Belgium's Long-Term Sick Crisis: Health Beyond the Diagnosis

Emily Sanders Journal · Health, Hormones & Prevention · 24 October 2026

Nearly 600,000 Belgians are on long-term sick leave. Is our idea of healthcare missing the bigger question?

Beyond the diagnosis: the question Belgium cannot ignore

Imagine a country where hundreds of thousands of people are ill for so long that ordinary working life becomes impossible. Then imagine treating that number as a budget problem, a political argument or a statistic on a dashboard—rather than a signal that something deeper deserves attention. Belgium does not have to imagine it. It is living it.

The Krachtpraat podcast brings this uncomfortable reality into the open. In an October 2026 conversation, hosts Tim Broekmans and René De Rop sit down with Dr Francis Coucke to discuss long-term sickness, chronic conditions, hormones, prevention, lifestyle and the limits of a system organised around diagnosing and treating disease.

The episode raises the kind of question we should not be afraid to ask: are we merely managing illness once people have already lost their health, or are we creating the conditions in which more people can remain well? Both matter. But pretending they are the same is part of the problem.

Almost 600,000: what the Belgian figures actually say

The headline is striking, and it deserves precision. According to Belgian figures reported for the end of 2025, 576,643 people were receiving invalidity benefits after more than one year of incapacity for work. That is why “nearly 600,000” appears in the Krachtpraat episode title. Belgian health-insurance authority RIZIV/INAMI publishes the underlying invalidity statistics for employees, unemployed people and the self-employed.

This is not a count of every person with a chronic illness. It is a definition linked to recognised long-term work incapacity. Some people in the statistics undertake authorised part-time work. Many others live with serious conditions that are invisible in this specific measure. Numbers tell us how large a problem is; they do not tell us everything about the people living inside it.

There is another important detail often lost in an angry headline. The increase in 2025 was affected by Belgium's higher statutory retirement age. RIZIV reports that, after accounting for this policy change, growth was much smaller. Demographics, longer careers, mental health problems and musculoskeletal conditions all play a role. We can acknowledge this complexity without diluting the urgency. The real question is not whether the number is politically convenient. It is why so many people find themselves unable to sustain healthy, workable lives.

What Krachtpraat puts on the table

Krachtpraat is built around frank conversations. Episode 69, released on 7 October 2026, features Dr Francis Coucke with Tim Broekmans and René De Rop. The official episode description identifies several recurring questions: why chronic illness can be hard to address; how hormones may matter; what prevention can achieve; how nutrition, movement and daily choices intersect with health; and where conventional healthcare encounters limitations.

These are themes described by the podcast itself, not direct quotations from an independently verified transcript. The distinction matters: we can engage seriously with the conversation without pretending we heard words we cannot verify.

An especially useful starting point is the uncomfortable tension between medical success and lived experience. A laboratory result can fall inside a reference range while somebody still reports exhaustion, poor sleep, pain or loss of function. That experience deserves proper clinical attention, but it does not automatically prove a hormonal deficiency—or validate a particular supplement, medication or intervention. Good medicine must be curious enough to investigate and disciplined enough to test its own explanations.

Treating illness is essential. Preventing it deserves equal ambition.

Modern medicine has saved countless lives through emergency care, surgery, vaccination, diagnosis and effective medications. The claim that healthcare is “only treating symptoms” is too simplistic. At the same time, it is fair to ask whether prevention receives the time, funding and continuity it deserves before problems escalate.

Think about the path from a first warning sign to an eventual long-term absence from work. It might include persistent pain that is never adequately rehabilitated, repeated nights of poor sleep, exhaustion dismissed as ordinary stress, a job with no room for recovery or a condition that takes too long to diagnose. None of these pathways is guaranteed; each can involve several causes at once. But they suggest opportunities for earlier support instead of waiting for crisis.

Prevention must be more than an instruction to “eat better and move more.” It means timely primary care, appropriate screening, healthier work design, mental-health access, support during menopause, rehabilitation, safe housing and realistic opportunities to be active. The World Health Organization notes that tobacco, inactivity, diet, harmful alcohol consumption and air pollution are important risk factors for noncommunicable diseases. Some influences are individual; others are environmental, economic and systemic. The strongest response works on both.

