Health Outlook 2025: Between Systemic Advances and Avoidable Threats

The 2025 edition of the Health at a Glance report published by the OECD[1] The report provides a nuanced overview of health in member countries. While life expectancy is rising again after the pandemic, risky behaviors (smoking, alcohol, obesity) remain major determinants of premature death. The report highlights that nearly 3 million deaths could have been avoided in 2023 within the OECD through strengthened prevention efforts and improved access to care. Despite improvements in the quality of care and the efficiency of hospital systems, pressure remains high on healthcare systems, particularly due to the rise in chronic diseases and the aging population.

The indicators presented come from OECD Health Statistics 2025. They are based on the most recent national data available (primarily 2023 for health indicators, 2022 for some behavioral data). The results allow for consistent comparisons between OECD member countries, thanks to methods of age standardization or demographic weighting. The analyses cover health status, risk factors, access to and quality of care, as well as health system resources.

Tobacco, alcohol, obesity: risk factors that weigh heavily on the health of populations

THE Health Outlook 2025 This shows that risky behaviors remain a major determinant of morbidity and preventable mortality across the OECD. Tobacco remains the leading risk factor associated with cancers, cardiovascular diseases, and respiratory illnesses. Some countries maintain particularly high levels of daily smoking: Greece, Hungary, and Latvia still exceed 20 daily smokers, unlike countries such as the United Kingdom, Australia, and Sweden where prevalence is significantly lower. Across the OECD, the average is 14.8 daily smokers, but the rise in vaping among young people, observed particularly in Canada, the United States, and New Zealand, is changing nicotine habits and calls for increased vigilance.

Alcohol is another major risk factor. Central and Western European countries have some of the highest levels, with annual consumption exceeding 12 liters of pure alcohol per capita in Austria, the Czech Republic, and Germany—well above the OECD average of 8.5 liters. This consumption significantly contributes to preventable mortality: cardiovascular diseases, cancers, cirrhosis, serious accidents, and violence. Conversely, Turkey, Israel, and Mexico are among the countries with the lowest consumption.

Finally, obesity continues to rise in almost all OECD countries. Rates exceed 30 in countries such as the United States, Chile, and Canada, while other Northern European countries—Denmark, Norway, and the Netherlands—maintain lower levels. On average, 19% of adults in member countries are obese (BMI ≥ 30). Insufficient physical activity is an aggravating factor: approximately 30% of adults report not engaging in sufficient physical activity, a phenomenon particularly pronounced in South Korea and Portugal, while countries like Switzerland and Iceland are among the most active.

Overall, the OECD believes that the combination of these factors (tobacco, alcohol, sedentary lifestyle, unbalanced diet) explains a substantial part of avoidable premature deaths, justifying the importance of intensifying prevention and risk reduction policies.

Healthcare systems that are generally effective but still unequal

Most OECD countries have made significant progress in healthcare, particularly in acute care. Thirty-day survival rates after a myocardial infarction or stroke have improved in countries such as Japan, Norway, and the Netherlands, where emergency care coordination and the availability of specialized units are particularly effective. These advances also reflect the positive impact of technological investments, notably in medical imaging and clinical monitoring devices, which have strengthened hospitals' capacity to respond quickly.

This improvement is also reflected in the levels of satisfaction expressed by the population: Scandinavian countries, such as Denmark and Sweden, have scores close to 90% regarding the availability of quality care, compared to an OECD average of 64%. In these countries, the strong presence of primary care centers and the widespread use of electronic health records facilitate access to services and continuity of care.

However, these positive results stand in stark contrast to the persistent inequalities observed within countries themselves. Countries where out-of-pocket expenses remain high are experiencing a particularly marked rate of foregoing necessary care. This is the case in Greece and Portugal, where more than 8% of the population report having had to forgo essential treatment due to lack of resources or excessively long waiting times. By comparison, this rate falls below 2% in countries like Germany and the Netherlands, where financial protection is stronger.

