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Links Between Unemployment And Health Health And Social Care Essay

Unemployment and health are recognised as being linked, though the relationship is complex. It is unclear how much continued unemployment is a result of ill health, and how much ill health is due to unemployment. The purpose of this report is to begin to explore any links between unemployment and health in Fife, to highlight those areas in Fife where problems lie and to add to the evidence and knowledge on this subject for those working within the unemployment and health sectors.

This report uses information held within the Fife Public Health Dataset to examine the relationship between unemployment and health by looking at those areas which have the highest levels of unemployment and the highest incidence of premature mortality in Fife. Information contained within this report can be found at the Fife Public Health Dataset website: www.show.scot.nhs.uk/fhb/fifepublichealthdataset/index.htm. The dataset contains a large amount of data from administrative sources, as well as information taken from surveys. Some administrative data also tends to be two or three years behind the current date, and may not therefore take into account the most recent initiatives or changes within a small area.

Literature Review

A literature review was conducted as part of the background to this report. The review found the link between unemployment and health to be well established in the literature. Evidence shows there is a link between unemployment and increased mortality, but that the observed link is stronger for population based studies than studies based around the health of the individual. Self reported health is lower during periods of unemployment and use of health services is increased. Decreased levels of mental health are particularly associated with unemployment, but a causal link has yet to be clearly established. There seems to be gap in the literature in relation to black and ethnic minorities, and the evidence for the effect of unemployment on women is less well reported than the effect on men. The full literature review is appended to this report (appendix one).

The Health Development Agency have also recently reviewed the literature relating to unemployment and health(1). The evidence review ‘Worklessness and health – what do we know about the causal relationship?’ included the conclusions:

there is a relationship between unemployment and poor health, although causation is not proven.

there is a strong association between deprived areas, poor health, poverty and worklessness although the exact relationship is not clear, and

given the potential differences on morbidity and life expectancy within local authorities, there may be an argument to examine the geographical dimension on worklessness and health at local authority ward level.

Background and Methods

The Fife Public Health Dataset contains information on unemployment levels across Fife at Local Authority Ward and Community Health Partnership levels. This information comes from NOMIS (the branch of National Statistics dealing with labour market information and statistics) and relates to the number of people who are registered as unemployed, and is based entirely upon claimants. What this information cannot do is quantify the number of people who are unemployed but who do not appear on unemployment statistics (sometimes referred to as the hidden unemployed). However, statistics from the benefits system can provide information on people who are unemployed through long term disability. Information on the number and percentage of the working age population who claim a number of benefits is also available at a local level on the Fife Public Health Dataset. This report includes information on people registered as unemployed, and people claiming job seekers allowance, income support and incapacity benefit.

For this report information on health within Fife has been limited to information on mortality. This information comes from the General Registrar Office (Scotland) and is presented here as standardised death rates. Standardisation allows comparison between areas, smoothing out differences attributable to the age structure of the ward populations, and is particularly useful when looking at a small number of events. Information on all causes of death as well as death from specific causes (coronary heart disease, cancer and stroke) have been presented in this report. The information is presented as deaths under the age of 65.

The population information contained in the Fife Public Health Dataset is based on the Community Health Index. It is this population information which has been used in this report to calculate percentages and rates of unemployment and of mortality.

The information used in this report has been limited to mortality for both sexes, and has not considered differences in mortality between men and women. Neither have differing unemployment rates between men and women been included in the analysis. Health information has been limited to mortality and has not considered morbidity.

The geographic boundaries used in this report are the 1996 based wards of which there are 92 in Fife. As well as ward names this report also makes reference to Fife Council's commonly used 3 geographic administrative areas (Central, West and East) and to NHS Fife's 3 Community Health Partnerships (CHPs) (Dunfermline and West Fife, Glenrothes and North East Fife, Kirkcaldy and Levenmouth).

2. Measuring unemployment

The tables which follow show the 10 wards in Fife with the highest or lowest percentage for each indicator. Within this report 10 is an arbitrary cut off point.

