Since 1992, the Public Health France Barometer has aimed to gain a better understanding of the health habits, preventive practices, and perceptions and opinions of French residents regarding various health-related issues (addictions, vaccination, nutrition, physical activity, etc.).
What makes it unique? It enables the simultaneous monitoring of risk perceptions on the one hand, and health behaviors on the other, as well as how these change over time.

This provides the indicators needed to define public health challenges and plans.

Objectives

The Santé publique France Barometer is part of the system for observing and monitoring the health status of the population and its main determinants, complementing the surveillance systems managed by Santé publique France, medical-administrative databases (BDMA), and surveys conducted among specific populations. This tool, based on self-reported individual data, provides information that cannot be collected elsewhere, whether regarding individual behaviors, opinions, knowledge, or health events not recorded in the BDMA.

The objectives of the Santé publique France Health Barometer are to:

• Monitor the health behaviors of the population residing in France and their determinants, with particular attention to modifiable behaviors and analyses of social and territorial inequalities, notably by producing estimates at the regional level;

• Document public health issues or guide policy decisions, particularly by surveying the population’s knowledge and opinions to inform the implementation or evaluation of prevention initiatives or public policies;

• Expand knowledge on the health status of the population residing in France, for indicators not covered by other surveys or surveillance systems.

For over 30 years, these repeated surveys have made it possible to monitor various public health issues such as: smoking, alcohol consumption, illicit drug use, vaccination practices, sexual health, cancer screening, physical activity, nutrition, quality of life, sleep, accidents, mental health, the environment, etc.

The survey thus helps answer questions such as:

• How much time do we spend in front of our screens?

• How many of us eat vegetables every day?

• How many of us know how to swim?

• Do we drink more alcoholic beverages than is recommended for maintaining good health?

Methodology

The Santé publique France Health Barometer is based on surveys of randomly selected individuals representing the entire population living in France. The data are considered “self-reported” because respondents describe their behaviors, opinions, and knowledge by answering questions. This survey is also “cross-sectional” because each survey provides a “snapshot” at a given point in time of the behaviors, knowledge, and opinions being studied. From one edition to the next, the survey does not interview the same people, but each edition represents the diversity of situations and opinions among the population living in France at the time of the survey.

The methodology of the Santé publique France Public Health Barometer survey allows results to be extrapolated to the entire population residing in France. To achieve this, survey participants must represent all profiles of individuals living in France, including those less interested in health or with less knowledge about prevention, who are less likely to participate in this type of survey. Consequently, significant efforts are made to contact individuals who are harder to reach and encourage them to participate: invitation letters and emails, follow-ups, a website providing extensive information about the survey, a toll-free hotline to answer questions and assist with participation, etc. In addition, statistical adjustments (weighting) are applied to ensure that survey participants accurately reflect the socio-demographic structure of the population.

A telephone survey from 1992 to 2023

Until 2023, the sample invited to participate in the survey consisted of randomly generated telephone numbers, and the survey was conducted by telephone with the assistance of an interviewer.

To ensure the quality of the respondent sample—and particularly to cover all segments of the population—the method has regularly evolved to adapt to the population’s telephone usage and equipment, as well as to technical and administrative constraints and developments in the telecommunications sector (end of the national telecommunications monopoly, diversification of telephone equipment and usage).

Thus, initially in 1992, only landline numbers were randomly selected from the telephone directory. Starting in 2000, individuals on the “red list” were included and could also be selected to be invited to participate. Then, in 2005, individuals with only a mobile phone were added to the selection. Between 2010 and 2023, telephone numbers were generated randomly in order to survey households and individuals not listed in telephone directories. Starting in 2014, due to the preferential use of mobile phones by a portion of the population, including those with a landline, two “overlapping” samples were created: one surveyed via landline, the other via mobile phone (see the methodology in the 2014 edition of the survey).

A redesign of the survey in 2024

Starting in 2024, the survey methodology changed. Individuals invited to participate in the survey are now randomly selected by INSEE from demographic databases on housing and individuals, which constitute a comprehensive list of housing units and their occupants. Respondents are then contacted through various channels (mail, email, phone calls, text messages) and can now participate in the survey online by completing a questionnaire, or by phone with the assistance of an interviewer, as was previously the case. Offering multiple response methods increases the likelihood of reaching all segments of the population; in particular, the addition of the online data collection method makes it easier for more internet-connected groups, such as young adults, to participate in the survey. Finally, the survey is now conducted on a regular basis (every two years), and regional estimates are now produced for each edition. The Santé publique France Barometer has been awarded the label of public interest and statistical quality by the Label Committee. These changes have improved survey participation and the quality of the estimates.

