French Guiana, Guadeloupe, and Martinique
- Overall Context
- Leading Health Challenges
- Health Situation and Trends
- Full Article
The islands of Guadeloupe and Martinique in the Lesser Antilles, and French Guiana, on the northern coast of South America between Suriname and Brazil, are the three French overseas departments in the Region of the Americas; they have been an integral part of France since 1946. Their political and administrative organization into departments and regions mirrors that of the rest of France. The archipelago of Guadeloupe, extending for 1,703 km2, is the larger of the two islands. It comprises Guadeloupe proper (with separate landmasses, Basse-Terre and Grande-Terre, bisected by a seawater channel), the islands of Marie-Galante, Les Saintes, La Désirade, Saint-Barthélemy, and the French section of Saint-Martin. Martinique spreads over 1,128 km2, and French Guiana, over 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 clime and 95% of its territory includes dense Amazonian forest, crisscrossed by rivers of all sizes.
Overseas France, which was restructured in 2003, is legislatively split into two distinct entities. The five overseas departments (Départements d’Outre-Mer) created in 1946 (Martinique, French Guiana, Guadeloupe, Mayotte, and Réunion), are subject to the same legislature as France’s metropolitan departments. On the other hand, the partially autonomous overseas territorial collectives (e.g., New Caledonia, French Polynesia), are subject to special legislative regimes.
State administration is centralized, but the French Overseas Departments have some decentralized government departments (services déconcentrés de l’état).
As of 1 January 2013, Guadeloupe and Martinique had comparable populations (402,119 and 385,551 inhabitants respectively). French Guiana had 244,118 inhabitants, but its population is expected to double by 2030. In terms of population density, Martinique is the most densely populated territory, with 342 inhabitants per km in 2013, followed by Guadeloupe with 247, and French Guiana with only 2.9.
Table 1. Basic health indicators, French Guiana, Guadeloupe, and Martinique, 2015 or latest available year
|Population (in thousands) (2015)||277||400||386|
|Annual population growth (%) (2015)||2.4||0.5||0.2|
|Total fertility rate (child/woman) (2015)||3.0||2.1||1.8|
|Life expectancy at birth (years) (2015)||79.9||81.5||82.1|
|General mortality rate per 1,000 population (2014)||4.16||3.79||3.53|
|Infant mortality rate per 1,000 live births (2015)||8.2||8.4||8.2|
|Reported mortality rate per 100,000 live births (2015)||16.4||17.3||21.7|
|HIV/AIDS incidence rate per 100,000 population (2014)||78.9||16.9||13.9|
|Physicians per 10,000 population (circa 2014)||17.5||26.4||26.2|
|Nurses per 10,000 population (circa 2014)||48.7||61.2||81.7|
|Hospital beds per 1,000 population (2011-2014)||2.7||5.2||4.1|
|Institutional delivery coverage (%) (2013)||n/a||100.0||99.9|
Source: Elaborated by the author with information from the Ministry of Health.
The population distribution also differs from department to department, the population in all three is still young, but aging. With 16.8% of its population aged 60 years or older in 2016, Martinique has the highest share of older adults. In contrast, French Guiana has the youngest population, with 44% being under the age of 20 years. Table 1 shows the basic health indicators for the French Departments in 2015, or latest available year. (Figures 1-3 show population pyramids for French Guiana, Guadeloupe, and Martinique for 1990 and 2015.) The population of the French West Indies is mainly mixed (Amerindian, Black, White, and Indian). French Guiana’s population is a mix of Amerindians, Europeans, Black African descendants, Chinese, and Lebanese; the territory also has a settlement of Hmong farmers from Upper Laos.
Figure 1. Population structure, by age and sex, French Guiana, 1990 and 2015
The population increased 132.0% between 1990 and 2015. In 1990, the population structure had an expansive structure in groups older than age 35 years, with lesser expansiveness in groups under that age. By 2015, the pyramidal structure had narrowed in the middle age groups, becoming expansive again in the groups younger than 30 years old. These changes reflect periods of natural growth, fertility, and migration, leading to the significant population growth in the last 25 years.
Source: Pan American Health Organization, based on the United Nations Department of Economic and Social Affairs, Population Division. Revision 2015, New York, 2015.
In Guadeloupe, over 40% of the population lives in Pointe-à-Pitre, the economic capital located on Grande-Terre; only 10% of the population lives in the administrative center of Basse-Terre, on the island of Basse-Terre. In Martinique, more than one-third of the population lives in the administrative center, Fort-de-France. In French Guiana, most of the population lives along the coast; the dense rainforest cover renders inland municipalities more difficult to reach.
