Economic downturn is linked to shorter lives and lower quality of life.

There has long been substantial evidence linking job loss to shorter lives and more health-related problems. A 2009 study on the impact of the 1980s oil crisis and subsequent recession in Pennsylvania, published by economists Daniel Sullivan and Till von Wachter in the Quarterly Journal of Economics, found that in the year after men lost their jobs in mass layoffs, their chances of dying doubled. And though the heightened risk tapered off over the years, it was still significantly higher 20 years later. If such trends were sustained indefinitely, the authors wrote, it would mean a loss in life expectancy of 1–1.5 years for a worker displaced at age 40.

Today, a new generation of researchers is building on this scientific foundation. Sociologist Clemens Noelke, David E. Bell Postdoctoral Fellow at the Harvard Center for Population and Development Studies (Pop Center), is in the final stretch of a study of the health impact of job loss during recessions and the extent to which unemployment benefits may cushion potential harms. Noelke’s research, which draws on data from a massive biannual study, focuses on U.S. workers ages 50 and older between 1992 and 2010—years that include the downturns of the early 1990s and the early 2000s, as well as the Great Recession (2007–2009). Among the health indicators he is looking at: mortality rates, cardiovascular disease, cognition, depression, and unhealthy behaviors such as smoking and drinking.

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Although joblessness has been a major problem in Europe, the unemployed face special challenges in the United States. “Earnings loss because of job loss seems to be larger in the United States, because after unemployment benefits run out, people are often forced to take jobs that don’t match well with their skills, © ANDREW KELLY / REUTERS

Why target an older population? “It’s harder for an older person to find a new job, and older individuals have more health conditions to begin with,” Noelke explains. “They’re also becoming a larger proportion of the workforce.” By 2016, one-third of the U.S. workforce will be age 50 and up.

While Noelke is not yet talking publicly in detail about his findings (currently under peer review), he expects the results to be in line with existing studies from European countries and the U.S. The studies have consistently tiedunemployment to elevated death rates. A 2011 meta-analysis of international research—published in Social Science & Medicine by David Roelfs, Eran Shor, Karina Davidson, and Joseph Schwartz—found that the risk of death was 63 percent higher during the study periods among those who experienced unemployment than among those who did not, after adjusting for age and other variables.

Some argue that this can be explained by the fact that sicker people are more likely to end up unemployed. But studies focusing on workplace closures—where all employees are let go—suggest otherwise. A 2009 report by University of Albany sociologist Kate W. Strully in the journal Demography found that losing a job when a business closes increased the odds of fair or poor health by 54 percent among workers with no preexisting health conditions, and increased by 83 percent the odds of new health conditions likely triggered by job loss—stress-related conditions such as stroke, hypertension, heart disease, arthritis, diabetes, and emotional and psychiatric problems.

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The Virginia Employment Commission office in Alexandria, November 2009. The U.S. unemployment rate had hit 10.2 percent the month before—the highest rate of joblessness during the Great Recession. Public health costs of the Great Recession may not be fully apparent for many years. © MOLY RILEY / REUTERS

Such findings would come as no surprise to those who responded to a 2010 poll, conducted jointly by Knowledge Networks and investigators at HSPH led by Gillian SteelFisher, a research scientist in the Department of Health Policy and Management. The survey found that many people with heart disease, diabetes, or cancer believed that the downturn was hurting their health and that these negative impacts would only worsen over time. Among the facts unearthed by the poll: About a third of those with heart disease or diabetes and a fifth of those with cancer blame the economic downturn for forcing them to use up their savings to deal with medical bills, co-payments, and other expenses related to their illnesses. More broadly, according to the poll, some 4 in 10 Americans with heart disease or diabetes and 1 in 5 with cancer said the downturn had made it more stressful for them to manage their illnesses, a scenario that in itself may have exacerbated existing health problems.

CASCADE OF CATASTROPHE

The United States is unique among developed countries in its historic reliance on employers to provide health insurance—leaving those who lose their jobs not only without an income but also without health care. While passage of the Affordable Care Act (ACA) in 2010 set the stage for a different scenario, it is not yet clear that the law will result in better health outcomes for the unemployed or underemployed.Katherine Baicker, professor of health economics, co-authored a 2011 paper published by the National Bureau of Economic Research that showed that the improved access to Medicaid resulting from the act raised rather than cut costs; yet while the price of care increased, people reported better health and fewer financial strains associated with health care costs.

The United States is unique among developed countries in its historic reliance on employers to provide health insurance—leaving those who lose their jobs not only without an income but also without health care.

