Unemployment in Scandinavia during an economic crisis: Cross-national differences in health selection

Worker and workplace determinants of employment exit: a register study

BACKGROUND

Workers with chronic illness are in higher risk of unemployment. This article investigated the worker and workplace characteristics associated with labour market inclusion for workers with a diagnosed chronic illness.

METHODS

Linked employer-employee register data covering all Norwegian employers and employees each month from February 2015 to December 2019 were merged with patient data from specialist healthcare (136 196 observations (job spells); 70 923 individual workers). Survival analysis was used to estimate the risk of employment exit, with age, gender, chronic illness, full-time/part-time employment, skill level, marital status, children in household, branch, share of chronically ill workers, firm size and unemployment rate as covariates.

RESULTS

85% of the study population was employed in December 2019; 58% remain employed throughout the follow-up period. Mental illness, male gender, young age, part-time employment and lower skill levels were the worker-level predictors of labour market exit. Employments in secondary industries, in firms with high shares of chronically ill workers and, to some extent, in larger firms were the significant workplace-level determinants.

CONCLUSION

Only a minority of our sample of workers with chronic illness experienced labour market exclusion. Targeted measures should be considered towards workers with poor mental health and/or low formal skills. Chronically ill workers within public administration have the best labour market prospects, while workplaces within the education branch have an unfulfilled potential.

Time trends in self-reported depressive symptoms, prescription of antidepressants, sedatives and hypnotics and the emergence of social media among Norwegian adolescents

BACKGROUND

Research has shown increased mental health problems and use of prescription drugs among adolescents in recent years and social media use has been linked to poorer mental health. However, trend studies concerning these topics are scarce. The purpose of this study was to analyze gender-specific trends in a) symptoms of depression and loneliness, and b) prescription of antidepressants, hypnotics and sedatives, in relation to the emergence of social media among adolescents in Norway.

METHODS

This is an ecological study using data from the 'Young in Oslo' surveys from 1996 to 2021. The surveys included approximately 110 000 students, 14-17 years of age, and yielded a response rate varying from 95% in 1996 to 64% in 2021. A self-report questionnaire was used to collect information on symptoms of depression and loneliness. Information on antidepressant and sleep medication prescription was retrieved from the Norwegian Prescription Database for the age group 15 to 19 years. A graphical approach and logistic regression models were used to examine gender-specific time-trends between 1996 to 2021.

RESULTS

We found a doubling in self-reported symptoms of depression and loneliness among girls between 1996 and 2021, with the steepest increase in the period from 2006 to 2012, when Facebook and other social media were introduced. A similar trend was observed in the prescription of antidepressants among girls, with the steepest increase between 2011 and 2013. Among both boys and girls, 'worried too much about things' and 'had sleep problems' were the two symptoms with the greatest changes.

CONCLUSION

A significant upward trend in self-reported depressive symptoms and medication use was observed over the past 25 years, with variations in the rate of increase, including a steeper trajectory during certain periods immediately after the introduction of social media platforms in Norway.

Promoting labour market inclusion of the chronically ill: a scoping review of Scandinavian countries' efforts

OBJECTIVES

This article is a scoping review of efforts in labour market inclusion of the chronically ill in the Scandinavian countries, a research area that has received much political as well as research attention in recent years. The aim of the review was to identify promising strategies and the need for further research.

METHODS

Six electronic databases were searched for literature published between 2015 and 2020. We included peer-reviewed articles that studied the effect of measures, aimed at the workplace or at the individual, that are intended to increase participation. Our search resulted in 2718 articles; our screening procedures resulted in 47 included articles.

RESULTS

Among the included studies, musculoskeletal problems (17 articles) and mental health problems (29 articles) were the most frequent chronic conditions. Multimodal occupational rehabilitation programmes directed towards the individual employee were the most frequent interventions (30 articles). Return to work (24 articles) and sickness absence (12 articles) were the most common outcomes. About half (25 articles) of the included studies reported a positive impact of the intervention on work inclusion of the chronically ill.

CONCLUSIONS

Our review found little evidence of how government programmes directed towards the supply side of the labour market succeed in including the chronically ill. Our review further indicated that multidisciplinary workplace interventions have a substantial effect. We also identified a significant lack of research on the effect of various governmental policies and programmes, including local health, work and welfare services, and limited coordination and cooperation between health and work services professions.

