For years there has been significant evidence linking socio-economic status and health. Statistics show a graded relationship, meaning the higher your social position the greater your level of health (figure 3). This shocking data not only shows the most deprived dying 7 years earlier than the least; they will also have a disability for a longer period of their shorter lives, which is likely to take affect before the ever increasing pension age, 17 years before that of the most affluent (Marmot 2010).
Figure 3: Life expectancy and disability-free life expectancy at birth, persons by neighbourhood income level (ONS 2009).
Recession does not uniformly impact the health of the nation, affecting different social-classes in different ways and by variable amounts, further accentuating health inequalities (Marmot and Bell 2009).This essay will examine how the behavioural, psycho-social, materialist and life-course aetiological pathways are involved in the health effects of the economic downturn on different socio-economic groups. Unemployment will be discussed in detail being the major variable during an economic downturn, having both direct and secondary causes, and a significant influence on health. Later, other indirect influences such as job insecurity and public sector cuts will also be discussed.
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Unemployment has a serious affect on health showing a much higher mortality rate for unemployed men (Figure 4). However some of this difference may be attributed to the theory of ‘selection’ that ill people are more likely to become or remain unemployed, rather than ‘exposure’ where unemployment causes health deterioration (Burgard et al. 2007). Although some less healthy individuals may lose their jobs before others, the sheer scale of unemployment during economic downturn will make exposure dominant. Contrasting to others Martikainen et al. (2007) argue that the mortality and therefore health during unemployment is often better during a recession due to better support in the form of unemployed peers. However in terms of the nation as a whole increased unemployment deteriorates health, and when considering the individual, although support from peers is important the financial strain combined with other factors such as increased cost of living and public sector cuts, discussed later, will exceed this positive effect.
Figure 4: Mortality of men in England and Wales in 1981-92, by social-class and employment status at the 1981 Census (Bethune 1997).
Unemployment’s major impact is on an individual’s mental health; Price et al. (1998) associated unemployment with decreased self-esteem and perceived competence, increased depression and anxiety along with an increased risk of suicide attempt, alcohol abuse and violence. However other research has indicated that the lack of income outweighs the stress related consumption of cigarettes and alcohol (Ruhm 2005) or that health damaging behaviours are influenced by feelings of control and expectation of future employment (Catalano 1997). Several studies link these psychological affects such as job stress increasing risk factors such as hypertension and serum cholesterol (Weber et al. 1997). In conjunction with this it seems the most common impacts of unemployment on physical health are on the cardiovascular system with Gallo et al. (2006) estimating a doubling of the risk of stroke and myocardial infarction with involuntary job loss.
The financial sector initiated the current recession so was the first to directly feel its effects, for example Northern Rock being taken into state ownership and forced to make 800 compulsory redundancies (Treanor 2008). The secondary impact of the recession involved decreased lending from the financial sector, forcing companies to close altogether or relocate abroad for a cheaper workforce, meaning mass unemployment and unlikely reemployment (Clancy and Jenkins 2009). Next as the government feels the squeeze public sector cuts are causing further unemployment.
Generally speaking the lower-classes are the most likely to become unemployed, occurring mainly via secondary impacts since they are the first to be made redundant during public sector cuts and they dominate industries such as retail and manufacturing which are the most suitable for relocation abroad (Clancy and Jenkins 2009). This unemployment causes a loss of income resulting in severe financial strain; with debt continuing to accumulate as they struggle to find a job and suffer with the social stigma associated with unemployment, individuals feel out of control with increasing levels of stress, depression deteriorating their health (Price et al. 2002). As money becomes increasingly tight basic needs such as nutrition and access to healthcare impact their physical health, this lack of finances means decreased opportunity for social activities and coping strategies further worsening their mental health (Price et al. 1998). Some people may lose hope all together and turn to health destructive behaviour such as smoking, alcohol and perhaps even suicide as described earlier. However in areas of high unemployment, the presence of many individuals in the same situation may protect individuals from such psychosocial impacts (Brenner and Mooney 1983).
The more affluent are also at risk of unemployment, many directly from the recession as higher socio-economic groups dominate the financial sector, however like the lower-classes the decreased lending and public sector cuts cause widespread unemployment but on a much smaller scale. The contrast with that of the lower-classes is that their higher salary over the years often enables them to have sufficient savings that can act as a buffer, whilst they wait for the economy to recover and apply for new jobs, which they are more likely to get due to their higher qualifications (Elliott et al. 2010). These wealthier individuals suffer more in terms of psychological health; many experience a loss of identity, as their job defines them and without it they feel lost and unaware of their place in society (Price et al. 1998). Their physical health may not be affected with finances available to provide food and other essentials, however it is these same finances that have the capacity to fund smoking, alcohol and even drug abuse.
