Population Europe: In most European countries women’s life expectancy is still higher than men’s. Even though this sounds nice, what are the main associated risks?
Chantal Cases: There are mainly two consequences: the first is loneliness, and the second is the need for support. Loneliness is very common for women because they live longer – longer than their husbands. And those two conditions have some direct results: women are older on average and much more frequently widowed. And secondly, women live longer but they also spend longer periods of their lives with health problems. They need more support than men, even at the same age. So these two factors lead to more important needs for care in old age for women.
PE: Even though older women need more help than men, women are still the main caregivers. How does this correlation work?
CC: Well, they are the main caregivers for demographic reasons: their spouses are often older and need help. And they are also the main caregivers for social reasons, due to gender roles. In every European country daughters provide more support than sons. And between spouses, women give more support than men.
When there is a living spouse in the same health situation, women are more likely to move into institutions than men. Men ask for professional assistance to help their wives more than women do themselves. So the main reasons are social, but there are also demographic reasons.
PE: What are the consequences of that?
CC: Providing help has health consequences for caregivers, and as the main caregivers are women, women are more often affected by these consequences. For instance, when people have to assist others in daily activities, such as a parent or a spouse who is dependent due to dementia, there are many psychological effects. And these have consequences for the health of the caregiver. So these problems can lead to functional problems for caregivers later on.
And there are also economic consequences: because women are the main caregivers, and now that more women are working, they have to adapt their professional lives to caregiving. This frequently means working fewer hours, for instance, which has consequences for wages and pension entitlement. Once they get older they benefit less from retirement schemes and they have less income to ensure their own needs for support.
PE: So what policies could help women in this situation?
CC: To help women in this situation I think the most important thing is more professional care to assist dependent people. This would help women, caregivers, and would reconcile work and family burdens. The key point I think is to have a real policy of professional care. That does not mean that family won’t help; generally when professional caregiving is acquired, this does not mean that the family stops helping. It changes. Care within the family is focused less on helping with daily activities and more on social activities, for instance. That is the main thing that could be done for women.
PE: But how can we finance this?
CC: That is of course an important problem, but it is a social choice. There is a debate about the amount of financing that countries should provide for this new social protection system. Different possibilities exist, and in Europe there are very different systems. I think that allowances for professional care must be a part of public insurance. Because dependence is a very special risk, and is a long-term risk, it is not very easy to put into a model, and private insurance does not fit very well with these characteristics. It is a risk to which people are very poorly equipped, so they generally don’t obtain private insurance. So it must become part of public insurance, and probably also in the case of long-term care, part of the public services. But it could be mixed with the mobilisation of private wealth and the incomes of older people, the wealthy. And it could be mixed with private insurance. But if that’s the case, I think the market must be highly regulated.
PE: Is this disparity you described between men and women a temporary trend or will it continue for future generations?
It will be a trend for at least the next decades. In Europe, depending on the impact of the baby boom in different countries, it will slow down in a few decades and will proceed differently in different countries. But it is, at least for next decades, an important problem and we will have to deal with it. In some countries the projections for the dependent population show that in the next twelve or thirteen years the number of dependent people will at least double. So we have to deal with it, even if the progress of healthcare systems could lead to later entry into dependence.
PE: And will there be changes in the difference between men and women?
CC: That will change slowly because the mortality difference between men and women is reducing slightly, that is the first point. And the second point is that for many demographic reasons, the importance of widows will also decrease. So in upcoming decades, older women will be less lonely than in our times. They will still comprise the majority of dependent persons but they will be less lonely, and for many, their husbands or at least one child will take care of them.
PE: But will these relatives be prepared to help?
CC: We know that the majority of dependent people growing older will have someone to help them. But we don’t know if people themselves and their possible caregivers will have the same behaviour in the future; if they will really accept help or agree to help under the same conditions as today. And that is a real problem, because when we ask people nowadays what they think the best way to take care of dependent people is, in every county, and even in southern countries where family support is very important, they all ask for professional help, at least for some of their needs. So it is not so clear, even if a population of potential caregivers exists, that this help will be possible and real in the same way as today.
PE: Thank you!
Chantal Cases graduated from National School of Statistics and Economic Administration (ENSAE). Since 2009 she is the director of the Institut national d'études démographiques (INED). Her research focuses onrecent health inequalities and the performance of health systems.
Interview: Sigrun Matthiesen and Katherine Knaust / Population Europe