One in four people aged 45–54 already has at least two chronic conditions. Midlife is a critical time to take effective, comprehensive action on health and to improve future resilience to aging.
Due to the rapidly aging population, the loss of independence is a major public health issue. France ranks among the top European countries in terms of life expectancy, but it ranks 10th in terms of healthy life expectancy.¹ Trends in healthy life expectancy appear stable or favorable for older adults. However, this trend may be less favorable among people approaching retirement age. Functional decline results from biological aging, unhealthy behaviors, and the onset of chronic diseases.
Programs to prevent loss of independence have so far targeted people aged 55 and older, particularly around the time of retirement. While these programs are necessary, strengthening preventive measures starting at age 40 is now recommended by expert consensus (NICE², SAPEA³, HCSP⁴) to reduce the loss of independence associated with the accumulation of chronic diseases. Some studies show that the more health-promoting behaviors (physical activity, diet, tobacco, alcohol) are adopted starting at this age, the greater the cumulative beneficial effect on aging.
The challenge today is to propose, in addition to preventive approaches based on determinants, a comprehensive approach that integrates the main risk factors and takes into account the barriers and enablers to adopting healthy behaviors, as well as the specific living conditions and environments of the 40–55 age group.
An overview of the health of the French population aged 40 to 645 highlights numerous concerning indicators related to the onset of chronic diseases and disabilities at an older age. This is particularly pronounced among people from lower socioeconomic backgrounds, underscoring significant social and regional inequalities.
25% of French adults aged 45–54 have high blood pressure, with 50% undiagnosed; there is a decline in the management of hypertension, particularly among women.
28% of women and 45% of men aged 45–54 have elevated LDL cholesterol, with a decline in medication management for hypercholesterolemia and a decrease in screening for the condition over the past 15 years.
10% of French adults aged 40–54 are prediabetic.
A 21% increase in overweight women aged 40 to 54 over the past 15 years.
There has been a sharp increase in hospitalization rates for COPD exacerbations since 2000 among those aged 45–54: an average of +1.5% per year among men and +7.4% per year among women.
25% of women and 30% of men aged 45–54 smoke daily, with the number of cases increasing among women in this age group since the 2000s.
20% of people aged 45–54 exceed recommended alcohol consumption limits.
50% of women and 30% of men aged 40–54 have low levels of physical activity.
15.6% of women aged 35–44 have a diagnosed depressive disorder; this rate has been rising since 2010.
Studies based on cohort follow-ups support a link between midlife risk factors and the onset of serious health events such as dementia, loss of independence, or frailty during aging6,7,8.
One-third of dementia cases are believed to be linked to modifiable risk factors—factors common to cardio-neuro-metabolic conditions and a wide range of cancers.
High blood pressure, diabetes, high cholesterol, and obesity in midlife are associated with an increased risk of dementia and cardiovascular disease.
Links between certain health-promoting lifestyle habits in midlife—physical activity, a healthy diet, not smoking, and moderate alcohol consumption—and healthy aging are also well established.
Social engagement, leisure activities, and cognitive stimulation have been positively associated with healthy aging, but these findings require further confirmation.
Links have also been established between certain psychosocial factors (unemployment or lack of employment), environmental factors, and poor health.
The accumulation of chronic diseases as people age is associated with numerous adverse health outcomes that notably impact functional abilities and quality of life.
About a quarter of people aged 45–54 already have at least two chronic conditions
In France, between 30% and 39% of people over the age of 259,10 have at least two chronic conditions (a condition known as multimorbidity). This prevalence increases with age—about a quarter of those aged 45–54 already have at least two chronic conditions—but is already common at younger ages. This multimorbidity is more frequent and occurs earlier, by 5 to 15 years, among women, as well as among those with the lowest income and education levels.
The co-occurrence of conditions is rarely a matter of chance but rather the result of a common etiology or shared determinants. Certain combinations of two, three, or four conditions warrant special attention to prevent their medium- and long-term consequences; for example, the most common combinations (hypertension-low back pain, obesity-hypertension) that share common determinants (obesity, mental health conditions) or those involving painful conditions (migraine, low back pain, osteoarthritis of peripheral joints) that present risks associated with the (over)use of analgesics. Finally, it is necessary to take into account the main conditions affected by socioeconomic health inequalities (including low back pain, COPD, and anxiety).
The onset of diseases and functional limitations as people age is interrelated with factors of social, economic, and environmental vulnerability.
