Introduction—There is a widespread perception in French Guiana that the healthcare system is in decline and has been neglected by the government. The objective of this study was to describe key health indicators and compare them with those of mainland France and the Americas, as well as to analyze trends over time. Methods—Data from death certificates, INSEE, and the United Nations were used to shed light on the situation in French Guiana. Cross-country and temporal comparisons were presented graphically. Results—Although lower than in metropolitan France, life expectancy at birth is rising steadily and is the highest in Latin America. Premature mortality (<65 years) is higher than in metropolitan France, but it is declining more rapidly, suggesting that this gap could disappear within 15 years. Despite a still very high rate of premature births (13%), infant mortality and mortality among children under 5 are declining and are among the lowest in Latin America. An examination of the leading causes of premature mortality revealed marked differences from mainland France: accidents, perinatal causes, AIDS, and cardiovascular and cerebrovascular diseases were the main contributors in French Guiana. Depending on the definition used, between 30% and 52% of premature deaths were preventable. Conclusions—Contrary to alarmist claims, health indicators in French Guiana are improving and are not far from those in France. While hospitals are the focus of attention, excess premature mortality is linked to conditions that are sensitive to primary care, underscoring the importance of strengthening these services.