Re: PEN-L digest 115: Health & UE

[Hari Kumar <hari.kumar@xxxxxxxxxxxx>]

ORIGINAL COMMENT:
>From today's SLATE summary of the major U.S. newspapers: >A researcher at
UNC-Greensboro has found, under certain circumstances, an inverse
relationship between health and prosperity, the NY [TIMES] reports. Any
number of infirmities--death, for example--drop off during short-term
recessions. Smoking, obesity, heavy drinking and some kinds of back
problems also decline, perhaps because there's no extra money (for booze, say) and
lots of free time (for exercise). Some numbers: A one-point rise in a
state's unemployment rate translates into a .5 percent drop in the total
death rate. Conversely, a point drop in unemployment brings fatal car
crashes up 2.4 percent. The inevitable kicker from the Times: "What's money
when you have your health?"<
so we need more unemployment?
JD
_______________________________________________________________________
REPLY:
I believe JD accepts this as balderdash. Most medical scientists would too ? unless COMPELLING data to the opposite. One small
aspect might be true ? relationship to alcohol consumption. HOWEVER, this is far outweighed by the other generalized health
consequences of unemployment (U/E).
Fraternal Greetings Hari Kumar
STRUCTURE OF THIS REPLY:
Given below are some abstracts available from the National Library of medicine (PUBMED) search engine. Search terms either:
?Unemployment and outcomes?; (Yield 64 articles) or: ??Unemployment and outcomes and Brenner? (Yeild 8 articles ? all shown
below).
I have further sub-divided these into categories that have a introductory sub-heading.
1) A SIMPLE OVER_VIEW:  Two interacting but mutually deleterious effects of health and U/E:
ARTICLE (I): Med J Aust 1998 Feb 16;168(4):178-82
Comment in:
Med J Aust. 1998 Aug 3;169(3):173.
The health consequences of unemployment: the evidence.
Mathers CD, Schofield DJ.
Australian Institute of Health and Welfare, Canberra. colin.mathers@xxxxxxxxxxx
Mathers and Schofield, from the Australian Institute of Health and Welfare, review recent studies, including Australian
research, on the health effects of unemployment and the mechanisms by which unemployment causes adverse health outcomes. The
relationship is complex: ill-health also causes unemployment, and confounding factors include socioeconomic status and
lifestyle. However, longitudinal studies with a range of designs provide reasonably good evidence that unemployment itself is
detrimental to health and has an impact on health outcomes--increasing mortality rates, causing physical and mental ill-health
and greater use of health services.
PMID: 9507716 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9507716&dopt=Abstract
ARTICLE (ii)
CMAJ 1995 Sep 1;153(5):529-40 Related Articles, Books, LinkOut

Comment in:
Can Med Assoc J. 1996 May 15;154(10):1467-8
The impact of unemployment on health: a review of the evidence.
Jin RL, Shah CP, Svoboda TJ.
Occupational Health Section (Medical Services Department), Workers' Compensation Board of British Columbia, Vancouver.
OBJECTIVE: To review the scientific evidence supporting an association between unemployment and adverse health outcomes and to
assess the evidence on the basis of the epidemiologic criteria for causation. DATA SOURCES: MEDLINE was searched for all
relevant articles with the use of the MeSH terms "unemployment," "employment," "job loss," "economy" and a range of mortality
and morbidity outcomes. A secondary search was conducted for references from the primary search articles, review articles or
published commentaries. Data and definitions of unemployment were drawn from Statistics Canada publications. STUDY SELECTION:
Selection focused on articles published in the 1980s and 1990s. English-language reports of aggregate-level research
(involving an entire population), such as time-series analyses, and studies of individual subjects, such as cross-sectional,
case-control or cohort studies, were reviewed. In total, the authors reviewed 46 articles that described original studies.
DATA EXTRACTION: Information was sought on the association (if any) between unemployment and health outcomes such as mortality
rates, specific causes of death, incidence of physical and mental disorders and the use of health care services. Information
was extracted on the nature of the association (positive or negative), measures of association (relative risk, odds ratio or
standardized mortality ratio), and the direction of causation (whether unemployment caused ill health or vice versa). DATA
SYNTHESIS: Most aggregate-level studies reported a positive association between national unemployment rates and rates of
overall mortality and mortality due to cardiovascular disease and suicide. However, the relation between unemployment rates
and motor-vehicle fatality rates may be inverse. Large, census-based cohort studies showed higher rates of overall mortality,
death due to cardiovascular disease and suicide among unemployed men and women than among either employed people or the
general population. Workers laid off because of factory closure have reported more symptoms and illnesses than employed
people; some of these reports have been validated objectively. Unemployed people may be more likely than employed people to
visit physicians, take medications or be admitted to general hospitals. A possible association between unemployment and rates
of admission to psychiatric hospitals is complicated by other institutional and environmental factors. CONCLUSIONS: Evaluated
on an epidemiologic basis, the evidence suggests a strong, positive association between unemployment and many adverse health
outcomes. Whether unemployment causes these adverse outcomes is less straightforward, however, because there are likely many
mediating and confounding factors, which may be social, economic or clinical. Many authors have suggested mechanisms of
causation, but further research is needed to test these hypotheses.
Publication Types:
Review
Review Literature
PMID: 7641151 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7641151&dopt=Abstract
________________________________________________________________________
2) SOCIAL CLASS GRADIENTS: Definitely known from a number of sources/studies - & all{serious studies!} go to showing relation
of LOWER Social class(In a ?sociological/monetary sense ? that has overlaps with the Marxist-Leninist sense) = WORSE health: A
GOOD OVERVIEW:
Eur J Epidemiol 1998 Jul;14(5):457-63
Strong regional links between socio-economic background factors and disability and mortality in Oslo, Norway.
Rognerud MA, Kruger O, Gjertsen F, Thelle DS.
Centre for Preventive Medicine, Ullevaal Hospital, Oslo, Norway.
STUDY OBJECTIVE: To study geographical differences in mortality and disability and socio-economic status in Oslo, Norway.
SETTING: A total of 25 local authority districts within the city of Oslo. DESIGN: Analysis of age adjusted mortality rates
aged 0-74 in the period 1991-1994, and cross sectional data on disability pensioners aged 50-66 and socio-economic indicators
(low education, single parenthood, unemployment, high income) in 1994. MAIN OUTCOME MEASURES: The levels of correlation
between the health outcomes (mortality and disability) and socio-economic exposure variables. MAIN RESULTS: The geographical
patterns of mortality and disability display substantial similarities and show strong linear correlation with area measures of
socio-economic deprivation. The ratios between the highest and lowest area mortality rates were 3.3 for men and 2.1 for women,
while the high-low ratios of disability were 7.0 for men and 3.8 for women. For women deprivation measures are better
correlated with disability than mortality. While disability and mortality display similar correlations with deprivation
measures for men. CONCLUSIONS: The social gradients in health are substantial in Oslo. Further ecological analysis of cause
specific morbidity and mortality and the distribution of risk factors ought to be done to identify problem areas suitable for
interventions. However, to understand the mechanisms and the relative importance of each etiological factor, studies based on
individual data have to be performed.

