An upside to the downturn?

Foreclosures. Layoffs. Retirement savings down the tube. One scary or embarrassing financial disaster after another. Such is life in the Great Recession of 2009. What if anything does this mean for our health?

It makes intuitive sense that health would suffer. But some research shows we’re actually ‘healthier’ in economic hard times and that death rates start to pick up right along with the economy.

Downsizing health: Dieting, cutting corners, and losing insurance

Maybe. Maybe not.

Dietitians and nutritionists aren’t an unbiased source of opinion when it comes to the demand for their services. Still, one hard statistic is that enrollment in Weight Watchers has declined in recent months.

The University of Michigan Medical School reports that people are saving money by cutting back on medication, skipping visits to the doctor, and electing to forego diagnostic tests. “One in nine people are cutting pills in half, taking them less frequently or ‘doing something’ their doctor did not recommend.”

The AARP did a survey of adults age 45+ in October 2008. Over half the respondents said they’d switched from a prescription drug to a generic or over-the-counter medication. 14 percent said they aren’t filling their prescriptions due to the economy. 22 percent said they’re postponing doctor visits. And 17 percent said the need to cut back on medical expenses had a negative effect on their health.

Add to this the matter of health insurance. For each one percent rise in unemployment, 1.1 million people lose their health insurance. Of course those who were covered by an employer’s health plan are eligible for the government-mandated program, COBRA. Unfortunately, COBRA coverage for a family currently costs more than 80 percent of an unemployment check.

Losing insurance is especially hard on children. Children without health insurance are less likely to see a doctor and are three times more likely to go without necessary medication. Individual states are going broke and can’t afford to enroll new members in Medicaid or the State Children’s Health Insurance Program (SCHIP). We resort to desperate measures. “Some 7% of people polled by the Kaiser Family Foundation in April [2008] reported that one member of their household got married to a health-insured person within the past year just to get a piece of the benefits.”

All these things support our intuitive hunch that health suffers in an economic downturn.

Counter-intuitive

But no, some economists and epidemiologists say it’s just the opposite of what we expect.

Christopher J. Ruhm, a professor of economics at the University of North Carolina at Greensboro, is every journalist’s favorite expert on health in a recession. Who wants to read the obvious? Ruhm’s work is counter-intuitive and controversial. Now that’s news.

Ruhm looked at mortality statistics in the U.S., state by state, from 1972 to 1991. In a public radio interview he explained:

Essentially what I was doing is using each state as an experiment, so I was comparing what was happening in one state, say in Massachusetts or Texas, relative to what was going on in other states, so if the Texas economy was weakening at a time when other states’ economies were strengthening, how were, say, mortality rates in Texas changing relative to other states and the result was just very robust, the result that health got better during bad economic times. (emphasis added)

How does he explain this? Well, people have more time if they’re unemployed, so they might be exercising more. (Yeah, sure.) They can’t afford to eat out as much, so they’re not downing those large portions of rich, fatty food. Maybe they can’t afford to smoke and drink as much. They drive less (after all, they don’t have to go to work), and driving is very risky. Industrial accidents go down, since there aren’t as many people at work. Pollution levels go down from the reduced traffic and all those vacant factories. Of the ten causes of death Ruhm tracked, the only one that didn’t fall with economic hard times was suicide.

And what happens when the economy turns around? Watch out.

The downturn in reverse

Epidemiologist Jose A. Tapia Granados studied U.S. mortality rates from 1900 to 1996. His analysis supports Ruhm’s findings for recessions, plus he found that more people die during economic expansions. The reason? It’s the downturn in reverse. There’s more traffic. More industrial accidents. We consume more tobacco, alcohol, and saturated fats. Our immunity levels go down because work is inherently stressful, it deprives us of sleep and, since it doesn’t leave us enough time for socializing, we don’t get as much social support.

One of Ruhm’s papers is called “Are recessions good for your health?” I can understand that the number of accidents might be inversely related to unemployment: When there’s higher unemployment, there are fewer accidents. And yes, health is ultimately a matter of life or death. But dying in an accident isn’t what people usually mean by ‘health’. So maybe the better question is “Are recessions good for your mortality?”

As for non-accidental causes of death and their correlation with economic cycles, I think the jury is still out. The effects of alcohol, tobacco, and poor diet take years to show up as chronic disease. An increase in deaths from poor health habits is not something you normally observe in the year or two it takes for an economic cycle to turn around.

On the other hand, there’s always the example of Morgan Spurlock, who demonstrated definitively that eating exclusively at MacDonald’s for a month will ruin your health immediately. Here’s the Supersize Me preview.

Related posts:
The financial crisis: Blame it on the collapse of Communism
Suicide in Japan (part 1): The recession
Suicide in Japan (part 2): The Internet and media coverage