Measuring health and dependency

Measuring health and dependency

The health of the population is measured through surveys of a representative sample of the population who are asked about their health. These self-administered surveys provide a picture of people’s own perception of their health, through various questions about how they feel in general and any diseases, disabilities or incapacity they have.

The determinants of perceived health

A. Désesquelles is developing research aimed at better understanding the determinants of perceived health. Measuring self-reported health must take the subjective dimension into account. The perceived health indicator reflects influential factors, not only related to disease and disability but also about how people feel and perceive their own health, irrespective of their "objective" state of health.

The response to the WHO’s question, "What is your general state of health?" is strongly determined by the presence of diseases or disabilities. However, other factors (particularly age, sex, social status and family environment) can also influence the response. A study by Hintermeyer and Avdeev based on data from the ERFI survey showed that the percentage of people who reported being in good health despite having a chronic or long-term illness increases with age. *

A. Désesquelles proposes using the data from the ERFI survey to analyse the determinants of perceived health among people aged 60 and over, paying special attention to the role played by the family environment. She will also use the data from the second round of the survey (the question on perceived health was asked again in 2008). The ERFI survey is the French version of the Generations and Gender Survey (GGS). She will therefore be able to replicate the analyses for other countries (particularly Germany) and test the stability of the results obtained for France.

What is disability or dependency?

E. Cambois and J. Robine define disability, incapacity and dependency as the impact of disease, accidents or deformities on an individual’s ability to function. These concepts are organised into models that describe a process ranging from disease to impairment (sensory, physical and intellectual) of the individual and his/her functioning. Functional impairment can hamper everyday activities (work, housework, personal care, leisure, etc.). This can limit social participation and sometimes lead to a loss of autonomy as the persons become dependent on other people to assist them with basic tasks (bathing, dressing, preparing meals, etc.).

Dependency is defined as a "situation in which people depend on someone or something for their welfare, their health or their survival. In the area of disability, we speak of dependency when people require regular assistance from another person with basic activities, such as personal care, housework and managing their day-to-day affairs, which they can longer perform unaided as a result of impairment or incapacity. With the increase in the number of elderly people, who have a high risk of incapacity, it is extremely important to anticipate future provision for dependency (household help, retirement homes)." (Dictionnaire de démographie).

The research conducted to date does not consider the loss of autonomy as automatic but as dependent on the individual’s resources to recover from a disease or to adjust to functional impairment. It also depends on the person’s environment, which may facilitate or hamper adjustment. Technical aids, rehabilitation and modifications to the environment can help offset the impact of functional limitations. Support for compensation strategies enables people to maintain a satisfactory level of activity and extend their day-to-day autonomy. Our work aims to identify the conditions and factors that facilitate the extension of autonomy.

Some references

Désesquelles A, Salvatore MA, Egidi V, Why do Italian people rate their health worse then French people? An exploration of cross-country differentials of subjective health, Social Science and Medicine, 2009;68:1124-112

Cambois, E. and J.-M. Robine, L'incapacité et le handicap dans l'enquête santé 2002-2003 : Diversité des approches et usage des indicateurs. Dossiers Solidarité Santé, 2006. 2: p. 23-31

Cambois, E. and J.-M. Robine, Concepts et mesure de l'incapacité : définitions et application d'un modèle à la population française. Retraite et Société, 2003. 39: p. 62-91

Sermet, C. and E. Cambois, Mesurer la santé, in Traité de Démographie : Tome III. Les déterminants de la mortalité, G. Caselli, J. Vallin, and G. Wunsch, Editors. 2002, Ined: Paris. p. 25-52

Robine, J.-M., J.-F. Ravaud, and E. Cambois, General concepts of disablement, in Osteoarthritis: public health implication for an aging population, D. Hamerman, Editor. 1997, John Hopkins University Press: Baltimore. p. 63-83