De la santé publique à la santé environnementale : le rôle des quartiers dans la production des inégalités en santé

An important empirically-based body of research has emerged over the past 10-15 years demonstrating that local areas, or neighbourhoods, shape social inequalities in health. While this research has been successful in showing that social inequalities in health are produced locally, much of it has treated neighbourhoods as a unit of analysis, thereby neglecting its role as a space where social inequalities play out due to policy trickle-downs from regional and national levels. A new theoretical framework will be presented that conceives neighbourhoods as unique systems of health-relevant resources and social relations embedded within geographical borders. The expression “distribution of resources” will be expanded beyond an outcome in terms of variation in the statistical sense, to include the set of processes through which resources are spread differentially among individuals. Neighbourhoods are defined as being spatial distribution networks through which resources are made accessible for producing health. It is this crucial dimension of access, and the channels through which resources can be transformed into health, that this conceptualisation of neighbourhood highlights as a contributor to social inequalities in health. The components of this framework, including four capitals at the individual level, five domains at the neighbourhood level and four sets of rules, will be presented. A discussion of our particular definition of equity, based on the work of Amartya Sen, will serve to help articulate how social inequalities in health can be addressed using the framework. Specific focus will be given to the importance of this model for our further understanding of how social inequalities in health are produced locally.