This report reviews the epidemiological evidence on these various conditions associated with a loss of independence during the aging process and describes their main risk factors, which are already common as early as midlife.¹ An assessment of the health status of the French population aged 40 to 64 reveals numerous concerning indicators. Among older adults, trends in the prevalence of various chronic diseases over the past decade have been somewhat mixed, but the aging of the population alone will lead to an increase in these conditions. In the face of population aging, the primary lever for action to reverse adverse trends lies in implementing an effective prevention policy starting at age 40, with measures that must continue throughout life. This report constitutes the first step in the “Health 40+” program developed by Santé publique France. It synthesizes the knowledge needed to address the various factors that promote healthy aging in the long term.

Acting Early for Healthy Aging

By 2050, INSEE estimates that 22.3 million people (1 in 3 residents) will be aged 60 or older, compared to 12.6 million in 2005 (1 in 5 residents), representing an 80% increase over 45 years. France currently ranks among the top European countries in terms of life expectancy but ranks 11th for healthy life expectancy—that is, life expectancy without functional disability.

While trends in disability indicators appear stable or favorable for the very elderly, they may be less favorable for those approaching retirement age. Functional decline results from biological aging, unhealthy behaviors, and the onset of chronic diseases. It reduces the quality of life not only for patients but also for their family caregivers. Prevention well before the onset of loss of independence, before the first signs of disability appear, has become a public health priority.

Studies based on cohort follow-ups support a link between midlife risk factors and the onset of serious health events.

• It is currently estimated that one-third of dementia cases are linked to modifiable risk factors, as are cardio-neuro-metabolic conditions and a large number of cancers.

• High blood pressure, diabetes, high cholesterol, and obesity in midlife are associated with an increased risk of dementia and cardiovascular disease.

• Health-promoting lifestyle habits in midlife—physical activity, a healthy diet, not smoking, and moderate alcohol consumption—are associated with healthy aging.

A concerning overview of the health of French adults aged 40 to 64³

Among people aged 40 to 64, numerous indicators linked to the onset of chronic diseases and disabilities in later life are cause for concern, particularly among those of lower socioeconomic status, highlighting marked social and regional inequalities:

• 25% of French people aged 45–54 have high blood pressure, 50% of whom are undiagnosed. The management of high blood pressure, particularly among women, has deteriorated;

• 10% of French adults aged 40–54 are prediabetic;

• 30% of men and 25% of women aged 45–54 smoke daily. Smoking rates have been rising since the 2000s among women in this age group;

• 20% of those aged 45–54 exceed alcohol consumption guidelines;

• A 21% increase in overweight women aged 40–54 has been observed since 2006;

• 50% of women and 30% of men aged 40–54 have low levels of physical activity;

• 15.6% of women aged 35–44 have experienced a major depressive episode in the past 12 months; this rate has been rising since 2010.

This overview highlights the importance of addressing these risk factors for loss of independence; most have shown unfavorable trends over the past decade.

Prevention in Midlife: At the Heart of the “Health 40+” Program

The results of qualitative studies⁴ show that facing initial health concerns and life events (separation, children leaving home, career change, job loss, etc.) prompt people aged 40–55 to reflect on their lifestyle. A comprehensive approach is now particularly relevant, especially among populations with lower socioeconomic status, by addressing health behaviors, living environments (such as the workplace and medical-social facilities), and environmental factors (air pollution, pesticides, etc.).

Developing a life-course approach to surveillance and prevention is a priority for Santé Publique France. It aligns with the guidelines of the 2018–2022 National Health Strategy and the government’s “Rendez-vous Prévention” initiative at certain key ages, which is currently being implemented.

This approach was initiated with studies and a program of information and prevention initiatives focused on a child’s first 1,000 days. From 2011 to 2020, Santé publique France also collaborated with the Inter-Regime of Pension Funds to develop knowledge, tools, and a website targeting people aged 55 and older living at home.

Today, the Agency continues its population-based approach across the different stages of life by offering a “Health 40+” program. It aims to provide knowledge to address the various factors that promote healthy aging in the long term by intervening as early as midlife, in accordance with the guidelines defined in the national strategy “Healthy Aging 2020–2022,^”5 including:

• monitoring the population’s health status starting in midlife (chronic diseases, injuries [falls], mental health, and health determinants) and developing comprehensive aging indicators designed to identify populations at risk of losing independence (indicators of frailty and multimorbidity);

• mobilizing communities to support the public, particularly the most disadvantaged (collective actions, local areas, workplaces), and promoting health through a comprehensive approach;

• the rollout of a prevention strategy supported by digital and media campaigns targeting the general public and healthcare professionals to support their efforts, with the launch in spring 2023 of a website dedicated to prevention for people aged 40 to 55.