The state of health of the population in France in the light of social inequalities

State of health of the population: a contrasting evolution marked by strong inequalities
The French population is aging and will be even more in the future: 9% of people are 75 years of age or older today, it should be 16% in thirty years’ time. Life expectancy continues to grow despite a cyclical decline in 2020 due to the Covid-19 epidemic, but its growth has slowed over the past decade. Disability-free life expectancy at age 65 is also slowing but increasing faster than life expectancy at age 65. Social inequalities in health are manifested in the emergence of chronic diseases which occur and most frequently affect people with low incomes. Territorial disparities manifest themselves in terms of life expectancy: this is lower in the north and east of metropolitan France and in the five overseas departments and regions (DROM).

Regarding mental health, one in ten people had symptoms indicative of depressive disorders in metropolitan France in 2019 among people aged 15 and over, with differences of one to two depending on the standard of living. In DROMs the situation is more critical with at least two out of ten people affected in Guyana or Mayotte. The psychological impact of the Covid-19 epidemic on the population has been significant, particularly among adolescents and young adults, with depressive syndromes reaching 22% among 15-24 year olds at the end of the first birth in May 2020. pre-epidemics in the following months (14% in July 2021 compared to 10% in 2019). The situation is particularly worrying among adolescent girls and young women.

Determinants of health and prevention
The field of behaviors that have an impact on health is very broad: it includes practically all daily activities such as nutrition, physical exercise, sleep, socializing, but also the consumption of substances and risky behaviours.

France remains in the group of European countries that consume more alcohol. Even as consumption continues to decline, occasional heavy alcohol consumption (API) is on the rise: it affected 27% of women and 50% of men aged 15 and over in 2019 in metropolitan France, compared to 17 % and 42% in 2014. also decreased between 2014 and 2019, but the decline seems to stop in 2020, in a context of health crisis. Furthermore, more than three out of four inhabitants consume fruit and vegetables every day in mainland France, but this is the case for less than half of the inhabitants in the DROMs, where the consumption of sugary drinks is also more common. Being overweight affects 45% of people in France, of which 14% suffer from obesity. The prevalence of obesity is highest in northern France and most DROMs, as well as among the poorest people.

The use of screening is unequal according to the standard of living and prevention is less widespread in DROMs, especially in Mayotte. Inequalities in access to health professionals (and in particular to private general practitioners) are increasing and are likely to penalize the poorest people the most.

From birth to old age, health problems evolve, inequalities remain
The type and importance of health problems are closely linked to age and, in the case of women, to maternity wards. Three population groups are distinguished by their specific health status: children and adolescents, women of childbearing age and the elderly.

Inequalities are present at all ages, with a higher risk of maternal and perinatal mortality in DROMs than in metropolitan France. Prematurity and low birth weight babies are more common when the mother comes from a modest background. Twice as many children of workers as children of executives are already overweight in the large daycare department.

In old age, health problems are mainly characterized by multiple pathologies: 21% of people aged 75 and over suffer from at least 3 pathologies, against 8% between 65 and 74 years old and 3% between between 45 and 64 years old.

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