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Martins SS, Segura LE, Marziali ME, Bruzelius E, Levy NS, Gutkind S, Santarin K, Sacks K, Fox A. Higher unemployment benefits are associated with reduced drug overdose mortality in the United States before and during the COVID-19 pandemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104522. [PMID: 38996642 PMCID: PMC11347091 DOI: 10.1016/j.drugpo.2024.104522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 06/03/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES Overdose mortality rates in the United States remain critical to population health. Economic , such as unemployment, are noted risk factors for drug overdoses. The COVID-19 pandemic exacerbated economic hardship; as a result, the US government enacted income protection programs in conjunction with existing unemployment insurance (UI) to dampen COVID-19-related economic consequences. We investigate whether UI, operationalized as the weekly benefit allowance (WBA) replacement rate, is negatively associated with drug-related overdoses. METHODS Data from the pooled 2014-2020 Detailed Restricted Mortality files for all counties from the Centers for Disease Control and Prevention, restricted to people ≥18 years of age, aggregated at the county-quarter level (n = 89,914). We included any fatal drug, opioid, and stimulant overdose. We modeled the association between WBA replacement rate (e.g., a greater proportion of weekly earnings replaced by UI) on each county-level age-adjusted mortality outcome using separate linear regression models during 2014-2020, pre-COVID (2014-2018), and post-COVID (2019-2020). We conducted sensitivity analyses using multi-level linear regression models. RESULTS Results indicated that a more robust WBA replacement rate any drug (Risk Difference [RD]: -0.06, 95 % Confidence Interval [CI]: -0.08, -0.05), opioid (RD: -0.04, 95 % CI: -0.06, -0.03), and stimulant (RD: -0.03, 95 % CI: -0.04, -0.02) across the entire study period (2014-2020). A more robust WBA replacement rate was associated with fewer fatal drug, opioid and stimulant overdoses in the pre-COVID-19 period and on fatal any drug and stimulant overdoses in the COVID-19 period. CONCLUSIONS Findings support the notion that income protection policies, such as robust UI, can have a supportive role in preventing fatal drug overdoses, calling for a broader discussion onthe role of the safety net programs to buffer drug-related harms.
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Affiliation(s)
- Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States.
| | - Luis E Segura
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Megan E Marziali
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Emilie Bruzelius
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Natalie S Levy
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Sarah Gutkind
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Kristen Santarin
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | | | - Ashley Fox
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, SUNY, United States
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2
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Burdorf A, Fernandes RCP, Robroek SJW. Health and inclusive labour force participation. Lancet 2023; 402:1382-1392. [PMID: 37838443 DOI: 10.1016/s0140-6736(23)00868-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 02/02/2023] [Accepted: 04/27/2023] [Indexed: 10/16/2023]
Abstract
The future of work is rapidly changing, with higher flexibility of the labour market and increasing informal employment in many countries worldwide. There is also an increased pressure to extend working careers until older age. We introduce the concept of working life expectancy as a useful metric, capturing the expected numer of years in paid employment across the working age individuals, in particular among different groups. We describe factors that determine working life expectancy. Macro-level factors focus on the socioeconomic and political context that influences labour force participation, primarily policies and legislation in specific countries. At the meso level, employment contracts and working conditions are important. The micro level shows that individual characteristics, such as education, gender, and age, influence working careers. There are three important groups with a disadvantaged position in the labour market-workers with chronic diseases, workers with impairing disabilities, and workers aged 50 years or more. Within each of these disadvantaged groups, macro-level, meso-level, and micro-level factors that influence entering and exiting paid employment are discussed. To assure that paid employment is available for everyone of working age and that work contributes to better health, specific challenges need to be addressed at the macro, meso, and micro levels. To reach inclusive labour force participation, national policies, company practices, and workplace improvements need to be aligned to ensure safe and healthy workplaces that contribute to the health and wellbeing of workers and their communities.
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Affiliation(s)
- Alex Burdorf
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
| | - Rita C P Fernandes
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Bahia, Brazil
| | - Suzan J W Robroek
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
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3
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Huang CY, Chen CC. The COVID-19 pandemic has impeded cytopathology practices and hindered cancer screening and management. Cytopathology 2023; 34:406-416. [PMID: 37332230 DOI: 10.1111/cyt.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/24/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
The COVID-19 pandemic has had a global impact on the environment and economy and has affected hospital administration and patient behaviour. Since human-to-human coronavirus transmission occurs via droplets and physical contact, health care professionals are particularly vulnerable to contracting COVID-19. Many cytopathology laboratories updated their workflow, established new standard biosafety protocols, and built digital pathology or telescope platforms to mitigate these risks and deal with the shortage of health care personnel. The COVID-19 pandemic also disrupted medical education-all indoor training events, including conferences, multidisciplinary tumour boards, seminars, and microscope inspections were postponed. As a result, many laboratories now use new web-based applications and platforms to maintain educational programs and multidisciplinary tumour boards. To comply with government directives, health care facilities postponed non-emergency surgeries, reduced the number of routine medical examinations, restricted visitor numbers, and scaled back cancer screening activities, resulting in a sharp decline in cytopathology diagnoses, cancer screening specimens, and molecular testing for cancer. Subsequent misses or delays in the diagnosis and treatment of cancer were not uncommon. This review aims to provide comprehensive summaries of the consequences of the COVID-19 pandemic for cytopathology, particularly in terms of cancer diagnosis, workload, human resources, and molecular testing.
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Affiliation(s)
- Cheng-Yi Huang
- Department of Pathology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Department of Biotechnology and Bioindustry Sciences, National Cheng Kung University, Tainan, Taiwan
- Ph.D. Program in Translational Medicine, Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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4
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ANDERSON NATHANIELW, HALFON NEAL, EISENBERG DANIEL, MARKOWITZ ANNAJ, MOORE KRISTINANDERSON, ZIMMERMAN FREDERICKJ. Mixed Signals in Child and Adolescent Mental Health and Well-Being Indicators in the United States: A Call for Improvements to Population Health Monitoring. Milbank Q 2023; 101:259-286. [PMID: 37052602 PMCID: PMC10262392 DOI: 10.1111/1468-0009.12634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 01/13/2023] [Accepted: 02/02/2023] [Indexed: 04/14/2023] Open
Abstract
Policy Points Social indicators of young peoples' conditions and circumstances, such as high school graduation, food insecurity, and smoking, are improving even as subjective indicators of mental health and well-being have been worsening. This divergence suggests policies targeting the social indicators may not have improved overall mental health and well-being. There are several plausible reasons for this seeming contradiction. Available data suggest the culpability of one or several common exposures poorly captured by existing social indicators. Resolving this disconnect requires significant investments in population-level data systems to support a more holistic, child-centric, and up-to-date understanding of young people's lives.
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Affiliation(s)
| | - NEAL HALFON
- University of California Los Angeles Jonathan and Karin Fielding School of Public
- University of California Los Angeles David Geffen School of Medicine
- University of California Los Angeles Meyer and Renee Luskin School of Public Affairs
| | - DANIEL EISENBERG
- University of California Los Angeles Jonathan and Karin Fielding School of Public
| | - ANNA J. MARKOWITZ
- University of CaliforniaLos Angeles Graduate School of Education and Information Studies
| | | | - FREDERICK J. ZIMMERMAN
- University of California Los Angeles Jonathan and Karin Fielding School of Public
- University of California Los Angeles Meyer and Renee Luskin School of Public Affairs
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5
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Lu P, Kezios K, Milazzo F, Jawadekar N, Shelley M, Zeki Al Hazzouri A. Racial Differences in Employment and Poverty Histories and Health in Older Age. Am J Prev Med 2023; 64:543-551. [PMID: 36642644 DOI: 10.1016/j.amepre.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Black Americans encounter more barriers in the job market and earn less than White Americans. However, the extent to which racial disparities in employment and poverty histories impact health is not fully understood. This study characterized employment‒poverty histories for Black and White middle-aged adults and examined their association with health. METHODS Respondents born in 1948-1953 and enrolled in the 2004 Health and Retirement Study (NBlack=555, NWhite=2,209) were included. Sequence analysis grouped respondents with similar employment‒poverty trajectories from 2004 to 2016, and confounder-adjusted regression analyses estimated the associations between these trajectories and health in 2018. Analyses were conducted in 2021-2022. RESULTS More than 23% of Black respondents experienced both employment and poverty fluctuations, including bouts of extreme poverty (<50% of the federal poverty threshold), whereas no trajectory for White respondents included extreme poverty. Adversities in employment‒poverty were associated with worse health. For example, among Black respondents, those who experienced both employment and poverty fluctuations had worse cognition than those employed and not poor (β= -0.55 standardized units, 95% CI= -0.81, -0.30). Similarly, among White respondents, those who experienced employment fluctuations had worse cognition than those employed (β= -0.35, 95% CI= -0.46, -0.24). Notably, the employed and not poor trajectory was associated with worse survival among Black respondents than among White respondents. CONCLUSIONS Employment fluctuations were associated with worse health, especially cognitive function, where the association was stronger among Black Americans who experienced both employment fluctuations and poverty. Findings highlight the importance of enhancing employment stability and of antipoverty programs, especially for Black Americans.
