Occupational inequalities in health expectancies in France in the early 2000s: Unequal chances of reaching and living retirement in good health

Abstract

Abstract Increasing life expectancy (LE) raises expectations for social participation at later ages. We computed health expectancies (HE) to assess the (un)equal chances of social/work participation after age 50 in the context of France in 2003. We considered five HEs, covering various health situations which can jeopardize participation, and focused on both older ages and the pre-retirement period. HEs reveal large inequalities for both sexes in the chances of remaining healthy after retirement, and also of reaching retirement age in good health and without disability, especially in low-qualified occupations. These results challenge the policy expectation of an overall increase in social participation at later ages. 1. Background 1.1 Population ageing, health, and working life: The French context France has one of the highest life expectancies (LE) at birth in the world: it topped 80 years in the early 2000s and increases, on average, by three months per year. Whether these years of life gained are years of good or poor health is a significant public health issue, especially for forecasting future levels of need of care and assistance (Manton 1982; Fries 1980; Kramer 1980). This is also a critical factor in appraising the potential for social participation at older ages and in identifying (un)equal opportunities in this domain. Indeed, a good health status is a basic requirement for social participation (World Health Organization 1946). Due to lengthening LE, the legal retirement age5 has recently been raised in France, to balance the number of pension contributors and recipients. However, trends and patterns in health, and therefore ability to work at later ages, received little attention in the debate. Health was only considered through references to studies on the unequal length of healthy life lived after retirement. Yet this issue is also important before retirement for the sustainability of the system. Poor health and activity limitations were found to be major determinants of labour force exit before the retirement age in France and elsewhere (Barnay 2009; Jusot et al. 2008; Sirven and Debrand 2008). Self-reported poor health increases in the years preceding retirement, even in occupational classes where it is already high, before decreasing again after retirement (Westerlund et al. 2009). These studies highlight occupational differentials in health, health deterioration, and the link between health and job loss. Health being a major determinant of social/work participation, social inequalities in health lead to unequal chances of social participation at later ages. This paper explores the extent to which the relatively long LE in France is associated with healthy life, based on various dimensions of health, and whether all social groups follow the same pattern. It presents computations of health expectancies (HE) for occupational groups at ages 50 and 65, and for the 50-65 age group. 1.2 Trends and patterns in health expectancies Health expectancy is the average number of years, at a particular age, to be lived in a given health status within total LE (Sullivan 1971). It complements the usual LE by integrating a health component, and has become a major population health indicator, used to monitor health trends worldwide (Jagger and Robine 2011). There are as many HEs as health measures (disability, diseases, perceived health, etc.). Among these, the European Community has recently included the so-called Healthy Life Years (HLY) or LE without activity limitation, in the list of structural indicators (Robine et al. 2009). Looking at international trends and patterns in HE, many countries, including France, have experienced a relatively good development, showing that the additional years of LE over the 1990s were not years of disability (Robine, Romieu, and Michel 2003). Even recently France was in the top group in Europe, with 20 remaining years without activity limitation after age 50 (Jagger et al. …