Job loss and fetal growth restriction: identification of critical trimesters of exposure

PURPOSE

Previous research suggests that job loss in a household during pregnancy may perturb fetal growth. However, this work often cannot rule out unmeasured confounding due to selection into job loss. Recent work using data on exogenous job loss (due to a plant closure) finds that a father's unexpected job loss during his spouse's pregnancy increases the risk of a low weight birth. Using a unique set of linked registries in Denmark, we build on this work and examine whether associations between a father's unexpected job loss and low birthweight differ by trimester of in utero exposure. We additionally examine trimester-specific associations of job loss with small-for-gestational-age, a proxy for restricted fetal growth, which may cause low birthweight.

METHODS

We apply a sibling control design to over 1.4 million live births in Denmark, 1980 to 2017, to examine whether this plausibly exogenous form of job loss corresponds with increased risk of low weight or small-for-gestational-age births, depending on the timing of displacement in the first, second, or third trimester.

RESULTS

Results indicate an elevated risk of low birthweight (OR = 1.80, 95% CI: 1.24, 2.62) and small-for-gestational-age (OR = 1.40, 95% CI: 1.02, 1.93) among gestations exposed to job loss in the second trimester of pregnancy. Sensitivity analyses using continuous outcome measures (e.g., birthweight in grams, birthweight for gestational age percentile) and maternal fixed effects analyses produce substantively similar inference.

CONCLUSIONS

Findings support the notion that unexpected job loss may affect fetal growth and that the second trimester in particular appears sensitive to this external stressor.

Disentangling the association between alcohol consumption and employment status: causation, selection or confounding?

BACKGROUND

Alcohol use constitutes a major health risk and is related to unemployment. However, the direction of this relationship is unclear: unemployment may change drinking patterns (causation), but heavy drinkers may also be more prone to lose their job (selection). We simultaneously examined selection and causation, and assessed the role of residual confounding. Moreover, we paid attention to the subgroup of abstainers and occupationally disabled, often disregarded in the literature.

METHODS

Longitudinal data (three waves collected between 2006 and 2018) of the Lifelines Cohort study from the Netherlands were used (138 875 observations of 55 415 individuals, aged 18-60 at baseline). Alcohol use was categorized as 'abstaining', 'moderate drinking' and 'binge drinking' (≥5 drinks/occasion for male; ≥4 for women). Employment status included occupational disability, short (<6 months) and long-term (≥6 months) unemployment. Random- and fixed-effects multinomial regression models were fitted in order to account for residual confounding. Reciprocal causality was assessed through generalized structural equation modelling with fixed-effects.

RESULTS

Long unemployment spells increase the risk for both binge drinking (β = 0.23; 95% CI 0.04-0.42) and abstinence (β = 0.27; 95% CI 0.11-0.44), and the effects hold after accounting for reciprocal causality and time-constant confounding. Contrarily, the effect of binge drinking on unemployment is weak (β = 0.14; 95% CI -0.03 to 0.31). Abstinence is strongly associated with occupational disability (β = 0.40; 95% CI 0.24-0.57).

CONCLUSIONS

We find evidence supporting the causation hypothesis (unemployment altering drinking patterns), whereas evidence for the selection hypothesis is weak and mostly confounded by unobserved variables, such as poor health prior to baseline.

Financial Reasons for Working beyond the Statutory Retirement Age: Risk Factors and Associations with Health in Late Life

Despite an increasing trend of working life prolongation, little is known about the risk factors for financial reasons for working beyond the statutory retirement age (SRA), and how these reasons relate to health. The present study examined (1) the determinants of working beyond the SRA, (2) the workers' self-reported reasons for working beyond the SRA, and (3) the association between these reasons and health in late life. Cross-sectional data of 1241 individuals from the Swiss survey "Vivre/Leben/Vivere" were analyzed. The results showed that people with a low level of education and with a low income have an 80% higher risk of working beyond the SRA for financial reasons than for other reasons (p < 0.001). Moreover, self-rated health was not significantly associated with working beyond the SRA for financial reasons but was significantly associated with education and income (p < 0.01). In conclusion, while previous studies have already identified financial difficulties as one important reason for working beyond the SRA, the present study indicated the socioeconomic factors that are crucial for increasing the risk for working beyond the SRA. Thus, our results help to guide the adaptation of social policies for better maintaining and promoting the health of particularly vulnerable older workers.