Although joblessness has been a major problem in Europe, the unemployed face special challenges in the United States. “Earnings loss because of job loss seems to be larger in the United States, because after unemployment benefits run out, people are often forced to take jobs that don’t match well with their skills,” says Noelke.

Others agree. “If you look at countries with strong social safety nets, it’s not as dire for people who are out of work,” says Laura Kubzansky, professor of social and behavioral sciences. “It’s unpleasant, but it doesn’t set up this cascade of catastrophe in the way that it can in this country, where the only net people have once unemployment runs out is frequently their family and savings.”

Foreclosure is equally traumatic. As a result of the subprime mortgage crisis that led to the Great Recession, more than 13 million American households were foreclosed between 2008 and 2013. That sprawling calamity yielded “a stressful life event of prolonged duration, with multiple phases of variable intensity,” wrote HSPH assistant professor of social and behavioral science Reginald Tucker-Seeley and co-authors Gary G. Bennett and Melissa Scharoun-Lee, both of Duke University, in a June 2009 essay titled “Will the Public’s Health Fall Victim to the Foreclosure Epidemic?”

FORECLOSING ON HEALTH

First the birds started dying—falling out of trees, found floating in backyard swimming pools. Then humans began to develop strange and frightening symptoms: tremors, confusion, and occasionally paralysis.

It was May 2007 in Bakersfield, California—a city hard hit by the nation’s foreclosure crisis—when the first cases appeared of what was ultimately determined to be West Nile virus infection, a mosquito-borne disease that sometimes leads to fatal brain damage. But if the diagnosis was clear, the cause was anything but, especially given that public health experts had considered this to be an unusually low-risk year.

The answer finally came in the form of aerial photos of Bakersfield. The images revealed hundreds of swimming pools, birdbaths, and Jacuzzis—an estimated one out of six—covered in green fuzz. Almost all of their owners had decamped, leaving empty homes and signs that said “For Sale” or “Bank-Owned Foreclosure.” Ultimately, investigators found more than 4,000 mosquito larvae infected with West Nile strains in 31 neglected pools. What began as a foreclosure crisis had become a public health menace, wrote sociologist David Stuckler, a former HSPH faculty member now at Oxford University, and Sanjay Basu, an assistant professor of medicine and epidemiologist at Stanford University, in their 2013 book The Body Economic: Why Austerity Kills.

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HSPH experts believe that the nation’s foreclosure crisis will be leaving its imprint on public health far into the future. © ADAM TANNER / REUTERS

Losing a home, in other words, may endanger not only the home dweller’s health but also the health of neighbors.

At HSPH, Mariana Arcaya, Yerby Postdoctoral Research Fellow at Harvard’s Pop Center, is also tackling the issue. Lead author of a 2013 report in the American Journal of Public Health, she discovered that people who live near foreclosed homes may be at greater risk of being overweight than those who don’t have such properties in their immediate neighborhoods.

Arcaya’s interest was in demonstrating the “spillover effect” of the foreclosure crisis—that is, its impact on those whose own homes did not fall prey to foreclosure. Because Americans so often view health outcomes as reflecting individual choices, Arcaya explains, it was important to show that even those who do everything “right” could be affected. “It’s easy to think ‘You’re the kind of person who let your home go into foreclosure, so you are also more likely to be the kind of person who gains weight. You’re irresponsible!’” she says. “Spillover effect reveals harmful structural forces in the larger economy.”

Arcaya and her colleagues analyzed housing and medical data from 2,078 study participants in Massachusetts from 1987 to 2008, looking at foreclosure records as well as the volunteers’ proximity to foreclosed homes and their body mass index (BMI) levels. They found that living within 100 meters of a foreclosed home was associated with a higher BMI of .2 units—the equivalent of a 1.3-pound weight gain in a 5-foot-6-inch person.

Some 4 in 10 Americans with heart disease or diabetes and 1 in 5 with cancer say the downturn had made it more stressful for them to manage their illness.

What accounts for higher obesity rates among those living near foreclosed homes? Perhaps people are less likely to be physically active when they live in places hit by foreclosure. “You may not want to walk your dog, go running, or garden as much when the physical environment is less appealing,” says Arcaya. “There may be houses boarded up. It may not feel as safe.”

Even more likely, Arcaya suspects, is that weight gain could stem from added stress fueled by factors that include anxiety over declining property values in the neighborhood. “Real estate is location, location, location, and zoning is such that if my house is 2,000 square feet, a foreclosed house is also probably 2,000 square feet. Why should someone buy my house when they don’t want to buy that house? Who would put faith in my neighborhood right now?”