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Affiliation(s)
- Peiyi Lu
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Katrina Kezios
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Floriana Milazzo
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Neal Jawadekar
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Mack Shelley
- Department of Political Science, Iowa State University, Ames, Iowa; Department of Statistics, Iowa State University, Ames, Iowa
| | - Adina Zeki Al Hazzouri
- From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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6
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Dorn F, Lange B, Braml M, Gstrein D, Nyirenda JLZ, Vanella P, Winter J, Fuest C, Krause G. The challenge of estimating the direct and indirect effects of COVID-19 interventions - Toward an integrated economic and epidemiological approach. ECONOMICS AND HUMAN BIOLOGY 2023; 49:101198. [PMID: 36630757 PMCID: PMC9642024 DOI: 10.1016/j.ehb.2022.101198] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 10/26/2022] [Accepted: 11/06/2022] [Indexed: 05/06/2023]
Abstract
Decisions on public health measures to contain a pandemic are often based on parameters such as expected disease burden and additional mortality due to the pandemic. Both pandemics and non-pharmaceutical interventions to fight pandemics, however, produce economic, social, and medical costs. The costs are, for example, caused by changes in access to healthcare, social distancing, and restrictions on economic activity. These factors indirectly influence health outcomes in the short- and long-term perspective. In a narrative review based on targeted literature searches, we develop a comprehensive perspective on the concepts available as well as the challenges of estimating the overall disease burden and the direct and indirect effects of COVID-19 interventions from both epidemiological and economic perspectives, particularly during the early part of a pandemic. We review the literature and discuss relevant components that need to be included when estimating the direct and indirect effects of the COVID-19 pandemic. The review presents data sources and different forms of death counts, and discusses empirical findings on direct and indirect effects of the pandemic and interventions on disease burden as well as the distribution of health risks.
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Affiliation(s)
- Florian Dorn
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; Department of Economics, University of Munich (LMU), Germany; CESifo Munich, Germany.
| | - Berit Lange
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; Hannover Medical School (MHH), Germany; German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Martin Braml
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; World Trade Organization, Economic Research and Statistics Division, Geneva, Switzerland
| | - David Gstrein
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; Department of Economics, University of Munich (LMU), Germany
| | - John L Z Nyirenda
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; University Hospital Freiburg, University of Freiburg, Germany
| | - Patrizio Vanella
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; Hannover Medical School (MHH), Germany; Department of Health Reporting & Biometrics, aQua-Institut, Göttingen, Germany
| | - Joachim Winter
- Department of Economics, University of Munich (LMU), Germany; CESifo Munich, Germany
| | - Clemens Fuest
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; Department of Economics, University of Munich (LMU), Germany; CESifo Munich, Germany
| | - Gérard Krause
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; Hannover Medical School (MHH), Germany; German Center for Infection Research (DZIF), Braunschweig, Germany
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7
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Agnew M, Bea MD, Friedline T. Payday lenders and premature mortality. Front Public Health 2022; 10:993585. [PMID: 36330114 PMCID: PMC9623148 DOI: 10.3389/fpubh.2022.993585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023] Open
Abstract
Relationships between debt and poor health are worrisome as access to expensive credit expands and population health worsens along certain metrics. We focus on payday lenders as one type of expensive credit and investigate the spatial relationships between lender storefronts and premature mortality rates. We combine causes of death data from the Centers for Disease Control and Prevention (CDC) and payday lender locations at the county-level in the United States between 2000 and 2017. After accounting for county socioeconomic and demographic characteristics, the local presence of payday lenders is associated with an increased incidence risk of all-cause and specific-cause premature mortality. State regulations may attenuate these relationships, which provides insights on policy strategies to mitigate health impacts.
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Affiliation(s)
- Megan Agnew
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Megan Doherty Bea
- Department of Consumer Science, University of Wisconsin-Madison, Madison, WI, United States
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8
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Jacques O, Noël A. Welfare state decommodification and population health. PLoS One 2022; 17:e0272698. [PMID: 36044426 PMCID: PMC9432727 DOI: 10.1371/journal.pone.0272698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
A generous welfare state decommodifies social relations and frees citizens from relying excessively on markets. We argue that decommodification is associated with population health in two ways: directly, as it provides better social protection to households and indirectly, as it mitigates health-damaging labour market polarization and reduces the incidence of labour market risks. Using time-series cross-sectional quantitative analysis for 21 OECD countries from 1971 to 2010, we observe a negative relationship between decommodification and the age-standardized death rate. We then analyze three correlates of decommodification—income redistribution, labour market polarization and the reduction of labour market risk incidence—and find that only the latter two are associated with population health. Higher labour market polarization, measured by the share of market income allocated to the richest decile relative to the share of the poorest decile, is associated with a higher death rate. A new measure of risk reduction, the degree to which the welfare state reduces the prevalence of large income losses, is also associated with lower death rates, especially for men. Welfare state decommodification thus contributes to population health directly, and indirectly, via the attenuation of labour market polarization and the mitigation of labour market risks.
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Affiliation(s)
- Olivier Jacques
- Département de Gestion, Évaluation et Politique de Santé, École de Santé Publique, Université de Montréal, Montréal, Québec, Canada
- * E-mail:
| | - Alain Noël
- Département de Science Politique, Université de Montréal, Montréal, Québec, Canada
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9
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Lapham J, Martinson ML. The intersection of welfare stigma, state contexts and health among mothers receiving public assistance benefits. SSM Popul Health 2022; 18:101117. [PMID: 35620484 PMCID: PMC9127679 DOI: 10.1016/j.ssmph.2022.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 11/27/2022] Open
Abstract
The stigmatizing nature of the US welfare system is of particular importance not only because it has shown to deter eligible applicants from participating in public assistance programs despite facing economic hardship, but also because stigma is an important fundamental cause of health inequities. Although scholars agree stigma is shaped by individual and contextual dimensions, the role of context is often overlooked. Given the heterogeneous nature of US state welfare environments, it may be critical to consider the ways in which state policy, social and economic contexts condition the relationship between welfare stigma and health. Using a multilevel lens, this study first examined the impact of experienced and perceived welfare stigma on self-reported health among female public assistance recipients with children. Second, we assessed the moderating effect of uneven state TANF policies, income inequality, and negative public welfare attitudes in shaping these associations. Using data from the Fragile Families and Child Wellbeing Study merged with state-level economic and social measures, we employed a series of multilevel logit models with random effects. Findings show experiences and perceptions of welfare stigma are significantly linked to poor health regardless of state contexts, and outcomes vary markedly by race, ethnicity and education. States with strong anti-welfare attitudes amplified the relationship between experienced welfare stigma and poor health for Black and Hispanic mothers, and state economic contexts modified the relationship between experienced welfare stigma and poor health for mothers with less than a high school education. TANF generosity had no moderating effect on health suggesting state policy environments have limited ability to protect welfare recipients against the stigmatizing effects of the US welfare system. Results have implications for explaining stigma related disparities in health within the context of U.S. welfare environments and informing policies that may be key levers for reducing health inequities.
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Affiliation(s)
- Jessica Lapham
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA, 98105, USA
| | - Melissa L. Martinson
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA, 98105, USA
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10
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Abstract
Over the past two decades, opioid overdose deaths contributed to the dramatic rise in all-cause mortality among non-Hispanic Whites. To date, efforts among scholars to understand the role of local area labor market conditions on opioid overdose mortality have led to mixed results. We argue the reason for these disparate findings is scholars have not considered the moderating effects of income support policies such as unemployment insurance. The present study leverages two sources of variation-county mass layoffs and changes in the generosity of state unemployment insurance benefits-to investigate if unemployment benefits moderate the relationship between job loss and county opioid overdose death rates. Our difference-in-differences estimation strategy reveals that the harmful effects of job loss on opioid overdose mortality decline with increasing state unemployment insurance benefit levels. These findings suggest that social policy in the form of income transfers played a crucial role in disrupting the link between job loss and opioid overdose mortality.
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Affiliation(s)
- Pinghui Wu
- The Federal Reserve Bank of Boston, Boston, MA, USA
| | - Michael Evangelist
- Department of Sociology, School of Social Work, and Poverty Solutions, University of Michigan, Ann Arbor, MI, USA
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11
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Aquino T, Brand JE, Torche F. Unequal effects of disruptive events. SOCIOLOGY COMPASS 2022; 16:e12972. [PMID: 38895138 PMCID: PMC11185416 DOI: 10.1111/soc4.12972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/07/2022] [Indexed: 06/21/2024]
Abstract
Disruptive events have significant consequences for the individuals and families who experience them, but these effects do not occur equally across the population. While some groups are strongly affected, others experience few consequences. We review recent findings on inequality in the effects of disruptive events. We consider heterogeneity based on socioeconomic resources, race/ethnicity, the likelihood of experiencing disruption, and contextual factors such as the normativity of the event in particular social settings. We focus on micro-level events affecting specific individuals and families, including divorce, job loss, home loss and eviction, health shocks and deaths, and violence and incarceration, but also refer to macro-level events such as recession and natural disasters. We describe patterns of variation that suggest a process of resource disparities and cumulative disadvantage versus those that reflect the impact of non-normative and unexpected shocks. Finally, we review methodological considerations when examining variation in the effect of disruptive events.
