Unemployment impact on mental health in Catalonia
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Presented in "How does policy get under the skin", Barcelona, 3 of july 2015.
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Unemployment impact on mental health in Catalonia
- 1. Unemployment impact on mental health in Catalonia Vanessa Puig-Barrachina ASPB, GREDS-EMCONET
- 2. Monitoring employment-related health inequalities • Employment relations and conditions differ according context, class, gender, migration status, …and also the health impact Benach, Puig-Barrachina et al. The challenge of monitoring employment-related health inequalities. J Epidemiol Community Health doi:10.1136/jech-2012-201103
- 3. Monitoring employment-related health inequalities • Employment relations and conditions differ according context, class, gender, migration status, …and also the health impact • Monitoring and analyzing the effects of an economic recession taking the population as a whole might lead to confusion Benach, Puig-Barrachina et al. The challenge of monitoring employment-related health inequalities. J Epidemiol Community Health doi:10.1136/jech-2012-201103
- 4. Monitoring employment-related health inequalities • Employment relations and conditions differ according context, class, gender, migration status, …and also the health impact • Monitoring and analyzing the effects of an economic recession taking the population as a whole might lead to confusion • Knowledge on employment-related health inequalities remains limited and monitoring over time limited to a few indicators not properly disaggregated Benach, Puig-Barrachina et al. The challenge of monitoring employment-related health inequalities. J Epidemiol Community Health doi:10.1136/jech-2012-201103
- 5. Health effects of unemployment Unemployed, Ben Shahn, 1938
- 6. Mental health Health effects of unemployment Unemployed, Ben Shahn, 1938
- 7. Mental health Health effects of unemployment Unemployed, Ben Shahn, 1938 Physical health
- 8. Mental health Health effects of unemployment Unemployed, Ben Shahn, 1938 Physical health Well-being
- 9. Mental health Health effects of unemployment Unemployed, Ben Shahn, 1938 Physical health Well-being Role functioning
- 10. Mental health Health effects of unemployment Unemployed, Ben Shahn, 1938 Physical health Well-being Role functioning Unhealthy behaviours
- 11. Mental health Health effects of unemployment Unemployed, Ben Shahn, 1938 Physical health Well-being Role functioning Unhealthy behaviours
- 12. Unemployment Mental health Physical health Well-being Role functioning Unhealthy behaviours Health effects of unemployment: causal pathways
- 13. Unemployment Economic deprivation Poverty Mental health Physical health Well-being Role functioning Unhealthy behaviours Health effects of unemployment: causal pathways
- 14. Unemployment Economic deprivation Poverty • Social isolation • Lack of time structure • Lost of individual identity • Collective aims • … Mental health Physical health Well-being Role functioning Unhealthy behaviours Health effects of unemployment: causal pathways Job latent functions deprivation
- 15. Unemployment Economic deprivation Poverty Mental health Physical health Well-being Role functioning Unhealthy behaviours Health effects of unemployment: causal pathways Job latent functions deprivation Stress theory (uncertainty about future)
- 16. Health inequalities How are social inequalities in health created, exacerbated and perpetuated?, Finn Diderichsen Ineqcities project https://www.ucl.ac.uk/ineqcities/atlas/cities/barcelona
- 17. Health inequalities How are social inequalities in health created, exacerbated and perpetuated?, Finn Diderichsen
- 18. Health inequalities How are social inequalities in health created, exacerbated and perpetuated?, Finn Diderichsen Social class Greater impact of unemployment among manual workers and lower socioeconomic groups Mechanisms: • Lower reemployment prospects • Less financial resources to cushion the effects Puig-Barrachina et al. Monitoring social determinants of health inequalities: the impact of unemployment among vulnerable groups, Int J Health Serv. 2011;41(3):459-82.
