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Indeed, according to the American Heart Assn., for every 10 micrograms per cubic meter increase in particulate matter in the air, a 3.4% increase in heart attack rates can be expected. Although elderly people are most vulnerable, pollution can also trigger sudden heart attacks in younger people who have cardiovascular disease or risk factors such as high blood pressure, diabetes, high cholesterol or a smoking habit.
Ruhm also looked at data from 1987 to 2000 collected by the Centers for Disease Control and Prevention in the world's largest telephone survey tracking health risk behaviors. He found that three of the risk factors linked to heart disease -- smoking, obesity and a sedentary lifestyle -- drop during recessions.
He quantified the drop, and found that a one-point increase in the unemployment rate reduces the prevalence of smoking by 0.6%, the obesity rate by 0.3% and physical inactivity by 1.8%. These may not look like big changes, but they represent a trend toward better behavior that could easily have health consequences, Ruhm believes.
Why these drops? It could be that when times are bad, some unemployed people use their increased free time to exercise more. And those who are still employed feel more urgently motivated to take care of the things still under their control. "The first thing is awareness that not everything [good times and good health] goes in the same direction," he says. "It's an individual thing. You can control some of it."
* Traffic accidents go down when fewer people are working. It makes sense, because fewer people are on the road commuting. In a November 2002 report for the National Bureau of Economic Research, Ruhm looked at statistics from 23 developed nations including the United States and extrapolated from them that if 1% more people have jobs, motor vehicle accidents will go up by 2.1%. "Risky activities, such as driving, increase in good economic times," he says.
With gas around $4 a gallon, that particular risky behavior will likely drop further. The Department of Transportation reported in March that Americans drove 4.3% less that month, or 11 billion fewer miles, than they did in March 2007.
And just as Ruhm might have thought, the federal department reported this month that deaths from motor vehicle accidents reached the lowest level in more than a decade, from 41,059 in 2006 to 39,459 in 2007.
* People drink less. That is to say, people who already drink, do less of it. Using CDC data and alcohol sales statistics, Ruhm found that existing drinkers cut back, and the heaviest drinkers cut back the most. Light drinkers, he found, actually upped the amount they drank just a little. He speculates, in a July 2002 paper in the Journal of Health Economics, that however much economic stress may send people to the bottle, the impulse is offset by money worries and a need to spend less on alcohol.
* Healthful living improves. This is the nuts and bolts of Ruhm's argument -- one he draws from those CDC survey data on health risk behaviors. He hasn't merely found that smoking declines, weight is lost and leisure-time physical activity rises during economic downturns. He's also found that the people who make the biggest changes are, fortunately, the ones who need it the most. He sees the highest drop in tobacco use among heavy smokers, the greatest weight reduction in the severely obese, and the most increase in exercise among people who were completely inactive.
"Health behaviors have a strong effect"on physical well-being, he says. And the effect he found was not just on death rates. He found that when unemployment went up one percentage point, it meant a 1.5% fall in the prevalence of medical problems and a 1.6% decrease in days people reported spending in bed.
Individual actions
These economic studies are from epidemiology -- research examining trends among whole populations. There's a lot of room for individual variation, enough for everyone -- the working worried and the wounded unemployed -- to make their own choices.
Take alcohol, for example. In rough times, some people imbibe less, while others find some solace in the bottle. "When there are stressful times, some people will respond by drinking more as a way of coping," says C. David Dooley, professor of psychology and social behavior at UC Irvine. And other people, in an effort to retain their jobs or save money, cut back. Dooley says this has been documented in several of his studies, in which he uses large-scale survey data asking about employment security and drinking habits.
And just because heart disease overall goes down when times are bad, individuals have the power to go either way. Some people worry their way into a heart attack, and it's there that a tweak in attitude could make all the difference. Instead of just fretting when watching coworkers get pink slips, they might opt to start straightening up their own act -- figuring that a workplace that tolerated bad personal habits in good times might be more choosy when budgets get tight.
People could, theoretically, minimize the effect of economic stress on their hearts, says Merz of Cedars-Sinai. It's the usual advice: Exercise more. Eat better. Relax. Meditate. Save some money by quitting smoking.
And public support for the effort would help. "If we actually played our cards right, put bike racks all over the city, helped people be more physically active, we could mobilize this [economic downturn] for the country and make it good for the heart," Merz says.
It's no surprise, Ruhm says, that when human-resources staffers give advice to the people they're about to lay off, they don't talk only about buffing up the old résumé.
"One of the things they'll tell you is to eat well and exercise. And if you feel better physically, you'll feel better mentally," he says. "One of the possible things going on is that when times are bad, people are actively doing those things to protect their health."
Doubts raised
Ruhm's findings have been duplicated by others. For example, Eric Neumayer, a London economist studying the people of Germany, found lower rates of heart disease, stroke, pneumonia, influenza and motor vehicle accidents during recessions.
Still, Ruhm's findings remain controversial. Catalano, the UC Berkeley economist, doesn't buy all of it. "I think the evidence is that the net effect of a bad economy is that health gets worse," he says.
Catalano's body of research shows that hard times affect pregnancy in the same way that a hurricane or a flood does -- which is to say, negatively. And he's found that the least controversial result from research on a bad economy and health is that mental health declines (see related stories).
"It depends on which illness you're studying," he says. Stress from any source is linked to a lot of bad health outcomes, including high blood pressure and depression. "Some part of the population is getting sicker," he says
But even skeptics agree on a few positive effects of a downturn. People who hang onto their jobs when unemployment goes up start drinking less and fighting less and take fewer risks -- probably in an attempt to remake themselves into ideal employees. "They find ways to cover themselves," Catalano says. "They come to work every day. They drink less because they don't want to be absent."