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Affiliation(s)
- Taylor Aquino
- University of California, Los Angeles, California, USA
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12
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Evangelist M, Wu P, Shaefer HL. Emergency unemployment benefits and health care spending during Covid. Health Serv Res 2022; 57:15-26. [PMID: 34517427 PMCID: PMC8652441 DOI: 10.1111/1475-6773.13772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To estimate the impact of the $600 per week Federal Pandemic Unemployment Compensation (FPUC) payments on health care services spending during the Covid pandemic and to investigate if this impact varied by state Medicaid expansion status. DATA SOURCES This study leverages novel, publicly available data from Opportunity Insights capturing consumer credit and debit card spending on health care services for January 18-August 15, 2020 as well as information on unemployment insurance claims, Covid cases, and state policy changes. STUDY DESIGN Using triple-differences estimation, we leverage two sources of variation-within-state change in the unemployment insurance claims rate and the introduction of FPUC payments-to estimate the moderating effect of FPUC on health care spending losses as unemployment rises. Results are stratified by state Medicaid expansion status. EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS For each percentage point increase in the unemployment insurance claims rate, health care spending declined by 1.0% (<0.05) in Medicaid expansion states and by 2.0% (<0.01) in nonexpansion states. However, FPUC partially mitigated this association, boosting spending by 0.8% (<0.001) and 1.3% (<0.05) in Medicaid expansion and nonexpansion states, respectively, for every percentage point increase in the unemployment insurance claims rate. CONCLUSIONS We find that FPUC bolstered health care spending during the Covid pandemic, but that both the negative consequences of unemployment and moderating effects of federal income supports were greatest in states that did not adopt Medicaid expansion. These results indicate that emergency federal spending helped to sustain health care spending during a period of rising unemployment. Yet, the effectiveness of this program also suggests possible unmet demand for health care services, particularly in states that did not adopt Medicaid expansion.
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Affiliation(s)
- Michael Evangelist
- Department of Sociology, Poverty SolutionsUniversity of MichiganAnn ArborMichiganUSA
| | - Pinghui Wu
- Gerald R. Ford School of Public Policy, Poverty SolutionsUniversity of MichiganAnn ArborMichiganUSA
| | - H. Luke Shaefer
- Gerald R. Ford School of Public Policy, Poverty SolutionsUniversity of MichiganAnn ArborMichiganUSA
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13
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Matthay EC, Hagan E, Joshi S, Tan ML, Vlahov D, Adler N, Glymour MM. The Revolution Will Be Hard to Evaluate: How Co-Occurring Policy Changes Affect Research on the Health Effects of Social Policies. Epidemiol Rev 2022; 43:19-32. [PMID: 34622277 PMCID: PMC8763115 DOI: 10.1093/epirev/mxab009] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 08/20/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Ellicott C Matthay
- Correspondence to Dr. Ellicott C. Matthay, Center for Health and Community, School of Medicine, University of California San Francisco, 550 16th Street, 2nd Floor, Campus Box 0560, San Francisco, CA 94143 (e-mail: )
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14
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Matthay EC, Gottlieb LM, Rehkopf D, Tan ML, Vlahov D, Glymour MM. What to Do When Everything Happens at Once: Analytic Approaches to Estimate the Health Effects of Co-Occurring Social Policies. Epidemiol Rev 2022; 43:33-47. [PMID: 34215873 PMCID: PMC8763089 DOI: 10.1093/epirev/mxab005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/14/2021] [Accepted: 06/21/2021] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Ellicott C Matthay
- Correspondence to Dr. Ellicott C. Matthay, Center for Health and Community, School of Medicine, University of California, San Francisco, 550 16th Street, San Francisco, CA 94143 (e-mail: )
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15
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Silver SR, Li J, Quay B. Employment status, unemployment duration, and health-related metrics among US adults of prime working age: Behavioral Risk Factor Surveillance System, 2018-2019. Am J Ind Med 2022; 65:59-71. [PMID: 34748231 PMCID: PMC8678322 DOI: 10.1002/ajim.23308] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND While unemployment has been associated with poor health, few recent studies in the United States have comprehensively assessed associations between employment status (including duration unemployed) and healthcare access, health-related behaviors, and specific health outcomes. METHODS We assessed health-related metrics by employment status in 2018-2019 Behavioral Risk Factor Surveillance System respondents ages 25-54. We calculated the unadjusted prevalence and adjusted prevalence ratios to compare employed workers to respondents who were self-employed, short-term (<12 months) unemployed, long-term unemployed, and unable to work. RESULTS Adverse health outcomes increased with unemployment duration and were highest for those unable to work. Non-Hispanic Blacks were most likely to be unemployed or unable to work. Short-term unemployment and self-employment were associated with poor healthcare access. Health behaviors and outcomes declined with increasing duration of unemployment and were worst for those unable to work. CONCLUSIONS In the United States, access to affordable healthcare is problematic for both the self-employed and the short-term unemployed. Short-term unemployment is a particularly important locus for intervention and provision of resources to prevent health declines that may hinder re-employment.
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Affiliation(s)
- Sharon R. Silver
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Health Informatics Branch
| | - Jia Li
- National Institute for Occupational Safety and Health, Division of Field Studies and Engineering, Health Informatics Branch
| | - Brian Quay
- National Institute for Occupational Safety and Health, Office of the Director, Economic Research and Support Office
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16
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Gimbrone C, Rutherford C, Kandula S, Martínez-Alés G, Shaman J, Olfson M, Gould MS, Pei S, Galanti M, Keyes KM. Associations between COVID-19 mobility restrictions and economic, mental health, and suicide-related concerns in the US using cellular phone GPS and Google search volume data. PLoS One 2021; 16:e0260931. [PMID: 34936666 PMCID: PMC8694413 DOI: 10.1371/journal.pone.0260931] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022] Open
Abstract
During the COVID-19 pandemic, US populations have experienced elevated rates of financial and psychological distress that could lead to increases in suicide rates. Rapid ongoing mental health monitoring is critical for early intervention, especially in regions most affected by the pandemic, yet traditional surveillance data are available only after long lags. Novel information on real-time population isolation and concerns stemming from the pandemic's social and economic impacts, via cellular mobility tracking and online search data, are potentially important interim surveillance resources. Using these measures, we employed transfer function model time-series analyses to estimate associations between daily mobility indicators (proportion of cellular devices completely at home and time spent at home) and Google Health Trends search volumes for terms pertaining to economic stress, mental health, and suicide during 2020 and 2021 both nationally and in New York City. During the first pandemic wave in early-spring 2020, over 50% of devices remained completely at home and searches for economic stressors exceeded 60,000 per 10 million. We found large concurrent associations across analyses between declining mobility and increasing searches for economic stressor terms (national proportion of devices at home: cross-correlation coefficient (CC) = 0.6 (p-value <0.001)). Nationally, we also found strong associations between declining mobility and increasing mental health and suicide-related searches (time at home: mood/anxiety CC = 0.53 (<0.001), social stressor CC = 0.51 (<0.001), suicide seeking CC = 0.37 (0.006)). Our findings suggest that pandemic-related isolation coincided with acute economic distress and may be a risk factor for poor mental health and suicidal behavior. These emergent relationships warrant ongoing attention and causal assessment given the potential for long-term psychological impact and suicide death. As US populations continue to face stress, Google search data can be used to identify possible warning signs from real-time changes in distributions of population thought patterns.
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Affiliation(s)
- Catherine Gimbrone
- Department of Epidemiology, Columbia University, New York, NY, United States of America
| | - Caroline Rutherford
- Department of Epidemiology, Columbia University, New York, NY, United States of America
| | - Sasikiran Kandula
- Department of Environmental Health Sciences, Columbia University, New York, NY, United States of America
| | - Gonzalo Martínez-Alés
- Department of Epidemiology, Columbia University, New York, NY, United States of America
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Columbia University, New York, NY, United States of America
| | - Mark Olfson
- Department of Epidemiology, Columbia University, New York, NY, United States of America
- Department of Psychiatry, Columbia University, New York, NY, United States of America
| | - Madelyn S. Gould
- Department of Epidemiology, Columbia University, New York, NY, United States of America
- Department of Psychiatry, Columbia University, New York, NY, United States of America
| | - Sen Pei
- Department of Environmental Health Sciences, Columbia University, New York, NY, United States of America
| | - Marta Galanti
- Department of Environmental Health Sciences, Columbia University, New York, NY, United States of America
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University, New York, NY, United States of America
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17
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Reynolds MM. Health Power Resources Theory: A Relational Approach to the Study of Health Inequalities. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:493-511. [PMID: 34846187 PMCID: PMC10497238 DOI: 10.1177/00221465211025963] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Link and Phelan's pioneering 1995 theory of fundamental causes urged health scholars to consider the macro-level contexts that "put people at risk of risks." Allied research on the political economy of health has since aptly demonstrated how institutions contextualize risk factors for health. Yet scant research has fully capitalized on either fundamental cause or political economy of health's allusion to power relations as a determinant of persistent inequalities in population health. I address this oversight by advancing a theory of health power resources that contends that power relations distribute and translate the meaning (i.e., necessity, value, and utility) of socioeconomic and health-relevant resources. This occurs through stratification, commodification, discrimination, and devitalization. Resurrecting historical sociological emphases on power relations provides an avenue through which scholars can more fully understand the patterning of population health and better connect the sociology of health and illness to the central tenets of the discipline.
