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1. How to Evaluate Health in All Policies at the Local Level: Methodological Insights Within Municipalities From the WHO French Healthy Cities Network

Author: Marion Porcherie, Marie-Florence Thomas, Frédérique Quidu, Zoé Héritage, Zoé Vaillant, Jean Simos, Stéphane Rican, Nicola Cantoreggi, Emmanuelle Faure, and Anne Roué Le Gall
Subjects: policies, local, assessment, quantitative, green spaces, healthy city, Public aspects of medicine, RA1-1270
Abstract: Background This article proposes a method for analysing the degree of maturity of Health in All Policies (HiAP) among World Health Organization-French Healthy Cities Network (WHO-FHCN) as part of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project. We focused on the creation or enhancement of healthpromoting environments, and more specifically, public green spaces.Methods We conducted a cross-sectional quantitative study guided by the evaluative framework of the HiAP maturity level developed by Storm et al mixed with a qualitative interpretation. A self-administered questionnaire was sent to elected officials and health department officers in the 85 member cities of the WHO-FHCN in 2017. Subsequently 58 cities were included in the analysis, which was based on a multiple correspondence analysis (MCA) and a hierarchical ascending classification (HAC).Results Thirty-two criteria among a total of 100 were identified and were used to organize the cities into 8 groups which was then reduced to three profiles among the cities: a less advanced HiAP profile, an established HiAP profile and an advanced HiAP profile. This process allows us to identify 4 dimensions that make it possible to evaluate the level of maturity of cities in the HiAP process, namely: (1) the consideration of social inequalities in health and/or health issues in the policies/actions of the sector studied, (2) occasional intersectoral collaboration, ie, one-off initiatives between the health department and others sectors, (3) the existence of joint projects, ie, common projects between two or more sectors, (4) the existence of intersectoral bodies, in this case on the theme of urban green spaces including an intersectoral committee and/or working groups.Conclusion Four dimensions which allow to the measurement of the degree of progress in implementing healthall-policies are proposed. With a view to integrating knowledge into public action, this study carried out under real conditions offers a realistic method to evaluate HiAP.
Published: 2022
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2. Spatial determinants of excess all-cause mortality during the first wave of the COVID-19 epidemic in France

Author: Hugo Pilkington, Thierry Feuillet, Stéphane Rican, Jeanne Goupil de Bouillé, Olivier Bouchaud, Johann Cailhol, Hélène Bihan, Pierre Lombrail, and Chantal Julia
Subjects: COVID-19, Mortality, Socioeconomic factors, Delivery of health care, Deprivation, Inequality, Public aspects of medicine, RA1-1270
Abstract: Abstract Background The first wave of the COVID-19 pandemic in France was associated with high excess mortality, and anecdotal evidence pointed to differing excess mortality patterns depending on social and environmental determinants. In this study we aimed to investigate the spatial distribution of excess mortality during the first wave of the COVID-19 pandemic in France and relate it at the subnational level to contextual determinants from various dimensions (socioeconomic, population density, overall health status, healthcare access etc.). We also explored whether the determinants identified at the national level varied depending on geographical location. Methods We used available national data on deaths in France to calculate excess mortality by department for three age groups: 0–49, 50–74 and > 74 yrs. between March 1st and April 27th, 2020. We selected 15 variables at the department level that represent four dimensions that may be related to overall mortality at the ecological level, two representing population-level vulnerabilities (morbidity, social deprivation) and two representing environmental-level vulnerabilities (primary healthcare supply, urbanization). We modelled excess mortality by age group for our contextual variables at the department level. We conducted both a global (i.e., country-wide) analysis and a multiscale geographically weighted regression (MGWR) model to account for the spatial variations in excess mortality. Results In both age groups, excess all-cause mortality was significantly higher in departments where urbanization was higher (50–74 yrs.: β = 15.33, p 74 yrs.: β = 18.24, p 74 yrs.: β = − 8.27, p 74 yrs. age group our measures of deprivation (β = 15.46, p
Published: 2021
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3. Advancing tools to promote health equity across European Union regions: the EURO-HEALTHY project

Author: Paula Santana, Ângela Freitas, Iwa Stefanik, Cláudia Costa, Mónica Oliveira, Teresa C. Rodrigues, Ana Vieira, Pedro Lopes Ferreira, Carme Borrell, Sani Dimitroulopoulou, Stéphane Rican, Christina Mitsakou, Marc Marí-Dell’Olmo, Jürgen Schweikart, Diana Corman, Carlos A. Bana e Costa, and on behalf of the EURO-HEALTHY investigators
Subjects: Health equity, European Union regions, Geographic inequalities, Population Health Index, Participatory approach, Foresight, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing best, which factors might shape future health outcomes and where there is room for improvement. Methods Under the EURO-HEALTHY project, tools combining the technical elements of multi-criteria value models and the social elements of participatory processes were developed to measure health in multiple dimensions and to inform policies. The flagship tool is the Population Health Index (PHI), a multidimensional measure that evaluates health from the lens of equity in health determinants and health outcomes, further divided into sub-indices. Foresight tools for policy analysis were also developed, namely: (1) scenarios of future patterns of population health in Europe in 2030, combining group elicitation with the Extreme-World method and (2) a multi-criteria evaluation framework informing policy appraisal (case study of Lisbon). Finally, a WebGIS was built to map and communicate the results to wider audiences. Results The Population Health Index was applied to all European Union (EU) regions, indicating which regions are lagging behind and where investments are most needed to close the health gap. Three scenarios for 2030 were produced – (1) the ‘Failing Europe’ scenario (worst case/increasing inequalities), (2) the ‘Sustainable Prosperity’ scenario (best case/decreasing inequalities) and (3) the ‘Being Stuck’ scenario (the EU and Member States maintain the status quo). Finally, the policy appraisal exercise conducted in Lisbon illustrates which policies have higher potential to improve health and how their feasibility can change according to different scenarios. Conclusions The article makes a theoretical and practical contribution to the field of population health. Theoretically, it contributes to the conceptualisation of health in a broader sense by advancing a model able to integrate multiple aspects of health, including health outcomes and multisectoral determinants. Empirically, the model and tools are closely tied to what is measurable when using the EU context but offering opportunities to be upscaled to other settings.
Published: 2020
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4. Ability of ecological deprivation indices to measure social inequalities in a French cohort

Author: Sofia Temam, Raphaëlle Varraso, Carole Pornet, Margaux Sanchez, Aurélie Affret, Bénédicte Jacquemin, Françoise Clavel-Chapelon, Grégoire Rey, Stéphane Rican, and Nicole Le Moual
Subjects: Socioeconomic factors, Deprivation index, Social inequalities, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Despite the increasing interest in place effect to explain health inequalities, there is currently no consensus on which kind of area-based socioeconomic measures researchers should use to assess neighborhood socioeconomic position (SEP). The study aimed to evaluate the reliability of different area-based deprivation indices (DIs) in capturing socioeconomic residential conditions of French elderly women cohort. Methods We assessed area-based SEP using 3 DIs: Townsend Index, French European Deprivation Index (FEDI) and French Deprivation index (FDep), among women from E3N (Etude épidémiologique auprès des femmes de la Mutuelle Générale de l’Education Nationale). DIs were derived from the 2009 French census at IRIS level (smallest geographical units in France). Educational level was used to evaluate individual-SEP. To evaluate external validity of the 3 DIs, associations between two well-established socially patterned outcomes among French elderly women (smoking and overweight) and SEP, were compared. Odd ratios were computed with generalized estimating equations to control for clustering effects from participants within the same IRIS. Results The analysis was performed among 63,888 women (aged 64, 47% ever smokers and 30% overweight). Substantial agreement was observed between the two French DIs (Kappa coefficient = 0.61) and between Townsend and FEDI (0.74) and fair agreement between Townsend and FDep (0.21). As expected among French elderly women, those with lower educational level were significantly less prone to be ever smoker (Low vs. High; OR [95% CI] = 0.43 [0.40–0.46]) and more prone to being overweight (1.89 [1.77–2.01]) than women higher educated. FDep showed expected associations at area-level for both smoking (most deprived vs. least deprived quintile; 0.77 [0.73–0.81]) and overweight (1.52 [1.44–1.62]). For FEDI opposite associations with smoking (1.13 [1.07–1.19]) and expected association with overweight (1.20 [1.13–1.28]) were observed. Townsend showed opposite associations to those expected for both smoking and overweight (1.51 [1.43–1.59]; 0.93 [0.88–0.99], respectively). Conclusion FDep seemed reliable to capture socioeconomic residential conditions of the E3N women, more educated in average than general French population. Results varied strongly according to the DI with unexpected results for some of them, which suggested the importance to test external validity before studying social disparities in health in specific populations.
Published: 2017
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5. The GREENH-City interventional research protocol on health in all policies

Author: Marion Porcherie, Zoé Vaillant, Emmanuelle Faure, Stéphane Rican, Jean Simos, Nicola Luca Cantoreggi, Zoé Heritage, Anne Roue Le Gall, Linda Cambon, Thierno Amadou Diallo, Eva Vidales, and Jeanine Pommier
Subjects: Health in all policies, Urban green spaces, Health inequities, Mixed-methods, Comparative multiple-case studies, Interventional research, Public aspects of medicine, RA1-1270
Abstract: Abstract Background This paper presents the research protocol of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project funded by the National Institute for Cancer (Subvention N°2017–003-INCA). In France, health inequities have tended to increase since the late 1980s. Numerous studies show the influence of social, economic, geographic and political determinants on health inequities across the life course. Exposure to environmental factors is uneven across the population and may impact on health and health inequities. In cities, green spaces contribute to creating healthy settings which may help tackle health inequities. Health in All Policies (HiAP) represents one of the key strategies for addressing social and environmental determinants of health inequities. The objective of this research is to identify the most promising interventions to operationalize the HiAP approaches at the city level to tackle health inequities through urban green spaces. It is a participatory interventional research to analyze public policy in real life setting (WHO Healthy Cities). Method/design It is a mixed method systemic study with a quantitative approach for the 80 cities and a comparative qualitative multiple case-studies of 6 cities. The research combines 3 different lens: 1/a political analysis of how municipalities apply HiAP to reduce social inequities of health through green space policies and interventions 2/a geographical and topological characterization of green spaces and 3/ on-site observations of the use of green spaces by the inhabitants. Results City profiles will be identified regarding their HiAP approaches and the extent to which these cities address social inequities in health as part of their green space policy action. The analysis of the transferability of the results will inform policy recommendations in the rest of the Health City Network and widely for the French municipalities. Discussion/conclusion The study will help identify factors enabling the implementation of the HiAP approach at a municipal level, promoting the development of green spaces policies in urban areas in order to tackle the social inequities in health.
Published: 2017
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6. Associations of cause-specific mortality with area level deprivation and travel time to health care in France from 1990 to 2007, a multilevel analysis

