The effect of unemployment benefits on health: A propensity score analysis

Is Redistribution Good for Our Health? Examining the Macrocorrelation between Welfare Generosity and Health across EU Nations over the Last 40 Years

CONTEXT

Social determinants of health are finally getting much-needed policy attention, but their political origins remain underexplored. In this article, the authors advance a theory of political determinants as accruing along three pathways of welfare state effects (redistribution, poverty reduction, and status preservation), and they test these assumptions by examining impacts of policy generosity on life expectancy (LE) over the last 40 years.

METHODS

The authors merge new and existing welfare policy generosity data from the Comparative Welfare Entitlement Project with data on LE spanning 1980-2018 across 21 countries in the Organization for Economic Cooperation and Development. They then examine relationships between five welfare policy generosity measures and LE using cross-sectional differencing and autoregressive lag models.

FINDINGS

The authors find consistent and positive effects for total generosity (an existing measure of social insurance generosity) on LE at birth across different model specifications in the magnitude of an increase in LE at birth of 0.10-0.15 years (p < 0.05) as well as for a measure of status preservation (0.11, p < 0.05). They find less consistent support for redistribution and poverty reduction measures.

CONCLUSIONS

The authors conclude that in addition to generalized effects of policy generosity on health, status-preserving social insurance may be an important, and relatively overlooked, mechanism in increasing LE over time in advanced democracies.

Ramifications of Precarious Employment for Health and Health Inequity: Emerging Trends from the Americas

Precarious employment (PE), which encompasses the power relations between workers and employers, is a well-established social determinant of health that has strong ramifications for health and health inequity. In this review, we discuss advances in the measurement of this multidimensional construct and provide recommendations for overcoming continued measurement challenges. We then evaluate recent evidence of the negative health impacts of PE, with a focus on the burgeoning studies from North America and South America. We also establish the role of PE in maintaining and perpetuating health inequities and review potential policy solutions to help alleviate its health burden. Last, we discuss future research directions with a call for a better understanding of the heterogeneity within PE and for research that focuses both on upstream drivers that shape PE and its impacts on health, as well as on the mechanisms by which PE causes poor health.

Effectiveness of the indigent support policy on food insecurity in South Africa: Experiences from Matatiele Local Municipality

The indigent and societally vulnerable have compromised capacities to achieve their full welfare potential. This necessitates polices that can cushion them, such as the indigent support policy in South Africa. However, there is little acknowledgement on the welfare effects of community and contextually derived support policies. The study seeks an understanding of the effectiveness of the indigent support policy on food insecurity in Matatiele Local Municipality, South Africa, using a cross sectional survey of a purposively selected sample of 549 households. Food insecurity, determinants of awareness and beneficiation as well as effectiveness from the policy are assessed through the Household Food In-Access Scale (HFIAS), Heckman two step model and Propensity Score Matching (PSM), respectively. Households are found to be food secure, with awareness and beneficiation from the indigent policy being affected by duration of stay, employment status, location, tenure, total monthly income, monthly food expenditure and food insecurity status. To add, the indigent support policy has a positive impact on food security. In conclusion, there is food security partly due to indigent support with beneficiation affected by various socio-economic factors. There is need to compliment indigent support products to include food products and promote the policy to increase awareness. Furthermore, there is need to capacitate and coordinate policy making to target food insecure households to augment and magnify the positive effects of indigent support.

Employment Insurance may mitigate impact of unemployment on food security: Analysis on a propensity-score matched sample from the Canadian Income Survey

Food insecurity, the inadequate access to food due to financial constraints, affects one-sixth of Canadian households, with substantial health implications. We examine the impact of unemployment and the mitigating effect of Employment Insurance (EI) on household food insecurity in Canada. Using the Canadian Income Survey 2018-2019, we sampled 28,650 households with adult workers 18-64 years old. We used propensity score matching to pair the 4085 households with unemployed workers with 3390 households with only continuously employed workers on their propensity towards unemployment. Among unemployed households, we also matched 2195 EI recipients with 950 nonrecipients. We applied adjusted logistic regression to the two matched samples. Food insecurity affected 15.1% of the households without unemployed workers and 24.6% of their unemployed counterparts, including 22.2% of EI recipients and 27.5% of nonrecipients. Unemployment was associated with 48% (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.32-1.66; 5.67 percentage points) higher likelihood of food insecurity. This association was significant and similar across income levels, full-time and part-time workers, and household compositions. EI receipt was associated with 23% (aOR 0.77, 95% CI 0.66-0.90; 4.02 percentage points) lower likelihood of food insecurity, but this association was only significant among households with lower income, full-time workers, and children under 18. The findings suggest a broad impact of unemployment on working adults' food insecurity and a substantial mitigating effect by EI on select unemployed workers. Making EI more generous and accessible for part-time workers may help alleviate food insecurity.

