Professionals between health and social. Divisions of labor and associative systems for access to care in Île-de-France
“The aim of this research is to question how social and health issues are the subject of joint work by doctors, paramedical staff and social workers”
Managing access to care
The research aims to question how much territorial and institutional resources enable (or not) professionals in associations to carry out their actions: relationships with their associative supervisory authority, links with the CPAM, the ARS, municipal and even departmental authorities, as well as their partnerships with other humanitarian associations in the territory, with translators or interpreters, etc. In other words, to what extent do their material working conditions, in the broad sense, give these actors the possibility of helping precarious populations as they would like? Then, by focusing on these professionals intervening in different systems (on the one hand, mobile teams “going towards” people, on the other hand, medical permanences in fixed locations), the objective of this research is also to question how social and health issues are the subject of joint work by doctors, paramedical staff and social workers. In other words, it is a question of asking: in what way do these actors manage to reconcile different professional cultures? Also, how does the fight against exclusion redefine the contours of their own professional groups?
Actors of access to care in Île-de-France
The survey focuses on two associative actors intervening with “excluded” populations (homeless people, drug addicts, undocumented immigrants) in Île-de-France. These are associations founded in the 1990s in a context of rising exclusion issues and the HIV epidemic – a phenomenon on which they will focus at the beginning before diversifying (risk reduction, support for opening social rights, medical consultations, screening, etc.). Acting at the level of cities in departments in the Paris region (in this case, Val-de-Marne and Seine-et-Marne), these associative actors are part of a local configuration of medico-social intervention. Their action with target audiences is reflected both in a fixed type of operation (permanent visits) and in a mobile activity (marauding). In order to question these humanitarian healthcare access systems, this research is based mainly on qualitative methods: semi-directed interviews with their professionals (nurses, educators, social service assistants, doctors), observations of their activity with their “users” or “patients”, consultations of the grey literature produced by these associations.
Reflecting on the actions of humanitarian actors
Explaining the know-how shared by professionals of associations promoting access to healthcare for the “excluded”, this research can help these actors, particularly those on the front line, to understand the strengths and pitfalls of their practices. This work can be useful for them to reflect on their ways of cooperating as a team, as well as their relationships with the populations affected by their action.
A cross-sectional analysis of healthcare access policy
Since the 1980s and 1990s, healthcare access policies for “excluded” populations have been developing in France. These measures, partly delegated to charitable or humanitarian associations, have been the subject of numerous scientific contributions that focus on the health care of precarious populations, thus focusing on target audiences or specific systems. In addition to this work, this research offers a cross-sectional analysis of the policy of access to care, focusing mainly on the professionals responsible for implementing it in Île-de-France. Through this work, it aims to contribute to academic reflection in the sociological fields of professional groups, public action (here the action delegated to associations by public authorities) and poverty.
Biography
Following a thesis in political science on the accommodation of the homeless (Université Paris Nanterre, 2019), Mr. Aranda’s postdoctoral research in sociology is devoted to the study of the institutional and professional dynamics of access to care for people in situations of great precariousness. This research, conducted in hospital and primary care settings in the city, was carried out in particular as part of a post-doctorate at the Sciences Po Health Chair during the 2020/2021 academic year. It continues today at CRESPPA-LabTop, thanks to the Red Cross Foundation grant, and focuses on associative action in this field.