Sante Publique最新文献

{"title":"Crainte de représailles dans les services sanitaires : validation d’un questionnaire par Delphi modifié.","authors":"Carine Bétrisey, François Bolduc, Nathalie Delli-Colli, Finn Makela, Anne Hudon, Marie-Ève Caty, Arnaud Duhoux, Annie Carrier","doi":"10.3917/spub.261.0123","DOIUrl":"https://doi.org/10.3917/spub.261.0123","url":null,"abstract":"<p><strong>Introduction: </strong>Under pressure, public social and health services systems call on professionals and clinical managers to take on the role of change agents to effectively meet population needs and promote equity in access to services. However, when faced with challenges in fulfilling their role, these field actors may hesitate to act, notably due to the fear of retaliation.</p><p><strong>Purpose of the study: </strong>To assess the prevalence of this fear, this study aimed to develop a questionnaire encompassing three key concepts: the problematic situations that may prompt actions, the agentic actions themselves, and the fear of retaliation. We used the modified Delphi method to design this tool, first based on scientific literature and exploratory interviews, and then with input from domain experts. Once developed, the items were validated by a panel for relevance, comprehensiveness, and clarity.</p><p><strong>Results: </strong>Eight panelists participated in the process. All questionnaire components reached consensus after two rounds of consultation. The process led to modifications (e.g., wording, measurement scales) and additions (e.g., frequency of refraining from acting due to fear) to the questionnaire.</p><p><strong>Conclusion: </strong>This measurement tool enables a better understanding of the complex process of fear of retaliation. Strategies can thus be implemented to encourage agentic actions among social and health services field actors.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"123-136"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"80 ans de la Sécurité sociale : mouvements sociaux, pacte solidaire et reconnaissance du travail social.","authors":"Vincent-Sosthène Fouda-Essomba","doi":"10.3917/spub.261.0117","DOIUrl":"https://doi.org/10.3917/spub.261.0117","url":null,"abstract":"<p><p>On the 80th anniversary of the French social security system, this article offers a critical analysis of its evolution through the social movements that have defended it, the contemporary transformations it faces, and the essential role of social workers in its daily implementation. It seeks to reexamine the foundations of the French solidarity pact and to highlight care and connection professions as key agents of social transformation.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"117-121"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"L’attestation. Une expérience d’obéissance de masse, printemps 2020.","authors":"François Bourdillon","doi":"10.3917/spub.261.0221","DOIUrl":"https://doi.org/10.3917/spub.261.0221","url":null,"abstract":"","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 1","pages":"221-222"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Les CLSM : faire de la santé mentale une affaire de territoire et de collectif.","authors":"Fanny Pastant, Sonia Charapoff","doi":"10.3917/spub.hs1.2026.0105","DOIUrl":"https://doi.org/10.3917/spub.hs1.2026.0105","url":null,"abstract":"<p><p>In France, Local Mental Health Councils (CLSMs) represent one of the few approaches that bring together the three core principles of public mental health: the inclusion of people with lived experience of mental health conditions, the territorial grounding of responses, and cross-sectoral approaches. However, despite nearly 30 years of existence and their gradual expansion (with around 300 territories covered in 2025), implementation remains uneven, resources are insufficient, and many stakeholders have yet to fully engage with them. At a time when mental health has been declared a national priority and debates oscillate between the need to support an under-resourced psychiatric system and the development of less medically centered responses, there is an urgent need to position CLSMs as strategic pillars of an ambitious public mental health policy in France. This article argues that CLSMs are neither a technical tool nor simply another coordination mechanism, but rather a fully-fledged democratic and political approach&amp;#8212;one that fosters local collective intelligence to act jointly on the factors that shape mental health at the community level. It seeks to open a space for debate: What institutional, political, and cultural conditions are needed to recognize, strengthen, and scale up CLSMs as key drivers of a genuine shift toward public mental health?</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 HS1","pages":"105-107"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semaines d’information sur la santé mentale : pratiques de coopération au sein des collectifs d’acteurs locaux.","authors":"Alice Pierre-François, Aude Caria","doi":"10.3917/spub.hs1.2026.0213","DOIUrl":"https://doi.org/10.3917/spub.hs1.2026.0213","url":null,"abstract":"<p><strong>Introduction: </strong>Mental Health Awareness Weeks (SISM, Semaines d&amp;#8217;information sur la sant&amp;#233; mentale) are an annual initiative aimed at promoting mental health among the general population across French territories. Through post-film discussions, exhibitions, and workshops, participants receive information, reflect on social representations, and identify individual and collective resources. These initiatives are led by diverse stakeholders organized within local SISM collectives. Given the growing number of events and participating groups, this study aims to analyze collaboration practices within these collectives in order to identify key factors associated with effective partnerships.