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Unemployment makes you sick

An interesting study published in The European Journal of Public Health recently November 2014) – Length of unemployment and health related outcomes: A life course analysis – provides fairly unambiguous evidence that the changes in labour markets under neo-liberalism towards higher entrenched unemployment rates, increased casualisation of work, the lockout of graduates and the widespread deskilling of the workforce are eroding the health outcomes of the population. While most studies of the link between unemployment and health have focused on cohorts that endure continuous long-term joblessness (unbroken spells exceeding 12 months), this study is novel because it studies whether accumulated spells of shorter-term unemployment over a person’s lifetime are detrimental to their health. The reason that is relevant is because under neo-liberalism, many individuals are forced to eke out an existence in low paid jobs interspersed with spells of unemployment. The evidence in the former case (continuous) long-term unemployment is clear – unemployment makes the person sick and they get sicker the longer they are unemployment (both physically and mentally). The new study shows that long-term unemployment generated over a person’s life through a series of accumulated spells of shorter-term unemployment also is bad for public health and well-being. It means that the emphasis on austerity which causes cyclical effects to be worse (entrenched mass unemployment) is bad but also the main structural bias in growth periods towards casualised, precarious work is also bad for our health.

The authors are Urban Janlert from Umeå University, Anthony H. Winefield from University of South Australia, Anne Hammarström from University of Adelaide.

This is a study in the field of “Life-course epidemiology”, which according the authors “has emerged within the research on the development of social inequalities in health”.

Lifecourse Epidemiology:

… is the study of antecedent exposures and later health outcomes, taking into account the pathways between the two and the evolution of health and disorders over time.

Which means that things that can happen earlier in life have health effects later in the life that might not have been obvious when the events occurred.

According to this article from the Journal of Epidemiology and Community Health (Vol 57, Issue 10, published 2003) – Life course epidemiology – this research area combines a range of health and social science disciplines (epidemiology, psychology, demography, anthropology, biology), and is:

… the study of long term effects on later health or disease risk of physical or social exposures during gestation, childhood, adolescence, young adulthood and later adult life … The aim is to elucidate biological, behavioural, and psychosocial processes that operate across an individual’s life course, or across generations, to influence the development of disease risk …

Life course epidemiology attempts to integrate biological and social risk processes rather than draw false dichotomies between them …

Life course epidemiology studies how socially patterned exposures during childhood, adolescence, and early adult life influence adult disease risk and socioeconomic position, and hence may account for social inequalities in adult health and mortality. Socioeconomic factors at different life stages may operate either via social chains of risk or by influencing exposures to causal factors at earlier life stages that form part of long term biological or psychological chains of risk. Differential health effects according to the timing or duration of exposure to socioeconomic circumstances may provide important clues to aetiology …

The idea is that individuals accumulate disease risk (both physical and mental) as they encounter damaging events in their lives.

So these studies try to assess the “extent of cumulative damage to biological systems as the number, duration or severity of exposures increase, as as body systems age and become less able to repair damage”.

The Swedish-Australian study notes there are three models of life-course epidemiology:

… critical periods, accumulation and pathways.

The “accumulation model” has proven to have the best “predictive power, aetiological insights and social policy implications”.

It is in this context that they analyse:

… how the accumulation of unemployment over time might influence health outcomes.

While a lot of research about the health impacts of unemployment have focused on the long-term unemployed (typically defined as a continuous spell of joblessness of 12 months or more), this study, consistent with the accumulation hypothesis within life-cycle epidemiology, notes that:

… even if the disparate unemployment periods are limited in time, many such periods (interrupted by casual work, labour market measures, studies etc.) can add up to a considerable time of temporary or insecure labour market positions. While the health consequences of short-term unemployment have been increasingly studied and are well-established for both men and women a question that remains unanswered is whether the accumulation of unemployment will have health effects on individuals.

That is their research brief and lead to two questions being posed:

1. “Will increasing accumulation of unemployment be followed by a deterioration in health, or will there develop a steady-state situation after sometime or will the association diminish over time?”