Health and labor force participation among older workers in Switzerland: a growth curve analysis

This study investigated how individual trajectories of self-rated health (SRH) and working hours among older workers in Switzerland are interrelated and how this relationship varies based on occupation. We used data from the Swiss Household Panel to analyze the long-term trajectories of older workers measured in terms of working hours and SRH. The sample included more than 4000 workers aged 50 to 65(men)/64(women). We ran a bivariate response multilevel model for growth that allowed the examination of between- and within-individual changes over time. On a between-individual level, we found that the upper non-manual workers were the most heterogeneous occupational group in terms of working hours and the lower non-manual workers were the most heterogeneous occupational group in terms of health. Within all occupational groups, we found a significant relationship between the level of working hours and level of SRH. The individual-level statistics showed consistently strongest effects for manual workers. This result confirms our hypothesis that labor force participation in individuals of the manual occupational group is more sensitive to their health status. Our findings contribute to the debate regarding the importance of older workers' health in the context of the extension of working life.

Gender roles and selection mechanisms across contexts: a comparative analysis of the relationship between unemployment, self-perceived health and gender

Health literature shows that unemployment has a gendered effect on health. However, whether men or women are more affected and why remains unclear. We assume that unemployment harms women less than men because of two mechanisms: social roles theories and health selection. First, the availability and centrality in individuals' lives of roles other than employment may reduce the detrimental effect of unemployment for women. Second, the gendered impact of unemployment on health results from the different ways selection mechanisms operate across genders. Moreover, these two mechanisms may operate differently in different contexts - for example, across different gender regimes. We investigate this by pursuing a three-step comparative approach. The analysis relies on EU-SILC data covering Italy and Sweden for 2004 to 2015 and SOEP data for Germany (1995-2017) and applies correlated dynamic random-effects probit models. While we find weak support for the role of health selection in shaping the relations between unemployment, health, and gender, our empirical results are in line with the hypothesis of a larger gendered effect in older (vs younger) cohorts, western (vs eastern) Germany and Italy (vs. Sweden). Future empirical research needs to directly address the role of gender regimes in moderating such complex relationships.

Birth outcomes following unexpected job loss: a matched-sibling design

BACKGROUND

Research documents social and economic antecedents of adverse birth outcomes, which may include involuntary job loss. Previous work on job loss and adverse birth outcomes, however, lacks high-quality individual data on, and variation in, plausibly exogenous job loss during pregnancy and therefore cannot rule out strong confounding.

METHODS

We analysed unique linked registries in Denmark, from 1980 to 2017, to examine whether a father's involuntary job loss during his spouse's pregnancy increases the risk of a low-weight (i.e. <2500 grams) and/or preterm (i.e. <37 weeks of gestational age) birth. We applied a matched-sibling design to 743 574 sibling pairs.

RESULTS

Results indicate an increased risk of a low-weight birth among infants exposed in utero to fathers' unexpected job loss [odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.07, 1.75]. Sex-specific analyses show that this result holds for males (OR = 1.70, 95% CI: 1.14, 2.53) but not females (OR = 1.24, 95% CI: 0.80, 1.91). We find no relation with preterm birth.

CONCLUSIONS

Findings support the inference that a father's unexpected job loss adversely affects the course of pregnancy, especially among males exposed in utero.

Accumulation of economic hardship and health during the COVID-19 pandemic: Social causation or selection?

This study examines whether economic hardship during the COVID-19 pandemic is deleteriously associated with psychological distress and self-rated health. A social causation perspective suggests that exposure to economic hardship will harm well-being, but a social selection perspective suggests that the appearance of health effects of hardship during the pandemic are attributable to the increased risk of exposure to hardship associated with poor well-being at the start of the pandemic. We also propose a third perspective, economic selection, which suggests that economic hardship prior to the pandemic negatively affects health and increases risk of exposure to hardship during the pandemic; consequently, an association between health and economic hardship during the pandemic may be spurious, and entirely due to pre-existing levels of hardship. To test these competing perspectives, we use a longitudinal study based in Canada that began in late March of 2020 and followed respondents monthly in April, May, and June. Baseline psychological distress and self-rated health, as well as economic hardship prior to the pandemic, independently predict the accumulation of monthly periods of hardship from April to June. The accumulation of periods of hardship from April to June is deleteriously associated with psychological distress and self-rated health in June. Controls for prior economic hardship and baseline health weaken the association between accumulation of periods of hardship and psychological distress, while also eliminating the association between accumulation of hardship and self-rated health. These findings favor a social causation perspective for psychological distress and a social selection perspective for self-rated health, with less evidence found in support of economic selection. This study took place during the first months of the COVID-19 pandemic, though, and associations with self-rated health may have become more evident as hardship further wore on individual well-being over a longer period of time.