</p><p><strong>Methods: </strong>A quantitative study was conducted using a self-administered questionnaire analyzed with descriptive statistics. The instrument was developed following exploratory semi-structured interviews.</p><p><strong>Results: </strong>We obtained 143 responses, primarily from peer support organizations and local authorities. The findings highlight the diversity of partnerships within the collectives. Collaborative work relies on regular meetings, coordination tools, and a climate of trust among members. Internal coordination is characterized by shared responsibilities and adaptive governance. These elements foster a sense of collective efficacy and pride regarding the perceived impact of SISM activities.</p><p><strong>Discussion: </strong>Our findings align with the existing literature on health partnerships. The study identifies concrete facilitators of collaboration, including flexible leadership, in-person meetings, and both formal and informal opportunities for exchange, as well as the use of charters and action plans. Volunteer engagement is widespread, and co-construction with individuals experiencing mental health conditions contributes to reducing interprofessional silos across territories.</p><p><strong>Conclusion: </strong>Partnership dynamics within local SISM collectives contribute to mental health promotion across territories and may provide a model for other local stakeholder networks.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 HS1","pages":"213-218"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersectionality in public and global health: Definitions and uses in Francophone contexts, a narrative review","authors":"Marion Perrot, Mira Johri","doi":"10.3917/spub.263.0347","DOIUrl":"10.3917/spub.263.0347","url":null,"abstract":"<p><strong>Introduction: </strong>Reducing health inequalities is a priority in public and global health. Intersectionality is a powerful tool for analyzing complex inequalities. Unfortunately, its use remains limited in Francophone contexts, where it is often confined to abstract theoretical considerations, thereby constraining its transformative potential.</p><p><strong>Method: </strong>This narrative review, guided by the SANRA criteria, was conducted between February and August 2025 using Google Scholar, PubMed, and Cairn to identify foundational texts, case studies, and practical resources addressing the application of intersectionality in public and global health. The aim was not exhaustiveness, but rather a reasoned selection intended to highlight its theoretical and practical contributions within Francophone contexts.</p><p><strong>Results: </strong>Intersectionality enables the analysis of structural mechanisms that sustain inequalities, brings to light paradoxical dynamics, and moves beyond unidimensional approaches. Its applications span three main domains: research (qualitative, quantitative, and mixed methods), policy (notably through the IBPA framework), and professional practice (via critical alliances and community engagement). It also reveals contextual tensions: resistance in France, greater uptake in Canada and Quebec, and growing diffusion in other Francophone contexts.</p><p><strong>Discussion: </strong>This review highlights the transformative potential of intersectionality in public and global health, as both a critical tool and an action-oriented approach. Its implementation raises methodological and epistemic challenges that must be addressed reflexively by researchers and practitioners. Intersectionality is a flexible tool for designing equitable and inclusive interventions that advance social justice.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 3","pages":"347-359"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private practice of children’s nurses in France: A descriptive survey","authors":"Madeleine Collombier, Emmanuelle du Plessis","doi":"10.3917/spub.263.0101","DOIUrl":"10.3917/spub.263.0101","url":null,"abstract":"<p><strong>Introduction: </strong>The private practice of children&amp;#8217;s nurses in France remains poorly documented, although it could contribute to early prevention and parental support during the first years of life. This study aims to describe their professional practices and their role within child healthcare pathways.</p><p><strong>Methods: </strong>A national descriptive survey was conducted in 2024 among children&amp;#8217;s nurses working in private practice, using an online questionnaire disseminated through professional networks. Data were analyzed using descriptive and thematic approaches.</p><p><strong>Results: </strong>Most children&amp;#8217;s nurses in private practice are highly experienced professionals, focusing their activities on prevention and health education for children aged 0&amp;#8211;6 years and their families. They provide individual consultations, but also implement innovative approaches such as group workshops and &amp;#8220;parent circles,&amp;#8221; which promote experience sharing and parental empowerment. Their interventions complement those of general practitioners, midwives, and maternal and child health services. Technical care is marginal, whereas psychosocial support and parental guidance are central. Motivations for private practice include professional autonomy and the desire to address unmet needs. However, the lack of public funding through national health insurance remains a major obstacle to the development and accessibility of this practice.</p><p><strong>Conclusion: </strong>Private practice of children&amp;#8217;s nurses represents an emerging resource to strengthen early prevention and complement the work of other primary care professionals. Better integration into coordinated care pathways, inspired by international models, could help consolidate public health policies in favor of early childhood and, potentially, adolescence.