France

Health systems in transition France 13
A tobacco ban initially in public places and workplaces was progressively
implemented in France (Act of 31 December 1970, Act of 9 July 1976, Act of
10 January 1991, Act of 21 July 2009). Since 1 January 2008, the tobacco ban
has been extended to bars, pubs, restaurants, hotels, casinos and nightclubs.
Individuals not respecting this ban may be fined from €68 to a maximum
of €450 (Ministerial Circular of 29 November 2006). After a decrease in the
prevalence of daily smokers between 2000 and 2005, smoking prevalence
increased from 27.3% in 2005 to 29.1% in 2010, the first significant increase
since the 1991 Evin Law prohibited smoking in most enclosed public places
(Beck et al., 2010). By comparison, the 2012 EU27 average percentage of daily
smokers was 28% (Danet, 2012). Two subpopulations are responsible for this
increase between 2005 and 2010: women (increasing from 23.3% to 26%)
and unemployed persons (from 44% to 50.8%). Nonetheless, the emergence
and increasing popularity of electronic cigarettes in recent years appears to
be reversing this trend. In 2013, cigarette sales declined 7.6% according to
the French Observatory on Drugs and Addictions (L’observatoire français des
drogues et des toxicomanies; OFDT) (OFDT, 2014).
The alcohol industry is a powerful economic sector in France, and wine
constitutes a particularly important cultural reference. The 1991 Evin Law
imposed a partial ban on alcohol advertising and permitted advertising requires
the following health warning: “alcohol abuse is dangerous for your health”. The
2009 HPST Act increased the legal drinking age to 18, banned open bars and set
limits on the sale of alcoholic beverages in petrol stations. Alcohol is the most
consumed psychoactive substance in France, with 9.7 million regular users,
corresponding to 21% of the population (OFDT, 2010). In 2012, annual alcohol
consumption was 11.8 litres per inhabitant aged over 15 years (INSEE, 2013a).
Despite a steady decrease over the last 50 years, this number remains higher
than the target of 11.5 litres set by the 2004 Public Health Act (Danet, 2012). It is
important to note that indicators such as average consumption do not reveal the
extent of harmful use of alcohol. In 2010, nearly a quarter of adults aged 18 to
75 indicated that they had engaged in risky drinking behaviours (Danet, 2012).
Socioeconomic health inequalities
France has long reported health inequalities across socioeconomic groups that
are wider than in most other European countries. These inequalities are more
pronounced for men than for women, with working-class individuals having
a significantly higher risk of death before age 65 than managers. At age 35, a
male labourer has a 13% risk of dying before age 65, while the risk for a male
manager is 6% (Blanpain, 2011).