Reduction Of Social Inequalities Research Articles

Communities on the move: community participation in health in rural territories of Buenaventura District in Colombia

BackgroundSocial and community participation is a fundamental component of the development of renewed primary healthcare (PHC). With the recognition of health as a right, such participation is a significant part of the design of public policies aimed at this sector. These policies contribute not only to overcoming inequity in the provision of this type of services but also to a reduction in social inequalities as a whole. Through a comparative analysis, this study aimed to explain the conditions through which ethnic-rural territories of the Colombian Pacific coast participate in health to contribute to the generation of policies and programs in territories with similar conditions.MethodsThe work was developed through the use of multiple techniques and strategies for information collection and analysis. These include several semi-structured interviews, multiple observation exercises and analysis based on a set theory, i.e., qualitative comparative analysis (QCA). The latter aims to develop a model that provides a count of the main causal combinations that allow high community participation in health.ResultsKey findings include how the trajectory of social mobilization and existence of a robust community social fabric became two critical conditions for community participation in the context of social exclusion. The presence of variables such as the implementation of PHC, guarantee of social rights, and trust in institutions, is underestimated as sufficient causal conditions for obtaining this result. Therefore, it is essential to recognize the existence, validity, and importance of processes, experiences, and resourcefulness of political natures, which aim at transforming the daily reality of the inhabitants of these communities. These also set a potential space and scenario for managing the communities’ main problems, including health, in the absence of institutionality that guarantees access to their social rights.ConclusionThis study points out the importance of understanding community participation as a political activity, expanding exchange dynamics and dialogs between institutions, rulers, and communities to provide social responses in health and well-being to communities and to understand local realities and their own community dynamics.

Physical and psychosocial work factors as explanations for social inequalities in self-rated health.

We investigated the contribution of physical and psychosocial work factors to social inequalities in self-rated health (SRH) in a sample of Danish 40 and 50 years old occupationally active women and men. In this longitudinal study, the study population consisted of 3338 Danish women and men. Data were collected by postal questionnaires in 2000 (baseline) and 2006 (follow-up). The independent variable, socioeconomic position (SEP), was assessed by the highest achieved educational level at baseline. We conducted gender-stratified parallel multiple mediation analyses. In the mediation analyses, SEP was categorised as SEP I, II, III, VI and V among men. Among women, SEP was dichotomised into SEP I-IV and V. The outcome, SRH, was assessed at baseline and follow-up. A wide range of physical and psychosocial work factors were included as potential mediators. We found a social gradient in SRH across all levels of SEP among men. Among women, we only found a poorer SRH among those with the lowest SEP. Mediation analyses showed that work factors together accounted for 56% of the social inequalities in SRH among men and 44% among women. In both genders, ergonomic exposures and job insecurity seemed to play the major role for social inequalities in SRH. For women only, we also found noise to contribute to the social inequalities in SRH. Physical and psychosocial work factors partially explained social inequalities in SRH among both genders. Improvement of the working environment can potentially contribute to the reduction of social inequalities in health.

Medical education in Brazil: public health as a didactic-pedagogical structure

Abstract Medical education in Brazil has a Flexnerian structure whose guidelines were instituted in the Americas in the early twentieth century, which led the academic to settle in the office and in the hospital with a focus on the biological processes of the health-disease process. However, since the 1970s, increasing social inequality in Brazil has led to marked poverty with a lack of access to basic health care for most of the Brazilian population. The 1988 Federal Constitution treats health as a democratic process where the social issue is fundamental to the development of the nation. The Italian health movement, guided by social studies by Giovanni Berlinguer, inspired the Brazilian Health Reform Movement. In this regard, the hospital-centered view began to be questioned. Wide critical-reflexive movements were being built in society and in the academy, looking for improvements in the population's quality of life. Issues related to promotion, treatment and prevention, both in medical training and in management and assistance, were gradually being incorporated into medical education. But it was in the national medical education change project that the National Curriculum Guidelines (DCN), launched in 2014, culminated. The medical course at the Federal University of Fronteira Sul - Chapecó campus (UFFS-Ch), in the state of Santa Catarina, was created in 2015, fully complies with the new guidelines and is supported by the Public Health. This orientation is guided by the political, economic and social development of the Country within a civilizing process that is based on the social and environmental determinants of health, with respect to the relations of society in its history and in its territory. In this way, medical training at UFFS has a vision of the health-disease process that transcends the individual and addresses the community, with a proposal to transform society based on democracy and social justice. Key messages To present a counterpoint between the Brazilian Health Reform and its inspiring one, an Italian, in the search to overcome social inequality, through a civilizing process based on Democracy and Health. To present a medical course based on the transformation of medical education with a structure in Public Health in order to provide a reduction in social inequality in Brazil.

