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Les technologies numériques en santé face aux inégalités sociales et territoriales : une sociologie de l’action publique comparée

Abstract : The link between digital health and equity is seldom studied, even less are the policies which tackle both issues, and this despite governments being urged to implement health-and-equity-in-all-policies strategies. This thesis has studied whether and how governments and health systems’ stakeholders address this linkage. Specifically, this piece of population health interventional and political science research has been based upon a qualitative study design and comparative public policy analysis of territories from four countries (France, Canada, Spain & England) since 2015. Data were gathered from official and various stakeholders’ documents and through interviews with key stakeholders in e-health and health equity fields. Digital health policy has been institutionalized to varying degrees in the four so-called developed countries focussed on. However, equity in digital health issue has not been placed on the political agenda, although it is acknowledged that digital health use can increase social health inequalities (SHI), in terms of unfair access, use, understanding and adoption of technologies. In the four territories, when (rarely) dealt with, digital inclusion is tackled through a set of instruments, by actors involved in several fora which coproduce public interventions on digital health, SHI and digital inclusion. Each mode of instrumentation of public action is affected by previous local institutions, along with actors’ interests and preconceptions about the issues involved. Our study proposes a conceptual framework for public action and policy implementation as regards digital health and equity in four territories. This study has been designed to be useful for analyzing policies in other settings and for suggesting strategies that could be directly implemented in the field.
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Submitted on : Friday, October 9, 2020 - 7:16:07 PM
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Viviane Ramel. Les technologies numériques en santé face aux inégalités sociales et territoriales : une sociologie de l’action publique comparée. Médecine humaine et pathologie. Université de Bordeaux, 2020. Français. ⟨NNT : 2020BORD0053⟩. ⟨tel-02963193⟩

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