Study suggests connections between recessions and public health | The Triangle

Study suggests connections between recessions and public health

Photo Credit: Department of History and Political Science
Photo Credit: Department of History and Political Science

Jose Tapia, associate professor of history and political science in the College of Arts and Sciences, co-authored a study and subsequent article with researchers from the University of Michigan titled “Individual Joblessness, Contextual Unemployment and Mortality Risk,” which was published in the August 2014 issue of the American Journal of Epidemiology.

The study concluded that the increased risk of death in individuals as a result of unemployment co-occurs with decreased risk of death in overall populations during a recession, due to the negative effects of unemployment being restricted to individuals who are unemployed. On the other hand, the positive effects of a recession affect the employed, unemployed and those not active in the labor market.

While this study did not look at the specific causes behind increased mortality in unemployed people, previous studies have shown that employees who lose their job have an increased mortality rate due to health issues arising from self-blame, depression, increased use of drugs and alcohol, suicidal ideation, and the psychological effects of the stigma of being unemployed.

“Psychologists have often emphasized that being unemployed has been associated with stigma,” Tapia said. “Previous studies show there is a strong correlation between unemployment and depression due the process of self-blaming rather than thinking maybe they were let go due to other reasons. Studies have also shown that suicide ideation is more [frequent] in males than females.”

This would typically lead to the conclusion that a recession increases the overall mortality rate. However, more comprehensive studies have shown that a recession decreases population mortality and has an overall positive effect on the health of a population. The results are paradoxical and it’s this paradox that the study investigated.

Researchers agreed that the results of past studies were sound but failed to explain how the two effects could occur together. They resolved the contradictory results by assuming that one effect occurred in some localities and the other in different areas. However, the latest study by Tapia found that for the first time the paradoxical effects do indeed occur together in the same dataset.

“It’s like the story of the Blind Men and the Elephant,” Tapia said. “Like the blind men who feel different parts of the elephant and argue over who is right, these previous studies are describing two different phenomena that are actually related and occur together. Both results are correct, but the connection wasn’t seen until now.”

The study used survey data collected between 1979-1997 from a nationally representative panel of 5,000 households called the “Panel Study of Income Dynamics” and data from the U.S. Department of Labor to examine the relationship between unemployment and its effects on individual health in the United States.

The study used statistical models to estimate the strength of the association between unemployment and the risk of death and included variables such as age, sex, marital status, household income and previous health. The models also took lag into account, which looked at the employment status one to two years before unemployment to ensure poor health wasn’t the reason a person became unemployed in the first place.

Tapia’s research found that those who lost their job had a 73 percent increase in mortality risk, which is the equivalent of aging 10 years. That means that 40-year-olds who have lost their jobs are statistically at the same risk of death due to heart attacks, cardiovascular disease or other illnesses as 50-year-olds, which is quite significant. However, the positive effects of a recession had caused a small decrease in risk of death.

In fact, the study found that a 1 percentage point increase in state unemployment levels, also called contextual unemployment, led to a 9 percent decrease in risk of death, which is the equivalent to being a little over one year younger. The mechanisms for the positive effect weren’t investigated, but Tapia suggested decreased air pollution, traffic fatalities and circulation of illnesses may be the causes behind the decreased mortality.

The positive effect of a recession is small compared to the negative effect of unemployment in individuals, but the reason the positive effect dominates in the overall population is due to the fact that all individuals, including the unemployed, benefit from the positive effect, while only unemployed persons suffer the negative health effects of unemployment.

However, the entire population — which includes those in the labor force in addition to children, retired people and other non-workers — benefits from decreased air pollution, one of several factors that vary based on economic upturns and recessions. Essentially, a small positive effect distributed to a large group of people wins over a large negative effect distributed to a small fraction of people.

The study resolves the paradox of increased individual mortality and decreased population mortality by showing they occur concurrently, and provides a substantial reason for studying the mechanisms that result in increased population health during recessions: in order to implement effective public health policies and practices.