Class transition: a life in between

Most scholars within sociology of education focus on the reproductive function of the education system and on inequalities related to it. Rarely attention is paid to cases which don’t reproduce the class of origin. In particularly to the circumstances under which the class-crossers succeed to make an upward transition and to their life after they enter the upper class. However even P. Bourdieu has actually searched for the mechanisms that could prevent reproduction of social inequality by means of education. This topic remains relevant also in the modern time of (un)equal access to the educational institutions. The problem of reconstruction of exiting social order by educational systems has been not solved yet. It would notably contribute to the reduction of social inequality if we could reconstruct the pattern, that promote/hinder social mobility during the education path. In this article, we analyze the class transition experience of P. Bourdieu and D. Eribon based on their self-analysis and try to integrate a new non-reproduction approach of C. Jaquet in this pattern of social mobility through the education. On the basis of the autobiographical life-stories of mentioned above two sociologists we try to reconstruct the main driving force that has enabled them the way up und also to determine how the life of a class-crosser looks after they succeed the transition. After analyzing the work of P. Bourdieu named “Ein soziologischer Selbstversuch” and the work of D. Eribon named “Rückkehr nach Reim” we could confirm an assumption of C. Jaquet that ambition is the most powerful driving force for social mobility. Moreover, we can conclude that not only a person can be willing to leave the milieu of origin, but that he/she can be just displaced by the milieu. In such a situation he/she is a refugee and is forced to flee. In the most cases of escape and desire to climb up the social ladder such “negative” feelings as shame play a role of a driving force. Besides, the fact of social mobility is usually regarded as an end destination when in fact this transition is a process that never ends but transmutes in new forms.

O que há de realmente atemorizador nos cenários tipo-Gattaca?

No filme Gattaca, imagina-se um futuro já nada distante em que os casais poderão consultar um especialista em fertilização artificial e escolher as características de seu futuro filho. Eles podem selecionar embriões fertilizados em laboratório, podendo também alterar seus traços genéticos, eliminando genes capazes de expressar doenças ou mesmo características físicas indesejáveis. Técnicas recentes, como a edição genética por Prime Editing ou por meio da CRISPR-Cas9, logo permitirão terapias gênicas em embriões fertilizados in vitro antes de sua implantação uterina. Neste artigo, pretendemos avaliar essas possibilidades, revisando criticamente alguns argumentos conhecidos contra o uso indiscriminado de tais técnicas (como o argumento da ladeira escorregadia, e os argumentos de Jurgen Habermas e Michael Sandel). Ao final, em defesa de que objeções de princípio a práticas eugênicas devem estar assentadas na proteção e promoção dos direitos humanos, pretendemos avaliar quais limites poderiam publicamente justificar a permissão ou proibição do uso privado de tais técnicas.

New Medical Studies, Same Old Politics: The Effects of Anti-Black Racism on Penetrative Trauma Research

The effects of medical racism on health outcomes of Black people in the U.S. are well recorded in prominent medical journals and governmental study data. Despite this documentation, there has yet to be broad structural change addressing the multiple oppressive systems intersecting to create adverse outcomes for Black people. Consequently, trust in medicine and medical practitioners continues to be low, which impacts the relationship between Black people and dominant institutions of medicine, including medical research. In this paper, I analyze the ethics of a forthcoming study on penetrative wound treatment from Temple University Hospital in Philadelphia. Using Franz Fanon’s analysis of medicine as a form of colonial practice and Dorothy Roberts’ analysis of the biological reduction of social inequities to problems of Black people themselves, I argue that the Philadelphia Immediate Transport in Penetrating Trauma Trial, or PIPT study 1) fails to meet the ethical requirement of treating study participants as human beings; 2) fails to engage with deep, structural inequities that produce higher rates of gun violence in communities from which study participants will be drawn; and 3) functions to reinforce stereotypes of Black men as violent and as thus to blame for the violence they face individually and at a community level. Without addressing the intersectional, structural, and interpersonal forms of oppression framing studies like the PIPT, I contend that medical researchers, medical practitioners, and policy makers cannot fully appreciate the extent to which race and anti-Black racism function to prevent the health and well-being of Black people.