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Affiliation(s)
- Megan M. Reynolds
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
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18
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Fedewa SA, Yabroff KR, Bandi P, Smith RA, Nargis N, Zheng Z, Drope J, Jemal A. Unemployment and cancer screening: Baseline estimates to inform health care delivery in the context of COVID-19 economic distress. Cancer 2021; 128:737-745. [PMID: 34747008 PMCID: PMC8653134 DOI: 10.1002/cncr.33966] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/03/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022]
Abstract
Background During the coronavirus disease 2019 pandemic, US unemployment rates rose to historic highs, and they remain nearly double those of prepandemic levels. Employers are the most common source of health insurance among nonelderly adults. Thus, job loss may lead to a loss of health insurance and reduce access to cancer screening. This study examined associations between unemployment, health insurance, and cancer screening to inform the pandemic's potential impacts on early cancer detection. Methods Up‐to‐date and past‐year breast, cervical, colorectal, and prostate cancer screening prevalences were computed for nonelderly respondents (aged <65 years) with 2000‐2018 National Health Interview Survey data. Multivariable logistic regression models with marginal probabilities were used to estimate unemployed‐versus‐employed unadjusted and adjusted prevalence ratios. Results Unemployed adults (2000‐2018) were 4 times more likely to lack insurance than employed adults (41.4% vs 10.0%; P < .001). Unemployed adults had a significantly lower up‐to‐date prevalence of screening for cervical cancer (78.5% vs 86.2%; P < .001), breast cancer (67.8% vs 77.5%; P < .001), colorectal cancer (41.9 vs 48.5%; P < .001), and prostate cancer (25.4% vs 36.4%; P < .001). These differences were eliminated after accounting for health insurance coverage. Conclusions Unemployment was adversely associated with up‐to‐date cancer screening, and this was fully explained by a lack of health insurance. Ensuring the continuation of health insurance coverage after job loss may mitigate the pandemic's economic distress and future economic downturns' impact on cancer screening. Unemployment is adversely associated with up‐to‐date cancer screening, and this is fully explained by a lack of health insurance.
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Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Priti Bandi
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Early Detection and Screening, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
| | - Jeffrey Drope
- Healthy Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Ahmedin Jemal
- Surveillance and Health Equity Sciences, Office of Cancer Research and Implementation, American Cancer Society, Atlanta, Georgia
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19
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Koltai J, Varchetta FM, McKee M, Stuckler D. The softer they fall: a natural experiment examining the health effects of job loss before and after Fornero's unemployment benefit reforms in Italy. Eur J Public Health 2021; 31:724-730. [PMID: 34491345 DOI: 10.1093/eurpub/ckab092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Job loss is a well-established social determinant of health. Recent research has taken an 'institutional turn', asking whether unemployment support could buffer the health consequences of job loss. Here, we exploit a quasi-natural experiment based on the Fornero reforms in Italy, which increased wage replacement rates from 60% to 75% on 1 January 2013. METHODS We employed difference-in-difference models using longitudinal data covering 202 incidents of job loss from the EU-Survey on Income and Living Conditions to quantify the impact of job loss on changes in self-reported health prior to and after the Fornero reforms (2011-14). RESULTS Job loss pre-Fornero was associated with health declines -0.342 [95% confidence interval (CI): -0.588 to -0.096] but did not significantly influence health post-Fornero 0.031 (95% CI: -0.101 to 0.164). The difference-in-difference estimate was 0.373 (95% CI: 0.107-0.639), or a -0.51 standard deviation in self-reported health, consistent with the buffering hypothesis. To put the magnitude of this estimate in perspective, the incidence of a chronic illness, such as diabetes, results in a similar magnitude decline in self-reported health. CONCLUSIONS Our analysis contributes to a growing body of evidence that the impact of job loss on health depends critically on the strength of social protection systems and, in some cases, could be eliminated completely.
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Affiliation(s)
- Jonathan Koltai
- Sociology Department, University of New Hampshire, Durham, NH, USA
| | - Francesco Maria Varchetta
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
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20
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Shahidi FV, Parnia A. Unemployment Insurance and Mortality Among the Long-Term Unemployed: A Population-Based Matched-Cohort Study. Am J Epidemiol 2021; 190:2124-2137. [PMID: 33997895 DOI: 10.1093/aje/kwab144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 11/12/2022] Open
Abstract
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.
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21
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Leigh JP, Chakalov B. Labor unions and health: A literature review of pathways and outcomes in the workplace. Prev Med Rep 2021; 24:101502. [PMID: 34471593 PMCID: PMC8387742 DOI: 10.1016/j.pmedr.2021.101502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Unique literature review links economic and epidemiologic studies on unions. Unions raise wages, decrease inequality, and thereby likely improve health. Unions decrease discrimination and affect other determinants of health. Unions improve workplace safety and health and decrease job-related fatalities. Unions are an underappreciated social determinant of health.
Extensive economic research demonstrates correlations between unions with wages, income inequality, health insurance, discrimination, and other factors. Corresponding epidemiologic literature demonstrates correlations between income, income inequality, insurance, discrimination, and other factors with health. The first purpose of this narrative review is to link these literatures and identify 28 possible pathways whereby labor unions might affect the health of workers. This review is restricted to effects within workplaces; we do not consider unions' political activities. This review covers studies from the US, Europe, and Canada from 1980 through April 1, 2021. Pathways are grouped within five domains informed by the CDC 5-domain model of social determinants of health and the traditional 3-domain model of occupational medicine. Linked pathways include wages, inequality, excessive overtime, job satisfaction, employer-provided health insurance (EPHI), and discrimination. Second, we identify studies analyzing correlations between unions directly with health outcomes that do not require links. Outcomes include occupational injuries, sickness absence, and drug overdose deaths. Third, we offer judgments on the strength of pathways and outcomes --- labeled “consensus,” “likely,” “disputed” or “unknown” --- based on literature summaries. In our view, whereas there are four “consensus” pathways and outcomes and 16 “likely” pathways and outcomes for unions improving health, there are no “consensus” or “likely” pathways for harming health. The strongest “consensus” pathways and outcomes with salubrious associations include EPHI, OSHA inspections, dangerous working conditions, and injury deaths. Fourth, we identify research gaps and suggest methods for future studies. Unions are an underappreciated social determinant of health.
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Affiliation(s)
- J Paul Leigh
- Department of Public Health Sciences, University of California, Davis, Davis, CA, United States.,Center for Poverty and Inequality Research, University of California, Davis, Davis, CA, United States.,Center for Healthcare Policy and Research, University of California, Davis, Davis, CA, United States
| | - Bozhidar Chakalov
- Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
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22
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Karim W, Courtin E, Muennig PA. Addressing the Social Determinants of Health in the Aftermath of COVID-19: Lessons From the 2008 Great Recession. Am J Public Health 2021; 111:1433-1435. [PMID: 34464203 PMCID: PMC8489602 DOI: 10.2105/ajph.2021.306359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Wasie Karim
- Wasie Karim and Peter A. Muennig are with the Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY. Emilie Courtin is with the Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Emilie Courtin
- Wasie Karim and Peter A. Muennig are with the Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY. Emilie Courtin is with the Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter A Muennig
- Wasie Karim and Peter A. Muennig are with the Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY. Emilie Courtin is with the Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
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23
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Fujishiro K, Ahonen EQ, Gimeno Ruiz de Porras D, Chen IC, Benavides FG. Sociopolitical values and social institutions: Studying work and health equity through the lens of political economy. SSM Popul Health 2021; 14:100787. [PMID: 33898729 PMCID: PMC8056461 DOI: 10.1016/j.ssmph.2021.100787] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022] Open
Abstract
Work contributes to health and health inequity in complex ways. The traditional exposure-disease framework used in occupational health research is not equipped to address societal contexts in which work is embedded. The political economy approach to public health directly examines macro-level societal contexts, but the attention to work in this literature is mostly on unemployment. As a result, we have limited understanding of work as a social determinant of health and health inequity. To fill this gap, we propose a conceptual framework that facilitates research on work, health, and health equity in institutional contexts. As an illustration of different social institutions creating different work-related health, we present characteristics of work and health in the United States and the European Union using the 2015 Working Conditions Surveys data. The results also highlight limitations of the traditional exposure-disease approach used in occupational health research. Applying the proposed framework, we discuss how work and health could be investigated from a broader perspective that involves multiple social institutions and the sociopolitical values that underpin them. Such investigations would inform policy interventions that are congruent with existing social institutions and thus have the potential for being adopted and effective. Further, we clarify the role of research in generating knowledge that would contribute to institutional change in support of population health and health equity.