Author: Walid Ghosn, Gwenn Menvielle, Stéphane Rican, and Grégoire Rey
Subjects: Cause-specific mortality, Contextual association, Deprivation, Travel time to health care, Geographical mortality disparities, Public aspects of medicine, RA1-1270
Abstract: Abstract Background It is now widely accepted that social and physical environment participate in shaping health. While mortality is used to guide public health policies and is considered as a synthetic measure of population health, few studies deals with the contextual features potentially associated with mortality in a representative sample of an entire country. This paper investigates the possible role of area deprivation (FDep99) and travel time to health care on French cause-specific mortality in a proper multilevel setting. Methods The study population was a 1% sample representative of the French population aged from 30 to 79 years in 1990 and followed up until 2007. A frailty Cox model was used to measure individual, contextual effects and spatial variances for several causes of death. The chosen contextual scale was the Zone d’Emploi of 1994 (348 units) which delimits the daily commute of people. The geographical accessibility to health care score was constructed with principal component analysis, using 40 variables of hospital specialties and health practitioners’ travel time. Results The outcomes highlight a positive and significant association between area deprivation and mortality for all causes (HR = 1.24), cancers, cerebrovascular diseases, ischemic heart diseases, and preventable and amenable diseases (HR from 1.14 to 1.29). These contextual associations exhibit no substantial differences by sex except for premature ischemic heart diseases mortality which was much greater in women. Unexpectedly, mortality decreased as the time to reach health care resources increased. Only geographical disparities in cerebrovascular and ischemic heart diseases mortality were explained by compositional and contextual effects. Discussion The findings suggest the presence of confounding factors in the association between mortality and travel time to health care, possibly owing to population density and health-selected migration. Although the spatial scale considered to define the context of residence was relatively large, the associations with area deprivation were strong in comparison to the existing literature and significant for almost all the causes of deaths investigated. Conclusion The broad spectrum of diseases associated with area deprivation and individual education support the idea of a need for a global health policy targeting both individual and territories to reduce social and socio-spatial inequalities.
Published: 2017
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7. Geographic Variations of Stroke Hospitalization across France: A Diachronic Cluster Analysis

Author: Yacine Lachkhem, Étienne Minvielle, and Stéphane Rican
Subjects: Neurology. Diseases of the nervous system, RC346-429
Abstract: Background. This study evaluates the clustering of hospitalization rates for stroke and compares this clustering with two different time intervals 2009-2010 and 2012-2013, corresponding to the beginning of the French National Stroke Plan 2010–2014. In addition, these data will be compared with the deployment of stroke units as well as socioeconomic and healthcare characteristics at zip code level. Methods. We used the PMSI data from 2009 to 2013, which lists all hospitalizations for stroke between 2009 and 2013, identified on the most detailed geographic scale allowed by this database. We identify statistically significant clusters with high or low rates in the zip code level using the Getis-Ord statistics. Each of the significant clusters is monitored over time and evaluated according to the nearest stroke unit distance and the socioeconomic profile. Results. We identified clusters of low and high rate of stroke hospitalization (23.7% of all geographic codes). Most of these clusters are maintained over time (81%) but we also observed clusters in transition. Geographic codes with persistent high rates of stroke hospitalizations were mainly rural (78% versus 17%, P < .0001) and had a least favorable socioeconomic and healthcare profile. Conclusion. Our study reveals that high-stroke hospitalization rates cluster remains the same during our study period. While access to the stroke unit has increased overall, it remains low for these clusters. The socioeconomic and healthcare profile of these clusters are poor but variations were observed. These results are valuable tools to implement more targeted strategies to improve stroke care accessibility and reduce geographic disparities.
Published: 2018
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8. Projet tutoré et plateforme « géeodépistage » en géographie de la santé. Pourquoi ? Comment ? Pour qui ?

Author: Zoe Vaillant, Myriam Baron, Stéphane Rican, Audrey Bochaton, and Hélène Charreire
Subjects: studio class project, education, healthcare geography, Education, Epistemology, Geography, Geography (General), G1-922
Abstract: The educational team responsible for the Master’s degree “Territories, Cities and Healthcare” offers students training in healthcare geography over a period of two years. As part of a programme offering academic training courses to future professionals and considering the need to show how useful and significant social and human sciences are to understand and tackle social inequalities, our team introduces the implementation of a “studio class” project (“projet tutoré”) involving all the students of the class (both 1st and 2nd year of Master’s degree). This experiment combines training, knowledge generation, decision-making tools, students’ professional integration and research. Moreover, this project is connected to - and contributes to feed - a regional platform called “Geo-cancer-screening multipartners platform”. It brings together students, university teachers, researchers in healthcare geography, Locally Elected Representatives, public health practitioners and healthcare officials. This article presents the implementation of this approach and the main progress it has offered in terms of students’ training and strengthening links between lecturer-researchers, local authorities and public health officials, i.e. an approach deliberately taken to do applied research.
Published: 2017
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9. Dépeuplement rural et offre de soins de premiers recours : quelles réalités et quelles solutions ?

Author: Guillaume Chevillard, Julien Mousquès, Véronique Lucas-Gabrielli, Yann Bourgueil, Stéphane Rican, and Gérard Salem
Subjects: health care need, depopulating area, general practitioner, multi-disciplinary group practice in primary care, rural area, Geography. Anthropology. Recreation, Social sciences (General), H1-99
Abstract: 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.
Published: 2016
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10. Bovine Spongiform Encephalopathy and Spatial Analysis of the Feed Industry

Author: Mathilde Paul, David Abrial, Nathalie Jarrige, Stéphane Rican, Myriam Garrido, Didier Calavas, and Christian Ducrot
Subjects: BSE, spatial analysis, epidemiology, cattle, feed industry, research, Medicine, Infectious and parasitic diseases, RC109-216
Abstract: In France, despite the ban of meat-and-bone meal (MBM) in cattle feed, bovine spongiform encephalopathy (BSE) was detected in hundreds of cattle born after the ban. To study the role of MBM, animal fat, and dicalcium phosphate on the risk for BSE after the feed ban, we conducted a spatial analysis of the feed industry. We used data from 629 BSE cases as well as on use of each byproduct and market area of the feed factories. We mapped risk for BSE in 951 areas supplied by the same factories and connection with use of byproducts. A disease map of BSE with covariates was built with the hierarchical Bayesian modeling methods, based on Poisson distribution with spatial smoothing. Only use of MBM was spatially linked to risk for BSE, which highlights cross-contamination as the most probable source of infection after the feed ban.
Published: 2007
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11. Correction to: The GREENH-City interventional research protocol on health in all policies

Author: Marion Porcherie, Zoé Vaillant, Emmanuelle Faure, Stéphane Rican, Jean Simos, Nicola Luca Cantoreggi, Zoé Heritage, Anne Roue Le Gall, Linda Cambon, Thierno Amadou Diallo, Eva Vidales, and Jeanine Pommier
Subjects: Public aspects of medicine, RA1-1270
Abstract: Abstract After publication of the article [1], it has been brought to our attention that in the original publication the third author’s name was spelt incorrectly. The correct spelling is “Emmanuelle Faure”. This was previously spelt as “Emmannuelle Faure”. The original article has been revised to reflect this.
Published: 2017
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12. Exposome Profiles and Asthma Among French Adults

Author: Alicia Guillien, Annabelle Bédard, Orianne Dumas, Julien Allegre, Nathalie Arnault, Audrey Bochaton, Nathalie Druesne-Pecollo, Dorothée Dumay, Léopold K. Fezeu, Serge Hercberg, Nicole Le Moual, Hugo Pilkington, Stéphane Rican, Guillaume Sit, Fabien Szabo de Edelenyi, Mathilde Touvier, Pilar Galan, Thierry Feuillet, Raphaëlle Varraso, Valérie Siroux, Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Equipe 3: EREN- Equipe de Recherche en Epidémiologie Nutritionnelle (CRESS - U1153), Université Sorbonne Paris Nord-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), and Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)
Subjects: Pulmonary and Respiratory Medicine, Male, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, Smoking, Environmental Exposure, Critical Care and Intensive Care Medicine, Asthma, White People, Exposome, Dogs, Humans, Animals, Female, Tobacco Smoke Pollution
Abstract: International audience
Published: 2022
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13. Impact of the COVID-19 crisis on the mortality profiles of the foreign-born In France during the first pandemic wave

Author: Myriam Khlat, Walid Ghosn, Michel Guillot, Stéphanie Vandentorren, Cyrille Delpierre, Annabel Desgrées du Loû, Anne Fouillet, Thomas Lefèvre, Stéphane Rican, Institut national d'études démographiques (INED), Centre d'épidémiologie sur les causes médicales de décès ( CépiDc), Institut National de la Santé et de la Recherche Médicale (INSERM), Santé publique France - French National Public Health Agency [Saint-Maurice, France], Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche Interdisciplinaire sur les enjeux Sociaux - sciences sociales, politique, santé (IRIS), École des hautes études en sciences sociales (EHESS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Sorbonne Paris Nord, Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), and Rican, Stéphane
Subjects: Male, Adult, Health (social science), [SHS.DEMO] Humanities and Social Sciences/Demography, COVID-19, Emigrants and Immigrants, Middle Aged, [SHS.DEMO]Humanities and Social Sciences/Demography, Europe, History and Philosophy of Science, Humans, Female, France, Pandemics, Aged
Abstract: Immigrants in Western countries have been particularly affected by the COVID-19 crisis.We analysed excess mortality rates among the foreign-born population and changes in their distinctive mortality profiles ("migrant mortality advantage") during the first pandemic wave in France.Deaths from all causes in metropolitan France from March 18 to May 19, 2020 were used, with information on sex, age, region of residence and country of birth. Similar data from 2016 through 2019 were used for comparisons.During the pre-pandemic period (2016-2019), immigrant populations (except those from Central and Eastern Europe) had lower standardized mortality rates than the native-born population, with a particularly large advantage for immigrants from sub-Saharan Africa. In the regions most affected by COVID-19 (Grand-Est and Île-de-France), the differences in excess mortality by country of birth were large, especially in the working-age groups (40-69 years), with rates 8 to 9 times higher for immigrants from sub-Saharan Africa, and about 3 to 4 times higher for immigrants from North Africa, from the Americas and from Asia and Oceania relative to the native-born population. The relative overall mortality risk for men born in sub-Saharan Africa compared to native-born men, which was 0.8 before the pandemic, shifted to 1.8 during the first wave (0.9 to 1.5 for women). It also shifted from 0.8 to 1.1 for men from North Africa (0.9 to 1.1 for women), 0.7 to 1.0 for men from the Americas (0.9 to 1.3 for women), and 0.7 to 1.2 for men from Asia and Oceania (0.9 to 1.3 for women).Our findings shed light on the disproportionate impact of the first wave of the pandemic on the mortality of populations born outside Europe, with a specific burden of excess mortality within the working-age range, and a complete reversal of their mortality advantage.
Published: 2022
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14. Géographie de la santé en France, regards rétrospectifs et actuels

