7.1 General context
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For more than twenty years, the aim of the French "Baromètre" surveys of Santé Publique France has been to monitor the main behaviours, attitudes and perceptions associated with risk-taking and the health of the French population: smoking, alcoholism, illegal drug use, nutrition, quality of life, etc. A specific version of this extensive scientific survey, conducted through interviews, has been produced on the subject of young people's health.
The 13th edition of the Health Behaviour Barometer was launched by Santé publique France in February 2021. It was carried out among a representative sample of 25,000 people aged 18 to 85 and led to the presentation, at the beginning of 2023, of separate results for French people living in metropolitan France and in the Overseas Departments and Regions.
The results of the survey showed a national prevalence of smoking among 18-75 year olds of 31.9% in 2021 compared to 30.4% in 2019. This prevalence persists among young people aged 18 to 24, where it is, however, decreasing in contrast to the rest of the population: this proportion is stable among young women (27.9% in 2020 and 2021) and decreasing among young men (35.7% in 2020 and 28.7% in 2021). Another major topic addressed during the survey was HPV vaccination coverage among women aged 15 to 18, which concerns 43.6% of this population in mainland France, 13.8% in Guadeloupe, 17.2% in Martinique, 22.6% in French Guiana and 24% in Reunion.
The 2023 Health Barometer was launched in February 2023 and the results will be presented in early 2024.
According to a study by the French Ministry of Health in 2017 (latest available data), 17% of the adult population is obese, which represents more than 8 million people. Obesity is a major risk factor for the most common pathologies (cardiovascular diseases, type 2 diabetes, etc.) and has psychological and social consequences, such as depression.
This 2017 study (latest data) from the Ministry of Health presents results showing adolescents in better physical health than 20 years ago. However, this study shows that 18% of these teenagers in the third grade (14-15 years) are overweight and 5% obese. Nutrition therefore remains an issue, particularly for young girls, whose overweight rate rose from 17% in 2009 to 20% in 2017. The issue of overweight increases with age: 24.7% of men and 20.5% of women aged 18 to 39 were considered overweight in 2015, according to this study (latest data available). Obesity is also linked to the persistence of strong social inequalities: for example, from the age of six, the children of blue-collar workers are four times more affected by obesity than the children of managers: 16% are overweight and 6% are obese, compared with 7% and 1% respectively for the children of managers.
Source : https://solidarites-sante.gouv.fr/systeme-de-sante-et-medico-social/strategie-nationale-de-sante/priorite-prevention-rester-en-bonne-sante-tout-au-long-de-sa-vie-11031/priorite-prevention-les-mesures-phares-detaillees/article/obesite-prevention-et-prise-en-charge
The national conferences on mental health and psychiatry (Assises de la santé mentale et de la psychiatrie), held in September 2021, produced new data. In particular, they show that suicide is the second most common cause of death among young people aged 10 to 25, after road accidents. 15% of young people aged 16 to 25 experience at least one depressive episode characterised as such by a health professional.
The 2020 edition of the national observatory of student life (Observatoire de la vie étudiante - OVE) 's annual 'Living Conditions' study presents one third of French students as 'showing signs of psychological distress' in the 4 weeks preceding their response to the survey. Women, foreign students and students receiving scholarships are the most represented.
Covid-19 and mental health
- According to the INJEP 2021 barometer, in 2021, 60% of young people aged 18 to 30 are confident about the future, 7 points less than in 2020. According to a study by Epi-Phare in 2021, between the beginning of 2020 and the end of 2021, 0-19 year olds increased their use of antidepressants by 13%. This phenomenon is marked, in particular, by the start of treatment during this period. The 20-39 age group saw an increase of 5.9% in the use of antidepressants.
- According to a Santé Publique France study of 2021 "Mental health and Covid-19 – suicidal behaviours", 11-24 year olds are experiencing an increasing trend in emergency room visits for suicidal acts or mood disorders.
- According to this study, the Agence Santé Publique France, the "health crisis has acted as a catalyst for mental health problems in France [...] the spread of the virus has been accompanied by a rise in anxiety about the infection and the implementation of restrictive measures on the social level, an essential dimension of well-being. Indeed, isolation, reduced physical activity, increased stress and boredom have all been factors that can have an impact on mental health, especially among young people, where increased anxiety has been particularly observed.
Various scientific studies have been carried out on the impact of the pandemic on young people, in particular with a view to assessing "the emotional state and psychological distress of children and young people during confinement as a function of their environment and their living and housing conditions". For example, the study during the first Covid-19 containment showed that:
- Adolescents appeared to have a greater impact on mental health than younger people and girls appeared to have a greater impact on mental health than boys during and after the lockdown.
