Intervention territoriale visant à lutter contre la pollution atmosphèrique et équité en matière de santé

La combinaison de la pollution atmosphérique et de la défaveur socioéconomique peut contribuer à l’aggravation des inégalités de santé. De nombreuses interventions de lutte contre la pollution atmosphérique sont mises en place à différentes échelles du territoire. La question soulevée est la suivante : « les bénéfices sur la santé des interventions visant à améliorer la qualité de l’air diffèrent-ils selon les caractéristiques socioéconomiques des populations ? ». Un panel de professionnels et d’acteurs politiques a été interrogé sur l’enjeu de l’équité en matière de santé dans l’élaboration et la mise en œuvre de ces interventions. Cette recherche révèle une absence d’évaluation de l’équité des politiques environnementales. Afin de prendre en compte les inégalités sociales de santé, nous suggérons d’évaluer systématiquement dans quelle mesure les interventions pourraient involontairement accroitre la vulnérabilité des populations défavorisées par une approche de type Evaluation d’Impact sur l’Equité en matière de Santé.Background – The relationship between the characteristics of the neighbourhoods where people live and health inequalities is now well documented. More specifically, socioeconomic characteristics have been indicated as mediating the health effect of environmental exposure; this is most documented in relation to air pollution. Two mechanisms have been advanced to explain the possible combined effect of socioeconomic status and environmental exposure: i) differential exposure, which explores the possibility that environmental pollutants are not equally distributed across population groups with different socioeconomic characteristics; ii) differential vulnerability, which states that, at the same level of exposure, socially disadvantaged groups experience more severe health effects. Since the ‘70s, corresponding to a growth in awareness of environmental issues, the number of interventions to protect the state of the environment in Europe increased. In France, there are many local interventions which aim to improve air quality, such as the bike share system, the French “bonus / malus” system, areas with 30 km/h speed limit and greater attention to environmental issues in urban planning. However, who will really benefit from these local interventions? Objective – The question raised in this present article is “ Are the health benefits of interventions which aim to reduce air pollution, experienced equally between populations characterized by different socioeconomic status? “ Material and methods – Our study is conducted in Lyon Metropolitan area located in Eastern France. We questioned a sample of 14 professionals with contrasting profiles in terms of their environmental engagement (such as decision-makers, specialists of public policies evaluation and researchers). We focused our interview on three points: the actions and the public policies implemented to decrease the atmospheric pollution; the assessment of these actions in term of health benefits and impact on the social health inequalities; recommendations to improve the consideration of equity in public health interventions. Our article is structured as follows. We will describe, in the first section, the Lyon Metropolitan area (Lyon MA). In the second section, we will give a brief summary of the principal interventions related to air pollution implemented in Lyon MA. In this section, we will also detail the consequences of one specific intervention in relation to neighborhood socioeconomic characteristics. In the third section, we will discuss the factors which might influence the lack of an assessment of implications for health equity in local interventions. Finally, the last section suggests recommendations for future investigations. Results – All professionals reported the absence of an assessment of health inequity as part of intervention; they added that, to their knowledge, social characteristics are not systematically reviewed as part of public health policy interventions. In France, the political climate could explain the lack of attention to issues of heath equity and social health inequity within local action planning; additionally, those professionals interviewed noticed a clear separation between heath, environment, and urbanism policies. Exceptions are found in public health research where socioeconomic status is considered as one important characteristic in health assessment of interventions aiming to improve air quality. Conclusion – The principal recommendation is to include equity issues at the beginning of the development of any given intervention within a territory; the underlying idea is to take into account in the process the ways in which the impact of such an intervention could be socially differentiated. This concept has already been introduced in several countries, for example in Canada, through the approach of Health Equity Impact Assessment (HEIA). In France, it is time to move from the health impact assessment to the HEIA in order to maximize the positive impacts of interventions and to reduce the collateral negative effects that could potentially widen health disparities between population groups