Counter intuitive

What happens to health during an economic recession?
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The question surely is a no-brainier.
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Wages drift down, unemployment goes up.
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Those who have lost jobs become depressed
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Those who haven’t grow fearful and anxious that they may.
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The outcome for many is stress if not deprivation.
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Health, it’s clear, will suffer; the death rate is bound to rise.
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Right?
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Wrong – at least if the experience of history, and one bit of history in particular, is anything to go by.
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Few economic downturns have been as dramatic and as deep as the Great Depression that overtook America during the 1930s.
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But figures from that time show that mortality fell and life expectancy increased.
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The data suggest that economic hardship is good for health.
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Can this be true?
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Links between bodily and economic well-being are far from straightforward.
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In the related area of socioeconomic inequality we’ve already become aware of unexpected influences through the work of Professor Richard Wilkinson of the University of Nottingham.
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In his 2009 book The Spirit Level, co-authored with Kate Pickett, he summarised a raft of research all pointing in more or less the same direction.
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In countries where there is a big earnings gap between rich and poor, life expectancy is lower while mental illness, obesity and drug and alcohol abuse are all more common.
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The real surprise is that it’s not only the poor who suffer.
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The population as a whole do less well if the gap is wider.
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The nations with the smallest wealth gap and the lowest incidence of health and social problems are the Japanese and the Scandinavians.
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The countries with, respectively, the greatest and highest are America, Portugal and Britain.
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The biological explanation for this is uncertain, but possibly mediated by the hormonal effects of perpetual anxiety about status and position, or loss of them.
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Economics affect health but not always as you might expect.
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Dr Jose Tapia Granados is a researcher with a particular interest in the Great Depression.
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A doctor by training, he moved into economics and works at the Institute for Social Research at the University of Michigan.
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During the Depression, from mid 1929 through to 1933, he says, life expectancy at birth rose from 57.1 to 63.3 years; mortality fell.
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The pattern was much the same for men and women, and blacks and whites.
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Years of recession are followed by years of recovery in which GDP returns to what it was and then grows.
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Between 1934 and 1936 the US economy boomed – but mortality rose and life expectancy fell.
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In 1938, there was another recession and another reversal of the trends.
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The pattern lasts throughout economic ups and downs from the start of the 1920s to the end of the 1940s.
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Deaths from TB and cardiovascular disease tended to fall in bad years, but peaked in economic expansions.
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This apparently perverse relationship between changes in economic activity and changes in mortality was first seen as far back as the 1920s – to the bewilderment of those who’d noticed it.
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They were so puzzled they felt they must be doing something wrong with the numbers,” says Dr Tapia Granados.
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More work in the 1970s fostered the suggestion that although the figures were right they reflected a lag between the downturns and the emergence of their damaging effects.
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Although the effects might appear during the recovery phase, it was said, they were not caused by it.
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Dr Tapia Granados doesn’t accept this explanation, saying that for this to be credible, he says, business cycles would have to be regular and of equal length.
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So what is going on?
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There is evidence that in periods of economic expansion people smoke and drink more, sleep less, work longer, experience more stress, and suffer more industrial injures – all bad for health.
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And what of the period of economic contraction?
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It’s a mirror image, he says, in which most of these influences are reversed.
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An enforced switch to part-time working, for example.
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To work many hours per day increases risk of heart attack.
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Fewer hours decreases risk.
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During recessions road traffic deaths decrease and during expansion they increase.”
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Hence the counterintuitive outcome; recovery from recession, not the recession itself, does harm.
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Critics point to a contradiction between this and the link between rising GDP and improving health.
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Dr Tapia Granados acknowledges this, but denies a contradiction, saying: I’m talking about fluctuations on top of the general trend.
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He suggests that a clearer understanding of what’s going on in economic cycles could contribute to the development of policies to minimise harm and enhance health.
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These might include a limitation on overtime, increased holiday entitlements, and improved safety legislation
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Independent