- 19. Health inequalities How are social inequalities in health created, exacerbated and perpetuated?, Finn Diderichsen • Similar role configurations: similar effects between men and women • Different role configurations: Stronger effects among men Gender interacts with family composition & social class: • Single mothers, exposed to several other risks • Married men in manual class (male breadwinner role) • Married women with no nurturing roles in non-manual class • Jobless household Gender Puig-Barrachina et al. Monitoring social determinants of health inequalities: the impact of unemployment among vulnerable groups, Int J Health Serv. 2011;41(3):459-82.
- 20. Health inequalities How are social inequalities in health created, exacerbated and perpetuated?, Finn Diderichsen • Protective effects depending on • Type of benefits • Quantity of money • Mechanisms: • Stigma • Low quantity poverty • Different effect according social position? Unemployment benefits Active labour market policies (reinsertion programs) • Mechanisms: • Can return some of the latent functions of employment • Increase reemployment prospects • Low quantity poverty O’Campo et al. Social welfare matters: A realist review of when, how, and why unemployment insurance impacts poverty and health, Social Science & Medicine, 2015
- 21. Health inequalities How are social inequalities in health created, exacerbated and perpetuated?, Finn Diderichsen
- 22. To analyze the relationship of unemployment and mental health with the aim of identifying which groups are the most vulnerable to poor health. Objective
- 23. • Design: Cross-sectional study • Data source: Catalonian Health Survey (2006) • Participants: Active population aged 25-64, excluding workers who left last job for health reasons (n= 8,591) • Statistical analysis: Prevalence ratio of poor mental health and 95% confidence intervals, using log-binomial regression, adjusted by age Methodology: design & analysis
- 24. • Outcome: Poor mental health (GHQ-12 score ≥ 3) • Main explanatory employment status: unemployed with and without benefits -- employed • Stratification: ₋ Sex ₋ Social class (non-manual/ manual) ₋ Family composition (main earner / other earners at home) Methodology: variables
- 25. Results
- 26. Results
- 27. Results
- 28. Results
- 29. Results
- 30. Results
- 31. Key points • Confirm a strong effect of gender roles & social class
- 32. *Glòria Pérez Albarracin, Agència de Salut Pública de Barcelona http://cadenaser.com/emisora/2015/03/18/radio_barcelona/1426674400_552101.html Key points • Confirm a strong effect of gender roles & social class • Main earner women a specific group with important unemployment health impact: • They are not ussually monitored – probably increasing group • Lone mothers in unemployment probability of 47% of poor mental health* • What is happening in times of austerity?
- 33. Key points • Unemployment policies: • Unemployment benefits: differential impact according groups
- 34. Key points • Unemployment policies: • Unemployment benefits: differential impact according groups • Active labour market policies? Do they work in terms of health in Catalonia? Is there a differential impact?
- 35. Key points • Unemployment policies: • Unemployment benefits: differential impact according groups • Active labour market policies? Do they work in terms of health in Catalonia? Is there a differential impact? • What happens when reemployment is precarious?
- 36. Key points • Unemployment policies: • Unemployment benefits: differential impact according groups • Active labour market policies? Do they work in terms of health in Catalonia? Is there a differential impact? • What happens when reemployment is precarious? • What is better for health? unemployment + benefits or precarious employment?
Editor's Notes
- It is well known that unemployment has important health effects on our population. Most important causal mechanisms or pathways are: 1) economic deprivation; 2) latent functions of employment deprivation (which means that employmen appart from providing economical resources it also provides a time structure, social life, xxxx), 3) trhough stress becuase of the unknown future.
- It is well known that unemployment has important health effects on our population. Most important causal mechanisms or pathways are: 1) economic deprivation; 2) latent functions of employment deprivation (which means that employmen appart from providing economical resources it also provides a time structure, social life, xxxx), 3) trhough stress becuase of the unknown future.
- It is well known that unemployment has important health effects on our population. Most important causal mechanisms or pathways are: 1) economic deprivation; 2) latent functions of employment deprivation (which means that employmen appart from providing economical resources it also provides a time structure, social life, xxxx), 3) trhough stress becuase of the unknown future.
