Poor health and unemployment go hand in hand

Recent research shakes up the myth that Scandinavia's welfare states are best at keeping unemployment from affecting health.

If you are a woman, are out of work and live in the far north of Europe, you have good reason to be depressed by the findings of SINTEF sociologist Terje Andreas Eikemo and his British colleague Clare Bambra of Durham University.

The two researchers studied the extent of differences in self-perception of health by unemployed and working women and men in various parts of Europe.

In all the regions surveyed, problems of health were more common among unemployed persons than those in work, with the greatest difference being found in Scandinavian women, according to the two researchers.

Published in highly respected journal

The article in which Eikemo and his British colleague have presented their findings appeared recently in the Journal of Epidemiology and Community Health, a highly respected British periodical.

The material analysed by the two researchers comes from the European Social Survey, one of the most comprehensive comparative population surveys carried out Europe, for 2002, 2004 and 2006.

Chicken or egg situation?

Terje Andreas Eikemo is a research scientist at SINTEF Technology and Society, and holds a doctorate in medical sociology.

He explains that the relationship that has just been demonstrated between unemployment and poor health in Scandinavian women may be a reflection of two different cause and effect relationships that point in different directions:

• Either that Scandinavia is a region in which women are more likely to suffer from poor health when they are unemployed than men - and than women and men in other parts of Europe.
• Or that Scandinavian women in poor health are more likely to lose their jobs than other Europeans.

Believes in a combination of the two cause

"Our material says nothing about which of these mechanisms is the key, but in all likelihood our findings reflect a combination of the two," says Eikemo.

Bigger drop in self-esteem

"Why should women in Scandinavia be more likely to become ill from losing their jobs than people in other countries, when we know that Scandinavia has welfare systems that were created to take good care of unemployed people?"

"Expectations that everyone should have a job have probably been particularly high in Scandinavia, and it is probably also more stigmatising for Scandinavian women to be out of work than for women in other countries with lower rates of female employment. This means that there is a bigger drop in self-esteem here.

A further point

Eikemo mentions a further point that suggests that it is natural for the difference in health between working and unemployed person to be particularly large in periods of high employment in our part of the world.

"Our data are from a period of prosperity, when even people in poor health are drawn into employment, and this sub-group naturally consists of those people who are least ill. Most of the women who are still unemployed in countries with such a high proportion of women in work as Scandinavia are thus women with major health problems," he points out.

Women most vulnerable

"And why should Scandinavia women be more likely than men to suffer  from poor health by being out of work?"

"This may be largely due to the fact that more of them are in part-time work and take longer maternity leave of absence than men, with the result that they do not receive such good benefits when they lose their jobs. It is well known that poor financial circumstances can lead to psychosocial stress and make people ill," says Eikemo.

Wants to look behind well-known relationships

A number of studies have already shown that unemployed people are more often ill than people who are in work.

However, it is much less clear whether this relationship varies among states that offer different levels of support to the unemployed. Or in other words: whether some welfare systems are better than others at preventing unemployment from leading to illness.

This is just what the two researchers wished to find out.

Surprising findings

"We have carried out the largest ever comparative study in Europe of perception of one's own health in the unemployed and people in work. And we were fairly surprised by what we found," says Eikemo.

Large differences in spite of generous welfare schemes

The SINTEF researcher describes the public welfare systems for the unemployed in Scandinavia as "generous in comparison with those in other parts of Europe, in the sense that our schemes are not means-tested and that they have identical maximum payments for everyone.

"As far as Scandinavia is concerned, we therefore expected to find only slight differences in self-perception of health between people in work and out of work. Instead, we found that women in Scandinavia were the worst when we made this comparison,'' says Eikemo.

Only the British come close

"Only in the British Isles, where support for the unemployed is means-tested and thus a source of stigma, was the relationship between unemployment and the perception of being in poor health even close to being as strong."

"You based your study on people's perception of their own health and thus own their own definitions are having a health problem. Could your findings be because we wealthy Scandinavians have a lower threshold for what we define as health problems than other people in Europe?"

Averages hide differences

"Previous studies have shown that self-perception of health is a very good, stable measure of health. People know their own health best. Even if it is true that we complain more here in the north, that shouldn't affect our results, because we compare differences in health within each individual country. It is these differences that we then compare between countries and between groups of countries with similar welfare systems.

"On average, Scandinavian evaluate their health as being better than other Europeans do. However, these average figure obscure large and small differences within each individual country. Our results show that the differences in people's perception of their own health are particularly great in Scandinavia, depending on whether or not they have a job. Therefore, from the perspective of public health, that is why we need to pay more attention to unemployed Scandinavian women," says SINTEF researcher Terje Andreas Eikemo.