The Body Economic (35 page)

28
. F. Ponsar, K. Tayler-Smith, M. Philips, S. Gerard, M. Van Herp, T. Reid, R. Zachariah, “No Cash, No Care: How User Fees Endanger Health—Lessons Learnt Regarding Financial Barriers to Healthcare Services in Burundi, Sierra Leone, Democratic Republic of Congo, Chad, Haiti and Mali,”
International Health,
2011. Available at:
http://fieldresearch.msf.org/msf/bitstream/10144/203642/1/Ponsar%20No%20cash,%20No%20care.pdf

29
. D. Stuckler, A. Feigl, S. Basu, M. McKee. “The Political Economy of Universal Health Coverage.” First Global Symposium on Heath Systems Research, 2009. Available at:
http://www.pacifichealthsummit.org/downloads/UHC/the%20political%20economy%20of%20uhc.PDF

Chapter 7: Returning to Work

1
. B. Wedeman, “Death and Taxes in Italy,” CNN, Sept 9, 2010. Available at:
http://edition.cnn.com/2012/09/10/business/italy-economy-suicide/index.html
; A. Vogt, “Widows of Italian Suicide Victims Make Protest March Against Economic Strife.” The
Guardian
, 2012. Available at:
http://www.guardian.co.uk/world/2012/may/04/widows-italian-businessmen-march

2
. “May Day: Italy's ‘White Widows' Give Private Pain a Public Face.” Available at:
http://thefreelancedesk.com/?p=543
; A. Vogt, “Italian Women Whose Husbands Killed Themselves in Recession Stage March,” The
Guardian,
April 30, 2012. Available at:
http://www.guardian.co.uk/world/2012/apr/30/italian-women-husbands-recession-march

3
. K. N. Fountoulakis, et al., “Economic Crisis-Related Increased Suicidality in Greece and Italy: A Premature Overinterpretation,”
Journal of Epidemiology and Community Health,
March 12, 2012. Available at:
http://jech.bmj.com/content/early/2012/12/03/jech-2012-201902.full.pdf+html
; to which we responded in R. De Vogli, M. Marmot, D. Stuckler. 2012. “Strong Evidence That the Economic Crisis Caused a Rise in Suicides in Europe: The Need for Social Protection.”
Journal of Epidemiology and Community Health
. Available at:
http://jech.bmj.com/content/early/2013/01/14/jech-2012-202112

4
. “In Debt or Jobless, Many Italians Choose Suicide,” NBC News, May 9, 2012. Available at:
http://worldblog.nbcnews.com/_news/2012/05/09/11621840-in-debt-or-jobless-many-italians-choose-suicide?lite

5
. Looking at data disaggregated by state from the US Centers for Disease Control and Prevention, we found that increases in state suicide rates corresponded in timing and size to the changes in each state's unemployment rate.

6
. Source for Figure 7.1: Authors'. Adapted from R. De Vogli, M. Marmot, D. Stuckler. 2012. “Excess Suicides and Attempted Suicides in Italy Attributable to the Great Recession,”
Journal of Epidemiology & Community Health.
doi: 10.1136/jech-2012-201607.

7
. G. Lewis and A. Sloggett. 1998. “Suicide, Deprivation, and Unemployment; Record Linkage Study,”
British Medical Journal
v317:1283. Available at:
http://www.bmj.com/content/317/7168/1283

8
. Source for Figure 7.2: Adapted from A. Reeves, D. Stuckler, M. McKee, D. Gunnell, S. Chang, S. Basu. November 2012. “Increase in State Suicide Rates in the USA During Economic Recession,” The
Lancet
v380(9856): 1813–14.

9
. The leading advocate of this theory was Professor Hugh Gravelle, who argued that people were not sick because they were unemployed, but unemployed because they were sick. Professor Mel Bartley, a social epidemiologist, criticized Gravelle's logic in the
BMJ
: Where, Bartley asked, was the sudden massive epidemic that preceded the rise in unemployment by 3 million people? He noted, “we really cannot plausibly argue that an increase in the incidence of mental ill health or alcoholism could cause an increase in unemployment at the level of a national population.”

K. Moser, P. Goldblatt, A. Fox, et al. 1987. “Unemployment and Mortality: Comparison of the 1971 and 1981 Longitudinal Study Census Samples,”
British Medical Journal
v294
:
86–90.