Bayesian analysis of Turkish Income and Living Conditions data, using clustered longitudinal ordinal modelling with Bridge distributed random effects

This article is motivated by the panel surveys, called Statistics on Income and Living Conditions (SILC), conducted annually on (randomly selected) country representative households to monitor EU 2020 aims on poverty reduction. We particularly consider the surveys conducted in Turkey within the scope of integration to the EU. Our main interests are on health aspects of economic and living conditions. The outcome is self-reported health that is clustered longitudinal ordinal, since repeated measures of it are nested within individuals and individuals are nested within families. Economic and living conditions have been measured through a number of individual- and family-level explanatory variables. The questions of interest are on the marginal relationships between the outcome and covariates that we address using a polytomous logistic regression with Bridge distributed random effects. This choice of distribution allows us to directly obtain marginal inferences in the presence of random effects. Widely used Normal distribution is also considered as the random effects distribution. Samples from the joint posterior densities of parameters and random effects are drawn using Markov Chain Monte Carlo. Interesting findings from the public health point of view are that differences were found between the subgroups of employment status, income level and panel year in terms of odds of reporting better health.

Is There Less Labor Market Exclusion of People With Ill Health in “Flexicurity” Countries? Comparative Evidence From Denmark, Norway, the Netherlands, and Belgium

Higher employment rates among vulnerable groups is an important policy goal; it is therefore vital to examine which social policies, or mix of policies, are best able to incorporate vulnerable groups – such as people with ill health – into the labor market. We examine whether 2 “flexicurity” countries, Denmark and the Netherlands, have less labor market exclusion among people with ill health compared to the neighboring countries of Norway and Belgium. We analyze the 2 country pairs of Denmark–Norway and the Netherlands–Belgium using OLS regressions and propensity score kernel matching of EU-SILC panel data (2010–2013). Both unemployment and disability likelihood is remarkably similar for people with ill health across the 4 countries, despite considerable social policy differences. There are 3 possible explanations for the observed cross-national similarity. First, different social policy combinations could lead toward the same employment outcomes for people with ill health. Second, most policy instruments are located on the supply side, and demand side reasons for the observed “employment penalty” (e.g., employer skepticism/discrimination) are often neglected. Third, it is too demanding to hold (full-time) employment for a sizeable proportion of those who have poor health status.

Controlling for Structural Changes in the Workforce Influenced Occupational Class Differences in Disability Retirement Trends

We explored occupational class differences in disability retirement trends accounting for structural changes in the workforce induced by the recent economic crisis and the following economic stagnation. Using nationwide register data on the general Finnish population aged 30–59 years, we examined trends in disability retirement due to all causes, musculoskeletal diseases, and mental disorders in 2007, 2010, and 2013. Applying propensity score (PS) matching to control for bias induced by structural changes in the workforce over time, we obtained 885,807 matched triplets. In the original study population, all-cause and cause-specific disability retirement declined between 2007 and 2013 for most occupational classes. In the matched study population, the disability retirement among skilled and unskilled manual workers sharply increased in 2010 and then declined in 2013. PS matching considerably attenuated the decline in disability retirement, particularly between the years 2007 and 2010. In general, the differences in disability retirement between both skilled and unskilled manual workers and upper-level non-manual employees widened during the period of economic stagnation. In occupational epidemiology, structural changes in the workforce should be accounted for when analysing trends in ill-health. Controlling for these changes revealed widening occupational class differences in disability retirement during the period of economic stagnation.

Cause-specific sickness absence trends by occupational class and industrial sector in the context of recent labour market changes: a Finnish panel data study

OBJECTIVES

We aimed to provide previously unestablished information on population-based differences in cause-specific sickness absence trends between occupational classes and further between four large industrial sectors within the different occupational classes while controlling for other socioeconomic factors and employment patterns. We focused on the period 2005-2013, during which the labour market underwent large economic and structural changes in many countries.

DESIGN

Register-based panel data study.

SETTING

Large representative datasets on Finnish wage earners aged 25-59 years.

OUTCOME MEASURE

Annual risk of sickness absence (>10 working days) based on repeated logistic regression.

