de maladies congénitales ou infectieuses, notamment dans les premiers mois ou années de la vie. Cela conduit à une surmortalité masculine « biologique » qui s’accentue avec le déclin de la mortalité, quand le p...

Au-delà des différences biologiques qui caractérisent chaque sexe, les inégalités de statut entre hommes et femmes et les rapports qui en découlent ont un caractère socialement construit, c’est ce qu’exprime le concept de « genre ». Chaque société structure un système de genre, c’est-à-dire un ensemble de normes, de croyances, de connaissances sélectives qui vont guider les comportements sexués, imposer des rôles, valoriser certaines attitudes et en condamner d’autres. La problématique du développement des pays du Sud est progressivement passée d’une vue misérabiliste de la « condition des femmes » à une approche qui place la dynamique des rapports sexués au cœur de la réflexion. Connaître ces dynamiques, leurs interférences avec les évolutions en cours et notamment les moyens de renforcer le pouvoir de décision des femmes (empowerment) est une priorité stratégique pour le développement. En Afrique, les recherches de projets intégrant le genre, encore très rares, restent un énorme chantier. Cet ouvrage fait un bilan des connaissances sur les rapports de genre tels qu’ils s’expriment dans l’histoire des sociétés, les institutions, la production économique et dans les comportements vis-à-vis de la santé, du mariage et de la constitution de la famille. Pour la première fois, des synthèses sur les inégalités de santé dans l’enfance et sur la nuptialité pour l’ensemble de l’Afrique, y sont présentées. Démographie et statistique ont une place centrale, mais les approches qualitatives et les contributions d’historiens, d’économistes et de sociologues apportent l’enrichissement d’une vision multidisciplinaire sur les questions de genre dans les sociétés africaines.