- Factors associated with psychological distress were housing conditions (being confined in an urban area, in a flat or house without a garden, not having access to an outside area in the dwelling, occupying an over-occupied dwelling and not being able to isolate oneself), economic conditions (financial and food difficulties, economic conditions (financial and food difficulties, decrease in income due to the epidemic or confinement, period of unemployment of parents, lack of Internet connection), parents' characteristics (single-parent family, level of education lower than or equal to the baccalaureate, working-class or employed parents, born abroad, lack of social support).
- Lack of activity, increased time spent on social networks and screens, feeling overwhelmed with school work, Covid-19 infection of a relative and hospitalisation following Covid-19 were also linked to distress in France.
Furthermore, according to an article by the INJEP on the consequences of the health crisis (Covid-19) on rural adolescents (Expériences des confinements par les adolescents ruraux. Des conséquences inégales sur les sociabilités, scolarités et aspiration), published in April 2021, shows "how much the health crisis has reinforced the pre-existing inequalities between [rural] young people living in the same territory, who are still too often perceived as a homogeneous youth.
Alcohol consumption studies show that consumption goes up with age, and becomes more of a regular occurrence. Only 2.5% of 15-30 year olds drink alcohol on a daily basis. That said, between 15 and 30 years of age, monthly, one-off consumption rates and episodes of drunkenness during the year are very high – 25.5% and 38.6% respectively. Alcohol consumption appears to be most common among males. But the trends concerning all of the indicators are pointing to increasingly similar consumption between men and women. Similar levels are now particularly evident among the 20-25 year-old age group.
According to the Santé Publique France agency, "although the overall volume of pure alcohol consumed in France (11.7 litres per inhabitant aged 15 and over in 2017) has been decreasing since the 1960s, France remains one of the most alcohol-consuming countries in the world. Young people are also concerned by this consumption:
- 87% of 18-75 year olds consume alcohol at least once a year
- 13.4% of 18-24 year olds declare at least 10 drunken episodes per year
- Weekly alcohol consumption among 18-30 year olds stands at 32.5% for metropolitan France and varies between 23.2% and 43.5% depending on the region.
According to a 2017 study (latest data to date) by the French Observatory of Drugs and Addictive Tendencies (OFDT), 8% of 17-year-olds drink alcohol at least 10 times a month, and 44% of this group declare that they have "significant occasional drinking".
According to the 2020 health barometer, 33.8% of 18-24 year olds say they exceed the "lower risk consumption" benchmarks.
However, whatever the product considered, adolescents are more vulnerable to psychoactive products than adults, as the process of cerebral maturation - up to the age of around 25 - leads to a particular vulnerability to the neurotoxicity of substances. The early stage of experimentation and entry into regular use increases the risk of subsequent dependence and, more generally, of subsequent harm, hence the importance of intervening early in development.
According to the European school project on Alcohol and other Drugs -ESPAD 2015 (latest comparative data to date), France is among the European countries with the highest smoking prevalence.
Smoking among young people is regular, but declining. According to the Public health 2020 barometer, in 2019, 32.1% of 18-24 year olds smoked daily (compared to 37.1% in 2014).
According to Santé Publique France (2022), the French are experiencing a resumption of smoking which does not concern young people. In 2021, 28.7% of men aged 18 to 24 (compared to 35.8% in 2020) smoke daily. In the same year, women aged 18 to 24 will experience stable daily smoking (27.9% in 2021 and 2020).
The fight against smoking has been strengthened since 2014 with the implementation of national plans which have led to a number of measures such as the neutral packet, the reimbursement of nicotine substitutes like any other medicine, renewed prevention campaigns with the Month Without Tobacco operation and the increase in prices to reach a €10 packet in 2020.
In 2018, the French Observatory for Drugs and Drug Addiction (OFDT), the medical service of the Toulouse rectorate (school administration) with the support of Insaerm-University Toulouse III and the contribution of the national education authorities carried out the "National Survey of Health and Substances among Adolescents in Middle and High Schools<", EnCLASS. This survey shows:
- In France, the use of tobacco, alcohol and cannabis among adolescents aged 11, 13 and 15 has been declining over the last 10 years. Among these three substances, alcohol remains the psychoactive product most often experimented with between the ages of 11 and 15.
- At 11 and 13, experimentation is more frequent among boys, but this is no longer the case at 15, where a difference between girls and boys remains only for experimentation with cannabis.
- In 2018, the levels of alcohol, tobacco and cannabis use of young French people are above the European averages. Compared to other countries, French 11-year-olds are at the top. However, levels of drunkenness among French 15-year-olds are among the lowest observed nationwide.
- According to the 2020 Public Health Barometer, 51.1% of 18-25 year olds have used cannabis, of which 25.8% have used it in the 12 months prior to the survey. According to a study by the French Observatory of Drugs and Addictive Tendencies (OFDT), levels of regular cannabis use appear to be falling between 2017 and 2021 among 18-24 year olds (8.4% vs. 6.3%) and among 25-34 year olds (6.3% vs. 4.4%).