Unemployment measured by claimant count

Table one shows those wards which in June 2002 had the highest percentage of their working age population registered as unemployed. Of these 10 wards, 9 are in Central Fife area, or in the Kirkcaldy/Levenmouth CHP area and one is in West Fife or in the Dunfermline and West Fife CHP area.

Table One: Unemployment count by ward at June 2002; percentage unemployed, number unemployed and population in the working age population

Ward Number

Ward Name

Percentage unemployed

Number unemployed

Population aged 16-64

-

Fife (all wards)

3.8

8858

236310

38

Linktown

10.2

243

2394

48

Smeaton/Overton

9.0

197

2193

49

Sinclairtown/Gallatown

7.7

149

1937

43

Raith/Longbraes

7.5

183

2496

53

Denbeath/Muiredge

7.5

167

2231

75

Cardenden

7.2

154

2130

55

Methilhill

7.2

169

2358

35

Burntisland West/Auchtertool

7.2

143

1996

51

Thornton/Wemyss

6.7

169

2523

54

Methil

6.6

174

2634

Source: NOMIS

Linktown, Smeaton/Overton and Sinclairtown/Gallatown have unemployment rates more than twice the Fife average. Linktown’s is nearly 3 times that of Fife.

The 10 wards listed in Table One tend to appear as the highest 10 wards for unemployment each year. The table below show the unemployment rate and the ward ranking of these wards for the years 1998 to 2002.

Table Two: Percentage of working age population registered as unemployed by ward; 1998-2002

Percentage unemployed (Ranking)

Ward Name

2002

2001

2000

1999

1998

Fife (all wards)

3.8 (50)

3.7 (48)

3.6 (43)

4.6 (44)

4.6 (43)

Linktown

10.2 (1)

9.1 (1)

9.7 (1)

12.5 (1)

10.1 (2)

Smeaton/Overton

9.0 (2)

8.7 (2)

9.4 (2)

10.4 (3)

9.4 (3)

Sinclairtown/Gallatown

7.7 (3)

8.0 (3)

8.3 (3)

10.6 (2)

10.7 (1)

Raith/Longbraes

7.5 (4)

6.8 (6)

7.0 (6)

8.8 (6)

8.1 (7)

Denbeath/Muiredge

7.5 (5)

7.0 (5)

7.8 (7)

8.6 (7)

9.4 (4)

Cardenden

7.2 (6)

7.3 (4)

7.6 (4)

8.8 (5)

7.1 (16)

Methilhill

7.2 (7)

6.5 (10)

6.6 (8)

8.3 (8)

8.1 (5)

Burntisland West/

Aucthertool

7.2 (8)

6.5 (11)

7.1 (5)

9.1 (4)

6.5 (21)

Thornton/Wemyss

6.7 (9)

6.6 (8)

6.0 (13)

6.3 (24)

7.7 (9)

Methil

6.6 (10)

6.7 (7)

6.0 (15)

6.6 (18)

6.6 (19)

Source: NOMIS

All of these 10 wards have unemployment rates considerably higher than the Fife average, with the highest 5 wards being twice the Fife rate. Most of these wards have been consistently in the highest 10 for the previous 5 years. Linktown, Smeaton/Overton and Sinclairtown/Gallatown have remained the highest 3 wards for unemployment. Whilst the unemployment rate in Sinclairtown/Gallatown appears to be falling the percentage of people remaining unemployed in Linktown and Smeaton/Overton remains more than twice the Fife average.

Looking at unemployment through the benefits system

In 1996 Job Seekers Allowance replaced Income Support as the benefit for people on low income who are unemployed. Income Support remains as a benefit for people who are not required to look for work eg. pensioners, lone parents, sick and disabled people. Whilst Income Support was conditional only on income and not on national insurance contributions, Job Seekers Allowance is claimed on the basis of low income and/or national insurance contributions. Job Seekers Allowance can be claimed by people under pensionable age who work less than 16 hours per week.

