Search

Les auteurs aimeraient partager dans cet article l’experience de trois sessions d’un seminaire residentiel en Suisse de 2,5 jours chacun, propose a des fins de formation systemique continue.Les seminaires varient entre des moments « d’exposition de soi » du therapeute, et d’exploration de conduite interactive de seances psychotherapeutiques in vivo.L’article decrit de quelle maniere une « communaute d’apprentissage » se cree et de quelle maniere elle favorise par « modeling circulaire » l’emergence des aspects uniques de la personne du psychotherapeute. Cette demarche permet d’augmenter ehez chaque participant la creativite de son style personnel, dans sa vie professionnelle d’abord, mais naturellement dans sa vie personnelle aussi. La matiere enseignee peut etre definie comme « l’art de conduire le processus therapeutique en utilisant la part humaine et subjective du therapeute ».

Background Anarchic and poorly controlled urbanization led to an increased risk of mosquito-borne diseases (MBD) in many African cities. Here, we evaluate the spatial heterogeneity of human exposure to malaria and arboviral disease vectors in an urban area of northern Senegal, using antibody-based biomarkers of exposure to Anopheles and Aedes mosquito bites. Methods A cross-sectional study was undertaken during the rainy season of 2014 in 4 neighborhoods of Saint-Louis, a city in northern Senegal. Among children aged 6–59 months in each neighborhood, the dried blood spot technique was used to evaluate immunoglobulin G (IgG) responses to both gSG6-P1 (Anopheles) and Nterm–34-kDa (Aedes) salivary peptides as validated biomarkers of respective mosquito bite exposure. Results IgG response levels to gSG6-P1 and Nterm–34-kDa salivary peptides varied significantly between the 4 neighborhoods (P < .0001). The level of exposure to Aedes bites also varied according to household access to sanitation services (P = .027), whereas that of exposure to Anopheles bites varied according to insecticide-treated bed net use (P = .006). In addition, spatial clusters of high contact between humans and mosquitoes were identified inside 3 neighborhoods. Conclusions Antibody-based biomarkers of exposure to Anopheles and Aedes mosquito bites could be helpful tools for evaluating the heterogeneity of exposure to malaria and arboviral disease vectors by national control programs.

International audience; This study contributes to the literature about the effects of space and place on health by introducing a socio-territorial approach to urban health disparities in West Africa. It explores how urban spaces, specifically neighbourhoods, are shaped by social and economic relations and strategies of territorial control. We examine the potential influence of socio-territorial processes on vulnerability to disease, access to medical care, healthscapes, and illness experiences. Our research was conducted in Senegal and relied on a mixed methods design. We identified four neighbourhoods that represent the socio-spatial heterogeneity of the city of Saint-Louis and utilized the following methods: geographic and anthropological field research, household surveys, health knowledge and behaviour surveys, clinical exams, and illness interviews. Our results highlight the socio-territorial processes at work in each neighbourhood, clinical findings on three health measures (overweight, high blood pressure, and hyperglycaemia) and health experiences of individuals with hypertension or type II diabetes. We found significant differences in the prevalence of the three health measures in the study sites, while experiences managing hypertension and diabetes were similar. We conclude that a socio-territorial approach offers insight into the complex constellation of forces that produce health disparities in urban settings.

International audience; Background : Many cities in developing countries experience an unplanned and rapid growth. Several studies have shown that the irregular urbanization and equipment of cities produce different health risks and uneven exposure to specific diseases. Consequently, health surveys within cities should be carried out at the micro-local scale and sampling methods should try to capture this urban diversity. Methods : This article describes the methodology used to develop a multi-stage sampling protocol to select a population for a demographic survey that investigates health disparities in the medium-sized city of Bobo-Dioulasso, Burkina Faso. It is based on the characterization of Bobo-Dioulasso city typology by taking into account the city heterogeneity, as determined by analysis of the built environment and of the distribution of urban infrastructures, such as healthcare structures or even water fountains, by photo-interpretation of aerial photographs and satellite images. Principal component analysis and hierarchical ascendant classification were then used to generate the city typology.Results : Five groups of spaces with specific profiles were identified according to a set of variables which could be considered as proxy indicators of health status. Within these five groups, four sub-spaces were randomly selected for the study. We were then able to survey 1045 households in all the selected sub-spaces. The pertinence of this approach is discussed regarding to classical sampling as random walk method for example. Conclusion : This urban space typology allowed to select a population living in areas representative of the uneven urbanization process, and to characterize its health status in regards to several indicators (nutritional status, communicable and non-communicable diseases, and anaemia). Although this method should be validated and compared with more established methods, it appears as an alternative in developing countries where geographic and population data are scarce.