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Affiliation(s)
- Kaori Fujishiro
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Emily Q. Ahonen
- Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health in San Antonio, The University of Texas Health Science Center in Houston, San Antonio, TX, USA
- Center for Research in Occupational Health, Universitat Pompeu Fabra, CIBER of Epidemiology and Public Health (CIBERESP) and IMIM – Parc Salut Mar, Barcelona, Spain
| | - I-Chen Chen
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Fernando G. Benavides
- Center for Research in Occupational Health, Universitat Pompeu Fabra, CIBER of Epidemiology and Public Health (CIBERESP) and IMIM – Parc Salut Mar, Barcelona, Spain
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24
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Berkowitz SA, Basu S. Unmet Social Needs And Worse Mental Health After Expiration Of COVID-19 Federal Pandemic Unemployment Compensation. Health Aff (Millwood) 2021; 40:426-434. [PMID: 33600235 PMCID: PMC8053426 DOI: 10.1377/hlthaff.2020.01990] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Federal Pandemic Unemployment Compensation (FPUC) provided unemployment insurance beneficiaries an extra $600 a week during the unprecedented economic downturn during the coronavirus disease 2019 (COVID-19) pandemic, but it initially expired in July 2020. We applied difference-in-differences models to nationally representative data from the Census Bureau's Household Pulse Survey to examine changes in unmet health-related social needs and mental health among unemployment insurance beneficiaries before and after initial expiration of FPUC. The initial expiration was associated with a 10.79-percentage-point increase in risk for self-reported missed housing payments. Further, risk for food insufficiency, depressive symptoms, and anxiety symptoms also increased among households that reported receiving unemployment insurance benefits, relative to the period when FPUC was in effect. As further unemployment insurance reform is debated, policy makers should recognize the potential health impact of unemployment insurance.
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Affiliation(s)
- Seth A Berkowitz
- Seth A. Berkowitz is an assistant professor of medicine in the Division of General Medicine and Clinical Epidemiology, School of Medicine, and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, in Chapel Hill, North Carolina
| | - Sanjay Basu
- Sanjay Basu is director of research at the Center for Primary Care, Harvard Medical School, in Boston, Massachusetts, and vice president of research and population health at Collective Health, in San Francisco, California
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25
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Sheehan LR, Lane TJ, Collie A. The Impact of Income Sources on Financial Stress in Workers' Compensation Claimants. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:679-688. [PMID: 32109310 DOI: 10.1007/s10926-020-09883-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Workers' compensation schemes usually recompense workers below their regular wage. This may cause financial stress, which has previously been associated with poorer health and work outcomes after injury. We sought to determine the level of financial stress experienced by injured workers and the influence of post-injury income source on financial stress. METHODS Analysis of a cross-sectional national survey of 4532 adults who had been injured at work and had at least one day of workers' compensation paid. Financial stress at time of survey was measured on a scale of 1-10 and subsequently dichotomised at the top quartile for further analysis. The effect of current main income source on financial stress, adjusted for demographic and psychosocial confounders, was assessed using logistic regression. RESULTS Sixty-nine percent of workers whose main income was social assistance or insurance and 54% whose main income was workers' compensation were experiencing financial stress. Relative to wages or salaries, workers with a main income from social assistance or insurance (odds ratio: 3.33, 95% CI 2.22-5.00) and workers' compensation (1.71, 1.31-2.24) had higher odds of financial stress. Workers with a main income of an aged pension or superannuation had lower odds of financial stress (0.52, 0.28-0.97). CONCLUSION Injured workers receiving workers' compensation or social assistance benefits are vulnerable to increased financial stress. Given the potential negative consequences of financial stress on health, particularly mental health, this study suggests the need for careful consideration of income replacement benefits in the design of workers' compensation schemes.
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Affiliation(s)
- Luke R Sheehan
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Tyler J Lane
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alex Collie
- Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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26
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Riley AR. Advancing the study of health inequality: Fundamental causes as systems of exposure. SSM Popul Health 2020; 10:100555. [PMID: 32099895 PMCID: PMC7029174 DOI: 10.1016/j.ssmph.2020.100555] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/28/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
We tend to study health inequalities as differentials in disease and death that exist within a population. But the most important cause of health inequality is social stratification, and social stratification only varies between populations. Here, I highlight a way forward in the study of health inequality that resolves this mismatch of analytical levels: we must study the fundamental causes as systems of exposure. Through this critical review of the literature, I argue that the explicit study of variation in social stratification is the next frontier in research on fundamental causes of health inequality.
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27
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Matilla-Santander N, Martín-Sánchez JC, González-Marrón A, Cartanyà-Hueso À, Lidón-Moyano C, Martínez-Sánchez JM. Precarious employment, unemployment and their association with health-related outcomes in 35 European countries: a cross-sectional study. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2019.1701183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nuria Matilla-Santander
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Juan Carlos Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Àurea Cartanyà-Hueso
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
- Health Sciences Research Institute, University of California Merced (UC Merced), Merced, CA, USA
| | - Jose M. Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
- Health Sciences Research Institute, University of California Merced (UC Merced), Merced, CA, USA
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d’Oncologia, L'Hospitalet de Llobregat, Spain
- Cancer Prevention and Control Group, Institut d’Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Spain
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Knapp EA, Bilal U, Dean LT, Lazo M, Celentano DD. Economic Insecurity and Deaths of Despair in US Counties. Am J Epidemiol 2019; 188:2131-2139. [PMID: 31172197 DOI: 10.1093/aje/kwz103] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 12/22/2022] Open
Abstract
Recent research has implicated economic insecurity in increasing midlife death rates and "deaths of despair," including suicide, chronic liver disease, and drug and alcohol poisoning. In this ecological longitudinal study, we evaluated the association between changes in economic insecurity and increases in deaths of despair and midlife all-cause mortality in US counties during 2000-2015. We extended a previously developed measure of economic insecurity using indicators from the Census and Federal Reserve Bank in US counties for the years 2000 and 2010. Linear regression models were used to estimate the association of change in economic insecurity with change in death rates through 2015. Counties experiencing elevated economic insecurity in either 2000 or 2010 had higher rates of deaths of despair and all-cause midlife mortality at baseline but similar rates of increase in deaths of despair from 2001 to 2015 compared with counties with stable low economic insecurity. Counties in the highest tertile of economic insecurity in 2000 and 2010 had 41% (95% confidence interval: 1.36, 1.47) higher midlife mortality rates at baseline and a rate of increase of 2% more per 5-year period (95% confidence interval: 1.00, 1.03) than counties with stable low economic insecurity. Economic insecurity may represent a population-level driver of US death trends.
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Affiliation(s)
- Emily A Knapp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Usama Bilal
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mariana Lazo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Barlow P, Reeves A, McKee M, Stuckler D. Employment relations and dismissal regulations: Does employment legislation protect the health of workers? SOCIAL POLICY & ADMINISTRATION 2019; 53:939-957. [PMID: 33776168 PMCID: PMC7983177 DOI: 10.1111/spol.12487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 06/12/2023]
Abstract
Sociologists have long acknowledged that being in a precarious labour market position, whether employed or unemployed, can harm peoples' health. However, scholars have yet to fully investigate the possible contextual, institutional determinants of this relationship. Two institutions that were overlooked in previous empirical studies are the regulations that set minimum compensation for dismissal, severance payments, and entitlements to a period of notice before dismissal, notice periods. These institutions may be important for workers' health as they influence the degree of insecurity that workers are exposed to. Here, we test this hypothesis by examining whether longer notice periods and greater severance payments protect the health of labour market participants, both employed and unemployed. We constructed two cohorts of panel data before and during the European recession using data from 22 countries in the European Union Statistics on Income and Living Conditions (person years = 338,000). We find more generous severance payments significantly reduce the probability that labour market participants, especially the unemployed, will experience declines in self-reported health, with a slightly weaker relationship for longer notice periods.
