The Epidemiologic Transition in French Guiana: Secular Trends and Setbacks, and Comparisons with Continental France and South American Countries

Abstract

There are great variations between population subgroups, notably in poorer countries, leading to substantial inconsistencies with those predicted by the classical epidemiologic transition theory. In this context, using public data, we aimed to determine how the singular case of French Guiana fit and transitioned in the epidemiologic transition framework. The data show a gradual decline in infant mortality to values above 8 per 1000 live births. Premature mortality rates were greater but declined more rapidly in French Guiana than in mainland France until 2017 when they reascended in a context of political turmoil followed by the COVID-19 pandemic and strong reluctance to get vaccinated. Although infections were a more frequent cause of death in French Guiana, there is a marked decline and circulatory and metabolic causes are major causes of premature death. Fertility rates remain high (>3 live births per woman), and the age structure of the population is still pyramid-shaped. The singularities of French Guiana (rich country, universal health system, widespread poverty) explain why its transition does not fit neatly within the usual stages of transition. Beyond gradual improvements in secular trends, the data also suggest that political turmoil and fake news may have detrimentally affected mortality in French Guiana and reversed improving trends.

Small for Gestational Age Newborns in French Guiana: The Importance of Health Insurance for Prevention

“…In French Guiana, despite substantial efforts to tackle the problem, preterm delivery remains double of that of mainland France [19]. In this context, perinatal causes weigh heavily on premature mortality (before age 65 years) [20]. Infant mortality is 2.6 times higher than in mainland France [20].…”

Contrasted life trajectories: reconstituting the main population exposomes in French Guiana

“…This apparently is a major social fact that aligns with ethnic communities and illustrates the strong distrust and resentment toward the Western health system ( 70–72 ). It is not the only visible social fact on the yearly life statistics: In 2017, a prolonged social movement (all major roads were blocked for a month, and Cayenne Hospital was struck by a 74-day strike) demanding strong measures to fill the perceived structural gap between mainland France and French Guiana, notably for healthcare, was synchronous with the reascension of premature mortality ( 8 ). Although causal pathways can only be hypothesized, “self-destructive” peaks of social opposition hence seem to have sufficiently large effects to be visible on life statistics—i.e., a 3- to 4-year drop in life expectancy at birth in French Guiana vs. half a year in France.…”

“…Socioeconomically, the gross national product per capita of French Guiana is the highest in Latin America. Many immigrants arrive to search for better economic prospects, but, in practice, they often live in great poverty when they reach French Guiana ( 8 ). In practice, nearly half of the adult population and 29% of the total population are of foreign origin.…”

“…As a tropical Amazonian territory, French Guiana still has a large variety of infectious diseases; the environment and climate are also quite different from mainland France. We have recently compared life indicators and mortality causes between French Guiana and mainland France, showing that there was generally a 2- to 3-year difference in terms of life expectancy at birth, which presumably reflected differences in mortality rates for different pathologies, with notable differences that were sensitive to primary healthcare and thus preventable ( 8 ). Although differences in healthcare may partly explain the observed differences (lack of physicians), other very important explanations are also involved.…”

Thirty years of HIV pregnancies in French Guiana: prevention successes and remaining obstetrical challenges

“…French Guiana is a French territory in South America that shares borders with Brazil and Suriname. For cultural reasons, it has the highest birth rate in Latin America (26.8 per 1,000 persons) ( 1 ). The HIV prevalence and incidence are the highest of all French territories.…”