High and Rising Mortality Rates Among Working-Age Adults (2021) / Chapter Skim
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10 The Relationship Between Economic Factors and Mortality
10 The Relationship Between Economic Factors and Mortality
Pages 363-374
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From page 363... ...
Research has shown that exposure to prolonged economic adversity may affect health outcomes via multiple mechanisms, including gaps in health care; chronic stress;1 anxiety; depression; and unhealthy coping behaviors, from smoking and overeating to drug and alcohol abuse, suicide, and violent crime. The complex interrelationships among economic conditions, place, and time, together with the inability to conduct controlled experiments, make it difficult to prove causal associations or confidently isolate the health impacts of economic trends (Gonsalves, 2019)
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From page 364... ...
. Much of the other empirical research examines changes in overall mortality, but some focuses on specific causes of mortality, with growing interest in deaths due to suicide and substance abuse.
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From page 365... ...
Within the bottom income quartile, life expectancy was approximately 5 years longer in geographic locations with the highest versus those with the lowest longevity. The lower life expectancy among the latter individuals was significantly correlated with health behaviors such as smoking, but not with physical environment factors, labor market conditions, income inequality, or access to medical care.
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From page 366... ...
The breadth of factors contributing to increases in working-age mortality in the past decade -- from external causes such as substance abuse to diseases involving multiple body systems and pathophysiological processes -- eludes attribution to a single cause, such as opioids or obesity. Rather, it suggests the possibility of one or more upstream systemic causes, such as economic disadvantage or increasing stress that can affect health across multiple pathways and disease processes (Woolf et al., 2018)
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From page 367... ...
Specifically, while international trade may be beneficial for overall economic growth, increased trade can prove disruptive to the domestic manufacturing industry, resulting in layoffs, plant closings, and reduced earnings for exposed workers (Autor et al., 2013)
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From page 368... ...
. LACK OF A STRONG ASSOCIATION BETWEEN ECONOMIC FLUCTUATIONS AND INCREASED MORTALITY Despite clear evidence relating economic disadvantage to mortality and demonstrating the deleterious economic consequences of job loss and trade competition, market-level economic fluctuations due to the business cycle are not strongly associated with increased mortality, including that related to opioids, at the population level.
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From page 369... ...
looks at medium-term economic changes that incorporate changes in a 3-year average poverty rate, in a 3-year average of median household income in 2015 dollars, in a 4-year average of median home prices, and in a 3-year average of the unemployment rate, as well as a measure of import competition. The evidence that excess mortality is concentrated in disadvantaged populations but that fluctuations in economic conditions are related only weakly to mortality may appear contradictory.
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From page 370... ...
. Because areas with higher income inequality often have larger proportions of the population at lower income levels, areas with more inequality will have worse health simply because of differences in the distribution of income.
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From page 371... ...
Quasi-experimental analyses of job loss, plant closings, and disruption from foreign trade support the notion that economic disruption increases mortality. But these studies focus on assessing changes in economic well-being due to a narrow set of causes, such as plant closings and trade disruptions, as opposed to such broader causes as technical change and general economic trends related to productivity, including automation and a host of related processes.
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From page 372... ...
For example, changes in medium-term economic conditions in themselves do not appear to have led to a very large increase in opioid deaths, but the increase in opioid availability may have contributed to a large increase in mortality because of a reservoir of susceptible individuals resulting from economic issues. A third important set of questions involves understanding the relationship between the duration of economic hardship and mortality.
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From page 373... ...
Another important set of research questions is related to how economic well-being is measured, questions that are important both substantively and methodologically. Taking the example of how to measure economic hardship, many studies in this area focus on unemployment rates.
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