PMID: 9744677 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9744677&dopt=Abstract

3) THE ?DEAN? OF STUDIES RELATING U/E TO ILL-HEALTH; Article that forms a good Overview:
1: Int J Health Serv 1983;13(4):563-620
Mortality and economic instability: detailed analyses for Britain and comparative analyses for selected industrialized
countries.
Brenner MH.
This paper discusses a first-stage analysis of the link of unemployment rates, as well as other economic, social and
environmental health risk factors, to mortality rates in postwar Britain. The results presented represent part of an
international study of the impact of economic change on mortality patterns in industrialized countries. The mortality patterns
examined include total and infant mortality and (by cause) cardiovascular (total), cerebrovascular and heart disease,
cirrhosis of the liver, and suicide, homicide and motor vehicle accidents. Among the most prominent factors that beneficially
influence postwar mortality patterns in England/Wales and Scotland are economic growth and stability and health service
availability. A principal detrimental factor to health is a high rate of unemployment. Additional factors that have an adverse
influence on mortality rates are cigarette consumption and heavy alcohol use and unusually cold winter temperatures
(especially in Scotland). The model of mortality that includes both economic changes and behavioral and environmental risk
factors was successfully applied to infant mortality rates in the interwar period. In addition, the "simple" economic change
model of mortality (using only economic indicators) was applied to other industrialized countries. In Canada, the United
States, the United Kingdom, and Sweden, the simple version of the economic change model could be successfully applied only if
the analysis was begun before World War II; for analysis beginning in the postwar era, the more sophisticated economic change
model, including behavioral and environmental risk factors, was required. In France, West Germany, Italy, and Spain, by
contrast, some success was achieved using the simple economic change model.
PMID: 6642812 [PubMed - indexed for MEDLINE] At:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6642812&dopt=Abstract
4) SEARCH ON BRENNER?S ARTICLES:
1: Brenner MH. Related Articles
Relation of economic change to Swedish health and social well-being, 1950-1980.
Soc Sci Med. 1987;25(2):183-95.
PMID: 3660009 [PubMed - indexed for MEDLINE]
2: Brenner MH. Related Articles
Mortality and economic instability: detailed analyses for Britain and comparative analyses for selected industrialized
countries.
Int J Health Serv. 1983;13(4):563-620.
PMID: 6642812 [PubMed - indexed for MEDLINE]
3: Brenner MH, Mooney A. Related Articles
Unemployment and health in the context of economic change.
Soc Sci Med. 1983;17(16):1125-38.
PMID: 6623119 [PubMed - indexed for MEDLINE]
4: Brenner MH, Mooney A. Related Articles
Economic change and sex-specific cardiovascular mortality in Britain 1955-1976.
Soc Sci Med. 1982;16(4):431-42.
PMID: 7079797 [PubMed - indexed for MEDLINE]
5: Brenner MH. Related Articles
Economic indicators as predictors of ill-health.
Lancet. 1981 Aug 1;2(8240):262. No abstract available.
PMID: 6114317 [PubMed - indexed for MEDLINE]
6: Brenner MH. Related Articles
Mortality and the national economy. A review, and the experience of England and Wales, 1936--76.
Lancet. 1979 Sep 15;2(8142):568-73. No abstract available.
PMID: 89569 [PubMed - indexed for MEDLINE]
7: Brenner MH. Related Articles
Health costs and benefits of economic policy.
Int J Health Serv. 1977;7(4):581-623. No abstract available.
PMID: 410738 [PubMed - indexed for MEDLINE]
8: Brenner MH. Related Articles
Economic changes and heart disease mortality.
Am J Public Health. 1971 Mar;61(3):606-11. No abstract available.
PMID: 5553649 [PubMed - indexed for MEDLINE]
5) FURTHER RECOGNITION OF THE GENERAL CONFOUNDING EFFECTS UPON SHOWING A DIRECT LINKAGE BETWEEN U/E & HEALTH: ie CHICKEN OR
EGG QUESTION? WHICH COMES FIRST? MENTAL ILL-HEALTH OR U/E???
1: Arch Gen Psychiatry 2002 Mar;59(3):225-31
Mental health, educational, and social role outcomes of adolescents with depression.

