Summary of THE HEALTH CONSEQUENCES OF UNEMPLOYMENT

by William R. Avison, PhD

The 1990s have been a decade of significant economic change in the structure of national economies in North America. Patterns of cyclical unemployment, a decline in the vitality of various economic sectors and resulting plant closings and downsizing have contributed to unprecedented high and prolonged unemployment rates.

Unemployment has a pervasive and pernicious impact on health. The stresses and strains that accompany the loss of a job erode an individual's physical and mental health. Moreover, there is a multiplier effect that has consequences for the health of other family members.

There now appears to be sufficient knowledge about the relationship between unemployment and health to suggest the kinds of strategies that are needed at individual, corporate and societal levels to alter the health consequences of unemployment.

Highlights from the Literature

Numerous studies in different countries confirm that job loss is a significant factor in physical and mental health problems.

Mortality

The association between unemployment and premature mortality emerges with remarkable consistency whether aggregate data or individual data is examined. Moreover, the longer the period of unemployment, the higher the mortality rate. Unemployment is specifically associated with suicide and cardiovascular disease.

Physical and Mental Health

The association between unemployment and physical illness is ambiguous. Several studies suggest that while there may be no correlation between the two during good economic times, job loss does contribute to symptoms of physical illness during economic recessions. There is, however, ample evidence that unemployed individuals experience higher levels of psychological distress than do their employed counterparts. They also suffer from higher rates of diagnosable disorders such as depression, panic and substance abuse. While these findings apply to both men and women, there is little gender comparison across different health outcomes; it may be important to look at this similarity.

Efforts have been made to draw conclusions about links between unemployment, elevated rates of illness and health care utilization. A key factor appears to be the variation in access associated with different health systems. In some countries, job loss is likely to reduce access to health care even though need may increase. In others with more universal access, unemployment does seem clearly related to greater use of health services.

The Health of Other Family Members

Evidence on the effects of unemployment on spouses and children in most studies focuses on men's job loss. There is substantially less knowledge about the effects of unemployment on women and their families. The most comprehensive studies about women may have been done on poverty, not unemployment, and the adverse consequences of multiple risk factors on childrens' well-being. Nevertheless, research does indicate that spouses of unemployed workers experience increased emotional problems. Further, children, especially teens, whose parents are unemployed appear to be at higher risk of emotional and behavioural problems.

The Impact of Re-employment

The little research available in this area suggests that recovery after re-employment is neither immediate nor complete. The physical and mental health problems that are the consequences of unemployment persist.

Mediating and Moderating Factors

The paper reviews some of the pathways that link unemployment to health problems in the context of a stress process model, including mediating aspects (i.e., intervening, interactive or buffering effects between stress and illness) and moderating aspects (i.e., exacerbating or attenuating the effects of stress and illness) of self-esteem, personal efficiency, social support networks, financial strains and marital and family conflict. The literature suggests that job loss simultaneously results in increases in stressors (principally financial strain and family conflict) and the erosion of self-esteem, self-efficacy and perceptions of social support.

Success Stories

There appear to be few well-documented, carefully evaluated programs that address the health of unemployed individuals. One such program is reviewed, along with several promising community initiatives.

The Michigan JOBS Program

This preventive program combines intervention with comprehensive evaluation and is designed to help unemployed individuals find new jobs and reduce the adverse effects of job loss and re- employment. The program is delivered in five segments, providing a combination of psychosocial support and skills training in job seeking. Evaluations demonstrate higher rates of re-employment and lower levels of psychological distress than in control group members. Further, analysis suggests that the program is especially effective among higher-risk individuals, that it can be delivered in a wide range of organizational contexts and that it can pay for itself within 12 months through higher participant incomes and tax revenues.

Women Immigrants of London

This is an integrated on-site and job placement program that provides employment training (i.e., life skills, work skills, job training and language and communication skills) to immigrant and visible minority women. The program reports a 92% success rate in placing graduates at a very low cost per participant.

The Learning Enrichment Foundation

This program provides an integrated spectrum of employment services to participants through the operation of 13 day-care centres and an industrial kitchen. Additional program elements include microcomputer, english-as-a-second-language and trade skill training as well as venture programs for small business starts. Eighty-five per cent of graduates find jobs.

Niigwin Skills Development and Placement Centre This program provides work and life skills training to long-term social assistance recipients, many with institutional, incarceration or substance abuse histories. The evaluation report asserts that for every program dollar spent a social return of over 30 dollars is realized.

Job Clubs

These programs are found across Canada and involve the creation of small groups of job seekers who assist each other in finding work. The few evaluations completed report impressive rates of re-employment.

Evaluations of the latter four initiatives are silent on their impact on health outcomes.

Policy Implications

The author suggests that future programs could be designed around four levels of intervention: reducing the numbers of individuals who will experience unemployment reducing the stresses of unemployment strengthening individuals' life skills and psychosocial resources providing counselling and clinical interventions. It is proposed that emphasis be placed on interventions at levels 1 to 3 through cost-effective health promotion and prevention strategies that limit the adverse health consequences of unemployment and mitigate further growth in health care costs.

Reducing Individual Unemployment

Education remains the most effective weapon against unemployment. Three principles should guide policy and program development in this area. First, Canada's youth must be given greater incentives to further their education and training. Reduction of the minimum wage for youth is one approach; tax credits for continuing education is another. Second, programs and incentives must be strengthened to maintain adult education and training as an effective strategy for re- employment. Third, educational institutions must continue to have the resources (including public and private sector involvement) to facilitate students' transitions from the classroom to the workplace.

Organizational and Corporate Intervention Corporations could contribute to reduced unemployment through a variety of means, including broader acceptance of job-sharing, movement toward a shorter work week (contributing to both higher productivity and lower absenteeism) and encouraging early retirement.

Community/Societal Intervention

High rates of unemployment threaten the well being of our communities and strain the fabric of society. Community-based primary prevention programs are needed that involve all sectors, address multiple risk factors, focus on a variety of settings (e.g., schools, families, neighbourhoods) and target communities with high needs. In addition, our economic, fiscal and monetary policies must be reconsidered in terms of their impact on unemployment. We have not really tested the dominant assumptions that deficit reduction and balanced budgets will lead to economic renewal and job creation. Alternative policies holding similar promise of renewal and jobs warrant consideration, including the lowering of interest rates.

Altering the Consequences of Unemployment Health promotion and primary prevention programs that intervene soon after job loss appear to be particularly helpful in reducing health burdens. Some of these programs are based on models that have worked in other social situations (e.g., parental separation and divorce). Professional associations, unions and corporations should include access to these programs as part of a healthy workplace.

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