To implement appropriate public health policies, it is crucial to understand the population’s health status and how it changes over time. This information is all the more important given that the COVID-19 pandemic has severely disrupted healthcare systems around the world.

For the first time, a study conducted by teams from Inserm, the University Hospital, and the University of Bordeaux in collaboration with Santé publique France, the National Health Insurance Fund (CNAM), and collaborators from the Global Burden of Disease (GBD) study, provides an overview of the health status of the French population just before the pandemic in 2019, and how it has evolved since 1990. This study also compares the situation in France with that of other European countries, resulting in a detailed assessment that can guide public policy decisions and help reflect on the broader impact that COVID-19 has had on the health of the French population. The results are published in the journal The Lancet Regional Health.

The COVID-19 pandemic has disrupted the organization of healthcare systems and exacerbated issues already facing many countries, including France, such as inequalities in access to care, as well as hospital strain and shortages of healthcare professionals. To address these challenges, it is essential—beyond standard surveillance systems—to conduct a more precise assessment of the health status of the French population prior to the COVID-19 crisis, particularly to analyze its specific impact on various health indicators.

This is the aim of a new study conducted by teams from Inserm, the University of Bordeaux, and the Bordeaux University Hospital, in collaboration with Santé publique France and the CNAM. This study evaluates several health indicators in France in 2019 prior to the pandemic, as well as their trends from 1990 to 2019, and also compares the situation in France with that of other Western European countries over the same period.

A study made possible by the wealth of GBD data

The “Global Burden of Disease study,” coordinated by the Institute for Health Metrics and Evaluation, has been conducted since 1990 by a global network of 5,647 collaborators in 152 countries and territories. The 2019 study analyzes 286 causes of death, 369 diseases and injuries, and 87 risk factors across 204 countries and territories. The GBD has been used to inform health policies in many nations and local jurisdictions, as well as by international organizations, including the World Bank and the World Health Organization.

But never before has this wealth of data been analyzed and presented specifically for France to describe changes in health status in France through a set of indicators reflecting, in particular, people’s sociodemographic status, life expectancy, healthy life expectancy, and years lived with disability.

An increase in healthy life expectancy

The results of the analysis confirm that over the period in question (1990 to 2019), life expectancy at birth in France improved over time, rising from 77.2 years in 1990 to 82.9 years in 2019, ranking France seventh in terms of highest life expectancy among the 23 Western European countries studied in this report. Furthermore, the French live longer on average in good health, with healthy life expectancy also increasing from 67 to 71.5 years, placing France fourth in the ranking this time.

The increase in healthy life expectancy allows us to hypothesize about progress that may have been made at various levels, such as improved disease management or more effective prevention, which helps limit the onset of diseases. This study thus enables us to estimate the burden of disease based on its impact on the various GBD indicators.

Compared to other European countries, cardiovascular diseases contribute less to morbidity and mortality in France. “We observed a lower burden of disease due to strokes and ischemic heart disease in France than in other Western European countries. This previously observed finding could be explained by a lower prevalence of many cardiovascular risk factors (hypertension, diabetes) and a healthier lifestyle (exercise, diet) in France. Efforts must continue to prevent and treat these conditions, the prevalence of which remains significant,” explain the authors.

It is also important to improve the management of mental health disorders (particularly depressive and anxiety disorders) and musculoskeletal disorders (especially lower back pain), which are the leading causes of years lived with disability. The study also highlights that progress is needed in cancer prevention, particularly by continuing efforts to combat smoking. Indeed, cancer remains the leading cause of death in France, as in other European countries.

“Overall, these results highlight a clear trend toward improved health in France. They should encourage policymakers to develop intervention strategies to reduce the burden of morbidity and mortality, paying particular attention to causes such as cancer, cardiovascular disease, mental health, and musculoskeletal disorders,” the authors emphasize.

This study therefore constitutes a valuable resource, complementing the regular epidemiological surveillance carried out notably by Santé publique France, to guide public policy and implement relevant measures to improve prevention and access to care. It also represents an important first step toward better understanding the impact the COVID-19 pandemic has had on the health of the French population. The same study will now need to be conducted using data collected after the health crisis on these same key indicators, in order to highlight any changes in the population’s health status.

Sources

The health state of France before the COVID-19 pandemic between 1990 and 2019: an analysis of the Global Burden of Disease study 2019
Francis-Oliviero Florence ^{a b c}, Constantinou Panayotis ^d, Haneef Romana ^e, French GBD collaborators, Schwarzinger Michaël ^{b f}, Anne Gallay ^e, Antoine Rachas ^d, François Alla ^{b c f
a} Medical Information Service, Bordeaux University Hospital, 33000 Bordeaux, France
^b Inserm UMR 1219-Bordeaux Population Health, 33000 Bordeaux, France
^c University of Bordeaux, 33000 Bordeaux, France
^d Directorate of Strategy, Research, and Statistics, Caisse nationale de l’Assurance Maladie, 75986 Paris Cedex 20, France
^e Department of Non-Communicable Diseases and Injuries, Santé publique France, Saint-Maurice, France
^f Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, 33000 Bordeaux, France

The Lancet Regional Health – Europe, February 2024