RESULTS

Between 2005 and 2013, the proportion of employees with sickness absence decreased. Occupational class differences in sickness absence trends varied by disease group. Overall, the decrease in absences was smallest among lower non-manual employees. Sickness absence levels were highest in the health and social work sector and in the manufacturing sector within the non-manual and manual classes, respectively. Absences due to musculoskeletal diseases decreased temporarily during the peak of the economic recession in 2009, particularly in the manufacturing sector within the manual class. The decrease in absences due to musculoskeletal diseases was smallest in the trade sector within the lower occupational classes. Overall, education, income and employment patterns partly explained the differences in the absence levels, but not in the trends.

CONCLUSIONS

We found a complex interplay between the associations of occupational class and industrial sector with sickness absence trends. During the economic recession, absences due to musculoskeletal diseases decreased temporarily in a segment of wage earners who were known to have been hit hard by the recession. However, the trend differences were not explained by the measured structural changes in the characteristics of the study population. Both occupational class and industrial sector should be taken into account when tackling problems of work disability.

Age and gender differences in the impact of labour-market transitions on subjective health in Germany

AIMS

Applying a gender- and age group-sensitive approach, we investigated the effect of labour-market transitions (job loss and re-employment) on subjective physical and mental health.

METHODS

A combination of the difference-in-differences approach and propensity score matching controls for selectivity and initial health differences. This allowed us to analyse the causal effect of job loss and re-employment on subjective health. We made use of data from the German Panel Study Labour Market and Social Security and combined survey information with administrative records of the Federal Employment Agency for employed and unemployed men and women 31-60 years of age ( n = 2213). We controlled for labour-market experiences before the time period under study and for labour-market transitions between the interviews. Subjective health was assessed using the SF-12 health questionnaire, enabling us to differentiate between subjective mental and physical health functioning.

RESULTS

We found that physical health was affected mainly in older persons between 45 and 60 years old. Controlling for covariates using propensity score matching, mental health was affected only when living-wage jobs (i.e. jobs that provide sufficient income to achieve a defined minimum standard of living above the social benefit level) are gained or lost. Younger women showed a significant improvement in mental health after re-employment. In contrast, job loss affected only older individuals' mental health, with a particularly negative effect observed for men.

CONCLUSIONS

Our results not only showed that women and men are affected differently by job loss and re-employment, but also that age is an important factor. Older men were affected most severely by job loss, whereas re-employment was found to improve mental health only in women aged 31-44 years. It is therefore important to address the health problems of different socio-demographic groups separately, and to apply active labour-market policies with regard to unemployed men and women with health impairments. Based on our results, we suggest the promotion of employment with income levels above the maximum welfare benefit award.

Health trends in the wake of the financial crisis—increasing inequalities?

Aim: The financial crisis that hit Europe in 2007–2008 and the corresponding austerity policies have generated concern about increasing health inequalities, although impacts have been less salient than initially expected. One explanation could be that health inequalities emerged first a few years into the crisis. This study investigates health trends in the wake of the financial crisis and analyses health inequalities across a number of relevant population subgroups, including those defined by employment status, age, family type, gender, and educational attainment. Methods: This study uses individual-level panel data (EU-SILC, 2010–2013) to investigate trends in self-rated health. By applying individual fixed effects regression models, the study estimates the average yearly change in self-rated health for persons aged 15–64 years in 28 European countries. Health inequalities are investigated using stratified analyses. Results: Unemployed respondents, particularly those who were unemployed in all years of observation, had a steeper decline in self-rated health than the employed. Respondents of prime working age (25–54 years) had a steeper decline than their younger (15–24) and older (55–64) counterparts, while single parents had a more favorable trend in self-rated health than dual parents. We did not observe any increasing health inequalities based on gender or educational attainment. Conclusions: Health inequalities increased in the wake of the financial crisis, especially those associated with employment status, age, and family type. We did not observe increasing health inequalities in terms of levels of educational attainment and gender.

Are immigrants and descendants with ill health more prone to unemployment? Evidence from 18 European countries

OBJECTIVE

Previous research has established that both ill health and minority status are associated with unemployment. Less is known, however, about the interplay between having ill health and being from minority background. The present study examines whether immigrants and descendants with ill health are particularly prone to unemployment during an economic downturn in Europe.