A major methodological overhaul was thus carried out between 2021 and 2023, leading to the implementation of this new system starting in 2024. This methodological overhaul had two objectives:

• To ensure and even improve the quality of the survey and the estimates, in a context of declining response rates and reduced reachability of individuals by telephone;

• To better meet expectations and needs, particularly by producing regional estimates and estimates for more vulnerable subpopulations, so that the survey is useful and consistent with the design of public health and prevention policies.

This methodological change to the Santé publique France Public Health Barometer represents a major evolution of the system. Consequently, in 2023, a pilot survey was conducted to test the new system. This pilot survey enabled the selection of the optimal contact and data collection protocol for the survey starting in 2024. It also provided guidance for trend analyses and the assessment of the methodological change’s impact on the estimates.

Target Populations

Between 1992 and 2023, the “target” population of the Public Health France Barometer was the general population residing in mainland France, with a lower age limit ranging from 12 to 18 years and an upper age limit ranging from 75 to 85 years (in 2010 and 2019). An adaptation of the Santé publique France Barometer was conducted in 2014 and 2021 in the French West Indies, French Guiana, and Réunion, in Saint-Pierre-et-Miquelon in 2020, and a specific survey in the territory of Mayotte took place in 2018–2019. Other specific populations were also surveyed, such as healthcare professionals (general practitioners, community pharmacists), people who are deaf, hard of hearing, or have hearing impairments, and African populations in the Île-de-France region.

Starting in 2024, the survey’s target population consists of adults aged 18 to 79 living in standard housing in mainland France or in the overseas departments and regions (DROM) excluding Mayotte: Guadeloupe, French Guiana, Martinique, and Réunion.

Topics Covered and Target Populations

The Santé publique France Barometer covers a wide range of public health topics. Since its inception in 1992, an increasing number of topics have been addressed (rising from 12 in the 2000 Health Barometer to around 20 since the 2010 Health Barometer).

Some editions have focused on a single health topic: nutrition in 1996, 2002, and 2008; cancer in 2005, 2010, and 2015; environmental health in 2007; infectious disease risk in 2006; mental health in 2005; sexual health in 2016; addictions in 2017; and tobacco in 2018.

As part of the redesign of the survey conducted between 2021 and 2023, the discussion regarding the survey methodology was accompanied by a review of the topics covered. Thus, the definition of the topics addressed in the survey was based on:

• an overview of French surveys focusing on health or including health indicators, to ensure complementarity with these surveys and avoid redundant measurements;

• an assessment of public health needs and challenges defined by Santé publique France’s 2030 roadmap;

• the timeline of relevant national plans and related information and prevention campaigns;

• the anticipated trends of the measured indicators to determine the frequency of data collection.

These priority issues have thus made it possible to define a core set of questions that will be asked in every edition starting in 2024.

To guide this process, an internal design committee was formed and tasked with defining the study’s objectives and the survey topics needed to achieve them, as well as the strategy for disseminating and leveraging the results. A steering committee was also formed to ensure that the survey’s objectives align with the expectations for informing public policy decisions on prevention, and to formulate recommendations regarding the scheduling of the themes addressed in the survey proposed by the Santé publique France design committee. Finally, the new framework was presented to representatives of labor unions, researchers, and associations.

This type of survey also makes it possible to identify, monitor, and compare populations with specific preventive needs to the general population. Depending on the topics addressed, these may include young people, retirees, those with the lowest levels of education, the unemployed, people facing financial difficulties, specific territories or regions… The Santé publique France Barometer thus helps to better measure and understand social and territorial health inequalities.

Dissemination

The survey results concerning various themes and populations are made public through summaries, articles, oral presentations, posters displayed at conferences, press releases, or other publication formats. A detailed list of these publications is available for each edition of the survey on the dedicated page (see below).

The insights derived from the Santé publique France Health Barometer are thus accessible to all stakeholders involved in prevention, health education, and health promotion (health professionals, social workers, researchers, practitioners, teachers, etc.), as well as to policymakers. They thus have access to scientific data (quantified indicators) to inform debates and discussions regarding public health policies, and to communicate on major health issues and take action based on facts validated by the scientific community.

Data from the Barometer have notably been used for the implementation and evaluation of several national public health plans (National Plan to Combat Tobacco Use 2018–2022, National Plan for Action Against Addictions 2018–2022, Annual Report on Infant Vaccination Requirements, National Health and Environment Plan 2 2009–2013, National Nutrition and Health Program 4 2019–2023, National Sexual Health Strategy 2017–2030), as well as for the production of national reports (Report on the State of Health of the Population in France, Indicators for the National Monitoring of Sustainable Development Goals).

This survey is thus used to develop communication campaigns and evaluate public policies. It provides a better understanding of the expectations of the population and professionals and is therefore an essential prerequisite for defining and implementing coherent, effective, and better-targeted prevention and health education initiatives. The Santé publique France Barometer is one of the data sources used to assess the health status of the population, providing information on lifestyle habits, risk factors, quality of life, and socioeconomic status.