Guadeloupe Antigua and Barbuda St. Kitts and Nevis FRENCH Montserrat Guadeloupe Dominica GUIANA, Martinique GUADELOUPE, AND MARTINIQUE Martinique Guadeloupe Fort-de-France Anguilla Saint- Pierre Saint-Martin La Trinité ^ Netherlands Antilles Fort-de-France Le Marin Saint-Barthélemy 02010 Miles 0105Miles French Guiana Grande -Terre La Suriname Cayenne ^ Désirade Saint Cayenne Laurent Basse-Terre du Maroni ^ Basse- Marie- Terre Galante Les Saintes 06030 Miles 02010 Miles Brazil he islands of Guadeloupe and Martinique in the Lesser Antilles,and French Guiana,lo- cated on the northern coast of South America between Suriname and Brazil,are the three TFrench overseas départements in the Region of the Americas that have been an integral part of France since 1946. Despite their geographical distance from France, their political and ad- ministrative organization into departments and regions coincides with that of the rest of France. GENERAL CONTEXT AND HEALTH but also a source of illegal employment and widespread traffick- DETERMINANTS ing. In Guadeloupe and Martinique, the banana production and exportation sector is hampered by constant fluctuations in mar- The archipelago of Guadeloupe, covering an area of 1,703 ket conditions. km2, is the largest of the two islands. It comprises, in addition to In terms of per capita GDP, despite a marked improvement Guadeloupe proper—which is actually two separate landmasses, over the past few years, the French Overseas Departments rank Basse-Terre and Grande-Terre, bisected by a seawater channel— lower than all regions in metropolitan France. In 2002, GDP per the islands of Marie-Galante, Les Saintes, La Désirade, Saint- capita was 15,622 euros in Martinique, 14,108 euros in Guade- Barthélemy, and the French section of Saint-Martin. Martinique loupe, and 12,858 euros in French Guiana. Compared to most of occupies an area of 1,128 km2, and French Guiana, 83,534 km2. their geographical neighbors, the French Overseas Departments Guadeloupe and Martinique enjoy a tropical climate tempered by have a relatively high standard of living, due to susidies and im- trade winds, but are often buffeted by tropical storms between ports from the French Government,but their performance in em- July and October, whereas the climate in French Guiana is equa- ployment and foreign trade places them at or near the bottom of torial. Even though French Guiana is the largest of the three the Caribbean group, and their GDP is less a reflection of wealth French Overseas Departments in the Americas, 94% of its land is and internal productive activities than it is of their unique de- dense Amazonian forest crisscrossed by rivers of all sizes. partmental status. The unemployment rate in 2005 was very high throughout the French Overseas Departments: in French Guiana, 26.5% of the Social, Political, and Economic Determinants working-age population was without a job; in Guadeloupe, this As part of France,French Guiana,Guadeloupe,and Martinique figure was 26%; and in Martinique, it was 21.8%.Although these belong to the European Union (EU), and the euro is the official rates have remained constant over the past several years, the sit- currency. The economy of the French Overseas Departments uation has improved somewhat compared to that of 1998, when shares a number of problems common to small island entities: unemployment peaked at 30% in the Antilles (Guadeloupe and insufficiently competitive exports, a tendency to specialize in Martinique). Those hardest hit by unemployment are the young, services, a strong reliance on tourism and natural resources, en- especially the least skilled in this group, and women. Unemploy- vironmental fragility, and vulnerability to natural disasters. Ad- ment on this scale is largely the product of a sharp increase in the ditionally, the Departments’ economic and political stability is size of the economically active population since the 1980s and accompanied by heavy financial dependence on metropolitan the shift from farming to tertiary services. In French Guiana, the France and limited economic exchanges with the rest of the unemployment issue is even more acute, since the marked in- world. Only 9% of imports from the three Departments come crease in workforce size has not been offset by the generation of from the Caribbean, and barely 3% of exports go to markets in sufficient job opportunities; the level of training available is that subregion. lower, and employers are unable to find qualified staff. The un- The economy of French Guiana includes two peculiarities.The employment situation is further compromised by the presence of first is a space center built by the French Government in the mid- illegal workers willing to work for low wages. 