The silent burden: mental health, pain and exhaustion

Long-term work incapacity is not explained by one fashionable diagnosis. Musculoskeletal problems, mental-health conditions and other illnesses all contribute. RIZIV's 2025 reporting shows that 38.3% of people on invalidity benefits for longer than a year were affected by mental or behavioural disorders. Depression or burnout accounted for around a quarter of all invalidity cases. From 2021 to 2025, the number attributed to depression or burnout rose by 32%.

Behind each percentage is a more complicated human story: a person who cannot concentrate, another whose body hurts every morning, somebody managing illness alongside children and a demanding job. It is easy to tell such people to be resilient. It is harder—and more useful—to ask what needs to change so that recovery is genuinely possible.

The solution cannot be to tell everyone to train harder, work harder or simply be positive. Movement can help some conditions, but an exhausted person may need diagnosis, pacing, treatment, workplace adaptation, financial stability or psychological support first. Health is not a contest in willpower. Discipline matters. So do resources, biology and circumstances.

Hormones: an important conversation, not a universal explanation

Hormones influence sleep, temperature regulation, reproductive health, metabolism, muscle, mood and much more. It is reasonable that Dr Coucke's episode gives the topic space. Yet “it must be your hormones” is not a diagnosis. Persistent fatigue, changes in weight, poor recovery or low libido have multiple possible explanations. Thyroid disease, iron deficiency, sleep disorders, medications, depression and many other factors can overlap.

For women, perimenopause and menopause deserve particular attention. Symptoms can affect work, training, relationships and self-confidence, while their connection to hormonal change may be missed. NICE recommends individualised discussion of menopause care and offers hormone replacement therapy for appropriate symptoms, with benefits and risks evaluated for the individual. That is very different from prescribing the same hormone protocol to every woman who feels unwell.

We should be able to say two things at once: women deserve to be heard when something feels wrong, and treatment decisions deserve high-quality evidence. A “normal” blood test should not end a thoughtful consultation. Neither should an online promise that a single hormone will solve every problem. Ask better questions, investigate properly, and make decisions with competent clinicians who explain their reasoning.

Women's health: why 'normal' is not always enough

In the Emily Sanders Journal, we return often to the difference between a reference range and a life that feels healthy and capable. A number on a lab report is a tool, not a verdict on your lived experience. If pain, fatigue, poor sleep or disruptive menopause symptoms are changing your daily life, they deserve attention even when the first tests are unremarkable.

But the reverse matters just as much: seeking “optimal” values must not become a chase for ever-higher hormone doses, questionable tests or unapproved treatments. Menopause hormone therapy has established clinical uses; female testosterone therapy has narrower evidence-based indications and needs specialist assessment. Investigational peptides are not interchangeable with licensed treatments, and enthusiasm about them cannot substitute for reliable safety and effectiveness data.

Good advocacy means refusing to be dismissed while refusing to settle for a compelling story instead of an accurate diagnosis. You have a right to ask what was tested, what alternatives are possible, what outcomes matter to you, and how a proposed treatment will be monitored. Informed choice is stronger than either blind trust or blanket rejection of medicine.

Personal responsibility and systemic responsibility belong together

There is something empowering about recognising what you can influence. Sleep consistency, food quality, resistance training, regular activity, not smoking, seeking help early and managing workload can improve the odds of better health. The World Health Organization recommends adults aim for 150–300 minutes of moderate aerobic activity a week, alongside muscle-strengthening activities on at least two days. These are public-health guidelines, not a test of personal worth.

Someone living with a chronic condition or disability may need to start far below those targets or use adapted activity. For many, five minutes is an achievement. For others, better access to medical care, less occupational strain or a stable income will matter more than another wellness checklist.

The message should never be “if you are sick, you failed.” Illness can occur despite excellent habits. Not every condition is preventable. You can take ownership of your decisions without accepting blame for circumstances beyond your control. And policymakers cannot outsource every healthcare challenge to individual discipline while ignoring workplace, financial and care-access barriers.

