PhD contract job profile2024-2027

Supporting in-home care for older people in France and Japan:

How can we reconcile the preference for homecare with the implementation of a homecare policy?
of economically, socially and ethically sustainable solutions in the digital age?
❖ Laboratory: Institute for Interdisciplinary Research on Social Issues - IRIS CNRS Inserm EHESS USPN
❖ Discipline: Public Health❖ Supervisor: Thomas Lefèvre (USPN) co-supervised with Sébastien Lechevalier (EHESS)❖ Contact: thomas.lefevre@univ-paris13.fr ; sebastien.lechevalier@ehess.fr ; estelle.girard@ehess.fr❖ Research areas: sociology (qualitative and quantitative); public health; health economics❖ Key words: innovation; care; autonomy; ageing; digital; social gerontology

1.

Suggested subject

Context
With longevity on the rise, the issues surrounding dependency and care are giving rise to newneeds. Today, home care is clearly favoured over nursing homes, whose reputation has
deteriorated considerably in recent years. Home care, which is the preferred option in France forolder people facing the challenge of dependency, also raises a number of issues, particularly interms of healthcare and social isolation.
The ideal of staying at home comes up against the issue of access to care, in a social andeconomic context that is both unequal across the country and constrained from a budgetary point ofview. As for the issue of social isolation, against a backdrop of profound changes in family and social
ties, it comes to the fore in times of crisis such as the 2003 heatwave or, more recently, the COVID 19 pandemic. These are two potentially contradictory objectives.
In the face of these tensions and contradictions between individual preferences and socioecological and health constraints, digital technologies are often presented as offering relevant
solutions for limiting the risks of social isolation by encouraging the circulation of information flows.
They require a digital infrastructure to be put in place that is consistent with individual homes. They
must also comply with fundamental ethical and legal rules concerning the transmission, storage andsharing of individual health data. The challenge here is to strike a balance between the most intimate
aspects of the private sphere and the need to socialise this data, taking into account economic andsocial constraints.
As far as we are aware, the solutions proposed to date are highly localised, lack coherence andreflect a segmentation of approaches, which has its counterpart in the scientific literature, which isitself scattered between different disciplines and theoretical approaches. In our view, this is the main
reason for the separation between housing and ageing policies.
Objectives
In this context, the scientific objective of this thesis project is to define the conditions for innovationthat will make it possible to reconcile the individual choices of older people with a loss of autonomy
in favour of remaining at home, access to quality healthcare, respect for the environment and thequality of life.

ethical and legal rules relating to the collection, storage and sharing of individual health data, while
taking account of socio-economic constraints, which implies a form of standardisation of solutions.
The challenge is therefore to promote the construction and development of homes thatreconcile the ideal of independence for older people with general ethical principles and physicaland economic constraints. This also means developing a detailed understanding of individuals intheir personal and social environments.
Research hypothesis(es)In order to carry out this research, we formulate a set of hypotheses, derived from a nonSchumpeterian approach to innovation and an understanding of the social bond interpreted throughthe prism of the ethic of care:i) The aim of innovation for frail older people is not to combat loss of autonomy at all costs, but toprevent it and support it, avoiding any sudden decline in quality of life and well-being, by promoting
people's empowerment;ii) The quality of life of the very aged depends on three essential abilities: (1) getting around in one'senvironment (coming and going as one pleases), (2) deciding for oneself (not being at the mercyof..., under someone else's rules...), and (3) contributing to social life (remaining useful, earningrespect...).
iii) The design and creation of habitats that reconcile homecare, autonomy, respect for fundamental
ethical rules concerning the circulation, storage and use of personal health data, and socio-economiclimits, all depend on the ability to standardise solutions that are easy to use but can be adapted
according to individual preferences, and the automatic nature of health data flows within a predefined ethical and legal framework;iv) This type of care-led innovation can only be developed if there is effective collaboration between
users, designers and contractors.
Methodology and relevance of the France/Japan comparison
To achieve these objectives, it is necessary to implement a methodological approach that i s both
multidisciplinary and mixed. The aim is to reconcile a very concrete approach based on ethnographic
observations with a more systemic and macro approach, making it possible to identify the conditions
under which such a strategy can be put in place. A sociological approach from a public healthperspective (health economics, public policy, user rights, population health, territorial and social
inequalities in health) will be favoured, whether in terms of analysing ageing, housing or digital
innovation.
This work will also be based on a comparison between France and Japan. The two countries arecomparable, but have markedly contrasting characteristics, which makes the comparison particularlyrelevant. Indeed, the increase in longevity, the contrast between areas with good medical
infrastructures and medical deserts, and the attempts to mobilise digital technologies are points thatthe two countries have in common. There are significant differences in the respective roles ofgovernments, the boundaries between the public and private spheres, the role of families andhousing policies. The comparison will be conducted on the basis of case studies, distinguishing
between two types of territory: an urban environment benefiting from the proximity of medical
infrastructures; and a medical desert-type environment.
2.

