State of Health in the EU France Country Health Profile 2017 European on Health Systems and Policies a partnership hosted by WHO The Country Health Profile series Contents The State of Health in the EU profiles provide a concise and 1 • HIGHLIGHTS 1 policy-relevant overview of health and health systems in the EU 2 • HEALTH IN FRANCE 2 Member States, emphasising the particular characteristics and 3 • RISK FACTORS 4 challenges in each country. They are designed to support the efforts of Member States in their evidence-based policy making. 4 • THE HEALTH SYSTEM 6 5 • PERFORMANCE OF THE HEALTH SYSTEM 8 The Country Health Profiles are the joint work of the OECD and 5.1 Effectiveness 8 the European Observatory on Health Systems and Policies, in 5.2 Accessibility 11 cooperation with the European Commission. The team is grateful for the valuable comments and suggestions provided by Member 5.3 Resilience 13 States and the Health Systems and Policy Monitor network. 6 • KEY FINDINGS 16 Data and information sources The data and information in these Country Health Profiles are The calculated EU averages are weighted averages of the based mainly on national official statistics provided to Eurostat 28 Member States unless otherwise noted. and the OECD, which were validated in June 2017 to ensure the highest standards of data comparability. The sources and To download the Excel spreadsheet matching all the methods underlying these data are available in the Eurostat tables and graphs in this profile, just type the following Database and the OECD health database. Some additional data StatLinks into your Internet browser: also come from the Institute for Health Metrics and Evaluation http://dx.doi.org/10.1787/888933593532 (IHME), the European Centre for Disease Prevention and Control (ECDC), the Health Behaviour in School-Aged Children (HBSC) surveys and the World Health Organization (WHO), as well as other national sources. Demographic and socioeconomic context in France, 2015 France EU Demographic factors Population size (thousands) 66 624 509 394 Share of population over age 65 (%) 18.4 18.9 Fertility rate¹ 2.0 1.6 Socioeconomic factors GDP per capita (EUR PPP2) 30 800 28 900 Relative poverty rate3 (%) 6.5 10.8 Unemployment rate (%) 10.4 9.4 1. Number of children born per woman aged 15–49. 2. Purchasing power parity (PPP) is defined as the rate of currency conversion that equalises the purchasing power of different currencies by eliminating the differences in price levels between countries. 3. Percentage of persons living with less than 50 % of median equivalised disposable income. Source: Eurostat Database. Disclaimer: The opinions expressed and arguments employed herein are solely those of the authors any territory, to the delimitation of international frontiers and boundaries and to the name of any and do not necessarily reflect the official views of the OECD or of its member countries, or of the territory, city or area. European Observatory on Health Systems and Policies or any of its Partners. The views expressed Additional disclaimers for WHO are visible at http://www.who.int/bulletin/disclaimer/en/ herein can in no way be taken to reflect the official opinion of the European Union. This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over © OECD and World Health Organization (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies) Highlights . 1 1 Highlights France The health status of the population in France is good and life expectancy continues to increase, but there are substantial disparities by gender and socioeconomic status. The French health system generally provides good access to high-quality care, but further improvements require greater emphasis on prevention and continuing the transformation of the system to better serve growing numbers of people living with chronic conditions. Health status Life expectancy at birth, years FR EU Life expectancy at birth in France reached 82.4 years in 2015, up from 79.2 years in 82 82.4 2000, and is one of the highest among EU countries. These gains have been driven mainly 81 by reductions in mortality rates after the age of 65. At age 65, women on average live 80 80.6 79.2 an additional 23.5 years, including 10.7 years disability free, for men 19.4 years and 9.8 79 78 years respectively. 