The incidence of tuberculosis and its relation to social inequalities: Integrative Review Study on PubMed Base

Abstract Objective: to identify how the literature presents the relation between tuberculosis and social inequalities. Method: integrative review in which the combination of the descriptors “tuberculosis” and “social iniquity” guided the search for articles available in PubMed. A total of 274 articles were identified, and after reading the title and abstract, 13 studies were selected. The empirical material was analyzed according to the hermeneutics, highlighting the variables related to social inequalities, seeking to understand the main themes that embody the association between tuberculosis and social inequalities. Results: In general, the literature presents the social inequalities as factors that can interfere in the cure and/or control of the disease, such as age, income, unemployment, unskilled labor, access to health services, among others. Therefore, it does not include a deeper relationship between the organization of society and the production of the disease. Conclusion and implications for practice: A comprehensive understanding of tuberculosis disease is required, in order to expand interventions to support the control and elimination of the disease and, above all, the reduction of social inequalities. The understanding of tuberculosis as a disease enables expanding strategies to face it.

Community participation in the fight against COVID-19: between utilitarianism and social justice.

This essay aims to discuss the foundations and possibilities for community participation in the fight against COVID-19. The first part discusses the meanings of community, defined according to geographic, aggregate-interest, or epidemiological criteria. In the context of the pandemic, none of the three perspectives can be considered alone. The essay discusses the need to link different approaches in order to produce socially contextualized health interventions. Next, the authors present the four main models in the international literature that provide the basis for community participation practices in various countries. The analysis of community participation in the context of COVID-19 uses conceptual systematization based on two meta-narratives: utilitarian and social justice. The utilitarian perspective involves measures to restrict social contact. Participation is thus understood as collaboration in implementing measures that contribute to controlling the problem. The social justice perspective especially addresses the social determinants of health and reduction in social inequalities. The approach focuses on community empowerment and the search for solutions to the social and economic problems that determine the spread of COVID-19 and other diseases. The essay concludes on the peculiarities and importance of each approach. Community participation in the fight against COVID-19 should consider the emergency contexts to strengthen the health system and the defense of the social protection system and democracy.

O BRICS e as iniciativas em ciência, tecnologia e inovação pós-cúpula de Joanesburgo.

O presente trabalho expõe as mais recentes iniciativas do BRICS no âmbito da ciência, da tecnologia e da inovação (CTI), a partir dos últimos instrumentos adotados para colocar em prática as propostas, além de iniciar a tarefa de investigar como vem se dando a sua implementação, principiando com a apresentação dos esforços do Brasil e da China nesse sentido. A abordagem traz os resultados e as propostas da 10ª Cúpula Presidencial do BRICS, realizada em Joanesburgo, África do Sul. O presente estudo, orientado pelos aspectos da CTI, enfoca os desenvolvimentos recentes e as parcerias estabelecidas entre o Brasil e a China. Enfatiza-se, no trabalho, que a cooperação em CTI só fará sentido nesse agrupamento com características tão peculiares — países em desenvolvimento com graves problemas de desigualdade social — se reverter em benefício para a sociedade, em minimização da desigualdade social e em melhoria geral das condições de vida nos países-membros. No contexto atual, deve-se rever os modelos existentes e estabelecer os requisitos legais para novos modelos. Além disso, verificar se a estrutura legal está alinhada com a convicção de que a diversidade cultural pode ajudar a encontrar soluções inovadoras para a condução pacífica dos novos desafios mundiais.

Normalcy, Race, and Biomedical Technology in Brazil: The Case of Low White Blood Cell Count.

This article explores the intersection between low-complexity biomedical technologies and ideas about race in Brazil. Using ethnographic material collected in the northeastern city of Salvador on the clinical management of low white blood cell count (leukopenia), and debates involving doctors, biomedical scientists, and social movement activists on establishing racialized parameters in complete blood count tests, I explore how the notion of normalcy is connected to ideas about racial difference. Taken both at a population and individual bodily level, normalcy serves to contrast local history, portrayed as the result of widespread admixture between groups, with other national contexts, such as that of the United States. While a material body that cannot be classified as racially pure is seen as normal in the contemporary Brazilian context, nevertheless these pure racial types feature discursively as existing in a long lost past of Brazil's history. At the same time, normalcy can also be locally challenged by certain actors, such as social movement activists, who underline the specific experience of certain racialized bodies, questioning the overarching national narratives of admixture and arguing for the need to recognize these bodies as normal as well, particularly in the context of political struggle for the reduction of social inequalities. These two ways in which normalcy appears articulated with local meanings of race gives way to seemingly contradictory and confronting discourses. Thus, racial categories that are explicitly not identified with admixture are seen as a thing of the past (the history of the Nation) and a thing of the future (a more racially equal country). This can be better comprehended by the process through which different historical discourses on racial difference in Brazil appear in connection with, or as a proxy for, ideas such as nation, population or gender, originating from different places and moments in history.