International audience; Dengue is an emerging infectious disease of global significance. Although this virus has been reported for a long time, its significance within the burden of diseases in West Africa is not obvious, especially in Burkina Faso. Our objective was to evaluate flavivirus presence in Ouagadougou (Burkina Faso) and the link between anti-flavivirus antibody seroprevalence and urbanization modes. A population-based cross-sectional survey was conducted and 3015 children were enrolled from Ouagadougou districts with different types and degrees of urbanization (with/without equipment and high/low building density). Flavivirus (FLAV) IgM MAC-ELISA and FLAV indirect IgG ELISA were performed. Associations between FLAV IgG presence (sign of past infection) and various independent variables were assessed using the chi-square test and a multivariate logistic regression analysis. The apparent prevalence of past flavivirus infections among the enrolled children was 22.7% (95% CI: 22.4-26.7) (n = 685). Eleven children (0.4%; 95% CI: 0.61-2.14) were positive for FLAV IgM, indicating active transmission. Factors associated with flavivirus infection were identified among the enrolled children (age, sex), householders (educational level, asset index) and in the environment (building density, water access, waste management and house appearance); however, they showed great variability according to the city districts. The water access modality did not significantly influence FLAV IgG positivity. Conversely, apparently good practices of waste management had unexpected consequences (increased risk related to municipal dumpsters). Given the scale of ongoing urbanization and the spread of arboviral diseases, close collaboration between health and city stakeholders is needed.

International audience

Un cas de maltraitance sexuelle sur mineur au sein d’une famille adoptive est presente dans l’article, de meme qu’un resume de la therapie familiale systemique qui a suivi. Le desir d’adoption des parents est recontextualise dans une perspective transgenerationnelle de chacun des parents, de meme que l’abus sexuel. Le concept de « deuxieme abandon » est propose dans le cadre general de la prevention et de la therapie de la maltraitance familiale.

International audience; Economic evaluations are critical for the assessment of the efficiency and sustainability of animal health surveillance systems and the improvement of their efficiency. Methods identifying and quantifying costs and benefits incurred by public and private actors of passive surveillance systems (i.e. actors of veterinary authorities and private actors who may report clinical signs) are needed. This study presents the evaluation of perceived costs and benefits of highly pathogenic avian influenza (HPAI) passive surveillance in Vietnam. Surveys based on participatory epidemiology methods were conducted in three provinces in Vietnam to collect data on costs and benefits resulting from the reporting of HPAI suspicions to veterinary authorities. A quantitative tool based on stated preference methods and participatory techniques was developed and applied to assess the non-monetary costs and benefits. The study showed that poultry farmers are facing several options regarding the management of HPAI suspicions, besides reporting the following: treatment, sale or destruction of animals. The option of reporting was associated with uncertain outcome and transaction costs. Besides, actors anticipated the release of health information to cause a drop of markets prices. This cost was relevant at all levels, including farmers, veterinary authorities and private actors of the upstream sector (feed, chicks and medicine supply). One benefit associated with passive surveillance was the intervention of public services to clean farms and the environment to limit the disease spread. Private actors of the poultry sector valued information on HPAI suspicions (perceived as a non-monetary benefit) which was mainly obtained from other private actors and media.

National audience; Primary health care (PHC) and the needs of local populations in rural depopulated areas have been little explored, although health care access remains an issue in those areas. This study compares depopulating areas with other rural areas, using several statistical and national approaches. Results show diminished health care access in those areas, although medical needs are critically high. In addition, this study assesses multi-disciplinary group practice in primary care, which aims to attract and retain the general practitioner. Results show that the PHCGP helps to reduce the erosion of PHC in some depopulated areas, but not systematically, and that other policies need to be deployed in these areas.; Les espaces ruraux en dépeuplement ont été peu explorés du point de vue de l'offre de soins de premiers recours et des besoins des populations résidentes, alors que ces questions y occupent une place importante. Ce travail caractérise les espaces en dépeuplement comparativement aux autres espaces ruraux à partir d'une typologie socio-sanitaire et d'une approche statistique nationale. Il met en évidence le déclin plus prononcé de l'offre de médecins généralistes libéraux dans ces espaces, alors que les besoins sanitaires demeurent élevés. Cette contribution évalue également les effets des maisons de santé mises en place pour attirer et maintenir des médecins généralistes dans les zones sous-dotées. Les maisons de santé permettent de diminuer l'érosion de l'offre de médecins généralistes dans certains espaces en dépeuplement, mais pas dans l'ensemble de ceux-ci appelant à des mesures plus larges ou spécifiques.