Fergusson DM, Woodward LJ.
Christchurch Health & Development Study, Christchurch School of Medicine, PO Box 4345, Christchurch, New Zealand.
david.fergusson@xxxxxxxxxxxx
BACKGROUND: This study used longitudinal data to examine the extent to which young people with depression in mid adolescence
(ages 14-16) were at increased risk of adverse psychosocial outcomes in later adolescence and young adulthood (ages 16-21).
METHODS: Data were gathered during a 21-year longitudinal study of a birth cohort of 1265 children. Measures included
assessments of DSM-III-R major depression (at age 14-16); psychiatric disorders, educational achievement, and social
functioning (at age 16-21); social, familial, and individual factors; and comorbid disorders. RESULTS: Thirteen percent of the
cohort developed depression between ages 14 and 16. Young people with depression in adolescence were at significantly (P<.05)
increased risk of later major depression, anxiety disorders, nicotine dependence, alcohol abuse or dependence, suicide
attempt, educational underachievement, unemployment, and early parenthood. These associations were similar for girls and boys.
The results suggested the presence of 2 major pathways linking early depression to later outcomes. First, there was a direct
linkage between early depression and increased risk of later major depression or anxiety disorders. Second, the associations
between early depression and other outcomes were explained by the presence of confounding social, familial, and individual
factors. CONCLUSIONS: Young people having early depression were at increased risk of later adverse psychosocial outcomes.
There was a direct linkage in which early depression was associated with increased risk of later major depression and anxiety
disorders. Linkages between early depression and other outcomes appeared to reflect the effects of confounding factors.
PMID: 11879160 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11879160&dopt=Abstract

6) EVEN REMARKABLY SHORT TERM EFFECTS OF U/E HAVE MEASURABLE EFFECTS:
BMJ 2001 Mar 17;322(7287):647-51
Employment status and health after privatisation in white collar civil servants: prospective cohort study.
Ferrie JE, Martikainen P, Shipley MJ, Marmot MG, Stansfeld SA, Smith GD.
International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical
School, London WC1E 6BT.
OBJECTIVES: To determine whether employment status after job loss due to privatisation influences health and use of health
services and whether financial strain, psychosocial measures, or health related behaviours can explain any findings. DESIGN:
Data collected before and 18 months after privatisation. SETTING: One department of the civil service that was sold to the
private sector. PARTICIPANTS: 666 employees during baseline screening in the department to be privatised. MAIN OUTCOME
MEASURES: Health and health service outcomes associated with insecure re-employment, permanent exit from paid employment, and
unemployment after privatisation compared with outcomes associated with secure re-employment. RESULTS: Insecure re-employment
and unemployment were associated with relative increases in minor psychiatric morbidity (mean difference 1.56 (95% confidence
intervals interval 1.0 to 2.2) and 1.25 (0.6 to 2.0) respectively) and having four or more consultations with a general
practitioner in the past year (odds ratio 2.04 (1.1 to 3.8) and 2.39 (1.2 to 4.7) respectively). Health outcomes for
respondents permanently out of paid employment closely resembled those in secure re-employment, except for a substantial
relative increase in longstanding illness (2.25; 1.1 to 4.4). Financial strain and change in psychosocial measures and health
related behaviours accounted for little of the observed associations. Adjustment for change in minor psychiatric morbidity
attenuated the association between insecure re-employment or unemployment and general practitioner consultations by 26% and
27%, respectively. CONCLUSIONS: Insecure re-employment and unemployment after privatisation result in increases in minor
psychiatric morbidity and consultations with a general practitioner, which are possibly due to the increased minor psychiatric
morbidity.
PMID: 11250849 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11250849&dopt=Abstract
____________________________END MESSAGE___________________________