The economy robbed Americans of insurance, exacerbated psychological stress, and, paradoxically, saw fewer people die.
Amid the sleaze and cynicism of the last election cycle, a Priorities USA spot titled "Understands" transcended the normal boundaries of smear. The ad insinuated that by eliminating steelworker Joe Soptic's job and health insurance, Romney and Bain Capital forced Soptic's wife to forego treatment for the early signs of the cancer that ultimately took her life. But although fact-checkers found the causality in this story overstated, public health research shows that recessions do carry human costs that are often neglected.
Public health practitioners have acknowledged the power of economic and social forces on peoples' health since German physician Rudolph Virchow first blamed poverty for a 19th century Typhus outbreak. Now, attempts to catalog the myriad mechanisms that allow socioeconomic conditions to "get under our skin" are a central public health concern. In 2005, the World Health Organization established a Commission on Social Determinants of Health to advise on how to reduce their harm. Three years after the end of the Great Recession, it's clear that this downturn affected health of Americans in three ways: robbing them of insurance, exacerbating psychological stress, and, paradoxically, causing fewer people to die.
By one estimate a one percent decrease in employment positively correlates with a 0.54% decrease in mortality rate: more than 13,000 averted deaths per year.
Unlike all other high-income nations that have universal healthcare systems, in the United States health insurance coverage fluctuates with the whims of the economy. Those without insurance, like Joe Soptic's wife, may refrain from preventative care or screenings necessary to identify illness early in its progression. While a small number of people lost insurance because their employer terminated healthcare benefits, the vast majority of the 5.6 million added to the rolls of the uninsured between 2007 and 2009 came from those that lost full-time employment. Young people, aged 19 to 34, composed nearly half of those that lost insurance during the official period of recession.
To mitigate the loss of insurance, the American Recovery and Reinvestment Act provided money to states for expanded children's health insurance programs and Medicaid as well as subsidized insurance premiums for the unemployed buying COBRA coverage. Such expansions not only prevented more widespread coverage loss among adults, but helped reduce the number of uninsured children by 600,000 in spite of the recession. Thankfully, provisions in the Affordable Care Act should help prevent future swings in insurance coverage and the Great Recession should be the last downturn to rob people of health coverage.
Beyond harm caused by loss of insurance, unemployment and job insecurity directly diminish peoples' health. A 2007 study by researchers at the University of Michigan and UCLA examined longitudinal interview data from American adults and found that while job loss leads to a significant decline in self-reported health and an increase in depression, the effects are concentrated among those that lost jobs because of poor health. Those that lost jobs for all other reasons -- such as a recession -- experienced only a slight increase in depressive symptoms and no significant decline in health. Instead, the authors found that persistent perception of job insecurity led to diminished self-reported health and increased depression even after adjusting for prior health and socioeconomic demographics. This confirms findings from a study of white-collar British civil servants and suggests that long-term anxiety over employment degrades health.
Accordingly, suicides, the most dramatic manifestation of depression and anxiety, proliferate during economic downturns. In twelve out of fourteen recessions since the 1920s the suicide rate accelerated upwards. Rates among 25 to 64-year-olds are more volatile than other age groups because, as many of them serve as primary breadwinners for their families, anxiety over job loss is compounded by fear of its impact on their dependents. According to a model recently published in the Lancet, between 2007 and 2010 in the United States approximately 4,750 people took their lives beyond the level that would be expected without the recession. Taken together, loss of insurance, persistent job insecurity and increased suicide rate paint a dour picture of health for individuals during recessions.