The tables below show the percentage of working age population in Fife claiming a series of benefits: Job Seekers Allowance, Income Support and Incapacity Benefit by ward for the years 1998 to 2000. As with the unemployment tables presented above, these table only show the highest 10 wards in Fife.

Table Three: Percentage of working age population claiming job seekers allowance by ward; 1998-2000

Percentage of working age population claiming Job Seekers Allowance

Ward Name

2000

1999 (rank)

1998 (rank)

Fife (all wards)

3.0

3.5

4.0

Crosshill and Lumphinnans

10.8

13.7 (1)

13.2 (1)

Smeaton/Overton

7.6

9.4 (2)

10.3 (2)

Buckhaven/Macduff

7.4

7.7 (7)

8.6 (6)

Dysart/Ravenscraig

7.4

8.0 (4)

9.4 (3)

Fair Isle/Chapel

7.3

8.3 (3)

9.0 (4)

Hayfield

6.8

7.8 (6)

7.9 (10)

Methil

6.6

7.5 (9)

8.3 (8)

Dunfermline Woodmill

6.6

7.5 (9)

8.8 (5)

Glenwood North

6.2

5.2 (18)

6.0 (21)

Methilhill

5.8

7.9 (5)

8.6 (7)

Source: NOMIS

Seven of the 10 wards listed are within the Kirkcaldy/Levenmouth CHP, or Central Fife. The three wards marked in bold (Smeaton/Overton, Methilhill and Methil) are also in the 10 wards with the highest unemployment rates. Eight of the 10 job seekers allowance wards have rates more than twice that for the whole of Fife. The ward with the highest percentage of people claiming job seekers allowance (Crosshill and Lumphinnans) has a rate of 10.8 which is more than 3 times greater than the Fife average. Nine of the 10 wards for 2000 were also in the highest 10 in 1999 and 1998. The rate in Crosshill and Lumphinnans has remained consistently at more than three times the Fife average between 1998 and 2000. Whilst the rate in Smeaton/Overton appears to be falling this ward still has the second highest percentage of people claiming job seekers allowance. Smeaton/Overton is also one of 2 wards which appear in the highest 10 wards for people registered unemployed and people claiming job seekers allowance.

Income Support is conditional on income not on national insurance contributions. In general income support is only available to those people who are not required to be available for work such as pensioners, lone parents, sick and disabled people, and can be claimed by anyone in these groups who is aged 16 years and over and who works less than 16 hours per week. Since this report is about those of working age the tables presented below have been restricted to information about those of working age and does not include those aged 65 and over.

Table Four: Percentage of working age population claiming Income Support

Percentage of working age population claiming Income Support

Ward Name

2000

1999 (rank)

1998 (rank)

Fife (all wards)

9.1

9.2

9.6

Smeaton/Overton

21.5

20.4 (2)

22.0 (1)

Ballingry and Lochore

19.3

20.6 (1)

21.1 (2)

Buckhaven/Macduff

18.0

18.2 (3)

19.1 (3)

Sinclairtown/Gallatown

17.1

15.3 (9)

16.0 (9)

Dysart/Ravenscraig

16.8

15.6 (8)

16.4 (7)

Dunfermline Woodmill

16.2

16.4 (4)

18.3 (4)

Methilhill

16.1

16.0 (6)

15.9 (11)

Methil

16.1

16.3 (5)

15.3 (13)

Kirkland/Mountfleurie

15.7

15.1 (13)

14.3 (19)

Crosshill and Lumphinnans

15.5

16.0 (7)

17.0 (5)

Source: NOMIS

Seven of the wards with the highest percentage of people claiming Income Support are within Central Fife area (Kirkcaldy and Levenmouth CHP). The remaining 3 wards are from West Fife area. The top 3 wards Smeaton/Overton, Ballingry and Lochore and Buckhaven/Macduff have remained the top 3 wards between 1998 and 2000, all 3 have consistently had percentage of Income Support claimants at twice the Fife rate. As with other benefit tables those in the top 10 during 2000 have for the most part been in the top 10 for the previous 2 years. The four wards in bold type face (Smeaton/Overton, Sinclairtown/Gallatown, Methilhill and Methil) are also in the top 10 wards for registered unemployed. Seven of the wards in the table (marked in italics) also appear in the top 10 wards for Job Seekers Allowance, highlighting these wards as having populations with low incomes regardless of whether they are able to seek employment or not.