Understanding the effect of loneliness on unemployment: propensity score matching

BACKGROUND

Loneliness and unemployment are each detrimental to health and well-being. Recent evidence suggests a potential bidirectional relationship between loneliness and unemployment in working age individuals. As most existing research focuses on the outcomes of unemployment, this paper seeks to understand the impact of loneliness on unemployment, potential interaction with physical health, and assess bidirectionality in the working age population.

METHODS

This study utilised data from waves 9 (2017-19) and 10 (2018-2020) of the Understanding Society UK Household Longitudinal Study. Nearest-neighbour probit propensity score matching with at least one match was used to infer causality by mimicking randomisation. Analysis was conducted in three steps: propensity score estimation; matching; and stratification. Propensity scores were estimated controlling for age, gender, ethnicity, education, marital status, household composition, number of own children in household and region. Findings were confirmed in panel data random effect models, and heterogeneous treatment effects assessed by the matching-smoothing method.

RESULTS

Experience of loneliness in at least one wave increased the probability of being unemployed in wave 10 by 17.5 [95%CI: 14.8, 20.2] percentage points. Subgroup analysis revealed a greater effect from sustained than transitory loneliness. Further exploratory analysis identified a positive average treatment effect, of smaller magnitude, for unemployment on loneliness suggesting bidirectionality in the relationship. The impact of loneliness on unemployment was further exacerbated by interaction with physical health.

CONCLUSIONS

This is the first study to directly consider the potentially bidirectional relationship between loneliness and unemployment through analysis of longitudinal data from a representative sample of the working age population. Findings reinforce the need for greater recognition of wider societal impacts of loneliness. Given the persisting and potentially scarring effects of both loneliness and unemployment on health and the economy, prevention of both experiences is key. Decreased loneliness could mitigate unemployment, and employment abate loneliness, which may in turn relate positively to other factors including health and quality of life. Thus, particular attention should be paid to loneliness with additional support from employers and government to improve health and well-being.

The impact of unemployment benefits on birth outcomes: Quasi-experimental evidence from European linked register data

Cash transfers have been shown to improve birth outcomes by improving maternal nutrition, increasing healthcare use, and reducing stress. Most of the evidence focuses on programs targeting the poorest in the US-a context with non-universal access to healthcare and strong health inequalities. It is thus unclear whether these results would apply to cash transfers targeting a less disadvantaged population and whether they apply to other contexts. We provide evidence on the impact of unemployment benefits on birth outcomes in Switzerland, where access to healthcare is near-universal and social assistance is relatively generous. Our study taps into a policy reform that reduced unemployment benefits by 56%. We use linked parent-child register data and difference-in-differences estimates as well as within sibling comparisons. We find that the reform did not impact birth outcomes when fathers were unemployed but reduced the birthweight of children when mothers were unemployed by 80g and body length by 6mm. There are stronger effects for children whose mothers were the primary earner before job loss, but effects do not differ systematically by household income. These results suggest that in the Swiss context, unemployment benefits improve birth outcomes by reducing (job search) stress rather than by improving nutrition or healthcare use. As such, cash transfers likely play a role for newborn health in most other contexts.

Downstream health impacts of employment losses during the COVID-19 pandemic

OBJECTIVES

The Canadian workforce has experienced significant employment losses during the COVID-19 pandemic, in part as a result of non-pharmaceutical interventions to slow COVID-19 transmission. Health consequences are likely to result from these job losses, but without historical precedent for the current economic shutdown they are challenging to plan for. Our study aimed to use population risk models to quantify potential downstream health impacts of the COVID-19 pandemic and inform public health planning to minimize future health burden.

METHODS

The impact of COVID-19 job losses on future premature mortality and high-resource health care utilization (HRU) was estimated using an economic model of Canadian COVID-19 lockdowns and validated population risk models. Five-year excess premature mortality and HRU were estimated by age and sex to describe employment-related health consequences of COVID-19 lockdowns in the Canadian population.

