Cette thèse s’intéresse à la contribution des expositions professionnelles —chimiques, biomécaniques, et psychosociaux—tout au long de la vie dans les inégalités sociales de santé liés au vieillissement. Les trois papiers de la thèse essaient de combler les lacunes dans les connaissances sur les effets à long terme des expositions professionnelles et la contribution des expositions individuelles et conjointes dans ces inégalités. Le premier papier cherche à savoir si le niveau d’éducation atteint dans l’enfance modifie l’effet de l’exposition professionnelle aux solvants au cours de la carrière sur la fonction cognitive après 55 ans.. Nous avons trouvé que l’effet de l’exposition aux solvants sur la fonction cognitive était différent selon le niveau d’éducation.. Le deuxième papier discute les effets combinés des expositions biomécaniques et psychosociaux au cours de la vie professionnelle sur la santé physique et fonctionnelle après la retraite. Nous avons trouvé qu’une forte exposition à la fois aux risques physiques et psychosociaux au cours de la vie active est associée à une capacité fonctionnelle bien plus faible après la retraite que l’exposition à un seul type de risques. Aussi, l’effet était différent chez les hommes et chez les femmes. Le troisième papier est un papier méthodologique qui discute des alternatives aux formes longues des échelles généralement utilisées pour évaluer les expositions biomécaniques au travail. Nous avons cherché à vérifier si la question « Trouvez-vous votre travail fatiguant physiquement?» pourrait être une mesure de substitution acceptable pour évaluer des expositions détaillées.. Nous avons comparé la mesure à un item à une mesure plus complète de 38 expositions spécifiques dans huit domaines. Nous avons trouvé que la mesure à un item était plus valide chez les participants fortement exposés à des contraintes biomécaniques de travail. En somme, cette thèse a montré que les expositions professionnelles peuvent à la fois exacerber les disparités existantes en matière de santé et les perpétuer au delà de la retraite. / This dissertation focuses on how occupational exposures throughout the lifecourse—chemical, physical, and psychosocial—contribute to social patterns in aging outcomes, addressing the gap in knowledge about lasting effects of occupational exposures and the contribution of individual and combined exposures to social patterns in aging. The first paper explores whether childhood educational attainment modifies effects of occupational solvent exposure during the career on cognitive function after age 55. We found differential effects of solvent exposure on cognition by educational attainment. The second paper looks at combined physical and psychosocial exposures during working life and effects on physical health and functioning after retirement. This paper finds that high exposure to both physical and psychosocial hazards at work is associated with worse functional capacity in retirement than exposure to either one separately; the pattern of this relationship differs for men and women. The third paper is a methodology paper exploring alternatives to extensive testing batteries often used to evaluate physical workplace exposures. We tested whether the question “Do you find your work physically strenuous?” was an acceptable proxy measure for more detailed exposure assessments by comparing the measure to a comprehensive self-report measure of 38 specific biomechanical strains across eight domains. We found that the measure was most valid in the populations that were most highly exposed to physical strains at work. In general, this dissertation found that occupational exposures can exacerbate existing disparities in health and perpetuate disparities into and beyond retirement.

Within and across all societies, some people live longer and healthier lives than others. Although many of us intuitively think of health as a very important good, general theories of justice have hitherto paid little attention to its distribution. This is a thesis about what we owe to one another, as a matter of justice, in view of our unequal levels of health. The first part of the thesis addresses the problem of social justice in health. I argue that the basic institutional framework of society must be arranged so as to ensure an egalitarian distribution of the 'social bases of health,' that is, the socioeconomic conditions that shape our opportunities for a healthy life. Inequalities in health, including those caused by differences in individual lifestyles, are only fair when people have been given fair opportunities. This egalitarian approach to the social bases of health must be complemented by a sufficientarian concern for meeting all basic health needs, regardless of whether these originate in unfair social arrangements. The second part of the thesis takes up the problem of global justice in health. Although I argue against the idea that domestic principles of justice can be simply replicated on a global scale, I emphasise the fact that there are a number of international institutions and practices that shape people's opportunities for health. One of these is the state system - the division of the world into sovereign states - which I argue grounds the idea of the human right to health. I also examine two more specific examples of global practices that contribute to global inequalities in health, namely global trade in tobacco and the global labour market for healthcare workers. Both of these, I suggest, must be restricted in light of their impact on health levels worldwide.

