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Lien social et santé en situation de précarité : état de santé, recours aux soins, abus d'alcool et réseau relationnel parmi les usagers des services d'aide

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  • Patrick Peretti-Watel

Abstract

[fre] Les usagers des services d'hébergement ou de distribution de repas chauds constituent une population très particulière, qui cumule précarité et problèmes de santé. Les contacts avec la famille, les proches et les connaissances sont caractérisés par un cumul et non une différenciation des relations interpersonnelles. On peut distinguer les enquêtés selon que ces contacts sont fréquents ou non, quel que soit le lien de parenté éventuel entre la personne interrogée et les proches. Une relation significative apparaît entre ce cumul et la santé perçue : ceux qui ont des contacts plus fréquents avec leurs proches se jugent plus souvent en bonne ou en très bonne santé. En présence d'une pathologie chronique ou grave, ces contacts pourraient jouer le rôle de facteurs protecteurs contre le risque de dépression et qu'à ce titre, ce soit l'absence relative de contacts avec les proches et non l'absence de proches à contacter qui soit la plus préjudiciable pour la personne malade, ce qui suggère qu'il faille privilégier une interprétation faisant intervenir l'influence des rapports avec les proches sur la construction de l'identité personnelle et l'estime de soi. Un autre aspect de la relation entre santé et lien social renvoie au recours aux soins, étudié ici dans le cas particulier des soins dentaires : l'isolement relationnel s'avère en effet significativement associé à un moindre recours à ces soins. Toutefois, si le lien fréquemment exploré dans la littérature entre lien social et santé s'avère ici globalement vérifié, il convient d'y apporter une nuance. En effet, s'il est très plausible que les liens interpersonnels aient une influence bénéfique sur la santé, il importe de souligner qu'ils ne constituent pas la panacée. Ici, seule la quantité des contacts a été mesurée, et non leur qualité : or, des contacts fréquents ne sont pas forcément de « bons » contacts, et peuvent éventuellement devenir le vecteur de contraintes et de violences. [eng] The users of homeless shelters or hot meal distribution services represent a very specifi c population, experiencing both precarious situations and health problems. Their contacts with family, close friends and acquaintances are very similar, with no differentiation between the different relationships. The respondents can be separated into groups according to whether their social contact is regular or not, whoever this is with. There is a signifi cant link between this contact and perceived health: those who have more regular contact with their close family and friends are more likely to state that they are in good or very good health. More specifi cally, in the case of a chronic or serious illness, contact with close family or friends can protect against the risk of depression; therefore, it is the relative lack of contact with close friends and family, and not the lack of close friends and family to contact, which is the most harmful for the ill person. This suggests that it is important to incorporate the infl uence of relationships with close family and friends into the study of the construction of personal identity and self-esteem. Another aspect of the link between health and social contact concerns the use of health care provisions, and in the particular case of this study, of dental care services: social isolation appears to be signifi cantly associated with a lower use of these services. However, even if the regularly explored link between social contact and health is here globally proved, and it remains very plausible that interpersonal relationships have a benefi cial effect on health, it is also important to highlight that they are not a cure-all. Only the quantity of social contact was measured in this study, and not their quality: regular contact is not necessarily •good” contact, and can possibly result in subjection and violence. Social Contact and Health of the Homeless. . State of Health, Health-Care Use, Alcohol Abuse and Relationships of the Users of Homeless Support Services [spa] Relación social y salud en situación de precariedad . Estado de salud, solicitud de tratamientos médicos, abuso de alcohol y red de relaciones entre los usuarios de los servicios de ayuda. Los usuarios de servicios de albergue o distribución de comida caliente constituyen una