Aske Egsgaard (p), Cecilie Dohlmann Weatherall

Pascal Pochet

This paper sets out to explore how the death of a spouse or partner and the transition into widowhood affects their sequential residential mobility. The loss of a partner has been shown to be associated with changes in several outcomes for the surviving partner, such as changes in psychological health and changes in economic resources but has not yet been linked to residential mobility and changes in housing demand. As the elderly population increases in the western world over the next couple decades we can expect this to be even more widespread, which could affect the housing demand in the future.
By use detailed administrative micro data on hospital admissions and cause of death from 1994 to 2012 combined with data on all households, including socioeconomic background, place of residence, family members etc., we create an extended panel dataset for all people in Denmark between 30 and 80 years old from 1980 and 2016. By using a complementary log-log duration model we can monitor changes in people hazard ratio to move. We find that people who have lost a partner within the past 4 year are significant more likely to move compared to couples where both partners are still alive. Furthermore, we find that this is even more so the case for women than for men. We also find that women with adult children living elsewhere have are even more likely to move, but that adult children living elsewhere don’t seem to affect men in a significant degree.

Pierrine Didier (p)

Pascal Pochet

In Madagascar, a large majority of population lives in rural areas where access to conventional health care is very difficult, due to several economic, political and geographical factors. Clinics and public hospitals, with doctors and medical material, are located in main cities. In rural areas, we find some dispensaries hold by health workers, like nurses and midwife. Medical material is usually very limited in those places.
Based on a fieldwork in Madagascar, I will present the ethnographical observations of villagers' quest for care, in a 600 inhabitants village (Rantolava) on the east coast, in the Analanjirofo region.
Rantolava is located 20 km north from the closest 15 000 inhabitants' city, where is located the closest small hospital, and is reachable by a 3 km track from the paved road. It is distant from 100 km from the closest city (200 000 inhabitants) reachable by a 4 hours drive, which counts the only regional hospital center. Villagers of Rantolava mainly live from fishing, farming and rice growing. Only one villager owns a car he uses for his grocery shop supplies. Some others own scooters and bikes. The majority of villagers walk from the village to the paved road where they can wait for a taxi brousse (bus), to go in town. The round-trip fee corresponds to the equivalent of a daily wage of working in fields.
In case of urgent need for care, no villagers can afford to pay for the ambulance fee from the next hospital, and no taxis reach the countrysides. To transport sick people, some villagers use stretchers they have built with bamboo sticks and canvas rice bags. A french resident who lives from time to time in a closed village, and owns a car, used to rent it to transport villagers to the hospital. A majority of people in Madagascar still uses traditional medicines and consults traditional healers, present in every villages. This local therapeutic offer is largely in use and can respond to people's care needs when no other offer is easily available.
Quality of care is unequal regarding location (rural vs. urban areas) as they are conditioned by available qualified health workers, medical equipment and pharmaceuticals. Social inequalities in health care are directly linked, in the case of rural areas in Madagascar, to territories and available transportation within these territories. Mobility is a constraint to choices villagers make in their search for health care.

Pauline Iosti (p)

Pascal Pochet

Since the Alma-Ata conference in 1978, primary health care has been determined to be the main organizational principle of all health care provision systems, because it allows a greater equity and accessibility to health care. Community-based primary health care are organized on a proximity basis, that allows health professionals to identify and specifically respond to local health needs. Based on this assumption, Brazil created in 1994 the Estrategia de Saúde da Família (Family Health Strategy - FHS). This program is organized on a territorial basis, which means that multidisciplinary medical teams are responsible for a population of about 1500 families, according to their place of residence. This program and its impact on health has been widely studied since its creation. Nevertheless, little has been said on the precise definition of proximity used in the FHS or on its impact on the users’ accessibility to health care and satisfaction. The goal of this contribution will be to question the definition, the extent and the benefits of proximity as an organizational principle of community-based primary care in Brazil.
The data was collected in São Paulo between October 2017 and May 2018, using a qualitative methodology (observations, interviews with about 20 administrative and health care professionals and 80 users). Two FHS facilities have been studied, with various territorial and social profile.
The results show that the use of proximity as an organizational principle of primary care refers in reality to three different types of proximity: a geographical, an organized and a relational one. Each of these definitions involve different actors and scales of action. Their impact on declared access to health care depends on the individual, social and health profile of the population. Proximity appears as a benefit mostly to elderly people or to people with a chronic disease, who need a regular and continuous care. For the rest of the population, the results are nuanced: if relational proximity is valued, territorialisation of health care was reported by some interviewees as a factor of unsatisfaction.
As a conclusion, these results do not question proximity itself as an organizing principle of primary care and as a potential benefit for populations’ health and access to health care, but it does question the choice of a territorial approach of this proximity.