{"id":537,"date":"2007-03-31T22:52:34","date_gmt":"2007-04-01T03:52:34","guid":{"rendered":"http:\/\/gillesenvrac.ca\/carnet\/2007\/03\/la-prevention-contre-lequite\/"},"modified":"2007-03-31T22:52:34","modified_gmt":"2007-04-01T03:52:34","slug":"la-prevention-contre-lequite","status":"publish","type":"post","link":"https:\/\/gillesenvrac.ca\/carnet\/2007\/03\/la-prevention-contre-lequite\/","title":{"rendered":"la pr\u00e9vention contre l'\u00e9quit\u00e9 ?"},"content":{"rendered":"

Un article tr\u00e8s provocateur tir\u00e9 du tr\u00e8s r\u00e9put\u00e9 British Medical Journal<\/a>, \u00e9crit par une omnipraticienne anglaise, Iona Heath : In defense of a National Sickness System<\/em><\/strong>. J’avais conserv\u00e9 sur mon bureau ce court article d’une page, dont je vous cite donne ici un assez long extrait :<\/p>\n

A National Health Service committed to prioritising the prevention of sickness above its treatment would accelerate the pursuit of biometric risk factors for this or that disease and the development of statistically effective treatments for each one in turn. This process legitimises investment in the wholesale drug treatment of healthy people and the increasing costs of this begin to pose a very real threat to the provision of universal healthcare systems that are available and accessible to all. No universal healthcare system, funded through taxation, can possibly pay for the pharmaceutical treatment of all risks to health. An excessive and unrealistic commitment to prevention of sickness could destroy our capacity to care for those who are already sick; everyone, in time, must become sick and die. One of the ambitions of preventive health care is that it will reduce the gap between rich and poor, but health inequalities reflect wider societal inequalities and cannot be solved by a health service operating within a persistently unequal society. As Peter Skrabanek asked many years ago, why does poverty matter only when it creates illness and disease? Why are we not appalled by poverty because it is \u201ccruel, demeaning and unjust\u201d long before it manifests itself as ill health? Through recent advances in psychoneuroimmunology, we begin to understand how the chronic psychosocial stress of finding oneself at the bottom of society\u2019s pile leads to compromised immunity, disordered metabolism, and premature disease. The primary solution should not be medication but a genuine commitment to fairness and justice in a humane society. [BMJ<\/a>]<\/p><\/blockquote>\n

Je ne suis pas certain que l’article soit accessible aux non abonn\u00e9s au site (de l\u00e0 la longue citation). C’est un discours plut\u00f4t iconoclaste que de d\u00e9fendre un \u00ab\u00a0syst\u00e8me de maladies\u00a0\u00bb. S\u00fbr que la pr\u00e9vention n’est pas suffisamment d\u00e9velopp\u00e9es dans nos syst\u00e8mes encore tr\u00e8s m\u00e9dico-pharmaco-hospitalocentr\u00e9s. Mais il n’est pas inint\u00e9ressant de se rappeler que le d\u00e9veloppement de m\u00e9thodes massives de d\u00e9pistage et de traitements pr\u00e9coces peuvent amener non seulement une m\u00e9dicalisation (pr\u00e9ventive) de la soci\u00e9t\u00e9 enti\u00e8re – le pouvoir des ayatollahs de la sant\u00e9 publique<\/em> – mais aussi une certaine dimminution de l’\u00e9quit\u00e9 dans l’acc\u00e8s aux soins pour les malades, en contexte de ressources limit\u00e9es. N’est-il pas \u00e9vident que plus il y aura de syst\u00e8mes \u00e9labor\u00e9s de pr\u00e9vention et de pressions sociales pour des comportements sanitaires… plus il y aura en corollaire une certaine stigmatisation des malades ? Et sa note sur la connaissance (psychoneuroimmunologique) de plus en plus fine que nous avons des processus qui conduisent ceux qui sont au bas de l’\u00e9chelle sociale \u00e0 devenir plus malade plus t\u00f4t nous rappelle que l’\u00e9quit\u00e9 en mati\u00e8re de sant\u00e9 passe plus par la justice sociale et \u00e9conomique que par la pr\u00e9vention.<\/p>\n","protected":false},"excerpt":{"rendered":"

Un article tr\u00e8s provocateur tir\u00e9 du tr\u00e8s r\u00e9put\u00e9 British Medical Journal, \u00e9crit par une omnipraticienne anglaise, Iona Heath : In defense of a National Sickness System. J’avais conserv\u00e9 sur mon bureau ce court article d’une page, dont je vous cite donne ici un assez long extrait : A National Health Service committed to prioritising the … <\/p>\n

