Une approche par les « capabilités » de la santé des populations et de l’élaboration des politiques publiques

Background. – The objective of this study is to outline a capabilities approach to the social determinants of population health and to compare its explanatory power and implications for public policy-making with psychosocial approaches. Methods. – A model linking the structures of economic and social relations to health outcomes is developed and logistic methods used to confirm its base validity for a representative sample of 16,488 citizens in 19 developed democracies drawn from the World Values Surveys of 1990 and 2005. Self-reported health is the dependent variable. Age, gender, education, employment status, self-mastery, income, autonomy at work, ties to family and friends, subjective social status, associational memberships and sense of national belonging are considered. Results. – At baseline, risk ratios reflecting movement from the 25th to 75th percentile in the distribution of the variable indicate that increases in income reduce the likelihood of poor health (0.78; 0.73–0.82) as does higher autonomy at work (0.90; 0.85–0.94) but so does access to social resources reflected in ties to family and friends (0.89; 0.86–0.92), associational memberships (0.93; 0.89–0.98), subjective social status (0.77; 0.54–0.90) while the absence of feelings of national belonging increases the likelihood of poor health (1.14; 1.06–1.23). Conclusion. – The results suggest that population health is dependent on the distribution of social as well as economic resources along the dimensions predicted by a capabilities model. Governments should be attentive to the impact of policy on the distribution of social, as well as economic, resources. # 2013 Elsevier Masson SAS. All rights reserved.