Nathalie Bajos is Director of Research at Inserm and Director of Studies at EHESS. Her research focuses on the social production of health inequalities in the field of sexuality and sexual health. She is co-responsible for three national surveys on sexuality, as well as a project on health inequalities focusing on Covid-19, cardiovascular disease, depression and cancer. She is a member of numerous scientific commissions in France and abroad, and has chaired the Conseil national du sida since February 2024.
For the year 2024-2025, she has been invited to hold the Public Health Annual Chair, created in partnership with the Agence nationale Santé publique France.
Understanding the origins of inequalities in health is what has motivated Nathalie Bajos for the past thirty years. Occupational illnesses, AIDS, contraception, abortion - these are just some of the areas of research that have enabled her to consolidate her position over the years. Together with other researchers, she recently launched a major research program on health inequalities, called Gender and Health Inequalities or GENDHI. It aims to understand how gender, but also social position, produces health inequalities, from birth to death. An approach that makes sense for the sociologist, who believes that " health inequalities represent a major social justice issue ".
A career in research
At the start of her career, Nathalie Bajos had no intention of becoming a researcher. With a double degree in sociology and demography, she was given the opportunity to write a thesis on emergency medical aid in Paris, financed by Europ Assistance. " In the years 1990, the 15center didnot exist. Emergency services were becoming increasingly busy with requests from people calling them for non-emergency reasons, although this spectacular increase was not understood ", she describes. In fact, at that time, the socio-demographic structure of the Parisian population was changing, and the proportion of young working people in large cities who had no family doctor was growing steadily." When they had a medical problem, these young working people contacted emergency services, especially the less socially well-off. At the same time, tensions between SOS Médecins, the Paris fire department and the Samu de Paris led these organizations to respond extensively to the so-called urgent requests addressed to them, in order to increase their activity, which reinforced the overall increase in calls, sometimes to saturation point. Since then, emergency services in France have been reorganized, and the results of the sociological work contributed to the creation of the 15centers. "
At the end of her PhD, the researcher joined an Inserm team headed by Annie Thébaud, her thesis supervisor, who had set up a research program on occupational illnesses. The aim was to understand the obstacles to the recognition of these pathologies, when such recognition gives entitlement to compensation. To achieve this, a wide range of cases were studied : silicosis among miners, lung disease, mesothelioma among workers exposed to asbestos, ethmoid cancer among carpenters, allergic dermatitis among hairdressers... " On the one hand, people exposed to serious health problems, sometimes at risk of death, and on the other, a system that failed to recognize the occupational origin of their illness. For me, this was a real wake-up call in terms of awareness of social inequalities in health ".
Broadening the scope of analysis
Between 1990 and 2015, Nathalie Bajos focused on sexual health issues. In particular, she worked on the study of AIDS at a time when the disease was wreaking havoc. " AIDS was a sexually transmitted disease, but the latest data on sexual behaviorin France dated back to 1970. In this context, it was difficult to develop effective prevention policies. The French National Agency for AIDS Research therefore decided to launch a major national survey on sexual behavior. " Conducted among twenty thousand people in 1992, the survey, which she coordinated with epidemiologist Alfred Spira, aimed to explore sexual and preventive practices and representations of sexuality in France. This revealed, among other things, a very marked asymmetry in sexuality between women and men - asymmetry which is also found in work, family and public life - and which made it difficult for women to negotiate the use of preventive practices with men. " We've shown that, when it comes to HIV, it's better to opt for several preventive measures to take account of the diversity of encounter situations and power relationships between partners, rather than relying on a single solution such as condoms, even if the latter remain the most effective method. We have also shown that homophobia is a genuine risk factor ", she comments. She then set up a multidisciplinary research program on contraception and abortion in France and sub-Saharan Africa.