DESIGN

The European Union Statistics on Income and Living Conditions (EU-SILC) cross-sectional data material is utilized, and linear probability models are estimated. The analysis is run for countries in which the two minority samples are acceptably large (N ≥ 100), resulting in 18 included European countries. The year 2011 is chosen because it is possible to identify both immigrants and descendants in EU-SILC due to a module on intergenerational transfer of disadvantages.

RESULTS

The results indicate - as expected - that both ill health and minority status are independently related to higher unemployment likelihood. Immigrants and descendants with ill health, however, are not particularly likely to be unemployed. This finding is robust to a number of sensitivity tests, and the empirical pattern is very similar across the 18 included countries.

CONCLUSION

Both minority status and ill health are associated with high unemployment probability in Europe. However, there does not seem to exist a 'double disadvantage' for immigrants and descendants with ill health, which is in line with a human capital perspective on how employers evaluate potential employees. Both a non-native-sounding name and bad health status are interpreted as a risk factor, but there is no reason to expect ill health to lower the productivity level more if the applicant is a descendant or immigrant.

"Times Are Changing": The Impact of HIV Diagnosis on Sub-Saharan Migrants' Lives in France

Background

Migrants account for 35% of HIV diagnoses in the European Union (ECDC/WHO 2014). Little is known about the impact of such a lifelong infection diagnosis on lives that are already disrupted by migration. In this paper, we assess the impact of HIV diagnosis on activity, union, well-being among African migrants living in France, the second group most affected by HIV after MSM. We compare it with the impact of the diagnosis of Hepatitis B, another lifelong infection affecting African migrants.

Methods

We use the ANRS PARCOURS survey, a retrospective life-event survey led in 2012–2013 in 74 health structures in Paris greater area which collected 926 life histories of Sub-Saharan migrants living with HIV and 779 with Hepatitis B. We modelled the probability year by year since 18 years of age until data collection to lose one’s activity, to experience a conjugal break up and degradation of well-being and we estimated the impact of migration and of HIV and Hepatitis B diagnoses on these probabilities, after adjustment on other factors, thanks to discrete-time logistic regressions.

Results

Migration entailed loss of activity and conjugal break up, though HIV diagnosis after migration did not statistically impact on these outcomes. Yet HIV diagnosis had a massive negative impact on well-being (aOR = 11.31 [4.64–27.56] for men and 5.75 [2.79–11.86] for women). This negative impact on well-being tended to diminish for persons diagnosed after 2004. The negative impact of HIV diagnosis on African migrants’ well-being seems to be attenuated in the last decade, which hints at a normalization of the subjective experience of HIV diagnosis.

Increase in Unemployment over the 2000's: Comparison between People Living with HIV and the French General Population

Background

Despite improved health, unemployment has increased among people living with HIV (PlwHIV) over the last decade. However, since the economic recession of 2008, unemployment also increased in the French general population. This paper aimed to determine if the increase in the unemployment rate in the HIV population was higher than that in the French general population.

Methods

We used data from the ANRS-Vespa study, a repeated cross-sectional survey among two national representative samples of PlwHIV followed at hospitals in France in 2003 and 2011. We compared employment and unemployment rates between HIV-infected people (overall and according to period of HIV diagnosis) and the French general population in 2003 and 2011, using multivariate Poisson regressions adjusted for individual sociodemographic characteristics.

Results

The employment rate among PlwHIV was consistently lower than that in the general population in 2003 and 2011. In contrast, there was a trend of an increasing unemployment rate difference between PlwHIV and the general population: PlwHIV’s unemployment rate was 1.48 (95% confidence interval [CI]: 1.16–1.90) times higher than that of the general population in 2003, versus 1.62 (95% CI: 1.34–1.96) times higher in 2011. This unemployment rate difference was the highest for PlwHIV diagnosed in or after 2008 (adjusted prevalence rate ratio: 2.06; 95% CI: 1.59–2.67).

Conclusions

These results suggest that in time of economic recession, an increasing proportion of PlwHIV may be excluded from the labor market although they are willing to re-enter it. This constitutes a major issue relative to social consequences of chronic disease.

