Population health and the economy: Mortality and the Great Recession in Europe

We analyze the evolution of mortality‐based health indicators in 27 European countries before and after the start of the Great Recession. We find that in the countries where the crisis has been particularly severe, mortality reductions in 2007–2010 were considerably bigger than in 2004–2007. Panel models adjusted for space‐invariant and time‐invariant factors show that an increase of 1 percentage point in the national unemployment rate is associated with a reduction of 0.5% (p < .001) in the rate of age‐adjusted mortality. The pattern of mortality oscillating procyclically is found for total and sex‐specific mortality, cause‐specific mortality due to major causes of death, and mortality for ages 30–44 and 75 and over, but not for ages 0–14. Suicides appear increasing when the economy decelerates—countercyclically—but the evidence is weak. Results are robust to using different weights in the regression, applying nonlinear methods for detrending, expanding the sample, and using as business cycle indicator gross domestic product per capita or employment‐to‐population ratios rather than the unemployment rate. We conclude that in the European experience of the past 20 years, recessions, on average, have beneficial short‐term effects on mortality of the adult population.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142224/1/hec3495_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142224/2/hec3495.pd

Physical and mental health correlates of status incongruence

The report explored the relationship between status incongruence, the degree of similarity of rankings on paired status variables, and diverse interview-based measures of physical and mental health. The subjects in the study were some 169 adult men; one half of them came from a national survey sample, while the other half represented an arthritis clinic sample with patients and controls. Data on education, occupation, income, and perceived social class (PSC) were used to construct several status incongruence indices. The major findings were: 1. Neither rheumatoid arthritis nor ulcer were related to status incongruence. 2. Education-occupation incongruence showed by far the strongest association with poor mental health. Among the two types of incongruence, education > occupation and occupation > education, the former had particularly poor mental health. 3. Education-PSC, occupation-PSC, education-income, and occupation-income types of incongruence showed weaker associations. Direction of incongruence made a difference in the education-PSC comparison: the education > PSC incongruent group had poorer mental health than the PSC > education incongruent group. Ce rapport étudie la relation entre la discordance du status («status incongruence»), le degré de similitude d'évaluation de variables couplées du status et diverses mesures de la santé physique et mentale basées sur des interviews. Les sujets de l'étude étaient 169 hommes adultes dont la moitié provenait d'un échantillon d'une investigation nationale, tandis que l'autre moitié représentait un échantillon d'une clinique d'arthritiques avec des patients et des cas de contrôle. Des données sur l'éducation, l'occupation, le revenu et la classe sociale (perceived social class = PSC) furent utilisées pour l'élaboration de divers indices de discordance de status. Les résultats principaux furent: 1) Ni l'arthrite rhumatoïde ni l'ulcère n'étaient reliés à la discordance du status. 2) La discordance éducation-occupation était de loin la plus étroitement associée à une santé mentale défaillante. Parmi les deux types de discordance, éducation > occupation et occupation > éducation, le premier était caractérisé par une santé mentale particulièrement mauvaise. 3) Les types de discordance éducation-PSC, occupation-PSC, éducation-revenu et occupationrevenu étaient plus faiblement associés. La direction de la discordance faisait une différence dans la comparaison éducationPSC: le groupe de discordance éducation > PSC se distinguait par une santé mentale moins bonne que le groupe de discordance PSC > éducation. Der Bericht gibt die Untersuchung der Beziehung zwischen der Unausgeglichenheit innerhalb des Sozialstands, dem Ausmaß der Ähnlichkeit von Einstufungen durch vorgegebene Gegensatzpaare von Statusmerkmalen und verschiedenen, auf Interviewbasis begründeten Einschätzungen der körperlichen und seelischen Gesundheit wieder. Die Probanden der Studie waren 169 erwachsene Männer; die Hälfte von ihnen stammte aus einer staatlichen Begutachtungsgruppe, die andere Hälfte verkörperten Patienten und Kontrollpersonen aus einer Arthritisklinik. Daten über Erziehung, Beruf, Einkommen und beurteilte Sozialklasse (perceived social class = PSC) wurden verwandt, um mehrere Indices für Statusinkongruenz zu bilden. Die Hauptergebnisse waren: 1) Weder rheumatische Arthritis noch Ulcus standen in Beziehung mit Statusinkongruenz. 2) Ein Mißverhältnis zwischen Erziehung und Beruf zeigte bei weitem die engste Beziehung zu schlechter seelischer Gesundheit. Von den beiden Inkongruenztypen, Erziehung > Beruf und Beruf > Erziehung, hatte der erste eine besonders schlechte seelische Gesundheit. 3) Mißverhältnisse zwischen Erziehung und PSC, Beruf und PSC, Erziehung und Einkommen und Beruf und Einkommen zeigten schwächere Beziehungen. Die Richtung der Inkongruenz bewirkte einen Unterschied im Vergleich zwischen Erziehung und PSC: die inkongruente Gruppe Erziehung > PSC war bei schlechterer seelischer Gesundheit als die inkongruente Gruppe PSC > Erziehung.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41742/1/127_2004_Article_BF00584107.pd

