Health disparities between mainland France and the overseas territories are no longer merely an isolated observation, but rather a structural imbalance. In a unanimously adopted opinion, the Economic, Social, and Environmental Council (EESC) presents a grim assessment of the healthcare situation in the overseas territories and calls for a national health strategy that is more coherent, more locally tailored, and sustainably funded. Beyond the statistics, the institution highlights a systemic vulnerability that calls into question the ability of public policy to guarantee equal access to healthcare throughout French territory.
Health disparities that persist
The EESC’s opinion is based on unambiguous data. For people of the same age, excess mortality stands at nearly 90 % in Mayotte, more than 35 % in French Guiana, and nearly 10 % in Guadeloupe compared to the national average. These persistent disparities reflect a unique public health reality, marked by a combination of vulnerabilities rarely seen elsewhere in France.
Overseas territories face a combination of adverse social determinants, increased exposure to environmental pollutants, the prevalence of tropical diseases, and the growing impact of extreme weather events. Added to this are situations of food and social insecurity, which directly affect the health of the populations.
A healthcare system under constant strain
The EESC also highlights the limitations of the healthcare system. Access to health care services remains unequal, the supply of services is often insufficient and poorly coordinated, and the medical workforce remains fragile. Difficulties in recruiting and retaining health care professionals affect the continuity of care pathways and weigh on the operations of health care facilities.
These vulnerabilities contribute to a loss of trust in the healthcare system, fueled by uneven availability of services, long wait times, and insufficient coordination among stakeholders. In the EESC’s view, these problems are not marginal: they have a lasting impact on how people in the overseas territories relate to healthcare and public institutions.
A public response deemed insufficiently appropriate
The report emphasizes that these health inequalities—which are widespread and persistent—are still not adequately addressed in national policies. This situation is viewed as a breach of the republican promise of equal access to health care, calling for a national response that is grounded in local realities.
The EESC’s Delegation for Overseas Territories has thus undertaken an in-depth study based on consultations with more than sixty stakeholders: institutions, experts, healthcare professionals, and representatives of the overseas CESERs. This work made it possible to reach a shared assessment and highlight the need for public policy to be scaled up.
Understand Better to Act More Effectively
Among its key priorities, the CESE emphasizes the importance of knowledge. It advocates for the development of health statistics that are more comprehensive and comparable to those of mainland France, in order to better identify the specific needs of each region. Regional health plans should systematically incorporate a health-environment perspective and a detailed comparison of capacity, facilities, and available medical specialties, particularly in the areas of emergency care and mental health.
The EESC calls on the regional health agencies to propose corrective measures in response to any significant discrepancies, including when such measures require enhanced cooperation with local and regional authorities.
Solidarity and Governance at the Heart of the Proposals
The opinion also calls for greater solidarity among territories. It proposes that each overseas territory enter into a formal partnership with a mainland French health region, particularly in the areas of telemedicine, training, and internships for medical residents. According to the CESE, the management of the medical workforce should be part of a forward-looking approach, involving regional health agencies (ARS) and local authorities in order to better train, recruit, and retain healthcare professionals.
At the institutional level, the CESE recommends the creation of an Interministerial Committee on Health in the Overseas Territories, tasked with ensuring the consistency and effectiveness of public policy. It also recommends the development of multi-year action plans addressing public health emergencies, accompanied by funding identified and evaluated by the General Inspectorate of Social Affairs.
Finally, the institution calls for the formalization, in each region, of an agreement between the government, local authorities, and healthcare facilities, in order to establish region-specific objectives regarding prevention, the organization of care, and the quality of care.
A Matter of Equality and National Cohesion
Through this opinion, the EESC does more than simply sound the alarm: it raises the question of the role of the overseas territories in public health policies. For the institution, reducing health inequalities is not merely a matter of technical adjustment, but a fundamental political choice that affects national cohesion and the credibility of republican equality.
As the Republic’s third constitutional assembly, the CESE advises the Government and Parliament and participates in the development and evaluation of public policies within its areas of competence. It comprises 175 members—men and women with practical experience—appointed by civil society organizations such as associations, labor unions, and employer organizations. The CESE serves as a key forum for citizen participation. Thierry Beaudet has been president of the CESE since May 2021.