Salem Gérard. L'enseignement de la géographie de la santé en France : bilan de 10 années de DEA et de Master (Teaching health geography in France : an assessment of 10 years of DEA and Masters). In: Bulletin de l'Association de géographes français, 89e année, 2012-2. La géographie de la santé en France, sous la direction de Jeanne-Marie Amat-Roze. pp. 180-183.

This article presents a training-action-research based on production by master students of health geography (Master Geography, Health, Environment and Territories co-accredited by the University of Paris Ouest -Nanterre la Défense / Paris East University -Créteil) of local health diagnoses corresponding with a social demand from local authorities. Two examples are specifically developed here : routine observation of the local health observatory in Nanterre and analysis of intra-urban disparities in access to screening for breast and colorectal cancer as part of a "tutored project" conducted throughout training. This knowledge translation process is based on building strong partnerships, rooted in time with the Elected Public Health Association and Territories, the Regional Council of Ile-de-France, with multiple local and other agencies such as the Regional Health Agency or the structures of cancer screening., Cet article présente un dispositif de formation-recherche-action reposant sur la production par des étudiants en master de géographie de la santé (Master Géographie, Santé, Territoires et Environnement co-habilité Université Paris Ouest-Nanterre-la-Défense / Université Paris Est-Créteil) de diagnostics locaux de santé répondant à une demande sociale émanant des collectivités locales. Deux exemples sont plus précisément développés ici : l'observation en routine de l'observatoire local de la santé à Nanterre et l'analyse des disparités intra-urbaines d'accès au dépistage des cancers du sein et colorectal dans le cadre d'un «projet tutoré » mené tout au long de la formation. Ce dispositif de transfert et co-production de connaissances s 'appuie sur la construction de partenariats forts, ancrés dans le temps avec l'association Elus Santé Publique et Territoires, le Conseil Régional d'Ile-de-France, avec de multiples collectivités locales et d'autres organismes tels que l'Agence Régionale de Santé ou les structures de dépistage du cancer., Vaillant Zoé, Rican Stéphane, Salem Gérard. Les diagnostics locaux de santé : levier de sensibilisation et de mobilisation pour le pilotage des politiques locales de santé publique visant à réduire les inégalités sociales et territoriales de santé ? (Local health diagnostics : a lever of awareness and mobilization for the management of local public health policies aimed at reducing social and regional unequalities in health ?). In: Bulletin de l'Association de géographes français, 89e année, 2012-2. La géographie de la santé en France, sous la direction de Jeanne-Marie Amat-Roze. pp. 184-193.

Dans le cadre du programme interdisciplinaire PERSAN (Populations et espaces a risques sanitaires) de l'IRD, centre sur la sante en milieu urbain africain, une etude epidemiologique transversale portant sur des enfants âges de 6 a 59 mois a ete realisee en mai 2002 a Yaounde (Cameroun). Entres autres objectifs, il etait question d'identifier les facteurs de risques des maladies diarrheiques dans la ville, de mesurer leur prevalence et d'apprehender leur distribution spatiale. Les analyses effectuees sur les selles des 3 034 enfants examines ont revele 437 cas de selles diarrheiques (soit une prevalence de 14,4 %). Parmi les nombreux facteurs de risques etudies, les pratiques d'assainissement des populations concernant les matieres fecales se sont revelees etre associees a ces diarrhees. De plus, il s'est avere que les niveaux d'atteinte diarrheique variaient considerablement d'un quartier a un autre du fait du caractere differencie de l'urbanisation de la ville.

Data show that hypertension has become a public health problem in developing countries. Many studies have reported social disparities among the affected populations, but few of them pointed out spatial disparities within towns. We aimed to show that hypertension could be a good indicator of the medical change that occurs unequally in towns. A cross-sectional survey was done in April and October 2004 in Ouagadougou, Burkina Faso, among 2087 adults over 35 years old in different kinds of urban areas. Social and demographic data were collected and blood pressure was measured. Prevalence of hypertension was 40.2%. Age, body mass index, level of equipment, absence of community integration, absence of occupation, duration of residence over 20 years, protein-rich diet and absence of physical activity were identified as risk factors, but there were social and spatial disparities according to location of housing (parcelled-out or non-parcelled-out areas) and to integration within the town. The high rate of hypertension found in Ouagadougou and the heterogeneity of the risk within the population highlights that social and spatial risk factors have to be taken into account for the prevention of the non-transmissible diseases in countries in full process of urbanization and medical change.