Relative social inequality in the world: Rigidity against the economic growth, 1992–2016

The study of economic growth and social inequality goes back to the works of S. Kuznets, A. Atkinson, P. Krugman, J. Stiglitz, T. Piketti, and B. Milanovic. Statistical analysis of social inequalities for a large set of countries, divided into seven clusters, was conducted for the period 2000–2016. The share of incomes of the 10th decile was used as a measure of inequality. The hypothesis of the positive impact of economic growth on the reduction of social inequality was tested. Stylized facts on an array of 106 countries for the period under review indicate a high degree of stability of the level of inequality in most groups, especially in the most developed countries, and in particular in the Anglo-Saxon ones. The distribution of key socioeconomic and even political indicators for clusters shows their strong relationship with the structure of cluster inequality. This makes it possible to significantly deepen the analysis, in particular the one concerning the stages of world development.

Microempresas brasileiras: entendendo seu papel socioeconÿmico

Este trabalho tem como objetivo fazer um breve resumo e melhorar o entendimento do papel das microempresas no cenário socioeconÿmico brasileiro. A metodologia utilizada neste estudo foi a revisão bibliográfica de alguns artigos publicados relacionados ao tema. Destacou-se, a partir da pesquisa, as fundamentais atribuições do Estado no desenvolvimento e fomentação dessa classe, além da assessoria diferenciada já existente. Outros aspectos obtidos foram: altos índices de mortalidade, diminuição de desigualdades sociais a partir da geração de empregos e participação expressiva no produto interno bruto. Concluiu-se que as microempresas são vitais para o desenvolvimento socioeconÿmico brasileiro, fazendo com que expressivos números destaquem a categoria.

Exclusão de mulheres negras: uma análise do filme “Histórias Cruzadas”

Na prática social da exclusão, os fatores raça e gênero somam-se ao se considerar as desvantagens históricas para mulheres negras. Em face dessa dupla desvalorização, as mulheres negras são a fatia mais marginalizada da sociedade. Embora o cenário atual possa ser considerado de redução das desigualdades sociais, ainda persistem padrões desprivilegiados para esse grupo social de participação na educação, mercado de trabalho, saúde e demais espaços públicos. Este artigo analisou o filme “Histórias Cruzadas”, no contexto dos anos 60, a fim de identificar processos de exclusão de mulheres negras, fazendo comparações com a realidade atual das negras no Brasil. Concluiu-se que dos anos 60 pra cá houve pouca evolução quanto aos direitos das mulheres negras, configurando-se como manutenção da exclusão e privação coletiva, recusa e abandono deste grupo social no país.

Early tracking and socioeconomic inequality in academic achievement: Studying reforms in nine countries

Between-school tracking is high on the agenda of academicresearchers and policy makers, as tracking children early in the school career is believed to enhance socioeconomic inequalities in learning opportunities. Contemporary debates on the relevance of inclusive education in the United States, the Netherlands, Belgium, England and Germany, may learn from changes in educational inequalities that have emerged after past reforms from early tracking to comprehensive systems. I study educational inequalities by socioeconomic background in nine countries, across time. Using a difference-in-difference design and international student assessment data collected among eighth-graders, it is demonstrated that socioeconomic inequalities are more strongly reduced in systems that have transformed their educational system from tracked to comprehensive education than in systems without this reform. Moreover, the reduction of social inequalities was most eminent at the top of the achievement distribution. Among top-performers, socioeconomic inequality was reduced after the reform. Among low-performing students, the reform did little to the level of inequality by social background. Robustness checks showed that especially the reform in England and Wales was influential on the observed reduction of inequalities in mathematics performance.