1960s as a base from which to launch its satellites. Located in the The available indicators show that the socioeconomic environ- small coastal town of Kourou, once known only as the headquar- ment in the French Overseas Departments is less favorable than ters for the infamous Devil’s Island penal colony, the center’s im- that found in other French regions, even though the overall stan- pact on GDP varies from year to year.The second is gold panning, dard of living is higher than in most neighboring countries. In the leading export activity (along with space-related activities), France,a mechanism was devised in 1988 called the Revenu Min- 345 HEALTH IN THE AMERICAS, 2007.VOLUME II–COUNTRIES imum d’Insertion (RMI),or Minimum Integration Income,which The impact of urban policy on the most precarious and poor- provides persons aged 25 or over with a minimum amount of re- est districts of French Guiana, Guadeloupe, and Martinique was sources, access to certain social benefits, and assistance with so- somewhat mixed in the 1990s.On the one hand,the government’s cial and/or professional integration. The percentage of RMI ben- efforts to improve housing and living conditions are evident. On eficiaries is much higher in the French Overseas Departments the other,the residents of those districts were the first to be hit by than in the regions of metropolitan France. On 31 December the rise in unemployment, despite the incentives designed to 2005,there were 80,000 RMI beneficiaries in the French Overseas generate jobs. Departments, representing 13% of the population between the School attendance is obligatory for children ages 6 to 16. Thus ages of 20 and 59 in French Guiana,14% in Guadeloupe,and 15% nearly all children ages 3 to 6 attend school. At the start of the in Martinique. 2005–2006 school year,the school population in the French Over- A 2001 French National Institute of Statistics and Economic seas Departments totaled almost 275,000. Over half of the pupils Studies (INSEE) survey found a larger percentage of poor house- were in nursery and elementary (primary) schools, one-quarter holds in the French Overseas Departments than in metropolitan attended junior high school, and one-fifth (aged 15 to 18) were France. It also showed that of the three departments, French enrolled in schools preparing them for the baccalaureate (lycée).2 Guiana fared the worst,with 20.7% of all households living below Baccalaureate pass rates are improving; in 2004, 72% of stu- the poverty line,1 compared to 12.5% in Guadeloupe and 12% in dents in French Guiana, 75% in Guadeloupe, and 79% in Mar- Martinique. The differences are even more marked when child tinique passed the general baccalaureate. These rates still lag be- poverty is measured: 32% of children in French Guiana live below hind those of metropolitan France, and the percentage of the poverty line, compared to 16% in Guadeloupe and 13% in nongraduates is relatively high, particularly in French Guiana, Martinique, as opposed to 8% in metropolitan France. with the rate increasing with the age bracket. To ensure access by the entire population to health care, the The French Overseas Departments had 19,050 university stu- French Government has implemented a measure called universal dents during the 2004–2005 school year, 60% of whom were en- basic health coverage, which provides access to health insurance rolled at the University of the Antilles French Guiana. After for anyone who has lived in France for at least three months and marked growth in the 1990s, the number of students has stabi- who does not otherwise already have health insurance coverage. lized in recent years. Not all courses of study are available locally, The plan also includes supplementary health insurance coverage, forcing some young people to continue their studies in metropol- which, unlike basic universal health insurance, provides addi- itan France or other countries. tional health care free of charge—that is, with no deductible and Various characteristics of the environment may affect the without having to pay an out-of-pocket reimbursement. Supple- health of the inhabitants of the French Overseas Territories. In mentary health insurance coverage is targeted towards the need- the Antilles, natural hazards, such as earthquakes, tropical iest populations. A high percentage of the population in the storms, and volcanic eruptions, are taken into account in the de- French Overseas Departments is covered by these basic and sup- velopment of major risk prevention plans. Moreover, the use of plementary universal health insurance arrangements. In 2005, organochlorine pesticides over a number of years in Guadeloupe one-quarter of the population in the Antilles and one-third of the and Martinique has negatively affected the natural environment population in French Guiana had supplementary universal health (water bodies, river sediment, and soils). Several studies have insurance coverage. been conducted or are currently under way to gauge the health The availability of housing is growing, due in part to tax mea- risks for the inhabitants of these regions. sures that encourage new housing construction as well as a greater In French Guiana, the principal environmental health issues supply of low-cost rental accommodations.