Incapacity Benefit is a benefit based on national insurance contributions and is paid to those aged under 65. The tables below show those wards in Fife which have the highest percentage of their population claiming income support and incapacity benefit.

Table Five: Percentage of working age population claiming Incapacity Benefit by ward; 1998-2000

Percentage of working age population claiming Incapacity Benefit

Ward Name

2000

1999 (rank)

1998 (rank)

Fife (all wards)

6.3 (45)

6.3 (43)

6.2 (43)

Crosshill and Lumphinnans

31.4

25.8 (1)

27.3 (1)

Ballingry and Lochore

16.5

16.4 (2)

16.9 (2)

Blairhall and Valleyfield

13.8

13.7 (3)

13.7 (3)

Kennoway

13.3

13.2 (4)

12.4 (4)

Cardenden

13.2

12.9 (5)

12.4 (5)

Methilhill

12.8

12.4 (6)

11.1 (9)

Methil

12.2

12.2 (7)

11.8 (6)

Denbeath/Muiredge

11.9

11.6 (8)

11.3 (8)

Lochgelly North

11.9

11.6 (9)

11.8 (7)

Leven West

11.6

11.5 (10)

10.6 (10)

Source: NOMIS

Half of the wards listed in the table above are from Kirkcaldy/Levenmouth CHP or Central Fife area, the remaining four are within West Fife area. The 3 wards with the highest levels of Incapacity Benefit are all in West Fife. The wards marked in bold (Cardenden, Methilhill, Methil and Denbeath/Muiredge) are also amongst the wards with the highest percentage of working age population registered as unemployed. Three of the wards (marked in italics) also appear in the table for top 10 wards claiming job seekers allowance.

Half of these wards have rate of incapacity benefit at twice the Fife level. In Crosshill and Lumphinnans ward the level of incapacity benefit is 5 times that of Fife.

Some conclusions on the unemployment tables

By and large for unemployment claimants the same wards appear in the top 10 for the past 5 to 6 years with the top 2 or 3 remaining at the top. With Job Seekers Allowance it is the same wards that appear in the top 10 during the years 1998 to 2000. The wards where unemployment is highest are in Kirkcaldy/Levenmouth CHP area or Central Fife. Benefits data such as Job Seekers Allowance, Income Support and Incapacity Benefit can tell us something about the unemployed adult population in addition to the labour market unemployment figures.

There is some overlap between those areas featuring high for unemployment and those featuring high for benefit claimants, these include:

Smeaton/Overton

Methilhill

Methil

Cardenden

Denbeath/Muiredge

Sinclairtown/Gallatown

Three wards (Crosshill and Lumphinnans, Methilhill and Methil) feature in all 3 of the benefit tables.

Health

One of the known indicators of inequalities in health is premature mortality (deaths in those aged less than 65). The Fife Public Health Dataset contains information on deaths in those aged under 65. The following tables show deaths in the under 65s for all causes, and for selected causes (cancer, coronary heart disease and stroke) for the years 2000 to 2002. Information in the tables is presented as a standardised rate. Standardisation allows comparison between areas, smoothing out differences attributable to the age structure of the ward populations, and is particularly useful when looking at a small number of events. Because of the small number of deaths occurring each year in each ward 3 years of data have been combined.