For suicide risk, see Lewis and Sloggett, “Suicide, Deprivation, and Unemployment; Record Linkage Study”; T. Blakely, S. C. D. Collings, J. Atkinson, “Unemployment and Suicide: Evidence for a Causal Association?”
Journal of Epidemiology & Community Health
v57(8): 594–600.

Montgomery and colleagues found that unemployment predated symptoms of depression and anxiety. See S. Montgomery, D. Cook, M. Bartley, et al. 1999. “Unemployment Pre-dates Symptoms of Depression and Anxiety Resulting in Medical Consultation in Young Men,”
Int J Epidemiol
v28
:
95–100.

10
. In 1994 Professor Mel Bartley later explained in the
Journal of Epidemiology and Community Health
: “It is no longer seriously argued that there is no such relationship [between unemployment and illness]. Lower levels of psychological well-being are found in all studies which compared unemployed people, at all ages and in both sexes. More persuasively, these differences in mental health have been shown to emerge after entry into the labor market in young people showing no such differences while still at school. Mental health improves when young people find jobs.” Available at:
http://jech.bmj.com/content/48/4/333.full.pdf
. Women report higher rates of depression, but men are about three times as likely as women to experience suicide. The reasons are multiple, but are in part because women are more likely to seek help.

R. Davis, “Antidepressant Use Rises as Recession Feeds Wave of Worry,” The
Guardian
, June 11, 2010. Available at:
http://www.guardian.co.uk/society/2010/jun/11/antidepressant-prescriptions-rise-nhs-recession

11
. “Workers Turn to Antidepressants as Recession Takes Its Toll,”
Mind,
May 17, 2010. Available at:
http://www.mind.org.uk/news/3372_workers_turn_to_antidepressants_as_recession_takes_its_toll

The
Telegraph
reported an even larger rise of 7 million prescriptions during the recession. See Martin Evans, “Recession Linked to Huge Rise in Use of Antidepressants,”
Telegraph,
April 7, 2011. Available at:
http://www.telegraph.co.uk/health/8434106/Recession-linked-to-huge-rise-in-use-of-antidepressants.html

12
. Unemployment was also correlated with rising prescriptions for pain medicines and stomach ulcers. F. Jespersen and M. Tirrell, “Stress-Medication Sales Hold Up as Economy Gives Heartburn to U.S. Jobless,”
Bloomberg
, Dec 27, 2011. Available at:
http://www.bloomberg.com/news/2011-12-27/stress-medications-holding-up-through-economic-doldrums-study-suggests.html

13
. Consistent with existing research, our further evidence found that fear of unemployment—economic insecurity—could be as harmful to mental health as actual job loss.

14
. We found this applied not only to the individual but also whether any member of the family had recently lost work. M. Gili, M. Roca, S. Basu, M. McKee, D. Stuckler. 2012. “The Mental Health Risks of Economic Crisis in Spain: Evidence from Primary Care Centres, 2006 and 2010,”
European Journal of Public Health
v23(1): 103–8. Available at:
http://eurpub.oxfordjournals.org/content/23/1/103
. We also found eviction was a major risk factor for mental health diagnoses.

15
. The OECD defines ALMPs as follows: “First, they make receipt of benefits conditional on the benefit recipient demonstrating active job search and/or a willingness to take steps to improve employability. Second, they provide a range of pre-employment services and advice to help the individuals in question find work or get ready for work.” For a distribution of passive versus active labor market policies, see J. P. Martin, “What Works Among Active Labour Market Policies: Evidence from OECD Countries' Experiences.” Available at:
http://www.rba.gov.au/publications/confs/1998/martin.pdf

16
. J. Vuori and J. Silvonen, et al. 2002. “The Tyohon Job Search Program in Finland: Benefits for the Unemployed with Risk of Depression or Discouragement,”
J Occup Health Psychol
v7(1): 5–19; J. Vuori and J Silvonen. 2005. “The Benefits of a Preventive Job Search Program on Re-employment and Mental Health at 2- year Follow-up,”
Journal of Occupational and Organization al Psychology
v78(1): 43–52. The specific Työhön program included the following components: The program paired a job-search trainer with newly unemployed people. The trainer worked five half-day sessions to help place unemployed people into the job search databases, and improve their skills—interviewing techniques, how to find jobs through social networks, how to assemble resumes and job applications—to overcome common setbacks and prevent the slump of chronic unemployment. The ALMPs also featured encouragement to take even part-time work or help gain job-training to switch to other types of work. Financial support was also a component of ALMP programs, but funds were provided only to those who participated in the part of the program that also helped them get back to work. Those participating in the program also found better-quality jobs, with the greatest benefits observed among those who had lost jobs within the past few years. Similar evidence that ALMPs helped prevent depression came from studies in the United States.