Experience of Health Complaints and Help Seeking Behavior in Employees Screened for Depressive Complaints and Risk of Future Sickness Absence

Introduction The aim of this study was to examine the associations between on the one hand depressive complaints and risk of future sickness absence and on the other hand experience of health complaints and help seeking behavior in the working population. Methods Cross-sectional data were used from employees working in the banking sector (n = 8,498). The screening instrument included measures to examine the risk of future sickness absence, depressive complaints and help seeking behavior. Results Of employees reporting health complaints, approximately 80% had already sought help for these complaints. Experience of health complaints and subsequent help seeking behavior differed between employees with mild to severe depressive complaints and employees at risk of future sickness absence. Experience of health complaints was highest in employees identified with both concepts (69%) compared with employees identified at risk of future sickness absence only (48%) and with mild to severe depressive complaints only (57%). In those employees identified with one or both concepts and who had not sought help already, intention to seek help was about 50%. Conclusions From a screening perspective, employees who do not experience health complaints or who do not have the intention to seek help may refuse participation in early intervention. This might be a bottleneck in the implementation of preventive interventions in the occupational health setting

Health status in the ambulance services: a systematic review

BACKGROUND: Researchers have become increasingly aware that ambulance personnel may be at risk of developing work-related health problems. This article systematically explores the literature on health problems and work-related and individual health predictors in the ambulance services. METHODS: We identified the relevant empirical literature by searching several electronic databases including Medline, EMBASE, PsychINFO, CINAHL, and ISI Web of Science. Other relevant sources were identified through reference lists and other relevant studies known by the research group. RESULTS: Forty-nine studies are included in this review. Our analysis shows that ambulance workers have a higher standardized mortality rate, higher level of fatal accidents, higher level of accident injuries and a higher standardized early retirement on medical grounds than the general working population and workers in other health occupations. Ambulance workers also seem to have more musculoskeletal problems than the general population. These conclusions are preliminary at present because each is based on a single study. More studies have addressed mental health problems. The prevalence of post-traumatic stress symptom caseness was > 20% in five of seven studies, and similarly high prevalence rates were reported for anxiety and general psychopathology in four of five studies. However, it is unclear whether ambulance personnel suffer from more mental health problems than the general working population. CONCLUSION: Several indicators suggest that workers in the ambulance services experience more health problems than the general working population and workers in other health occupations. Several methodological challenges, such as small sample sizes, non-representative samples, and lack of comparisons with normative data limit the interpretation of many studies. More coordinated research and replication are needed to compare data across studies. We discuss some strategies for future research

A Randomized Trial of a Physical Conditioning Program to Enhance the Driving Performance of Older Persons

BACKGROUND: As the number of older drivers increases, concern has been raised about the potential safety implications. Flexibility, coordination, and speed of movement have been associated with older drivers’ on road performance. OBJECTIVE: To determine whether a multicomponent physical conditioning program targeted to axial and extremity flexibility, coordination, and speed of movement could improve driving performance among older drivers. DESIGN: Randomized controlled trial with blinded assignment and end point assessment. Participants randomized to intervention underwent graduated exercises; controls received home, environment safety modules. PARTICIPANTS: Drivers, 178, age ≥ 70 years with physical, but without substantial visual (acuity 20/40 or better) or cognitive (Mini Mental State Examination score ≥24) impairments were recruited from clinics and community sources. MEASUREMENTS: On-road driving performance assessed by experienced evaluators in dual-brake equipped vehicle in urban, residential, and highway traffic. Performance rated three ways: (1) 36-item scale evaluating driving maneuvers and traffic situations; (2) evaluator’s overall rating; and (3) critical errors committed. Driving performance reassessed at 3 months by evaluator blinded to treatment group. RESULTS: Least squares mean change in road test scores at 3 months compared to baseline was 2.43 points higher in intervention than control participants (P = .03). Intervention drivers committed 37% fewer critical errors (P = .08); there were no significant differences in evaluator’s overall ratings (P = .29). No injuries were reported, and complaints of pain were rare. CONCLUSIONS: This safe, well-tolerated intervention maintained driving performance, while controls declined during the study period. Having interventions that can maintain or enhance driving performance may allow clinician–patient discussions about driving to adopt a more positive tone, rather than focusing on driving limitation or cessation

Health Education and Community Empowerment: Conceptualizing and Measuring Perceptions of Individual, Organizational and Community Control

Also PCMA Working Paper #38.http://deepblue.lib.umich.edu/bitstream/2027.42/51259/1/493.pd

Will the Public's Health Fall Victim to the Home Foreclosure Epidemic?

Gary Bennett and colleagues discuss the ways in which the dramatic rise in home foreclosures, particularly in the US, may have health consequences