Table Six: All cause mortality rate per 10,000 population aged under 65, 2000-2002

Ward

Rate per 10,000 population

Fife (all wards)

69.9

Kirkland/Mountfleurie

132.5

Dunfermline Woodmill

131.5

Methil

131.2

Dunfermline Linburn

118.2

Hill of Beath

115.9

Rosyth South and West

108.4

Cowdenbeath Central

107.5

Denbeath/Muiredge

107.4

Dunfermline North and Halbeath

106.3

Oakley and Saline

105.7

Source: CHI and General Register Office (Scotland)

Kirkland/Mountfleurie appears as the ward with the highest death rate among the under 65s (132.5 per 10,000 population) a rate almost twice that for the whole of Fife. Dunfermline Woodmill is one of the wards which appears in the highest ten wards for both jobseekers allowance and income support claimants. Methil ward is also in the highest 10 wards for those registered unemployed and in all 3 benefits tables. One other ward (Denbeath/Muiredge) also features in the tables of highest 10 wards with people registered unemployed and people claiming incapacity benefit. Three wards Kirkland/Mountfleurie, Dunfermline Woodmill and Methil have premature mortality rates nearly twice the rate for the whole of Fife.

Table Seven: Cancer mortality rate per 10,000 population aged under 65; 2000-2002

Ward

Rate per 10,000 population

Fife (all wards)

23.6

Collydean/Balgeddie

55.7

Hayfield

45.8

Burntisland West/Auchtertool

45.1

Cowdenbeath Central

43.2

Denbeath/Muiredge

42.5

Cardenden

40.2

Dysart/Ravenscraig

40.2

Bowhill/Linglassie

38.6

Hill of Beath

38.3

Methil

38.3

Source: CHI and General Register Office (Scotland)

Collydean/Balgeddie has the highest premature cancer mortality rate (55.7 per 10,000 population), more than twice the Fife rate. However, it does not feature in any of the unemployment or benefit tables. Six of the other wards (Hayfield, Burntisland West/Auchtertool, Denbeath/Muiredge, Cardenden, Dysart/Ravenscraig and Methil) do feature in at least one of the unemployment or benefit tables

Table Eight: Coronary heart disease mortality rate per 10,000 population aged under 65; 2000-2002

Ward

Rate per 10,000 population

Fife (all wards)

12.6

Dunfermline Woodmill

40.4

Methil

35.8

Rosyth South and West

30.5

Hill of Beath

29.3

Bowhill/Kinglassie

26.9

Inverkeithing South & North Queensferry

26.7

Rosyth West & Dockyard

26.6

Cowdenbeath Foulford

26.1

Rosyth East

24.2

Sinclairtown/Gallatown

23.9

Source: CHI and General Register Office (Scotland)

Eight of the wards shown in table eight have coronary heart disease mortality rates more than twice the Fife rate. Dunfermline Woodmill, Methil and Sinclairtown/Gallatown are amongst the highest wards in at least one of the unemployment and benefit tables.

Table Nine: Stroke mortality rate 10,000 population aged under 65, 2000-2002

Ward

Rate per 10,000 population

Fife (all wards)

3.0

Dunfermline Woodmill

16.4

Kirkland/Mountfleurie

11.4

Rosyth West & Dockyard

10.1

Kinghorn/Invertiel

8.8

Oakley & Saline

8.6

Cupar North

7.9

Leslie/Whinnyknowe

7.8

Pathhead/Victoria

7.7

Carnock, Cairneyhill & Torryburn

7.4

Buckhaven/Macduff

7.4

Source: CHI and General Register Office (Scotland)

All of the wards in Table Nine have a stroke mortality rate per 10,000 population that is more than twice the Fife rate. Three of the wards (Dunfermline Woodmill, Kirkland/Mountfleurie and Buckhaven/Macduff) are also amongst the highest wards in the tables on unemployment and benefit.

4. Conclusions

The literature review concluded that the link between unemployment and health is well established. Evidence shows that there is a link between unemployment and increased mortality, but that this link is stronger when reviewing population based studies than studies based around the health of the individual.

From the information presented in this report there is some overlap between those areas in Fife which have high rates of unemployment and/or benefit uptake and premature mortality, eg Methil ward appears in all of the benefit tables, the unemployment tables and the all cause and cancer mortality tables, Dunfermline/Woodmill is amongst the highest wards in 3 of the premature mortality tables and appears in 2 of the benefit tables. Although some of the wards are in both the premature mortality tables and the unemployment and benefit tables this is not true for all of the wards. However, as was previously stated all of the tables show only the highest 10 wards and it may be that the other wards fall within the next group of 10 wards.

