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Yesterday once more? Unemployment and health inequalities across the life course in northern Sweden
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.ORCID iD: 0000-0002-4118-6441
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Abstract

Background. It is relatively well established in previous research that unemployment has direct health consequences in terms of mental and physical ill health. Recently, knowledge has emerged indicating that unemployment can lead to economic consequences that remain long after re-establishment in the labour market. However, few empirical studies have been able to apply a life course perspective asking whether there are also long-term health consequences of unemployment, and, when and in which context unemployment may affect the individual health status across the life course. The aim of this thesis was to analyse the relationship between unemployment and illness across the life course, and how it relates to individual and structural factors in the geographical setting of northern Sweden. In particular, three main areas have been explored: youth unemployment and illness in adulthood (Paper I and Paper II), contextual unemployment of national unemployment rate and neighbourhood unemployment (Paper II and Paper III) and lastly, social determinants of health inequality between employment statuses (Paper IV).

Methods. This thesis is positioned in Sweden between the early 1980s and the mid-2010s, following two comparable cohorts sampled from northern Sweden (26 and 19 years follow-up time respectively from youth to midlife) and a cross-sectional sample from 2014 of the four northernmost counties in Sweden. The two longitudinal cohorts comprised the Northern Swedish Cohort and the Younger Northern Swedish Cohort, consisting of all pupils in the 9th grade of compulsory school in Luleå municipality in 1981 and 1989. The participants responded to an extensive questionnaire on socioeconomic factors, work and health, in 5 and 2 waves respectively of data collections. Neighbourhood register data from Statistics Sweden was also collected for all participants in the Northern Sweden Cohort. At the latest data collection, 94.3% (n=1010) participated in the Northern Sweden Cohort and 85.6% (n=686) in the Younger Northern Sweden Cohort. The cross-sectional study Health on Equal Terms is a national study, administered by the Public Health Agency together with Statistics Sweden and county councils with the aim of mapping public health and living conditions in the country over time. In this thesis, material from 2014 has been used for northern Sweden with a response rate of around 50% (effective sample n=12769). The statistical analyses used were linear regression, multilevel analysis and difference-in-difference analysis to estimate the concurrent and long-term health consequences of unemployment, and a decomposition analysis to disentangle the inequality in health between different labour market positions. The health outcomes in focus were functional somatic symptoms (the occurrence of relatively common physical illnesses such as head, muscle and stomach ache, insomnia and palpitation) and psychological distress.

Results. Among men only, as little as one month of youth unemployment was related to increased levels of functional somatic symptoms in midlife, regardless of previous ill health or unemployment later in life, although only during relatively low national unemployment (pre-recession) when comparing with youth unemployment during high national unemployment (recession). This was explained by the health promoting effect of more time spent in higher education during the recession period. Furthermore, the health impact of neighbourhood unemployment highlights the importance of the contextual setting for individuals’ health both across the life course and at specific periods of life. Lastly, employment-related mental health inequalities exist for both men and women in all life phases (youth, adulthood and midlife). Economic and social deprivation related to unemployment and illness varied across different phases in life and across genders.

Conclusion. The key findings of this thesis paint a rather pessimistic vision of the future: one’s own and others’ unemployment may cause not only ill health today but also ill health later in life. Importantly, the responsibility of unemployment and the associated ill health should not be placed on the already marginalised individuals and communities. Instead, the responsibility should be directed towards the structural aspects of society and the political choices that shape these. In other words, health inequality manifested by the position in the labour market is socially produced, unfair and changeable through political decisions. The results of this study therefore cannot contribute to any simple or concrete solutions to the concurrent or long-term health consequences of individual or contextual unemployment, as the solution is beyond the areas of responsibility and abilities of research. However, if there are long-term health consequences of one’s own and other people’s unemployment, labour market and public health policies should be initiated from a young age and continue throughout the life course to reduce individual suffering and future costs of social insurance, sick-leave and unemployment benefits.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2017. , 67 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1914
Keyword [en]
unemployment, life course, long-term health consequences, health inequity, national unemployment rates, neighbourhood unemployment rates, northern Sweden
Keyword [sv]
arbetslöshet, livslopp, långsiktiga hälsokonsekvenser, ojämlikhet i hälsa, nationella arbetslöshet, arbetslöshet i bostadsområdet, norra Sverige
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health; Epidemiology; Social Medicine
Identifiers
URN: urn:nbn:se:umu:diva-139563ISBN: 978-91-7601-760-9 (print)OAI: oai:DiVA.org:umu-139563DiVA: diva2:1142489
Public defence
2017-10-13, Major Groove, Byggnad 6L, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2011-0445Swedish Research Council Formas, 259-2012-37
Available from: 2017-09-22 Created: 2017-09-19 Last updated: 2017-09-21Bibliographically approved
List of papers
1. Youth unemployment and functional somatic symptoms in adulthood: results from the Northern Swedish cohort
Open this publication in new window or tab >>Youth unemployment and functional somatic symptoms in adulthood: results from the Northern Swedish cohort
2015 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 5, 796-800 p.Article in journal (Refereed) Published
Abstract [en]