At what scale should proportionate universalism be applied to ensure health equity? Towards a contextualised approach to prevention and health promotion actions

Reduction of social inequalities in health has been one of the main political pillars of Regional Health Agencies in France since their creation in 2009. This paper presents a contextual analysis of the effects on social inequalities in health of a hospital-based health promotion and disease prevention programme in terms of overall health policy and scope. Qualitative analysis was used to describe the impact on social inequalities in health according to the classification proposed by Diderichsen et al. Carey's framework was used to apply proportionate universalism in order to analyse its action on these inequalities, adopting a contextualised and holistic approach with regard to regional and national public policy. The results showed that the intervention focused on targeted actions, but may have broader applications. The intervention strategy shifts between closing the inequality gap and levelling up the social gradient. However, analysis of this type of intervention using the proportionate universalism framework may lead to a revised view of the effects of the intervention on social inequalities in health. Implementing health-equity focused interventions remains a challenge for each institution, including Regional Health Agencies. However, research on hospital-based preventive interventions highlights contrasting results in terms of social gradient, depending on whether the intervention is considered in isolation or in its broader context. This article advocates a contextualised approach to analysing local interventions and their effects on social inequalities in health.

Impact of Public Smoking Bans on Social Inequalities in Children's Exposure to Tobacco Smoke at Home: An Equity-Focused Systematic Review.

A systematic review was conducted to evaluate the impact of public smoking bans on social inequalities in children's secondhand smoke (SHS) exposure at home. Five databases were electronically searched for articles on children's SHS exposure at home related to public smoking bans. In addition, the gray literature and German public health journals were considered. Search was restricted to English and German publications. Of 3037 records screened, 25 studies fulfilled the inclusion criteria by either measuring SHS exposure before and after public smoking ban introduction or by comparing exposure between regions with and without smoke-free legislation. Studies were further examined whether they additionally reported on impacts on social inequalities in SHS exposure. Information on children's SHS exposure at home in relation to smoke-free legislation were extracted by one reviewer and checked for accuracy by a second reviewer. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) guidelines for equity-focused systematic reviews, the PROGRESS-Plus framework was applied to data extraction and analysis with focus on social inequalities in SHS exposure. Results were visualized by a harvest plot. Eight studies gave results on the impact of public smoking bans on social inequalities in children's SHS exposure. Whereas only one study indicated widening of the social gap in exposure, seven studies showed no impact or a reduction of social inequalities in exposure. First evidence on short-term impact of public smoking bans does not support the assumption of intervention-generated inequalities in children's SHS exposure at home. Future studies should focus on long-term equity impacts of smoke-free legislation. There are substantial social inequalities in children's SHS exposure in many countries. Both hypotheses on the effect of smoke-free legislation on children's SHS exposure at home, the displacement hypothesis and the social diffusion hypothesis, did not take social inequalities into account. Up to now, only few studies analyzed the effects of smoke-free legislation on social inequalities in children's SHS exposure at home. Public smoking bans had overall no negative impact on social inequalities in children's SHS exposure at home. More consistent reporting of absolute and relative inequalities is needed to comprehensively assess equity impact of smoke-free legislation.

La unión hace la fuerza: bases para un pleno desarrollo de la indagación científica en Latinoamérica

En un artículo precedente (“La ciencia en Latinoamérica: tendencias y patrones”) se analiza con ciertas herramientas estadísticas sencillas, el estado de la ciencia y, en menor grado, de la tecnología en la región. Partiendo de los resultados obtenidos, en este nuevo artículo se indaga las bondades y debilidades del sistema de “Ciencia, Tecnología e Innovación” (CTI), intentando entender los pasos que debieran seguir los países de LA para engancharse al tren de los Estados más prósperos y desarrollados. La conclusión es clara: por si solos, cada uno de ellos difícilmente podría lograr progresar significativamente en estas materias. Actualmente la CTI depende de contextos económicos y geopolíticos, y demanda esfuerzos colectivos, a no ser que se trate de Estados muy industrializados y extensos como China o EE.UU, por citar tan solo dos ejemplos. Con vistas a exponer estos hechos, se explica cómo han logrado salir del ostracismo y mejorar palmariamente sus CIT países latinos europeos como España y Portugal. Su integración en una mancomunidad de países como lo es la Unión Europea (UE), así como una estabilidad democrática dilatada en el tiempo, resultaron imprescindibles. Más aun, el esfuerzo colectivo de la UE demuestra, sin la menor duda, que la integración de todos los países de la región en una Unión Latinoamericana (ULA), con una gobernanza supranacional en diversas materias (y entre ellas la CIT) es el único pilar fundamental que ofrece garantías. Este modo de proceder, aunando esfuerzos, atesora enormes posibilidades para fortalecer LA en todos los sentidos. Los efectos de tal estrategia son explicados con cierto detalle. Adicionalmente, con vistas a desbrozar un poco el camino, se han desglosado las bondades y debilidades de la CIT en LA (sistemas educativos, cultura digital, problemas de género, producción de patentes, dependencia económica exterior y estratégica de organismos internacionales -FMI, Banco Mundial, etc.-, como también de las inversiones de grandes compañías multinacionales, riesgo de las privatizaciones de centros y actividades previamente Estatales, etc., etc.). Con vistas a encuadrar tal información en un contexto global, se ha escogido como contrapunto la estrategia exitosa (aunque a menudo reprobable respecto a la reducción de desigualdades sociales) que han logrado lanzar el CIT en diversos países del SE asiático.