What would a prevention-first health culture actually do?

It would begin before a person crosses the threshold into serious dysfunction. A general practitioner could have adequate time to examine persistent symptoms and coordinate care. Employers could identify harmful working conditions before burnout becomes a long absence. Mental-health services would be accessible early enough to prevent worsening, rather than only after a crisis. Rehabilitation and supported return-to-work pathways would be tailored, not punitive.

Women's midlife health would be treated as a normal part of preventive care rather than a niche conversation. Appropriate cardiovascular risk assessment, strength and mobility support, nutrition and sleep evaluation would sit beside—not replace—evidence-based treatment. And success would be measured by functioning, quality of life and sustained participation, not only by how quickly a form is closed or a benefit is reduced.

We also need honest evaluation. Prevention programmes should demonstrate real outcomes; not every fashionable intervention delivers. Doing more tests is not automatically better care. The standard should be simple: does this approach help people live healthier, more functional lives, without exposing them to disproportionate harm or cost?

Seven questions worth taking to your next appointment

If you recognise yourself in this conversation, start with questions rather than a shopping list of products or treatments. What might explain my symptoms? Which serious or common causes need to be ruled out? How do my sleep, medications, stress, work demands and stage of life fit into the assessment? Which tests would actually change the treatment plan? What interventions have the strongest evidence for my specific situation? What warning signs need urgent attention? And when do we review progress together?

Write down the pattern of your symptoms and what you can no longer do as easily as before. Ask for a second opinion when concerns are repeatedly dismissed or unanswered. The point is not to demand a particular diagnosis. It is to build a better conversation and an individual plan that can be evaluated over time.

The uncomfortable conclusion: healthier lives need more than prescriptions

The most compelling part of the Krachtpraat premise is not its headline figure. It is the invitation to question what we consider success in healthcare. A society can become exceptionally sophisticated at billing, coding and treating illness while still failing to give prevention, recovery and daily functioning enough attention.

The answer is not to turn our backs on modern medicine. It is to expect more from it—and from our workplaces, public policy and our own routines. Recognise illness early. Take symptoms seriously. Use treatments that work. Create conditions in which recovery is possible. And remember that a person's value is never measured by their capacity to work.

Listen to the full conversation and decide which questions it raises for you. The right kind of debate does not end with “medicine is wrong” or “lifestyle fixes everything.” It begins where evidence, experience and curiosity meet.

Frequently asked questions

Does Belgium really have almost 600,000 long-term sick people?

Figures reported for the end of 2025 put the number at 576,643 people receiving invalidity benefits after more than one year of incapacity for work. This is a social-insurance definition, not a tally of everybody with chronic illness.

What is the difference between prevention and treatment?

Treatment addresses a condition that is already present. Prevention aims to reduce risk, detect problems earlier and support healthier conditions. Good healthcare needs both.

Can hormone imbalance cause fatigue and poor recovery?

Hormonal disorders can contribute to these symptoms, but so can sleep disorders, medications, chronic illness, psychological stress and other causes. A tailored evaluation matters.

Is HRT an option for menopause symptoms?

For many people with relevant menopause symptoms, hormone replacement therapy is an evidence-based option. Suitability depends on personal history, symptoms, benefits and risks, discussed with a qualified clinician.

Does lifestyle prevent all chronic disease?

No. Regular movement, nutrition, sleep and not smoking can reduce some risks, but genetics, environment, infections, injuries and many other factors matter. Serious illness is not proof of poor discipline.

Sources and further reading

1. Krachtpraat, Episode 69, 7 October 2026 — official episode description
2. RIZIV/INAMI — invalidity benefits statistics, 2025
3. RIZIV/INAMI — mental disorders, depression and burnout statistics, 2025
4. WHO — noncommunicable diseases and prevention
5. WHO Europe — physical activity guidelines
6. NICE — menopause identification and management

Editorial note: this article is inspired by the episode's published topic description and independent sources; it is not a verbatim transcript and does not attribute unverified quotations to the guests. Not medical advice; consult a qualified healthcare professional.