Abstract
Studies from single countries suggest that local labour market conditions, including rates of employment, tend to be associated with the health of the populations residing in those areas, even after adjustment for individual characteristics including employment status. The aim of this study is to strengthen the cross-national evidence base on the influence of regional employment levels and individual worklessness on health during the period of the Great Recession. We investigate whether higher regional employment levels are associated with better health over and above individual level employment. Individual level data (N = 23,078 aged 15–64 years) were taken from 16 countries (Austria, Belgium, Czech Republic, Denmark, Finland, France, Germany, Hungary, Ireland, Netherlands, Norway, Poland, Portugal, Spain, Sweden and United Kingdom) participating in the 2014 European Social Survey. Regional employment rates were extracted from Eurostat, corresponding with the start (2008) and end (2013) of the Great Recession. Health outcomes included self-reported heart or circulation problems, high blood pressure, diabetes, self-rated health, depression, obesity and allergies (as a falsification test). We calculated multilevel Poisson regression models, which included individuals nested within regions, controlling for potential confounding variables and country fixed effects. After adjustment for individual level socio-demographic factors, higher average regional employment rates (from 2008 to 2013) were associated with better health outcomes. Individual level worklessness was associated with worsened health outcomes, most strongly with poor self-rated health. In models including both individual worklessness and the average regional employment rate, regional employment remained associated with heart and circulation problems, depression and obesity. There was evidence of an interaction between individual worklessness and regional employment for poor self-rated health and depression. The findings suggest that across 16 European countries, for some key outcomes, higher levels of employment in the regional labour market may be beneficial for the health of the local population.
Highlights
Since the onset of the global financial crisis in 2008 and the subsequent recession experienced in many countries, there has been renewed interest in the role of unemployment, job insecurity and worklessness in influencing population health (Bambra, 2011)
Our results demonstrate that higher regional employment levels during 2008 and 2013, as well as the average regional employment rate across the period of the Great Recession, were associated with reduced risk of most health outcomes
When we investigated the interaction between the regional employment rate and individual level worklessness we found interesting results for the depression and poor self-rated health outcomes
Summary
Since the onset of the global financial crisis in 2008 and the subsequent recession experienced in many countries, there has been renewed interest in the role of unemployment, job insecurity and worklessness in influencing population health (Bambra, 2011). This study aims to strengthen the cross-national evidence base on the influence of individual worklessness and regional employment levels (as a measure of the local labour market) on health during the Great Recession. Worklessness - being outside the labour market due to unemployment (out of work but actively looking for a job); lone parenthood; and long-term disability (Gabbay et al, 2011), is associated with poorer health and social exclusion (Bambra, 2011). Links between unemployment and poor health have conventionally been explained through two inter-related concepts: the psychosocial effects of unemployment (e.g. stigma, isolation and loss of self-worth) and the material consequences of unemployment (e.g. wage loss and resulting changes in access to essential goods and services) (Bambra, 2011)
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