Author: Sébastien Fleuret, Anne Peggy Hellequin, Véronique Lucas-Gabrielli, Stéphane Rican, Rican, Stéphane, Nicolas Rouget, Nacima Baron, Amaël Cattaruzza, Nathalie Lemarchand, Bastien Sepulveda, Espaces et Sociétés (ESO), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Le Mans Université (UM)-Université d'Angers (UA)-Université de Rennes 2 (UR2), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS)-Institut de Géographie et d'Aménagement Régional de l'Université de Nantes (NantesUniv – IGARUN), Nantes Université - pôle Humanités, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Humanités, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut Agro Rennes Angers, Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Institut de Recherche et Documentation en Economie de la Santé (IRDES), Institut de la Recherche et Documentation en Economie de la Santé, Nicolas Rouget, Nacima Baron, Amaël Cattaruzza, Nathalie Lemarchand, and Bastien Sepulveda
Subjects: [SHS.GEO] Humanities and Social Sciences/Geography, [SHS.GEO]Humanities and Social Sciences/Geography
Abstract: International audience
Published: 2022

15. Géographie de la population des enfants en situation de handicap en France métropolitaine

Author: Amélie Etchegaray, Stéphane Rican, Hubert Mazurek, and Sophie Bourgarel
Subjects: Political science, Public Health, Environmental and Occupational Health, Humanities
Abstract: L’adequation entre offre et demande de service ou d’equipement pour les enfants handicapes n’est pas aisee a determiner car d’une part, la distribution du handicap n’est pas homogene sur le territoire, et d’autre part il existe une diversite de bases de donnees qui ne fournit pas une estimation reelle de la demande. Nous proposons dans un premier temps une discussion sur les sources de donnees disponibles pour approcher la repartition geographique des enfants en situation de handicap. Dans un second temps nous proposons un modele de repartition sur la base d’une analyse statistique spatiale des determinants du handicap. Notre objectif est de comprendre de quelles facons les donnees disponibles peuvent etre, en evaluant leur convergence, indicatrices de la repartition de la population des enfants en situation de handicap sur le territoire. Une discussion critique est necessaire sur les lacunes des dispositifs de mesure et d’appreciation du handicap afin d’ameliorer le lien entre l’estimation de la population et l’offre de service.
Published: 2019
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16. Déterminants contextuels de la surmortalité générale lors de la première vague de pandémie de COVID-19 en France, par département, du 1er mars au 27 avril 2020

Author: Hugo Pilkington, Thierry Feuillet, Stéphane Rican, Jeanne Goupil De Bouillé, and Chantal Julia
Subjects: Public Health, Environmental and Occupational Health
Published: 2022
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17. Temporalités et appropriations des connaissances dans une démarche de recherche partenariale : les décalages à l’oeuvre dans le projet GREENH-City

Author: Marion Porcherie, Emmanuelle Faure, Clément Bader, Anne Roué Le Gall, Stéphane Rican, Zoe Heritage, Zoé Vaillant, Jean Simos, Nicola Cantoreggi, Nina Lemaire, Marie-Florence Thomas, EHESP-ARENES (EHESP-ARENES), École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université de Paris (UP), Réseau Français des Villes Santé de l’OMS, Santé publique France - French National Public Health Agency [Saint-Maurice, France], Université de Genève (UNIGE), Laboratoire d'étude et de recherche en environnement et santé (LERES), Les auteur.e.s ont indiqué avoir reçu le soutien financier suivant pour la recherche, la paternité ou la publication de cet article : le projet GREENH-City fait l'objet d’un financement de l’Institut national du cancer (RI-2017-03)., Département des sciences humaines et sociales (SHS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Département Santé Environnement Travail et Génie Sanitaire (DSETGS), Université de Genève = University of Geneva (UNIGE), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)
Subjects: ddc:333.7-333.9, 030505 public health, Santé dans toutes les politiques, Recherche interventionnelle, équité, Transfert de connaissances, recherche interventionnelle, Public Health, Environmental and Occupational Health, espaces verts, Espaces verts, [SHS.GEO]Humanities and Social Sciences/Geography, collaboration / partenariat, santé dans toutes les politiques, 16. Peace & justice, [SHS.SCIPO]Humanities and Social Sciences/Political science, 03 medical and health sciences, Collaboration/partenariat, 0302 clinical medicine, transfert de connaissances, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 030212 general & internal medicine, 0305 other medical science, Équité, ddc:613
Abstract: International audience; Cet article interroge les effets des modalités partenariales de recherche du projet GREENH-City associant des chercheur.e.s au Réseau français des Villes-Santé OMS (RfVS). Il propose une analyse de l’appropriation des connaissances scientifiques liées au projet par les villes membres du RfVS à partir du modèle de partage de connaissances. L’article montre qu’un décalage temporel peut s’opérer entre la production et l’utilisation des données liées au projet et interroge les modalités de partage de connaissances comme les pratiques de cette recherche interventionnelle.
Published: 2021
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18. Relationship Between Urban Green Spaces and Cancer: A Scoping Review

Author: Emmanuelle Faure, Anne Roué Le Gall, Jean Simos, Zoé Vaillant, Nyan Linn, Marion Porcherie, Nicola Cantoreggi, Marie-Florence Thomas, Jean-Philippe Regnaux, Linda Cambon, Stéphane Rican, Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Département des sciences humaines et sociales (SHS), École des Hautes Études en Santé Publique [EHESP] (EHESP), Département Santé Environnement Travail et Génie Sanitaire (DSETGS), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Laboratoire d'étude et de recherche en environnement et santé (LERES), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Université de Genève = University of Geneva (UNIGE), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Epidemiology in Dermatology and Evaluation in Therapeutics (EpiDermE), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), INCA - National Institute for Cancer (RI–2007-03), GREENH-City, Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université de Paris (UP), Université de Genève (UNIGE), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), EHESP, SCD, Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), and Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: Gerontology, Scoping review, Parks, Recreational, Rsk factors, ddc:354.3, MEDLINE, Contributing factors, lcsh:Medicine, [SDV.CAN]Life Sciences [q-bio]/Cancer, Review, law.invention, [SDV.CAN] Life Sciences [q-bio]/Cancer, Randomized controlled trial, anthropology_ethnography, law, Neoplasms, 11. Sustainability, medicine, [SDV.EE.SANT] Life Sciences [q-bio]/Ecology, environment/Health, Humans, risk factors, Prospective Studies, Prospective cohort study, Qualitative Research, Cancer, ddc:333.7-333.9, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, business.industry, lcsh:R, Scoping study, medicine.disease, 3. Good health, Systematic review, Risk factors, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Observational study, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Urban green spaces, Qualitative research
Abstract: International audience; This scoping study aims to explore the relationships between urban green spaces (UGSs) and the onset, remission and recovery of cancer. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (protocol published in 2018). Eligibility criteria for papers were: (1) to be concerned with UGSs, (2) reporting effects of UGSs on cancer-related outcomes including direct or indirect measures, (3) reporting randomized controlled trials, prospective cohort studies, case studies, observational studies, non-comparative studies, (4) in English or French. The search covered primary studies in the published and unpublished (grey) literatures searching by hand and electronic databases (MEDLINE, Green File, Cumulative Index to Nursing and Allied Health Literature and ScienceDirect). Among 1703 records screened by two reviewers independently, 29 were included for qualitative synthesis. We classify the cancers concerned and the effects reported i.e., protective effect, risk or without association. The most investigated cancers are bladder, breast and lung cancer. Our study also identified contributing factors and their mediating effects between UGSs and cancer. Even though the strength of the evidence of the associations between UGSs and cancer is still weak due to the low number of studies and their design, results highlight the wide variety of possible mediating factors between the use of green spaces and cancer occurrence, remission and/or prevention. Knowledge gaps and future research perspectives should be oriented to qualitative research on protective factors with an attention to equity in UGS access and use.
Published: 2021
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19. [Geography of the disabled child population in metropolitan France]

Author: Amélie, Etchegaray, Sophie, Bourgarel, Hubert, Mazurek, and Stéphane, Rican
Subjects: Health Services Needs and Demand, Geography, Humans, Disabled Persons, Family, France, Child, Disabled Children
Abstract: The match between supply and demand for services or equipment for children with disabilities is not easy to determine because, on the one hand, the distribution of disability is not homogeneous across the territory, and on the other hand there is a diversity of databases that does not allow a real estimate of demand. We propose first a discussion on the available data sources to approximate the geographical distribution of children with disabilities. In a second step, we propose a distribution model based on a spatial statistical analysis of the determinants of disability. Our goal is to understand in which ways the available data can be, by assessing their convergence, indicative of the distribution of the population of children with disabilities in the territory. A critical discussion is needed on gaps in disability measurement and assessment systems to improve the link between population estimation and service provision.
Published: 2020

20. Espaces verts urbains. Promouvoir l’équité et la santé

Author: Marion Porcherie, Emmanuelle Faure, Anne Roué Le Gall, Marie-Florence Thomas, Lorène Panet, Nina Lemaire, Jean Simos, Stéphane Rican, Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), École des Hautes Études en Santé Publique [EHESP] (EHESP), Département des sciences humaines et sociales (SHS), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), Département Santé Environnement Travail et Génie Sanitaire (DSETGS), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Laboratoire d'étude et de recherche en environnement et santé (LERES), Ed. Réseau des villes santé OMS, EHESP-ARENES (EHESP-ARENES), Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université de Paris (UP), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Faure, Emmanuelle, Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), and Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )
Subjects: [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, [SHS.ARCHI]Humanities and Social Sciences/Architecture, space management, Aménagemant urbain, [SHS.GEO] Humanities and Social Sciences/Geography, Santé - inégalités, Espace vert public, [SHS.GEO]Humanities and Social Sciences/Geography, [SHS.SCIPO]Humanities and Social Sciences/Political science, Santé - environnement, [SDV.EE.SANT] Life Sciences [q-bio]/Ecology, environment/Health, Espace vert urbain, Aménagement, Ville Durable, [SHS.ARCHI] Humanities and Social Sciences/Architecture, space management, [SHS.SCIPO] Humanities and Social Sciences/Political science, ComputingMilieux_MISCELLANEOUS
Abstract: International audience
Published: 2020

21. De la discrimination positive à la discrimination territoriale : les quartiers en politique de la ville, inégaux face à la santé