2. “Will repeated exposure lead to some sort of immunity or not?”

The study was “based on a cohort study of all 1083 pupils who, in 1981, attended or should have attended the last year of compulsory school (age 16) in a medium-sized industrial town in the north of Sweden.”

I will leave it to you to familiarise yourself with the research design and the techniques deployed. In my view the study is sound in methodological terms.

They followed the cohort at the ages of 18, 21 and 30 and accumulated information regarding health status and labour market status. This allowed them to derive an estimate of the months of cumulative unemployment endured by summing all the spells of unemployment the person endured in the period between questionnaires.

The following graph (Figure 1 in the paper) shows the male and female cumulative unemployment in months from the sample of 1083 pupils.

The Paper notes that under Swedish law, a person who has been unemployed for 12 months (6 months for those under 19 years of age), is forced into “some sort of labour market arrangement for at least half a year” (pointless training etc).

This means that a person with a accumulated 4.5 years (54 months) of accumulated unemployment must have had at least “at least five unemployment periods, interrupted by these labour market programmes or other work opportunities.”

So there were a significant number of people in the sample who had been churned through these sequences and had endured long cumulated unemployment spells.

Sweden_Lifecourse_Unemployment_Cohort

The health variables assessed were:

1. “Poor self-assessed health” – that is, did the person think they were sick.

2. “Somatic symptons” – that is, was the person sick in the last 12 months.

3. “Depressive symptoms” – that is, was the person sad or depressed.

4. “Visiting a physician” – in the last 12 months.

5. “Daily smoking”.

6. “High alcohol consumption” – measured in decilitres of pure alcohol. Above average consumption was considered “high”.

Table 1 in the study (Reproduced below) shows the “prevalence of health status and behaviour for men and women at 30 years of age” in percent of total sample.

Sweden_Unemployment_Cohort_Health_Stats

They used these health variables as ‘dependent variables’ (that is, to be explained) in models using the “repeated logistic regression procedure with the accumulated unemployment as the independent variable”. The independent variable is assumed to causally explain variation in the dependent variable.

Control variables were use to isolate variations in the dependent variable in each equation that might be caused by other factors – for example, gender.

There are three hypothesised outcomes:

1. “the traditional dose-response” effect – “the longer the unemployment, the more of the health-related outcome”

2. “a steady-state outcome—after a certain level of effect additional unemployment will not add anything more”.

3. “after a maximum is reached more unemployment will result in a lower value of the effect variable, or ‘adaptation’ to the unemployed role.”

They also acknowledge that “possible ‘threshold’ situations” could occur in any of these hypothesised patterns so that a “minimum requirement of unemployment duration before any effect can be expected”.

The authors did not study the reverse causality where “impaired health could be the ground for unemployment”.

The findings were:

1. With respect to health status, the authors found that for “self-assessed health, somatic symptoms and depression … women showed a … dose–response” pattern “… indicating a mainly positive correlation between health outcome and duration of unemployment. For men, self assessed and somatic symptoms tended to follow the adaptation pattern, i.e. after an initial increase of health problems, there is a decrease as unemployment duration increases. For depression, however, there seems to develop a steady-state situation”.

2. With respect to “health behaviour (visiting a physician, smoking and high alcohol consumption)”, the authors found that “men who showed the dose–response pattern, while the women showed more of the adaptation.”

Their main conclusion was that the results show a statistically significant:

… negative or steady-state relationship between accumulation of unemployment during a 14-year period and different health-related outcomes.

The reason this study is important is that the focus of this type of research has mostly been on the impacts of continuous spells of long-term unemployment. Those studies are categorical – those who endure such long-term unemployment exhibit inferior health outcomes to those who do not.

But this study took a different approach to the concept of long-term unemployment – seeking to see whether separate spells of unemployment which accumulated into long-term unemployment over a person’s life also caused poor health outcomes.

This is relevant to the neo-liberal era where labour markets have become fractionalised and underemployment is a large a problem in many nations as is unemployment.