RESULTS

With federal income supplementation like the Canadian Emergency Response Benefit, we estimate that each month of economic lockdown will result in 5.6 new high-resource health care system users (HRUs), and 4.1 excess premature deaths, per 100,000, over the next 5 years. These effects were concentrated in ages 45-64, and among males 18-34. Without income supplementation, the health consequences were approximately twice as great in terms of both HRUs and premature deaths.

CONCLUSION

Employment losses associated with COVID-19 countermeasures may have downstream implications for health. Public health responses should consider financially vulnerable populations at high risk of downstream health outcomes.

The Revolution Will Be Hard to Evaluate: How Co-Occurring Policy Changes Affect Research on the Health Effects of Social Policies

Extensive empirical health research leverages variation in the timing and location of policy changes as quasi-experiments. Multiple social policies may be adopted simultaneously in the same locations, creating co-occurrence that must be addressed analytically for valid inferences. The pervasiveness and consequences of co-occurring policies have received limited attention. We analyzed a systematic sample of 13 social policy databases covering diverse domains including poverty, paid family leave, and tobacco use. We quantified policy co-occurrence in each database as the fraction of variation in each policy measure across different jurisdictions and times that could be explained by covariation with other policies. We used simulations to estimate the ratio of the variance of effect estimates under the observed policy co-occurrence to variance if policies were independent. Policy co-occurrence ranged from very high for state-level cannabis policies to low for country-level sexual minority-rights policies. For 65% of policies, greater than 90% of the place-time variation was explained by other policies. Policy co-occurrence increased the variance of effect estimates by a median of 57-fold. Co-occurring policies are common and pose a major methodological challenge to rigorously evaluating health effects of individual social policies. When uncontrolled, co-occurring policies confound one another, and when controlled, resulting positivity violations may substantially inflate the variance of estimated effects. Tools to enhance validity and precision for evaluating co-occurring policies are needed.

What to Do When Everything Happens at Once: Analytic Approaches to Estimate the Health Effects of Co-Occurring Social Policies

Social policies have great potential to improve population health and reduce health disparities. Increasingly, those doing empirical research have sought to quantify the health effects of social policies by exploiting variation in the timing of policy changes across places. Multiple social policies are often adopted simultaneously or in close succession in the same locations, creating co-occurrence that must be handled analytically for valid inferences. Although this is a substantial methodological challenge for researchers aiming to isolate social policy effects, only in a limited number of studies have researchers systematically considered analytic solutions within a causal framework or assessed whether these solutions are being adopted. We designated 7 analytic solutions to policy co-occurrence, including efforts to disentangle individual policy effects and efforts to estimate the combined effects of co-occurring policies. We used an existing systematic review of social policies and health to evaluate how often policy co-occurrence is identified as a threat to validity and how often each analytic solution is applied in practice. Of the 55 studies, only in 17 (31%) did authors report checking for any co-occurring policies, although in 36 studies (67%), at least 1 approach was used that helps address policy co-occurrence. The most common approaches were adjusting for measures of co-occurring policies; defining the outcome on subpopulations likely to be affected by the policy of interest (but not other co-occurring policies); and selecting a less-correlated measure of policy exposure. As health research increasingly focuses on policy changes, we must systematically assess policy co-occurrence and apply analytic solutions to strengthen studies on the health effects of social policies.

Unemployment Insurance and Mortality Among the Long-Term Unemployed: A Population-Based Matched-Cohort Study

Unemployment insurance is hypothesized to play an important role in mitigating the adverse health consequences of job loss. In this prospective cohort study, we examined whether receiving unemployment benefits is associated with lower mortality among the long-term unemployed. Census records from the 2006 Canadian Census Health and Environment Cohort (n = 2,105,595) were linked to mortality data from 2006-2016. Flexible parametric survival analysis and propensity score matching were used to model time-varying relationships between long-term unemployment (≥20 weeks), unemployment-benefit recipiency, and all-cause mortality. Mortality was consistently lower among unemployed individuals who reported receiving unemployment benefits, relative to matched nonrecipients. For example, mortality at 2 years of follow-up was 18% lower (95% confidence interval (CI): 9, 26) among men receiving benefits and 30% lower (95% CI: 18, 40) among women receiving benefits. After 10 years of follow-up, unemployment-benefit recipiency was associated with 890 (95% CI: 560, 1,230) fewer deaths per 100,000 men and 1,070 (95% CI: 810, 1,320) fewer deaths per 100,000 women. Our findings indicate that receiving unemployment benefits is associated with lower mortality among the long-term unemployed. Expanding access to unemployment insurance may improve population health and reduce health inequalities associated with job loss.