Territorial disparities constitute another major challenge. In several countries, including Canada, Australia, and the United States, access to healthcare is severely limited in rural or remote areas, where the number of doctors and nurses remains far below national averages. Conversely, countries like Finland and South Korea have implemented targeted strategies to deploy professionals in underserved areas, gradually reducing these disparities.

Meanwhile, the availability of long-term care remains highly uneven. While the Netherlands and Sweden have more than 10 workers in the sector for every 100 people aged 65 and over, countries like France, Spain, and Italy remain far below this number, which complicates the management of the aging population and increases the pressure on families and hospitals.

Finally, despite the consensus on the importance of prevention, it remains underfunded in most countries. While New Zealand and the United Kingdom allocate larger budgets to screening programs, nutritional support, and addiction treatment, the majority of OECD countries maintain an investment level below 3% of health expenditure, fueling an increasing reliance on curative care. This structural weakness, combined with staff shortages in certain critical sectors, perpetuates inequalities and hinders the reduction of preventable diseases.

France: a contrasting profile and more encouraging national data on smoking

The picture of France is mixed: the country presents several generally favorable health indicators, but remains exposed to high risk factors, particularly related to tobacco and alcohol. According to comparative data used by the OECD, the prevalence of daily smoking in France reaches 23.1 per 100,000 adult smoking rates, a level significantly higher than the OECD average (14.8 per 100,000 adult smoking rates) and placing the country among those where the burden of tobacco use remains structurally high. This estimate, based on previous data, does not, however, reflect the most recent trends: according to the Public Health France 2024 Barometer, daily smoking has declined at a historic low, reaching 17.4 per 100, its lowest level in over two decades. This progress, attributed to public policies implemented since 2016—regular tax increases, plain packaging, national campaigns, strengthening of smoke-free areas, and coverage of smoking cessation treatments—constitutes a particularly encouraging sign for French public health.

The report also notes a higher-than-average level of alcohol consumption per capita, at 10.4 liters, compared to an OECD average of 8.5 liters. This confirms that alcohol, like tobacco, is a major determinant of preventable diseases in France, particularly cancers and liver diseases. However, the OECD emphasizes that France performs better than average on other behavioral indicators: the prevalence of self-reported obesity is only 14 per 100,000 live births (14% per 100,000 live births), compared to 19 per 100,000 live births in the OECD, and the proportion of adults reporting a lack of physical activity is lower (27 per 100,000 live births compared to 30 per 100,000 live births). Air quality also remains slightly better than average, with exposure to fine particulate matter (PM2.5) estimated at 9.5 µg/m³, compared to 11.2 µg/m³ in the OECD area.

In terms of health status, France stands out favorably: life expectancy reaches 83 years, nearly two years above the OECD average. Avoidable mortality is lower (114 deaths per 100,000 inhabitants, compared to an average of 145), and treatment-avoidable mortality is also better controlled (48 per 100,000, compared to 77 in the OECD). These results reflect the efficiency of the healthcare system, which is widely accessible thanks to near-universal coverage and a high level of financial protection: 84% of healthcare expenditure is covered by mandatory schemes, compared to 75% in the OECD.

The report does, however, highlight certain weaknesses, including a slightly higher than average rate of people forgoing care and lower satisfaction with the availability of quality services compared to other European countries. Finally, the number of professionals in the long-term care sector remains insufficient given the aging population, which will be a growing challenge in the years to come.

Thus, while France currently presents a generally favorable profile in terms of health and access to care, this protective system now appears to be partially challenged. Furthermore, the country remains marked by historically high levels of tobacco and alcohol consumption. Recent national data, however, show significant improvement—particularly regarding smoking—confirming the impact of public policies to combat tobacco use and the importance of continuing efforts to sustainably reduce addictions and preventable diseases.

©Generation Without Tobacco

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[1] OECD (2025), Health at a Glance 2025: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/2f564c6c-fr