Introdução: Dentre as várias áreas, abordagens e temas que compõem a Saúde Pública, a Promoção da Saúde constitui-se como um dos mais estabelecidos o que indica a pertinência de reflexão sobre sua produção. E dentre as linhas de pesquisa na área de Promoção da Saúde, nos últimos anos, tem se destacado o tema de Determinantes Sociais de Saúde, essa preocupação expressa por essa linha de pesquisa e atuação sobre os Determinantes Sociais de Saúde (DSS) assim como as propostas de promoção da saúde remetem necessariamente à reflexão sobre a dinâmica social visto que estão voltadas para a transformação das condições de vida. Objetivo: Esse estudo teve por objetivo identificar a produção da pesquisa em DSS na Faculdade de Saúde Pública da Universidade de São Paulo, no período de 2004 a 2008, e apontar as áreas de interesse e tendências desse campo de estudo. Metodologia: A metodologia consistiu em uma revisão bibliográfica de estudos sobre DSS, realizada a partir de um levantamento de dados baseado na consulta às seguintes bases de dados: BVS (Biblioteca Virtual em Saúde), SciELO (Scientific Electronic Library Online) e banco de tese da Capes. Os indexadores para a pesquisa foram selecionados segundo os Descritores em Ciência da Saúde (DeCS). Resultados: Dentre os diversos determinantes sociais de saúde encontrados durante a coleta de dados, os mais citados foram: inclusão social, segurança, justiça social, transporte, qualidade de vida, modelos de atenção à saúde, educação, lazer, ambiente de trabalho, equidade, distribuição de renda, recursos sustentáveis, ecossistema saudável, stress e saneamento. Deu-se preferência pelos resultados que se referiram diretamente ao tema da pesquisa sobre Determinantes Sociais de Saúde, resultados esses que foram classificados por ano, tipo de publicação: teses, dissertações, artigos de periódicos e por classificação de determinantes sociais de saúde. Conclusão: Verificou-se que a produção cientifica com Determinantes Sociais de Saúde na Faculdade de Saúde Pública USP tem crescido continuamente nesses últimos anos e que a maioria dos trabalhos está voltada para o estudo sobre as iniquidades em saúde seguido, de estudos sobre o empoderamento e a qualidade de vida / Introduction: Among the various areas, approaches and themes that compose the Public Health, Health Promotion was established as one of the most established which indicates the relevance of reflection on their production. And among the lines of research in the area of Health Promotion, in recent years has highlighted the topic of Social Determinants of Health, this concern expressed by this line of research and action on the Social Determinants of Health (SDH) as well as proposals for health promotion necessarily refer to a reflection on the social dynamics as they are geared towards the transformation of living conditions. Objective: This study aimed to identify the production of research in SDH at the School of Public Health, University of São Paulo in the period 2004 to 2008, and point out areas of interest and trends of this field of study. Methodology: The methodology involved a literature review of studies in SDH. Data collection was based on consultation with the following databases: BVS (Virtual Library in Health), SciELO (Scientific Electronic Library Online) and CAPES thesis database. The indices for the study were selected according to the Health Sciences Descriptors (DeCS). Results: Among the many social determinants of health found during the data collection, the most cited were: social inclusion, security, social justice, transportation, quality of life, models of health care, education, leisure, work environment, fairness and distribution in income, resources sustainable, healthy ecosystem, stress and sanitation. It was given preference for results that are reported directly to the research theme on Social Determinants of Health, these results were sorted by year, type of publication: theses, dissertations, journal articles and for classification of social determinants of health. Conclusion: It was found that the scientific production with the Social Determinants of Health in the School of Public Health - USP has grown steadily in recent years and that most work is directed toward the study of inequities in health, followed by studies on the empowerment and quality of life

