The media have been reporting these days that the U.S. economy continues to grow, and more people are being hired each month, bringing the unemployment rate down to 5.6%--a level not seen since the late 1990s. Unfortunately, in some parts of the world, the negative impact of the 2008 Great Recession continues to be felt. Among some European Union countries, the share of the unemployed remains at unprecedented high levels, particularly among young adults. In Spain and Greece, for example, the unemployment rate is about 25%.
As discussed in a recent paper by researchers from the Urban Institute, being out of work for six months or more is associated with lower well-being among the unemployed, their families, and their communities. While tax and social transfer programs can help mitigate the consequences of long-term unemployment, a decline in family income due to a worker’s lack of earnings directly reduces the quantity and quality of goods and services the worker’s family can purchase, and exacerbates stress as well. The erosion in the tax base used to fund essential public services, such as health care, can negatively affect individuals and families by constraining access to these services when needed.
So, the question for those of us working in the health sector is how unemployment and its duration, as well as its consequences, affects individuals’ health behaviors and health outcomes, and what can be done to ameliorate them?
The authors of a longitudinal study just published by the National Bureau of Economic Research (NBER), which tracked the same people over two recessions in the United States, including the Great Recession of 2008, caution against broad generalizations about the consequence of job loss on individual health behaviors. That is because, they argue, behaviors vary differently in the face of resource constraints, stress level due to job loss, and expectations regarding prolonged duration of job loss.
In terms of the effect of unemployment on physical activity (energy expenditure), food consumption (energy intake), and the effect on body weight (as measured by body mass index or BMI), the study found that both energy intake and expenditure decline after a job loss, leaving BMI unchanged or slightly higher (mostly among previously obese individuals). The study also found that among females, job loss is associated with an increase in the probability of being a current smoker, consistent with a decline in smoking cessation or a relapse into smoking among former smokers due to stress. Among males, the study found no significant effect on smoking, although, similar to females, there is a reduction in cigarettes consumed among heavy smokers.
Since physical activity can be health-promoting, the paper concludes that even though unemployment is only weakly associated with weight gain, lower total physical activity which reflects high job losses in manual labor (e.g., housing construction) and spending more time on sedentary activities (e.g., watching TV, surfing the internet), may have adverse effects on health. Also, unemployed people are more likely to delay routine health care visits or taking medication because of income constraints or because they have lost their health insurance.
In terms of change in the association between macroeconomic conditions and overall mortality, another NBER study found effects for specific causes of death, rather than changes in the composition of total mortality across causes. For example, the lack of a significant effect of unemployment on changes in healthy behaviors is consistent with evidence that cardiovascular disease deaths have not changed dramatically over time, while road traffic fatalities tend to decrease during economic downturns because reduced income due to unemployment is associated with a decrease in miles driven in a car.
A negative correlation is found over time for cancer fatalities and some external sources of death (particularly those due to accidental poisoning). The study concluded that the changing effect of macroeconomic conditions on cancer deaths may partially reflect the availability of financial resources or health insurance coverage, which can be used to obtain high-cost, specialized treatments.
An increase in observed deaths as a result of accidental poisoning may occur due to increased stress or depression related to job loss during economic downturns. This, in turn, is associated with the use of prescribed or illicitly obtained medications that carry risks of fatal overdoses. Additional evidence presented in a BMJ article shows that, after the 2008 economic crisis, rates of suicide increased in a group of European and American countries studied, particularly among men and in countries with higher levels of job loss.
Given the cyclical nature of economic activity, perhaps those of us in the health sector working as part of cross-sectoral teams need to place particular attention on understanding more clearly the underlying mechanisms through which losing a job impacts health behaviors and conditions, both during and after economic downturns and in situations of long-term unemployment. This type of knowledge is essential for developing evidence-based policies and programs to ameliorate the consequences of job loss, particularly among those who are most vulnerable to economic and health shocks, and ensure that they are protected and supported throughout and after the crisis.
Follow the World Bank health team on Twitter: @WBG_Health.
Urban Institute. 2013. “Consequences of Long-Term Unemployment”
NBER Working Paper 20748. 2014. “Unemployment and Health Behaviors over the Business Cycle. A Longitudinal View.”
NBER Working Paper 19287. 2013. “Recessions, Healthy no More?.”
BMJ. 2013. “Impact of 2008 global economic crisis on suicide: time trend study in 54 countries.”
El desempleo daña la salud en Latinoamérica