Co-direction of work

The proposed topic will be co-directed by two IRIS research fellows: Thomas Lefèvre and Sébastien
Lechevalier.
Thomas Lefèvre is a senior lecturer and hospital practitioner at Sorbonne Paris Nord University andAssistance Publique - Hôpitaux de Paris, and is qualified to direct research.

in public health at the ED Erasme. Trained as a Mines-Telecom engineer, with a doctorate in appliedmathematics and social epidemiology, and as a public health doctor, one of his two main areas ofresearch is the study of digitally-induced transformations, including the use of AI, at the microsocialand organisational levels. He is a member of the PersMed laboratory of the France-Japan Foundationof the EHESS, focusing o n personalised medicine and the social protection system in France andJapan; co-pilot of the Safepaw PEPR in digital health, on the SHS and mental health aspects, focusing
on the benefits of digital technology in coordinating patient pathways; and a member of the Innovcare
PPR, led by Sébastien Lechevalier. He is an elected member of the executive board of the Haut conseil
de la santé publique, where he is more specifically interested in the contribution of digital technology
to the current and future healthcare system, as well as social and territorial inequalities in health. Heis an elected member of the ethics committee at the University of Paris. He (co-)supervises or has (co)supervised several doctorates in public health and sociology.
Sébastien Lechevalier is Director of Studies at EHESS and Chairman of the France-Japan Foundation.
An economist, he is a specialist in Japan (https://sebastienlechevalier.wordpress.com/). He is themain coordinator of the INNOVCARE project (Innovation driven by care: the case of care for theelderly in France and Japan), which has been selected as part of the Autonomy PPR for the period2024-2028 (https://innovcare.hypotheses.org/).
This type of doctoral project is by its very nature interdisciplinary, and co-direction by two researcherswith complementary areas of expertise and research, who have already collaborated on thesethemes, is an added value for the candidate.

3.

Skills and qualities expected of the candidate

The subject has a strong interdisciplinary component, which is its interest and strength, and also
leaves some scope for adapting it according to the candidates' preferred disciplines and skills. Above
all, you will be asked to demonstrate the following:--

A great capacity for intellectual curiosity and an ability to combine elements from different
and complementary disciplines, although it is not expected that the candidate will be anexpert in each of the fields; nevertheless, a background in two (or more) different areas oftraining would be a plus;
A strong interest in the two cultures and countries of France and Japan, and a taste for working
in the field in contact with these two cultures;
The ability to undertake visits to Japan as part of the project;
A capacity for critical analysis of the concepts of innovation and digital technology, among others, andtheir use in a specific, applied context;
An openness to mixed methods (qualitative and quantitative) as complementary andarticulated methods;
The ability to be autonomous in several aspects of research, and to work within a project
involving teams of researchers;

In terms of disciplines, several profiles are possible: sociology, public health and the socio-economics
o f innovation in particular.
Candidates should send their CV and covering letter to the contacts mentioned on the cover page assoon as applications are opened. The candidate cannot be a graduate of the USPN (as the only
diploma entitling the holder to enroll for a doctorate).

4.

Inclusion of the subject in IRIS policy and collective projects

The subject fits in very naturally with IRIS's areas of research, starting with Axis 3 (Health: practices,policies, inequalities), but also with various aspects of Axis 2 (biography, pathways, trajectories) andAxis 1 (ethnography of domination). The relationship with Axis 3 is clear and direct, in that it focuseson the relationship between innovation, particularly digital innovation, and populations that a r e
often the targets of unequal treatment, particularly in terms of health and policies. The inclusion ofthis theme in Axis 2 means that we will be studying the individual and collective specificities of thelife trajectories and preferences of older people, at the frontiers between the public and the private,and questioning the freedoms they enjoy within spaces reconfigured by innovation and healthpolicies. Finally, in connection with this last point, the relationship with Axis 1 will enable us to observe
how more or less implicit or deliberate relationships of domination emerge when innovations aremobilised and then applied to particular populations, via health.
The subject also forms part of collective projects run by IRIS and its researchers, including in particular
the Innovcare (PPR autonomy), PersMed (innovation and social protection, health system) andSafepaw (PEPR digital health) projects.

5.

Timetable-15 March 2024: launch of the call for applications; receipt of applications
From 15 April 2024: organisation of candidate auditions (preferably in Aubervilliers on theCondorcet campus, by video if not possible).
2 May 2024: selection of the candidate and preparation of the application for the audition by
the Doctoral School (ED)During May 2024 (date not yet fixed): audition of the candidate by the ED
Results in June 2024
October 2024: start of thesis
Spring-summer 2025: on the ground in JapanThe rest of the timetable will be established with the candidate as part of the preparation of his/herapplication.

6.

Indicative bibliographical references

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Courbebaisse, A., & Salembier, C. (2022) "L'espace au prisme de l'éthique du care / Housing through thelens of care", Les Cahiers de la recherche architecturale urbaine et paysagère [Online], Research Materials
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Hoppmann, C. A., Lay, J. C., Pauly, T., & Zambrano, E. (2021). Social isolation, loneliness, and solitudein older adulthood. The handbook of solitude: Psychological perspectives on social isolation, social
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Lechevalier, S. (2019). Innovation beyond technology. Springer.
Lefèvre, T. (2023). Frontiers and modes of existence of personalised medicine in the digital age: aproposal for stakeholder analysis. Fondation France- Japon de l'EHESS, Discussion Papers
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Lefèvre, T., Saas, C., Chariot P., Laugier V., Guez S. (2021) Big data Drop It: utilisation,comprehension et impact des techniques prédictives. http://www.gip-recherchejustice.fr/publication/big-data-drop-it-big-data-et-droit-penal-utilisation-comprehension-et-impactdes-techniques-predictives-etude-drop-it-exemple-de-levaluation-de-lincapacite-totale- de-travailchez-les-victi/
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Sovacool, B. K., & Del Rio, D. D. F. (2020). Smart home technologies in Europe: A critical review ofconcepts, benefits, risks and policies. Renewable and sustainable energy reviews, 120, 109663.
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Thomas, V., Balzer Carr, B., Azmitia, M., & Whittaker, S. (2021). Alone and online: Understanding therelationships between social media, solitude, and psychological adjustment. Psychology of PopularMedia, 10(2), 201.
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