Further analysis of the information by age group and by length of time on benefit would be a good starting point for considering other aspects of ill-health within those wards which consistently appear in tables relating to unemployment and benefits and those tables relating to premature mortality.

This information presented in this paper should be useful to those working with the unemployed and particularly with those working to get people off benefits and into employment. It will also be useful to those in the health sector in focusing health improvement work on those who are living on benefits.

References

1. Mclean, C., Carmona, C., France, S., Wholgemuth, C. and Mulvihill, C. (2005). Worklessness and health – what do we know about the causal relationship? (1st edition) London:HDA

Appendix One

UNEMPLOYMENT AND HEALTH - A LITERATURE REVIEW

Summary

There is an abundance of literature available about the impact of unemployment on health, with a peak of interest around the early 1980’s, when unemployment was becoming a significant political and social issue in the UK.

There is an undoubted link between mental health and unemployment, and this well reported in the available literature. However, the causality between the two is disputed, with thinking tending towards the theory that those with poor mental health are more likely to lose their jobs and be unable to regain employment than those with better mental health.

There is also an established link between unemployment and mortality, but this link is stronger when the research focuses on population based data, suggesting that the prevalence of unemployment can safely be used as an indicator for increased risk of mortality at a population level.

Methodology

Literature Search

A literature search was undertaken on AMED, ASSIA, BNI, Cinahl, Cochrane Library, ERIC, HMIC, Medline, PsychInfo and Social Work Abstracts using the search terms:

unemployment

health

mortality

morbidity

coronary heart disease

cancer

mental health

cardiovascular disease or

stroke

All search terms were entered as both subject headings and as keywords and truncated as appropriate to ensure that the search was as sensitive as possible. The results were restricted to English language only and (where the database allowed) to reviews, systematic reviews and meta-analyses. References for the retrieved articles were also scanned for additional articles not retrieved by the literature search.

Only articles which specifically looked at the correlation unemployment and health were considered, although these criteria excluded some of the core studies which draw conclusions about the effect of unemployment on health, but which look primarily at inequality (notably the Whitehall and Whitehall II studies). These are included as evidence in articles which are included in this review, so they were not specifically included here. Articles which looked at both population based studies and individual record linkage studies were included.

No date limit was set for the articles retrieved, acknowledging that much of the important work on unemployment and health in the UK was undertaken in the early 1980’s,

Critical Appraisal/Quality of Evidence

An attempt was made to appraise all articles using the SIGN Methodology Checklist1, although few of the articles fitted the checklist criteria.

The majority of articles considered were summary review articles, and these did not follow a systematic review structure. One study which claimed to be a cohort study was considered2, although this was actually a retrospective record linkage analysis, again making critical appraisal challenging. One meta-analysis3 was retrieved from the search, and while this is a good quality article in itself, it acknowledges the limitation of only being able to include articles which considered statistical information, which are not prevalent in the current literature, leading to a possible bias in the reported results.

Unemployment

The scope of this review was to look at unemployment in terms of those individuals between 16 and 65 who were involuntarily out of work. The definition of unemployment varies between self reported unemployment (usually studies based on census data or retrospective record linkage studies), or at worklessness, which also includes individuals who choose, for one reason or another, not to take paid employment as well. The inclusion of those who choose not to work may cause an underestimation of the effects of involuntary unemployment.

Mental Health

Suicide and parasuicide

The link between suicide and unemployment has been clearly identified by a number of studies2,4,5, although the causal link of this association has yet to be established. Blakely and Collings2 suggest that approximately 50% of this increase in risk of suicide could be attributable to unemployment, however Platt6 suggests that there is more evidence for psychiatric illness preceding unemployment than vice versa.