Some researchers are now studying the dichotomy between “adequate and inadequate employment” rather than between employment and unemployment, given that to be classified as employed under the ILO standards used by most national statistical agencies, a person only has to work 1 or more hours in the reference (survey) week.

And neo-liberalism has created a bias away from full-time hours for many workers, an increasing number of which signal they desire more hours but cannot find the extra work.

Not only has neo-liberal economic policy such as austerity rationed the number of jobs but it also rations the number of working hours available.

Remember that the study was based on a sample who were 16 years of age in 1981 (when Swedish unemployment was relatively low) and then followed them until 1995.

So the unemployment experience in this sample is largely due to cycling between casualised jobs and unemployment rather than entrenched mass unemployment due to a major recession, although the 1991 recession is included in their sample and they say that “It cannot be ruled out that some of the cumulated unemployment relate more to the recession period from 1991 an onwards, but in most cases the unemployment load is well correlated over time”.

The findings that there is “no general adaptation to increasing unemployment load when it comes to health and health behaviour” is important because it relates not only to mass entrenched long-term unemployment but unemployment that comes from job instability during periods of growth where a bias emerges towards the creation of de-skilled, casualised and precarious jobs.

So the findings suggest that neo-liberalism – both in its cyclical and structural impacts – is bad for our health and well-being.

The research also is relevant for spurious claims made by mainstream economists that precarious and low-paid casual and part-time work provides a ‘stepping stone’ to better things so does not constitute a policy problem.

Some of my own research (with Dr Riccardo Welters from James Cook University) has focused on the validity of the ‘stepping stone’ hypothesis.

The mainstream argument posits that:

1. Casual (part-time) employment provides work experience which enhances human capital formation while unemployment leads to skill atrophy.

2. Casually employed workers signal their ability and willingness to accept work by accepting casual employment.

3. (Casual) employment enlarges the social network of job seekers, which in turn, provides valuable linkages to a wider knowledge of job vacancies.

These so-called advantages are then used to justify the claim that job seekers have a higher probability of gaining a non-casual job if they are first in casual employment rather than from a state of unemployment.

In our own work, we sought to investigate the proposition that casual work acts as a stepping stone to more secure work.

Some of the mainstream research used to substantiate the stepping stone argument does not exclude students who combine school/study and casual work. This biases the results in favour of the stepping stone argument. Why? Because students who engage in casual work to support them while studying and then upon graduation enter a professional occupation are not representative examples.

The sucessful transition from casual work to full-time work has nothing to do with the casual work experience. The casual work has nothing much to do with the skills they subsequently garner in their professional capacity which requires only a university qualification for entry. Further, the casual employment undertaken typically bears no relationship to the industry or occupation that they enter after finishing their studies.

So in research studies, one must always exclude this cohort.

Some conclusions we have reached:

First, we consider the predictions from Dual Labour Market theory – or Segmented Labour Market theory to be a reasonable description of the structure of labour markets in most countries.

SLM theory argues that the labour market is segmented into two separate labour markets each with different processes for allocation and reward. These segments resist transitions from each other.

The most basic demarcation is between the Primary Labour Market (PLM) and the Secondary Labour Market (SLM). PLM workers are typically employed in a tight internal labour market structure which provides for career advancement and tend to search for jobs within the firm while already employed. The jobs are secure and relatively well-paid.

The SLM is characterised by low-paid, insecure ‘dead-end’ jobs which have high turnover rates. The jobs do not have well-defined career ladders and offer very little training for higher productivity.

While the PLM worker searches for new ways in which to climb the career ladder, the SLM worker usually searches to avoid being sacked.

Given the lack of mobility between the ‘segments’, a SLM worker will typically not make the transition into the PLM. Workers thus become “trapped” in poor jobs with spells of unemployment intervening periods of low paid work.

Our research shows that casually employed workers find it harder to transit to non-casual employment in Australia if they start their working life in the secondary labour market – that is, if they are working in low skill occupations.

Second, we have found that casually employed workers find it easier to move into non-casual employment if they are employed in large firms rather than small firms. The reason is that the large firms provide exposure to a broader and deeper social network.

