France

Health systems in transition France 185
(see Table 1.4). However, gender differences are apparent, with cancer being
the leading cause for men and heart disease the leading cause for women.
Excess mortality for both heart disease and cancer is found in men linked to
alcohol and tobacco use as well as to environmental exposures in the workplace.
Nonetheless, between 2000 and 2010, an increase in certain cancers in women
is linked to increases over the same period in smoking behaviour (larynx,
trachea, bronchial and lung) and alcohol consumption (pancreas, liver and
bladder). Excess mortality among men remains high with respect to traffic
accidents (3.9 times higher than in women) and suicides (3.1 times higher). The
suicide rate in France is among the highest in Europe for both men and women.
A 2003 study of mortality amenable to health care found that France ranked
favourably compared with other European countries on all classifications:
excluding ischaemic cardiopathies, only Sweden and Norway had lower rates
of avoidable mortality; when 50% of ischaemic cardiopathies were included,
France had the lowest rate of avoidable mortality. For life expectancy adjusted
for incapacity, France ranked first among the 14 countries studied (HCSP, 2013).
The periodic report on the health state of the French population (L’état de santé
de la population en France), which reports on the indicators identified in the
2004 Public Health Act, did not include mortality amenable to health care
among its indicators because of definitional problems (DREES, 2011a).
The five-year survival rates for breast cancer and colorectal cancer have
improved since the 1990s. For breast cancer, five-year survival for patients
diagnosed in 2001–2004 was 89%, compared with 81% for those diagnosed
in 1989–1991. This trend is seen in most western countries, reflecting
improvements in therapeutic treatments since the early 2000s as well as early
diagnosis from screening. Five-year survival for colorectal cancer increased
from 53% to 58% for patients diagnoses in the same period. For cervical cancer,
the five-year survival rate is 65%, reflecting a slight decrease over time that
paradoxically may be linked to screening, which permits early detection of
invasive lesions that have a poorer prognosis (Grosclaude et al., 2013).
One-third of deaths before age 65 were for causes considered avoidable
through risk reduction (tobacco, alcohol, dangerous driving and suicide).
Between 2000 and 2008, the greatest reductions in avoidable mortality were
seen for traffic accidents, AIDS and alcohol-related deaths (DREES, 2011a).
In 2013, mortality from traffic accidents reached its lowest level since 1948
and was 10.5% lower than in 2012 (Ministry of the Interior, 2014). Policies
imposing lower speed limits and lower thresholds for blood alcohol of drivers
have unquestionably been key factors.