Figure 2. Population structure by sex and age groups, Guadeloupe, 1990 and 2015
The population increased 20.1% between 1990 and 2015. In 1990, the population structure had an expansive structure in the age groups older than 15 years and a regressive shape in the groups younger than that. By 2015, the pyramidal shape moved to ages older than 50 years. The structure became irregular under that age, with regressive trends in the groups under 15 years. The age groups in between had narrowed, especially between 20 and 40 years. These changes reflected the influence of ageing, natural growth (regressive in the last two decades), and migration.
Source: Pan American Health Organization, based on the United Nations Department of Economic and Social Affairs, Population Division. Revision 2015, New York, 2015.
Life expectancy at birth is highest in Martinique, at 83.9 years for women and 78.1 years for men in 2014. In Guadeloupe the figure was 83.4 years for women and 76.1 years for men; in French Guiana, 83.1 years for women and 76.7 years for men. These figures represent an increase compared to 1990, when life expectancy at birth was 79.6 years for women and 73.3 years for men in Martinique; 78.5 years for women and 70.8 years for men in Guadeloupe; and 76.1 years for women and 67.2 years for men in French Guiana.
Figure 3. Population structure, by age and sex, Martinique, 1990 and 2015
Martinique’s population increased 10.6% between 1990 and 2015. In 1990, the population structure had an expansive structure in the groups older than 15 years, and stationary growth in the groups under that age. By 2015, the pyramidal shape had shifted to age groups older than 50 years old. The structure became irregular under that age, with regressive trends in the groups younger than 15 years. The age groups in between narrowed, especially in the fourth decade of life. These changes reflect the influence of ageing, natural growth (regressive in the last two decades), and migration.
Source: Pan American Health Organization, based on the United Nations Department of Economic and Social Affairs, Population Division. Revision 2015, New York, 2015.
Because they are part of France, the French Overseas Departments are considered to be “ultra-peripheral regions” in terms of the European Union, meaning that they benefit from special protective measures and structural funding. The euro is their official currency. The economy of the French Overseas Departments shares challenges common to small island entities, such as a reliance on tourism and natural resources. Moreover, the Departments’ economic and political stability is tied to a heavy financial dependence on metropolitan France. French Guiana’s economy depends on earnings from Europe’s Spaceport, which France has made available to the European Space Agency as a satellite-launching base. Gold panning is the leading export activity for the territory, an activity that is also a source of illegal employment and widespread trafficking. In Guadeloupe and Martinique, the mainstay of the economy is the cultivation and export of bananas, a sector that is beset by constant fluctuations in market conditions.
The French Overseas Departments rank lower than all regions in metropolitan France in terms of per capita GDP. In 2015, per capita GDP was € 22,571 in Martinique, € 20,163 in Guadeloupe, and € 16,645 in French Guiana. It should be noted that their GDP is less a reflection of wealth and productive activities than it is of their unique departmental status, with the French Government providing them with subsidies and imports.
School attendance is obligatory for children ages 6 to 16 years old, and nearly all children ages 3 6 years old attend school. There were 138,000 students in the French departments during the 2014 2015 school year. Baccalaureate pass rates are improving. Because not all study courses are available locally, some young people must continue their studies in metropolitan France or other countries.
The French Departments are environmental fragile and vulnerable to natural disasters. Natural hazards, such as earthquakes, tropical storms, and volcanic eruptions, are taken into account in the development of major risk prevention plans. In French Guiana, the leading environmental health issues are water supply problems and the consequences of gold panning. The pillaging of gold deposits takes place on the fringes of authorized mining sites and in the jungle interior. The environmental impact of this activity has manifested itself dramatically through deforestation, the decimation of wildlife, mercury pollution of rivers, and malaria transmission.
The unemployment rate in 2015 was very high in all three departments: in French Guiana, 22.3% of the working-age population was without a job; in Guadeloupe, it was 23.7%; and in Martinique, 19.4%. Those hardest hit by unemployment are the young, especially the least skilled among them, and women. In French Guiana, unemployment is felt more acutely, because the generation of job opportunities has not kept pace with the marked increase in the size of the workforce.
In France, a mechanism was devised in 2008 called the Revenu de Solidarité Active (RSA), or Minimum Integration Income, which provides individuals with a minimum of resources, access to certain social benefits, and assistance with social or professional integration. The percentage of RSA beneficiaries is higher in the French Overseas Departments than in metropolitan France (7.86% in France and 26.4% in the Overseas Departments).
