An annual report on the health status of the French population has just been published by the “DREES“, the National Directorate of Research, Studies, Evaluation and Statistics. The report includes a summary which emphasizes there are “divergent developments intertwined with clear-cut inequalities“.
Aging and Its’ Impact
Firstly, the report deals with the well-known phenomenon of ageing. Compared to 1960 when only 4.3% of the population were over age 75, this group now represents 9% of the population. Population forecasts predict this age group will reach 13% by 2032 and 16% by 2052. Chronic pathologies or multiple pathologies are also more prevalent for them, with 91% having at least one pathology or chronic treatment. Compared to 9% of the general population who use psychotropic medications, 27% of those over age 75 use them. Another important health issue is Alzheimer’s disease and other dementias which cause suffering for 760,000 people and for those around them.
This means that the needs of this ageing population will continue to be a source of supplementary needs that weigh heavily on the health care system, thus intensifying an already overburdened situation.
Lack of Clarity for Defining Healthy and Disability-free Life Expectancy
One page of the report is devoted to life expectancy and the concept of disability-free life expectancy. Although life expectancy at birth is constantly increasing, lately it has done so at a slower rate. In 2021, women’s life expectancy was 85.4 years, compared to 79.3 years for men, a gap that has been narrowing in recent years.
Healthy life years, (“HLY”) and also referred to as disability-free life expectancy (“DFLE”), is defined as the number of years that a person is expected to continue to live in a healthy condition, taking into account the current health situation. In France, it is estimated at 65.9 years for women and 64.4 years for men. Although life expectancy is calculated from demographic data on the entire population, the difference with healthy life expectancy is that it is based on the responses to the survey question: “Has a health problem been limiting you, for at least six months, from performing normal everyday activities? »
The possible answers are:
1-yes, severely limited; 2- yes, somewhat limited; 3- no, no limitations at all.”
The methodology states that “only people who have no limitations at all are considered healthy”. This marker is included in the national wealth indicators established by “INSEE”, the French National Statistics and Economics Bureau. The report quotes a former Director-General of the WHO, Dr Hiroshi Nakajima, who declared in 1997: “Without quality of life, increased longevity is of little interest (…) health expectancy is more important than life expectancy.” While the importance of good health is undeniable, it would be prejudicial to view the complexities of aging taking into account only in function one’s disability. The wisdom from the elderly and their contributions to society must not remain unseen by statistical indicators based on the subjectivity of one’s diminished physical activity.
Regional and Social Differences
Many examples of disparities and inequalities in the health status of the French are also described. For example, mortality from cancer deaths is higher in the north and northeastern regions. The socio-professional categories have an impact on Life expectancy. Statistically, when evaluating men from age 35 onward, a male manager lives an average of 6 years longer than a manual worker.
For some chronic diseases, such as diabetes, and psychiatric diseases, there are significant additional risks between those who are less well-off and the more affluent. For example, the poorest 10% of the population is affected by diabetes 2.8 times more than the richest 10% of the population.
Regarding Covid-19, the proportion of people placed in a hospital decreases in correlation with their standard of living. The population has a general tendency towards a sedentary lifestyle, but obesity is more common among people with lower incomes. The report states that “17% of individuals whose standard of living is below the first quarter of the distribution are obese, compared to 10% for those whose standard of living falls in the quartile for a higher standard of living“. The different socioeconomic groups also showed disparities for taking part in early diagnostic health screening. Regarding abortion, the report confirms the previously published data which signaled that the women with the lowest standard of living abort more often than the others. Finally, it should be noted that individuals living in the Overseas Departments and Regions (“DROM”) are particularly affected by many of the disparities studied in this report.
All in all, the DREES’ detailed report on the health status of the French confirms the necessity, even the urgency to make improvements in the current health system in order to provide better care for the all the population. In particular, anticipating and planning ahead for taking care of the elderly will become even more crucial, exactly the antithesis of rationing healthcare.