población muy particular, que reúne precariedad y problemas sanitarios. El contacto con la familia, los parientes y conocidos se caracteriza por un cúmulo y no por una diferenciación de relaciones interpersonales. Se puede distinguir a los encuestados según que sus contactos sean frecuentes o no, sin importancia de los vínculos de parentesco entre la persona interrogada y los allegados. Aparece una relación signifi cativa entre este cúmulo y el estado de salud: los que mantienen más frecuencia de contacto con sus parientes tienen a menudo una buena o muy buena salud. Más específi camente, parece que en presencia de una patología crónica o grave estos contactos constituyen factores protectores contra el riesgo de depresión y en este orden, la ausencia relativa de contacto con los allegados y no la ausencia de allegados que contactar sería mas perjudicial para la persona enferma, lo que sugiere la necesidad de una interpretación que haga intervenir la infl uencia de las relaciones con los parientes para edifi car la identidad personal y la autoestima. Otro aspecto de la relación entre salud y relación social es la solicitud de tratamientos médicos, estudiada aquí en el caso particular de tratamientos dentales: el aislamiento relacional se ve asociado signifi cativamente, en efecto, a una menor demanda de estos tratamientos. Sin embargo, si el vínculo frecuentemente explorado en la literatura entre relación social y salud se ve aquí globalmente verifi cado, debe matizarse. En efecto, si es muy plausible que las relaciones interpersonales tengan una infl uencia benéfi ca sobre la salud, es importante señalar que no constituyen la panacea. Aquí, sólo se ha medido la cantidad de los contactos y no su calidad, pero los contactos frecuentes no son necesariamente «buenos” contactos pudiendo ocasionalmente convertirse en vector de presiones y violencia. [ger] Soziale Beziehungen und Gesundheit im Falle von Prekarität . Gesundheitszustand, Inanspruchnahme medizinischer Behandlung, Alkoholmissbrauch und Netz persönlicher Beziehungen der Nutzer von Hilfsdiensten. Die Nutzer von Obdachlosenheimen oder Suppenküchen bilden eine sehr besondere Population, bei der Prekarität und gesundheitliche Probleme zusammenkommen. Die Kontakte zu der Familie, den Verwandten und Bekannten sind eine Kumulierung und keine Differenzierung der zwischenmenschlichen Beziehungen. Die Befragten können nach der Häufi gkeit dieser Kontakte unterschieden werden, unabhängig vom etwaigen Verwandtschaftsgrad zwischen Befragten und Verwandten. Eine signifi kante Beziehung besteht zwischen dieser Kumulierung und der gefühlten Krankheit: Diejenigen, die mehr Kontakte zu ihren Verwandten haben, betrachten sich häufi ger als gesund oder sehr gesund. Es scheint, dass im Falle einer chronischen oder schweren Krankheit diese Kontakte als Schutz vor Depressionen dienen könnten und dass in dieser Hinsicht das relative Fehlen von Kontakten zu Verwandten und nicht das Fehlen von Verwandten, an die man sich wenden kann, für den Kranken am schädlichsten ist; mithin liegt eine Interpretation nahe, der zufolge die Beziehungen zu den Verwandten die Herausbildung der persönlichen Identität und die Selbstachtung beeinfl ussen. Ein anderer Aspekt der Beziehungen zwischen Gesundheit und sozialen Beziehungen betrifft die Inanspruchnahme medizinischer Behandlung, die hier im besonderen Falle der Zahnbehandlung untersucht wird: Zwischen persönlicher Isolierung und Vernachlässigung dieser Behandlung besteht in der Tat ein signifi kanter Zusammenhang. Die in der Fachliteratur häufi g analysierte Beziehung zwischen sozialen Banden und Gesundheit erweist sich hier generell als zutreffend, muss aber nuanciert werden. Denn es ist überaus plausibel, dass sich die zwischenmenschlichen Beziehungen positiv auf die Gesundheit auswirken; festzuhalten ist aber auch, dass diese kein Patentrezept darstellen. Hier wurde lediglich die Quantität der Kontakte und nicht deren Qualität gemessen: häufi ge Kontakte sind aber nicht unbedingt «gute» Kontakte und können ggf. zu einem Vektor von Zwang und Gewalttätigkeit werden.

Suggested Citation

  • Patrick Peretti-Watel, 2006. "Lien social et santé en situation de précarité : état de santé, recours aux soins, abus d'alcool et réseau relationnel parmi les usagers des services d'aide," Économie et Statistique, Programme National Persée, vol. 391(1), pages 115-130.
  • Handle: RePEc:prs:ecstat:estat_0336-1454_2006_num_391_1_7156
    DOI: 10.3406/estat.2006.7156
    Note: DOI:10.3406/estat.2006.7156
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