Housing is increasingly available due, in part, to tax measures that encourage new housing construction, as well as to a greater supply of low-cost rental accommodations. The demand for housing remains high, particularly in French Guiana, due to its population’s growth and the number of households. A 2011 survey conducted by the National Institute of Statistics and Economic Studies (INSEE for its French acronym) of France found that the percentage of poor households in the French Overseas Departments was higher than in metropolitan France: 19% in Guadeloupe, 21% in Martinique, and 44% in French Guiana.
The Health System
The Agence Regionale de Santé (ARS), or Regional Health Agency, is charged with implementing health policies in each of the French Departments. Health care is provided by hospital complexes and private clinics. French Guiana has primary health centers specifically designed to respond to the needs of geographically isolated residents; for the scattered and isolated communities that make up 20% of French Guiana’s population, these health centers represent the only access to health care. Facilities in the short-term care sector are generally satisfactory, but inadequate in the area of follow-up care and psychiatry.
Expenditures on health care and medical products continued to increase between 2010 and 2015. Annual expenditure is approximately € 2,000 per inhabitant in Martinique, € 1,800 in Guadeloupe, and € 1,400 in French Guiana; these variations are partly due to the different population structures in each Department and to historical inequalities in care. Hospitals, especially public hospitals, account for the bulk of expenditures. In addition to these outlays, major sums are disbursed each year by the State, or the Conseil Général, in the social sector for special groups, including the elderly and persons with disabilities.
Technical cooperation funding for the French Overseas Departments comes exclusively from partnerships, programs, and financing mechanisms that have been developed with other EU members; the Overseas Departments do not receive cooperation funds from international institutions such as the World Bank, or from United Nations entities.
Leading Health Challenges
Critical Health Problems
In Guadeloupe and Martinique, health conditions generally reflect those of developed countries. The situation in French Guiana is more mixed, however: while some indicators resemble those of developed countries, such as chronic disease incidence and relative wealth, the territory continues to exhibit some characteristics typical of developing countries, such as a young population, high perinatal mortality, and a high incidence of infectious and parasitic diseases.
Dengue is endemic in all departments and malaria is widespread in French Guiana’s interior, with few non-autochthonous cases in the other two departments. In the French Overseas Departments, there was a serotype 2 dengue epidemic Between September 2012 and October 2013 the French Overseas Departments experienced a severe serotype 2 dengue epidemic that affected more than 13,000 persons and was responsible for 6 registered deaths. The dengue epidemic in Guadeloupe and Martinique at the end of 2012 was mainly due to serotypes 2 and 4. In Martinique, the epidemic in 2013 2014 is estimated to have affected approximately 10,000 people, leading to 128 hospitalizations and 3 deaths (case fatality ratio of 0.03%). In Guadeloupe, approximately 15,000 cases were estimated, leading to 235 hospitalizations and 9 deaths (case fatality ratio of 0.06%). The first case of chikungunya in the Caribbean was detected in Saint Martin in December 2013; the epidemic then spread to all departments. The number of consultations in general practice for chikungunya were estimated at 72,500 in Martinique, 81,200 in Guadeloupe, and 5,320 in Saint Martin.
Zika circulated in all the departments; 16 cases of congenital syndrome associated with Zika were confirmed in French Guiana, 6 in Guadeloupe, and 18 in Martinique (on 18 January 2017).
Neglected Diseases and other Infections Related to Poverty
Leprosy, or Hansen’s disease, remains endemic in the French Overseas Departments, although the incidence is declining. In 2015, there were no cases reported in Martinique, 5 were reported in Guadeloupe, and 21 in French Guiana. Each of the French Overseas Departments has a referral center for the disease, where patients’ screenings are done, consultations with a physician and social worker are conducted, and arrangements for home visits are made.
Surveys conducted between 2001 and 2005 in Martinique’s watercress fields and aquatic environments confirmed the successful eradication of the Biomphalaria glabrata snail, the main intermediate host for schistosomiasis. The absence of active transmission of the parasite for more than 20 years suggests that as of 2005 schistosomiasis had been eradicated. The acidic waters of French Guiana are very inhospitable habitats for the snail.
Better hygiene and imporved prevention and detection activities led by local health authorities, have led to a sharp decline in the number of helminth infections (ancylostomiasis and strongyloidiasis) in the French Departments over the past 20 years.
