Can ill health in the economy make us unwell?

MEDICAL MATTERS: Historically, recession has been shown to be bad for human health

WILL THE sharp economic downturn affect your health? With a prolonged recession likely to follow the collapse of world financial markets, should you be worried about your health as well as your wallet?

The most dramatic effect of falling share values and bankruptcy is reflected in the iconic images associated with the Wall Street Crash of 1929. Pictures of bankers and stockbrokers jumping from office blocks illustrate the severe mental stress brought about by a sudden downturn.

For those of us in salaried jobs, a more realistic threat is that of rising unemployment. There is a wealth of evidence linking poor health to unemployment.

Several UK studies from the 1970s and 1980s show the unemployed tend to have much poorer health than those in work. The British Regional Heart Study reported high death rates among unemployed men, while the OPCS longitudinal study found especially high levels of lung cancer, suicide, accidents and heart disease among the unemployed.

A Scottish study found that the risk of attempted suicide increased sharply with the length of time the person was unemployed. The evidence that unemployment causes deterioration in mental health is strong.

People moving in and out of work show a decline in psychological health on becoming unemployed, with an improvement in mental health when the person finds work again.

The children of the unemployed have also been shown to experience poorer health. Children in deprived districts of Glasgow were nine times more likely to be admitted to hospital than children in more affluent areas.

And a 1981 study of births in Dublin found a greater number of low birth weight babies were born to unemployed fathers compared with the children of fathers who were at work.

As with much health research, the results can be interpreted in different ways. Are people who are in poor health more likely to become unemployed, or does the experience of unemployment have an adverse effect on health?

Some research actually points to the possibility that an economic downturn can have a beneficial effect on health. One economic study analysed death rates and compared the data with jobless rates in the US from 1972 to 1991.

It found death rates dropped during the 1974 and 1982 recessions, but increased alongside the economic recovery of the 1980s. The researchers identified a drop in heart disease and road accidents as the main drivers of lower death rates. But cancer deaths rose 23 per cent during the recession years with suicides up 2 per cent.

The Celtic Tiger years were associated with work-related time pressures. As a result, people had less time to look after themselves and were more likely to eat poorly and not exercise. In theory, with more time on their hands, you would expect these trends to reverse.

Proponents of the time-poverty theory argue that children of time-rich adults get looked after better during a downturn. That may apply to double-income families where one parent loses a job but is hardly relevant in the catastrophic scenario of losing the family home and not having enough money to buy nutritious food. A recent Dutch study suggests babies in poorer households do worst in a recession because of reduced access to healthcare.

Perhaps one of the best pieces of research in this field was carried out in a general practice in England in the 1980s. Doctors traced the health of workers from a local meat factory over an eight-year period.

They found a significant increase in GP consultation rates and hospital referrals after workers were made redundant. Interestingly, the decline in health was evident two years prior to job loss and could be linked to the exact time when the threat of redundancy became apparent.

In a separate study, middle-aged men who experienced unemployment in the five years after initial screening were twice as likely to die during the next five years compared with men who remained continually employed. Most of the additional deaths were due to cancer and cardiovascular disease.

Many people are suffering economically following the Celtic Tiger's ill health and subsequent demise. Unfortunately, the effects may not be confined to the health of economy. Recession may also be bad for your personal health.

• Dr Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he is unable to reply to individual medical queries