Surveys on the health status of the French population reveal striking social and regional health inequalities. A few examples:
an INSEE study estimates a 13-year gap in life expectancy between the wealthiest and poorest individuals;
a study by Santé publique France shows that the presence of risk factors for chronic diseases and multimorbidity in midlife is associated with a low socio-educational level and begins 10 to 15 years earlier in disadvantaged populations12;
data from Santé publique France’s barometers indicate an unfavorable trend in perceived general health between 2010 and 2017, which is more pronounced among younger individuals and marked by significant social inequalities, with occupational determinants having a very significant impact on these trends13.
All of this data highlights the importance of addressing the risk factors for loss of independence as early as possible; most of these factors have shown unfavorable trends over the past decade.
Santé publique France’s “Healthy Aging” program aims to offer a combined approach, targeting multiple determinants to achieve a positive synergistic effect on health. This new program complements the Agency’s other thematic programs.
Adopting multiple positive behaviors increases the benefits of aging in good health compared to individual behaviors
To foster synergy between an individual approach to behavior change and the development of environments more conducive to health, our “Healthy Aging” program will rely on a social marketing initiative targeting the general public and healthcare professionals, as well as mobilizing communities to support the public, particularly the most disadvantaged.
This new prevention initiative will enable adults, particularly those in midlife, to address health issues that concern them holistically, taking into account the diversity of their situations and living environments. A qualitative study¹⁴ conducted by Santé publique France showed that facing initial health concerns and significant life events (separation, children leaving home, career changes, etc.) prompts people aged 40–55 to reflect on their lifestyle.
The development of a population-based approach and the early prevention of loss of independence starting at age 40 are priorities of the 2018–2022 National Health Strategy and the 2020–2022 National Strategy for Healthy Aging.
mobilizing communities to support the public, particularly the most disadvantaged (community initiatives, local areas, workplaces);
monitoring the population’s health status starting in midlife through the creation and development of indicators for this population that allow for tracking health in all its dimensions (physical, mental, and social). The indicators monitored by Santé publique France will include: indicators related to aging (frailty, multimorbidity) as well as indicators of subjective health (perceived health, quality of life).
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1 Statistics on healthy
life years 2 National Institute for Health and Care Excellence (NICE). Dementia, disability, and frailty in later life – mid-life approaches to delay or prevent onset. October 2015.
3 Science Advice for Policy by European Academies (SAPEA). Transforming the Future of Ageing. Berlin: 2019 978-3-9820301-1-1.
4 High Council for Public Health (HCSP). Prevention of Alzheimer’s Disease and Related Disorders. December 2017.
5 Health Challenges of Aging: Epidemiology of Chronic Diseases Linked to Loss of Independence and Their Determinants at Midlife. Report coordinated by L. Carcaillon-Bentata, Santé publique France, 2022.
6 Sabia S, Fayosse A, Dumurgier J, Schnitzler A, Empana JP, Ebmeier KP, et al. Association of ideal cardiovascular health at age 50 with incidence of dementia: 25-year follow-up of the Whitehall II cohort study. BMJ. 2019;366:l4414.
7 High Council for Public Health. Prevention of Alzheimer’s Disease and Related Disorders. December 2017.
8 Science Advice for Policy by European A. Transforming the Future of Ageing. Berlin: 2019 978-3-9820301-1-1.
9 Coste J, Valderas JM, Carcaillon-Bentata L. The epidemiology of multimorbidity in France: variations by gender, age, and socioeconomic factors, and implications for surveillance and prevention. PLoS One. April 6, 2022;17(4):e0265842.
10 The epidemiology of multimorbidity by gender, age, and socioeconomic factors: implications for surveillance and prevention
11 Life expectancy by socioeconomic status: among men, a 13-year gap between the wealthiest and the poorest. INSEE 2018, July 2019.
12 Coste J, Valderas JM, Carcaillon-Bentata L. The epidemiology of multimorbidity in France: variations by gender, age, and socioeconomic factors, and implications for surveillance and prevention. PLoS One. 2022 Apr 6;17(4):e0265842.
13 L. Carcaillon-Bentata, N. Soullier, N. Beltzer, J. Coste. Deterioration of self-perceived health between 2010 and 2017 in people aged 55 to 65: impact of socioeconomic determinants. BMC Public Health. 2021 Oct 7;21(1):1804.
14 Qualitative study to better understand the knowledge, attitudes, beliefs, and behaviors of adults aged 40 to 55 in France, conducted in 2020, based on 58 individual interviews and 7 focus group sessions with 8 to 10 participants.