In 2013, the incidence rate of tuberculosis was 4.5 cases per 100,000 habitants; the disease was reported in Guadeloupe (45 cases per 100,000 population), Martinique (3.8), and French Guiana (28.0).
The number of teenage pregnancies is very high in French Guiana: in 2015, 6.2% of pregnancies occurred in mothers under 18 years, compared to the 1% figure in the French mainland. Elective abortion rates also are higher in French Departments, 26 per 1,000 woman in 2015, compared to an average of 14.4 in the mainland. Guadeloupe has the highest rate in all of France, at 37.4 per 1,000 women.
Noncommunicable, chronic diseases are the most common conditions in the population. For the 15 34-year-old age group, the leading chronic conditions among both sexes are mental disorders, diabetes mellitus, and cardiovascular diseases. However, among both women and men in the 35-64-year-old age group, the leading chronic conditions are cardiovascular diseases, diabetes mellitus, and neoplasms.
Mental health programs and services are available in all departments; in 2010 2015, the most frequent pathologies diagnosed were depression, suicidal tendencies, and generalized anxiety. The leading causes of hospitalization were schizophrenia, psychoses with delirium, and addiction-related disorders. Suicide and suicidal behaviour are addressed in a national plan covering each region in France, but a special plan has been addressed for the population of young Amerindian communities in French Guiana, where the suicide rate is 10 times higher than on mainland of France. In the French Overseas Departments, the average annual number of deaths from suicide is 10 per 100,000 population, most of them among men and the population older than 35 years.
The shortage and uneven distribution of health professionals are challenges in all three departments, but particularly in French Guiana, where the number of physicians, especially specialists, is insufficient. At the Cayenne hospital complex, numerous positions remain vacant or are filled by unqualified physicians; this situation is replicated in all the department’s health centers.
In Guadeloupe and Martinique, there are sufficient midwives. Nurses in the private sector meet current needs, but not in the public sector; for all other human resources in health career categories, the density rates are below those in metropolitan France. Medical and paramedical schools have substantially increased the number of training programs available and of students being trained, but the output of new professionals has remained insufficient to meet the demand. The first, second, and third year of medical studies are taught in the French Overseas Departments and training schools are there for health and paramedical professions, such as nursing and midwifery, physical therapists, nurse-anesthetists, and biomedical technicians.
Health Knowledge, Technology, and Information
As in all regions of France, 27 communicable diseases were identified for mandatory reporting to public health authorities through the sentinel surveillance system. The system is supported by a network of physicians, who, on a weekly basis, report suspected cases of dengue, influenza-like conditions, gastroenteritis, measles, chicken pox, gonorrhoea, and STIs, among others. The system is reinforced by reports from public and private laboratories, including the Pasteur Institute in Pointe-à-Pitre, Guadeloupe, which specializes in mycobacteria, and another Pasteur Institute in Cayenne, French Guiana, which is a referral center for arbovirus and influenza viruses. Given new potential threats to public health and heightened security concerns in the current global environment, strengthening early warning and response systems is a priority for the French Ministry of Health. The plan dealing with alert systems and health emergency management will strengthen local and regional health watch and warning facilities in the French Overseas Departments.
Registration of births and deaths is done at “Etat Civil” and then sent to the National Institute of Statistics and Economic Studies in each department. Coverage is exhaustive, except for very rare cases.
Health research mainly is carried out at the hospital level, with the involvement of reference centers for some pathologies and of each department’s Center for Clinical Investigation.
The Environment and Human Security
Two agencies are primarily responsible for environmental health concerns in the French Overseas Departments: the Interregional Epidemiology Unit (Cellule Interrégionale d’Épidémiologie d’Intervention [CIRE]), which directs interventions and responses to address environmental threats to health, and the National Health and Medical Research Institute (France), which focuses on research to address these issues.
In 2002-2003, the French Agency for Food Safety (Agence nationale de sécurité sanitaire de l’alimentation, de l’environment et du travail, or Anses) assessed the harmful effects to health of exposure to the organochlorine pesticide chlordecone in Martinique. According to a survey conducted by that Agency, 3% of Martinique’s population had been exposed to this pesticide in excess of the established safety benchmark for repeat exposure. It was found that mercury used in gold panning in French Guiana’s interior is contaminating river fish that, were being consumed by the population, particularly by some Amerindian populations living in the interior whose diet is high in freshwater fish (). Further studies of mercury exposure by CIRE confirmed that the most exposed population groups were those living along the upper reaches of the Maroni and Oyapock rivers, whose diet was largely based on fish consumption (). In response, a pesticide exposure prevention program was implemented.
