“You know that life expectancy in good health in France is 64 years…” Monday April 11, facing Emmanuel Macron on BFM-TVthe journalist Bruce Toussaint opposed to the presidential plan to postpone the retirement age to 65 the difficulties it would pose to people who would no longer be able to benefit from it without incapacity.
The argument had already been raised in October 2021 by the deputy of La France insoumise du Nord, Adrien Quatennens, or from the 2017 presidential election, by the candidate of the National Rally Marine Le Pen. But while healthy life expectancy is a recurring topic in debates about 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 the classic life expectancy goes back to the mortality tables established in the XVIIand century in the Netherlands, the concept of life expectancy in good health did not begin to germinate until the 1960s. “Many academics have tried to come up with an indicator that is as simple as life expectancy, but less quantitative”explains Jean-Marie Robine, demographer at the National Institute of Health and Medical Research (Inserm) and specialist in the aging of society.
This reflection has led to several avenues of evaluation, such as Sullivan’s method, which combines mortality data with the prevalence of certain pathologies. “But it is very hard 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 state, that is to say the level of disability of people”, continues Jean-Marie Robine. This is how the EVSI imposed itself, until in 2004 it became one of the official indicators of the European Union.
Concretely, it measures the impact of health on daily life and its management by society. “So it’s a theme related to disability,” explains Thomas Deroyon, 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 at advanced ages”adds the anthropologist and doctor 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 exhaustive mortality data for a country, by sex and age. In 2019, life expectancy at birth (i.e. the average age of 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 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 by a very simple declarative survey, since‘it is composed of a single question : “Have you been limited, for at least six months, because of 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 to the latest INSEE report based on Eurostat calculations, disability-free life expectancy in 2020 was 65.9 years for women and 64.4 years for men, which is a significant increase compared to the mid-2000s. According to 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 correctly quoted: Adrien Quatennens mentioned wrongly an average of 62 years, and falling, which is doubly false, while Marine Le Pen asserted that “What matters is the life expectancy in good health and this is quite low,” which also contradicts the official data. It is also often quoted without the usual precautions.
What are the limitations of this indicator?
The first relates to its methodology. Based on a declarative survey, the DLE relies on a part of subjectivity, “even if studies have shown that it can capture objective realities”, nuance 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 rely on a more modest sample of around 16,000 respondents, which makes the annual differences more difficult to interpret.
In addition, these surveys are conducted only within households, with a huge 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 weigh it against the major surveys that France has for unemployment or price monitoring, we wonder why we have not put in place more robust studies.regrets Jean-Marie Robine.
Finally, due to a 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 to live with disabilities. » Chopped careers, with high precariousness, are also overexposed, she reports.
While the study has not been replicated since, experts expect little has changed. Similar surveys conducted recently abroad come to the same conclusion, reports Ms. Cambois. A INSEE study shows that the life expectancy of manual workers is six to seven years shorter 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 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, in the event of lengthening of careers, the most weakened by precariousness and hardship may not be able to reach the 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.
By supplementing 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 should be calculated according to life expectancy in good health, which the reform envisaged by the President of the Republic does not take into consideration.remarks Didier Fassin.
This is even the main political utility of this indicator. “If we want a fair society, if we cannot act on death or illness, we can at least act on the retirement age”emphasizes Jean-Marie Robine.