Working In These Times
Is Unemployment Killing Us? Workers in Critical Condition
The recession has left millions of Americans sick and tired of being sick and tired... literally.
With unemployment claims climbing again, it doesn't take an empirical study to know how bad it feels to be living through the worst economic crisis in generations. But the New York Times this week explores a potential trend that's tragically predictable: this economy may be killing us. While lawmakers are on the edge of bungling both health care and jobs legislation, Michael Luo ties new research to the stories of steel mill workers who were hit with heart attacks shortly after getting hit with job loss.
"I think the stress just got to him,” said the wife of one of the workers, Bob Smith of Lackawanna, New York, who had been otherwise healthy before he was seized with chest pains in bed.
So how hazardous is the recession to your health? It may seem intuitive that a bad economy makes it harder to survive physically and emotionally. Yet studies that link economic hardship to death and illness attest to less obvious structural inequities underlying the lethality of unemployment.
One study cited in the Times, by State University of New York-Albany sociologist Kate Strully, found that losing your job is associated with “an 83 percent greater chance of developing a stress-related health problem, like diabetes, arthritis or psychiatric issues.” Reflecting the enduring scars of a volatile economy, even unemployed workers got jobs later on “faced an increased risk of developing new health conditions."
On the other hand, there's some evidence that tough times could indirectly bring healthy lifestyle changes: you might skip dessert, for instance, or walk to work to save gas. But don't try to sell a laid-off factory worker on the virtues of forced austerity.
A study of displaced workers by Columbia and Chicago Fed economists connected job loss and changes in mortality for senior male workers. Comparative data between workers who were displaced and those who stayed expose the human toll of what executives coldly justify as “reducing labor costs”:
The gap between the groups’ mortality rates was especially high in the 1987-93 period shortly after displaced workers lost their jobs. Indeed, during this period, displaced workers were more than 40% more likely to die as non-displaced workers (5.151 per 1,000 versus 3.670 per 1,000). However, even 20 years later, during the 2000-06 period, mortality rates were more than 15% higher for the displaced workers.
While the pink slip might be a shock, the long-term ramifications may be slower yet more devastating: “A worker displaced in mid-career can expect to live about one and half years less than a non-displaced counterpart.” Challenging the assumption that economic decline promotes healthier lifestyles, the authors added, “the workers we study, while having fewer lifetime resources, did not enjoy the increases in leisure, healthier life-styles, or reductions in accidents” experienced by more fortunate job-losers. (Read: idling for hours at the unemployment office doesn't count as rest and recovery.)
The study underscores the role of the social safety net: those who lost their jobs near retirement age didn't fare as badly, presumably because “older workers are more likely to have access to Social Security benefits, to company pension plans, or to Medicare.”
Economic insecurity is compounded by a dysfunctional health care system. According to the Robert Wood Johnson Foundation's report on the recession and public health, financial troubles push people to skimp on their health:
One privately-funded panel survey of more that 100,000 households found a marked increase in the percentage of households reporting that they had deferred (delayed or cancelled) health visits in early 2009, compared to 2006.... Deferring care was most prominent in lower-income households, but occurred across all income and age cohorts. A survey of employees who were [still] employed and insured through employer-sponsored or union-sponsored plans found evidence that the recession was taking a toll on employees’ physical and emotional health: 27 percent reported that they had chosen not to receive health care treatment to save money on coinsurance or copayments, 20 percent had skipped taking medications at the prescribed dosage, 17 percent were splitting drug dosages to make them last longer, and 40 percent said their mental health/stress/anxiety levels had become worse since the economic downturn.
Still, cause-and-effect are difficult to parse; poor health could be a factor in job loss, or the other way around. Either way, the health system sets up workers for a death spiral in which the sick and unemployed are punished by shrinking access to health care and growing economic alienation. As Don Peck reported in the Atlantic, unemployment among young people is linked to heavy drinking and depression later on. Over time, it appears that the longer a worker is shut out of the rapidly changing job market, the harder it becomes to regain steady employment.
On a systemic level, the recession strangles the entire health care infrastructure, as more people, especially poor people of color, are forced to lean on public services like community clinics. Health care providers meanwhile struggle with dwindling budgets and staff shortages.
William T. Gallo, professor of epidemiology and biostatistics at Hunter College, offered an interesting idea in the Times piece: “We want to find out how we can intervene so we can lessen the effects of job loss, or eliminate them.”
For starters, we could mitigate the “effects of job loss” by helping people keep their jobs. But aside from an overhaul of fiscal and financial policy, providing universal comprehensive health care would go a long way toward shielding people from the cruelest consequences of a volatile economy (another common sense solution affirmed by research on health care spending and mortality). If it can't provide full employment, the government could at least try to ensure that while job loss is a fact of life, it won't be a death knell.