The use of organochlorine pesticides over a number of years in Guadeloupe and Martinique has negatively affected the natural environment (water bodies, river sediment, and soils). Several studies have been conducted or are currently under way to gauge the health risks for the inhabitants of these regions ().
Due to its geographical features, French Guiana is unable to supply all of its inhabitants with safe water. This is particularly true for inland populations and for certain segments living along riverbanks or in marginal urban and periurban districts.
In French Guiana, the distribution of gastroenteritis is associated with water supply contamination for certain population segments. The incidence of enteric diseases exceeds 10% in some inland municipalities. Every year, an average of 10 outbreaks of food poisoning are recorded in each of the three French Overseas Departments. Cases of ciguatera poisoning are regularly reported in the Antilles (45 cases in Guadeloupe in 2015).
Long considered islands with young populations, Guadeloupe, and to an even greater extent Martinique, are now increasingly facing issues associated with an aging population. The percentage of those aged 65 years and older in Martinique almost tripled between the 1967 and 1999 censuses. In 2012, this population group was estimated to account for 20% of the total population in Guadeloupe and 22% in Martinique. At the other extreme, in French Guiana the proportion of those aged 65 years and older represented only 5.5% of the population in 2013.
The incidence of major health problems is highest after age 65 years, leading to more frequent contact with the health system in search for care. The frequency of comorbidities also increases, such as high blood pressure associated with diabetes, which significantly diminishes the quality of life. For persons 85 years and older, the prevalence of physical and/or psychological dependence rapidly increases.
In Martinique, the minority population of external origin-mainly Haitian and Saint Lucian nationals-remained stable at 1.8% of the total population in 2013. In Guadeloupe, immigrants accounted for 5% of the population, almost half of them from Haiti; Saint-Martin municipality accounts for half of all foreign nationals in that department.
In French Guiana the largest immigrant contingents are from Suriname (39%), Haiti (30%), and Brazil (15%). Officially, the population of external origin accounts for 33% of the population, but the numbers are likely to be higher, given the length of the territorial borders, the ease with which borders defined by the Maroni and Oyapock rivers may be crossed, and activities such as gold panning, all of which foster clandestine immigration.
Monitoring of the Health System’s Organization, Provision of Care, and Performance
In French Guiana, obstacles to access to health care include the territory’s geography (sizeable remote areas and the challenges these pose for timely communication and accessibility), its socio-demographic indicators (a rapidly growing population, fragile economy, and migration flows), and a scarcity of human resources and infrastructure (too few health professionals and a chronic shortage of medical equipment). To ensure that the entire population has access to health care, the French Government has implemented a measure called universal basic health coverage (), which provides access to health insurance for anyone who has lived in France for at least three months and who does not otherwise already have health insurance coverage. The plan also includes supplementary health insurance coverage, which, unlike basic universal health insurance, provides additional health care free of charge-that is, with no deductible and without having to pay an out-of-pocket reimbursement. Supplementary health insurance coverage is targeted towards the neediest populations. A high percentage of the population in the French Overseas Departments is covered by these basic and supplementary universal health insurance arrangements.
There are 359 pharmacies in the French Overseas Departments, excluding medical dispensaries in health centers. Of these, 164 are in Guadeloupe, 146 are in Martinique, and 49 are in French Guiana. Most pharmaceuticals are imported from France. Prices for reimbursable medications are set by the French public health authorities. There is no local production of vaccines in the French Overseas Departments and all vaccines are imported from France.
Health Situation and Trends
Health of Population Groups
Maternal and Reproductive Health
In 2013, the overall birth rate was 10.8 births per 1,000 inhabitants in Martinique, 12.9 in Guadeloupe, and 26.8 in French Guiana. Women of childbearing age (15-49 years) accounted for 50% of the female population in the Antilles and 52% of the female population in French Guiana. In 2015, there were 6,401 births reported in Guadeloupe, 4,645 in Martinique, and 6, 901 in French Guiana. The estimated fertility rate was two children per woman in the Guadeloupe and Martinique, and four children per woman in French Guiana. The two leading causes of maternal death are hemorrhage in childbirth and maternal high blood pressure. The average age of mothers at first birth is increasing in Martinique (29.3 years in 2013, according to INSEE) and Guadeloupe.
