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Maladie subie, maladie dominee, industrialisation et technologie medicale: Le cas de la tuberculose

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  • Thebaud, Annie
  • Lert, France
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    Abstract

    Résumé Ce texte présente la synthèse de travaux de recherches menées en France et en Algérie par A. Thebaud et F. Lert sur la tuberculose et l'application du traitement anti-tuberculeux. La tuberculose constitue un des meilleurs indicateurs sanitaires de l'inégalité sociale. Cette maladie est prise ici comme modèle des rapports entre industrialisation et santé, en ce qui concerne l'évolution du modèle épidémiologique et l'influence de la chimiothérapie comme innovation thérapeutique dans l'organisation des soins aux tuberculeux, en référence aux transformations socio-économiques et culturelles de la société française et de la sociéte algérienne au cours du XXe Siècle. Dans la première partie, l'article montre comment l'épidemiologie de la tuberculose tend à se différencier en fonction de l'evolution dynamique des rapports sociaux au cours du processus d'industrialisation dans chaque pays tandis que les tendances épidémiologiques mondiales constituent un des meilleurs indicateurs sanitaires de l'inégalité des rapports nord-sud. La deuxième partie du texte est consacrée à l'étude des conditions d'application du traitement antituberculeux en France, d'une part, en Algérie, d'autre part, en fonction de l'organisation du système de soins dans chaque pays, de la place et du pouvoir médical au sein de la sociéte, et de l'impact de l'innovation technologique sur l'évolution des formes de prise en charge des malades tuberculeux dans chacun des deux pays. En France, on observe que l'organisation du système antituberculeux mise en place entre les deux guerres tend à persister sans changement en dépit des possibilités de restructuration de la lutte antituberculeuse et d'allègemment des normes de traitement, liées à la baisse d'incidence de la maladie et à l'introduction du traitement antibiotique. Cette résistance semble due principalement aux difficultés de reconversion des personnels de santé et à l'inertie de l'organisation très structurée de la lutte anti-tuberculeuse au sein du système socio-sanitaire français. En revanche, en Algérie, dans un pays où le système de santé est en formation, l'appropriation sociale des progrès les plus récents en matière de lutte anti-tuberculeuse est rendue possible grâce à l'espace social laissé ouvert--mais pour combien de temps?--à une organisation des soins fondée sur une volonté d'adéquation des résponses de l'institution sanitaire aux besoins des malades. La comparaison des deux situations permet de mettre en évidence les rapports de pouvoir qui président aux choix de politique de santé et d'organisation des soins au sein de sociétés différentes, liées cependant, l'une par rapport à l'autre, par 130 ans d'occupation coloniale française en Algérie et l'influence historique du modèle médical français sur l'organistion sociale de la médecine dans ce pays. This article presents an overview of the research work undertaken in France and Algeria on tuberculosis and the application of tuberculosis treatments. Tuberculosis is one of the best medical pointers to social inequality. The disease is seen here as typical of the links between industrialization and health, with regard to the evolution of the epidemiological model and the influence of innovatory treatments, based on chemotherapy, on the organization of care for tubercular patients, together with the socio-economic and cultural changes that have affected both French and Algerian society during the twentieth century. The first part of the article shows how the epidemiology of tuberculosis tends to vary in accordance with the dynamic evolution of social relationships as industrialization occurs in each country, and how world-wide epidemiological trends are one of the best medical pointers to the North-South divide. The second part of the article is given over to a study of the way in which the application of tuberculosis treatments in both France and Algeria is a function of the organization of the health system in each country, of the status and power of the medical profession within society, and of the impact of technical innovations on the changing forms of care for tubercular patients in both countries. In France, it can be seen that the structure of the system set up to combat tuberculosis in the inter-war years has tended to remain unchanged, despite the opportunities for re-organization of tuberculosis treatment and for making therapy less onerous which have arisen as the incidence of the disease has dropped and antibiotics have been introduced. This resistance to change seems due primarily to the difficulty of achieving redeployment of medical staff, and the inertia caused by the rigid structure of tuberculosis care within the French socio-medical system. On the other hand, in Algeria, a country where the health service is still in the process of taking shape, acceptance by society of the most recent progress in the fight against tuberculosis by the social space left open for an organization of treatments based on a real desire to match the responses of medical institutions to the needs of patients, though one wonders how long this state of affairs will last. Comparison of the situation in the two countries highlights the power relationships that control health policy decision-making and the organization of health care in two differing societies, which are nonetheless linked to each other by 130 years of French colonial presence in Algeria and the historical influence of the French medical pattern on the social organization of medicine in that country.

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    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 21 (1985)
    Issue (Month): 2 (January)
    Pages: 129-137

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    Handle: RePEc:eee:socmed:v:21:y:1985:i:2:p:129-137

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