77.3 77 82.4 76 YEARS 2000 2015 Risk factors % of adults in 2014 FR EU In 2014, 22% of French adults smoked tobacco every day, down from 27% in 2000, but still above the EU average. Overall alcohol consumption per adult has also decreased, but remains Smoking 22% higher than the EU average. About 15% of adults in France were obese in 2014, up from 9% in 2000. Overweight and obesity among 15-year-old adolescents has also increased to Alcohol 12 litres 14% in 2013-14, up from 11% in 2001-02. Regular physical activity among adolescents is lower than in most other EU countries, notably among girls. Obesity 15% Health system Per capita spending (EUR PPP) FR EU Health spending in France is higher than in most other EU countries, with health €4 000 expenditure reaching EUR 3 382 per capita in 2015, compared to the EU average of €3 000 EUR 2 797. This is equivalent to 11.1% of GDP, also well above the EU average of 9.9%. €2 000 Because over three-quarters of health expenditure is publicly funded and complementary €1 000 health insurance plays an important role, the share of out-of-pocket spending is the lowest among EU countries. €0 2005 2007 2009 2011 2013 2015 Health system performance Effectiveness Access Resilience Amenable mortality in France is among Access to health care is generally good, The modernisation and the lowest in EU countries. More people and unmet care needs remain low in streamlining of the hospital survive life-threatening conditions such as comparison with EU average, even if sector are under way, heart attack, stroke and different cancers. disparities across income groups exist. One but the challenges are persisting challenge is to address regional to strengthen prevention, disparities in access to care. primary care and care coordination. Another Amenable mortality per 100 000 population FR EU challenge is to promote a more appropriate % reporting unmet medical needs, 2015 250 High income All Low income use of pharmaceuticals and balance access 200 and affordability considerations in the 175 150 FR coverage of innovative medicines. 126 100 103 78 50 EU 0 2005 2014 0% 3% 6% STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – FRANCE 2 . Health in France France 2 Health in France Life expectancy in France is among the There are also large disparities in mortality and life expectancy highest in the EU attributable to preventable causes across socioeconomic groups, particularly among men. Life expectancy at age 35 for men in France has the third highest life expectancy among all EU lower occupational categories is more than 6 years shorter than countries (after Spain and Italy), with life expectancy at birth for men in higher occupational groups (Blanpain, 2016). reaching 82.4 years in 2015, nearly two years above the EU average (80.6 years) (Figure 1). The life expectancy in France Cancer is the main cause of death in France, 1 increased by more than three years between 2000 and 2015. followed by deaths from cardiovascular There is a strong gender and socioeconomic diseases gap in life expectancy Cancer is the leading cause of death in France, accounting for 28.5% of all deaths in 2014, followed by cardiovascular The gender gap in life expectancy in France is higher than in most diseases, which accounted for 25%. However, there are gender other EU countries, and women lived more than six years longer differences (Figure 2): 33% of all deaths among men were related than men in 2015. However, the gender gap in healthy life years is to cancer, while this proportion was lower among women (24%). much smaller as women live a greater proportion of their lives with Cardiovascular diseases accounted for the greatest share of some disabilities.2 At age 65, only 45% of the remaining years female deaths (27%). of life for French women on average are lived without disabilities (10.7 years out of 23.5 years in remaining life expectancy), while Looking at trends in more specific causes of death, heart diseases this proportion is about half among men (9.8 years out of 19.4 (ischaemic and other) are the main causes of death, but the years of life expectancy). Figure 1. The French population enjoys the third highest life expectancy at birth in the EU France Years 2015 2000 90 82.4years of age 85 EU Average 80.6 years of age 83.0 82.7 82.4 82.4 82.2 81.9 81.8 81.6 81.6 81.5 81.3 81.3 81.1 81.1 81.0 80.9 80.8 80.7 80.6 80 78.7 78.0 77.5 77.5 76.7 75.7 75.0 74.8 74.7 75 74.6 70 65 60 EU Italy Spain Malta Latvia Cyprus Poland Ireland Greece Austria Croatia Finland France Estonia Sweden Belgium Bulgaria Portugal Hungary Slovenia Romania Denmark Germany Lithuania Netherlands Luxembourg Czech Republic Slovak Republic United Kingdom Source: Eurostat Database. 1. For the first time in many years, life expectancy came down in 2015 compared to 2014 (by 0.5 year). This reduction was driven mainly by an increase in mortality among elderly people due to an exceptionally long epidemic of flu and some exceptional weather fluctuations (Bellamy and Beaumel, 2016).