- Baromètre Santé publique 2020
Behaviours regarding the use of screens and electronics
According to the 2021 barometer of the Interministerial Mission for the Fight against Drugs and Addictive Behaviour (MILDECA), in 2015 nearly 50% of children aged 6-10 said they spent three hours or more in front of a screen each day, with this proportion reaching 70% of 11-14 year olds and up to 87% of 15-17 year old boys.
The number of intensive daily users (more than 4 hours/day) is twice as high among 15-24 year olds as among their elders. However, 42% of them consume more sweets, soft drinks and snacks during their digital activities.
Source : Mildeca 2021
The National Barometer of Sports Practices 2020 carried out by the INJEP (National Institute of Youth and Popular Education) shows that in 2020, 65% of French people aged 15 and over have practised at least one physical and sports activity in the last twelve months. "During the two months of the first 2020 confinement, this practice was reduced by a dozen points to 53%.
Still according to the National Institute of Youth and Popular Education (INJEP), the practice of sports and physicial activites in France (La pratique d'activité physiques et sportives en France), "the practice of sport is stronger among young people and decreases with age, as confirmed by two publications from 2020 (Caille, 2020; Chiffres-clés du sport, 2020): "at 13 or 14 years of age, secondary school students give a great deal of importance to sport in their leisure time: 83% of them practice a sporting activity at least once a week and almost two thirds are registered in a sports association or club".
As far as licensed practice is concerned, the key figures for sport 2020 indicate that the under-15s account for 40% of all licences in France, of which only one third are issued by school multisport federations.
Reproductive and sexual health
According to the Santé Publique France health barometer, the median age at first sexual intercourse is 17 for boys and 17.6 for girls (stable since the 1980s).
Young people are a prime target for prevention because it is during this period that representations related to sexuality are formed. It is important to help them acquire the keys to make informed and appropriate choices that promote their sexual health.
Young people aged 15 to 24 accounted for around 41% of STI cases (HIV, syphilis, gonorrhoea and chlamydia) in 2014 (CNSHV, 2017), and this proportion is increasing. Between 2017 and 2019, for example, there was a 41% increase in the number of chlamydia diagnoses among women aged 15 to 24, and 45% among men aged 15 to 29 (BEH Santé Publique France, December 2020).
However, half of students have never been tested for hepatitis B or C and a fifth state that they do not know if they have ever been tested (OVE 2018). Overall, more students have already been tested for HIV (42%). This proportion is higher among older people, sexually active students and women for HIV and hepatitis B tests.
With regard to contraception, despite a contraceptive coverage rate of 90% among young women aged 15 to 24, two-thirds of unplanned pregnancies are contraceptive. The abortion rate is highest in the 20-24 age group, at 27.3 per 1,000.
In 2016, the contraceptive methods used by women aged 20-24 concerned with contraception were mainly the pill alone (52.6%), the condom (18.6%), the implant (9.6%), the pill combined with the condom (6.9%), and the IUD (4.7%). No method of contraception is used by 4.3% of them. (Public health barometer, 2016).
Several concepts and notions help to gain a clear idea of public health policies, particularly those focusing on young people. The notions of "Public Health", "general law" and "access to healthcare" define and characterise the French public health system.
Youth health policies normally fall within the Public Health sphere – which goes beyond the scope of curative medicine and encompasses all the factors which contribute to the development and determination of individuals' health: including the social environment and living conditions (housing, employment, recreation, etc.). Part of the objectives of Public Health is to limit health risks, guarantee the very best quality of care and ensure the greatest possible equality among the population in terms of health. Public Health forms part of a general law health service.
General law health service
The French health service is governed by general law, which designates all of the health service to which any resident must have access, pursuant to the "right to health protection" as recognised by the Preamble of the 1946 French Constitution. Since health comes under the general law system, it is therefore accessible to all; but the population is first required to become a member of a Compulsory Health Insurance Scheme: in this way they benefit from basic social cover. The range of available general law medical care is provided by both public facilities (hospitals, health centres, mother and child protection centres, etc.) and liberal medical practice (private clinics, physicians, etc.). In the general law health service, everyone is free to choose where they want to be treated.
"Access to health care"
Although health education and prevention do feature in the policies that the public authorities put into practice, the French health service is primarily based on a curative approach and access to health care. Access to health care means an individual's ability to access health resources and services.
It is influenced by social, economic (level of education, etc.), geographic, environmental, cultural and organisational factors which can either help or hinder a person in accessing such services. It is closely tied in with the notion of accessibility, which refers more to the reimbursement of services, but also the proximity or distance of healthcare services (medical cover, insurance, doctor's surgery, health centre, etc.). Unequal access and accessibility in terms of health care are issues that the public authorities need to address.