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

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

“You know that the healthy life expectancy in France is 64 years …” On Monday 11 April, in front of Emmanuel Macron on BFM-TV, journalist Bruce Toussaint opposed the presidential plan to postpone the retirement age to 65, the difficulties it would pose to people who would no longer be able to enjoy without disabilities .

The topic had already been raised in October 2021 by the deputy of La France insoumise du Nord, Adrien Quatennens, or as soon as the presidential election of 2017, by the candidate of the National Gathering Marine Le Pen. But while healthy life expectancy is a recurring topic in retirement age debates, this indicator is often misunderstood or misused.

What is the 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, explains Research, Studies, Evaluation and Statistics (Drees), which falls under the Ministry of Health. It is also called life expectancy without disability (DFLE) or, more rarely, health expectancy.

While the classic life expectancy dates back to the mortality tables established in the seventeenthAnd century in the Netherlands, the concept of healthy life expectancy didn’t begin to germinate until the 1960s. “Many academics have tried to find a simple indicator like life expectancy, but less quantitative”explains Jean-Marie Robine, a demographer at the National Institute of Health and Medical Research (Inserm) and a specialist in the company’s aging.

This reflection has led to different ways of evaluating, such as the Sullivan method, which combines mortality data with the prevalence of some 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 the people “continues Jean-Marie Robine. This is how the EVSI was established, until it became one of the official indicators of the European Union in 2004.

Specifically, it measures the impact of health on daily life and its management by society. “So it’s a disability issue”, explains Thomas Deroyon, statistician and author of a Drees study on HLE in 2020. More specifically, it allows ” take into account the deterioration of the body and the quality of life in old age “adds anthropologist and physician Didier Fassin, author of Of the inequality of lives (Fayard, 2020).

How do we calculate it?

Whether measured by DREES or by the European statistical body Eurostat, healthy life expectancy is calculated on the basis of comprehensive mortality data for a country, by gender and by age. In 2019, life expectancy at birth (i.e. the average death age 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 is crossed 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 with a very simple declarative survey, as it consists of a single question: “Have you been restricted, for at least six months, due to a health problem, in the activities that people usually do? “. Three answers are possible: no, a little and forcefully.

What is the current healthy life expectancy of the French?

According to the latest INSEE report based on Eurostat calculations, life expectancy without disabilities in 2020 was 65.9 years for women and 64.4 years for men, a significant increase compared to the middle of the years. 2000. According to Eurostat, in France the DLE at the age of 65 was 11 years in 2019, above the European Union average (10.3 years).

It should be noted that the indicator is rarely quoted correctly: Adrien Quatennens incorrectly evoked an average of 62, and falls, which is doubly false, while Marine Le Pen claimed that “What matters is the healthy life expectancy and this is quite low”, which also contradicts official data. It is often mentioned even without the usual precautions.

What are the limits of this indicator?

The first concerns its methodology. Based on a declarative investigation, the DLE relies on a part of subjectivity, “even though studies have shown it can capture objective realities”, Thomas Deroyon shade. Furthermore, compared to mortality surveys calculated on the basis of the 600,000 people who die each year in France, the indicator can only rely on a more modest sample of around 16,000 respondents, which makes the annual differences more difficult to interpret.

Furthermore, these surveys are conducted only within families, with a huge blind spot on the side of accommodation facilities for the dependent elderly (Ehpad), whose residents are, by definition, more prone to disabilities. “It’s like polls, there is a margin for error. When we weigh that against the major surveys France has for monitoring unemployment or prices, we wonder why we haven’t set up more robust studies.Jean-Marie Robine regrets.

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

Although the study hasn’t been replicated since then, experts expect little has changed. Similar investigations recently conducted abroad come to the same conclusion, Ms Cambois reports. An INSEE study shows that the life expectancy of workers is six to seven years lower than that of executives and that the poorest 5% die on average thirteen years before the richest 5%.

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

Yes, although it is important not to take DLE as anything other than an average. Disability-free life expectancy at age 65 does not mean that 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, if careers are extended, those most weakened by precariousness and hardship may not be able to reach full retirement age. What they wouldn’t cost in old-age pension, they would cost in unemployment and sickness benefits, warns Emmanuelle Cambois.

By integrating it with more precise surveys on healthy life expectancy according to professions, this indicator could really allow for a more finer and fairer adjustment of the legislation. “Today the poorest contribute to pay the pensions of the richest. The retirement age must be calculated on the basis of life expectancy in good health, which the reform envisaged by the President of the Republic does not take into account ». observes Didier Fassin.

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

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