Third, the longer a person is in casual employment the harder it gets to exit that state. This is called “duration dependence” in the literature. The evidence suggests that any period beyond three years triggers this constraint and traps the worker into a circle of precarious casual work with intervening periods of joblessness.

An important part of this research is that the transition probabilities are not exclusively defined by the individual characteristics of the worker, which is usually assumed by the mainstream paradigm.

That is, they consider individuals make choices to invest in skills and then their destiny is in their own hands. The evidence clearly rejects that idea and indicates that ‘environmental’ factors – which are beyond a worker’s control are very important.

Please read my blog – Casual work traps workers into low-pay and precarious jobs – for more discussion on this point.

So being locked into precarious employment not only undermines the future job prospects of an individual (our research), it also, by dint of the characteristics of this type of work (regular spells of unemployment interspersed), undermines the health and well-being of the person (the research I discussed earlier).

This also bears on the current labour market policy structures that dominate in this austerity age. The so-called structural activation policies all assume the individual is to blame in some way for their poor labour market outcomes – either through poor attitude (laziness etc) or poor skills.

They consider forcing an individual into precarious work and/or short-term training programs interspersed with unemployment is a virtue.

In Australia, the current conservative government will introduce its so-called – jobactive – model for employment services on July 1, 2015.

It will replace the failed Job Services Australia framework. The new scheme is pernicious and will fail like the last because it doesn’t address the cause of the unemployment problem – a lack of jobs.

Instead, it punishes the unemployed by imposing ridiculous requirements on them in return for the receipt of income support which is below the accepted poverty line.

A person will have to apply for at least 20 jobs a month when there is a clear (and massive) job shortage.

The person will have to engage in temporary short-term jobs (Work for the Dole) at below the legal minimum wage or lose income support.

The private service providers will be paid an incentive payment if they place persons in jobs that are of a 4-week duration.

When the Prime Minister announced the scheme on March 31, 2015 he said (Source):

We know there are a lot of short-term jobs available, particularly in regional Australia, there are jobs that are seasonal and these are often the start of someone’s renewed connection with the labour market … [short-term work was] … the best possible stepping stone into secure long-term jobs … The best preparation for work is work …

The research I pointed to today and my own work indicates that this sort of compulsion will not only fail to act as a ‘stepping stone’ but will also be detrimental to the person’s health.

It is clear that a rising number of jobs available in the Australian labour market are inferior – short-term, precarious, and poorly paid. Individuals who take them are also cycling between work and unemployment.

While unemployed they are harassed by the Job Service providers acting acting as the agents of the Government. The Government seeks all avenues to punish any behaviour that is outside their ridiculous guidelines (quota of job applications etc).

Conclusion

It is clear that we are leaving a massive burden for our kids and the future generations. And that burden has nothing to do with the public debt ratio.

It has everything to do with the health and well-being – both physical and mental of our future adults brought on by their scarred experiences with unemployment as youth and young adults.

That is enough for today!

(c) Copyright 2015 William Mitchell. All Rights Reserved.

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    This Post Has 7 Comments
    1. A very interesting study. Unfortunately the full paper is gated. Out of interest, did they look at changes in physical activity patterns in the unemployed? Scandinavians are typically very active, and I wondered whether that changes in the unemployed. Exercise is thought to have a positive influence on depression and chronic stress.

    2. Good read Bill- interesting. Short term, precarious and poorly paid very true. All the bull about staying in work for longer and whatever game they will play with super makes you feel like giving up when you cant pull a job. Even the ones I put in for were pulled through lack of funding. The job providers just make things worse offering little in the way of help given the nature of psychological grief anomie and depression especially in the young. Luckily am old jaded and care less about their wasteful schemes offering consultants fees for shamelessly wasteful ‘training programs’.
      But after over 12 mths I finally landed s permanent job 2 weeks ago….wish me luck!
      Thanks for the break from the heavier economics…would like to know what you have to say about the JP Morgan ‘suicides’ though..

