Rises in unemployment akin to those during the existing economic crisis increase the rates of suicides and murders in the population, while at the same time reducing the numbers of road-traffic accidents. Active labour market programmes that keep and reintegrate workers in jobs could mitigate some of the adverse effects. These are the conclusions of an Article published Online First and in an upcoming edition of the Lancet, written by Dr David Stuckler, University of Oxford, UK, and Professor Martin McKee, London School of Hygiene and Tropical Medicine, UK, and colleagues.
Many commentators say that economic downturns can adversely affect health, since they can lead to mental health and addiction problems, increased stress, and more suicides. Yet there is also the opposing view that recessions can make people healthier, because they engage in more healthy behaviour—for example walking instead of driving, and less over-consumption of food and alcohol. But which view of the effect of economic downturns on public health is best supported by empirical data? The authors looked at how economic changes have affected mortality rates in 26 European Union (EU) countries over the past three decades, and identified how governments might reduce adverse effects.
They found that for every 1% increase in unemployment, there was a 0.8% rise in suicide rates at ages younger than 65 years—or between 60 and 550 extra suicides per year across the EU. Murder rates also rose 0.8%. Both these effects were greatest at working ages. By contrast, road traffic accidents decreased by 1.4%. If unemployment rose by more than 3%, suicide rates for those aged under 65 rose by 4.5%, and deaths from alcohol abuse by 28%. The authors found no evidence across the EU that all-cause mortality rates increased when unemployment rose, although different populations had different responses, depending partly on the social protection mechanisms in place that could mitigate the damage caused by unemployment—such as active labour market programmes. The authors note that weaker labour market protections in the central and eastern European countries have made their populations very exposed to the potential for negative health effects when unemployment rates rise sharply. And while there may be no net effect on a particular country (some people get healthier, others less healthy), research suggests those who lose their jobs are most at risk, and, among them, the least well educated are at even higher risk. Furthermore, the authors note their study only looks at mortality—the effects of recession on risk factors and disease were not covered.
The authors say: "Some negative health effects of the Great Depression seem to have been manifested only 5 years after the bank crises of the late 1920s and early 1930s. A related concern is that fear and anxiety in the present crisis could be particularly longlasting; even when the market recovers, people's worries and associated behaviours (such as health-care seeking, or alterations to health-system budgets) might not."
They say the effects of the current economic crisis may be less than some commentators predicted (25—290 additional suicides in Britain attributable to unemployment rises). But they add: "Nevertheless, although the financial sector of an economy may be principally responsible for risk-taking related to the present economic crisis, the true costs of this risk-taking behaviour are to society as a whole."
They conclude: "The analysis also suggests that governments might be able to protect their populations, specifically by budgeting for measures that keep people employed, helping those who lose their jobs cope with the negative effects of unemployment, and enabling unemployed people to regain work quickly. We observed that social spending on active labour market programmes greater than $190 per head purchasing power parity mitigated the effect of unemployment on death rates from suicides, creating a specific opportunity for stimulus packages to align labour market investments with health promotion."
In an accompanying Comment, Dr Andreas Lundin and Dr Tomas Hemmingsson, Karolinska Institutet, Stockholm, Sweden, say: "When the social security system is less extensive, unemployment is a more probable mediator between mental illness and suicide. Without a moderating effect of unemployment benefits, an increase in suicide rates following increased unemployment rates is, as suggested by Stuckler and colleagues, more plausible."
Dr David Stuckler, University of Oxford, UK T) +44 (0) 7726 422212 E) David.stuckler@chch.ox.ac.uk
Maria Coyle, Press Office Oxford University, T) +44(0)1865 280534 E) Maria.Coyle@admin.ox.ac.uk
Professor Martin McKee, London School of Hygiene and Tropical Medicine, UK T) +44 (0) 7973 832576 E) martin.mckee@lshtm.ac.uk
Dr Andreas Lundin, Karolinska Institutet, Stockholm, Sweden T) +46 8-524 876 04 E) andreas.lundin@ki.se
For full Article and Comment see: http://press.thelancet.com/crises.pdf
Journal
The Lancet