Published on 27/12/2011
Chronic diseases and injuries
In France, chronic diseases affect nearly 20% of the population and are one of the main causes of death and handicaps. These long-term and progressive illnesses are a major public health issue that often lead to a deterioration in the quality of life and are sometimes associated with disabilities or severe health complications. These medical conditions or their determinants include cancers (which account for 30% of causes of death every year), diabetes, high blood pressure (which affects 66% of people over 50), obesity (which affects 50% of people aged 18 to 74) and cardiovascular diseases.
Intentional or unintentional injuries are also an issue for health policies. In addition to causing death they also require multiple care and treatment services (emergency admission, hospitalization, etc.) and occasionally lead to major physical or psychological damage.
InVS’s Department of Chronic Diseases and Injuries (DMCT) is in charge of monitoring non-communicable diseases and everyday injuries. It focuses not only on determinants but also on complications. Through six theme-based units the department coordinates several monitoring programs and conducts major population surveys.
- Look up InVS publications on this topic
Everyday accidents are a major public health issue. They occur in very large numbers and counting them is difficult as this depends on how serious they are, and this itself determines the type of care to provide or how to manage injured individuals.
In France, 19,000 people die every year from everyday accidents, i.e. 3.6% of causes of death. That number has been declining since the 1980s, likely thanks to the information and prevention campaigns against accidents that have been conducted for some 20 years now. However, this figure remains high when compared to similar mortality data in other countries of the European Union, and many deaths could still be avoided with adequate measures of prevention, regulation, training, etc. It is likely to increase within the next two years given the large number of deaths due to everyday accidents among elderly people and the expected increase in the ratio of elderly people within the population. In the 15 countries of the European Union there are approximately 80,000 deaths caused by everyday accidents every year, and several million throughout the world.
Asthma is a chronic disease caused by inflammation of the airways and characterized by the occurrence of “crises” (difficulties in breathing). Crises can be triggered by various factors such as allergens (mites, mould, animal hairs, etc.), respiratory infections or respiratory irritants (air pollution, tobacco smoke, etc.). Asthma surveillance is part of the InVS’s program aimed at monitoring chronic respiratory diseases. The purpose of this topic is to present the asthma surveillance mechanism in France in several key areas: prevalence, mortality, hospitalization, emergency room admissions, and occupational asthma.
The cancer topic covers the epidemiological surveillance of cancers (incidence and mortality) and the evaluation of national programs for organized cancer screening (breast, colorectal and cervical cancers).
The epidemiological surveillance of cancers is part of the overall surveillance of the French population's health status, a task that is handled by the French Institute for Public Health Surveillance (InVS). Surveillance helps to manage and evaluate cancer prevention as well as care and treatment measures; it is conducted by a network of partners coordinated by the InVS and is based among other things on cancer records. Strengthening the epidemiological surveillance of cancers is part of the 2009-2013 Cancer Plan (measure #7). This plan reiterates support to existing records in order to increase and optimize record activities as well as support for implementing the Multisource Cancer Surveillance System (SMSC).
Cardiovascular diseases cover a variety of frequent and serious diseases. Topping the list are ischemic heart diseases, cerebrovascular diseases, peripheral vascular diseases, hypertension-related diseases, heart failures, etc. For a long time these diseases were the primary causes of death in France, as in many countries. For the past two years they now rank second, right behind tumours, due to a continuous decline in the number of cardiovascular deaths thanks to improved prevention and therapeutic care and treatment.
After introducing and presenting InVS’s program for cardiovascular diseases, the topic presents epidemiological data for various cardiovascular diseases as well as the main cardiovascular risk factors.
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease. In more than 80% of cases COPD is the result of smoking. Other risk factors include occupational exposures, atmospheric pollution, exposure to passive smoking and genetic factors. Exposure to tobacco smoke (smoking or secondary smoking) is always an aggravating factor.
The disease progresses insidiously and its clinical signs are often dismissed. The earliest symptoms include coughing and sputum (chronic bronchitis). Shortness of breath gradually sets in. This progression is exacerbated in more than one way: episodes of worsening cough, sputum and shortness of breath, which might require hospitalization.
A working group has been set up that includes pulmonary specialists and epidemiologists from the National Institute for Health and Medical Research (Inserm) and from the French Institute for Public Health Surveillance. The purpose is to outline relevant surveillance indicators, identify data sources, implement appropriate studies if necessary, and to promote the collection of surveillance indicators in existing studies.
The topic on diabetes presents the epidemiological surveillance program for diabetes at the French Institute for Public Health Surveillance (InVS). It includes general information on diabetes and provides details on the main features of this disease (frequency, complications, mortality, quality of medical care and treatment, quality of life, etc.). In every subsection of the diabetes topic there is a brief description as well as links to slideshows, articles or websites offering alternative information or additional information.
Nutrition and health
The Nutritional Epidemiology Surveillance Unit (USEN, a joint unit staffed with personnel from the French Institute for Public Health Surveillance (InVS) and the University of Paris 13) is tasked with ensuring surveillance of food consumption, physical activity and the nutritional status of people living in France. These three nutritional aspects constitute significant risk or protection factors for chronic diseases such as cardiovascular diseases, some cancers, diabetes, osteoporosis, etc.
More specifically, the unit’s activities are expected to help describe risk or protection nutritional factors among the population, monitor any changes in those nutritional factors, identify the emergence of decisive nutritional factors in terms of public health, describe their relationship with morbidity and mortality, assess the impact of preventive actions on nutritional factors, in particular within the National Nutrition and Health Programme (PNNS). This topic includes key elements stemming from nutritional surveillance in France and provides details on the main studies conducted by USEN.
A disease is said to be rare if fewer than one in 2,000 individuals is affected by it, which in the case of France means fewer than 30,000 people for a given disease. At present, nearly 7,000 rare diseases have been identified that are more or less debilitating. Approximately 80% of these are caused by genetic factors.
The legislation pertaining to public health policy dated 9 August 2004 identified rare diseases as a priority, which led to the implementation of the 2005-2008 National Plan for Rare Diseases (PNMR). PNMR suggested a series of specific measures to improve care and treatment for these diseases through various strategic areas involving epidemiology, information to affected individuals and health-care professionals, screening, access to health care, orphan drugs and research.
The first focus area of the PNMR, entitled “Building Understanding of the Epidemiology of Rare Diseases”, tasked the InVS with implementing and coordinating the epidemiological surveillance of these rare diseases. It is within that framework that the Rare Disease Program was set up at the InVS in 2005 (the Rare Disease Program integrated the Rare Disease Unit in May 2009).