Unemployment can have a major effect on health, so efforts should be made to get people back to work, says Dr Jessica Allen
There is a wealth of evidence showing clear links between unemployment and poor and worsening health. An immediate negative health impact can be seen as soon as a person is made redundant or is under the threat of redundancy - stress, anxiety, loss of self-esteem - leading to worse physical and mental health. Many studies emphasise the continuing negative health effects of unemployment, which get worse the longer a person is out of work. Adverse effects on health are greatest among the long-term unemployed.
There are three ways that unemployment affects health and, ultimately, death rates. Firstly, financial problems resulting from unemployment, which bring lower living standards and stress. Secondly, it is loss of self-esteem, and a person's role in their family and community. This loss of confidence and identity takes a toll on physical and mental wellbeing. Thirdly, unemployment affects health behaviours and is associated with increased smoking and alcohol consumption and decreased physical exercise.
All these health impacts are, of course, bad for the individuals involved and their families. But what is more, they also place additional demands and expense on the National Health Service.
Unemployment reinforces existing inequalities in society and this is true as regards health. A wealth of evidence demonstrates the clear link between health and wealth - the healthiest people are the richest, then the next richest are the next healthiest, and so on down to the very poorest, who endure shorter lives and more years of disability and illness.
The graph below illustrates the difference unemployment makes to death rates, comparing employed and unemployed people. It also clearly shows the social class impact (class I is highest and class V is lowest). Although everyone's health is made worse by unemployment, it is made even worse for those in lower social-economic groups.
Some groups of people are much more at risk of long-term unemployment than others - the lower your social and economic position is, the more likely you are to be unemployed. For those aged under 25, the younger you are, the more likely you are to be unemployed and to be long-term unemployed, which is why the current very high youth unemployment rate is of such particular concern.
Also, unemployment is higher for those with existing poor health - those who have some sort of illness or disability are much more likely to be unemployed - and their health will deteriorate further.
There is therefore a clear economic and health argument for getting people back into work and this is particularly important for those already most at risk - those who are long-term unemployed, are younger or poorer, or have existing health conditions - often, in fact, those people who are already the most disadvantaged. The attention of government and employers should be focused more on those groups and unemployment should also be a central focus for all those involved in health and healthcare.
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Dr Jessica Allen is co-director, European social determinants and health divide review and project director, Fair society, healthy lives (Marmot Review). She is on the staff at University College London
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