Evaluating the speed camera sites selection criteria in the UK

INTRODUCTION

Speed cameras have been implemented to improve road safety over recent decades in the UK. Although the safety impacts of the speed camera have been estimated thoroughly, the criteria for selecting camera sites have rarely been studied. This paper evaluates the current speed camera sites selection criteria in the UK based on safety performance.

METHOD

A total of 332 speed cameras and 2,513 control sites with road traffic accident data are observed from 2002 to 2010. Propensity score matching method and empirical Bayes method are employed and compared to estimate the safety effects of speed cameras under different scenarios.

RESULTS

First, the main characteristics of speed cameras meeting and not meeting the selection criteria are identified. The results indicate that the proximity to school zones and residential neighborhoods, as well as population density, are the main considerations when selecting speed camera sites. Then the official criteria used for selecting camera sites are evaluated, including site length (a stretch of road that has a fixed speed camera or has had one in the past), previous accident history, and risk value (a numerical scale of the risk level). The results suggest that a site length of 500 m should be used to achieve the optimum safety effects of speed cameras. Furthermore, speed cameras are most effective in reducing crashes when the requirement of minimum number of historical killed and seriously injured collisions (KSIs) is met. In terms of the risk value, it is found that the speed cameras can obtain optimal effectiveness with a risk value greater than or equal to 30, rather than the recommended risk value of 22.

Are multiple speed cameras more effective than a single one? Causal analysis of the safety impacts of multiple speed cameras

Most previous studies investigate the safety effects of a single speed camera, ignoring the potential impacts from adjacent speed cameras. The mutual influence between two or even more adjacent speed cameras is a relevant attribute worth taking into account when evaluating the safety impacts of speed cameras. This paper investigates the safety effects of two or more speed cameras observed within a specific radius which are defined as multiple speed cameras. A total of 464 speed cameras at treated sites and 3119 control sites are observed and related to road traffic accident data from 1999 to 2007. The effects of multiple speed cameras are evaluated using pairwise comparisons between treatment units with different doses based on the propensity score methods. The spatial effect of multiple speed cameras is investigated by testing various radii. There are two major findings in this study. First, sites with multiple speed cameras perform better in reducing the absolute number of road accidents than those with a single camera. Second, speed camera sites are found to be most effective with a radius of 200 m. For a radius of 200 m and 300 m, the reduction in the personal injury collisions by multiple speed cameras are 21.4 % and 13.2 % more than a single camera. Our results also suggest that multiple speed cameras are effective within a small radius (200 m and 300 m).

The effect of welfare reform on the health of the unemployed: evidence from a natural experiment in Germany

BACKGROUND

Over the past several decades, governments have enacted far-reaching reforms aimed at reducing the generosity and coverage of welfare benefits. Prior literature suggests that these policy measures may have deleterious effects on the health of populations. In this study, we evaluate the impact of one of the largest welfare reforms in recent history-the 2005 Hartz IV reform in Germany-with a focus on estimating its effect on the health of the unemployed.

METHODS

We employed a quasi-experimental difference-in-differences (DID) design using population-based data from the German Socio-Economic Panel Study, covering the period between 1994 and 2016. We applied DID linear probability modelling to examine the association between the Hartz IV reform and poor self-rated health, adjusting for a range of demographic and socioeconomic confounders.

RESULTS

The Hartz IV reform was associated with a 3.6 (95% CI 0.9 to 6.2) percentage point increase in the prevalence of poor self-rated health among unemployed persons affected by the reform relative to similar but unaffected controls. This negative association appeared immediately following the implementation of the reform and has persisted over time.

CONCLUSION

Governments in numerous European and North American jurisdictions have introduced measures to further diminish the generosity and coverage of welfare benefits. In line with growing concerns over the potential consequences of austerity and associated policy measures, our findings suggest that these reform efforts pose a threat to the health of socioeconomically disadvantaged populations.