With the recovery underway, things are starting to look up. Consumer confidence rose to a six-year high on Friday, the housing sector is improving, the economic gears are turning. But there may also be a less-welcome rebound: Fatalities could rise.
A growing body of research has found time and again that public health actually improves when times are tough economically. That’s right: Temporary downturns have been associated with declines in deaths, alcohol consumption, and other unhealthy behaviors. It’s a finding that researchers have replicated both here and abroad; a downturn, it seems, could be good for your health.
“This result seems to be quite strong and robust,” says University of Virginia public policy and economics professor Christopher J. Ruhm, whose 2000 paper linking downturns and public health increases has been widely cited in subsequent studies. “The effects have looked fairly stable across time periods,” too, Ruhm says, adding, however, that his own preliminary research suggests the effect may be fading.
It may at first seem counterintuitive. Downturns are associated with stressful events like pay cuts, layoffs, and stagnating incomes. And mental health often deteriorates during bad times, too. But a sluggish economy can change behavior.
A 1 percentage-point increase in the unemployment rate, according to Ruhm’s research, is associated with: 0.3 percent to 0.5 percent fewer deaths; a 1 percent to 3 percent decline in traffic deaths; fewer fatal heart attacks; a 0.6 percent reduction in smoking; a 0.4 percent reduction in obesity; and a 0.4 percent increase in physical activity. All told, that 1 percentage-point increase in unemployment is associated with 11,000 fewer deaths, he found.
Others have confirmed the finding, and similar effects have been found in Germany, Spain, France, Canada, and the OECD countries. Some researchers found the effect held true from 1900 to 1996. And life expectancy reportedly increased during the most recent recession.
What’s less clear is exactly why the relationship between downturns and public health is so strong. Ruhm and others have argued that when business is slow and hours are cut, people have more time to spend on diet and exercise. Fewer workers and shorter hours may mean fewer work-related accidents, too.
But other researchers dispute that explanation. In a 2009 paper, economists Douglas Miller, Marianne Page, Ann Huff Stevens, and Mateusz Filipski argued that the linkage really comes down to two factors: a decrease in car accidents, and fewer deaths among the elderly. When employment is up, they argue, more people are on the road, so fatal accidents are more likely. It’s less clear why fewer seniors die during downturns, although it may have something to do with less pollution or changes in the quality, quantity, and nature of health care, they say.
What may be as surprising as the finding itself is how far back it goes. Researchers in the early 1920’s saw a similar correlation, although they seemed to have doubted their own results. “[I]t should be remembered that there are other factors affecting the fluctuations of death rates from year to year,” Columbia University’s William Ogburn and Dorothy Thomas wrote in the Journal of the American Statistical Association in September 1922. The finding was largely ignored for decades, however.
As with all research, there are important caveats. The effect seems to be true only when downturns are short-lived and not severe. And health actually improves in upturns that are long-lasting. Perhaps the biggest note of caution comes from Ruhm himself: In new research, he finds that the link between downturns and health improvements may be breaking down.
“The procyclical relationship has pretty much disappeared,” he says. That’s the conclusion from recent research he’s conducted using data from 1976 to 2009, the latest available. But the finding is still very preliminary, he warns.
Two factors are largely driving the possible change, Ruhm says. First is a trend related to painkillers. As mental health declines in downturns, it is often manifested by physical symptoms such as pain. In seeking to treat that pain, people may be increasingly putting themselves at risk by taking painkillers, which have become more widely available in recent years and have contributed to a general rise in poisoning deaths. Second, cancer death rates are increasing in downturns. That, he suggests, may be because cancer patients are living longer thanks to expensive treatments. Cancer deaths may fall during economic upturns because individuals have better health coverage and more money.
But it’s still early, Ruhm warns, and more than a decade of studies that have confirmed his initial findings shouldn’t be ignored just because of one paper. “Honestly, I think we have to be a bit more tentative,” he says. And more research has to be done.