La mortalite par cancer aux grands âges reste peu analysee. Elle est en particulier marquee par la qualite de la certification a des âges ou la comorbidite est frequente. Une analyse des tendances sur les 30 dernieres annees et des disparites de mortalite permet de souligner le recul progressif de l’âge aux deces, le poids grandissant des cancers dans la mortalite apres 65 ans ainsi que l’importance de la prise en compte des contextes sanitaires locaux pour expliquer les ecarts importants constates en France.

This paper describes a knowledge transfer experiment that has been conducted since September 2012 in Argenteuil (Val d'Oise, France). This experiment is part of an interventional research project called DeCL/C: "Knowledge translation on social and spatial inequalities: a tool to raise local awareness and mobilization to lessen cancer screening participation rate disparities': The project is carried out by health geographers from Paris Ouest University (UPO) and the National Association of Cities for Public Health (Elus, Sante Publique et Territoires, ESPT). It encompasses two main components: intervention designed to implement a knowledge co-production and transfer process among researchers, stakeholders and decision makers at various levels. This knowledge concerns social and spatial determinants of inequalities of access to breast cancer screening programmes in cities. The research is multidisciplinary (geography, sociology, political science, epistemology) and is designed to measure the impact of this knowledge co-production and transfer in terms of actions in the targeted cities (six cities in the Paris region) as well as the reduction of inequalities of access to breast cancer screening programmes. This article, based on knowledge transfer literature and an empirical experiment in Argenteuil, describes the ongoing knowledge transfer process. It also highlights Argenteuil stakeholders' and decision makers' interest in action and research. The analysis of the knowledge co-production, sharing and ownership process by local actors a e both "strategic" and "profound'

Cet article propose une premiere evaluation des maisons et poles de sante a travers une demarche mobilisant des outils geographique et econometrique. L'objectif de cette double demarche est l'analyse de l'implantation de ces structures, puis une analyse de l'impact de celles-ci sur la densite de medecins generalistes liberaux. La methodologie repose sur l'elaboration de typologies spatiales, puis d'une analyse cas-temoin comparant l'evolution de la densite de medecins generalistes dans les espaces avec et sans maisons de sante, avant et apres la generalisation de cette politique. Les resultats obtenus mettent en evidence une implantation davantage rurale de ces structures, de surcroit dans des espaces fragiles, ainsi qu'une moindre diminution de l'offre dans certains espaces ruraux et periurbains dotes de maisons et poles de sante.