In Belgium, life expectancy is now twice what it was 170 years ago due to improvements in public and private hygiene, nutrition, medical procedures and the organization of health services. The average lifespan of a Belgian resident is now over 80 years, but inequalities persist and sometimes even intensify. In Belgium, like in other European countries, a negative relationship has been demonstrated between socio-economic position on the one hand and health and mortality on the other hand. This project aimed to investigate whether or not this social gradient in health and mortality is associated with the growing de-standardisation of employment arrangements and family situations. The goal was to obtain information about the mechanisms by which social differences in mortality and health are generated in Belgium, in order to provide insight in policy measures that could prove effective in countering these inequalities. In a first part of the project, the evolution of mortality inequalities in Belgium between 1991 and 2016 was studied. It has been shown, based on a multidimensional indicator combining educational level, employment category and housing characteristics, that social inequalities in death are significant in Belgium and that they have been increasing for both women and men since at least the 1990s. In relative terms, gaps between social groups are especially wide between 25 and 50 years but have little impact on differences in life expectancy because the risk of dying is inherently low at these ages. The social disparities in mortality for older people (65+) – and especially the delay of the underprivileged in the health transition and the fight against cardiovascular diseases – have a far greater effect on differences in life expectancy. In general, social inequalities in mortality and their variation along the social continuum are observed for each of the major causes of death, but they are particularly pronounced for diseases of the respiratory and circulatory systems. The results also point out that spatial disparities in mortality linger and have been worsening for at least a quarter century. The spatial pattern of mortality for the underprivileged social group resembles the spatial patterns of the privileged and intermediate social groups. Within the same social group, spatial disparities endure. This indicates that beyond the socioeconomic composition of regions and districts, other factors – environmental, cultural and behavioural – are involved and affect mortality across social groups in the same way. The second part of the project focused on the relationship between employment situation and (cause-specific) mortality. Mortality inequalities by employment status were considered, controlled for other dimensions of socio-economic position. The association between mortality and unemployment in Belgium was investigated in detail at the individual level. Results showed that the unemployed have a two times higher mortality risk than the employed. Even when they have a high educational level, excellent housing conditions and healthy living arrangements, unemployed men still have a higher mortality risk than their employed counterparts. Conclusions for women were comparable, but inequalities were smaller. A slight protective effect of education against the detrimental health impact of unemployment was demonstrated. Analyses clearly showed that the mortality excess of the unemployed results from an excess mortality in practically all main cause groups. Focusing on specific causes within each main group, we observed large inequalities for alcohol-related mortality. Furthermore, our results illustrated the importance of municipality of district characteristics, such as urbanicity, the aggregated unemployment rate, etcetera. The mortality excess for unemployed men and women was for example smaller in regions with higher aggregate unemployment levels. The higher mortality of the unemployed suggests a positive effect of having a job, which is a reasonable assumption since employment is a key factor determining the financial and psychological wellbeing of individuals and their families. Getting people into work should therefore be an important goal of labour market policies and is of critical importance for reducing health inequalities. However, this is not the whole picture. Analyses including non-standard types of contract show that jobs need to be sustainable as well. Overall and cause-specific mortality differentials by marital status and type of family situation were the focus of a third part of the CAUSINEQ project, in order to gain insight into the effect of the de-standardisation of family formation processes. With regard to marital status, it does appear that matrimonial behaviour varies from one Belgian administrative region to another. Flanders is characterised by a greater share of married couples and a lower proportion of divorced and single people. In contrast, isolated individuals are overrepresented in Brussels, compared to Flanders in particular, but also compared to Wallonia. At the same time, married individuals and those who are not married but live in a couple do seem to be subject to lower levels of mortality in each of the three regions of Belgium. Results from Poisson regression models point out the interactions between the undermortality of (married) couples and the differences in matrimonial behaviour between the three regions are relatively small and do not provide a satisfying explanation for the differences in mortality observed between the regions. The main factor explaining regional differences in mortality is the socio-economic situation of the residents. With regard to type of family situation, excess mortality was revealed for children under 5 years of age living in single-parent families, even after controlling for the main socio-demographic variables. This excess mortality is particularly pronounced for violent deaths. This observation raises questions. Is this a manifestation of less parental supervision or is it a reflection of less safe housing or living conditions? In order to characterise violent deaths in single-parent families and to distinguish them from those in two-parent families, Chi-square tests were used with the place of death (home, school, etc.), the type of death (traffic accident, other accidents, etc.) and the day of the week in which the death occurred. However, none of these analyses was statistically significant. Finally, analyses were performed to show how adverse health – as an important precursor of mortality – varies jointly by employment and living arrangements. A typology of labour market positions was constructed and enriched with survey-data information about respondents’ employment conditions (for those in waged employment). This endeavour shows Belgium as a country with a stable, low prevalence of precarious employment when compared to other EU-countries. However, the prevalence of one particular type of precarious employment is considerable and growing in Belgium, namely ‘precarious unsustainable employment’, characterised mainly by low working hours and low monthly wages and often held by female workers. The labour market typology shows clear relationships with the health of individuals. Three labour market positions are most likely to be associated with general and mental health problems: unemployment, precarious employment and instrumental employment. Controlling for social precarity indicators causes a (sometimes spectacular) reduction in the odds for poor health, which clearly shows how the broader social situation “interacts” with labour market positions in creating social health inequalities. It is therefore important to keep in mind that the accumulation of health-damaging positions in different life spheres is in fact a worrisome reality for a part of the Belgian population. These results indicate that precarious labour market situations are to be taken serious as a public health risk and suggest that stable and secure employment of good quality is the “healthiest form of employment”. From a policy perspective, our findings make clear that the potential health impact of labour market policies should be considered whenever labour market reforms are planned. Policy makers should be aware of the fact that flexible labour market policies may stand at odds with policies aiming for longer and sustainable working careers.

International audience

Analyse de l'évolution des inégalités sociales de mortalité en Belgique et de ses déterminants (état-civil, emploi, niveau d'instruction et conditions de logement)

Analyses de l'évolution des inégalités sociales de mortalité en Belgique et de ses déterminants (emploi, logement, niveau d'instruction, état-civil)

Cette thèse aborde la relation entre la famille et les activités professionnelles dans trois villes ouest africaines : Cotonou (Bénin), Lomé (Togo) et Ouagadougou (Burkina Faso). Le contexte urbain en Afrique de l’Ouest est marqué à la fois par une séparation des rôles masculins et féminins où les femmes exécutent la grande majorité des tâches domestiques et une forte implication des femmes dans les activités économiques avec très peu de structures de garde d’enfants. A partir des données quantitatives et qualitatives collectées dans le cadre du projet « Familles, genre et activités en Afrique de l’Ouest », nous analysons d’abord la répartition des tâches domestiques et des dépenses entre les membres du ménage. Nous analysons ensuite l’effet du ménage sur les activités économiques des hommes et des femmes dans les trois villes. Enfin, à partir de récits de vie de femmes collectés à Lomé et Cotonou, nous étudions les stratégies mises en œuvre par les femmes pour mener conjointement leur double rôle professionnel et domestique. Nos résultats montrent que la conciliation entre vies professionnelle et familiale reste une problématique féminine dans les villes ouest africaines. Tandis que les domestiques deviennent rares dans les ménages, d’autres formes de contournement émergent. (POLS - Sciences politiques et sociales) -- UCL, 2019

