New York Times, October 6, 2008.
1936 In hard times, as in the Great Depression, laborers have more time to care for their children.
Most people are worried about the health of the economy. But does the economy also affect your health?
It does, but not always in ways you might expect. The data on how an economic downturn influences an individual’s health are surprisingly mixed.
It’s clear that long-term economic gains lead to improvements in a population’s overall health, in developing and industrialized societies alike.
But whether the current economic slump will take a toll on your own health depends, in part, on your health habits when times are good. And economic studies suggest that people tend not to take care of themselves in boom times — drinking too much (especially before driving), dining on fat-laden restaurant meals and skipping exercise and doctors’ appointments because of work-related time commitments.
“The value of time is higher during good economic times,” said Grant Miller, an assistant professor of medicine at Stanford. “So people work more and do less of the things that are good for them, like cooking at home and exercising; and people experience more stress due to the rigors of hard work during booms.”
Similar patterns have been seen in some developing nations. Dr. Miller, who is studying the effects of fluctuating coffee prices on health in Colombia, says that even though falling prices are bad for the economy, they appear to improve health and mortality rates. When prices are low, laborers have more time to care for their children.
“When coffee prices suddenly rise, people work harder on their coffee plots and spend less time doing things around the home, including things that are good for their children,” he said. “Because the things that matter most for infant and child health in rural Colombia aren’t expensive, but require a substantial amount of time — such as breast-feeding, bringing clean water from far away, taking your child to a distant health clinic for free vaccinations — infant and child mortality rates rise.”
In this country, a similar effect appeared in the Dust Bowl during the Great Depression,according to a 2007 paper by Dr. Miller and colleagues in The Proceedings of the National Academy of Sciences.
The data seem to contradict research in the 1970s suggesting that in hard times there are more deaths from heart disease, cirrhosis, suicide and homicide, as well as more admissions to mental hospitals. But those findings have not been replicated, and several economists have pointed out flaws in the research.
In May 2000, the Quarterly Journal of Economics published a surprising paper called “Are Recessions Good for Your Health?” by Christopher J. Ruhm, professor of economics at the University of North Carolina, Greensboro, based on an analysis measuring death rates and health behavior against economic shifts and jobless rates from 1972 to 1991.
Dr. Ruhm found that death rates declined sharply in the 1974 and 1982 recessions, and increased in the economic recovery of the 1980s. An increase of one percentage point in state unemployment rates correlated with a 0.5 percentage point decline in the death rate — or about 5 fewer deaths per 100,000 people. Over all, the death rate fell by more than 8 percent in the 20-year period of mostly economic decline, led by drops in heart disease and car crashes.
The economic downturn did appear to take a toll on factors having less to do with prevention and more to do with mental well-being and access to health care. For instance,cancer deaths rose 23 percent, and deaths from flu and pneumonia increased slightly. Suicides rose 2 percent, homicides 12 percent.
The issue that may matter most in an economic crisis is not related to jobs or income, but whether the slump widens the gap between rich and poor, and whether there is an adequate health safety net available to those who have lost their jobs and insurance.
During a decade of economic recession in Japan that began in the 1990s, people who were unemployed were twice as likely to be in poor health than those with secure jobs. During Peru’s severe economic crisis in the 1980s, infant mortality jumped 2.5 percentage points — about 17,000 more children who died as public health spending and social programs collapsed.
In August, researchers from the Free University of Amsterdam looked at health studies oftwins in Denmark. They found that individuals born in a recession were at higher risk for heart problems later in life and lived, on average, 15 months less than those born under better conditions.
Gerard J. van den Berg, an economics professor who was a co-author of the study, said babies in poor households suffered the most in a recession, because their families lacked access to good health care. Poor economic conditions can also cause stress that may interfere with parent bonding and childhood development, he said.
He noted that other studies had found that recessions can benefit babies by giving their parents more time at home.
“This scenario may be relevant for well-to-do families where one of the parents loses a job and the other still brings in enough money,” he said. “But in a crisis where the family may have to incur huge housing-cost losses and the household income is insufficient for adequate nutrition and health care, the adverse effects of being born in a recession seem much more relevant.”
In this country, there are already signs of the economy’s effect on health. In May, the market research firm Information Resources reported that 53 percent of consumers said they were cooking from scratch more than they did just six months before — in part, no doubt, because of the rising cost of prepared foods. At the same time, health insurancecosts are rising. With premiums and co-payments, the average employee with insurance pays nearly one-third of medical costs — about twice as much as four years ago, according to Paul H. Keckley, executive director of the Deloitte Center for Health Solutions.
In the United States, which unlike other industrialized nations lacks a national health plan, the looming recession may take a greater toll. About 46 million Americans lack health insurance, Dr. Keckley says, and even among the 179 million who have it, an estimated 1 in 7 would be bankrupted by a single health crisis.
The economic downturn “is not good news for the health care industry,” he said. “There may be slivers of positive, but I view this as sobering.”
(A version of this article appeared in print on October 7, 2008, on page D1 of the New York edition.)
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