[From social medicine to the management of precariousness in health]

A review of the history leading from the creation of social medicine to the management of precariousness in the health field. We will define the main concepts (precariousness, poverty, social inequalities in health) and indicate the main barriers to access to care for people in precarious situations. Finally, we will give some guidelines for the healthcare community in order to improve care.

[Cognitive aging apart from dementia]

Cognitive aging apart dementia results from different genetic programming, different according to individuals. The aging of the various cognitive and very heterogeneous cognitive functions largely depends on the life course of each person. Social factors, in particular the environment in which a person lives, may or may not accelerate the processes of cognitive aging. The slower processing speeds of information from the environment, practical or strategic new acquisitions, and the difficult management of multiple tasks, reflect an age-related hypofrontality. Physical and mental health, social and relational well-being participate in good cognitive aging. Exploration of the different facets of cognitive aging shows its complexity.

[Gender and health: what are we talking about?]

In terms of health, women and men are not on equal footing. Not only due to biological factors, but also in the social, cultural and economic realms. Gender bias influences medical practice, research, teaching and behaviour of both caregivers and patients. This bias results in situations of inequality as well as gender discrimination in access to health and medical care. Taking gender into account in matters of health is a major bioethical issue.

[Refusing care: a gender thing?]

Quantitative surveys reveal that a greater number of women than men report that they refuse care. This article presents three complementary approaches to gender which examine this disparity and allow us to think about the differences between men and women when it comes to health in a more complex way. These approaches are also useful for considering the conditions for equal access to healthcare for everyone.

Economic impacts of chronic conditions in a country with high levels of population health coverage: lessons from Mongolia

OBJECTIVE

To analyse the impact of non-communicable diseases (NCDs) on household out-of-pocket (OOP) expenses, catastrophic health payments and medical impoverishment in Mongolia, a middle-income country with a high population health insurance coverage rate.

METHODS

Secondary data analysis of the Mongolian Household Socioeconomic Survey with 12 840 households, including information on standard of living, OOP spending, and health conditions of household members. Measures of catastrophic spending and medical impoverishment were constructed for Mongolia. The association of medical impoverishment and catastrophic spending with a range of socioeconomic and demographic covariates and health conditions was assessed using multiple regression models.

RESULTS

OOP health spending contributed to an 8% increase in the incidence of poverty in Mongolia. The impoverishment associated with medical expenses is concentrated in the poorer quintiles, indicating some deepening of poverty among the already poor. Households with a member affected by NCDs and with multiple morbidities were more likely to experience catastrophic spending and medical impoverishment than those with infectious diseases. The main drivers of the financial distress were expenditures incurred for outpatient services, including for diagnostics and drugs.

CONCLUSION

Despite high rates of population health insurance coverage, health expenditures have substantial impoverishing effects in Mongolia, with the impacts being greater among households containing individuals with chronic conditions. Addressing the goal of universal health coverage (UHC) in Mongolia needs attention to the depth of coverage, especially for expenditures on outpatient care and medicines, and targeting the poor effectively.

[Racism, between representations of the 'other' and nursing practices]

The care environment, renowned for being humanistic and egalitarian, has long remained impenetrable to sociological studies. Surveys, however, reveal another side, where prejudices, unequal treatment and racism in care are expressed. Medicine is itself built on racial categories which still pervade epidemiology and genetics.

[The shift towards ambulatory care, from wishful thinking to practice]

For several years, there has been a distinct political will for the development of home care. However, this shift to ambulatory care, a source of financial savings for the health system and comfort for the patient, requires sociological debate. Notable issues for discussion are the social inequalities caused by this evolution and the role of the family in the care.

Socio-economic differences in HIV/AIDS mortality in South Africa

OBJECTIVES

To quantify socio-economic differences in the risk of HIV/AIDS mortality in South Africa for different measures of socio-economic status.

METHODS

Systematic literature search in Web of Knowledge and PubMed. Measures of relative risk (RR) were pooled separately for education, income, assets score and employment status as measures of socio-economic status, using inverse-variance weighted DerSimonian-Laird random effects meta-analyses.

RESULTS

Ten studies were eligible for inclusion comprising over 175 000 participants and 6700 deaths. For income (RR 1.55, 95% confidence interval (CI) 1.15-2.09), assets score (RR 1.63, 95% CI 1.12-2.36) and employment status (RR 1.52, 95% CI 1.21-1.92), persons of low socio-economic status had an over 50% higher risk of dying from HIV/AIDS. The RR of 1.10 for education was not significant (95% CI 0.74-1.65).

CONCLUSIONS

Future research should identify effective strategies to reduce HIV/AIDS mortality and alleviate the consequences of HIV/AIDS deaths, particularly for poorer households.