In Senegal, despite recent health progress, water-related infections still constitute an acute urban health concern, particularly with regard to children. In the capital, Dakar, the rapid urbanization of recent decades lead to high population densities with diverse socio-economic profiles, in a very heterogeneous urban space. Often, underprivileged families also reside in areas with deficient living arrangements and subpar infrastructure, which means that Dakar's children may be exposed to very different risks for water-related infections. With this in mind, the present thesis analyzes the determinants of water-related diseases, focusing on the effects of behavior and the immediate environment. A mixed-methods approach is used, combining statistical models with semi-structured interviews. In terms of data collection and analysis, the general approach of the study follows a deductive and quantitatively-driven design, whereby the construction of the qualitative instrument is built upon the initial quantitative results. In the context of an ongoing debate regarding whether it is private actions or external physical conditions which determine the transmission of water-related diseases, the present study's results point to both spheres. Findings also indicate that health-related behavior in the family is often a function of the immediate environment, calling attention to the need to take into account characteristics of the wider area, when investigating infectious diseases. The research also points out that, in developing contexts, some of the commonly used statistical indicators may not convey an accurate picture of living conditions. Thus, complementary qualitative analyses may be necessary for a proper understanding of the risk factors involved in the transmission of water-related infections. (POLS - Sciences politiques et sociales) -- UCL, 2019

Ce mémoire a pour objectif de faire le point sur les discussions autour du lien entre urgence, réhabilitation et développement et d’analyser comment cette dimension a été incluse dans les dynamiques des opérations humanitaires au Sri Lanka à la suite du tsunami de 2004. Pour ce faire, les principaux débats théoriques sur la question du lien entre urgence, réhabilitation et développement sont abordés en premier lieu. Il est ensuite question de savoir comment les opérations d’aide humanitaire au Sri Lanka étaient régies par des idées et des pratiques favorisant le lien entre l’urgence, la réhabilitation et le développement. Master [120] en sciences politiques, orientation relations internationales, Université catholique de Louvain, 2017

Cette thèse vise à contribuer à l’amélioration des connaissances sur la contraception d'urgence, dans un contexte d’étude comme celui de Yaoundé, caractérisé notamment par un faible niveau de la pratique contraceptive, la problématique des grossesses non-désirées et les avortements clandestins. L’objectif général de la recherche est de comprendre dans quelle mesure les femmes ont accès à l’information en matière de contraception d’urgence, et d’analyser la place de cette dernière dans leurs pratiques contraceptives. Selon une approche méthodologique essentiellement qualitative, nous nous intéressons à la fois à l’offre et à la demande de la contraception d’urgence. Il s’agit d’appréhender les opinions, les attitudes et les pratiques non seulement des utilisatrices et non-utilisatrices de cette méthode contraceptive, mais aussi celles des professionnels de santé. Les arguments de santé publique, les perceptions sociales de la contraception d’urgence, les normes sociales en matière de sexualité et de reproduction, les situations relationnelles et les rapports de genre sont des facteurs qui soulignent la diversité et la complexité des logiques et des enjeux sous-jacents à l’utilisation de la méthode. (POLS - Sciences politiques et sociales) -- UCL, 2017

