The research project, conceptualized through a comparative historical framework, focuses on an analysis of American and English education policy from 1964 to 2000 with particular emphasis on the inter-relationships between education policy and socio-economic disadvantage. Although the focus of the project is primarily the last four decades of the twentieth century, there is an initial consideration of immediate post-war discourses on poverty and education focusing on the impact that these had upon educational structures and curricula. Critical theory, particularly as conceptualized by Jürgen Habermas, and the Culture of Poverty thesis advanced by Oscar Lewis, form the methodological frameworks that underpin the research project. The research, which was conducted in two post-industrial communities with significant rates of socio-economic deprivation and records of poor educational attainment within secondary education, considers the impact of national policy upon the communities, particularly in relationship to socio-economic deprivation, access to education, equality of opportunity and equality of outcomes. The research design utilises the case study method to scrutinise two secondary schools within these communities as a means of analysing how teachers negotiated the implementation of education policies for their respective student populations. Documentary evidence and oral histories provide the methods to delve into this interconnection between education and socio-economic deprivation while modified Skinnerian and Eastonian frameworks provide the foundations upon which to analyse the data. The dissertation is not meant to trace the history of two schools and two communities but to see the schools and communities as a microcosm of American and English secondary education. The intention, therefore, is to employ the research findings to prescribe potential and future policy directions. Essentially, tracing educational history to understand it while utilising educational history as a tool to inform new and innovative policy where education can ameliorate socio-economic deprivation in each nation.

Contexte : Les inégalités sociales de santé représentent un problème de santé publique considérable. Dans le cadre du cancer du sein, la précarité est associée au pronostic. En effet, une relation entre précarité géographique et stade au diagnostic a été établie dans la littérature. Cependant, à ce jour, aucune étude n'a encore analysé l'association de ce dernier à la précarité individuelle.Objectifs : Les objectifs de ce travail de recherche sont (1) d'estimer le risque de cancer du sein de stade avancé associé à la précarité individuelle, (2) d'étudier l'impact des facteurs pouvant modifier ce risque, (3) d'évaluer la robustesse de l'association face au choix de la mesure de précarité.Population et méthode : Les données sont issues d'une étude cas-témoins. Les Cas et les Témoins de l'étude ont été recrutés parmi les patientes de l'Hérault atteintes de cancers du sein invasifs diagnostiqués entre 2011 et 2012. Les Cas correspondent aux patientes présentant un cancer du sein de mauvais pronostic (taille de tumeur supérieure à 5cm, ou atteinte ganglionnaire ou atteinte métastatique) et les Témoins aux patientes présentant des cancers de bon pronostic (taille de tumeur inférieure à 5cm et aucune atteinte ganglionnaire et aucune atteinte métastatique). Au total 604 patientes ont été incluses : 173 Cas et 431 Témoins. L'exposition à la précarité a été recueillie par un questionnaire standardisé.Résultats : Les patientes précaires ont, toutes variables égales par ailleurs, 2 fois plus de risque d'avoir un cancer de stade avancé comparée aux patientes non précaires. La précarité n'est associée à aucun autre facteur biologique (grade SBR, types histologique et moléculaire). Chez les patientes asymptomatiques (diagnostiquées suite à un dépistage) les patientes précaires ont plus de risque d'avoir des cancers de stade avancé. Chez les femmes avec un antécédent familial de cancer du sein tout comme chez les femmes vivant dans une zone géographique favorisée, les patientes précaires et non-précaires ont le même risque de cancer de stade avancé. Comparé aux autres mesures de l'environnement socio-économique (classe sociale, précarité géographique…), le score EPICES semble la méthode de mesure la plus adaptée pour étudier l'association entre précarité et stade au diagnostic.Conclusion : Nos résultats suggèrent que les écarts observés entre les patientes précaires et les patientes non-précaire semblent être plutôt liés à retard au diagnostic plutôt qu'à des différences biologiques entre les tumeurs. Ce retard au diagnostic semble dépendre de composantes individuelles mais aussi collectives. De plus, une meilleure connaissance du cancer du sein pourrait permettre de réduire les barrières supplémentaires vécues par les précaires. / Context: Socio-economic inequalities in health represent a significant public health problem. In the breast cancer context, socio-economic deprivation is associated with prognosis. Indeed, a relationship between area-based deprivation and diagnostic stages was already described in the international literature. However, the association between individual deprivation and diagnostic stages was not study so far.Objectives: Our aim was to (1) estimate the risk of advanced breast cancer associated with individual socio-economic deprivation, (2) study the impact of modifying factors, (3) evaluate the strength of this association according to the method used to measure deprivation.Population and methods: Data were collected from a Case-Control study. Cases and Controls were recruited among invasive breast cancer patients diagnosed between 2011 and 2012 in the Hérault. Cases were defined as patients with poor prognosis breast cancer (with tumor size over 5cm, or with lymph node involvement, or with metastasis). Controls were defined as patients with good prognosis breast cancer (with tumor size under 5cm, and without lymph node involvement, and without metastasis). A total number of 604 patients were included: 173 Cases and 431 Controls. The exposition to deprivation was measured by a standardized questionnaire.Results: Deprived patients, with all other variables remaining constant, have a two-fold risk of having advanced breast cancer compared to non-deprived patients. Deprivation was not associated with the other biological factors (SBR grade, histologic and molecular type). Among asymptomatic patients (diagnosed after a mammographic screening), deprived patients have a higher risk of advanced breast cancer. Among women with family history of breast cancer so as women living in affluent geographic areas, deprived and non-deprived patients have the same risk of advanced breast cancer. Compared to other measures of socio-economic environment (social class, area-based deprivation…), EPICES score seems to be the most adapted method to study the association between deprivation and breast cancer diagnostic stages.Conclusion: Our results suggest that the gap observed between deprived and non-deprived patients seem to be associated with delayed diagnosis more than biological differences between tumors. This delayed diagnosis seems depend on individual and geographic components. Moreover, a better knowledge of breast cancer could allow a reduction of the barrier experienced by deprived women.