Author: Stéphane Rican, Julia Bardes, Zoé Vaillant, Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), and Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)
Subjects: territoire, gradient socio-territorial, 030505 public health, [SHS.STAT]Humanities and Social Sciences/Methods and statistics, [SHS.GEO]Humanities and Social Sciences/Geography, intégration socio-spatiale, dépistage organisé du cancer du sein, quartier politique de la ville, 03 medical and health sciences, 0302 clinical medicine, Inégalités sociales de santé, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 030212 general & internal medicine, 0305 other medical science, enclavement, [STAT.ME]Statistics [stat]/Methodology [stat.ME], discrimination
Abstract: International audience; Les inégalités sociales et territoriales de santé ne cessent de se creuser en France à toutes les échelles. La réponse de l’État a été d’inclure un volet santé dans la mise en œuvre de la politique de la ville, ciblant des quartiers défavorisés pour tenter un rattrapage. Une analyse axée sur les inégalités d’accès au dépistage du cancer du sein comparant 33 quartiers en politique de la ville (QPV) d’Île-de-France montre un investissement à degrés variables des acteurs politiques et de la prévention sur ces quartiers en fonction de la configuration (ou caractéristiques) socio-territoriale de ces quartiers (enclavement physique et social, attractivité). Il apparaît que l’attention politique privilégiée est placée sur les quartiers plus centraux, plus dynamiques par rapport aux autres. Les QPV les plus enclavés et les moins « attractifs » sont, contrairement à ce que l’on pourrait attendre de la politique de la ville, aussi ceux qui bénéficient d’une moindre attention politique et d’actions de promotion du dépistage moins intenses, voire inexistantes. L’analyse montre que la capacité d’agir, que ce soit celle des acteurs ou des habitantes, est elle-même prise dans une matrice socio-territoriale marquée par les inégalités dans laquelle elle se moule.Les moyens et les conditions de mise en œuvre des politiques locales de santé publique qui s’appuient très largement sur la politique de la ville sont questionnés : ne permettant pas de moduler les processus ségrégatifs déjà à l’œuvre, ne contribuent-ils pas à des logiques de gestion des territoires qui finissent par devenir discriminatoires dans leurs effets ?
Published: 2020
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22. Intervention research partnerships: enablers for activating health in all policies approach?

Author: Jean Simos, Stéphane Rican, A Roué le Gall, Clément Bader, Zoé Vaillant, N Cantorregi, M-F. Thomas, Emmanuelle Faure, M Porcherie, École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Réseau Français des Villes Santé de l’OMS, Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA)
Subjects: Service (systems architecture), Knowledge management, business.industry, Information sharing, Research, Public Health, Environmental and Occupational Health, Equity (finance), Diffusion of innovations, [SHS.SCIPO]Humanities and Social Sciences/Political science, 12. Responsible consumption, Knowledge sharing, Appropriation, Conceptual framework, Collaborations, 13. Climate action, 11. Sustainability, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Social determinants of health, GREENH-City project, business, Partnership, ComputingMilieux_MISCELLANEOUS, Health in all policies
Abstract: Introduction Action on the determinants of health and equity involves the participation of all sectors, including non-health sectors. Understanding the opportunities and constraints to engage in the complex issue of health inequalities requires opening the black box of policy making. It also requires close interaction between field actors and researchers. This paper will aim to analyze the modalities of collaboration between researchers and field actors in the service of knowledge sharing, within the GREENH-City project. Methods The GREENH-City project was built in an interdisciplinary and intersectoral manner and involves close collaboration with the WHO French Healthy Cities Network (FHCN). Its objective is to characterize the most promising health interventions in all policies at the city level to promote equity through green space policies. Based on the knowledge sharing model and the theory of diffusion of innovations, we will analyze how this research allows initiating collaborations between the different municipal sectors on health issues. Results The intervention nature of the project seems to help the dissemination of collaborations, particularly between health services and green space services within the cities of the FHCN. The analysis, using theoretical models, of the body of empirical data collected from cities will make it possible to identify the levers and collateral effects activated by the research project. Discussion The GREENH-City project was built on the basis of an interventional research framework. This choice was made precisely because of the interaction it induces between researchers and practice environments. Initial empirical results suggest that it promotes the dissemination of knowledge, a necessary first step in the evolution of practices. Indeed, the effective appropriation of research results can only be assessed in the long term and must take into account the contextual elements specific to each FHCN involved in the research. Key messages Implementation of interventional research helps to engage fields collaborations. Health in all policies may be supported by a research project at the local level.
Published: 2019
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23. Has the diffusion of primary care teams in France improved attraction and retention of general practitioners in rural areas?

Author: Stéphane Rican, Véronique Lucas-Gabrielli, Guillaume Chevillard, Julien Mousquès, Institut de Recherche et Documentation en Economie de la Santé (IRDES), Institut de la Recherche et Documentation en Economie de la Santé, Laboratoire d'Economie de Dauphine (LEDa), Université Paris Dauphine-PSL, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), and Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Economic growth, Primary health care, Public policy, Medically Underserved Area, Personnel Turnover, Health human resources, Public Policy, Primary care, Group practices, 03 medical and health sciences, 0302 clinical medicine, General Practitioners, Humans, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Patient Care Team, Primary Health Care, 030503 health policy & services, Health Policy, 1. No poverty, [SHS.GEO]Humanities and Social Sciences/Geography, 3. Good health, Incentive, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Business, France, Rural Health Services, Rural area, 0305 other medical science, Geographical inequalities
Abstract: Many countries, including France, are facing the old and persistent problem of geographical inequalities of their health human resources, in particular general practitioners (GPs). This situation leads, among other things, to underserved areas, which could result in a lower level of primary health care accessibility. Since the mid-2000s in France, several policies were implemented to provide financial as well as other incentives to support the development of multi-professional group practices, Primary Care Teams (PCTs), in order to attract and retain GPs in underserved areas. This study aims to measure the impact of PCTs settlement on the evolution of GP density in rural areas. To this end, we compare the evolution of GP density between rural areas with PCTs and similar rural areas without PCTs, before (2004-2008) and after (2008-2012) the development of PCTs facilities. The results show that PCTs are mainly located in underserved areas and suggest that they could attract and retain GPs there. Those results should be of interest to countries facing relatively similar geographical inequalities issues and that are also experimenting with multi-professional group practices.
Published: 2019
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24. [Gender inequalities and health promotion at the local scale. The case of Gennevilliers (Paris region)]

Author: Emmanuelle, Faure and Stéphane, Rican
Subjects: Male, Paris, Sex Factors, Organizational Case Studies, Preventive Health Services, Humans, Female, Health Promotion, Healthcare Disparities
Abstract: Social inequalities in health and access to care remain significant in France. Cultural and socioeconomic dimensions of health inequalities are often studied, but gender-specific behaviors and local dynamics are rarely investigated. This article aims to examine the role of municipal representatives, public health policies and local communities in unequal access to prevention for men and women. We analyze the relationship between gender, space and health through the case study of health promotion in the town of Gennevilliers (Paris region). We rely on data from over six months of field work based on semi-structured interviews with elected officials, health professionals, social field and civil society actors as well as archival consultations and field observations. We show that the town of Gennevilliers, by the age of the inclusion of health in local policies, the dynamism of the associative network and local players or the number of innovative actions, is a relevant and inspiring example for analyzing the obstacles and means of health interventions. But, this article also demonstrates that the promotion of preventive health, rooted in long-term and complex territorial dynamics, can also contribute to the strengthening of gender roles and differences between men and women. Finally, this study pinpoints the need for an approach integrating both gender and territorial questions in the analysis as well as the development of health promotion campaigns.
Published: 2019

25. Collaboration et partenariat dans le projet GREENH-City. GouveRnance for Equity, ENvironment and Health in the City

Author: Marion Porcherie, Clément Bader, Anne Roué Le Gall, Emmanuelle Faure, Zoé Héritage, Zoe Vaillant, Stéphane Rican, Jean Simos, Nicola Luca Cantoreggi, Marie-Florence Thomas, Institut national de prévention et d'éducation pour la santé (INPES), Institut national de prévention et d'éducation pour la santé, Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), École des Hautes Études en Santé Publique [EHESP] (EHESP), Département des sciences humaines et sociales (SHS), Unité de soutien méthodologique à la recherche clinique [Bordeaux] (USMR), Service d'Information médicale [Bordeaux], Pôle de Santé publique [Bordeaux], CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux]-Pôle de Santé publique [Bordeaux], CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université de Genève (UNIGE), Ecole des Métiers de l'Environnement (EME), Institut national du cancer, Inserm, Institut de recherche en santé publique (IReSP), GREENH-City, Université de Genève = University of Geneva (UNIGE), and Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Inéquités de santé, Promotion de la santé, [SHS.SOCIO]Humanities and Social Sciences/Sociology, Santé dans toutes les politiques, Milieu urbain, Espaces verts, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, [SHS.SCIPO]Humanities and Social Sciences/Political science, Environnement
Abstract: National audience; En France, les inéquités de santé tendent à augmenter depuis les années 80.De nombreuses études concernent l’influence des déterminants sociaux, économiques, géographiques ou politiques dans une approche tout au long de la vie.Les expositions aux facteurs environnementaux sont inéquitables au sein de la population.L’environnement peut être un facteur protecteur, tels que sont les espaces verts en milieu urbain.En milieu urbain, les espaces verts contribuent à créer des milieux de vie favorables à la santé qui peuvent impacter les inéquités de santé.Les approches de santé dans toutes les politiques (HiAP) sont l’une des stratégies clés pour prendre en compte les déterminants sociaux et environnementaux et créer des milieux urbains favorables à la santé. (Extrait)
Published: 2019