Background: Little is known about the possible long-term health consequences of youth unemployment. Research indicates that unemployment may lead to socioeconomic downward mobility and mental health problems, but we still lack knowledge of the long-term health consequences of youth unemployment. This article examines the potential long-term association between youth unemployment and functional somatic symptoms in adulthood. 

Methods: The ‘Northern Swedish cohort’ was used with data from five data collections, from 1981 (age 16) until 2007 (age 42). Youth unemployment was measured as months in unemployment between age 16 and 21, and health outcome as functional somatic symptoms (an index of 10 items of self-reported symptoms). Linear regression was used to analyse the relationship between months in youth unemployment and functional somatic symptoms at age 21 and age 42, stratified for women and men and adjusted for potential confounders, such as time spent in education at age 21 and later unemployment between age 21 and 42. 

Results: Youth unemployment was significantly related to functional somatic symptoms at age 21 for men after controlling for confounders, but not for women. Among men, the association remained for functional somatic symptoms at age 42, after controlling for confounders. 

Conclusions: Adolescence seems to be a sensitive period during which unemployment could have remaining health effects in adulthood, at least for men, though assumptions of causality are tentative and more research is needed.

Place, publisher, year, edition, pages
Oxford University Press, 2015
National Category
Public Health, Global Health, Social Medicine and Epidemiology Other Social Sciences
Identifiers
urn:nbn:se:umu:diva-101052 (URN)10.1093/eurpub/ckv038 (DOI)000362972700013 ()25772751 (PubMedID)
Funder
Swedish Research Council Formas, 259-2012-37Forte, Swedish Research Council for Health, Working Life and Welfare, 2011-0445
Available from: 2015-03-18 Created: 2015-03-18 Last updated: 2017-09-19Bibliographically approved
2. The impact of economic recession on the association between youth unemployment and functional somatic symptoms in adulthood: a difference-in-difference analysis from Sweden
Open this publication in new window or tab >>The impact of economic recession on the association between youth unemployment and functional somatic symptoms in adulthood: a difference-in-difference analysis from Sweden
2016 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, 230Article in journal (Refereed) Published
Abstract [en]

Background: The impact of macroeconomic conditions on health has been extensively explored, as well as the relationship between individual unemployment and health. There are, however, few studies taking both aspects into account and even fewer studies looking at the relationship in a life course perspective. In this study the aim was to assess the role of macroeconomic conditions, such as national unemployment level, for the long-term relationship between individual unemployment and functional somatic symptoms (FSS), by analysing data from two longitudinal cohorts representing different periods of unemployment level in Sweden.

Methods: A difference-in-difference (DiD) analysis was applied, looking at the difference over time between recession and pre-recession periods for unemployed youths (age 21 to 25) on FSS in adulthood. FSS was constructed as an index of ten self-reported items of somatic ill-health. Covariates for socioeconomics, previous health status and social environment were included.

Results: An association was found in the difference of adult FSS between unemployed and employed youths in the pre-recession and recession periods, remaining in the adjusted model for the pre-recession period. The DiD analysis between unemployed youths showed that men had significantly lower adult FSS during the recession compared to men in the pre-recession time.

