Pan American Health Organization

Country Report: French Guiana, Guadeloupe, and Martinique

Guadeloupe, French Guiana, and Martinique are French Overseas Departments in the Americas and have been an integral part of France since 1946. The archipelago of Guadeloupe is the larger of the two island territories, with a land area of 1,703 km2. Martinique has 1,128 km2, and French Guiana, 83,534 km2.

Guadeloupe and Martinique enjoy a tropical climate and are often buffeted by tropical storms between July and October. French Guiana has an equatorial climate, and 95% of its territory is covered by dense Amazonian forest. In 2015, the populations of Guadeloupe and Martinique were comparable in size (402,119 and 385,551, respectively), while that of French Guiana numbered 244,118.

In 2014, life expectancy at birth in Martinique was 83.9 years in women and 78.1 years in men; in Guadeloupe, it was 83.4 years and 76.1 years, respectively; while in French Guiana, it was 83.1 years and 76.7 years, respectively. Per capita gross domestic product (GDP) in 2015 was €22,571 in Martinique, €20,163 in Guadeloupe, and €16,645 in French Guiana.

Highlights
  • As part of France, the three French Overseas Departments have an effective social security system and universal basic health coverage, in addition to robust and complementary health insurance systems based on solidarity.
  • In 2016, the strategy for the overseas territories formulated by the Ministry of Health and Ministry of Overseas Territories set five broad priorities for public health action: a) improve health status, reduce inequalities, and increase health promotion; b) carry out health surveillance and crisis management; c) respond to the needs of an aging population and people with disabilities; d) improve the health system, research, and innovation; and e) reduce inequities in access to health services.
  • The Guadeloupe Health Education Committee and the Martinique Committee for Prevention and Health Education contribute to health promotion, which the strategy has designated a priority.
  • In addition, numerous associations, including entities at the national, district, and municipality levels, as well as patient advocacy groups, together play an essential role as partners in disease prevention, bringing their expertise to bear in such areas as HIV/AIDS, substance abuse, sickle-cell disease, and cancer.
Figure 1. Distribution of the population by age and sex, Guadeloupe, 1990 and 2015
Figure 2. Distribution of the population by age and sex, French Guyana, 1990 and 2015
Figure 3. Distribution of the population by age and sex, Martinique, 1990 and 2015
 MORTALITY CAUSES
Proportional Mortality (% of all deaths, all ages, both sexes), 2014

Source: Pan American Health Organization and PAHO Health Information Platform (PHIP).

 SELECT BASIC INDICATORS
Indicator Year Guadeloupe French Guyana Martinique
Population (thousands) 2015 402.1 244.1 385.6
Gross national income by purchasing power parity (ppp, US$ per capita) 2014 ... ... ...
Human Development Index 2013 ... ... ...
Mean years of schooling 2014 ... ... ...
Improved drinking-water source coverage (%) 2015 99.0 92.0 100.0
Improved sanitation coverage (%) 2015 97.0 92.0 92.0
Life expectancy at birth (years) 2013 81.5 79.9 82.1
Infant mortality (per 1,000 live births) 2013 8.4 8.2 8.2
Maternal mortality (per 100,000 live births) 2013 17.3 16.4 21.7
TB incidence (per 100,000 inhabitants) 2013 4.5 28.0 3.8
TB mortality (per 100,000 inhabitants) 2013 ... ... ...
Measles immunization coverage (%) 2015 ... ... ...
Births attended by trained personnel (%) 2014 100.0 ... 99.9

   Source: National estimates and Organización Panamericana de la Salud. PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.

