{"id":6547,"date":"2024-04-01T10:48:00","date_gmt":"2024-04-01T10:48:00","guid":{"rendered":"http:\/\/nccdh.local\/resource\/keeping-it-political-and-powerful-defining-the-structural-determinants-of-health\/"},"modified":"2025-11-06T17:15:15","modified_gmt":"2025-11-06T17:15:15","slug":"keeping-it-political-and-powerful-defining-the-structural-determinants-of-health","status":"publish","type":"resource","link":"https:\/\/nccdh-dev.media-doc.ca\/fr\/resources\/entry\/keeping-it-political-and-powerful-defining-the-structural-determinants-of-health\/","title":{"rendered":"Keeping it political and powerful: Defining the structural determinants of health"},"content":{"rendered":"<p><em>Cette ressource est disponible en anglais seulement.<\/em><\/p>\n<p>Cet article soutient que la d&eacute;politisation du concept de d&eacute;terminants sociaux de la sant&eacute; s&rsquo;explique par une perception g&eacute;n&eacute;ralis&eacute;e qui le cantonne uniquement aux conditions communautaires et le d&eacute;connecte du changement structural.<\/p>\n<p>Pour corriger la situation, les auteurs ont fait &eacute;tat de la n&eacute;cessit&eacute; de proposer une d&eacute;finition &eacute;pur&eacute;e, nette et pratique des d&eacute;terminants structuraux de la sant&eacute;. Ils ont mis au point cette d&eacute;finition &agrave; partir d&rsquo;un examen de th&eacute;ories sociales et politiques.<\/p>\n<h3>Red&eacute;finir les d&eacute;terminants structuraux<\/h3>\n<p>Leur d&eacute;finition des d&eacute;terminants structuraux de la sant&eacute; est bipartite :<\/p>\n<ol>\n<li>les r&egrave;gles &eacute;crites et non &eacute;crites qui cr&eacute;ent, maintiennent ou &eacute;liminent des sch&eacute;mas durables et hi&eacute;rarchiques d&rsquo;avantages au sein de groupes de nature sociale, qui nuisent &agrave; la sant&eacute;;<\/li>\n<li>la manifestation de rapports de force qui font en sorte que des personnes et des groupes d&eacute;tenant plus de pouvoir selon les structures sociales actuelles fonctionne &mdash; de fa&ccedil;on implicite et explicite &mdash; de mani&egrave;re &agrave; ce qu&rsquo;ils conservent leurs avantages gr&acirc;ce &agrave; un renforcement ou &agrave; la modification de ces r&egrave;gles (p. 1).<\/li>\n<\/ol>\n<h3>Cerner les d&eacute;terminants structuraux<\/h3>\n<p>Les auteurs dressent aussi une liste suivante des principaux d&eacute;terminants structuraux de la sant&eacute; et les d&eacute;finissent :<\/p>\n<ul>\n<li>valeurs, croyances, visions du monde, culture et normes;<\/li>\n<li>gouvernance;<\/li>\n<li>lois, politiques, r&egrave;glements et budgets;<\/li>\n<li>pratiques institutionnelles (p. 7).<\/li>\n<\/ul>\n<p>Ils font remarquer que &laquo; les d&eacute;terminants structuraux de la sant&eacute; ench&acirc;ssent et codifient le racisme structurel, la supr&eacute;matie blanche, le capitalisme n&eacute;olib&eacute;ral, la cis h&eacute;t&eacute;ronormativit&eacute; et d&rsquo;autres formes d&rsquo;oppression et d&rsquo;alt&eacute;rit&eacute; &raquo; [traduction] (p. 7). Par ailleurs, le racisme structurel est un autre type de d&eacute;terminant structurel de la sant&eacute; &eacute;tabli par des visions du monde, des croyances, des lois, des pratiques dominantes, entre autres, dans lesquelles il est perceptible.<\/p>\n<p>Les auteurs esp&egrave;rent que &laquo; cette d&eacute;finition th&eacute;orique des d&eacute;terminants structuraux peut favoriser une analyse concert&eacute;e des causes profondes des iniquit&eacute;s en sant&eacute; et l&rsquo;adoption du r&ocirc;le de la sant&eacute; publique dans le basculement des rapports de force et l&rsquo;engagement politique &raquo; [traduction] (p. 1).<\/p>\n<h3>Utilisez cette ressource pour<\/h3>\n<ul>\n<li>Renforcer la compr&eacute;hension des d&eacute;terminants structuraux de la sant&eacute; et leur lien avec le pouvoir et l&rsquo;&eacute;quit&eacute; en sant&eacute;<\/li>\n<li>Faciliter les conversations &agrave; propos des d&eacute;terminants structuraux de la sant&eacute; et les voies que doit emprunter la sant&eacute; publique pour s&rsquo;engager politiquement et faire progresser le changement structurel et l&rsquo;&eacute;quit&eacute; en sant&eacute;<\/li>\n<\/ul>\n<h3>&nbsp;<\/h3>\n<h3>Ressources connexes :<\/h3>\n<p><a href=\"http:\/\/nccdh-dev.media-doc.ca\/fr\/resources\/entry\/lets-talk-redistributing-power-to-advance-health-equity\">Repenser la r&eacute;partition du pouvoir pour favoriser l&rsquo;&eacute;quit&eacute; en sant&eacute; : parlons-en<\/a>&nbsp;(2023)<\/p>\n<p><a href=\"http:\/\/nccdh-dev.media-doc.ca\/fr\/resources\/entry\/health-equity\">L&rsquo;&eacute;quit&eacute; en sant&eacute; : Parlons-en<\/a>&nbsp;(2023)<\/p>\n<p><a href=\"https:\/\/nccdh-dev.media-doc.ca\/fr\/resources\/type\/category\/power\/\"><strong>Consultez d&rsquo;autres ressources du CCNDS sur les d&eacute;terminants sociaux de la sant&eacute; et le pouvoir<\/strong><\/a>.<\/p>\n<hr \/>\n<h3>R&eacute;f&eacute;rence<\/h3>\n<p>Heller, J. C., Givens, M. L., Johnson, S. P., &amp; Kindig, D. A. (2024). Keeping it political and powerful: Defining the structural determinants of health. <em>The Milbank Quarterly.<\/em> Advance online publication.&nbsp;<a href=\"https:\/\/doi.org\/10.1111\/1468-0009.12695\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1111\/1468-0009.12695<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Formul\u00e9 \u00e0 partir d\u2019un examen de th\u00e9ories sociales et politiques, cet article propose une d\u00e9finition \u00e9pur\u00e9e, nette et pratique des d\u00e9terminants structuraux de la sant\u00e9. Les auteurs montrent que les interventions diff\u00e8rent en ce qui concerne les d\u00e9terminants sociaux et les d\u00e9terminants structuraux de la sant\u00e9  parce qu\u2019elles provoquent un basculement des rapports de force quand elles ciblent les d\u00e9terminants sociaux.<\/p>\n","protected":false},"featured_media":8753,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","_uag_custom_page_level_css":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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