Evidence-based decision making or a tunnel vision effect? TIMSS, problem definition and policy change in Israeli mathematics education

ABSTRACT This study examines the influence of the Trends in International Mathematics and Science Study (TIMSS) 1999 results on mathematics education policy in Israel. Analyzing various documents, the study shows how these results transformed policymakers’ discourse regarding mathematics education. In order to achieve improvement in Israel’s ranking, the middle school mathematics curriculum was aligned with the TIMSS test. Following this change, the scores of Israeli students rose considerably in TIMSS 2011. Parallel results from Programme for International Student Assessment (PISA) and Israeli internal standardized tests, however, do not show comparable improvement in mathematics achievement. High school matriculation data for the same period of time show a decline in the percentage of students who took the most advanced mathematics courses. Furthermore, none of these data sources show any noticeable reduction in social inequality in mathematics achievement. On the basis of theoretical insights from political science, it is argued that international tests influence the way educational problems are framed and defined. Thus, instead of enriching educational decision-making processes, these tests can create a tunnel vision effect that restricts policymakers’ attention to ‘problems’ and ‘solutions’ defined by the tests themselves.

Envejecimiento poblacional y desigualdades sociales en la mortalidad del adulto mayor en Colombia

Objective: to analyze the magnitude of population aging and the social inequalities existing in the mortality of the elderly in Colombia. Methodology: an ecological study which analyzed the breaches between the people via sub-national data on mortality, poverty, barriers preventing access to healthcare services, illiteracy and the elderly population. The trends of three impact indicators were calculated and compared: life expectancy (2005-2020), aging and over-aging indices (2005-2012). Furthermore, three measures were estimated to summarize absolute and relative inequality: the slope index of inequality (SII), Kunst and Makenbach’s relative index of inequality (RII) and the concentration index (CI). Results: The ratio of elderly people will be ever increasing in Colombia. The barriers preventing access to healthcare services were the most inequitable dimension. Two patterns of inequality were identified: a marginal exclusion for 60% of the elderly who had the most advantages and opportunities, and a linear gradient pattern existing only in the incidence of poverty. The third quintile was the group of departments most affected by the inequity throughout the assessed social dimensions. Discussion: This study provides evidence of inequality patterns in the mortality of the elderly. Regarding the trends, it was only possible to know that the breach has become larger in terms of poverty incidence. Conclusions: Five areas of action are described in order to achieve a desirable context to address population aging and the reduction of social inequalities as challenges for the healthcare and social protection system. These challenges may undermine the progressive realization of universal healthcare coverage and the achievement of sustainable development goals by 2030.

Patient navigation to reduce social inequalities in colorectal cancer screening participation: A cluster randomized controlled trial.

Despite free colorectal cancer screening in France, participation remains low and low socioeconomic status is associated with a low participation. Our aim was to assess the effect of a screening navigation program on participation and the reduction in social inequalities in a national-level organized mass screening program for colorectal cancer by fecal-occult blood test (FOBT). A multicenter (3 French departments) cluster randomized controlled trial was conducted over two years. The cluster was a small geographical unit stratified according to a deprivation index and the place of residence. A total of 14,556 subjects (72 clusters) were included in the control arm where the FOBT program involved the usual postal reminders, and 14,373 subjects (66 clusters) were included in the intervention arm. Intervention concerned only non-attended subjects with a phone number available defined as the navigable population. A screening navigator was added to the usual screening organization to identify and eliminate barriers to CRC screening with personalized contact. The participation rate by strata increased in the intervention arm. The increase was greater in affluent strata than in deprived ones. Multivariate analyses demonstrated that the intervention mainly with phone navigation increased individual participation (OR=1.19 [1.10, 1.29]) in the navigable population. For such interventions to reduce social inequalities in a country with a national level organized mass screening program, they should first be administered to deprived populations, in accordance with the principle of proportionate universalism. ClinicalTrials.gov Identifier: NCT01555450.