Child Health (Under 1 Year Old)
Although infant mortality improved in the French Overseas Departments, certain perinatal indicators remain higher than those in metropolitan France. While slight improvements have been recorded in the Guadeloupe and Martinique, progress in French Guiana has been slow and intermittent. 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, high compared to France mainland (3.4/1,000 live births). Most mortality occurred in the first weeks of life; the gap with mainland France is mainly linked to a higher rate of perinatal infection. In the French Overseas Departments, 10% to 12% of all births are premature.
Health of Children and Youth (1-14 Years Old)
The death rate in this group is low, roughly 1% of all deaths. Deaths as a result of trauma or poisoning represented 40% of all deaths in this age group in all three departments. In French Guiana, one-third of all deaths were due to trauma or poisoning, followed by 17% due to infectious and parasitic diseases. In Guadeloupe and Martinique, 40% of all deaths were due to trauma or poisoning, followed by 10% due to diseases of the respiratory system.
Health of Adolescents and Young Adults (15-34 Years Old)
Deaths in this age group represent approximately 5% of all deaths in the departments. Traffic accidents and other forms of violence were the leading causes in all three departments. In Guadeloupe and Martinique, these were followed by neoplasms and diseases of the circulatory system, while in French Guiana many deaths were caused by infectious and parasitic diseases. The leading chronic conditions among both sexes in this age group are mental disorders, diabetes mellitus, and cardiovascular diseases.
Health of Adults and the Elderly (35-64 years old)
Deaths in this age group account for an average of 25% of all deaths. Neoplasms and cardiovascular diseases were the leading causes of mortality in all three departments; in Guadeloupe and Martinique, these were followed by traffic accidents and other forms of violence. The leading chronic conditions among women and men 35-64 years old were cardiovascular diseases, diabetes mellitus, and neoplasms.
After age 65, the first two leading causes of death were diseases of the circulatory system and neoplasms, in rank order. In Guadeloupe and French Guiana, endocrine, nutritional, and metabolic disorders, primarily diabetes mellitus were the third leading cause of death. In Martinique, the third leading cause of death was respiratory diseases. For males in this age group, the three leading chronic conditions requiring long-term care were cardiovascular diseases, neoplasms, and diabetes mellitus. In women, the three leading chronic diseases requiring long-term care were cardiovascular diseases, diabetes mellitus, and mental disorders, including dementia and Alzheimer’s disease.
Health of the Family
Household size has continued to decline during 2010-2015: the decline is less marked in French Guiana; household size in Guadeloupe and Martinique is under three persons per household. Family structure also has shown a pronounced shift toward single-parent households, with approximately 40% of families in Guadeloupe and Martinique and one-third in French Guiana being headed by a single parent. In nine out of ten cases, these households are headed by women, reflecting both tradition (matriarchal societies) and more recent social trends (less permanent unions).
Health of the Disabled
As a consequence of the aging of the population, the number of disabled people that will need special care in French Departments in the Americas is expected to grow. This issue has been established as a priority in France’s new health strategy for overseas territories (). Adults with disabilities usually live with their families or in their own homes. There is limited space to care for disabled adults in specialized institutions, although there is more specialized institutional care available for children.
Approximately 7,000 deaths are registered each year in the three French Departments. The leading cause of death in all three departments is cardiovascular diseases, followed by neoplasms and external causes. In French Guiana, infectious and parasitic diseases rank fourth, while in the Antilles, endocrine, nutritional, and metabolic disorders-primarily diabetes mellitus-are the next leading cause of death.
In terms of vector-borne diseases, Martinique and Guadeloupe report fewer than 10 imported cases of malaria per year, but the disease is widespread in French Guiana’s interior. The annual number of cases in the French Guiana provinces where malaria is endemic, held stable at 4,000-5,000 reported cases until 1999, when there was a decline to 3,000 cases in 2002 and only 434 cases in 2015. Unregulated gold mining and the persistent population movement across vast remote areas make it extemely difficult to control malaria in French Guiana.
There were no reported cases of yellow fever in French Guiana, Guadeloupe, or Martinique in 2010-2015. All travellers to French Guiana are required to provide proof of yellow fever vaccination.
Chagas’ disease is not found in Guadeloupe or Martinique. Between 1939 and 1989, only nine cases of Chagas’ disease were reported in French Guiana. Between 2000 and 2009, 192 cases of Chagas’ disease have been diagnosed. Deforestation, uncontrolled migration, and the importation of the Chagas’ vector have increased the risk of disease in French Guiana.
