What if the president fixed unemployment but it wasn't enough?

By Jonathan Purtle

Jobs jobs jobs. Both parties' national conventions were abuzz with talk of plans to address unemployment — 8.1 percent nationally in August, the government reported Friday (and certainly higher locally, where preliminary July rates were 9.1 percent for the Philadelphia metro area and 11.6 percent in the city). The importance of revitalizing the economy undoubtedly resonates with most Americans, for obvious reasons. Here's another: A vast body of public health research indicates that losing your job can mean losing your health.

And while creating new jobs, and well-paying ones at that, may solve unemployment, a new study published in the journal Social Science & Medicine raises questions about the potentially lingering health effects of the nation’s economic downturn.

In the fall of 2009, near the height of the great recession, researchers at Yale conducted the random door-to-door survey of households in New Haven, Conn. Seventy three percent of those approached completed the survey, yielding a study sample of over 1,200 people. Of them, 14.5 percent reported being unemployed and looking for work, 18.4 percent working part-time.

Compared to those who were working, unemployed respondents reported smoking more cigarettes, consuming more alcoholic beverages, eating unhealthy food with greater frequency and healthy food less often; they exercised less, too. Interestingly, a pattern also emerged along the lines of un/full/part-time employment — with those working part time faring better on certain health behaviors than the unemployed, but worse than those who had full-time jobs.

The researchers also collected information on stress and depression to better understand how these variables might mediate, or explain, the correlation between employment status and health behaviors. In addition to finding that unemployed respondents had significantly higher levels of stress and more symptoms of depression than their employed counterparts, the researchers discovered that stress directly increased the level of unhealthy eating, physical inactivity, cigarette smoking, and alcohol consumption — providing some indication that the psychological stresses associated with unemployment leads people to engage in unhealthy behaviors that help them cope.

The Social Science & Medicine article presents the results of one survey conducted in one city at a single point in time. So it’s not clear if respondents’ health behaviors changed after they became un/under employed. The study also didn’t collect information on possible confounding variables that could be associated with unemployment and health behaviors — characteristics of the physical ("built") and food environments in respondents’ neighborhoods, for example, or other sources of stress, such as community violence. Despite these limitations, the findings are consistent with the larger body of research on stress and coping, and shed light on a new dimension of America’s employment and public health crises. And they should raise challenging questions for both politicians and public health professionals.

For one, Republicans might want to reconsider their pledge to repeal President Obama's health-system overhaul, the Affordable Care Act, if Romney is elected. A major flaw in the current design of our employer-based health care system is that it cuts out on people when their needs are greatest. Unemployment is a time when people most benefit from primary care and mental health services. Denying access to preventive services at such a critical juncture is a great recipe for increasing the incidence of costly chronic diseases — and, incidentally, the cost of uncompensated care that ends up being shouldered by taxpayers.

Public health officials should more consistently think of unemployment as a risk factor for adverse health outcomes. They should direct resources — such as interventions to increase physical activity and reduce stress — to the communities most affected.

With rates of unemployment seemingly stuck on high, we need to protect the psychological well-being, and health, of those who are still without work. If not, we risk an unpleasant scenario that you probably never heard mentioned at the Democratic or Republican conventions: the domestic economy might rebound, but the population's health might not.

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