Unemployment indirectly impacts on the health of their entire family. The Office of Population, Censuses and Surveys revealed wives of unemployed men experienced 20% excess deaths to those with employed husbands (Moser and Goldblatt 1990). There are also strong links between unemployment and domestic violence, unwanted pregnancy, divorce and impaired infant growth (Mathers and Schofield 1998). Social support from family and friends is crucial to combat unemployment’s negative psychological effects, but unemployment itself disrupts social support and friendship networks, often resulting in conflict (Price et al. 1998). The financial strain of recession puts significant pressures on parenting and ultimately deteriorates the health and development of their children which will affect them throughout their life-course (Solantus et al. 2004). This is accentuated by the government increasing the cost of university, denying those with potential in lower social-classes, the opportunity of upward mobility. These family impacts are more prominent in lower socio-economic groups, with greater financial burden meaning lower control and more pressure on relationships.
Some of the more indirect impacts of recession on health are not directly linked with unemployment, although some such as job insecurity and unsuitable reemployment may be associated with it.
Job insecurity is a feature of modern Britain with our shift from manufacturing to service sector employment still struggling against strong international competition. The economic downturn increasing unemployment worsens the UK’s already high job insecurity, with more people worried about their own or their company’s longevity. The mechanism by which job insecurity impacts health is similar to that of unemployment; many view job loss anticipation as the first step of unemployment. With Petterson et al.(2005) observing insecure workers exhibiting declining concentration and increased irritation and long term sick leave it’s no wonder they may soon become unemployed. Dekker and Shaufeli (1995) even argue that it may be more difficult to cope with job uncertainty due to not knowing what to expect. These impacts relate to feelings of low control over their future, but this differs for the individual, the level of insecurity and the prospect of reemployment. Redundancies within an organisation can affect the health of all the employees, with those remaining exhibiting a lack in trust of those in power, competition with other workers at risk and resentment for those already redundant (Campbell and Pepper 2006).
Unsatisfactory reemployment is an indirect impact due to decreased job opportunities, affecting those who have recently become unemployed and those looking for first time employment. The depression caused by unemployment itself severely reduces the chances of reemployment and the longer they spend unemployed they become deskilled making it even more difficult to escape the ‘spiral of disadvantage’ (Price et al. 2002). Most would think it’s beneficial to gain employment and income, but the pressures of financial strain make lower socio-economic groups more likely to accept unsustainable employment, that is temporary, high-demand and low-pay. Whilst it may help financially in the short-term it won’t have any long-term improvements and due to the type of work being unrewarding, monotonous and insecure means it has negative health implications such as depression, hence it may be just as bad as unemployment (Grzywacz & Dooley 2003).
Along with unemployment and pay cuts, a higher cost of living involving increasing VAT and escalating food and petrol prices all create financial strain, especially in the lower-classes, which itself causes negative health effects as discussed with unemployment. However this decreased disposable income reduces public spending, causing the local economy to fail (Brenner and Mooney 1983). Although large areas such as cities contain people of all socio-economic status, they are segregated into smaller communities of a particular social-class. Lower-class communities have the least public spending so are the worst affected;
places like the high street which are important hubs for social integration soon become dilapidated, increasing levels of depression, crime and social exclusion, severely impacting the health of the community (Yuill 2009). Increased poverty and ill health puts tremendous pressure on public services such as social welfare, primary health care and the police. Public sector cuts in these areas further worsen the health impacts by reducing their ability to cope and reducing availability of such services to an ever increasing number of people who require them.
In conclusion, the economic downturn has several impacts on the health of the UK, both directly and indirectly. These impacts do affect everyone so no groups should be ignored, but it’s clear that socio-economic status influences the mechanisms and severity by which it impacts people’s health. The majority of research indicates that lower-classes are the worst affected; they are most likely to become unemployed, experience job insecurity and undertake unsuitable employment (Clancy and Jenkins 2009). They also experience greater financial strain from pay cuts and increased cost of living, all of which result in more serious health connotations. Higher socio-economic groups don’t experience such a financial loss and are considered to have more control over their futures due to assets such as savings and good qualifications, but they do experience negative mental health impacts, such as loss of identity, different to that of lower-classes (Price et al. 1998). Indirect impacts of the recession such as reduced public spending and public sector cuts reduce service availability, particularly in deprived areas where they are needed the most. It is important to understand that it’s not just about individuals, the recession indirectly affects family and friends and that lower-class families raising a child in times of struggle will severely affect that child’s health throughout their life-course (Marmot and Bell 2009).
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