Bien que plus tardive qu’ailleurs dans le monde, l’urbanisation est en pleine expansion sur le continent africain. Contrairement à ce que l’on avait pu observer en Europe, elle ne s’accompagne pas de la disparition des maladies de type infectieux ou parasitaire, bien que le poids des maladies non transmissibles se fasse largement sentir. Ainsi, le paludisme dont on prédisait la disparition dans les villes souvent perçues comme délétères du fait notamment de la pollution de l’environnement, y persiste. L’adaptation des moustiques vecteurs de la maladie à la pollution est une des causes de ce maintien mais aussi certaines pratiques spatiales de la population comme la persistance d’une agriculture périurbaine, voire même intra urbaine. Dans ces conditions, la transmission de la maladie pourrait être inégale et les populations ne seraient donc pas soumises au même risque. L’étude conduite à Bobo-Dioulasso, seconde ville du Burkina Faso, avait pour objectif d’analyser la distribution du paludisme dans des quartiers différemment urbanisés et d’identifier les facteurs de risque permettant d’expliquer sa transmission. Il apparaît que la distribution du paludisme dans les quartiers étudiés est inégale : les quartiers centraux et anciennement urbanisés sont plus exposés au paludisme que les quartiers périphériques et plus récents. Cependant, il existe au sein de chaque quartier des sous espaces au sein desquels les enfants sont plus exposés à la maladie. Les déterminants du paludisme font ressortir l’importance de l’environnement (proximité des bas fonds) mais également des facteurs sociaux comme le niveau d’éducation de la mère des enfants et le niveau socio-économique des ménages. Au-delà de la démonstration de l’importance d’études croisant la diversité urbaine et la santé permettant de définir des profils sanitaires d’espaces et de populations, passant par l’élaboration de méthodologies adaptées au contexte urbain, notre ambition était de souligner le besoin d’une concertation entre politiques de santé et de la ville pour un meilleur contrôle de maladies comme le paludisme, à l’heure de la mise en œuvre de leur élimination. Occurring with a time delay compared to what was observed elsewhere in the world, urbanization is expanding in Africa. In contrast to what happened in Europe, the decline of infectious diseases is not perceived, although non communicable diseases increase. Thus, malaria which should disappear from the cities because of environment pollution persists in cities. The adaptation of the vectors to water pollution could explain its persistence, with also some practices like urban agriculture. Under these conditions, transmission of the disease could be unequal and populations may be exposed to a different risk. The study conducted in Bobo-Dioulasso, second city of Burkina Faso, aimed to analyze the distribution of malaria in differently urbanized districts, and to identify the risk factors which may explain its spatial distribution. It appeared that the old central districts were more exposed to malaria than the recent peripheral ones. Moreover, spatial disparities could be observed inside districts. The determinants of malaria emphasized the importance of the environment (proximity of lowlands) and social factors like education level of the mother and socio-economic level of the household. This kind of study allowed defining health patterns of areas and populations according to methodologies adapted to the urban context. Beyond the demonstration of the importance of studies crossing urban diversity and health, our ambition was to underline the need for a dialogue between health and urban policies for a better control of diseases like malaria, at the time of the implementation of their elimination.

This paper describes a knowledge transfer experiment that has been conducted since September 2012 in Argenteuil (Val d'Oise, France). This experiment is part of an interventional research project called DeCL/C: "Knowledge translation on social and spatial inequalities: a tool to raise local awareness and mobilization to lessen cancer screening participation rate disparities': The project is carried out by health geographers from Paris Ouest University (UPO) and the National Association of Cities for Public Health (Elus, Sante Publique et Territoires, ESPT). It encompasses two main components: intervention designed to implement a knowledge co-production and transfer process among researchers, stakeholders and decision makers at various levels. This knowledge concerns social and spatial determinants of inequalities of access to breast cancer screening programmes in cities. The research is multidisciplinary (geography, sociology, political science, epistemology) and is designed to measure the impact of this knowledge co-production and transfer in terms of actions in the targeted cities (six cities in the Paris region) as well as the reduction of inequalities of access to breast cancer screening programmes. This article, based on knowledge transfer literature and an empirical experiment in Argenteuil, describes the ongoing knowledge transfer process. It also highlights Argenteuil stakeholders' and decision makers' interest in action and research. The analysis of the knowledge co-production, sharing and ownership process by local actors a e both "strategic" and "profound'

Le nombre de deces par cancer et le poids des cancers dans la mortalite totale ont beaucoup augmente tout au long du XXe siecle. Dans le meme temps, les taux de mortalite diminuent depuis la fin des annees 1980. Le traitement des donnees de mortalite de 2003, recemment validees, permet d'apprecier les tendances recentes de la mortalite par cancer a l'aune de ces tendances anciennes. L'augmentation du nombre de deces et de la part des cancers dans la mortalite se confirme de meme que la diminution de la letalite. Les ecarts entre les hommes et les femmes se reduisent. Le cancer est aujourd'hui la premiere cause de deces entre 40 et 75 ans. L'analyse des tendances recentes confirme egalement la diminution de la mortalite pour differentes localisations cancereuses (estomac, voies aerodigestives superieures ou colorectales), l'augmentation pour d'autres (peau, systeme nerveux central, bronchopulmonaires pour les femmes). Cette approche permet aussi d'envisager l'amorce d'une inversion de tendance pour la mortalite par lymphome non hodgkinien (diminution pour les femmes apres une phase de forte augmentation). Ces changements ne modifient cependant pas l'importance des disparites geographiques de mortalite, tant pour les hommes que pour les femmes.

Les deces feminins dus a un cancer du poumon sont de plus en plus frequents en France, traduction differee du developpement du tabagisme depuis les annees 1970. Les auteurs etudient les etapes de cette veritable epidemie par une serie de cartes qui rendent compte de la diffusion spatiale. La generalisation progressive de taux de mortalite forts mais encore inegaux, donne des indications operationnelles pour les soins preventifs et curatifs.

