Health in the downturn: Route to recovery lies in return to work

Economic downturns are definitely bad for mental health.

Research shows that the death toll from suicide and murder tends to grow during recession - and more people show symptoms of depression. But the impact of recession on health generally is less certain.

While unemployment has an adverse effect on the individuals thrown out of work, overall mortality and sickness rates do not necessarily increase during bad economic times. Some causes of death and disease diminish; less road traffic, for example, means fewer accidents and less pollution.

Analysis by Stephen Bezruchka of the School of Public Health at the University of Washington in Seattle, published this month in the Canadian Medical Association Journal (CMAJ), concluded that on balance mortality rates during recessions in developed countries decline rather than increase.

"In terms of business cycles, mortality is pro-cyclical, meaning it goes up with economic expansions and down with contractions, and not counter-cyclical as expected," said Dr Bezruchka.

There are myriad mechanisms through which health could improve during economic downturns, he says. Increased leisure time can be used for friendships, exercise and enjoyable physical activity and can be spent with family. And some studies have suggested that adverse health behaviours such as overeating, smoking and excessive alcohol use decline during recessions.

A large European study, published in July in the Lancet, came to rather different conclusions. Researchers at Oxford University and the London School of Hygiene and Tropical Medicine found that, taking the European Union as a whole, there was little overall correlation of mortality with changing unemployment rates over the past 40 years.

A 3 per cent increase in unemployment led to rises of about 4 per cent in suicide and 6 per cent in murders but a 4 per cent fall in traffic fatalities. The biggest impact was on deaths from alcohol abuse, which rose 28 per cent.

Although heart disease as a whole did not vary much with economic conditions, there was a relationship between recession and heart attacks in men aged 30 to 44. Heart attack deaths in this group increased 0.86 per cent for every 1 per cent increase in unemployment.

But there were significant differences between countries. The health impact of recession is worst where social spending is low, such as in eastern Europe, and least where spending is high, such as Scandinavia.

The researchers found that substantial government support to keep people in work and help the unemployed find jobs could reduce some of the adverse health effects of recession.

If social spending on these "active labour market" programmes exceeds $190 per head of population per year, suicide rates do not rise with unemployment, the researchers found.

In the UK, where about $150 per head is spent on active labour market programmes, the researchers estimated that between 25 and 290 suicides a year would occur as a direct result of the current financial crisis.

"If governments have funds to protect the working population in a recession, it is more effective to spend it on measures to help people get back to work than on healthcare or increasing unemployment benefit," said David Stuckler of Oxford, a co-author of the study.

Martin McKee, of the London School of Hygiene and Tropical Medicine, said: "Suicides are just the tip of the iceberg: rising suicide rates are a sign of many failed suicide attempts and high levels of mental distress among workers and families."

The authors said their analysis had limitations that might be overcome by further research: for example, the focus on entire populations meant the experience of vulnerable groups, such as migrants or refugees, was ignored. The use of death rates also meant that the conclusions "almost certainly understate the full effects of recession on health".

A third recent study, published this month in the journal BMC Public Health, focused on the impact of labour market trends on teenagers' mental health. Researchers from the Swedish National Institute of Public Health found, on the basis of data from 1985 to 2002, that as the proportion of young people out of work increased, so did the proportion of 15-year-olds who reported symptoms such as feeling low, difficulty sleeping or headaches.

Anton Lager, co-author of the study, said: "Changes in the proportion of 15-to-24-year-olds not in the labour force were significantly associated with changes in the proportion of 15-year-olds with mental health symptoms, both in boys and in girls."

It appears that the threat of unemployment can unsettle schoolchildren even before they have to find a job.

Could recession increase infectious diseases? There has been little research on the matter but James LeDuc, a leading US microbiologist, thinks the question is worth asking.

"We've started to see pockets of tent cities appearing across the United States as people lose their homes thanks to the recession," says Dr LeDuc, deputy director of the Galveston National Laboratory. "These makeshift communities may be insanitary and could create the perfect conditions for exposure to diseases like West Nile and diarrhoeal infections. This, coupled with crippled state budgets, sets the stage for some very bad things to happen."

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