Is the economic downturn improving Americans' health?

How to fix health policy.
Jan. 7 2010 7:46 PM

Bernie Madoff, M.D.

Is the recession good for your health?

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Bezruchka's findings apply only to wealthy nations like the United States. In poor countries, economic growth decreases mortality rates, just as we expect it would, "by providingthe means to meet essential needs such as food, clean waterand shelter, as well access to basic health care services." (This payoff, however, disappears after gross domestic product rises to a not-very-high $5,000 to $10,000 per capita.)

Also, losing your job remains under most circumstances bad for your health, just as you'd expect. According to one study cited by Bezruchka, "Losing one's job was associated with a 54 percentchance of reporting fair or poor health, and for a person withno pre-existing health conditions, the chances of reportinga new one increased by 83 percent." The message a fired employee often receives—that this is the best thing that ever happened to you (lampooned deftly in the film Up in the Airand in Barbara Ehrenreich's book Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America) is a con devised to reduce the discomfort and/or legal liability of the person or company doing the firing. It is not an accurate or sincere prediction of the ditched employee's true prospects.

Paradoxically, though, during an economic downturn in which a lot of people are losing their jobs, collective health tends to improve.

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Some of the Bezruchka's explanations sound so Marie Antoinettish that I hesitate to repeat them with a straight face. He cites a study by Christopher J. Ruhm, an economist at the University of North Carolina who has studied this topic extensively, showing that during recessions fat people lose weight, heavy smokers buy fewer cigarettes, and couch potatoes exercise more. Another Ruhm study shows that, although casual drinking increases during downturns, heavy drinkers reduce their intake so much that the aggregate consumption of alcohol declines. Bezruchka also suggests that having more time on your hands allows you to cultivate friendships, which have been shown to improve health, while working a lot and having little personal time increases your opportunities to experience job-related stress. Babies conceived during recessions tend to be healthier, too.

Why do we find these beneficial health effects when people lose their jobs in a bad economy but not when they lose them in a good one? Bezruchka doesn't offer much here in the way of explanation. Perhaps it's easier to take constructive steps to improve your health when you know your job loss is the result of economic forces beyond your control. Maybe there are more people with whom to cultivate friendships when unemployment is high. Automobile crashes decline during recessions; is that because fewer people are racing to work?

Bezruchka mentions the corrosive effect of economic inequality (globally speaking, high in the United States) on a population's physical health. This point is amply demonstrated by the United States' famously poor ranking (37) on the World Health Organization's international scorecard even though it spends a larger share of its gross domestic product on health care than any other nation. (One reason for the connection may be that economic inequality allows wealthier people to bid up the prices of health services and drugs to the point where they become unaffordable to the unwealthy.) If a recession has the effect of reducing inequality (as may be the case now), that might improve health outcomes.

That isn't Bezruchka's argument. He writes that an economic crisis can improve health outcomes by giving the government a concrete, urgent reason to address the problem of inequality. During the Great Depression, relief spending helped reduce inequality while simultaneously lowering the infant mortality rate. Bezruchka urges the federal government to use social welfare spending in a similar way today, perhaps by increasing spending directly on health care. That, of course, is precisely what the health reform bill will do. Would we have gotten this close to its enactment without the sense of urgency created by the 2008 recession? If not, then maybe Madoff, Mozilo, and Greenberg deserve our thanks.

So E-mail Timothy Noah at chatterbox@slate.com.

Timothy Noah is a former Slate staffer. His  book about income inequality is The Great Divergence.

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