A. Vinokur, R. Price, and Y. Schul. 1995. “Impact of the JOBS Intervention on Unemployed Workers Varying in Risk for Depression,”
American Journal of Community Psychology
v23(1): 39–74; A. Vinokur, et al. 2000. “Two Years After a Job Loss: Long-term Impact of the JOBS Program on Reemployment and Mental Health,”
J Occup
Health Psychol
v5(1): 32–47. ALMP strategies were tested at Michigan's Prevention Research Center. The Michigan researchers introduced a JOBS workshop program in which 1,801 participants were randomly assigned to a job-search intervention or to a control group. This was the equivalent of a laboratory study, but done in the real world. It found that within two years, those who received job-search support were more likely to be working again, had higher monthly earnings, and lower risks of depression. Further research found that these persons were not simply jumping the queue to find jobs; ALMPs were helping to increase overall employment rates across countries.

17
. Another way was that ALMPs help promote full employment. Some ALMPs had a component to work with firms to help them retain workers instead of making them redundant. This would help prevent a recession from leading firms to shed more jobs, so that fewer people were put in the risky situation of unemployment in the first place. As the World Bank defines them, “ALMPs have two basic objectives: (i) economic, by increasing the probability of the unemployed finding jobs, productivity and earnings; and (ii) social, by improving inclusion and participation associated with productive employment. As a consequence, they can contribute to increased employment opportunities and address the social problems that often accompany high unemployment.”

18
. OECD Database on Social Expenditure. Available at:
http://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&ved=0CDoQFjAB&url=http%3A%2F%2Fstats.oecd.org%2Ffileview2.aspx%3FIDFile%3D91c26892-ed0b-41f6-bf61-fd46e39a40e8&ei=gZMOUc2JJqnD0QX75oCgDA&usg=AFQjCNG–faugVqOyVi1uaA1OX_9ZlYwMQ&sig2= qOCNRgH_F7x2unphGfzd8w&bvm=bv.41867550,d.d2k
;
http://www.oecd.org/els/employmentpoliciesanddata/36780874.pdf

19
. L. Jonung and T. Hagberg, “How Costly Was the Crisis of the 1990s? A Comparative Analysis of the Deepest Crises in Finland and Sweden over the Last 130 Years,”
European Commission. Economic Papers,
2005. Available at:
http://ec.europa.eu/economy_finance/publications/publication692_en.pdf

See also L. Jonung, “The Swedish Model for Resolving the Banking Crisis of 1991–93. Seven Reasons Why It Was Successful.” Available at:
http://ec.europa.eu/economy_finance/publications/publication14098_en.pdf

20
. OECD Social Expenditure Database 2008 edition.

21
. Source for Figure 7.3: D. Stuckler S. Basu M. Suhrcke, A. Coutts, M. McKee. 2009. “The Public Health Impact of Economic Crises and Alternative Policy Responses in Europe,” The
Lancet
v374:315–23.

22
. Source for Figure 7.4: Stuckler, et al. “The Public Health Impact of Economic Crises and Alternative Policy Responses in Europe.”

23
. Jonung and Haberg, “How Costly Was the Crisis of the 1990s?

24
. Our colleague, the medical doctor Sir Michael Marmot, had already warned UK policymakers in 2011 that the “scale of youth unemployment was a public health emergency.” See Michael Marmot. 2011. “Scale of Youth Unemployment Is a Public Health
Emergency, Marmot Says,”
British Medical Journal
. Available at:
http://www.bmj.com/content/343/bmj.d7608?tab=related

25
. For a version that is at the time of this writing available online, see “Recession and Unemployment Could Be Blamed for 1,000 More Suicides,”
London Evening Standard
, 2012. Available at:
http://www.standard.co.uk/news/health/recession-and-unemployment-could-be-blamed-for-1000-more-suicides-8049459.html

26
. Cited in B. Barr, D. Taylor-Robinson, A. Scott-Samuel, M. McKee, D. Stuckler. 2012. “Suicides Associated With the 2008–10 Economic Recession in En gland: A Time-Trend Analysis,”
British Medical Journal
v345:e5142. Available at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419273/