Introdução: O Projeto Viva Seu Bairro (PVSB) foi uma iniciativa desenvolvida em seis regiões urbanas da cidade de Campo Grande MS, no período de 2001 a 2004, nas áreas de maior risco social, identificadas pelas equipes de agentes comunitários de saúde e saúde da família. O projeto teve como objetivo a redução das desigualdades sociais por meio de ações que atuaram sobre Determinantes Sociais da Saúde (DSS). Objetivo: A pesquisa buscou conhecer a relação entre o PVSB e os determinantes sociais da saúde, bem como identificar a presença da participação social e da intersetorialidade nas ações desenvolvidas. Material e Métodos: Trata-se de pesquisa de abordagem qualitativa. Foram realizadas entrevistas individuais com gestores da administração municipal e com técnicos da Unidade Técnica Central (UTC), responsável pelo gerenciamento do projeto. Seis grupos focais foram realizados, um em cada região urbana que teve a implementação da iniciativa, com representantes dos Conselhos Regionais Urbanos (CRU). Além disto, foi feita a análise de documentos relacionados ao PVSB. Para a análise dos dados, utilizou-se a análise de conteúdo, por meio da análise temática com a triangulação dos dados obtidos. Resultados: Os resultados da pesquisa apontam uma série de ações que incidiram sobre as condições materiais e psicossociais nas quais as pessoas vivem e trabalham, como proposto pelo modelo adotado nas recomendações do Relatório Final da Comissão Nacional sobre Determinantes Sociais da Saúde (2008). As mais descritas pelos participantes foram as que visaram assegurar saneamento básico, habitação adequada, emprego, serviços de saúde e de educação de qualidade. Verificou-se o protagonismo do setor saúde no desencadeamento da iniciativa. Conclusões: A participação social foi fortalecida na cidade durante e após a iniciativa. Quanto à intersetorialidade, houve a busca por parcerias e o reconhecimento, por parte dos representantes de governo, da necessidade de se implementar redes sociais, o que, no entanto, não se institucionalizou como práticas da administração municipal. A discussão sobre a sustentabilidade ocorreu de modo insuficiente e a avaliação da iniciativa começou um ano e meio após o seu início, o que comprometeu a avaliação de processo. Os participantes da pesquisa reconheceram que o PVSB interferiu na melhoria da qualidade de vida da população local. Conclui-se que o PVSB configurou-se como iniciativa do campo da promoção da saúde, atuou sobre os DSS, fortaleceu os mecanismos de participação nos CRU e buscou mecanismos de ação intersetorial / Introduction - The Project \"Viva Seu Bairro\" (PVSB) was an initiative developed in six urban regions of the city of Campo Grande - MS, from 2001 until 2004, in the areas of greater social risk, identified by the teams of community health and family health agents. The project had as its aim to reduce the social inequalities through actions, which acted on the Social Determinants of Health (SHD). Objective - The research tried to know the relation between PVSB and the Social Determinants of Health, as well as to identify the presence of the social participation and the intersectoriality in the developed actions. Material and Methods - It is about a research of qualitative approach. Individual interviews were performed with managers of the municipal administration and with technicians from Central Technical Unity, responsible for the project administration. Six focal groups were carried out, one in each urban region that had the initiative implementation, with representatives from the Urban Regional Councils. Moreover, an analysis of the documents related to PVSB was done. The Content Analysis was used for the analysis of the data through the thematic analysis and then the triangulation of the obtained data. Results - The results of the research point out a series of actions that occurred to the material and psychosocial conditions in which the people lived and worked, as proposed by the model adopted in the recommendations of the Final Report of the National Commission on Social Determinants of Health (2008). The items most described by the participants were the ones that targeted to assure basic sanitation, appropriate dwelling, employment, health and education services of quality. It was verified the prognostic of the health sector in the breaking of the initiative. Conclusions - The social participation was strengthened in the city during and after the initiative. In relation to the intersectoriality, there was a search for partnerships and the recognition, from the government representatives, of the necessity to implement social nets, which however, was not institutionalized as a practice in the municipal administration. The discussion about the sustainability occurred in an insufficient way and the initiative evaluation started one year and a half after its beginning, which compromised the process of evaluation. The research participants recognized that PVSB interfered in the improvement of the local population life quality. It was concluded that PVSB configured as an initiative in the field of health promotion, acted on SHD, strengthened the mechanisms of participation in the CRU and looked for mechanisms of intersectorial action.

Official-language minorities in Canada may face specific issues in accessing health care services that can lead to negative consequences on their health, utilization of health care services and satisfaction with the health care system. A secondary data analysis of the 2006 Survey on the Vitality of Official-Language Minorities revealed significant differences between the Anglophone minority (n=5,161) and the Francophone minority (n=12,029) with regards to general health, and access to and use of health care services. Important predictors of these outcomes included age, education level, household income, marital status and place of residence (urban/rural). Access to health care services in the minority language was associated with self-perceived health in the Anglophone minority only. Health policy recommendations elaborated in light of the findings include working on both the supply and the demand of health care services offered in the two official languages, while taking into consideration important contextual differences between regions.

Although evidence of health inequities abound, why people in lower socio-economic classes have poorer health has not been sufficiently explored. The purpose of this study is to examine day labourers’ pathways to health inequities in a segregated, urban district in Japan. Critical ethnography was employed to investigate day labourers’ social environments and cultural behaviours in order to reveal the ways that social inequalities embedded in mainstream society and the day labourers’ sub-culture produce and sustain day labourers’ disadvantages, leading them into poorer health than the average population. Data were collected through observations of day labourer’s daily activities, events within the district and their interactions with social workers at a hospital. In addition, interviews were conducted with 16 day labourers and 11 professionals and advocates. The study found several components in the pathways to health inequities of day labourers. First, certain people in Japan are ostracized from the social, economic and political mainstream due to an inability to enact traditional Japanese labour practices. Commonly such exclusions make men become day labourers to survive. In a day labourer district, they are exposed to further social inequalities embedded in the work system and their living circumstance. Living and working as a member of the day labour community, they develop collective strategies in order to survive and preserve their social identities as day labourers. However, such strategies do not provide people with opportunities to lead healthy lives. The study also identified several social determinants of health for day labourers, including: 1) employment, 2) working conditions, 3) temporary living, 4) housing quality, 5) social networks and support, 6) marginalized neighbourhood, 7) access to health care, and 8) gender. The findings contribute to a better understanding of social construction of health inequities, which provides insight on the impact of precarious work in the Japanese society at large. Implications of these findings for public health policy and practice are also discussed.