26. Espaces verts urbains et équité en santé : quelle méthode d'analyse ?

Author: Jean Simos, Marion Porcherie, Emmanuelle Faure, Nicola Cantoreggi, Anne Roué Le Gall, Linda Cambon, Stéphane Rican, Zoé Vaillant, Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université de Paris (UP), Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), École des Hautes Études en Santé Publique [EHESP] (EHESP), Département des sciences humaines et sociales (SHS), Institut national contre le cancer (INCA), Institut Fédératif d’Études et de Recherches Interdisciplinaires Santé Société (IFERISS), GREENH-City, Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Socio-Psychologie et Management du Sport (SPMS), Université de Bourgogne (UB), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), EHESP, SCD, Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), and Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS)
Subjects: GREENH-City, Equité en santé, Epidemiology, [SHS.GEO] Humanities and Social Sciences/Geography, Santé environnement, [SHS]Humanities and Social Sciences, Espace vert, 03 medical and health sciences, 0302 clinical medicine, 11. Sustainability, [SDV.EE.SANT] Life Sciences [q-bio]/Ecology, environment/Health, 030212 general & internal medicine, Méthodologie analyse, ComputingMilieux_MISCELLANEOUS, ddc:613, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, [STAT.AP]Statistics [stat]/Applications [stat.AP], Santé, 030505 public health, Public Health, Environmental and Occupational Health, [SHS.GEO]Humanities and Social Sciences/Geography, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, 13. Climate action, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, [SHS] Humanities and Social Sciences, 0305 other medical science, Analyse spatiale statistique
Abstract: Introduction Espace du quotidien, de détente et de récréation, lieu de promenade, de rencontre et de pratiques sportives, l'espace vert est vecteur de bien-être et de santé. Au regard des multiples bénéfices potentiels que représente l'exposition des populations aux espaces verts urbains et des problématiques contemporaines de santé, l'accessibilité de tous à ces lieux constitue un enjeu majeur de santé publique. Le projet de recherche GREENH-City (Inca RI 2017-03) propose, parmi les communes du Réseau Français des Villes Santé de l'OMS, d'analyser en quelle mesure les politiques municipales intègrent des démarches de santé dans toutes les politiques, de promotion de l'équité et les appliquent aux politiques de verdissement. L'objectif de cette communication est d'examiner les enjeux théoriques et méthodologiques de l'analyse socio-spatiale des espaces verts urbains dans le contexte français afin, notamment, d'objectiver l'accessibilité de tous aux espaces verts, quels que soient les territoires de vie ou les situations socio-économiques des populations. Méthode Les données municipales, nationales (Institut national de l'information géographique et forestière) et internationales (« Open Street Map ») disponibles pour appréhender les espaces verts, ainsi que des indicateurs socio-économiques (Institut national de la statistique et des études économiques) permettent en effet d'appréhender les surfaces et types d'espaces verts disponibles, des distances d'accès moyens des ménages aux espaces verts, et ce, au regard des disparités socio-économiques infra-urbaines en présence. Par exemple, les espaces verts d'une ville peuvent s'avérer beaucoup plus accessibles à une partie de la population (accessibilité pédestre très aisée) et cette même population peut disposer d'une surface moyenne par habitant très restreinte. Une analyse comparative et multiscalaire permet d'illustrer la diversité des situations. En effet, l'ampleur des écarts entre classes sociales ou entre quartiers dépend des contextes urbains considérés. De telles analyses permettent d'interroger la démarche, les échelles et les outils de mesure à mobiliser lorsque l'on interroge l'équité et l'accessibilité aux espaces verts urbains. Des analyses qualitatives des usages et des pratiques de ces espaces par les individus devront également compléter cette approche. En effet, un espace potentiellement disponible n'est pas forcément approprié, utilisé de façon optimale. En mobilisant une approche mixte et comparative, la recherche développée dans le cadre du projet GREENH-City permettra d'apporter des réponses à cet enjeu majeur.
Published: 2019
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27. Low socioeconomic position and neighborhood deprivation are associated with uncontrolled asthma in elderly

Author: Stéphane Rican, Margaux Sanchez, Valérie Siroux, Marie-Christine Boutron-Ruault, Nicole Le Moual, Orianne Dumas, Sofia Temam, Annabelle Bédard, Raphaëlle Varraso, Sébastien Chanoine, Vieillissement et Maladies chroniques : approches épidémiologique et de santé publique (VIMA), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 - Faculté de médecine (UP11 UFR Médecine), Université Paris-Sud - Paris 11 (UP11), Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Faraldo, Beatrice, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris-Sud 11 - Faculté de médecine (UP11 UFR Médecine), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, Pulmonary and Respiratory Medicine, Socioeconomic position, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Residence Characteristics, immune system diseases, Humans, Medicine, 030212 general & internal medicine, Socioeconomic status, Aged, Asthma, Aged, 80 and over, business.industry, social sciences, Odds ratio, medicine.disease, Confidence interval, 3. Good health, Uncontrolled asthma, Disadvantaged, respiratory tract diseases, Socioeconomic Factors, 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, Demography
Abstract: Background While uncontrolled asthma in adults is frequent in Europe, the impact of socioeconomic position (SEP) was little investigated. We aimed to investigate the respective association of individual- and area-level SEP with uncontrolled asthma among French elderly women. Methods Analyses were conducted in the Asthma-E3N study, among participants with current asthma (i.e., asthma attacks, treatment, or symptoms in previous year). Asthma control was evaluated using Asthma Control Test (uncontrolled: score ≤19); SEP was defined at both individual- and area-level, using educational level (low, medium, high), the French Deprivation index (tertiles defined at national level), and by merging them in a combined-SEP index. Associations between SEP and asthma control were estimated for 2258 women by logistic regression adjusted for age. Analyses were stratified by asthma controller medication use estimated through a drug reimbursement database. Results Women were 70 years on average and 24% had uncontrolled asthma. A low educational level (11%) was associated with an increased risk of uncontrolled asthma [odds ratio (95% confidence interval) = 1.9 (1.4,2.6)], especially among women not using controller medication [3.1 (1.9,5.1)]. Using the combined-SEP index, the highest risk of uncontrolled asthma was observed among women with the most disadvantaged socioeconomic profile (low educational level and low-SEP neighborhood) [2.5 (1.5,4.2)]. Conclusions Women with low SEP had more often uncontrolled asthma, which might be partly explained by inadequate asthma treatment. To achieve the best management of asthma for elderly patients, a specific attention should be given not only to disadvantaged population and neighborhoods, but also to disadvantaged populations in affluent neighborhoods.
Published: 2019
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28. Health in all policies, Urban Green Spaces and Health : The GREENH-City research project with French Healthy-Cities

Author: Clément Bader, Zoé Héritage, Marion Porcherie, Emmanuelle Faure, Zoe Vaillant, Jean Simos, Stéphane Rican, Anne Roué Le Gall, Linda Cambon, Nicola Luca Cantoreggi, Unité de soutien méthodologique à la recherche clinique [Bordeaux] (USMR), Service d'Information médicale [Bordeaux], Pôle de Santé publique [Bordeaux], CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux]-Pôle de Santé publique [Bordeaux], CHU Bordeaux [Bordeaux]-CHU Bordeaux [Bordeaux], Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), École des Hautes Études en Santé Publique [EHESP] (EHESP), Département des sciences humaines et sociales (SHS), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université de Genève = University of Geneva (UNIGE), Chaire Prévention [Bordeaux], Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen - Bordeaux 2-Université Bordeaux Segalen - Bordeaux 2, Réseau européen des Villes-santé de l’OMS, Réseau des réseaux nationaux européens des Villes-santé, GREENH-City, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), and Université de Genève (UNIGE)
Subjects: Urban Green Spaces, Health, GREENH-City research project, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Cities, ComputingMilieux_MISCELLANEOUS, [SHS.SCIPO]Humanities and Social Sciences/Political science, Health in all policies
Abstract: International audience
Published: 2018

29. Understanding delays in acute stroke care: a systematic review of reviews

Author: Stéphane Rican, Yacine Lachkhem, Etienne Minvielle, EA Management des Organisations de Santé (EA MOS), PRES Sorbonne Paris Cité-École des Hautes Études en Santé Publique [EHESP] (EHESP), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), École des Hautes Études en Santé Publique [EHESP] (EHESP)-PRES Sorbonne Paris Cité, Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), and Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: medicine.medical_specialty, Psychological intervention, MEDLINE, Context (language use), Alteplase, Time-to-Treatment, Stroke onset, 03 medical and health sciences, 0302 clinical medicine, Cerebrovascular accident, medicine, Humans, Acute cerebrovascular accidents, 030212 general & internal medicine, Recombinant tissue plasminogen activator, Intensive care medicine, Stroke, ComputingMilieux_MISCELLANEOUS, Acute stroke, Ischemic stroke, [SHS.STAT]Humanities and Social Sciences/Methods and statistics, business.industry, Public Health, Environmental and Occupational Health, [SHS.GEO]Humanities and Social Sciences/Geography, medicine.disease, 3. Good health, Thrombolytic therapy, Review Literature as Topic, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, [STAT.ME]Statistics [stat]/Methodology [stat.ME], 030217 neurology & neurosurgery
Abstract: International audience; BackgroundStroke is the leading cause of adult long-term disability in Western countries. Intravenous thrombolytic therapy with recombinant tissue plasminogen activator is safe and effective within the first 4.5 h after the onset of stroke. Various factors delaying acute stroke care have been identified in the literature. This review aimed to provide an overview of factors delaying acute stroke care and attempted to show how they interact in a synthetic framework.MethodsWe conducted a systematic review of literature reviews published in Medline and DORIS until 2016 on factors influencing acute stroke pathway timeframe.ResultsWe analyzed 31 reviews that cover all factors of delays from stroke onset to treatment. We identified 27 factors that had a significant impact on acute stroke care and can be categorized into four distinct categories: patient-related factors, training, resources and lack of coordination. We also reported associations between factors observed in both between categories (mainly between patients and organizational/logistical factors) and within categories.ConclusionThis review provides a wide overview of factors influencing acute stroke pathway. Since it was observed that the identified factors were interrelated, they needed to be analyzed in a systematic way. We hence created a synthetic framework that combines several categories of factors while assuming that factor weight varies from a study context to another. Better knowledge on underlying mechanisms between factors would provide crucial improvement of the interventions aiming at reducing delays in both pre-hospital and inhospital stages. For future research, we recommend adopting a systemic perspective on factors influencing acute stroke pathway.
Published: 2018
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30. Urban green spaces and cancer: a protocol for a scoping review

