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From Croatia, our travels take us to France, famous for their food, wine, culture and health care system. France often ranks among the healthiest places in the world. I’ll take a crack at explaining why.

Health Care: Universal Insurance with Personal Freedom

France’s health care system is built on national health insurance. Everyone is covered, with funding coming from payroll and general taxes. Patients can choose their own doctors, and fees are regulated to keep care affordable. Most people buy supplemental coverage (mutuelles) to cover co-pays, but the baseline system guarantees care for all.

Hospitals are a mix of public and private, all working under national price controls and quality standards. Unlike the U.S., there’s nobody uninsured.

Public Health Framework

The Ministry of Health provides national policy leadership, while the Agences Régionales de Santé run programs locally. This ensures that immunization campaigns, infectious disease surveillance, and hospital inspections are standardized but responsive to local needs, much like in the US. Santé publique France, the national public health institute, tracks health outcomes, runs surveillance systems, and offers scientific guidance.

Oversight of Facilities

Hospitals, nursing homes, and child care facilities are licensed and regularly inspected by the regional Agences Régionales de Santé using national standards. These inspections cover hygiene, staffing, patient safety, and quality of care. Child care facilities also fall under the Ministry of Education, but health and safety oversight is coordinated through regional Agences Régionales de Santé ARS inspectors.

Food Safety and Restaurant Oversight

France has rigorous food safety rules shaped heavily by the EU. The Ministry of Agriculture and Food Sovereignty manages national policy, while local health authorities inspect restaurants, markets, and producers.

EU rules limit additives, require detailed labeling, and ensure traceability from farm to fork. Restaurant inspections check for hygiene, safe storage, and compliance with these EU standards.

Emergency Services

France’s emergency medical service is unique: ambulances are staffed with physicians or advanced nurses, not EMTs and paramedics like here.

This means hospital-level care often begins at the patient’s doorstep. Epidemiology and outbreak response are centralized through Santé publique France, with regional ARS coordinating local action.

Clinical Workforce

Like in the US, France also suffers from a shortage of physicians. Until 2020, acceptance to France’s medical schools was regulated by the “numerus closus” which set strict limits on how many students could enter the schools annually.

While the annual acceptance number was supposed to account for population growth, the process was highly influenced by the Ordre des Médecins, France’s powerful physicians accreditation board (like the AMA kinda), which wanted to keep access to the profession exclusive.

The 2020 pandemic brought to light the severe shortage of physicians and the numerus closus were eliminated. Today, each medical school works collaboratively with their Agence Régionales de Santé to set their own admission limits, which considers regional population growth and medical desert.

Training physicians takes time and the first cohort of non-numerus closus physicians won’t be ready to practice until 2029 at the earliest  (9 years post highschool). France has been working to create a new level of nurses, similar to the US Nurse Practitioner model, which has been receiving lots of resistance from the Ordre des Médecins.

Nutrition, Physical Activity and Urban Planning

France is designed for walking, even here in Paris. Cities have dense cores with wide sidewalks, bike lanes, and pedestrian-only areas. Public transport systems are robust, reducing reliance on cars. Cycling is encouraged through dedicated bike infrastructure, and Paris in particular has expanded bike lanes dramatically in recent years.

The result is purposeful physical activity, walking to the store, biking to work, and using stairs instead of cars. Walking is a normal part of daily life, one of the reasons why they have way lower obesity rates compared with the U.S.

Farmers Markets are an integral part of a city’s urban planning and French’s way of life. Visit any town in France and you will see a “Place du Marché” where open-air farmers markets still take place to this day (beware of where you park your car the eve of a market-day!). Farmers Markets (open-air or covered) are part of Parisian’s weekly (and in some cases, daily) activities. There is a farmers’ market every day of the week and the Ville de Paris maintains a calendar of events.

There, Parisians access fresh and locally sourced produce, meats and fish that support a healthy diet. Farmers’ markets also support a strong local economy; with the high fixed costs of brick and mortar stores (and uncertainty around folks passing by your location to purchase your goods), many small businesses choose the itinerant modalities of the farmers market and bring their goods directly to their customers around the city.

Mental Health and Substance Use

Mental health services are fully integrated into the national system. Psychiatric hospitals and clinics provide inpatient and outpatient care, while community-based mental health centers are expanding. Treatment for serious mental illness is covered under insurance, ensuring access regardless of income.

Substance abuse services like alcohol and opioid treatment are provided through hospitals and specialized clinics, often with strong links to social services. France has pioneered harm reduction policies, including safe injection sites in major cities.

Alcohol Consumption and Health

Alcohol plays a large cultural role in France, especially wine, but binge drinking is rare even though the drinking age is 18 rather than 21. Per capita consumption is higher than in the U.S., though it has declined in recent decades due to public health campaigns and taxation policies, although I have to say a nice bottle of Burgundy is only like 10 euro.

Reproductive Health

Shortly after the US Supreme Court Dobbs decision, France’s Assemblé National (legislative body) was swift in identifying the need to guarantee women access to their full suite of health care and reproductive health services. The agreement was widely accepted across all political parties (a rarity) and France started the process to amend their constitution.

On March 8, 2024, the following statement was included in Article 34 of the Constitution “ The law determines the conditions under which Women have the guaranteed freedom to access a “Voluntary Interruption of Pregnancy” and France became the first country in the world to guarantee access to abortion services in their constitution.

The Role of the European Union

EU membership shapes much of France’s public health policy. Food ingredient rules are stricter than in the U.S., banning many additives and requiring clear labeling. EU environmental and occupational health directives influence air quality standards and workplace safety. The EU also coordinates cross-border infectious disease surveillance, ensuring France has early warning for outbreaks.

Localities can’t set their own health policies like restricting universal access to care, changing to rules around immunizations requirement to start school or altering a pandemic response set by the central government

Health Outcomes Compared to the U.S.

● Obesity: 17% of adults, compared to over 40% in the U.S.

● Smoking: Higher than the U.S. but declining due to tobacco control.

● Alcohol: Higher than the U.S. but falling steadily.

● Life Expectancy: Around 82 years, several years higher than in the U.S.

Supplemental Material:  Differential Diagnoses | A comparative History of Health Care Problems and Solutions in the United States and France by Paul V. Dutton (brief book review here). Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France (The Culture and Politics of Health Care Work): 9780801445125: Medicine & Health Science Books @ Amazon.com