The French Overseas Departments have a good record on the elimination of vaccine-preventable diseases. There have been no reported cases of poliomyelitis, diphtheria, or neonatal tetanus in the French Overseas Departments for decades. Epidemics and isolated cases of whooping cough are regularly reported. A few cases of tetanus are reported in older adults whose immunity has weakened or who were never revaccinated. Between 1993 and 2003, nine cases of tetanus were reported in Guadeloupe, five in Martinique, and none in French Guiana; however, in 2005, French Guiana reported two cases. Measles and rubella have been declared eliminated in the French departments. Sentinel network surveillance continues for detection of imported case.
HIV/AIDS is more prevalent in the French Departments than in mainland France, with French Guiana being the most affected. Stigmatization and discrimination against persons with HIV/AIDS posed major obstacles for early screening and detection, and access to treatment and care, all of which hinders efforts to control the infection. The situation is particularly worrisome for vulnerable groups such as injection drug users, commercial sex workers, and illegal immigrants. Health personnel must overcome language barriers and social, cultural, and religious constraints in order to fully reach all those who need screening and treatment.
In 2013, 907 new cases were detected in French Guiana, 240 in Guadeloupe, and 225 in Martinique. Due to the availability of antiretroviral drugs, the AIDS death rate remained relatively low and stable. Since the triple drug regimen was introduced in 1996, the number of persons living with HIV has increased, and the progression to AIDS occurs primarily among those who are not receiving treatment. In March 2003, it became mandatory to report HIV diagnoses, a measure that affords better insight into the HIV-positive population and facilitates the tracking of HIV infections. HIV screening occurs at medical laboratories and screening centers. At the center for the free screening and diagnosis of HIV (known as CeGIDD for its French acronym) screening is anonymous and free of charge. Since 2015 a self-diagnostic test for HIV can be bought in pharmacies; some NGOs have rapid diagnostic tests available.
Zoonoses remain a matter of concern in the Departments. The incidence of confirmed leptospirosis cases is higher in Guadeloupe than Martinique. In Guadeloupe, the incidence was 69.4 cases per 100,000 inhabitants in 2011, with the incidence peaking in October to December. In 2011, the incidence rate was 60.9 cases per 100,000 inhabitants in Guadeloupe with incidence peaking at the same period. In French Guiana, leptospirosis cases have been reported regularly over the past 30 years. Icterohaemorrhagiae and ballum (or castellonis) are the more prevalent serogroups found in the Guadeloupe and Martinique, although some 10 other serogroups are also found there, including australis, cynopteri, canicola, panama, sejroë, and grippotyphosa.
Chronic, Noncommunicable Diseases
Nutritional diseases are of growing concern in the Departments. Obesity, diabetes, and high cholesterol, increasingly have gathered importance as public health concerns in the French Departments. In 2013, according to the Kannari survey (), the prevalence of reported diabetes fluctuated between 10% and 11% in the French Departments, although this figure may be higher due to under-reporting; the prevalence increased through the life cycle.
In Guadeloupe and Martinique, there are many cases of chronic renal insufficiency, with an estimated incidence of 200 cases per 1,000,000 population in Guadeloupe. Diabetes is the leading cause for dialysis (one-third of all those on dialysis are diabetics), the second leading cause of blindness, and the third leading cause for amputation. Since late 2004, kidney transplants for patients with renal insufficiency in all three departments have been offered in Guadeloupe.
The proportion of the population that is overweight or obese is growing in Guadeloupe and Martinique. The 2013 Kannari survey showed that in Martinique 31% of the population over 15 years old was overweight with no difference between males and females; 28% of the population was obese, with little difference between the sexes (33% of females and 21% of males) (). Guadeloupe showed similar results: overweight females, 32%, overweight males, 37%; obese females 31%; obese males, 12%) ().
Cardiovascular diseases are the leading cause of death in Guadeloupe and French Guiana; they rank second in Martinique, following cancer. The figures are higher for women than men. The share of cardiovascular diseases in overall mortality increases with age, reaching a high after age 65 years. Compared to metropolitan France, the French Overseas Departments are characterized by a higher incidence of cerebrovascular diseases, while ischemic heart diseases are less common. Among diseases covered for long-term care, cardiovascular diseases account for 38% of annual admissions, with most cases involving hypertensive and cerebrovascular diseases. Patients with cardiovascular diseases are likely to suffer from such comorbidities as high blood pressure, diabetes, and high cholesterol, leading to serious complications that include stroke, amputation, renal insufficiency, and blindness.
Hypertension is common in the French Overseas Departments. According to a 2003-2004 survey, the incidence of high blood pressure in the population 16 years or older is 22% (20% among men; 25% among women). The incidence increases with age, rising from 5% among 25-34-year-olds to 65% among those 65 years or older.
