What is “healthy life expectancy”, a recurring indicator in debates about retirement age?

Emmanuel Macron in Denain (North), April 11, 2022.

“You know that life expectancy in good health in France is 64 years…” Monday, April 11, face Emmanuel Macron at BFM-TVthe journalist Bruce Toussaint opposed the presidential plan to postpone the retirement age to 65 because of the difficulties it would entail for people who could no longer benefit from it without disability.

The argument had already been made. in october 2021 by the deputy of La France insoumise du Nord, Adrien Quatennens, or of the 2017 presidential election, by National Rally candidate Marine Le Pen. But while healthy life expectancy is a recurring theme in discussions of retirement age, this indicator is often misunderstood or misused.

What is healthy life expectancy?

Introduced in the mid-2000s, this public health indicator measures the number of years a person can expect to live without being limited in their daily activities by a health problem. explain the Department of Research, Studies, Evaluation and Statistics (Drees), which depends on the Ministry of Health. It is also called disability-free life expectancy (DFLE) or, more rarely, health expectancy.

While classical life expectancy dates back to mortality tables established in the 17th centuryme century in the Netherlands, the concept of healthy life expectancy did not begin to germinate until the 1960s. “Many academics have tried to arrive at an indicator as simple as life expectancy, but less quantitative”explains Jean-Marie Robine, a demographer at the National Institute for Health and Medical Research (Inserm) and a specialist in the aging of society.

This reflection has given rise to several ways of evaluation, such as the Sullivan method, which combines mortality data with the prevalence of certain pathologies. “But it is very difficult to assess this prevalence: people are not necessarily aware that they are sick, it depends on the level of education, medical knowledge, etc. So the simplest thing is to look at the functional status, that is, the level of disability of people”continues Jean-Marie Robine. This is how the EVSI was imposed, until in 2004 it became one of the official indicators of the European Union.

Specifically, it measures the impact of health on daily life and its management by society. “So it’s a disability-related issue,” explains Thomas Deroyon, a statistician and author of a DREES study on EVSI in 2020. More specifically, it allows “taking into account the degradation of the body and the quality of life in advanced ages”adds the anthropologist and physician Didier Fassin, author of Of the inequality of lives (Fayard, 2020).

How do we calculate it?

Whether measured by the DREES or by the European statistics body Eurostat, life expectancy in good health is calculated from complete mortality data for a country, by sex and age. In 2019, life expectancy at birth (i.e., the median age at death of a generation subject to current mortality conditions) is 85.6 years for women and 79.7 years for men, according to the National Institute of Statistics and Economic Studies (INSEE).

This purely statistical data intersects with a second factor, that of the existence or not of a pathology perceived as disabling over time by the person who suffers from it. This is measured by a very simple declarative survey, since‘consists of a single question : “Have you been limited, for at least six months, by a health problem, in the activities that people usually do? » Three answers are possible: no, a little and strongly.

Currently, what is the life expectancy in good health of the French?

According the latest INSEE report According to Eurostat calculations, disability-free life expectancy in 2020 was 65.9 years for women and 64.4 years for men, a significant increase compared to the mid-2000s. Eurostat, in France, the DLE at age 65 was 11 years in 2019, above the European Union average (10.3 years).

Note that it is rare for the indicator to be quoted correctly: Adrien Quatennens mentioned incorrectly an average of 62 years, and falling, which is doubly false, while Marine Le Pen I affirm that “What matters is life expectancy in good health and this is quite low,” which also contradicts the official data. It is also often cited without the usual precautions.

What are the limitations of this indicator?

The first relates to its methodology. Based on a declarative survey, the DLE is based on a part of subjectivity, “even if studies have shown that it can capture objective realities”, clarifies Thomas Deroyon. Furthermore, compared to mortality surveys calculated on the basis of the 600,000 people who die each year in France, the indicator can only be based on a more modest sample of around 16,000 respondents, making annual differences more difficult to interpret.

In addition, these surveys are carried out only within households, with a large blind spot on the side of accommodation establishments for dependent elderly people (Ehpad), whose residents are, by definition, more subject to disabilities. “It’s like polls, there is a margin of error. When we compare it with the main surveys that France has on unemployment or price control, we wonder why we have not established more solid studies.laments Jean-Marie Robine.

Finally, due to lack of resources, the EVSI details life expectancy in good health according to sex and age, but not by socio-professional category. But the differences are significant. Emmanuelle Cambois, researcher at the National Institute for Demographic Studies (INED) and author in 2008 of a study on the “double jeopardy” workers, was able to measure these inequalities: “Workers have a shorter life expectancy, and within that shorter life expectancy, they also have more years of life left with disabilities. » The cut races, with high precariousness, are also overexposed, he reports.

While the study hasn’t been replicated since then, experts expect little has changed. Similar surveys conducted recently abroad come to the same conclusion, reports Ms. Cambois. AN INSEE study shows that the life expectancy of blue-collar workers is six to seven years less than that of executives, and that the poorest 5% die on average thirteen years earlier than the richest 5%.

Can we refer to it in the debate on retirement age?

Yes, although it is important not to take the DLE as anything more than an average. « Disability-free life expectancy at age 65 does not mean you will live to age 65 and suddenly become disabled. Some will be disabled at 37 and others at 73, there is individual variability”, says Jean-Marie Robine. However, in case of career extension, those most weakened by precariousness and hardship may not reach retirement age at the full rate. What they would not cost in retirement pensions, they would cost in unemployment and sickness benefits, warns Emmanuelle Cambois.

Complementing it with more precise surveys on life expectancy in good health according to professions, this indicator could precisely make it possible to adapt the legislation in a finer and fairer way. “Today the poorest contribute to paying the pensions of the richest. The retirement age must be calculated according to life expectancy in good health, which does not take into account the reform planned by the President of the Republic.Didier Fassin comments.

This is even the main political utility of this indicator. “If we want a fair society, if we cannot act on death or illness, at least we can act on the retirement age”underlines Jean-Marie Robine.

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