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Affiliation(s)
- Pepita Barlow
- Bennett Institute for Public Policy, Department of Politics and International StudiesUniversity of CambridgeCambridgeUK
| | - Aaron Reeves
- International Inequalities InstituteLondon School of Economics and Political ScienceLondonUK
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Martin McKee
- Faculty of Public Health and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
| | - David Stuckler
- Carlo F. Dondena Centre for Research on Social Dynamics and Public Policy, Department of Social and Political SciencesBocconi UniversityMilanItaly
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Grasset L, Glymour MM, Elfassy T, Swift SL, Yaffe K, Singh-Manoux A, Zeki Al Hazzouri A. Relation between 20-year income volatility and brain health in midlife: The CARDIA study. Neurology 2019; 93:e1890-e1899. [PMID: 31578298 PMCID: PMC6946474 DOI: 10.1212/wnl.0000000000008463] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Income volatility presents a growing public health threat. To our knowledge, no previous study examined the relationship among income volatility, cognitive function, and brain integrity. METHODS We studied 3,287 participants aged 23-35 years in 1990 from the Coronary Artery Risk Development in Young Adults prospective cohort study. Income volatility data were created using income data collected from 1990 to 2010 and defined as SD of percent change in income and number of income drops ≥25% (categorized as 0, 1, or 2+). In 2010, cognitive tests (n = 3,287) and brain scans (n = 716) were obtained. RESULTS After covariate adjustment, higher income volatility was associated with worse performance on processing speed (β = -1.09, 95% confidence interval [CI] -1.73 to -0.44) and executive functioning (β = 2.53, 95% CI 0.60-4.50) but not on verbal memory (β = -0.02, 95% CI -0.16 to 0.11). Similarly, additional income drops were associated with worse performance on processing speed and executive functioning. Higher income volatility and more income drops were also associated with worse microstructural integrity of total brain and total white matter. All findings were similar when restricted to those with high education, suggesting reverse causation may not explain these findings. CONCLUSION Income volatility over a 20-year period of formative earning years was associated with worse cognitive function and brain integrity in midlife.
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Affiliation(s)
- Leslie Grasset
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY.
| | - M Maria Glymour
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Tali Elfassy
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Samuel L Swift
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Kristine Yaffe
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Archana Singh-Manoux
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Adina Zeki Al Hazzouri
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
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31
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Single transitions and persistence of unemployment are associated with poor health outcomes. BMC Public Health 2019; 19:740. [PMID: 31196081 PMCID: PMC6567908 DOI: 10.1186/s12889-019-7059-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/29/2019] [Indexed: 12/23/2022] Open
Abstract
Background Although job loss has been associated with decline in health, the effect of long term unemployment is less clear and under-researched. Furthermore, the impact of an economic recession on this relationship is unclear. We investigated the associations of single transitions and persistence of unemployment with health. We subsequently examined whether these associations are affected by the latest recession, which began in 2008. Methods In total, 57,911 participants from the Dutch Health Interview Survey who belonged to the labour force between 2004 and 2014 were included. Based on longitudinal tax registration data, single employment transitions between time point 1 (t1) and time point 2 (t2) and persistent unemployment (i.e. number of years individuals were unemployed) between t1 and time point 5 (t5) were defined. General and mental health, smoking and obesity were assessed at respectively time point 3 (t3) and time point 6 (t6). Logistic regression models were performed and interactions with recession indicators (year, annual gross domestic product estimates and regional unemployment rates) were tested. Results Compared with individuals who stayed employed at t1 and t2, the likelihood of poor mental health at the subsequent year was significantly higher in those who became unemployed at t2. Persistent unemployment was associated with poor mental health, especially for those who were persistently unemployed for 5 years. Similar patterns, although less pronounced for smoking, were found for general health and obesity. Indicators of the economic recession did not modify these associations. Conclusions Single transitions into unemployment and persistent unemployment are associated with poor mental and general health, obesity, and to a lesser extend smoking. Our study suggests that re-employment might be an important strategy to improve health of unemployed individuals. The relatively extensive Dutch social security system may explain that the economic recession did not modify these associations.
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32
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Fu W, Liu F. Unemployment insurance and cigarette smoking. JOURNAL OF HEALTH ECONOMICS 2019; 63:34-51. [PMID: 30453224 DOI: 10.1016/j.jhealeco.2018.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 10/17/2018] [Accepted: 10/20/2018] [Indexed: 06/09/2023]
Abstract
We provide evidence for the causal relationship between unemployment insurance (UI) and individuals' smoking behavior using the 1995-2011 Current Population Survey-Tobacco Use Supplement data. Our identification relies on the exploitation of the exogenous variations of the maximum UI weekly benefits across states and over years. Instead of focusing on all unemployed people, we concentrate on those who are eligible for UI benefits. We find that when the maximum UI weekly benefit level increases by $100, smoking cessation increases by approximately 2.9 percentage points among the UI-eligible unemployed. The results are robust to various model specifications. We also explore the mechanism and find suggestive evidence that the increase in the maximum UI weekly benefit leads to a decrease in the probability of over-work of the respective spouse. Moreover, the unemployed who are less educated are more responsive to the increasing UI benefits.
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Affiliation(s)
- Wei Fu
- College of Business and Economics, Lehigh University, United States
| | - Feng Liu
- School of Management and Economics, The Chinese University of Hong Kong, Shenzhen, China.
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33
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Bilal U, Cooper R, Abreu F, Nau C, Franco M, Glass TA. Economic growth and mortality: do social protection policies matter? Int J Epidemiol 2018; 46:1147-1156. [PMID: 28338775 DOI: 10.1093/ije/dyx016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Usama Bilal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Social and Cardiovascular Epidemiology Research Group, Universidad de Alcala, Madrid, Spain
| | - Richard Cooper
- Department of Public Health Sciences, Loyola University Stritch School of Medicine, Chicago, IL, USA
| | | | - Claudia Nau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Manuel Franco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Social and Cardiovascular Epidemiology Research Group, Universidad de Alcala, Madrid, Spain
| | - Thomas A Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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34
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Hessel P, Riumallo-Herl CJ, Leist AK, Berkman LF, Avendano M. Economic Downturns, Retirement and Long-Term Cognitive Function Among Older Americans. J Gerontol B Psychol Sci Soc Sci 2018; 73:744-754. [PMID: 28402464 DOI: 10.1093/geronb/gbx035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 03/09/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Workers approaching retirement may be particularly vulnerable to economic downturns. This study assesses whether exposure to economic downturns around retirement age leads to poorer cognitive function in later life. Method Longitudinal data for 13,577 individuals in the Health and Retirement Study were linked to unemployment rates in state of residence. Random- and fixed-effect models were used to examine whether downturns at 55-64 years of age were associated with cognitive functioning levels and decline at ≥65 years, measured by the Wechsler Adult Intelligence Scale-Revised. Results Longer exposure to downturns at 55-64 years of age was associated with lower levels of cognitive function at ≥65 years. Compared to individuals experiencing only up to 1 year in a downturn at 55-64 years of age, individuals experiencing two downturns at these ages had 0.09 point (95% Confidence Interval [CI, -0.17, -0.02]) lower cognitive functioning scores at ≥65 years (3 years: b = -0.17, 95%CI [-0.29, -0.06]; 4 years: b = -0.14, 95%CI [-0.25, -0.02]; ≥5 years: b = -0.22, 95%CI [-0.38, -0.06]). Downturns at 55-64 years of age were not associated with rates of cognitive decline. Discussion Exposure to downturns around retirement is associated with a long-lasting decline in cognitive function in later life. Policies mitigating the impact of downturns on older workers may help to maintain cognitive function in later life.
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Affiliation(s)
- Philipp Hessel
- Harvard University, Center for Population and Development Studies, Cambridge, Massachusetts.,Universidad de los Andes, Escuela de Gobierno Alberto Lleras Camargo, Bogotá, Colombia
| | - Carlos J Riumallo-Herl
- Harvard T.H. Chan School of Public Health, Department of Global Health, Boston, Massachusetts
| | - Anja K Leist
- University of Luxembourg, PEARL Institute for Research on Socio-Economic Inequality, Luxembourg
| | - Lisa F Berkman
- Harvard University, Center for Population and Development Studies, Cambridge, Massachusetts.,Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts
| | - Mauricio Avendano
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts.,King's College London, Department of Global Health and Social Medicine, UK
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Abstract
In this review, we examine the effects of family economic security policies (i.e., minimum wage, earned income tax credit, unemployment insurance, Temporary Assistance to Needy Families) on child and family health outcomes, summarize policy generosity across states in the USA, and discuss directions and possibilities for future research. This manuscript is an update to a review article that was published in 2014. Millions of Americans are affected by family economic security policies each year, many of whom are the most vulnerable in society. There is increasing evidence that these policies impact health outcomes and behaviors of adults and children. Further, research indicates that, overall, policies which are more restrictive are associated with poorer health behaviors and outcomes; however, the strength of the evidence differs across each of the four policies. There is significant diversity in state-level policies, and it is plausible that these policy variations are contributing to health disparities across and within states. Despite increasing evidence of the relationship between economic policies and health, there continues to be limited attention to this issue. State policy variations offer a valuable opportunity for scientists to conduct natural experiments and contribute to evidence linking social policy effects to family and child well-being. The mounting evidence will help to guide future research and policy making for evolving toward a more nurturing society for family and child health and well-being.
