Quels territoires de santé gérontologique pour repenser l’adéquation entre offre et besoins d’aides en Wallonie ?

Résumé Fr En

Le vieillissement des populations fait aujourd’hui partie des défis à assumer par les autorités locales et supra-locales. D’après les projections de population, les effets de ce processus risquent même à terme de durcir le débat. Mais les évolutions globales masquent de réelles disparités locales. En Wallonie, l’une des régions administratives de la Belgique avec la Flandre et Bruxelles, il existe d’importantes disparités entre les communes, notamment en ce qui concerne l’ampleur du vieillissement des populations, leur isolement, leur état de santé, mais également la disponibilité d’aides, de soins et de services. C’est sur base de ces constats que cet article a été rédigé, en vue de fournir une réponse à la question de recherche suivante : comment l’offre de soins, de services et d’aides varie-t-elle spatialement et s’adapte-t-elle, ou non, aux besoins des populations âgées ? Plus largement, cet article vise à nourrir la discussion relative à l’existence de bassins ou territoires de santé gérontologique.

Today, population aging is one of the most important challenges for local, regional, and national authorities. The consequences of population ageing for elderly care as foreseen by population projections may lead to tense debates in the future. However, global evolutions tend to hide local disparities. Wallonia, one of the Belgian administrative regions along with Flanders and Brussels, shows significant disparities between municipalities particularly as regards to the extent of population aging, the isolation and health of elderly people, and also the availability of care, support and services for the elderly. This paper aims to provide an answer to the following research questions: how does the provision of care, support and services vary across Walloon municipalities? How is it compatible with elderly needs? More broadly, this article aims to stimulate discussion about the existence of gerontological health territories. Data used for this article come from different sources depending on their availability at the local level (National Register, national institute for health insurance, mutual insurance system, etc.). Elderly needs are estimated from local age structures, health indicators, social characteristics and isolation of the elderlies. We also use the availability of formal and informal support to estimate elderly care supply. Our methodology attributes two scores for each Walloon municipality: one for needs and one for care supply. We compare local situations to the regional average level on a scale from 1 to 3 (“1” for higher supply than needed for of older people; “3” for higher needs than available services can provide; “2” refers to the mean score for Wallonia) – See map below-. According to our analysis the care supply does not meet everywhere the needs of the elderlies. Several dichotomies are observed in Wallonia mainly between the north and the south of the region but also between urban, suburban, and rural areas. Walloon Brabant and the South of the province of Luxembourg are areas where needs are low and/or supply is higher than in the rest of the Wallonia. On the contrary, the South of the Wallonia is mainly rural where needs are higher than elsewhere. To note, these areas are attractive for the elderly who migrates after leaving the labor market. Despite higher needs, those rural areas are geographically isolated and the gap between elderly care supply and needs is more important than elsewhere. This is also the case for municipalities in former industrial areas. There, the gap is mainly explained by higher fragility of older people that sometimes hold concomitantly bad health and poor socioeconomic conditions.