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The impact of the recession on health Eva Elliott, Emily Harrop, Michael Shepherd, Heather Rothwell, Gareth Williams.

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Presentation on theme: "The impact of the recession on health Eva Elliott, Emily Harrop, Michael Shepherd, Heather Rothwell, Gareth Williams."— Presentation transcript:

1 The impact of the recession on health Eva Elliott, Emily Harrop, Michael Shepherd, Heather Rothwell, Gareth Williams

2 Research objectives To identify and explain how the recession may impact directly on health and through its determinants across the social gradient. To identify additional population groups who may be particularly vulnerable or resilient to the effects of the recession To characterise the effects of previous government and public agency measures taken to respond to financial crises on health To identify and characterise the potential material, cultural, and psycho-social resources that reside within communities themselves that produce related vulnerability and resilience To map available evidence on impact to existing policy divisions and service areas in the Welsh Assembly Government, local government, regeneration, and health and social care services.

3 Methods Literature review: what is known about the effects of recession as well as the effectiveness of measures to respond to them Expert interviews: officials in two localities working in sectors associated with main determinants Policy dialogue, with national and local stakeholders, to discuss emerging findings and issues to provide the review with a context to refine conclusions and recommendations (February 2010)

4 Literature on previous recessions and health Looked at recessions elsewhere and impact of recessions in the UK in 1970s, 1980s and 1990s Focus on unemployment: key variable in considering the association between recessions and health. However different in boom and bust economies (pro and counter cyclical) Focus on impact on experience and mechanisms rather than aggregate associations (evidence of reduction on inequality, economic growth not necessarily good for health, some improvement to health during recession) Need to consider the aftermath of recession – as effects on unemployed individuals and on high unemployment areas continue


6 Unemployment and health Unemployment a key factor affecting health in a recession Some concerns over causal direction – but longitudinal studies show unemployment to be a strong independent causal factor Evidence of impact stronger for mental health


8 …than for physical health or health behaviours …


10 …even during a recession.

11 Unemployment as complex process Difference between unemployment and redundancy (some people long-term unemployed, never entered the job market) Health impacts on people already long term unemployed different to people made redundant, during a recession Difference between lay-offs due to downsizing and plant/works closure (also downsizing not just about lay-offs) Anticipation of unemployment and insecure re- employment also have negative health impacts



14 Individual factors that make a difference Socio-economic status (impact greater on lower SES) Gender (dependent on gender role and expectation with regard to work and social support) Ethnicity (little research but some showing independent negative impact) Relationship to work: employment condition v work role centrality Age (effects in middle age very different to young people struggling to enter job market) When you are made unemployed Where you live

15 Mechanisms Financial strain (cascade of disadvantage) Latent functions of work (time structure, regular social contacts, engagement in activities for collective purposes, status, and regular activity: Jahoda) Uncertainty Fairness Stigma and shame (context dependent – different in good times and bad times)

16 Level of impact On individuals On families –Impact on parental relationships –Ability to parent –Child mental health –Long term: economic inactivity seen as the norm On places where people live –Uneven geographical impact –Impact though loss of local employment, services, amenities, shops, support structures –Increase in crime, anti-social behaviour


18 Coping and resilience Coping is ‘the cognitive and behavioural efforts used to contend with events appraised as stressful.’ Lazarus and Folkman 1984 Most of the literature focuses on individual coping styles and strategies (problem based and symptom based) in relation to perceived stressors (job insecurity and job demand), how job loss is appraised and personality type Strategies aimed at finding jobs not necessarily best for health – dependent on local labour markets Most research stresses the importance of social support in minimising distress Positive self-identity important in how people cope

19 Interventions and protective policies Suggestion that governments with strong social/financial support for low income/unemployed protective of health Workplaces – supportive programmes before and during redundancies Schemes/interventions that lead to real, secure and satisfying jobs rather than stop-gaps providing activity and training but no prospect of long term secure employment (eg YOPS - (UK)) However programme that help to cope with setbacks help (eg JOBs (US) +, work experience combined programme (Sweden +)) Interventions that aimed at creating supporting environments for unemployed have been promising (Australia and Sweden)

20 Recession today Different in character to earlier recessions in UK – financial sector relatively stable previously Significant nation debt (impact on public sector) Interaction with pension insecurity, unsustainable housing loans/debt, interaction with welfare ‘reforms’ (conditionality) Impact greatest on younger people, rise in employment in post –state retirement age, impact greatest in men but set to change with public sector cuts, large increase in workless rate (for couples with dependent children, and owner occupied households)

21 Qualitative Research Interviews in two Local Authority areas with staff in sectors relevant to determinants of health in recession Areas chosen: –Blaenau Gwent – high overall deprivation –Cardiff – high internal inequalities Analysis ongoing. Primary health care interviews ongoing