In other words, they start behaving better. It can serve them well.
susan.brink@latimes.com
Ruhm also looked at data from 1987 to 2000 collected by the Centers for Disease Control and Prevention in the world's largest telephone survey tracking health risk behaviors. He found that three of the risk factors linked to heart disease -- smoking, obesity and a sedentary lifestyle -- drop during recessions.
He quantified the drop, and found that a one-point increase in the unemployment rate reduces the prevalence of smoking by 0.6%, the obesity rate by 0.3% and physical inactivity by 1.8%. These may not look like big changes, but they represent a trend toward better behavior that could easily have health consequences, Ruhm believes.
Why these drops? It could be that when times are bad, some unemployed people use their increased free time to exercise more. And those who are still employed feel more urgently motivated to take care of the things still under their control. "The first thing is awareness that not everything [good times and good health] goes in the same direction," he says. "It's an individual thing. You can control some of it."
* Traffic accidents go down when fewer people are working. It makes sense, because fewer people are on the road commuting. In a November 2002 report for the National Bureau of Economic Research, Ruhm looked at statistics from 23 developed nations including the United States and extrapolated from them that if 1% more people have jobs, motor vehicle accidents will go up by 2.1%. "Risky activities, such as driving, increase in good economic times," he says.
With gas around $4 a gallon, that particular risky behavior will likely drop further. The Department of Transportation reported in March that Americans drove 4.3% less that month, or 11 billion fewer miles, than they did in March 2007.
And just as Ruhm might have thought, the federal department reported this month that deaths from motor vehicle accidents reached the lowest level in more than a decade, from 41,059 in 2006 to 39,459 in 2007.
* People drink less. That is to say, people who already drink, do less of it. Using CDC data and alcohol sales statistics, Ruhm found that existing drinkers cut back, and the heaviest drinkers cut back the most. Light drinkers, he found, actually upped the amount they drank just a little. He speculates, in a July 2002 paper in the Journal of Health Economics, that however much economic stress may send people to the bottle, the impulse is offset by money worries and a need to spend less on alcohol.
* Healthful living improves. This is the nuts and bolts of Ruhm's argument -- one he draws from those CDC survey data on health risk behaviors. He hasn't merely found that smoking declines, weight is lost and leisure-time physical activity rises during economic downturns. He's also found that the people who make the biggest changes are, fortunately, the ones who need it the most. He sees the highest drop in tobacco use among heavy smokers, the greatest weight reduction in the severely obese, and the most increase in exercise among people who were completely inactive.
"Health behaviors have a strong effect"on physical well-being, he says. And the effect he found was not just on death rates. He found that when unemployment went up one percentage point, it meant a 1.5% fall in the prevalence of medical problems and a 1.6% decrease in days people reported spending in bed.
Individual actions
These economic studies are from epidemiology -- research examining trends among whole populations. There's a lot of room for individual variation, enough for everyone -- the working worried and the wounded unemployed -- to make their own choices.
Take alcohol, for example. In rough times, some people imbibe less, while others find some solace in the bottle. "When there are stressful times, some people will respond by drinking more as a way of coping," says C. David Dooley, professor of psychology and social behavior at UC Irvine. And other people, in an effort to retain their jobs or save money, cut back. Dooley says this has been documented in several of his studies, in which he uses large-scale survey data asking about employment security and drinking habits.
And just because heart disease overall goes down when times are bad, individuals have the power to go either way. Some people worry their way into a heart attack, and it's there that a tweak in attitude could make all the difference. Instead of just fretting when watching coworkers get pink slips, they might opt to start straightening up their own act -- figuring that a workplace that tolerated bad personal habits in good times might be more choosy when budgets get tight.
People could, theoretically, minimize the effect of economic stress on their hearts, says Merz of Cedars-Sinai. It's the usual advice: Exercise more. Eat better. Relax. Meditate. Save some money by quitting smoking.
And public support for the effort would help. "If we actually played our cards right, put bike racks all over the city, helped people be more physically active, we could mobilize this [economic downturn] for the country and make it good for the heart," Merz says.
It's no surprise, Ruhm says, that when human-resources staffers give advice to the people they're about to lay off, they don't talk only about buffing up the old résumé.
"One of the things they'll tell you is to eat well and exercise. And if you feel better physically, you'll feel better mentally," he says. "One of the possible things going on is that when times are bad, people are actively doing those things to protect their health."
Doubts raised
Ruhm's findings have been duplicated by others. For example, Eric Neumayer, a London economist studying the people of Germany, found lower rates of heart disease, stroke, pneumonia, influenza and motor vehicle accidents during recessions.
Still, Ruhm's findings remain controversial. Catalano, the UC Berkeley economist, doesn't buy all of it. "I think the evidence is that the net effect of a bad economy is that health gets worse," he says.
Catalano's body of research shows that hard times affect pregnancy in the same way that a hurricane or a flood does -- which is to say, negatively. And he's found that the least controversial result from research on a bad economy and health is that mental health declines (see related stories).
"It depends on which illness you're studying," he says. Stress from any source is linked to a lot of bad health outcomes, including high blood pressure and depression. "Some part of the population is getting sicker," he says
But even skeptics agree on a few positive effects of a downturn. People who hang onto their jobs when unemployment goes up start drinking less and fighting less and take fewer risks -- probably in an attempt to remake themselves into ideal employees. "They find ways to cover themselves," Catalano says. "They come to work every day. They drink less because they don't want to be absent."
In other words, they start behaving better. It can serve them well.
susan.brink@latimes.com
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