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 3","pages":"101-115"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Andes virus aboard the MV Hondius: Transnational public health challenges in ocean-going cruise travel","authors":"Pengyuan Huang, Xin Chen","doi":"10.3917/spub.263.0011","DOIUrl":"10.3917/spub.263.0011","url":null,"abstract":"<p><p>This article analyzes the cluster of Andes virus infections that occurred aboard the expedition vessel MV Hondius during a transatlantic crossing. Drawing on publicly available information released by the World Health Organization, the European Centre for Disease Prevention and Control, and the US Centers for Disease Control and Prevention, it examines the key characteristics of this event: probable exposure in a natural reservoir area in South America before embarkation, limited human-to-human transmission in a closed maritime environment, difficulties in early case recognition, and the complexity of international contact tracing. The analysis shows that the vessel itself was not the source of the virus, but rather a setting in which public health risks were amplified due to prolonged cohabitation, limited onboard medical resources, and the cross-border mobility of passengers. Finally, the article highlights the importance of stratified contact management, timely reporting, effective international cooperation, and clear risk communication to avoid both underestimation of the risk and unnecessary public panic.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 3","pages":"11-17"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatial disparities and the paradox of healthcare access in Morocco: An econometric analysis of the relationship between the generalization of medical coverage and infrastructure density","authors":"Aazelarab Boughaleb, Mounir Jerry","doi":"10.3917/spub.263.0029","DOIUrl":"10.3917/spub.263.0029","url":null,"abstract":"<p><strong>Introduction: </strong>&amp;#160;Health system reform in Morocco aims to achieve universal health coverage (UHC), primarily through the expansion of health insurance. However, financial coverage does not automatically guarantee physical access to services. This study examines the spatial efficiency of this reform by comparing the geography of financially solvent demand (coverage rate) with that of healthcare supply (infrastructure density).</p><p><strong>Method: </strong>&amp;#160;Based on official data from the Ministry of Health (2023) and the Census (2024), this mixed quantitative approach combines inequality analysis using Lorenz curves and econometric modeling (OLS) to test the correlation between medical coverage and infrastructure density across the Kingdom&amp;#8217;s twelve regions.</p><p><strong>Results: </strong>&amp;#160;The analysis reveals a major structural asymmetry. While the distribution of coverage has become spatially homogeneous (CV=0.06), the supply of care remains highly concentrated and unequal. Linear regression (R2 = 0,137) confirms the absence of a statistically significant relationship between coverage and the local availability of infrastructure.</p><p><strong>Conclusion: </strong>&amp;#160;These results highlight a&amp;#160;&amp;#8220;solvabilization paradox&amp;#8221;: the administrative right to care does not correspond to an adequate supply in peripheral regions, risking the transformation of insurance into an &amp;#8220;empty shell.&amp;#8221; The success of the reform now requires moving beyond the simple solvabilization of demand toward a proactive policy of territorializing healthcare supply.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 3","pages":"29-37"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From technical optimization to system-level value in oncology: Integrating quality assurance, economic evaluation and governance","authors":"Christos Melidis","doi":"10.3917/spub.263.0019","DOIUrl":"10.3917/spub.263.0019","url":null,"abstract":"<p><p>A persistent paradox characterizes health policy in oncology: Scientific and technical knowledge progresses rapidly, yet system performance and public decision-making do not always reflect these advances. Despite major improvements in radiotherapy, imaging, and the standardization of clinical trials, European health systems continue to face rising costs, inequalities in access, and variations in outcome that cannot be fully explained by epidemiological factors alone. This article advances the hypothesis that these limitations stem less from a lack of evidence than from insufficient integration among three essential dimensions of public action: technical quality assurance, health economic evaluation, and governance. The experience of quality assurance in radiotherapy demonstrates that variability can be reduced when standards are harmonized and embedded at the system level. Economic evaluations, in turn, highlight that the value of interventions depends closely on organizational and territorial constraints. However, these dimensions are often addressed sequentially rather than in a coordinated manner: technical validation, followed by economic analysis, and then policy decision-making. Such fragmentation limits the ability of health systems to translate available knowledge into coherent and sustainable policies. Beyond oncology, this analysis examines decision-making processes in high-technology health domains and advocates for an integrated policy framework articulating quality, efficiency, and governance.</p>","PeriodicalId":49575,"journal":{"name":"Sante Publique","volume":"38 3","pages":"19-22"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}