Research on urban health in developing countries is becoming an increasingly research issue, as in some Sub-Saharan Africa settings we had to observe a few cases of urban health penalties. In addition, research results are sometimes marked by contradictions or uncertainties in relation to health advantage for people living in cities, in particular for children. With a view of contributing to the scientific debate on urban health issues and the influencing factors, the main purpose of this study is to analyze the role and mechanisms through which migration, poverty and the living environment contribute to heterogeneity of health status and to lead to more urban health inequalities among children in Ouagadougou, Burkina Faso. Based on prospective longitudinal data, we used events history analysis, Heckman selection models and multilevel modelling to identify not only the overall health prevailing in the city, but health situations that would reflect the plurality or intra-urban disparities in health according to socioeconomic characteristics and demographic factors or dynamics in the city. The study is based on the premise that socioeconomic disparities related to poverty and poor living conditions among migrants in Ouagadougou contribute to produce urban health inequalities in terms of birth weight, vaccination coverage and under-five child mortality; out of favour of children in poor living conditions, migrant children or children born to migrants. Through an empirical testing of this theoretical proposition, the aim of this study is to increase political awareness about urban health plurality and inequities among children in order to develop appropriate and adapted health programs tackling both the increase and diversity of child health needs from an equity perspective. Les enjeux de recherche sur la santé urbaine dans les pays en développement deviennent d’autant plus importants qu’on a eu à observer dans certains contextes des paradoxes sanitaires urbains, des contradictions, des incertitudes ou des interrogations par rapport à l’avantage sanitaire des villes notamment pour la santé des enfants. Dans la perspective de contribuer au débat scientifique sur les enjeux sanitaires urbains et les facteurs d’influence, l’objectif général de cette étude est d’analyser le rôle et les mécanismes à travers lesquels la migration et l’environnement de vie contribuent à l’hétérogénéité des situations sanitaires et à la production d’inégalités urbaines de santé des enfants à Ouagadougou au Burkina Faso. Sur la base de données longitudinales prospectives, des modèles d’analyses biographiques, de régressions de Heckman adaptées aux biais de sélection ou multi-niveaux cherchent à cerner non pas l’état sanitaire général prévalant dans cette ville, mais des situations sanitaires qui refléteraient la pluralité ou les disparités intra-urbaines de santé au regard des caractéristiques et des dynamiques sociodémographiques de la ville. L’étude repose sur le postulat que les disparités socioéconomiques liées à la précarité de l’environnement de vie et aux conditions de pauvreté des migrants à Ouagadougou contribuent à la production d’inégalités urbaines de santé des enfants, en termes de poids à la naissance, de statut vaccinal et de mortalité avant l’âge de cinq ans. Les indicateurs de santé relatifs à ces différents phénomènes seraient davantage négatifs parmi les enfants vivant dans des conditions de précarité socioéconomique, les enfants migrants ou ayant des parents migrants. A travers une vérification empirique de cette proposition théorique, il s’agit d’accroître la prise de conscience des politiques sur la pluralité et les iniquités urbaines de santé des enfants, afin que des programmes de santé adéquats et adaptés à la fois à l’ampleur et à la diversité des besoins puissent être éventuellement développés dans une perspective d’équité. (POLS - Sciences politiques et sociales) -- UCL, 2016

This thesis delves into the issue of availability and creation of knowledge in complex emergencies. We discuss health and nutrition data quality, accessibility and use for operational, policy and scientific purposes. Understanding the impact of conflict on populations’ health is essential for humanitarian interventions to effectively respond. Yet, collecting data to generate sound evidence is arduous due to limited access and insecurity. Meanwhile, Non-Governmental Organisations providing humanitarian aid have greater access to populations and collect data to monitor programmes. We investigate how programme data can be exploited by applying scientific methods. We focused on small-scale mortality and nutrition surveys, extensively used to collect representative data on emergency-affected communities. Small-scale surveys proved to be an important source of health and nutrition information. Their aggregated analysis elucidates trends and associations of health variables. Specifically, the case study on undernutrition in Ethiopia provides estimates of wasting prevalence, identifies factors explaining its variation and can guide survey planning towards areas with limited data availability. (SP - Sciences de la santé publique) -- UCL, 2016

Health is a major issue in development. The health sector of developing countries is frequently supported by international cooperation. Long term technical assistance (LT-TA) is a common cooperation instrument. Our research aims to understand ‘‘how’’ long-term technical assistance interventions contribute or can contribute effectively to the strengthening of the counterpart organization. Our case study is based on the support to the “Health System Strengthening Strategy” implementation at provincial level of the health administration in the Democratic Republic of Congo. Our methodological framework is complex systems theories. The research consist of an in-depth literature review and three field studies, namely a study about actors’ perceptions and two studies of technical assistance’s interventions in two provinces. LT-TA interventions are relevant, but their potential is not sufficiently used. Key-elements are the demand of the local counterpart, “process” skills which empower LT-TA to implement change process, interactions based on responsibility. Complexity is a relevant theoretical methodological framework for health systems research and should be developed further. (SP - Sciences de la santé publique) -- UCL, 2015