On average, approximately 1,300 deaths from malignant neoplasms are registered annually in the French Overseas Departments, accounting for one death in four among men and one in five among women. In men, the most common forms of cancer are prostate cancer, followed by colorectal cancer. Among women, the most common cancers are breast, followed by colon or rectal cancer and cervical cancer. Systematic screening for breast cancer has been in place in all three French Overseas Departments since 2005; Martinique also provides cervical cancer screening. Guadeloupe’s population is scattered across several islands and many of French Guiana’s inland municipalities are isolated, which present formidable obstacles to providing universal cancer screening and care.
Sickle cell disease is the leading genetic disease in Guadeloupe and Martinique. Newborns are routinely screened and, on average, each year 1 newborn in 300 is born with a sickle cell trait leading to a major sickle cell syndrome (SS, SC, or S/b thal). Guadeloupe and Martinique have specialized facilities that provide medical care and offer preventive activities. As a result of improved management, sickle cell disease now poses problems similar to those of other chronic diseases, with increased numbers of active patients, longer life expectancy, and complications that accompany aging.
Accidents and Violence
There were 40 deaths linked to road traffic accidents in Guadeloupe in 2015, 29 in Martinique, and 28 in French Guiana.
Risk and Protective Factors
Guadeloupe and Martinique are traditional producers of rum, and while consumption of this product may be declining, consumption of other alcoholic beverages such as wine, champagne, whisky, and beer is on the rise. A survey of patients under the care of general practitioners that was conducted in late 2000 and early 2001 found that of the 26 regions in France, Martinique ranked third; French Guiana, fourth; and Guadeloupe, fifth in prevalence of alcoholism among men. Periodic surveys conducted in Martinique and French Guiana also point to a growing prevalence of alcohol consumption among school-aged children ().
By contrast, tobacco use in the French Overseas Departments is relatively low. According to a 2014 survey, 15% of those aged 16 or older in Martinique smoke every day; 12% do so in French Guiana and Guadeloupe. More men than women were smokers and the largest proportion of current smokers were between the ages of 25 and 34 years.
Illegal drug abuse in the French Overseas Departments is characterized mainly by high rates of cannabis consumption (although it is lower than that in France’s mainland). Among schoolchildren, cannabis is the most frequently used substance; in fact, there is very little use of other illegal substances in this age group. There are, however, age- and sex-related differences, such as increased experimentation or more regular use as children grow older, and greater use by boys. Since the mid-1980s, however, there has been an increased prevalence of crack cocaine use. Most of those addicted to illicit substances are users of crack cocaine, male, and between the ages of 25 and 39 years.Addictions are among the priority health concerns in each of the French Overseas Departments.
Despite some challenges, the population’s health status has improved over the past 30 years. In Guadeloupe, the leading indicators show improvement 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 progress in these areas, certain health problems have proven to be especially intractable in Guadeloupe and the other two French Overseas Departments, including high blood pressure, stroke, diabetes, mental health problems (including alcohol abuse and addiction to crack cocaine), prostate cancer, and HIV infection. Martinique and Guadeloupe, with older populations than that of French Guiana, are increasingly facing public health issues related to aging.
The health strategy for the overseas territories released in May 2016 by the Ministry of Health and Ministry of Overseas France () sets forth five broad public health priorities: improve the state of health, reduce inequalities, and increase health promotion; health surveillance and crisis management; a response to the ageing population and persons with disabilities; improvements to the health system, research, and innovation; and a reduction in inequities in access to health services.
Health promotion has been identified as a priority in the health strategy. Developed with the National Institute for Prevention and Health Education were the Guadeloupean Committee for Health Education and the Martinican Committee for Prevention and Health Education.
In addition, numerous associations, including entities at the national, district, and municipality levels, as well as patient advocacy groups, play an essential role as partners in prevention of disease, bringing their expertise to bear in such areas as HIV/AIDS, substance abuse, sickle-cell disease, and cancer.
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1. A person is considered “poor” if he or she lives in a household whose standard of living is below the poverty line, with the latter being defined as half the median standard of living. The median standard of living divides the totality of households in a given geographical area into two equal halves. This definition is both monetary and relative, since the poverty line is a function of its position on the income ladder of a set of households. This explains why the poverty line differs from one territory to another and why these lines are calculated separately for the French Overseas Territories and metropolitan France.
2. Overweight, BMI ≥25 and <30
3. Obese, BMI ≥30