 SOCIAL DETERMINANTS OF HEALTH
  • Nineteen percent of households are poor in Guadeloupe, 21% in Martinique, and 44% in French Guiana.
  • In 2015, the unemployment rate was 22.3% in French Guiana, 23.7% in Guadeloupe, and 19.4% in Martinique. Young people and women were the most affected.
  • School attendance is compulsory for children aged 6-16.
  • The three territories are highly vulnerable to natural disasters, especially earthquakes, tropical storms, and volcanic eruptions.
  • In 2008, France created a welfare program that provides eligible individuals with a guaranteed minimum income and access to certain social benefits, along with social and employment services. In the Overseas Departments, 26.4% of the population benefits from this program.
  • In French Guiana, access to clean drinking water is more limited, especially for populations in the interior and marginal urban sectors. This is associated with a higher incidence of enteric diseases.
  • Gold mining in French Guiana gives rise to environmental problems such as water pollution, deforestation, the decimation of wildlife, and malaria transmission.
  • In 2013, migrants represented 1.8% of the population in Martinique, 5% in Guadeloupe, and 33% in French Guiana.
 HEALTH SITUATION AND THE HEALTH SYSTEM
  • The two leading causes of maternal death are hemorrhage during delivery and maternal hypertension.
  • In 2015, the infant mortality rate was 7.6 deaths per 1,000 live births in Martinique, 8.1 in Guadeloupe, and 9.9 in French Guiana. Between 10% and 12% of births are premature.
  • In 2013, 6,600 deaths were recorded in the three departments. The principal groups of causes of death were cardiovascular diseases, infectious and parasitic diseases, and symptoms and signs not elsewhere classified (the latter are as high as 18.3% in French Guiana and 13.4% in Guadeloupe).
  • Martinique and Guadeloupe report less than 10 imported cases of malaria per year, but the disease is endemic in French Guiana, with 434 cases recorded in 2015.
  • Between 2000 and 2009, 192 cases of Chagas disease were recorded in French Guiana, but none were recorded in the two island departments.
  • No cases of poliomyelitis, diphtheria, or neonatal tetanus have been reported in decades. Measles and rubella have been declared eliminated in the departments.
  • Dengue is endemic in all three departments, and malaria is widespread in French Guiana’s interior. The three territories have had frequent dengue epidemics, resulting in a number of serious and even fatal cases (the case-fatality rate ranges from 0.03% to 0.06%).
  • The chikungunya virus was introduced in late 2013, triggering an epidemic that led to 72,500 medical consultations in Martinique, 81,200 in Guadeloupe, and 320 in French Guiana. Zika virus has circulated in all the departments, with 16 reported instances of associated congenital syndrome in French Guiana, 6 in Guadeloupe, and 18 in Martinique by the beginning of 2017.
  • Leprosy is endemic. In 2015, 21 cases were recorded in French Guiana, 5 in Guadeloupe, and none in Martinique.
  • The tuberculosis incidence rate in 2013 was 4.5 cases per 100,000 population, ranging from 4.5 in Guadeloupe and 3.8 in Martinique to 28.0 in French Guiana.
  • In 2013, 907 new cases of human immunodeficiency virus (HIV) infection were reported in French Guiana, 240 in Guadeloupe, and 225 in Martinique. Due to the availability of antiretroviral drugs, mortality from AIDS is relatively low and stable.
  • Guadeloupe and Martinique recorded 69.4 and 60.9 cases of leptospirosis per 100,000 population, respectively, in 2011. In French Guiana, leptospirosis cases have been reported regularly over the past three decades.
  • Chronic non-communicable diseases are the most common illnesses affecting the population, and cardiovascular diseases are the leading cause of death in Guadeloupe and French Guiana.
  • In 2014, diabetes prevalence ranged from 10% to 11%, increasing with age. A growing proportion of the population in both Guadeloupe and Martinique is overweight or obese.
  • In 2003-2004, the prevalence of hypertension in the population aged 16 or over was 22% (20% in men and 25% in women). Prevalence increases with age, affecting 65% of people aged 65 and over.
  • Approximately 1,300 deaths from malignant neoplasms are recorded annually. In men, the most common forms are prostate and colorectal cancers; in women, breast, colorectal, and cervical cancers.
  • In 2015, there were 40 deaths linked to road traffic accidents in Guadeloupe, 29 in Martinique, and 28 in French Guiana.
  • Daily tobacco use in people aged 16 or over was 15% in Martinique, 12% in French Guiana, and 12% in Guadeloupe in 2014.
  • The Regional Health Agency (ARS) is in charge of implementing health policies in each of the French Overseas Departments. Health care is provided by hospital complexes and private clinics.
  • France has a system of universal basic health coverage that provides access to health insurance to anyone who has lived in France for at least three months and who does not have other health insurance coverage. The fee at point of service is low, and most of it is reimbursed under the social security health plan.
  • The plan also includes supplementary health insurance coverage, which, unlike basic universal health insurance, provides additional health care free of charge. This type of supplementary health insurance is targeted to the neediest populations.
  • A high percentage of the population in the three French Overseas Departments is covered by these basic and supplementary health insurance regimens.
  • French Guiana has primary care health centers that are designed to serve geographically isolated residents with limited access to services, who account for approximately 20% of the population.
  • Annual per capita health expenditure is approximately € 2,000 in Martinique, € 1,800 in Guadeloupe, and € 1,400 in French Guiana.
  • The shortage and uneven distribution of health professionals is most critical in French Guiana, which has an insufficient number of general practitioners and specialists in both hospitals and outpatient centers.
  • In French Guiana, topography hinders the population’s mobility and thus its access to health care. The remotest areas suffer from a scarcity of health care centers and health workers.
 ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
  • The population’s health status has improved over the past 30 years. In Guadeloupe, the main indicators show gains over the past two decades, with a decline in infant mortality, an overall improvement in the standard of living, and progress in medical care and health services delivery.
  • Despite advances in health, certain problems persist, such as hypertension, stroke, diabetes, and mental disorders.
  • Martinique and Guadeloupe, whose populations have greater life expectancy at birth and greater longevity than French Guiana, increasingly face public health problems associated with aging, especially chronic non-communicable diseases.
  • Zoonoses continue to be a cause for concern in the departments, especially in French Guiana, together with HIV infection.
  • The health strategy designates health promotion as a priority, along with prevention and education.
 WEB / SOCIAL MEDIA
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