In many countries, the objective of reducing public spending combined with the introduction of New Public Management reforms have led to changes in the territorial organization of public services and to a withdrawal of public facilities in many places. Our hypothesis is that in France, this territorial process has not occurred in the same way in all cities. We assume that while medium-sized cities are seeing a reduction in some public service facilities, their disappearance usually occurs in small cities. Larger metropolitan areas have not been affected by such territorial retrenchment of public services facilities. These differences could lead to increased territorial inequalities at the level of urban systems and to a marginalization of some small cities. This paper examines these processes through a quantitative analysis of changes in the location of justice courts and hospital beds from 2000 to 2016, within French Functional Urban Areas.It shows that the decrease in the number of justice and hospital facilities was significant and has affected small cities.
Socio-economic and geographical inequalities in breast cancer mortality have been widely described in European countries and the United States. To investigate the combined effects of geographic access and socio-economic characteristics on breast cancer outcomes, a systematic review was conducted exploring the relationships between: (i) geographic access to healthcare facilities (oncology services, mammography screening), defined as travel time and/or travel distance; (ii) breast cancer-related outcomes (mammography screening, stage of cancer at diagnosis, type of treatment and rate of mortality); (iii) socioeconomic status (SES) at individuals and residential context levels. In total, n = 25 studies (29 relationships tested) were included in our systematic review. The four main results are: The statistical significance of the relationship between geographic access and breast cancer-related outcomes is heterogeneous: 15 were identified as significant and 14 as non-significant. Women with better geographic access to healthcare facilities had a statistically significant fewer mastectomy (n = 4/6) than women with poorer geographic access. The relationship with the stage of the cancer is more balanced (n = 8/17) and the relationship with cancer screening rate is not observed (n = 1/4). The type of measures of geographic access (distance, time or geographical capacity) does not seem to have any influence on the results. For example, studies which compared two different measures (travel distance and travel time) of geographic access obtained similar results. The relationship between SES characteristics and breast cancer-related outcomes is significant for several variables: at individual level, age and health insurance status; at contextual level, poverty rate and deprivation index. Of the 25 papers included in the review, the large majority (n = 24) tested the independent effect of geographic access. Only one study explored the combined effect of geographic access to breast cancer facilities and SES characteristics by developing stratified models.
Revue francophone sur la santé et les territoires Pandémie, crises et perspectives : lectures territoriales de la Covid-19 | 2021 Reforms and sanitary covid crisis: have spatial inequalities in resuscitation beds increased since 2008? Réformes hospitalières et crise pandémique de la Covid-19 : depuis 2008 les inégalités spatiales d'équipement en lits de réanimation ont-elles augmenté ?
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