[Thesis defense] Mira Rahal

On May 12th, 2026, Mira Rahal defended her thesis in economics :

‘Understanding Gender Disparities in Healthy Ageing in France: The Contribution of Health and Social Conditions’

Her thesis was co-directed by Pierre-Yves Geoffard and Emmanuelle Cambois.

Jury:

• Bénédicte Apouey, Paris School of Economics (Examiner)
• Emilie Counil, INED (Examiner)
• Clémentine Garrouste, Paris Dauphine University (Referee)
• Owen O’Donnell, Erasmus University Rotterdam (Referee)

Abstract :

Women live longer than men, yet spend more years with activity restrictions, a pattern known as the gender-health survival paradox. This thesis examines how specific health and social conditions contribute to gender disparities in healthy ageing in France. Drawing on the disablement process framework, which identifies chronic diseases as initiating factors in the pathway toward disability, it investigates which diseases drive women’s excess activity restrictions, and whether they do so through higher prevalence or a stronger disabling impact. The analysis extends from older ages to mid-adulthood and connects these health vulnerabilities to pension reforms extending working lives. Three complementary studies are conducted on recent French data, combining cross-sectional and longitudinal designs.The first chapter assesses how eight categories of chronic diseases contribute to activity limitation among adults aged 60 and over, using nationally representative data from the French CARE surveys (2015–2016), across gender and socio-occupational groups. Musculoskeletal and cardiovascular diseases emerge as the leading contributors, with musculoskeletal diseases and depression more prevalent among women, and cardiovascular diseases among men. Additive hazard regressions and decomposition analyses show that disparities are primarily driven by differences in disease prevalence rather than disabling impact: women’s higher prevalence of musculoskeletal diseases, depression, and neurodegenerative conditions accounts for their excess limitation, while the greater prevalence of musculoskeletal and cardiovascular diseases among manual workers and farmers explains their higher burden compared to highly skilled workers.Building on these findings, the second chapter focuses on musculoskeletal conditions and depressive symptoms in mid-adulthood (ages 50–69), using longitudinal data from the French CONSTANCES cohort. It broadens the outcomes to include employment restrictions, captured through the risk of being ”Neither employed nor retired” (NENR). Both conditions increase the risk of onset and persistence of activity limitation and of transitioning into NENR status. No gender differences in the strength of these associations are found: women’s disadvantage stems from greater exposure rather than a stronger disabling impact.The third chapter carries the inquiry of employment restrictions into the policy domain, asking whether the employment effects of raising retirement ages are heterogeneous with respect to health. It examines whether individuals with histories of the conditions examined in the preceding chapters, depression, osteoarticular diseases, and cardiovascular diseases, face a higher risk of being NENR when the 2010 French pension reform raised statutory retirement ages. Combining CONSTANCES with administrative records from the French National Old-Age Insurance Fund in a difference-in-differences approach, the analysis finds evidence of heterogeneity for all three conditions, with the most robust results for depression, a condition more prevalent among women and for which early retirement provisions remain limited. These findings show that gender disparities in healthy ageing arise primarily from women’s higher prevalence of musculoskeletal diseases and poor mental health, while cardiovascular diseases, though more relevant to men’s burden and to the social gradient, are also important contributors to activity limitation. The unequal prevalence of these conditions reflects both biological vulnerabilities and social circumstances, including occupational exposures and domestic responsibilities, and the interaction between the two. These findings point to prevention and improved disease management as essential levers for promoting healthy ageing and reducing inequalities, and underscore the importance of accounting for health vulnerabilities in the design of pension reforms extending working lives.