Study finds job programs protect public health during periods of recession

A rapid rise in unemployment can be linked to an increase in suicides, homicides, and alcohol abuse, but job programs can successfully mitigate these rates, according to a new study reported in the “Lancet” medical journal.

Study findings, published in the July 8, 2009 online issue, show that a rise of 3 percent in unemployment is associated with a 4.5 percent increase in suicides and a 28 percent increase in deaths from alcohol abuse in the population younger than age 65. Each percent increase in unemployment raised suicide rates by 0.8 percent and homicide rates by 0.8 percent, but a key government program may be effective at preventing these deaths, according to the research team.

The study was conducted by researchers at the University of California, San Francisco; University of Oxford, and London School of Hygiene and Tropical Medicine.

Because of widespread concern that the present economic crisis, particularly its effect on unemployment, will adversely affect population health, the research team investigated how economic changes have affected mortality rates over the past three decades in European Union countries. The team also identified government actions that could modify the health effects of economic stability, reporting all the findings in a paper titled “The public health effect of economic crisis and alternative policy responses in Europe: an empirical analysis.”

“Financial crisis causes economic hardship for many people, but it does not have to cost them their lives. Our data suggests that investments in job creation and retention programs may be key to preventing a rise in deaths during recession,” said study co-author Sanjay Basu, MD, PhD, a resident physician in the Department of Medicine at the University of California, San Francisco and San Francisco General Hospital Medical Center.

The research team found that if a government spent above $190 per person per year in “active labor market programs” — programs that help unemployed people quickly enter new jobs or retain work — then a mass rise in unemployment would be unlikely to increase mortality rates. These active labor programs were more effective at protecting public health during recessions than many current alternative government proposals, such as hospitalization programs or pension adjustments, the researchers noted.

Using data from WHO and the International Labour Organization, the researchers analysed more than 50 causes of death in 26 EU countries between 1970 and 2007 and compared the results to unemployment data. They also examined the different levels of government social spending during the same period, taking into account other factors that might affect rising death rates, such as population aging and the different ways that countries monitor employment rates and causes of death.

The stress of recessions, particularly of unemployment, seemed to markedly increase rates of death from intentional violence, with women particularly affected by homicide and men by suicide, according to study results.

The U.K. government spends about $150 per head per year on active labor market programs, and the U.S. spends about half of that. Researchers estimate that rising unemployment would result in 300 to 3800 additional suicides as a direct result of the financial crisis.

The study draws on a larger range of countries than in other previous studies, which offer mixed results due to lack of statistical control for differences in environments of risk and healthcare benefits between countries, according to the research team.

In Sweden, a previous study showed no effect of financial crises on health, but in Spain and the U.S., some negative effects and some cases of improved health were found. According to this research, the varying levels of government investment in social support and efforts to bolster the labor market can largely explain the mixed picture across the different countries.

“Suicides are just the tip of the iceberg” said lead author David Stuckler, PhD, of the University of Oxford and London School of Hygiene and Tropical Medicine. “Rising suicide rates are a sign of many failed suicide attempts and high levels of mental distress among workers and families.”

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