Conclusions: Adulthood FSS showed to be significantly lower among unemployed youths, in particular among men, during recession compared to pre-recession times. Since this is a fairly unexplored research field, more research is needed to explore the role of macroeconomic conditions for various health outcomes, long-term implications and gender differences.

Keyword
Youth unemployment, Recession, National unemployment, Longitudinal analysis, Functional somatic mptoms, Difference-in-difference analysis, Northern Sweden Cohort, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-118967 (URN)10.1186/s12889-016-2917-0 (DOI)000371867200001 ()26944536 (PubMedID)
Available from: 2016-05-03 Created: 2016-04-07 Last updated: 2017-09-19Bibliographically approved
3. Does contextual unemployment matter for health status across the life course? A longitudinal multilevel study exploring the link between neighbourhood unemployment and functional somatic symptoms
Open this publication in new window or tab >>Does contextual unemployment matter for health status across the life course? A longitudinal multilevel study exploring the link between neighbourhood unemployment and functional somatic symptoms
2017 (English)In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 43, 113-120 p.Article in journal (Refereed) Published
Abstract [en]

This study examines whether neighbourhood unemployment is related to functional somatic symptoms, independently of the individual employment, across the life course and at four specific life course periods (age 16, 21, 30 and 42). Self-reported questioner data was used from a 26-year prospective Swedish cohort (n=1010) with complementary neighbourhood register data. A longitudinal and a set of age-specific cross-sectional hierarchal linear regressions was carried out. The results suggest that living in a neighbourhood with high unemployment has implications for residents' level of functional somatic symptoms, regardless of their own unemployment across time, particularly at age 30.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-131334 (URN)10.1016/j.healthplace.2016.11.014 (DOI)000394402400014 ()27997864 (PubMedID)
Funder
Swedish Research Council Formas, 259-2012-37Forte, Swedish Research Council for Health, Working Life and Welfare, 2011-0445
Available from: 2017-02-13 Created: 2017-02-13 Last updated: 2017-09-20Bibliographically approved
4. Health inequalities between employed and unemployed in northern Sweden: A decomposition analysis of social determinants for mental health
Open this publication in new window or tab >>Health inequalities between employed and unemployed in northern Sweden: A decomposition analysis of social determinants for mental health
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Abstract

Background. Even though population health is strongly influenced by employment and working conditions, public health research has to a lesser extent explored the social determinants of health inequalities between people in different positions on the labour market, and whether these social determinants vary across the life course. This study analyses mental health inequalities between unemployed and employed in three age groups (youth, adulthood and mid-life), and identifies the extent to which social determinants explain the mental health gap between employed and unemployed in northern Sweden.

Methods. The Health on Equal Terms survey of 2014 was used, with self-reported employment (unemployed or employed) as exposure and the General Health Questionnaire (GHQ-12) as mental health outcome. The social determinants of health inequalities were grouped into four dimensions: socioeconomic status, economic resources, social network and trust in institutional systems. The non-linear Oaxaca decomposition analysis was applied, stratified by gender and age groups.

Results. Mental health inequality was found in all age groups among women and men (difference in GHQ varying between 0.12 and 0.20). The decomposition analysis showed 43–51% of the total inequality among youths, 42–98% among adults and 60–65% among middle-aged. The main contributing factors were shown to vary between age groups: cash margin (among youths and middle-aged men), financial strain (among adults and middle-aged women), income (among men in adulthood), along with trust in others (all age groups), practical support (young women) and social support (middle-aged men); stressing how the social determinants of health inequalities vary across the life course.

Conclusions. The health gap between employments was explained by the difference in access to economic and social resources, and to a smaller extent in the trust in the institutional systems. Findings from this study corroborate that much of the mental health inequality in the Swedish labour market is socially and politically produced and potentially avoidable. Greater attention from researchers, policy makers on unemployment and public health should be devoted to the social and economic deprivation of unemployment from a life course perspective to prevent mental health inequality.

Keyword
social determinants of health inequality, unemployment, life course, northern Sweden, Oaxaca decomposition analysis, mental health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine; Epidemiology; Public health
Identifiers
urn:nbn:se:umu:diva-139562 (URN)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2011-0445Swedish Research Council Formas, 259-2012-37
Available from: 2017-09-18 Created: 2017-09-18 Last updated: 2017-09-20

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