Author: Marion Porcherie, Mathilde Lejeune, Marion Gaudel, Jeanine Pommier, Emmanuelle Faure, Zoé Heritage, Stéphane Rican, Jean Simos, Nicola Luca Cantoreggi, Anne Roué Le Gall, Linda Cambon, Jean-Philippe Regnaux, Institut national de prévention et d'éducation pour la santé (INPES), Institut national de prévention et d'éducation pour la santé, Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), École des Hautes Études en Santé Publique [EHESP] (EHESP), Université de Genève (UNIGE), Institut National Du Cancer, GREENH-City, Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Département des sciences humaines et sociales (SHS), Université de Genève = University of Geneva (UNIGE), INSTITUTE OF GLOBAL HEALTH FACULTY OF MEDICINE UNIVERSITY OF GENEVA CHE, Partenaires IRSTEA, Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA), Département Santé Environnement Travail et Génie Sanitaire (DSETGS), Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique (CRESS - U1153), Université Paris Descartes - Paris 5 (UPD5)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Knowledge management, health promotion, Parks, Recreational, MEDLINE, Personal Satisfaction, Population health, 010501 environmental sciences, 01 natural sciences, 03 medical and health sciences, urban setting, 0302 clinical medicine, Neoplasms, 11. Sustainability, Controlled vocabulary, green space, Protocol, Humans, Medicine, cancer, 030212 general & internal medicine, Cities, License, Built environment, ComputingMilieux_MISCELLANEOUS, ddc:613, 0105 earth and related environmental sciences, Protocol (science), business.industry, General Medicine, Grey literature, [SHS.SCIPO]Humanities and Social Sciences/Political science, 3. Good health, Health promotion, Research Design, [SDE]Environmental Sciences, Quality of Life, Environment Design, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Public Health, GREENH-City project, [SDE.BE]Environmental Sciences/Biodiversity and Ecology, business, Risk Reduction Behavior, population health, Systematic Reviews as Topic
Abstract: International audience; Introduction Green space in the built environment is an important topic on the health agenda today. Studies have shown that access to green spaces is associated with better mental and physical health, yet green spaces can also be detrimental to health if they are not managed appropriately. Despite the increasing interest in urban green spaces, little research has so far been conducted into the links between green spaces and cancer.Objective The purpose of this scoping review is therefore to map the literature available on the types of relationship between urban green spaces and cancer.Method and analysis We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guideline to report the protocol. To conduct this scoping review, we will use a structured search strategy based on controlled vocabulary and relevant key terms related to green space, urban space and cancer. We will search MEDLINE (PubMed), GreenFILE (EBSCOhost), Cumulative Index to Nursing and Allied Health Literature (EBSCOhost) and ScienceDirect as electronic database as well as hand-search publications for grey literature. This review will therefore provide evidence on this current topic, one which could have practical implications for policy-makers involved in choices which are more conducive to healthy living.Ethics and dissemination No primary data will be collected since all data that will be presented in this review are based on published articles and publicly available documents, and therefore ethics committee approval is not a requirement. The findings of this review will be presented at workshops and conferences, and will be submitted for publication in a peer-reviewed journal.This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
Published: 2018
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31. Genre, inégalités et promotion de la santé à l’échelle locale. L’exemple gennevillois

Author: Stéphane Rican, Emmanuelle Faure, Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), and Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Civil society, medicine.medical_specialty, Economic growth, Inequality, media_common.quotation_subject, Public health, Inégalités sociales et territoriales de santé, Public Health, Environmental and Occupational Health, Psychological intervention, Promotion santé, 030208 emergency & critical care medicine, [SHS.GEO]Humanities and Social Sciences/Geography, 03 medical and health sciences, 0302 clinical medicine, Health promotion, Promotion (rank), 030228 respiratory system, Politiques locales, Political science, Territoire, medicine, Social inequality, Genre, Socioeconomic status, media_common
Abstract: International audience; En France, les inégalités sociales de santé restent importantes,tant en ce qui concerne les variations d’états de santé que cellesde l’accès aux soins de la population. Si leurs dimensions socioéconomiquessont largement documentées, les processusconcourant aux inégalités entre hommes et femmes ainsi queleur inscription dans les dynamiques territoriales restent peuanalysés. Cet article vise à interroger le rôle de ces dynamiquesdans l’accès des hommes et des femmes à la prévention. Nousnous appuyons sur l’étude des modalités locales de promotionde la santé dans la commune de Gennevilliers (Hauts-de-Seine)pour interroger ce processus de construction des inégalités. Desentretiens semi-directifs ont été menés auprès d’élus, de professionnelsdu champ sanitaire et social et d’acteurs associatifs. Laconsultation de différentes sources manuscrites et des observationsde terrain complètent ce travail. La commune deGennevilliers, par l’ancienneté de la prise en compte de la santé,le dynamisme des réseaux d’acteurs ou bien le nombre d’actionsinnovantes qui caractérisent sa politique sanitaire, constitue unexemple mobilisateur et pertinent pour l’analyse des freins etleviers de l’intervention en santé. Cet article démontre que lesdispositifs de promotion de la santé s’inscrivent dans des dynamiquesterritoriales complexes, mais peuvent également contribuerau renforcement des normes de genre et des écarts entrehommes et femmes. Finalement, cette recherche illustre lanécessaire prise en compte des questions de genre et de territoiredans l’analyse comme dans l’élaboration des actions depromotion de la santé.
Published: 2018

32. Correction to: The GREENH-City interventional research protocol on health in all policies

Author: Stéphane Rican, Linda Cambon, Jeanine Pommier, Jean Simos, Marion Porcherie, Thierno Diallo, Nicola Cantoreggi, Emmanuelle Faure, Anne Roué Le Gall, Zoé Vaillant, Eva Vidales, Institut national de prévention et d'éducation pour la santé (INPES), Institut national de prévention et d'éducation pour la santé, Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), Université de Genève (UNIGE), École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Ecole Supérieure d'aménagement du territoire et de développement régional, Université Laval, Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université Laval [Québec] (ULaval), GREENH-City, Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Université de Genève = University of Geneva (UNIGE), and Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Protocol (science), Medical education, medicine.medical_specialty, business.industry, lcsh:Public aspects of medicine, Public health, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, 030209 endocrinology & metabolism, Spelling, 03 medical and health sciences, Health in all policies, 0302 clinical medicine, Nursing, Epidemiology, Medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, 030212 general & internal medicine, Biostatistics, business
Abstract: International audience; After publication of the article [1], it has been brought to our attention that in the original publication the third author's name was spelt incorrectly. The correct spelling is "Emmanuelle Faure". This was previously spelt as "Emmannuelle Faure". The original article has been revised to reflect this.
Published: 2017
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33. Projet tutoré et plateforme « géeodépistage » en géographie de la santé. Pourquoi ? Comment ? Pour qui ?

Author: Myriam Baron, Hélène Charreire, Audrey Bochaton, Stéphane Rican, Zoé Vaillant, Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), Géographie-cités (GC (UMR_8504)), Université Panthéon-Sorbonne (UP1)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), LAB'URBA (LAB'URBA), Université Paris-Est Marne-la-Vallée (UPEM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), and Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)
Subjects: épistémologie, studio class project, lcsh:G1-922, healthcare geography, PARIS team, 03 medical and health sciences, géographie critique, 0502 economics and business, ComputingMilieux_COMPUTERSANDEDUCATION, critical geographies, education, 030505 public health, ACL, 4. Education, 05 social sciences, epistemology, [SHS.GEO]Humanities and Social Sciences/Geography, General Medicine, General Chemistry, éducation, projet tutoré, 0305 other medical science, lcsh:Geography (General), 050203 business & management, géographie de la santé
Abstract: International audience; The educational team responsible for the Master’s degree2 “Territories, Cities and Healthcare” offers students training in healthcare geography over a period of two years. As part of a programme offering academic training courses to future professionals and considering the need to show how useful and significant social and human sciences are to understand and tackle social inequalities, our team introduces the implementation of a “studio class” project (“projet tutoré”) involving all the students of the class (both 1st and 2nd year of Master’s degree). This experiment combines training, knowledge generation, decision-making tools, students’ professional integration and research. Moreover, this project is connected to - and contributes to feed - a regional platform called “Geo-cancer-screening multipartners platform”. It brings together students, university teachers, researchers in healthcare geography, Locally Elected Representatives, public health practitioners and healthcare officials. This article presents the implementation of this approach and the main progress it has offered in terms of students’ training and strengthening links between lecturer-researchers, local authorities and public health officials, i.e. an approach deliberately taken to do applied research.; L’équipe pédagogique du master « Territoires, Villes et Santé » (TVS)1 forme en deux ans des étudiants en géographie de la santé. En lien avec la professionnalisation des formations universitaires et la nécessité de montrer l’utilité des approches en sciences humaines et sociales pour apporter des clés de lecture et d’interventions pour lutter contre les inégalités sociales, notre équipe revient sur la mise en place d’un projet tutoré mobilisant l’ensemble des étudiants inscrits dans les 2 années de Master. Cette expérience allie formation, production de savoirs, aide à la décision, insertion professionnelle des étudiants et recherche. De plus, elle s’adosse et nourrit une plateforme régionale dite « Géodépistage », espace de rencontres et d’échanges entre étudiants, enseignants-chercheurs, élus locaux et responsables du secteur de la santé. Il s’agit ici de présenter l‘organisation et les principales avancées que ce dispositif a permis, tant pour la formation des étudiants, que pour l’approfondissement des liens entre enseignants-chercheurs, collectivités territoriales et responsables de la santé correspondant à une manière assumée de faire de la recherche « appliquée ».
Published: 2017
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34. How to tackle social inequalities in health in urban areas through political action on green spaces: A research protocol on the Health in All Policies approach concerning green spaces in the French Healthy Cities network

Author: Marion Porcherie, Jeanine Pommier, Emmanuelle Faure, Zoé Vaillant, Zoé Héritage, Jean Simos, Stéphane Rican, Anne Roué Le Gall, Linda Cambon, Eva Vidales, Nicola Luca Cantoreggi, Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), École des Hautes Études en Santé Publique [EHESP] (EHESP), Département des sciences humaines et sociales (SHS), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Département Santé Environnement Travail et Génie Sanitaire (DSETGS), INCA - Institut National du Cancer, Elsevier B.V., GREENH-City, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université de Paris (UP), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), MOELLIC, Béatrice, Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), and Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, [SHS] Humanities and Social Sciences, ComputingMilieux_MISCELLANEOUS, [SHS]Humanities and Social Sciences
Abstract: International audience
Published: 2017