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36
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Reynolds MM, Avendano M. Social Policy Expenditures and Life Expectancy in High-Income Countries. Am J Prev Med 2018; 54:72-79. [PMID: 29254555 PMCID: PMC5739520 DOI: 10.1016/j.amepre.2017.09.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/31/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The U.S. spends more than any other country on health care, yet Americans have lower life expectancy than people in most industrialized countries. Recent studies suggest that lower expenditures on social policies in the U.S. may contribute to less-favorable trends in life expectancy. This study tests the hypothesis that greater social spending will be positively associated with life expectancy across the countries of the Organisation of Economic Co-operation and Development and that the magnitude of these associations will outweigh those between government healthcare spending and life expectancy. METHODS In 2016, longitudinal data on six domains of social expenditures for the U.S. and 19 other wealthy nations between 1980 and 2010 were used to estimate the associations between prior year expenditures on education, family, unemployment, incapacity, old age, and active labor market programs, and period life expectancy using fixed effects models. RESULTS Controlling for a wide set of confounders and government healthcare expenditures, a 1% increase in prior year education expenditures was associated with 0.160 (95% CI=0.033, 0.286) of a year gain in life expectancy, whereas a 1% increase in prior year incapacity benefit expenditures was associated with 0.168 (95% CI=0.003, 0.333) of a year gain in life expectancy. Counterfactual models suggest that if the U.S. were to increase expenditures on education and incapacity to the levels of the country with the maximum expenditures, life expectancy would increase to 80.12 years. CONCLUSIONS The U.S. life expectancy lag could be considerably smaller if U.S. expenditures on education and incapacity programs were comparable with those in other high-income countries.
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Affiliation(s)
- Megan M Reynolds
- Department of Sociology, University of Utah, Salt Lake City, Utah.
| | - Mauricio Avendano
- Department of Global Health and Social Medicine, King's College London, London, England; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts
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Margerison-Zilko CE, Li Y, Luo Z. Economic Conditions During Pregnancy and Adverse Birth Outcomes Among Singleton Live Births in the United States, 1990-2013. Am J Epidemiol 2017; 186:1131-1139. [PMID: 29036485 DOI: 10.1093/aje/kwx179] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/09/2017] [Indexed: 12/20/2022] Open
Abstract
We know little about the relationship between the macroeconomy and birth outcomes, in part due to the methodological challenge of distinguishing effects of economic conditions on fetal health from effects of economic conditions on selection into live birth. We examined associations between state-level unemployment rates in the first 2 trimesters of pregnancy and adverse birth outcomes, using natality data on singleton live births in the United States during 1990-2013. We used fixed-effect logistic regression models and accounted for selection by adjusting for state-level unemployment before conception and maternal characteristics associated with both selection and birth outcomes. We also tested whether associations between macroeconomic conditions and birth outcomes differed during and after (compared with before) the Great Recession (2007-2009). Each 1-percentage-point increase in the first-trimester unemployment rate was associated with a 5% increase in odds of preterm birth, while second-trimester unemployment was associated with a 3% decrease in preterm birth odds. During the Great Recession, however, first-trimester unemployment was associated with a 16% increase in odds of preterm birth. These findings increase our understanding of the effects of the Great Recession on health and add to growing literature suggesting that macro-level social and economic factors contribute to perinatal health.
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38
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Björklund O, Häggström E, Nyström L. Young Finnish Unemployed Men's Experiences of Having Participated in a Specific Active Labor Market Program. Am J Mens Health 2017; 11:1426-1435. [PMID: 26345403 PMCID: PMC5675199 DOI: 10.1177/1557988315604020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of the present study was to describe young Finnish unemployed men's experiences of having participated in a specific active labor market program, intended to fight unemployment and offered at a resource center. Fifteen young unemployed Finnish men in the age range 18 to 27 years were interviewed face-to-face. Purposive sampling was used to increase the variation among informants. The interview texts were analyzed using both manifest and latent qualitative content analysis. The present results reported that the young men felt that they, thanks to the program at the resource center, had acquired daily routines and could ultimately believe in the future. The young men described how they now had a structure, economic support, and that they could return to their daily life. The informants also described how they could see new possibilities and believe in oneself. There is a lack of empirical studies assessing the possible impact of active labor market programs on the unemployed based on participants' own experiences. Further research is needed to describe and elucidate in more detail the effects of targeted support measures and the needs of unemployed men of different ages and living in different contexts.
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Affiliation(s)
- Ove Björklund
- University of Gävle, Gävle, Sweden
- Åbo Akademi University, Vaasa, Finland
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39
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Beckfield J, Morris KA, Bambra C. How social policy contributes to the distribution of population health: the case of gender health equity. Scand J Public Health 2017; 46:6-17. [DOI: 10.1177/1403494817715954] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: In this study we aimed to analyze gender health equity as a case of how social policy contributes to population health. We analyzed three sets of social-investment policies implemented in Europe and previously hypothesized to reduce gender inequity in labor market outcomes: childcare; active labor market programs; and long-term care. Methods: We use 12 indicators of social-investment policies from the OECD Social Expenditure Database, the OECD Family Database, and the Social Policy Indicators’ Parental Leave Benefit Dataset. We draw outcome data from the 2015 Global Burden of Disease for years lived with disability and all-cause mortality among men and women ages 25–54 for 18 European nations over the 1995–2010 period. We estimate 12 linear regression models each for mortality and morbidity (i.e. years lived with disability), one per social-investment indicator. All models use country fixed-effects and cluster-robust standard errors. Results: For years lived with disability, women benefit more from social investment for most indicators. The only exception is the percentage of young children in publicly funded childcare or schooling, which equally benefits men. For all-cause mortality, men benefit more or equally from social investment for most indicators, while women benefit more from government spending on direct job creation through civil employment. Conclusions: Social policy contributes to the distribution of population health. Social-investment advocates argue such policies in particular enhance economic gender equity. Our results show that these polices have ambiguous effects on gender health equity and even differential improvements among men for some outcomes.
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Affiliation(s)
- Jason Beckfield
- Department of Sociology, Harvard University, Cambridge, MA, USA
| | | | - Clare Bambra
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Employment history indicators and mortality in a nested case-control study from the Spanish WORKing life social security (WORKss) cohort. PLoS One 2017; 12:e0178486. [PMID: 28570614 PMCID: PMC5453531 DOI: 10.1371/journal.pone.0178486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/12/2017] [Indexed: 11/19/2022] Open
Abstract
Employment has transitioned from stable to more flexible schemes. Little is known about the effects of dynamic working lives and mortality. We examined the association of employment, unemployment and inactivity on mortality among workers born in 1926-1988, in a nested case-control study of workers from the Spanish WORKss cohort. Cases were all deaths that occurred during 2004-2013 and controls were living persons, matched for sex and age at the time the case occurred. We had information on employment from 1981 to 2013. Logistic regression was used to measure the associations between the 3 employment history indicators separately by sex. There were 53,989 cases and an equal number of controls (n = 107,978). More than 16 years employed showed a protective effect against mortality in women (OR = 0.88, 95%CI: 0.81, 0.94) and men (OR = 0.76, 95%CI: 0.70, 0.79). The number of spells and time in unemployment and inactivity were significantly related to mortality in men, but not women. Sensitivity analyses by labor relationship showed stronger associations of unemployment (OR = 1.42, 95%CI: 1.13, 1.78) and inactivity (OR = 1.34; 95%CI: 1.09, 1.65) for temporary workers. Employment gaps are detrimental to health and have worse effects if the gaps occur without unemployment benefits or after temporary contracts. These results may drive improvement of labor and social policies that protect workers against the potential negative effects of dynamic work lives.
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Cylus J, Avendano M. Receiving Unemployment Benefits May Have Positive Effects On The Health Of The Unemployed. Health Aff (Millwood) 2017; 36:289-296. [DOI: 10.1377/hlthaff.2016.1040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jonathan Cylus
- Jonathan Cylus ( ) is a research fellow at the London School of Economics and Political Science and at the European Observatory on Health Systems and Policies, in England
| | - Mauricio Avendano
- Mauricio Avendano is an associate professor in the Department of Global Health and Social Medicine at King’s College London and an adjunct associate professor in the Department of Social and Behavioral Sciences at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
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Avendano M, Moustgaard H, Martikainen P. Are some populations resilient to recessions? Economic fluctuations and mortality during a period of economic decline and recovery in Finland. Eur J Epidemiol 2016; 32:77-85. [PMID: 27730407 PMCID: PMC5331077 DOI: 10.1007/s10654-016-0152-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 04/22/2016] [Indexed: 12/24/2022]
Abstract
This paper uses individual-level longitudinal data on working-age Finns to examine the health effects of economic fluctuations during a period of economic decline (1989–1996) and recovery (1997–2007) in Finland. We used a nationally representative, longitudinal sample formed by linking population, employment and mortality registers (n = 698,484; 7,719,870 person-years). We implemented a region fixed-effect model that exploits within-regional variations over time in the unemployment rate to identify the effect of economic fluctuations on mortality, controlling for individual employment transitions. Unemployment rates increased from 5.2 % in 1989 to 19.8 % in 1996, declining gradually thereafter and reaching 9.7 % in 2007. Results indicate that these large fluctuations in the economy had no impact on the overall mortality of most working age Finns. The exception was highly educated men, who experienced an increase of 7 % (Rate ratio = 1.07, 95 % confidence interval 1.04, 1.10) for every one-point increase in the regional unemployment rate during the period 1989–1996 due to increased mortality from cardiovascular disease and suicide. This increase, however, was not robust in models that used the employment to population ratio as measure of the economy. Unemployment rates were unrelated to mortality among females, lower educated men, and among any group during economic recovery (1997–2007). For most Finns, we found no consistent evidence of changes in mortality in response to contractions or expansions in the economy. Possible explanations include the weak impact of the recession on wages, as well as the generous unemployment insurance and social benefit system in Finland.