En France, actuellement un homme sur deux et une femme sur trois risque, au cours de sa vie, de developper un cancer. Ces moyennes nationales ne traduisent cependant pas l’extreme heterogeneite du pays en terme de cancers. Une analyse portant sur les disparites spatiales d’incidence de cancers par l’intermediaire des donnees de mises en Affections Longues Durees (ALD) permet de souligner l’extreme heterogeneite du territoire francais. Ces differences concernent aussi bien les hommes que les femmes, a tous les âges. Cette analyse confirme l’interet d’une demarche geographique en sante et la confrontation d’indicateurs de morbidite et de mortalite dans une perspective de sante publique, afin notamment, de mieux evaluer les disparites d’acces aux soins, de recours et de qualite des soins.

Les consequences sanitaires des processus d'urbanisation restent peu etudiees. Une analyse des disparites spatiales de sante respiratoire en France permet de mieux comprendre les liens entre environnement urbain et sante. L'evolution des indicateurs de sante respiratoire selon differents niveaux d'urbanisation, l'analyse des rapports centre-peripherie et la prise en compte des disparites intra-urbaines de sante respiratoire permettent de remettre en cause certaines idees recues et d'insister sur la persistance et l'importance de veritables contextes regionaux.

This study contributes to the literature about the effects of space and place on health by introducing a socio-territorial approach to urban health disparities in West Africa. It explores how urban spaces, specifically neighbourhoods, are shaped by social and economic relations and strategies of territorial control. We examine the potential influence of socio-territorial processes on vulnerability to disease, access to medical care, healthscapes, and illness experiences. Our research was conducted in Senegal and relied on a mixed methods design. We identified four neighbourhoods that represent the socio-spatial heterogeneity of the city of Saint-Louis and utilized the following methods: geographic and anthropological field research, household surveys, health knowledge and behaviour surveys, clinical exams, and illness interviews. Our results highlight the socio-territorial processes at work in each neighbourhood, clinical findings on three health measures (overweight, high blood pressure, and hyperglycaemia) and health experiences of individuals with hypertension or type II diabetes. We found significant differences in the prevalence of the three health measures in the study sites, while experiences managing hypertension and diabetes were similar. We conclude that a socio-territorial approach offers insight into the complex constellation of forces that produce health disparities in urban settings.

Salem Gérard, Suss Cyrille. Maillage territorial et données statistiques sur quelques pays africains, Nigeria, Burkina Faso, Bénin, Guinée, Côte d'Ivoire. In: Espace, populations, sociétés, 1999-1. Les populations de l'Afrique subsaharienne. pp. 155-160.

Cet article tente d’eclaircir les processus lies a la reconnaissance en psychotherapie, en particulier la maniere dont ces processus constituent une experience correctrice en psychotherapie systemique. Sont abordes les aspects theoriques de l’acte de reconnaissance sur le plan philosophique et social, ainsi que dans la psychologie interpersonnelle.La deuxieme partie illustre, a la faveur de plusieurs situations cliniques dont une plus exhaustive, l’application pratique en psychotherapie systemique de l’acte de reconnaissance, avec ses repercussions sur les relations familiales et la suite du processus therapeutique.

Background: Although some studies have reported that population change is associated with spatial mortality inequalities, few of them have tried to take a dynamic approach to the association. The aim of this study was to explore and interpret the ecological association between the change in cause-specific mortality inequalities and population change over a 30-year period in areas exhibiting different deprivation and urbanization levels in France. Methods : The French communes were classified by category of demographic change during the period 1962–2006. The changes in standardized mortality ratios were analysed by category over 5 inter-censal periods, taking into account degree of urbanization and deprivation quintile. The magnitude and significance of the associations for various causes of death were estimated using a Generalised Estimating Equation Poisson model. Results : Overall, the change in relative mortality was negatively associated with population growth. For a compound annual population growth rate of 1% in 1990–99, the standardized mortality ratios decreased, on average, by 2.1% (95% confidence interval: −1.45 to −2.72). The association was stronger in urban areas, and reversed in the least deprived areas. The association was stronger and more significant for men, subjects aged less than 65 years and alcohol-related and violent deaths. Conclusion : This study highlights the significance of dynamic approaches. Population growth was associated with a decrease in relative mortality level; the direction and strength of the association varied depending on the socio-territorial characteristics. As is the case for English-speaking countries, in France, population growth may be considered a component of current social dynamics that are not measured by usual indicators.