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A study on the pre-COVID-19 health of French citizens to help decision-makers reduce the disease burden

20 Mar 2024 | By Inserm (Newsroom) | Public health

StéthoscopeA new study provides an overview of the health of French citizens just prior to the 2019 pandemic and its evolution from 1990 to 2019 © Unsplash

In order to implement suitable public health policies, it is crucial to know the health status of the population and its evolution over time. This knowledge is all the more important given the severe disruptions caused by the COVID-19 pandemic to healthcare systems worldwide. For the first time, a study by teams from Inserm, Université de Bordeaux and Bordeaux University Hospital in collaboration with Santé publique France, French National Health Insurance (CNAM) and the Global Burden of Disease (GBD) study collaborators, provides an overview of the health of French citizens just prior to the 2019 pandemic, and its evolution from 1990 to 2019. This research also compares the French situation with that of other European countries, resulting in an accurate assessment to guide public decision-making and reflect on the more general impact of COVID-19 on French health. The study findings have been published in The Lancet Regional Health.

The COVID-19 pandemic has disrupted the organisation of healthcare systems and exacerbated problems that many countries, including France, were already facing, such as inequalities in healthcare access, hospital pressures and shortages of healthcare professionals. In order to address these challenges beyond the usual surveillance systems, it is essential to make a more accurate diagnosis of the health of French citizens prior to the COVID-19 crisis, particularly in an attempt to analyse its specific impact on different health indicators.

This is the proposal of a new study by teams from Inserm, Université de Bordeaux and Bordeaux University Hospital, in collaboration with Santé publique France and French National Health Insurance (CNAM). This study evaluated several French health indicators in 2019 prior to the pandemic, as well as their evolution from 1990 to 2019, and offers a comparison of France’s situation with that of other Western European countries over the same period.

The added value of GBD data

The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation, has been conducted since 1990 by a global network of 5,647 employees across 152 countries and territories. The 2019 study analyses 286 causes of death, 369 diseases and injuries, and 87 risk factors in 204 countries and territories. GBD has been used to inform health policies in many nations and local jurisdictions, as well as by international organisations such as the World Bank and World Health Organization.

However, this wealth of data had never previously been used and presented specifically for France to describe the health evolution of its citizens through indicators reflecting sociodemographic status, life expectancy, healthy life expectancy and years lived with disability.

Some definitions

Life expectancy: this is the life expectancy at birth, which represents the average life expectancy of a fictitious generation subject to the age-specific mortality conditions prevailing that year.

Healthy life expectancy: this is the average life in good health, i.e. without irreversible limitation of activity in daily life or disability – of a fictitious generation subject to the conditions of mortality and morbidity prevailing that year.

Years of life lost: this is an indicator of premature mortality. It represents the number of life years lost due to a disease having caused premature death in relation to the life expectancy of the population.

Years lived with disability: this is an indicator used to estimate morbidity – i.e. the ‘weight of a disease’ in terms of disability – in years lived with the disability for a given disease. This number of years is weighted according to the nature of the disability.

Disability-adjusted life-years (DALYs): this is the number of years of healthy life years ‘lost’ due to illness, disability or death and is the sum of the two previous indicators (Years of life lost + Years lived with disability).

Improved life expectancy and healthy life expectancy

The results of the analysis confirm that over the period considered (1990 to 2019), life expectancy at birth in France had improved over time, from 77.2 years in 1990 to 82.9 years in 2019, ranking it seventh in terms of life expectancy among the 23 western European countries studied. What is more, the French live longer in good health on average, with their healthy life expectancy having also increased – this time from 67 to 71.5 years, and placing the country in fourth position.

The increase in healthy life expectancy makes it possible to hypothesise on the improvements made in certain areas, such as better care or more appropriate prevention, thereby limiting the development of diseases. This study thus makes it possible to estimate the burden of diseases according to their impact on the various GBD indicators.

Compared to other European countries, cardiovascular diseases play a smaller role in morbidity and mortality in France.

‘We have observed that the stroke and ischaemic heart disease burden is lower in France than in other Western European countries. This finding, which has been seen in the past, could be explained by a lower prevalence of many cardiovascular risk factors (hypertension, diabetes) and a healthier lifestyle (exercise, diet) in France. Efforts must continue to be made to prevent and treat these diseases, whose prevalence nevertheless continues to remain high,’ explain the authors.

It is also important to provide better care for mental health disorders (particularly depressive- and anxiety disorders) and musculoskeletal disorders (particularly low back pain) which represent the main reasons for years lived with disability.

The study also highlights the progress that needs to be made in preventing cancer, particularly by continuing efforts to combat smoking. In France, as in other European countries, cancer is still the leading cause of mortality.

‘Overall, these findings highlight a marked trend towards the improvement of health in France. They should encourage decision-makers to design intervention strategies to reduce the burden of morbidity and mortality, paying particular attention to causes such as cancer, cardiovascular diseases, mental health and musculoskeletal disorders,’ the authors point out.

This study is therefore a valuable resource, complementing the regular epidemiological surveillance conducted by Santé publique France in particular, to guide public policies and implement relevant measures to improve prevention initiatives and access to healthcare. It is also an important first step towards improving our understanding of the impact of the COVID-19 pandemic on the health of French people. The same study will now have to be carried out with the data collected at the end of the health crisis on these same key indicators, in order to highlight any changes in the population’s health.

Researcher Contact

François Alla

Bordeaux Population Health (Inserm/Université de Bordeaux)

CHU Bordeaux

email: rf.xuaedrob-uhc@alla.siocnarf

Florence Francis-Oliviero

Bordeaux Population Health (Inserm/Université de Bordeaux)

CHU Bordeaux

email: rf.xuaedrob-u@sicnarf.ecnerolf

Press Contact



The health state of France before COVID-19 pandemic between 1990 and 2019: an analysis of the Global Burden of Disease study 2019


The Lancet Regional Health – Europe, February 2024



Francis-Oliviero Florence a b c,

Constantinou Panayotis d, Haneef Romana e,

French GBD collaborators, Schwarzinger Michaël b f,

Anne Gallay e, Antoine Rachas d, François Alla b c f


a Service d’information médicale, Bordeaux University Hospital, 33000 Bordeaux, France

b Inserm UMR 1219-Bordeaux Population Health, 33000 Bordeaux, France

c University of Bordeaux, 33000 Bordeaux, France

d Direction de la stratégie, des études et des statistiques, Caisse nationale de l’Assurance Maladie, 75986 Paris Cedex 20, France

e Department of Non-Communicable Diseases and Injuries, Santé publique France, Saint-Maurice, France

f Department of Methodology and Innovation in Prevention, Bordeaux University Hospital, 33000 Bordeaux, France