Health Effects of Unemployment in Europe During the Great Recession: The Impact of Unemployment Generosity

Social and economic security could be particularly important for health among the unemployed. Nevertheless, knowledge is still lacking as to whether and how different policy contexts affect health when people move into unemployment. This article investigates whether and to what degree the unemployment generosity explains why individual health effects of unemployment vary across Europe. The 2008-2011 longitudinal panel of the European Union statistics on income and living conditions (EU-SILC) and fixed-effects models are used to estimate the individual effects of unemployment on self-rated health (SRH). Social spending on unemployment is used as a proxy for unemployment generosity. The results show that unemployment generosity is associated with reduced negative effects of unemployment on SRH. For every increase in adjusted purchasing power standard spending, the negative effect of unemployment on SRH is reduced by 0.003 (SE = 0.001) and the change in SRH is improved by 0.002 (SE = 0.001) for each year following the transition, after controlling for time-variant confounders at the individual level and unemployment rate at the macro level. The association between spending on unemployment and cross-national differences in individual health changes that occur as people enter unemployment provides a robust indication of the mitigating health effects of unemployment generosity.

Health and unemployment: 14 years of follow-up on job loss in the Norwegian HUNT Study

BACKGROUND

Many studies have investigated how unemployment influences health, less attention has been paid to the reverse causal direction; how health may influence the risk of becoming unemployed. We prospectively investigated a wide range of health measures and subsequent risk of unemployment during 14 years of follow-up.

METHODS

Self-reported health data from 36 249 participants in the Norwegian HUNT2 Study (1995-1997) was linked by a personal identification number to the National Insurance Database (1992-2008). Exact dates of unemployment were available. Cox's proportional hazard models were used to estimate hazard ratios (HR) for the association of unemployment with several health measures. Adjustment variables were age, gender, education, marital status, occupation, lifestyle and previous unemployment.

RESULTS

Compared to reporting no conditions/symptoms, having ≥3 chronic somatic conditions (HR 1.78, 95% CI 1.46-2.17) or high symptom levels of anxiety and depression (HR 1.57, 95% CI 1.35-1.83) increased the risk of subsequent unemployment substantially. Poor self-rated health (HR 1.36, 95% CI 1.24-1.51), insomnia (HR 1.19, 95% CI 1.09-1.32), gastrointestinal symptoms (HR 1.17, 95% CI 1.08-1.26), high alcohol consumption (HR 1.17, 95% CI 0.95-1.44) and problematic use of alcohol measured by the CAGE questionnaire (HR 1.32, 95% CI 1.17-1.48) were also associated with increased risk of unemployment.

CONCLUSION

People with poor mental and physical health are at increased risk of job loss. This contributes to poor health amongst the unemployed and highlights the need for policy focus on the health and welfare of out of work individuals, including support preparing them for re-employment.

Unemployment and health selection in diverging economic conditions: Compositional changes? Evidence from 28 European countries

Unemployment and health selection in diverging economic conditions: Compositional changes? Evidence from 28 european countries.

INTRODUCTION

People with ill health tend to be overrepresented among the unemployment population. The relationship between health and unemployment might, however, be sensitive to the overall economic condition. Specifically, the health composition of the unemployment population could change dramatically when the economy takes a turn for the worse.

METHODS

Using EU-SILC cross sectional data from 2007 (pre-crisis) and 2011 (during crisis) and linear regression models, this paper investigates the relationship between health and unemployment probabilities under differing economic conditions in 28 European countries. The countries are classified according to (i) the level of and (ii) increase in unemployment rate (i.e. >10 percent and doubling of unemployment rate = crisis country).

RESULTS

Firstly, the unemployment likelihood for people with ill health is remarkably stable over time in Europe: the coefficients are very similar in pre-crisis and crisis years. Secondly, people with ill health have experienced unemployment to a lesser extent than those with good health status in the crisis year (when we pool the data and compare 2007 and 2011), but only in the countries with a high and rising unemployment rate.

CONCLUSION

The health composition of the unemployment population changes significantly for the better, but only in those European countries that have been severely hit by the current economic crisis.

Unemployment transitions and self-rated health in Europe: A longitudinal analysis of EU-SILC from 2008 to 2011

The Great Recession of 2008 has led to elevated unemployment in Europe and thereby revitalised the question of causal health effects of unemployment. This article applies fixed effects regression models to longitudinal panel data drawn from the European Union Statistics on Income and Living Conditions for 28 European countries from 2008 to 2011, in order to investigate changes in self-rated health around the event of becoming unemployed. The results show that the correlation between unemployment and health is partly due to a decrease in self-rated health as people enter unemployment. Such health changes vary by country of domicile, and by individual age; older workers have a steeper decline than younger workers. Health changes after the unemployment spell reveal no indication of adverse health effects of unemployment duration. Overall, this study indicates some adverse health effects of unemployment in Europe--predominantly among older workers.