Addressing the unemployment-mortality conundrum: non-linearity is the answer

Health status and the Great Recession. Evidence from electronic health records

We investigate the impact of the Great Recession in Italy on the incidence of chronic diseases using new individual longitudinal data from Electronic Health Records. We exploit the exogenous shock in the economic conditions occurred in 2008 to estimate heterogeneous effects of an unprecedented rise in local unemployment rates in an individual fixed-effects model. Our results document that harsh economic downturns have a negative long-lasting effect on cardiovascular disease and a temporary effect on depression. This effect is heterogeneous across gender, increases with age and is stronger right before the retirement age. An important policy recommendation emerging from this study is that prolonged economic downturns constitute an additional external risk for individual health and not a temporary benefit.

The health of Italians before and after the economic crisis of 2008

This article examines the relationship between the financial crisis of 2008 and the health of Italians using aggregate and individual health indicators in correlation with the socioeconomic changes which have occurred in the Italian population. First, the study contextualises the changes referring to some important health indicators (life expectancy, death and suicide rates). Then, the main hypothesis on the relation between worsened individual health conditions and socioeconomic deterioration is tested. For this purpose, individual data from 2005 to 2013 stemming from Health Condition and Use of Health Services surveys (Italian National Institute of Statistics) are analysed. The results show that the social categories most severely affected by the crisis, in both employment and economic terms, were basically the same as those that experienced a worsening of their physical and psychological health conditions. These categories of people have a low level of educational attainment, live in southern and insular regions and are most often men.

Unfolding the relationship between mortality, economic fluctuations, and health in Italy

Despite the long-run strong negative association between economic development and mortality, their short-run relationship remains controversial. In the present work, we study co-movement between mortality growth (overall, gender- and cause-specific) and economic fluctuations in Italy over the period 1862-2013. To this aim, we use Johansen (Econometrica 59:1551-1580, 1991) procedure to jointly estimate the short- and long-run dynamics of the two variables, avoiding omitted variable bias in the cyclical co-movement extraction or spurious association attributable to trends. We also take into account possible asymmetric responses of mortality growth to shocks in GDP. We find that an increase of 1% in real GDP per capita induces a reduction in mortality rate of 0.27% for total population. Moreover, we observe that business cycle fluctuations do not affect mortality in the pre-wars era, where only the long run decreases matters driven by reduction in infections and accidents mortality. On the contrary, in the post-wars period, expansive phases of business cycle are associated with reduction in mortality growth and periods of recession generate an ever-deeper decrease. However, in this period, mortality for cancer is procyclical and significantly increasing in expansion: this reinforces the debate for controlling environmental factors.

Does austerity really kill?

A growing body of the literature has argued that austerity has been bad for health, though without directly measuring austerity. This paper explicitly distinguishes the association of mortality with macroeconomic fluctuations from that with fiscal policy measures, using data for 28 European Union (EU) countries covering the period 1991-2013. The main results present a nuanced, complex picture about the mortality impact of fiscal policies. We confirm the mortality decreasing (increasing) effect of recessions (booms), with the exception of suicide mortality, which shows the opposite effects. Austerity regimes are associated with an increase in all-cause mortality (0.7%). At the same time, fiscal stimuli tend to significantly increase death rates due to cirrhosis or chronic liver disease (3%) and those due to vehicle accidents (4.3%). Our results are sensitive to the set of countries included: when excluding the Baltics, Romania and Hungary, austerity policies turn out to significantly increase suicide-related mortality (2.8%), while the effect on all-cause mortality remains unaffected (0.7%). Overall, however it appears that the austerity-increasing effects are mostly compensated by the (mostly) mortality-decreasing effects of recessions. A notable exception appears to be suicides, which receive a 'double-boost' from both recessions and austerity.

Crises and mortality: Does the level of unemployment matter?

The relationship between mortality and economic fluctuations has been a topic of long interest, which intensified following the 2008 global financial crisis. We study whether mortality responds non-linearly and asymmetrically to unemployment in the context of national economic crises. Although these assumptions have been challenged in other domains, they have been neglected in the mortality literature. Greece offers an ideal setting as unemployment was decreasing until mid-2008, but then it was sharply increased as a result of a severe economic crisis. We use quarterly data on regional unemployment and mortality from 1999 to 2013, giving a balanced panel of 780 observations. We find evidence of a countercyclical total mortality, especially for the older groups, and a further deteriorating crisis effect. We provide evidence that the relationship is non-linear and asymmetric, suggesting that the effect on death rates changes for very high values of unemployment and depends on its direction. Both non-linearity and asymmetry are mainly driven by those above 65 years old. The results suggest that the mechanisms explaining these effects are likely to vary across age groups. Our findings have important methodological implications and suggest that empirical investigations on fluctuations, recessions and mortality should not ignore possible non-linear and asymmetric behaviours, especially during turbulent times.

Economic growth and mortality: do social protection policies matter?

Background

In the 20th century, periods of macroeconomic growth have been associated with increases in population mortality. Factors that cause or mitigate this association are not well understood. Evidence suggests that social policy may buffer the deleterious impact of economic growth. We sought to explore associations between changing unemployment (as a proxy for economic change) and trends in mortality over 30 years in the context of varying social protection expenditures.

Methods

We model change in all-cause mortality in 21 OECD (Organization for Economic Cooperation and Development) countries from 1980 to 2010. Data from the Comparative Welfare States Data Set and the WHO Mortality Database were used. A decrease in the unemployment rate was used as a proxy for economic growth and age-adjusted mortality rates as the outcome. Social protection expenditure was measured as percentage of gross domestic product expended.