    3. I wasted much of my youth working in the lower levels of a American multinational and it made me sick ….to the pit of my stomach.
      In particular the corrupt interaction between the union and those other corporate bastards.

      I obviously disagree with this war economy view of the world.
      In primitive societies the women generally do housework while the men hunt.
      In between there is a mass of spare time to talk shit.

      In film John Boormans “The Emerald Forest” got closest to this previous reality.
      However our world view is corrupted by the rise of agricultural surplus production which was heavy in carbohydrate rather then protein which made constant hard work possible as the war lords of the bronze age and beyond concentrated this energy power for their own ends.

      Read Stephan Baxters Time series to get a feel for this transitional time which first happened on the Turkish plateaux a few thousand years after the ice age.
      My point is for most of human evolution we never operated at full employment in particular if there was big game available.
      This gave us time to think , to look after our elderly and infirm etc etc .

    4. The connections between unemployment/poverty and stress are well recognized as are the long term health effects of chronic stress. Not only are neoliberals working to impoverish us, they are also working to shorten our lives. The average life span of our poorest, those who become homeless (usually through no fault of their own), typically measures just a few years after they find themselves on the streets.
      The response to growing homelessness in some cities has been proposals to move the homeless out of the city core and out of sight in the outskirts of town where they can quietly perish without bothering others.

      Unemployment and poverty are strong evidence for a dysfunctional economy. If we can’t make things operate to the benefit of everyone within a modern mix including manufacturing and service sector level economy, then perhaps moving back toward simpler more agrarian ways of living on commonly held land needs to be considered?The key word being living.

    5. Dork,
      You say
      “This gave us time to think , to look after our elderly and infirm etc etc .”
      We need to expand our definition of “work” including these activities. This is what JG and education is for.

    6. Bill,

      Poor health being associated with long term unemployment is very believable. It would involve higher stress for many, and that is highly associated with physical disorders. And our new problem of a steady, large population of long-term unemployed is something we can probably expect to see for a while. Even after our economy picks up with our next President (hopefully, one who will work wih congress), our poorest will still be there.
      The well described divergence in modern, western societies due to growing meritocracy has been noted for over a generation-I have no doubt that you and many other of your readers besides myself are aware of this. A NY Times columnist named David Brooks wrote a book similar to Bowling Alone, called BoBos in paradise. BoBo stood for a growing, self segregating group of high achieving affluent’s with Bohemian being one “bo” and bourgeois being the other “bo” in BoBos. Their self-segregated culture is the part fo the upper middle class-lower to higher level of rich who can be seen in activity social pages of big city society columns, and who take their bohemian counterculture served up by the establishment-today’s media, who were yesterdays counterculture rebels and still celebrate it.
      The BoBos aren’t the totality of the upper middle class and rich-a movement between economic levels has been taking place amoung all groups of achievers for the last few deacades, essentially unchanged. This is reported otherwise from time to time, but this is usually part of an argument for more welfare fo some kind. An article from Reason.com, Jan 10, ’14, titles “Why President Obama is wrong on inequality debunks both the “income inequality” error and the “America is now harder to advance in” error. Heres a short quote that gives a taste, describing “income mobility”-how much we move from level to level-using Treasury Dept data:
      “The U.S. Treasury researchers updated their analysis of income mobility trends in a May 2013 study for the American Economic Review. Their new study reports that about 75 percent of taxpayers between 35 and 40 years of age in the second, middle and fourth income quintiles in 1987 had moved to in a different quintile by 2007.”
      Basically, even with the weird Obama economy, the US still does pretty well for most. From a longer perspective, a lower-succeeding lowest level of success is going to continue to exist. Since civil servants can be expected to perpetuate a given “served” population, it’s incumbent on non-civil servants to become part of joining organizations that help the poorest,
      Over time, help for these most needy among us will get better, as developing tech will enable identifying fraudulent purveyors of and beneficiaries of assistance programs. This is currently estimated to be a large problem, and any degree of fixing it means more help to those who are supposed to get it.

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