Abstract
This paper uses individual-level longitudinal data on working-age Finns to examine the health effects of economic fluctuations during a period of economic decline (1989–1996) and recovery (1997–2007) in Finland. We used a nationally representative, longitudinal sample formed by linking population, employment and mortality registers (n = 698,484; 7,719,870 person-years). We implemented a region fixed-effect model that exploits within-regional variations over time in the unemployment rate to identify the effect of economic fluctuations on mortality, controlling for individual employment transitions. Unemployment rates increased from 5.2 % in 1989 to 19.8 % in 1996, declining gradually thereafter and reaching 9.7 % in 2007. Results indicate that these large fluctuations in the economy had no impact on the overall mortality of most working age Finns. The exception was highly educated men, who experienced an increase of 7 % (Rate ratio = 1.07, 95 % confidence interval 1.04, 1.10) for every one-point increase in the regional unemployment rate during the period 1989–1996 due to increased mortality from cardiovascular disease and suicide. This increase, however, was not robust in models that used the employment to population ratio as measure of the economy. Unemployment rates were unrelated to mortality among females, lower educated men, and among any group during economic recovery (1997–2007). For most Finns, we found no consistent evidence of changes in mortality in response to contractions or expansions in the economy. Possible explanations include the weak impact of the recession on wages, as well as the generous unemployment insurance and social benefit system in Finland.
Highlights
A growing literature suggests that job loss is associated with poorer health and higher mortality [1,2,3,4,5,6]
Over the follow-up period, 115,671 deaths were observed in men and 48,094 in women. 65 % of all person-years corresponded to stable employment, 3 % of person-years to job loss, and 3 % to a return to work, while 23 % of the person-years were spent out of the labor force. 29 % of the sample had a tertiary education while 32 % had only basic or unknown education
In a model that examined interactions with education, we found that an increase in unemployment rates in year t - 2 during the deep economic recession (1989–1996) was associated with an increase in mortality among highly educated men (RR 1.05, 95 % CI 1.01, 1.09), but this effect was not observed for years t - 3 to t - 6 (Supplementary Table 2, in online resource)
Summary
A growing literature suggests that job loss is associated with poorer health and higher mortality [1,2,3,4,5,6]. Studies have started to examine this question using individual-level data and have found that there is a ‘contextual’ protective effect of economic recessions over and above the increased mortality effect of individual job loss [13, 14]. They suggest that recessions may have heterogeneous effects by increasing mortality among the unemployed while reducing mortality among the employed [14, 15]. Little research has examined how mortality changed in response to these dramatic changes in the Finnish economy [18]
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