Yet, when looking at mortality data for the entire United States, a paradox emerges: despite the harmful aspects for workers, overall death rates fall and people live longer during recessions. In a study examining mortality between 1900 and 1996, death rates rise and fall with economic growth so that the fewest deaths occur during the sharpest downturns. By one estimate a one percent decrease in employment positively correlates with a decrease of 0.54% in the mortality rate: more than 13,000 averted deaths per year. Economist Tyler Cowen published an essay in the New York Times during the deepest point of the Great Recession that exalted how, counterintuitively, the recession would improve quality of life.
One explanation for this trend relies on the changing behavioral patterns as the economy fluctuates. Christopher Ruhm, professor of Public Policy and Economics at the University of Virginia, has demonstrated that during economic expansions use of tobacco and alcohol as well as obesity increase while exercise decreases. Additionally, boom periods are accompanied by reduced nightly sleep. Between tightening budgets and less busy schedules, recessions free people to partake in healthy activities that, in turn, decrease mortality.
As economic activity slows in recessions, according to another theory, transportation and production slow as well. Changes in economic output produce swings in the total level of particulate air pollution and, while this has little impact on adults, the increased air quality during recessions notably improves infant mortality rates. Deaths from auto vehicle accidents follow the same trend of pro-cyclic mortality.
Neither of these explains how during recessions individuals are harmed but the populace prospers. In order to reconcile these trends, a study published by the National Bureau of Economic Research looks at cause of death and unemployment from 1978 to 2006 broken down by demographics. For working-age adults, changes in vehicle accidents account for almost all of the changes in death rates. However, working-age adults and vehicle accidents do not power this national trend: they barely make up 10 percent of the change. Elderly Americans, those not themselves working, drive the decreased mortality during recessions as 70 percent of averted deaths come from those over 70.
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Therefore, while grandma living longer causes the trend seen across the population, changes in her interactions with people in the workforce must explain why she lives longer in the first place. One such regular interaction takes place for the elderly living in nursing homes. For Americans over 65, the death rate for those in nursing homes drastically decreases during recessions while death rate slightly increases for those not in nursing care. Enough deaths are averted in nursing homes to compromise the entire effect among those over 65. Plus, in comparison between states, those with the greatest percentage of elderly living in nursing care saw the most substantial decrease in the death rate.
Nursing homes are chronically understaffed in times of economic prosperity. But, when the job market tightens, a one percent increase in unemployment sees full time employment in nursing facilities rise three times as fast. After a recession, when the economy picks back up and jobs become available again, low skilled workers abandon nursing homes jobs' low pay and even fewer accolades for better prospects. The shift of workers in and out of nursing jobs drives the swings in the national death rate and underscores the importance of these under-appreciated jobs.
A look at the relationship between economic downturns and health outcomes in the United States reveals a complex picture: harm from lost insurance and increased anxiety but better care for the elderly. These two trends coexist because, while harm concentrates in working age people, retirees reap the majority of the benefit. They do not offset one another but instead further deepen our nation's indefensible health disparities. While the Affordable Care Act should help prevent harm in future recessions from loss of insurance, an aging populace and uncertainty around the economy will allow these trends to recur for the foreseeable future.