The impact of global economic policies on health equity and social development has been well-documented and, in the current phase of economic globalization, profound health inequities have been attributed to these policies. In response to these inequitable trade conditions, which are especially pronounced in the trade of boom-and-bust commodities like coffee, alternative trade models such as Fair Trade have proliferated. Although there is great potential for these alternative economic policies to achieve health and gender equity, these considerations have largely been left out of existing analyses, which focus on gender-blind economic, organizational, and environmental indicators. <p>To address these omissions, this study explores the experiences, perceptions, and aspirations of an organized group of coffee-producing women with regards to Fair Trade. The study was conducted in Northern Nicaragua in 2009 and focuses on the experiences of women supported by a local feminist organization, la Fundación Entre Mujeres, in an embedded, single case study design. It is informed by participant-observation, interviews, and dialogic focus groups. The study situates participants perceptions and aspirations in a globalization and health framework as well as an empowerment framework. Considered in this light, womens experiences provide valuable insights about the perceived and potential health and gender impacts of alternative models of trade and provide a vision for the future directions of these models. <p>The womens experiences reveal that although valuable benefits are being experienced as a result of participation in Fair Trade especially in terms of a higher income and a commitment to organic agriculture there are lingering doubts as to whether Fair Trade is actually "fair" or simply "better". The women supported by la Fundación Entre Mujeres aspire to more equitable trade characterized by solidarity, justice, a focus on womens rights, and a fairer valuation and recognition of womens efforts inside and outside of coffee. In order to move towards this "fair" system of trade, the current Fair Trade model must become more oriented towards equitable control for all of its stakeholders and must broaden its definition of empowerment so as to more actively and vocally participate in the broader contexts of international trade that are influencing health and gender equity for women around the world.

Aboriginal Head Start Urban and Northern Communities (AHSUNC) Initiative in Ontario provides an early childhood development program specifically for urban Aboriginal children between 3 and 5 years old. Twenty-nine families from Waabinong Head Start in Sault Ste Marie, Ontario, completed two questionnaires given four months apart covering a range of health and education topics. The completed surveys supported a trend toward healthier lifestyle choices, improved education of the children, upward mobility in employment, increases in self-perceived general and mental health of primary and second caregivers, and decreases in smoking, illegal drug use, and alcohol use. Families reported an increased sense of pride in being Aboriginal shown by their children, plus learning of culture and Ojibwe language, which has lead to improvement in all of the child’s skills and abilities.

Aboriginal Head Start Urban and Northern Communities (AHSUNC) Initiative in Ontario provides an early childhood development program specifically for urban Aboriginal children between 3 and 5 years old. Twenty-nine families from Waabinong Head Start in Sault Ste Marie, Ontario, completed two questionnaires given four months apart covering a range of health and education topics. The completed surveys supported a trend toward healthier lifestyle choices, improved education of the children, upward mobility in employment, increases in self-perceived general and mental health of primary and second caregivers, and decreases in smoking, illegal drug use, and alcohol use. Families reported an increased sense of pride in being Aboriginal shown by their children, plus learning of culture and Ojibwe language, which has lead to improvement in all of the child’s skills and abilities.

Although evidence of health inequities abound, why people in lower socio-economic classes have poorer health has not been sufficiently explored. The purpose of this study is to examine day labourers’ pathways to health inequities in a segregated, urban district in Japan. Critical ethnography was employed to investigate day labourers’ social environments and cultural behaviours in order to reveal the ways that social inequalities embedded in mainstream society and the day labourers’ sub-culture produce and sustain day labourers’ disadvantages, leading them into poorer health than the average population. Data were collected through observations of day labourer’s daily activities, events within the district and their interactions with social workers at a hospital. In addition, interviews were conducted with 16 day labourers and 11 professionals and advocates. The study found several components in the pathways to health inequities of day labourers. First, certain people in Japan are ostracized from the social, economic and political mainstream due to an inability to enact traditional Japanese labour practices. Commonly such exclusions make men become day labourers to survive. In a day labourer district, they are exposed to further social inequalities embedded in the work system and their living circumstance. Living and working as a member of the day labour community, they develop collective strategies in order to survive and preserve their social identities as day labourers. However, such strategies do not provide people with opportunities to lead healthy lives. The study also identified several social determinants of health for day labourers, including: 1) employment, 2) working conditions, 3) temporary living, 4) housing quality, 5) social networks and support, 6) marginalized neighbourhood, 7) access to health care, and 8) gender. The findings contribute to a better understanding of social construction of health inequities, which provides insight on the impact of precarious work in the Japanese society at large. Implications of these findings for public health policy and practice are also discussed.