The relative risk of parasuicide (unsuccessful suicide attempts or deliberate self harm behaviours) are clearly linked to unemployment, with Platt6 estimating a 19:1 relative risk of parasuicidal behaviour among those who had been unemployed for more than 12 months compared to employed persons. The same article identified a steep gradient in relative risk with duration of unemployment, although McKee-Ryan et al3 commented that poor mental health also reduces the opportunity for re-employment, which might explain this trend.

McLean et al7 also reported links between unemployment and suicide or parasuicide, noting at the same time that levels of social support, geography, gender, age and type of employment seem to be confounders. Bartley8 also identified that the impact of unemployment on suicide and parasuicide is mediated by poverty and financial anxiety and that stigma and social isolation also have a key role in the contribution to poor psychological health.

Other mental health conditions

According to McLean et al7, “evidence suggests that there is a strong association between unemployment and increased psychological and psychiatric morbidity.” Several studies support this, identifying a clear relationship between unemployment and a variety of psychiatric disorders3,4,5,9.

Shortt10 found that those unemployed living within areas of high unemployment show lower emotional distress than those living in areas of low unemployment. This article also demonstrated that the levels of depression, anxiety and somatization regressed with re-employment or formal retirement.

Jin et al5 found that the disruption of community and social relationships, greater risk behaviours, stress and bereavement reactions were mechanisms through which unemployment may “exert a detrimental effect on health”.

Mortality

The evidence for an association between mortality and unemployment is established, but the nature of the association is still under debate. McLean et al7 identify that the evidence supports a strong association at an aggregate level, and Jin et al5 have also identified a strong link at a population level, with a weaker link between mortality and unemployment at an individual level. The research undertaken by Van Lenthe et al11 also identified that there is an increased risk of mortality for men living in the quartile of neighbourhoods with the highest unemployment rates compared to those living in the quartile of neighbourhoods with the lowest unemployment rates.

At an individual level, Lynge12 identified a 40-70% increased risk of lung cancer among unemployed men even when social class, smoking, alcohol and previous sick leave are accounted for. Worryingly, the risk was found to persist long after the unemployment started. There was a higher risk of cancer generally among unemployed compared to employed men, however the link to lung cancer was the strongest.

Shortt10 found a short term link between unemployment and mortality for older men and a strong correlation between unemployment and ischemic heart disease. The research also noted that there was an increase in mortality rates generally for men over 45, but an improvement in mortality rates for unemployed men under 45 and unemployed women under 65.

Weber and Lehnert13 looked specifically at unemployment and coronary heart disease, but found the evidence for a link unclear.

Morbidity

Investigating a link between morbidity and unemployment was outside the scope of this review, however, the evidence reviewed establishes a strong link between disease morbidity and with self reported poor health10. Weber and Lehnert13 also reported higher health service use from unemployed men than employed men, although McLean et al7 reported that the evidence for this was contradictory and that no overall pattern was observable.

A lack of serious illness prior to unemployment was identified by Shortt10, which suggests that unemployment may be a direct cause of an increased risk of morbidity.

Gender, age and other issues

McLean et al7 commented that there is a dearth of literature on black and minority ethnic groups and that gender is under-reported, with the majority of studies concentrating on male unemployment. Shortt10 looked at the impact of unemployed spouses, and wives were seen to feel the health effects of the unemployment of their partners through an increased risk of cancer, suicide and ischemic heart disease, suggesting that this link could be related socio-economic status rather than directly to unemployment. Where gender issues were considered, the effects of unemployment on women tended to be less severe than on men11.

Age issues are considered, with one article looking specifically at the effect of unemployment in young people, where suicide (particularly amongst young men) is a key issue7,9.

Conclusion

The link between unemployment and health is well established in the literature. Decreased levels of mental health are particularly associated with unemployment, but a causal link has yet to be clearly established. Evidence shows that there is a link between unemployment and increased mortality, but that this link is seen to be stronger when reviewing population based studies than studies based around the health of the individual. Self reported health is lower during periods of unemployment and use of health services is increased. There seems to be a gap in the literature in relation to black and ethnic minorities, and the evidence for the effect of unemployment on women is less well reported than the effect on men.

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