some progress and still strong social and territorial inequalities


Risky behavior, eating habits, physical activity, life expectancy, chronic diseases, use of and access to care…: on all fronts, health inequalities persist in France. In this respect, the report on the state of health of the population in France, published Wednesday September 21 by the direction of research, studies, evaluation and statistics (Drees), will hardly surprise. No more than a reminder of the main drivers of these inequities: the socio-economic level and the region of residence, two partly linked determinants. “The first killer in the world is misery and poverty, and France is no exception”notes Mahmoud Zureik, professor of epidemiology and public health at the University of Versailles-Saint-Quentin (Yvelines).

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To compile these figures, the DREES has gathered, in addition to its own data, the results of numerous studies by Public Health France, Health Insurance, Inserm, the National Institute of Statistics and Economic Studies ( Insee), Epi-Phare…

This report recalls first of all a demographic perspective: if, today, 9% of people are aged 75, they should be 16% in thirty years. Life expectancy at birth continues to grow despite a drop linked to Covid-19 in 2020 (minus seven months for men and minus six months for women). In 2021, it was 85.4 years for women and 79.3 years for men. But the gains dwindle over time. Between 2014 and 2019, it increased by 0.2 years among women, compared to a one-year gain between 2009 and 2014; and in men 0.5 years compared to 1.5 years.

Territorial disparities

A positive point, however: disability-free life expectancy (without loss of autonomy linked to a disability, illness, etc.) at age 65 is progressing faster than life expectancy at age 65. Between 2009 and 2019, the former increased by 2.1 years and the latter by 0.8 years for women – and by 1.4 years and 1.2 years for men. “This is a sign that France has made progress in terms of prevention”observes Antoine Flahault, director of the Institute of Global Health in Geneva. “Our country had some catching up to do, especially compared to Sweden or Spain”adds Philippe Amouyel, professor of public health at the University of Lille and at the Lille University Hospital.

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But this progress is still marked by strong inequalities. The disparities are territorial, first of all. Life expectancy thus remains lower in the north and east of metropolitan France and in the five overseas departments and regions (DROM). In Maine-et-Loire, it peaks at 86.3 years at birth for women and 80.3 years for men. In Mayotte, it does not exceed 73.6 years for women and 72.3 years for men. Furthermore, “the north and north-east of France are distinguished by higher mortality for all cancers, diseases of the respiratory system and cardio-neurovascular diseases”notes the Drees.

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