Inequalities between France and overseas territories are an established fact and this is also the case in terms of access to health. The National Economic, Social and Environmental Council (Cese) published a report on the issue on Tuesday January 27. As the document points out, the main objectives of this work were to shed light on the situation in these territories, ” often insufficiently known, documented, and taken into account in national policies “, and to propose transversal solutions. Note that if New Caledonia is competent in health matters, it is also associated with the recommendations made by the Council.
For Cese, this inequality of access to healthcare provision raises the question of the inclusion of overseas populations and national cohesion. “ If the health system is failing, the question of the place given to the citizen who must put up with these failures automatically arises, particularly in Overseas Territories. And therefore that of adherence to a republican model which would not keep its commitments “, underlines the report. A situation which is, again according to the report, at the origin of a distrust towards the health authorities which was particularly illustrated during the Covid crisis.
Excess mortality in overseas territories
The lack of infrastructure, health policies, statistics as well as evaluation or management have very concrete effects for different populations. The Cese thus highlights levels of excess mortality ” higher than statistically expected in the overseas departments and regions “. We thus learn that at the same age, mortality is 89% higher in Mayotte, 37% in Guyana or even 9% in Guadeloupe.
For the Council, the situation is the fruit ” of unthoughts “ Who ” concern both the organization of healthcare provision […] as prevention, research or taking into account traditional knowledge and practices. “
The absence of a global strategy and anticipation makes advisors fear the occurrence of health and social crises. This is particularly the case with the problem of aging populations. ” Lack of preparation for rapid aging constitutes a major risk for health and medico-social systems “, alarms the CESE, which fears the coming explosion of this social bomb, poorly anticipated and underfunded.
The phenomenon is all the more worrying in the Overseas Territories as it is combined with higher levels of precariousness than in France, as well as more frequent chronic pathologies, earlier loss of autonomy and even heavier out-of-pocket expenses for families.
Fragility of health systems
More generally, the Cese report emphasizes the fragility of overseas health systems in the face of external shocks. He demonstrates this by taking the example of the May 2024 insurrection which caused a breakdown in access to care, particularly problematic for chronically ill people, but also caused the departure of caregivers.
In its opinion, Cese recommends above all better documenting health overseas, by producing the same indicators as in France and by harmonizing statistics between national organizations and local institutes, including Isee for Caledonia. The stated objective is to enable finer management and real territorialization of health policies.
The Council also calls for health objectives adapted to each territory, backed by multi-year budgetary programming, and for better coordination of public action via the creation of an interministerial committee dedicated to Overseas Territories. On access to care, he calls for correcting funding inequalities, securing medical evacuations and the supply of medicines.
On the other hand, no specific recommendations are made on aging, although they are documented at length in the report. For New Caledonia, anticipation of the shock of old age and catching up in terms of infrastructure are in fact referred to New Caledonian decision-makers, who are entirely competent in health and social matters.
The report can be read in its entirety on the Cese website