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Affiliation(s)
- Mauricio Avendano
- Department of Global Health & Social Medicine, King's College London, East Wing, Strand Campus, Strand, London, WC2R 2LS, UK.
- Department Social and Behavioral Sciences, Harvard T.H. Chan School of Public health, Boston, MA, USA.
| | - Heta Moustgaard
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland
- Centre for Health Equity Studies (CHESS), Stockholms Universitet and Karolinska Institutet, Stockholm, Sweden
- The Max Planck Institute for Demographic Research, Rostock, Germany
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Shahidi FV, De Moortel D, Muntaner C, Davis O, Siddiqi A. Do flexicurity policies protect workers from the adverse health consequences of temporary employment? A cross-national comparative analysis. SSM Popul Health 2016; 2:674-682. [PMID: 29349179 PMCID: PMC5757780 DOI: 10.1016/j.ssmph.2016.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/26/2016] [Accepted: 09/12/2016] [Indexed: 11/19/2022] Open
Abstract
Flexicurity policies comprise a relatively novel approach to the regulation of work and welfare that aims to combine labour market flexibility with social security. Advocates of this approach argue that, by striking the right balance between flexibility and security, flexicurity policies allow firms to take advantage of loose contractual arrangements in an increasingly competitive economic environment while simultaneously protecting workers from the adverse health and social consequences of flexible forms of employment. In this study, we use multilevel Poisson regression models to test the theoretical claim of the flexicurity approach using data for 23 countries across three waves of the European Social Survey. We construct an institutional typology of labour market regulation and social security to evaluate whether inequalities in self-reported health and limiting longstanding illness between temporary workers and their permanent counterparts are smaller in countries that most closely approximate the ideal type described by advocates of the flexicurity approach. Our results indicate that, while the association between temporary employment and health varies across countries, institutional configurations of labour market regulation and social security do not provide a meaningful explanation for this cross-national variation. Contrary to the expectations of the flexicurity hypothesis, our data do not indicate that employment-related inequalities are smaller in countries that approximate the flexicurity approach. We discuss potential explanations for these findings and conclude that there remains a relative lack of evidence in support of the theoretical claims of the flexicurity approach.
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Affiliation(s)
- Faraz Vahid Shahidi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Corresponding author.
| | - Deborah De Moortel
- Interface Demography, Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Bloomberg School of Nursing, University of Toronto, Toronto, Canada
| | - Owen Davis
- School of Social Policy, Sociology and Social Research, University of Kent, UK
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Gillings School of Public Health, University of North Carolina, Chapel Hill, United States
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Kaspersen SL, Pape K, Ose SO, Gunnell D, Bjørngaard JH. Unemployment and initiation of psychotropic medication: a case-crossover study of 2 348 552 Norwegian employees. Occup Environ Med 2016; 73:719-726. [PMID: 27165811 DOI: 10.1136/oemed-2016-103578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 04/19/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The study investigated initiation of psychotropic medication in relation to unemployment in the months before, during and after job loss, to detect the period of greatest risk. METHODS The Norwegian working population in 2004 (N=2 348 552) was observed from 2005 to 2010 through administrative registries linked to the Norwegian Prescription Database. A case-crossover design was used to analyse within-person relative risk of incident purchases of prescribed psychotropic drugs in relation to timing of unemployment. Control periods were defined 12, 24 and 36 months before the drug purchase. Supplementary analyses were performed on medication for cardiovascular disease, diabetes, obesity, thyroid disorder, pain and musculoskeletal conditions. RESULTS Purchases of all psychotropic drugs increased 1-3 months before job loss. Antidepressants had the highest estimate in the month before job loss (OR 2.68, 95% CIs 2.39 to 3.01), followed by hypnotics/sedatives (OR 2.21, 95% CI 1.97 to 2.48), anxiolytics (OR 2.18, 95% CI 1.91 to 2.48) and antipsychotics (OR 2.09, 95% CI 1.76 to 2.48). Rises were greatest in men. Risk of starting psychotropic medication remained raised during a spell of unemployment, but returned to close-to-baseline levels following re-employment. Drugs used to treat somatic and pain conditions showed similar trends but with weaker associations. CONCLUSIONS Concerns about impending unemployment may influence mental health several months prior to job loss, especially around the time of notification. The clinical implications of this might be a strengthening of preventive health initiatives early in the unemployment process.
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Affiliation(s)
- Silje L Kaspersen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Department of Health, SINTEF Technology & Society, Trondheim, Norway
| | - Kristine Pape
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Solveig O Ose
- Department of Health, SINTEF Technology & Society, Trondheim, Norway
| | - David Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Johan Håkon Bjørngaard
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Forensic Department and Research Centre Bröset, St. Olav's University Hospital, Trondheim, Norway
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Margerison-Zilko C, Goldman-Mellor S, Falconi A, Downing J. Health Impacts of the Great Recession: A Critical Review. CURR EPIDEMIOL REP 2016; 3:81-91. [PMID: 27239427 DOI: 10.1007/s40471-016-0068-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The severity, sudden onset, and multipronged nature of the Great Recession (2007-2009) provided a unique opportunity to examine the health impacts of macroeconomic downturn. We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations. Overall, studies reported detrimental impacts of the Recession on health, particularly mental health. Macro- and individual-level employment- and housing-related sequelae of the Recession were associated with declining fertility and self-rated health, and increasing morbidity, psychological distress, and suicide, although traffic fatalities and population-level alcohol consumption declined. Health impacts were stronger among men and racial/ethnic minorities. Importantly, strong social safety nets in some European countries appear to have buffered those populations from negative health effects. This literature, however, still faces multiple methodological challenges, and more time may be needed to observe the Recession's full health impact. We conclude with suggestions for future work in this field.
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Affiliation(s)
- Claire Margerison-Zilko
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Rd., Rm 601, East Lansing, MI 48824, Ph: 517-353-8623
| | - Sidra Goldman-Mellor
- Department of Public Health, University of California, Merced, 5200 N. Lake Rd., Merced, CA 95342, Ph: (209) 228-2498
| | - April Falconi
- General Internal Medicine, Stanford University, Palo Alto, CA 94305, Ph: (703) 328-4851
| | - Janelle Downing
- School of Public Health, University of California, Berkeley, 545 University Hall, University of California, Berkeley, CA 94720-7360, Ph: (510) 643-8571
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Hamad R, Rehkopf DH. Poverty, Pregnancy, and Birth Outcomes: A Study of the Earned Income Tax Credit. Paediatr Perinat Epidemiol 2015; 29. [PMID: 26212041 PMCID: PMC4536129 DOI: 10.1111/ppe.12211] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Economic interventions are increasingly recognised as a mechanism to address perinatal health outcomes among disadvantaged groups. In the US, the earned income tax credit (EITC) is the largest poverty alleviation programme. Little is known about its effects on perinatal health among recipients and their children. We exploit quasi-random variation in the size of EITC payments to examine the effects of income on perinatal health. METHODS The study sample includes women surveyed in the 1979 National Longitudinal Survey of Youth (n = 2985) and their children born during 1986-2000 (n = 4683). Outcome variables include utilisation of prenatal and postnatal care, use of alcohol and tobacco during pregnancy, term birth, birthweight, and breast-feeding status. We first examine the health effects of both household income and EITC payment size using multivariable linear regressions. We then employ instrumental variables analysis to estimate the causal effect of income on perinatal health, using EITC payment size as an instrument for household income. RESULTS We find that EITC payment size is associated with better levels of several indicators of perinatal health. Instrumental variables analysis, however, does not reveal a causal association between household income and these health measures. CONCLUSIONS Our findings suggest that associations between income and perinatal health may be confounded by unobserved characteristics, but that EITC income improves perinatal health. Future studies should continue to explore the impacts of economic interventions on perinatal health outcomes, and investigate how different forms of income transfers may have different impacts.
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Affiliation(s)
- Rita Hamad
- Stanford University, Division of General Medical Disciplines, 1070 Arastradero Rd, Palo Alto, CA 94304; Fax: (650) 498-7750
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