From 2015 onwards, she felt driven by a need to broaden the scope of her research, but also by a desire to better understand the role of public authorities in the genesis of these inequalities. She joined the Défenseur des droits as head of the Promotion of Equality and the Fight against Discrimination department, until 2018. Among the many projects she has undertaken to combat discrimination from a socio-political perspective, she has carried out a national survey to gain a better understanding of the profiles of those who do not turn to this institution even though they can, and has shown that there is a gap between those who are supposed to turn to this institution and the reality.
Inequalities and power relations
Nathalie Bajos is one of the proponents of the intersectional approach to sociology :" What the intersectional approach tells us is that health inequalities reflect inequalities in society as a whole. In short, that they are the result of power relations that structure every society, and that refer to class and gender positions as well as ethno-racial positions. The intersectional approach makes it possible to explain why certain people will not contract illnesses, why sick people will not have the same relationship to symptoms, and why the care system will not necessarily treat them in the same way ". The term "intersectionality" first appeared in the scientific literature in 1989, in the work of Kimberlé Crenshaw, an American jurist working on the legalization of the situation of black women confronted with sexual violence. The notion has been mobilized in the scientific field since 2000, although as early as the late 1970s, the work of French sociologists such as Danièle Kergoat helped lay the foundations of the concept. " Intersectional analysis shows us that we cannot understand health inequalities without simultaneously taking into account class, gender and "race" relations. If you only look at one aspect, you will have a biased understanding of the phenomenon. "
Three mechanisms contribute to the construction of health inequalities throughout life. Firstly, greater or lesser exposure to risk depending on living conditions, and in particular working conditions :" If you are a construction worker, you are more likely than an executive to be exposed to certain diseases, and in particular occupational diseases ", explains the researcher. Secondly, the perception of symptoms. When faced with a health problem, we're not going to attach the same importance to how the symptoms of an illness manifest themselves. Men will be particularly sensitive to symptoms that affect the body's functioning, while women will be more attentive to symptoms such as fatigue that disrupt their social role. When women complain of anxiety, fatigue and chest pain, the medical profession tends to downplay them, whereas in men they are immediately taken seriously to diagnose a cardiovascular problem. The opposite is also true. While a third of hip fractures in men are attributable to osteoporosis, very few men receive treatment for this disease, which is still seen as " a women's disease ". These are all biases attributable to gendered representations of disease. " In medicine, we are only just beginning to question these biases and the scientific literature, which most often postulates that these dimensions are solely biological, when in reality they are also eminently social ", notes Nathalie Bajos, who recently showed with her colleagues that the recommendations of the European Society of Cardiology, based on scientific literature relying on samples in which men are largely over-represented, were biased and resulted in less effective treatment for women. Lastly, the third mechanism refers to the conditions of access to the healthcare system and to treatment modalities, which can differ according to the social position of individuals.
Dialogue with political players
While class position has long been taken into account in the study of health inequalities, and gender more recently, ethno-racial position remains largely neglected, particularly in France. The Covid-19 pandemic showed just how fundamental this dimension is. " Insee data noted as early as 2020 a high excess mortality among people born in sub-Saharan Africa compared to those born in France. " With her epidemiologist colleague Josiane Warszawski, she showed that this risk was not linked to a lower propensity to adopt preventive practices such as wearing a mask, using gel or distancing oneself :" This overexposure was linked to the living conditions of immigrants from North Africa and sub-Saharan Africa: density of communes of residence, overcrowded housing. But also to their working conditions, with these people most often using public transport to get to their place of work, and more often occupying so-called front-line jobs such as drivers or cleaners, which are particularly exposed to the risk of contamination". These particularities are "the result of social housing policies implemented over several decades and a socially segregated job market ".
The researcher is pursuing a line of thought that began several years ago. During her lecture series at the Collège de France, she will address the social production of health inequalities. " I don't consider it to be the job of researchers to do prevention work. But our job as scientists is also to dialogue with the people in charge of prevention ", explains the sociologist, who makes a point of guaranteeing her independence. " Thisis fundamental. It's not a question of responding to a political commission, but of having total scientific freedom in the choice of subjects and in carrying out our research. "
Article by Emmanuelle Picaud