Results

A 1% decrease in unemployment (i.e. the proxy for economic growth) was associated with a 0.24% increase in the overall mortality rate (95% confidence interval: 0.07;0.42) in countries with no changes in social protection. Reductions in social protection expenditure strengthened this association between unemployment and mortality. The magnitude of the association was diminished over time.

Conclusions

Our results are consistent with the hypothesis that social protection policies that accompany economic growth can mitigate its potential deleterious effects on health. Further research should identify specific policies that are most effective.

Job displacement and social safety net on depressive symptoms in individuals aged 45 years or above: findings from the Korean Longitudinal Study of Aging

This study aimed to investigate the relationship between the unemployment experience and depressive symptoms among mid-aged (ages 45–59) and elderly (ages 60 or above) persons and to examine further the effects of unemployment insurance, industrial accident compensation insurance (IACI) and national pension on the stated relationship. Data were used from the Korean Longitudinal Study of Aging (KLoSA) between 2006 and 2012. A total of 1,536 individuals employed at the 2006 baseline were followed. The association between employment status change during 2006 to 2008, 2008 to 2010 or 2010 to 2012 and depressive symptoms in years 2008, 2010 or 2012 were analysed using a generalised estimating equation model. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale (CES-D 10) scale. The results showed that the ‘employed to unemployed’ group had statistically significant increases in depression scores in the mid-aged (β = 0.4884,p= 0.0038) and elderly (β = 0.8275,p⩽ 0.0001) categories, compared to the ‘employed to employed’ group. Findings were maintained in groups without a social safety net. Contrastingly, the ‘employed to unemployed’ groups with unemployment insurance and IACI did not show statistically significant increases in depression scores. The ‘employed to unemployed’ category of individuals enrolled in the national pension system exhibited a lower increase of depression. Therefore, an enhanced focus on the mental health of unemployed individuals is required, in addition to the provision of a reliable social safety net.

Changes in the labour market and health inequalities during the years of the recent economic downturn in Italy

There is widespread concern that episodes of unemployment and unstable working conditions adversely affect health. We add to the debate by focusing on the relationship between work trajectory and the self-reported health of Italian men and women during the present economic downturn. Relying on Italian data in the EU-SILC project (from 2007 to 2010), our sample includes all individuals aged 30 to 60 in 2010, and uses multivariate binomial regression models for preliminary analyses and the Structural Equations modelling (SEM) to observe the cumulative effects of health status according to different job trajectories. Our main findings show similar pictures for men and women. Individuals who are unemployed, ejected or in precarious occupational positions have a higher risk of worsening their health status during these years.

The Economic Crisis and Acute Myocardial Infarction: New Evidence Using Hospital-Level Data

OBJECTIVE

This research sought to assess whether and to what extent the ongoing economic crisis in Italy impacted hospitalizations, in-hospital mortality and expenditures associated with acute myocardial infarction (AMI).

METHODS

The data were obtained from the hospital discharge database of the Italian Health Ministry and aggregated at the hospital level. Each hospital (n = 549) was observed for 4 years and was geographically located within a "Sistema Locale del Lavoro" (SLL, i.e., clusters of neighboring towns with a common economic structure). For each SLL, the intensity of the crisis was determined, defined as the 2012-2008 increase in the area-specific unemployment rate. A difference-in-differences (DiD) approach was employed to compare the increases in AMI-related outcomes across different quintiles of crisis intensity.

RESULTS

Hospitals located in areas with the highest intensity of crisis (in the fifth quintile) had an increase of approximately 30 AMI cases annually (approximately 13%) compared with hospitals in area with lower crisis intensities (p<0.001). A significant increase in total hospital days was observed (13%, p<0.001) in addition to in-hospital mortality (17%, p<0.001). As a consequence, an increase of around €350.000 was incurred in annual hospital expenditures for AMI (approximately 36%, p<0.001).

CONCLUSIONS

More attention should be given to the increase in health needs associated with the financial crisis. Policies aimed to contrast unemployment in the community by keeping and reintegrating workers in jobs could also have positive impacts on adverse health outcomes, especially in areas of high crisis intensity.

Who suffers during recessions? Economic downturns, job loss, and cardiovascular disease in older Americans

Job loss in the years before retirement has been found to increase risk of cardiovascular disease (CVD), but some studies suggest that CVD mortality among older workers declines during recessions. We hypothesized that recessionary labor market conditions were associated with reduced CVD risk among persons who did not experience job loss and increased CVD risk among persons who lost their jobs. In our analyses, we used longitudinal, nationally representative data from Americans 50 years of age or older who were enrolled in the Health and Retirement Study and surveyed every 2 years from 1992 to 2010 about their employment status and whether they had experienced a stroke or myocardial infarction. To measure local labor market conditions, Health and Retirement Study data were linked to county unemployment rates. Among workers who experienced job loss, recessionary labor market conditions at the time of job loss were associated with a significantly higher CVD risk (hazard ratio = 2.54, 95% confidence interval: 1.39, 4.65). In contrast, among workers who did not experience job loss, recessionary labor market conditions were associated with a lower CVD risk (hazard ratio = 0.50, 95% confidence interval: 0.31, 0.78). These results suggest that recessions might be protective in the absence of job loss but hazardous in the presence of job loss.