Should We Be More Like the French?
While the French model for national healthcare may have its flaws, the benefits to Americans – including better diets, more walking and more social interaction -- could survive a transatlantic translation.
I learned a good lesson early in my writing career. You don’t need to look for stories; stories have a way of finding you. This is one such tale.
Let me set the stage with Scene One.
About a month ago, I was preparing to spend several weeks playing in France. This vacation was meant to be a true break -- no email, no voicemail and no laptop. That’s a daunting proposition for someone hardwired for communication.
The trade-off for my escape was a couple of intense workweeks prior to leaving.
The day before my departure, an HR leader sent me a link to Dean Witherspoon’s blog post called It’s Time to Stop Pandering to Participants. He asked me to read it and comment. I didn’t have the time, but I agreed to do so because that leader is also a friend.
Maybe it was my state of mind. Perhaps it was a radio interview I co-hosted that day with B.J. Fogg about behavior change. But something about the underlying essence of Dean’s post bothered me. He seemed to suggest we tell employees that behavior change is hard and to get on with it.
So, I commented and an interesting discussion evolved.
I left the next day with remnants of the post and ensuing exchange packed in the back of my brain.
Scene Two: France.
France evokes myriad images for most people -- deep history contained within beautiful architecture, scenic landscapes and incredible food and wine.
For those involved in health and healthcare issues, France provides other interests as well, including what some consider the best healthcare system in the world delivered at a price tag slightly below 12 percent of the gross domestic product.
For me, it became clear that the country’s admired health profile is like the French pastry -- the mille-feuille -- a result of a thousand layers of ingredients.
It begins with the infrastructure of cities and countrysides literally built for walking -- an advantage resulting from people living on French soil since Paleolithic times.
My Nike FuelBand reported that the daily mileage I covered in France ranged from a low of five to a high of almost 10 miles.
Food and wine are a source of pleasure and national pride. In 2010, UNESCO, the cultural arm of the United Nations, recognized the French meal as part of the world’s Intangible Cultural Heritage. UNESCO honored the French mealtime tradition with its rituals, table settings, multiplicity of courses and the matching of wines with food.
Food produced in France is among the most diverse in the world. As Elaine Sciolino described in La Seduction: How the French Play the Game of Life, “The genius of French cuisine does not rest in theatrical presentations. Some cheeses disappear, but new ones -- real farm cheeses -- are being created. Old varieties of fruits and vegetables are being resurrected.”
And the French raise their children with a reverence for meals. They are taught to respect mealtimes, to generally stick to three meals a day (no snacking) and to sit down and savor their food -- in the company of others.
In fact, it may be at the table where the French love of conversation first develops.
I often quote one friend’s saying, “We should start conversations we can finish.” But, in France, I learned a slightly different take I may appreciate more: We should start conversations that never end.
In our French travels, we found most people loved to engage us, not simply in conversation, but in discussions. The most popular topic was the American presidential election, which we deliberated at great length in a combination of English, French, Spanish (when at a loss for the right words on our part) and hand gestures coupled with facial expressions.
Placed on top of a culture embedded in walking, food that is relished and social interaction is the French healthcare system.
The National Health Insurance program covers all citizens and legal residents for healthcare through a tax-funded, government-run program. About 60 percent of NHI’s funds are derived from the income of France’s working population. Almost 21 percent of an employee’s compensation, including an employer contribution, is remitted to the government. The employer and employee contribute 12.5 and 0.75 percent, respectively, and the employee adds another 7.5 percent in a social-security tax. Other fund sources are indirect taxes from alcohol and tobacco.
In addition, more than 92 percent of French residents have private, supplemental insurance, which is funded by employers about half the time.
But, alas, all is no longer seemingly perfect in France when it comes to health.
ObEpi-Roche recently released its 2012 survey results in a follow-up to its ongoing studies on French overweight and obesity prevalence. While the obesity rate grew only 0.5 percent between 2009 and 2012, the 15-percent figure is almost double the 8.6 percent obesity prevalence first reported in 1997. In fact, when you add in the number of overweight Frenchmen, less than one in two people have a normal body-mass index.
The French healthcare system is also struggling. Despite the fact that an MRI only costs $280 in France, NHI has been in the red since 1989. And the country is struggling with similar U.S. issues such as rising drug costs, an aging population and unemployment. (In the United States, we can lose our health insurance when we lose our jobs. In France, job losses create a funding deficit for NHI.)
Part of France’s health challenge is the changing culture. Sciolino notes that a generation ago, the average meal in France lasted 88 minutes. Now, it ends after 33. Mega-supermarkets account for 75 percent of all retail-food sales.
In the time between my first visit to France in the mid-1990s and now, I was shocked by the prevalence of pizza parlors. And local establishments are not driving this trend. Case in point: In July 2010, Ann Arbor, Michigan-based Domino’s Pizza Enterprises became the No. 1 pizza company in France.
Other American food chains are invading France. Starbucks grew from hosting one to more than 50 Parisian storefronts between 2004 and 2011. And, by 2009, McDonald’s had opened up more than 1,100 outlets in France and is the chain’s second-most profitable market.
Meanwhile, the number of French cafés dropped to 40,000 from a high of 200,000 in 1960.
What I admire, however, is how the French are fighting back -- particularly when it comes to nutrition.
No one is telling France’s residents to buckle down and trim up. Instead, the Ministry of Health launched the National Health and Nutrition Program to “improve the health of the entire French population.”
Imagine this: The nutrition program’s strategies to support nine diet, physical activity and nutritional status objectives are based on fundamental principles, including food culture, pleasure and gastronomy.
As a human resource executive, you may feel limited as to how you can impact rising healthcare expenditures through pleasure-based food and activity principles. I am more convinced than ever, however, that efforts like the Blue Zones Project taking place in California’s Beach Cities and Iowa -- which are including employers as communities within the context of the larger community with great success -- are worth your attention.
Perhaps it’s time to at least experiment with the pleasure versus buckle-down principle to address employee-health status and costs. Then we, too, may be able to say Vive la différence!
Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.