Working worried

As more people bike or bus to work to save gas money, they thank their lucky stars that they still have a job to commute to. (Robert Neubecker / For The Times)

AS MORE people watch their home equity erode, put off retirement because their nest eggs are taking a dive, and bike or bus to work to save gas money, many are thanking their lucky stars that they still have a job to commute to.

Unstable times breed worry and stress, so there should be worry and stress aplenty right now. Nearly 8 in 10 Americans believe the country is headed in the wrong direction, according to a Gallup poll in August, and with the national unemployment rate up to 5.7% in July -- make that 7.3% in California -- millions of gainfully still-employed people who thought they were safe and secure might fear a Dickensian poorhouse closing in on them.

You'd think that the health of the nation would suffer as well, what with emotional stress and less money for medical appointments, gym memberships and healthful food. And in certain ways, health does worsen in times of economic uncertainty. Medical science has accumulated a solid body of research showing that poverty and unemployment lead to higher rates of obesity and more cases of diabetes, asthma, kidney disease, cardiovascular disease, some cancers -- the list goes on.


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But strange as it may seem, bad times can also be good for health. Forget individual health for a minute. This is about the macro picture, the health of entire societies. And there statistics show that as economics worsen, traffic accidents go down, as do industrial accidents, obesity, alcohol consumption and smoking. Population-wide, even deaths from heart disease go down during recessions.

"Deaths go down when unemployment goes up," says Christopher J. Ruhm, professor of economics at the University of North Carolina at Greensboro, who for the last few years has been publishing counterintuitive and controversial papers on the economy and health. Put total mortality numbers on a spreadsheet, he's found, and the population's physical well-being improves as just about every measure of economic health dips.

No one -- certainly not Ruhm -- is arguing that recessions are good. For unemployed individuals and for people who fear financial disaster -- relentlessly forecast in headlines and top-of-the-hour newscasts -- the outcome is mixed. Mental health worsens even for the vast majority who maintain their jobs, as the onslaught of bad news causes anger, anxiety and depression. And prenatal problems increase, leading to more miscarriages and higher infant mortality rates.

But even as people are worrying more, they're smoking, drinking and driving less, reducing their risks of heart disease, liver disease and car crashes. People who have lost jobs likely cut back because of lost income, whereas those still employed may be cutting back as they stare down inflation and stagnant incomes.

Some may take better care in order to look better to their bosses, says Ralph Catalano, economist at the School of Public Health of UC Berkeley. "They look around and think, 'I better cool it,' " he says. "Those people may be getting healthier."

Forewarned is forearmed. The research into the effects of tough times can show worried workers which reactions are helpful and which ones make things worse. Economists look at national trends, but real people can buck those trends -- maybe by taking a lesson from their grandparents.

"We know from the old days, 50 to 100 years ago, that people who were less well off actually did better," says Dr. C. Noel Bairey Merz, director of the preventive and rehabilitative cardiac center at Cedars-Sinai Medical Center. "They were working as laborers, they ate rice and beans, and they couldn't afford cigarettes."

Doing better, in other words, means following the advice of every public health agency in the world: exercise, eat healthful food and don't smoke.

Consequences

Deaths from some diseases, such as cancer, seem to be unaffected by the ups and downs of the economy, studies generally find. That's probably in part because it takes years or decades for cancer to form -- too long a lag to be clearly tied to a temporary downturn or economic upswing.Also, the majority of cancer deaths are among people older than 65, most likely out of the workforce and less susceptible to the cost-cutting whims of an employer.

But deaths, overall, do decrease when times turn bad, Ruhm has found from studying the stats of the U.S. as well as the 23 developed nations of the Organisation for Economic Co-operation and Development, matching them to economic shifts.

To put the economic fluctuations in perspective: Ruhm notes in a May 2000 paper in the Quarterly Journal of Economics that in 1990, 1.5 million Americans older than 65 died from all causes, as well as 145,000 people 25 to 44.

Based on his calculations, a rise in unemployment of one percentage point would have predicted 2,900 fewer deaths among the young adults. It would have spared, for a while at least, 4,900 seniors. Both groups gain, but among the young -- who are far less likely to die -- the percentage of saved lives is greater: 2% versus 0.3%.

The more that a cause of death affects primarily young people (traffic accidents, for example), the greater the effect of a shifting economy, Ruhm says. "Some dimensions of health respond more or less quickly."

Researchers have found good news in bad times for a number of diseases, specifically illnesses most affected by lifestyle changes.

* Heart disease is at the top of that list. In a March 2006 report for the National Bureau of Economic Research, Ruhm looked at federal mortality statistics from 1979 to 1998, comparing periods of higher and lower employment rates as a measure of economic conditions. He found a percentage-point reduction in unemployment was associated with a 0.75% rise in heart disease deaths -- about 3,900 additional deaths a year. The finding held across all age groups.