Continuer la lecture de « la pr\u00e9vention contre l'\u00e9quit\u00e9 ? »<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"atmosphere_disabled":false,"atmosphere_custom_text":"","_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[],"tags":[97,133],"class_list":["post-537","post","type-post","status-publish","format-standard","hentry","tag-inegalites-de-sante","tag-prevention"],"jetpack_featured_media_url":"","jetpack-related-posts":[{"id":3265,"url":"https:\/\/gillesenvrac.ca\/carnet\/2010\/06\/la-sante-down-under\/","url_meta":{"origin":537,"position":0},"title":"la sant\u00e9 \u00ab\u00a0down under\u00a0\u00bb","author":"Gilles Beauchamp","date":"21 juin 2010","format":false,"excerpt":"the Government will reform the health system to place a greater emphasis on the importance of keeping people healthy and out of hospital, and implement its response to the report of the Preventative Health Taskforce. Plusieurs commissions australiennes relatives \u00e0 la sant\u00e9 ont remis leurs rapports en 2009 : the\u2026","rel":"","context":"Dans \"politiques\"","block_context":{"text":"politiques","link":"https:\/\/gillesenvrac.ca\/carnet\/tag\/polis\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":809,"url":"https:\/\/gillesenvrac.ca\/carnet\/2008\/08\/professionnels-citoyens\/","url_meta":{"origin":537,"position":1},"title":"professionnels – citoyens","author":"Gilles Beauchamp","date":"13 ao\u00fbt 2008","format":false,"excerpt":"Here, professionals are learning to talk and listen to increasingly assertive patients. Improving the quality of conversations is key to empowerment and innovation. For professionals and policy makers, this means letting go of some old assumptions about expertise and professionalism. The future of healthcare depends not only on new technologies\u2026","rel":"","context":"Dans \"professionnel\"","block_context":{"text":"professionnel","link":"https:\/\/gillesenvrac.ca\/carnet\/tag\/professionnel\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":1444,"url":"https:\/\/gillesenvrac.ca\/carnet\/2008\/12\/nouvelles-diverses\/","url_meta":{"origin":537,"position":2},"title":"nouvelles diverses","author":"Gilles Beauchamp","date":"4 d\u00e9cembre 2008","format":false,"excerpt":"One of the most worrying effects of this trend has been a boom in the prescription of antidepressant medication and quotes the worrying figures that \"Roughly 10% of women and 4% of men in the United States take antidepressant medication at any time. By 2000, antidepressants were the best-selling prescription\u2026","rel":"","context":"Dans \"neurologie\"","block_context":{"text":"neurologie","link":"https:\/\/gillesenvrac.ca\/carnet\/tag\/neuro\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/gillesenvrac.ca\/biblio\/Images\/79.jpg?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":722,"url":"https:\/\/gillesenvrac.ca\/carnet\/2008\/03\/les-antidepresseurs-sont-ils-efficaces\/","url_meta":{"origin":537,"position":3},"title":"les antid\u00e9presseurs sont-ils efficaces ?","author":"Gilles Beauchamp","date":"12 mars 2008","format":false,"excerpt":"La question de l'efficacit\u00e9 des antod\u00e9presseurs, le premier rem\u00e8de propos\u00e9 aux personnes souffrant de d\u00e9pression (mais aussi d'anxi\u00e9t\u00e9...) fait l'objet de beaucoup de d\u00e9bats... depuis longtemps. Le British Medical Journal publiait en \u00e9ditorial la semaine derni\u00e8re un compte-rendu critique d'une m\u00e9ta-analyse publi\u00e9e sur PLoS Medecine. L'enjeu porte sur la mani\u00e8re\u2026","rel":"","context":"Dans \"sant\u00e9 mentale\"","block_context":{"text":"sant\u00e9 mentale","link":"https:\/\/gillesenvrac.ca\/carnet\/tag\/sante-mentale\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":33,"url":"https:\/\/gillesenvrac.ca\/carnet\/2005\/02\/portails-communautaires-pas-juste-des-problmes-technos\/","url_meta":{"origin":537,"position":4},"title":"Portails communautaires : pas juste un acc\u00e8s techno","author":"Gilles Beauchamp","date":"12 f\u00e9vrier 2005","format":false,"excerpt":"This paper considers the attributes of community portals; questions the sustainability of such portals, and suggests a likely direction that portal evolution may take. The context is that of UK local government portals, over the period from 1999-2004. Research has been undertaken to investigate the extent to which locally deployed\u2026","rel":"","context":"Dans \"acc\u00e8s\"","block_context":{"text":"acc\u00e8s","link":"https:\/\/gillesenvrac.ca\/carnet\/tag\/acces\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":658,"url":"https:\/\/gillesenvrac.ca\/carnet\/2007\/11\/problemes-de-sante-mentale-et-sante-physique\/","url_meta":{"origin":537,"position":5},"title":"probl\u00e8mes de sant\u00e9 mentale et sant\u00e9 physique","author":"Gilles Beauchamp","date":"16 novembre 2007","format":false,"excerpt":"Disparities in appendicitis rupture rate among mentally ill patients: \"Many studies have been carried out that focus on mental patients' access to care for their mental illness, but very few pay attention on these same patients' access to care for their physical diseases. Acute appendicitis is a common surgical emergency.\u2026","rel":"","context":"Dans \"sant\u00e9 mentale\"","block_context":{"text":"sant\u00e9 mentale","link":"https:\/\/gillesenvrac.ca\/carnet\/tag\/sante-mentale\/"},"img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/gillesenvrac.ca\/carnet\/wp-json\/wp\/v2\/posts\/537","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/gillesenvrac.ca\/carnet\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/gillesenvrac.ca\/carnet\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/gillesenvrac.ca\/carnet\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/gillesenvrac.ca\/carnet\/wp-json\/wp\/v2\/comments?post=537"}],"version-history":[{"count":0,"href":"https:\/\/gillesenvrac.ca\/carnet\/wp-json\/wp\/v2\/posts\/537\/revisions"}],"wp:attachment":[{"href":"https:\/\/gillesenvrac.ca\/carnet\/wp-json\/wp\/v2\/media?parent=537"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/gillesenvrac.ca\/carnet\/wp-json\/wp\/v2\/categories?post=537"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/gillesenvrac.ca\/carnet\/wp-json\/wp\/v2\/tags?post=537"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}