35. The GREENH-City interventional research protocol on health in all policies

Author: Zoé Vaillant, Marion Porcherie, Stéphane Rican, Nicola Cantoreggi, Jeanine Pommier, Jean Simos, Linda Cambon, Thierno Diallo, Emmanuelle Faure, Eva Vidales, Anne Roué Le Gall, École des Hautes Études en Santé Publique [EHESP] (EHESP), Centre de Recherches sur l'Action Politique en Europe (ARENES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université de Paris (UP), Université de Genève (UNIGE), Ecole Supérieure d'aménagement du territoire et de développement régional, Université Laval [Québec] (ULaval), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Institut National Du Cancer, GREENH-City, Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Université de Genève = University of Geneva (UNIGE), Université de Rennes (UR)-Institut d'Études Politiques [IEP] - Rennes-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Centre National de la Recherche Scientifique (CNRS), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Université Laval, and Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Economic growth, Social Determinants of Health, Comparative multiple-case studies, Study Protocol, 0302 clinical medicine, 11. Sustainability, Medicine, 030212 general & internal medicine, ddc:333.7-333.9, education.field_of_study, lcsh:Public aspects of medicine, Health Policy, [SHS.GEO]Humanities and Social Sciences/Geography, 3. Good health, Research Design, Life course approach, France, 0305 other medical science, Urban green spaces, medicine.medical_specialty, Population, Public policy, Health Promotion, 03 medical and health sciences, Environmental health, Humans, Social inequality, Social determinants of health, Cities, education, ddc:613, Health in all policies, Mixed-methods, 030505 public health, Equity (economics), Operationalization, business.industry, Healthy Cities Network, Public health, Public Health, Environmental and Occupational Health, Correction, lcsh:RA1-1270, Health Status Disparities, Transferability, Interventional research, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Environment Design, Health inequities, GREENH-City project, business
Abstract: Background This paper presents the research protocol of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project funded by the National Institute for Cancer (Subvention N°2017–003-INCA). In France, health inequities have tended to increase since the late 1980s. Numerous studies show the influence of social, economic, geographic and political determinants on health inequities across the life course. Exposure to environmental factors is uneven across the population and may impact on health and health inequities. In cities, green spaces contribute to creating healthy settings which may help tackle health inequities. Health in All Policies (HiAP) represents one of the key strategies for addressing social and environmental determinants of health inequities. The objective of this research is to identify the most promising interventions to operationalize the HiAP approaches at the city level to tackle health inequities through urban green spaces. It is a participatory interventional research to analyze public policy in real life setting (WHO Healthy Cities). Method/design It is a mixed method systemic study with a quantitative approach for the 80 cities and a comparative qualitative multiple case-studies of 6 cities. The research combines 3 different lens: 1/a political analysis of how municipalities apply HiAP to reduce social inequities of health through green space policies and interventions 2/a geographical and topological characterization of green spaces and 3/ on-site observations of the use of green spaces by the inhabitants. Results City profiles will be identified regarding their HiAP approaches and the extent to which these cities address social inequities in health as part of their green space policy action. The analysis of the transferability of the results will inform policy recommendations in the rest of the Health City Network and widely for the French municipalities. Discussion/conclusion The study will help identify factors enabling the implementation of the HiAP approach at a municipal level, promoting the development of green spaces policies in urban areas in order to tackle the social inequities in health. Electronic supplementary material The online version of this article (10.1186/s12889-017-4812-8) contains supplementary material, which is available to authorized users.
Published: 2017
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36. Les déterminants du recours aux médecins généralistes des hommes et des femmes : constructions sociales de la distance et inscriptions territoriales

Author: Emmanuelle Faure, Stéphane Rican, Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), and Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Geography, Planning and Development, Territorialité, 03 medical and health sciences, 0302 clinical medicine, Ville, genre, politique publique de santé, territoriality, public health policies, Politique publique de santé, gender, 030212 general & internal medicine, Global and Planetary Change, [SHS.STAT]Humanities and Social Sciences/Methods and statistics, 030503 health policy & services, territorialité, City, Gender, [SHS.GEO]Humanities and Social Sciences/Geography, 3. Good health, Urban Studies, city, ville, 0305 other medical science, Territoriality, Genre, [SHS.GENRE]Humanities and Social Sciences/Gender studies, Public health policies
Abstract: International audience; This article examines the interactions between gender and the city through a public health policy: colorectal cancer screening. We analyze urban representations and practices of men and women through the use of trajectories and criteria mobilized by individuals when choosing their GP (key player in this programme). Two cities are compared: Boulogne-Billancourt and Gennevilliers. The complementarity of quantitative and qualitative approaches shows that individuals mobilize multiple criteria. Then, we propose different dimensions of the notions of proximity and distance. Indeed, people strategies result from both economic factors (price of the consultation) and geographical ones (proximity of the surgery to the home); but also social representations of medicine and health care professionals such as their cities. Finally, these strategies are articulated with gender (role of women in the management of the health of the family or entourage) illustrating the relationship between men and women, and the links of men and women with their cities.; Cet article interroge les interactions entre le genre et la ville, au regard d’une politique publique de santé : le dépistage organisé du cancer colorectal. Nous proposons d’analyser les représentations et pratiques urbaines des hommes et de femmes au regard des trajectoires de recours, ainsi que les critères mobilisés par les individus lors du choix de leur médecin généraliste (acteur clé de ce programme). Deux contextes urbains alto-séquanais sont comparés : Boulogne-Billancourt et Gennevilliers. La complémentarité des approches quantitative et qualitative permet de montrer que les individus mobilisent de multiples critères, et permet d’interroger les différentes dimensions des notions de proximité et de distance. En effet, ces stratégies résultent à la fois de facteurs économiques (prix de la consultation) et géographiques (proximité du cabinet au domicile) ; mais aussi de représentations sociales de la médecine et des professionnels de santé, comme de leurs territoires d’exercice. Enfin, elles s’articulent avec des normes de genre (rôle des femmes dans la gestion de la santé du foyer ou de l’entourage) illustrant les rapports entre hommes et femmes, ainsi que les rapports des hommes et de femmes à leurs villes.
Published: 2017
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37. Spatial interactions between urban areas and cause-specific mortality differentials in France

Author: Eric Jougla, Stéphane Rican, Walid Ghosn, Grégoire Rey, and Daouda Kassie
Subjects: Male, Health (social science), Databases, Factual, Urban Population, Inequality, media_common.quotation_subject, Geography, Planning and Development, Population, Unit (housing), Cause of Death, Humans, Spatial inequalities, Mortality, education, Socioeconomic status, Aged, media_common, education.field_of_study, 000 - Autres thèmes, Public Health, Environmental and Occupational Health, Cause specific mortality, Health Status Disparities, Middle Aged, Models, Theoretical, Geography, Social Class, Gravity model of trade, Small-Area Analysis, Female, Pairwise comparison, France, Algorithms, Demography
Abstract: Spatial interactions constitute a challenging but promising approach for investigation of spatial mortality inequalities. Among spatial interactions measures, between-spatial unit migration differentials are a marker of socioeconomic imbalance, but also reflect discrepancies due to other factors. Specifically, this paper asks whether population exchange intensities measure differentials or similarities that are not captured by usual socioeconomic indicators. Urban areas were grouped pairwise by the intensity of connection estimated from a gravity model. The mortality differences for several causes of death were observed to be significantly smaller for strongly connected pairs than for weakly connected pairs even after adjustment on deprivation.
Published: 2013
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38. The Influence of Urbanization Modes on the Spatial Circulation of Flaviviruses within Ouagadougou (Burkina Faso)

Author: Daouda Kassie, Roch K. Dabiré, Florence Fournet, Zoé Vaillant, Aude Meunier-Nikiema, Anna Roudot, Gérard Salem, Stéphane Rican, Diversity, ecology, evolution & Adaptation of arthropod vectors (MIVEGEC-DEEVA), Evolution des Systèmes Vectoriels (ESV), Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Institut de Recherche pour le Développement (IRD [France-Sud])-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Institut de Recherche pour le Développement (IRD [France-Sud])-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Institut de Recherche pour le Développement (IRD [France-Sud])-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Institut de Recherche pour le Développement (IRD [France-Sud])-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Laboratoire Espace, Santé et Territoires (LEST), Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Animal et gestion intégrée des risques (UPR AGIRs), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Institut de Recherche pour le Développement (IRD [France-Sud])-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), L'Equipe Santé et Territoires (LEST), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Animal et gestion intégrée des risques (Cirad-Bios-UPR 22 AGIRs), Département Systèmes Biologiques (Cirad-BIOS), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), and Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: Male, Health, Toxicology and Mutagenesis, lcsh:Medicine, L73 - Maladies des animaux, Gestion des déchets, Logistic regression, infectious diseases, Santé publique, Dengue fever, urban health, Dengue, 0302 clinical medicine, Environmental protection, Seroepidemiologic Studies, Analyse du risque, Facteur de risque, Prevalence, Flavivirus Infections, 030212 general & internal medicine, Child, education.field_of_study, biology, [SHS.GEO]Humanities and Social Sciences/Geography, 3. Good health, Épidémiologie, Flavivirus, Geography, arboviruses, S50 - Santé humaine, Child, Preschool, Emerging infectious disease, Female, L20 - Écologie animale, Enfant, Zone urbaine, 030231 tropical medicine, Population, Urbanisation, Article, 03 medical and health sciences, Maladie de l'homme, Ville, Environmental health, Urbanization, West Africa, Burkina Faso, Population urbaine, medicine, Seroprevalence, Humans, Surveillance épidémiologique, education, Retrospective Studies, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, Spatial Analysis, lcsh:R, Public Health, Environmental and Occupational Health, Infant, Newborn, Infant, health inequalities, biology.organism_classification, medicine.disease, Cross-Sectional Studies, Logistic Models, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Abstract: 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.
Published: 2016
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39. Amenable mortality in European Regions for the last fifteen years

Author: Carlos A. Bana e Costa, Paula Santana, and Stéphane Rican
Subjects: Amenable mortality, business.industry, Public Health, Environmental and Occupational Health, Medicine, business, Demography
Published: 2016
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40. Dépeuplement rural et offre de soins de premiers recours : quelles réalités et quelles solutions ?

Author: Stéphane Rican, Gérard Salem, Yann Bourgueil, Julien Mousquès, Véronique Lucas-Gabrielli, Guillaume Chevillard, Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), Laboratoire d'Economie de Dauphine (LEDa), Université Paris Dauphine-PSL, Institut de Recherche et Documentation en Economie de la Santé (IRDES), Institut de la Recherche et Documentation en Economie de la Santé, Groupe IMAGE, ENSP, L'Equipe Santé et Territoires (LEST), Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Ecole Nationale Supérieure Polytechnique de Yaoundé (ENSPY), Université de Yaoundé I-Université de Yaoundé I, Laboratoire Espace, Santé et Territoires (LEST), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), and Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)
Subjects: besoins de soins, Geography, Planning and Development, Espace rural, 0507 social and economic geography, rural area, Rural areas, depopulating area, General practitioner, [SHS]Humanities and Social Sciences, médecin généraliste libéral, 03 medical and health sciences, espace rural, 0302 clinical medicine, Médecin généraliste libéral, Political science, Health care need, Multi-disciplinary group practice in primary care, 030212 general & internal medicine, lcsh:Social sciences (General), espace en dépeuplement, Demography, Maison de santé, Besoins de soins, health care need, 05 social sciences, lcsh:Geography. Anthropology. Recreation, Depopulating area, [SHS.GEO]Humanities and Social Sciences/Geography, maison de santé, 3. Good health, lcsh:G, general practitioner, multi-disciplinary group practice in primary care, Espace en dépeuplement, lcsh:H1-99, 050703 geography, Humanities
Abstract: 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.
Published: 2016
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41. 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 ?)