22 Interviews Blaenau Gwent (n=11)Cardiff (n=7) Debt12 (3 interviewees) Unemployment1 (both areas) Children's services1 (group interview)1 Further Education11 Community development2 (1 with 2 interviewees)0 Housing21 (national perspective, no base in Cardiff) Primary health care10 Mental health2 ( 1 with 2 interviewees, 1 with 1 person with overview of both areas) 1 (2 interviewees)

23 Impacts on health and its determinants across social groups Mental health – primary impact Housing – “trapped” in unsuitable housing Financial strain mediates effects of unemployment and other factors (Weich & Lewis 1998) Financial strain Deterioration in mental health Increased insecurity of housing

24 “...if their income drops then their health is affected because they can’t afford nutrition, they can’t afford to go out which helps them in engaging within the community and with enjoyment of facilities, like leisure facilities, the council are having to increase [prices] - because of cutbacks in their resources and people can’t afford to go. They can’t access transport, transport is a major issue in this area, buses stop at five o’clock on some of the estates.” (Community development interviewee, Blaenau Gwent)

25 Vulnerable groups (1) Blaenau Gwent –Low wages –Incomplete recovery from closure of primary industries, high deprivation –Poor public transport –Small population – less per capita funding –Legacy of ill health resulting from poor air quality in the past Cardiff –Deprived areas within the city, but –More job opportunities and higher wages –Better public transport –Large population – advantages of scale

26 “I think with Cardiff there’s a lot more - We’ve got no, hardly any jobs down here, hardly any manufacturing left, the manufacturing companies we have got some of them are absolute pigs to work for. (...) I notice the difference when I go down to Cardiff on training courses that there’s – it’s like a different world down there (...) I had to go down to the Welsh Assembly to the Bay on a training course and it’s like the recession’s not there in some areas it really is, it’s a really different world and (...) I think the Valleys get forgotten (...) They can just plough money after money after money into the Valleys and I just don’t think it’s going to make any difference, it’s like a bottomless pit, we haven’t had any security in the Valleys jobwise since the pits went. None.” (Debt interviewee)

27 Vulnerable groups (2) People with greater dependence on wider community support to improve quality of life are most vulnerable The recession has increased their numbers (unemployment, repossessions) Providers of community services are also experiencing greater financial strain and expect this to worsen as need for them increases

28 “it's a relatively new service and we’re still finding our feet and when people come to cut back on things - because in the strength of unions and the strength of long established settings, usually the first things that go are the projects, the new, innovative - the new things that are trying to do things a bit differently. So it may be that some of these things will be much harder to do and possibly get lost.” (Children’s services interviewee, Cardiff)

29 Wider support for vulnerable people Extended family (both areas) – but may be compromised by financial strain Assembly initiatives – ProAct, ReAct, mortgage rescue scheme Crossroads (support for carers) – cutbacks in Blaenau Gwent Citizens Advice Bureau – no funds to link with other community services in Blaenau Gwent Credit union – short of money in Blaenau Gwent, thriving in Cardiff Access to public space, street lighting Local authority and voluntary services – reduced funding, expecting further reductions; time-limited funding for projects; Blaenau Gwent Council is biggest employer in the area Further education – fewer vocational courses, less help with transport costs in Blaenau Gwent; wide reorganisation in both areas. Jobmatch (Blaenau Gwent) – conflicting reports Flying Start - time limited funding; already resource-poor in Blaenau Gwent

30 Who are the vulnerable groups? Young people –16-18, especially those with mental health problems and/or lacking family support –16-25 looking for their first job– scarcity of jobs, lower benefit payments –18-30 more vulnerable to loan sharks (Children’s services BG, Debt Cardiff) Newly unemployed and –Over 50 –With children and mortgage Managers trying to deal with increased financial strain within organisations –impact on quality of working life for all employees

31 “when you had industry in the local area you had a community... well most of us used to work together and a lot of the adults used to mentor young people when they first started work and some of the young people we work with still require that, they still require a mentor within the workplace and that’s not how jobs or even training are offered nowadays, you know, where somebody’s working alongside them, not just monitoring them and watching them every half hour and peeping in to see what they’re up to but actually doing the job with them and showing them the ropes and that sort of thing.” (Children’s services interviewee, Blaenau Gwent)

32 How does it feel? Unfair – benefits and bankers Hopeless - Media promote negative perceptions of employment prospects and services Lonely - Increasing cultural tendency to greater isolation intensified by unemployment and loss of confidence in community support

33 “What isn’t good for mental health is sat at home doing nothing.” (Mental health services interviewee, Blaenau Gwent)

34 Is there an upside? Quick response by Assembly Government and (recently) the Southwark ruling have mitigated the effect of homelessness and job shortages on young people More jobs in employment services (Cardiff) More incentive to recycle and make links with others to swap resources An upsurge in demand for further education and training (Cardiff) More demand for debt services/advice (Cardiff) Benefit to employed people from lower housing prices and interest rates More opportunities to volunteer

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