Author: Stéphane Rican, Zoé Vaillant, and Gérard Salem
Subjects: diagnostic de santé, cancer, politique de santé, Ile-de-France, education, Geography, Planning and Development, Ile-de-France region, health policies, health diagnostics, Earth-Surface Processes
Abstract: 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.
Published: 2012
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42. Low exposure to sunlight is a risk factor for Crohn’s disease

Author: Patrick Dubost, Elisabeth Monnet, Virginie Nerich, Alain Weill, Hubert Allemand, Guy Robert Auleley, Franck Carbonnel, Corinne Balaire, Vincent Vanbockstael, Stéphane Rican, Marie-Christine Boutron-Ruault, and Prevost Jantchou
Subjects: Pathology, medicine.medical_specialty, Inflammatory bowel disease, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Environmental health, Epidemiology, medicine, Pharmacology (medical), Poisson regression, Risk factor, 030304 developmental biology, Sunlight, 0303 health sciences, Crohn's disease, Hepatology, business.industry, Incidence (epidemiology), Gastroenterology, medicine.disease, 3. Good health, Relative risk, symbols, 030211 gastroenterology & hepatology, business
Abstract: Aliment Pharmacol Ther 2011; 33: 940–945 Summary Background Low sunshine exposure might contribute to the pathogenesis of inflammatory bowel disease (IBD). Aim To assess the geographic distribution of IBD incidence in relation to sunshine exposure in France to test the hypothesis that higher sun exposure is associated with lower IBD risk. Methods Using the national health insurance database, incidence rates of Crohn’s disease (CD) and ulcerative colitis (UC) were estimated for each of the 94 French administrative areas (‘departements’), between 2000 and 2002. The surface UV radiation intensity was obtained by combining modelling and satellite data from Meteosat, the European meteorological satellite. Relationships between incidence rates and sun exposure were tested for significance by using a Poisson regression. We mapped smoothed relative risks (sRR) for CD and UC, using a Bayesian approach and adjusting for sun exposure, to search for geographical variations. Results Areas with a smoothed RR of CD incidence significantly above 1 corresponded to areas with low sunshine exposure, whereas those with high or medium sunlight exposure had smoothed RRs either lower than 1 or not significantly different from 1. There was no association between sun exposure and UC incidence. Conclusions This geographic study suggests that low sunlight exposure is associated with an increased incidence of Crohn's disease. Further studies are needed to determine if this association is causal.
Published: 2011
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43. Territoires et santé : enjeux sanitaires de la territorialisation et enjeux territoriaux des politiques de santé

Author: Stéphane Rican and Zoé Vaillant
Subjects: Issues, ethics and legal aspects, Health (social science), Health Policy, Political science, Public Health, Environmental and Occupational Health
Published: 2009
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44. Cancer mortality after age 65 in metropolitan France (1973–2003)

Author: Z. Vaillant, Eric Jougla, G. Gourdon, D. Kerzerho, Stéphane Rican, and Gérard Salem
Subjects: Oncology
Abstract: 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.
Published: 2007
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45. [Knowledge co-production and local transfer to reduce inequalities of access to breast cancer screening]

Author: Marianne, Viot, Zoé, Vaillant, Lucile, Harel, Stéphane, Rican, Mélanie Boulland, Dauchez, Marie, Baron, El Hadji Malik Lam, Ndiaye, Eva, Delpech, Sylvie, Bréchenade, Laurent, El Ghozi, and Gérard, Salem
Subjects: Translational Research, Biomedical, Humans, Breast Neoplasms, Female, France, Early Detection of Cancer, Health Services Accessibility
Abstract: 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'
Published: 2015

46. Mesure de l'impact d'une politique publique visant à favoriser l'installation et le maintien de médecins généralistes : l'exemple du soutien au développement des maisons et pôles de santé en France

Author: Julien Mousquès, Guillaume Chevillard, Stéphane Rican, Véronique Lucas-Gabrielli, Yann Bourgueil, Gérard Salem, Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), Laboratoire d'Economie de Dauphine (LEDa), Université Paris Dauphine-PSL, Institut de Recherche et Documentation en Economie de la Santé (IRDES), Institut de la Recherche et Documentation en Economie de la Santé, Groupe IMAGE, ENSP, L'Equipe Santé et Territoires (LEST), Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Ecole Nationale Supérieure Polytechnique de Yaoundé (ENSPY), Université de Yaoundé I-Université de Yaoundé I, Laboratoire Espace, Santé et Territoires (LEST), and Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Soins de santé primaires, Evaluation de politiques publiques, Médecins généralistes, Maisons de santé, General Medicine, Pôles de santé, [SHS.GEO]Humanities and Social Sciences/Geography, 010501 environmental sciences, 01 natural sciences, [SHS]Humanities and Social Sciences, 03 medical and health sciences, 0302 clinical medicine, 030212 general & internal medicine, 0105 earth and related environmental sciences
Abstract: 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.
Published: 2015

47. Transfert de connaissances pour réduire les inégalités infra-communales d'accès au dépistage du cancer du sein

Author: Sylvie Bréchenade, Zoé Vaillant, Laurent El Ghozi, Mélanie Boulland Dauchez, Eva Delpech, Marie Baron, Stéphane Rican, Gérard Salem, Marianne Viot, Lucile Harel, El Hadji Malik Lam Ndiaye, Laboratoire Dynamiques Sociales et Recomposition des Espaces (LADYSS), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Espace, Santé et Territoire (LEST), Université Paris Nanterre (UPN), Laboratoire Espace, Santé et Territoires (LEST), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), L'Equipe Santé et Territoires (LEST), Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Nanterre (UPN)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Biologie du Développement et Reproduction (BDR), Institut National de la Recherche Agronomique (INRA), PRIEUR, Cha, Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7), and Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris Nanterre (UPN)-Université Paris Diderot - Paris 7 (UPD7)
Subjects: medicine.medical_specialty, Inequality, [SHS.GEO] Humanities and Social Sciences/Geography, media_common.quotation_subject, [SHS]Humanities and Social Sciences, Co-production et partage de connaissances, Breast cancer screening, Politiques locales, Multidisciplinary approach, Knowledge translation, Cancer screening, Géographie de la santé, medicine, media_common, Dépistage du cancer du sein, medicine.diagnostic_test, business.industry, Public health, Inégalités sociales et territoriales de santé, Public Health, Environmental and Occupational Health, [SHS.GEO]Humanities and Social Sciences/Geography, Public relations, 3. Good health, Intervention (law), [SHS] Humanities and Social Sciences, business, Knowledge transfer
Abstract: 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'
Published: 2015

48. The Expansion of the Economic Frontier and the Diffusion of Violence in the Amazon

Author: Patrícia Feitosa Souza, Christovam Barcellos, Stéphane Rican, Diego Ricardo Xavier, Vanderlei Pascoal de Matos, Escola Nacional de Saude Publica Sergio Arouca [Rio de Janeiro] (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Laboratoire Espace, Santé et Territoire (LEST), Université Paris Nanterre (UPN), This article is a contribution of studies scholarship from CNPq (National Council for Scientific and Technological Development) of the Ministry of Science and Technology of Brazil funded by CNPq Grant Number 246183/2012-8 and this research was supported by the National Research Council (CNPq—project 402867/05-0) and Brazilian Ministry of Health (DECIT)., Study conception and design: Patrícia Souza, Christovam Barcellos, Diego Xavier and Stephane Rican. Acquisition of data: Patrícia Souza, Vanderlei Pascoal de Matos, Christovam Barcellos and Diego Xavier. Analysis and interpretation of data: Patrícia Souza, Christovam Barcellos, Diego Xavier and Stephane Rican. Drafting of manuscript: Patrícia Feitosa, Christovam Barcellos and Diego Xavier., and Escola Nacional de Saude Publica Sergio Arouca / Sergio Arouca National School of Public Health [Rio de Janeiro] (ENSP)
Subjects: Conservation of Natural Resources, pioneer area, MESH: Socioeconomic Factors, Economic expansion, Health, Toxicology and Mutagenesis, Population, lcsh:Medicine, Poison control, Geographic Mapping, Context (language use), Violence, MESH: Violence/statistics & numerical data, Article, Frontier, MESH: Agriculture/economics, Environmental protection, Deforestation, Humans, MESH: Agriculture/statistics & numerical data, Economic geography, MESH: Homicide/trends, education, MESH: Geographic Mapping, education.field_of_study, Amazon rainforest, spatial diffusion of disease, MESH: Conservation of Natural Resources/statistics & numerical data, lcsh:R, Public Health, Environmental and Occupational Health, Spatial analysis, MESH: Conservation of Natural Resources/trends, Agriculture, [SHS.GEO]Humanities and Social Sciences/Geography, 15. Life on land, MESH: Conservation of Natural Resources/economics, Geography, Socioeconomic Factors, MESH: Homicide/statistics & numerical data, Spatial ecology, MESH: Agriculture/trends, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Homicide, MESH: Brazil, Brazil
Abstract: International audience; Over the last few decades, the occupation of the Amazon and the expansion of large-scale economic activities have exerted a significant negative impact on the Amazonian environment and on the health of the Amazon's inhabitants. These processes have altered the context of the manifestation of health problems in time and space and changed the characteristics of the spatial diffusion of health problems in the region. This study analyzed the relationships between the various economic processes of territorial occupation in the Amazon and the spatial diffusion of homicidal violence through the configuration of networks of production, as well as the movements of population and merchandise. Statistical data on violence, deforestation, the production of agricultural items, and socio-economic variables, georeferenced and available for the 771 municipalities of the Legal Amazon were used in this study. The results suggest that the diffusion of violence closely follows the economic expansion front, which is related to deforestation and livestock production but has little relation to grain production, demonstrating steps and typologies of recent occupation in the Amazon that promote violence. These spatial patterns reveal environmental and socio-economic macro-determinants that materialize in geographic space through the construction of highways and the formation of city networks.
Published: 2015
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49. Cancer mortality in France: recent trends (2000–2003)

Author: Gérard Salem, G. Gourdon, Stéphane Rican, D. Kerzerho, and E. Jougla
Subjects: Oncology
Abstract: 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.
Published: 2006
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50. Disparit�s de la mortalit� par cancer dans l?Union Europ�enne*

Author: Eric Jougla, Gérard Salem, Stéphane Rican, Gérard Pavillon, and H. Lefevre
Subjects: Oncology
Abstract: Les deces par cancer representent un quart des deces survenant dans les pays de l’UE. Les plus frequentes localisations sont, pour les hommes, le poumon, l’intestin et la prostate, et pour les femmes, le sein, l’intestin et le poumon. Les niveaux de mortalite s’ameliorent globalement a l’exception du cancer du poumon chez la femme et du melanome chez l’homme. C’est en France que l’on observe les taux de deces masculins les plus eleves. Cette situation defavorable s’explique par le poids des cancers des VADS, du foie et du poumon. Si les femmes francaises se situent dans une position globalement favorable, elles ont actuellement la plus forte augmentation pour les cancers pulmonaires. L’analyse des disparites par cancer en UE montre ainsi clairement l’impact particulierement negatif et augmente en France de la consommation d’alcool et de tabac sur le niveau de la mortalite.
Published: 2004
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