- It is well known that unemployment has important health effects on our population. Most important causal mechanisms or pathways are: 1) economic deprivation; 2) latent functions of employment deprivation (which means that employmen appart from providing economical resources it also provides a time structure, social life, xxxx), 3) trhough stress becuase of the unknown future.
- It is well known that unemployment has important health effects on our population. Most important causal mechanisms or pathways are: 1) economic deprivation; 2) latent functions of employment deprivation (which means that employmen appart from providing economical resources it also provides a time structure, social life, xxxx), 3) trhough stress becuase of the unknown future.
- It is well known that unemployment has important health effects on our population. Most important causal mechanisms or pathways are: 1) economic deprivation; 2) latent functions of employment deprivation (which means that employmen appart from providing economical resources it also provides a time structure, social life, xxxx), 3) trhough stress becuase of the unknown future.
- It is well known that unemployment has important health effects on our population. Most important causal mechanisms or pathways are: 1) economic deprivation; 2) latent functions of employment deprivation (which means that employmen appart from providing economical resources it also provides a time structure, social life, xxxx), 3) trhough stress becuase of the unknown future.
- What is less known is the unequal distribution of the health effects of unemployment. If we consider this model of diderichsen, health inequalities created by unemployment are related to three main mechanisms: first, the differencial exposure to unemployment, differential vulnerability, and differential consequences. Differential exposure to unemployment is probably the most obvious. Here I show you two different maps of barcelona, above you can see the percentage of unemployment in each area of Barcelona, below the mortality ratios are represented. As you can see in Barcelona unemployment is specially concentrated in specific areas such as nou barris neighbourghood. At ecological level, you can see how most deprived areas are also the areas with higher mortality.
- As you know territory or region is not the only social mechanism of inequality, and unemployment is unequally distributed by social class, gender, ethnicity, age, region – and all they interact, as probably in barcelona what you can see are clusters of socioeconomic deprivation.
- The second mechanism is what he calls differential vulnerability or what we could call differential impact of unemployment on health. That is, once unemployed the risk of being ill due to unemployment also varies according to the axes of inequality. However, there is no much scientific research about the mechanisms undergoing this differential impact of unemployment on health. What do we know? Regarding social class, manual workers and lower socioeconomic gruops experience a greater impact on health due to unemployment. Some of the explanations are that theses groups have lower reemployment prospects and less financial resources to cushion the effects. However apart from the unequal distribution in employment, once unemployed the risk of being ill due to unemployment also varies according to those axes of inequality. There is no much scientific research about the mechanisms undergoing the differential impact of unemployment on health. What do we know? Xxx It is specially relevant the fact that these associations of unemployment with health might change according the context: that is gender relations are not the same in Spain that in Sweden, type of benefits also, or maybe being immigrant has not the same meaning and even the same circumstances in terms of social benefits and citizenship here than in the US. Another important point regarding inequalities is the fact that they intersect creatig an specifi matrix of power.
- What do we know? Regarding social class, manual workers and lower socioeconomic gruops experience a greater impact on health due to unemployment. Some of the explanations are that theses groups have lower reemployment prospects and less financial resources to cushion the effects.
- Regarding gender, the impact of unemployment depends on role configurations – in those countries where role configurations are similar the effects between men and women are similar, however where role configuration are different we find stronger effects among men. Moreover, we have seen that gender interacts with family composition and social class: in that case single mothers generally are more affected by the impact of unemployment on health, probably because they are exposed to several other risks, married men in manual class – because of the male breadwinner role, some studies found that married women with no nurturing roles in non-manual classes – and also those people living in a jobless household.
- At this point there are also possible entrances for policies – policies for decreasing unemployment – thus decreasing exposure; and policies for decreasing the impact of unemployment – as Carles showed unemployment benefits might decrease the impact of unemployment, but these depend on the type of benefits if they are contributive or means-tested, and the quantity of money. Why? Because means-tested benefits have some stigma – and stigma of being unemployed is one important pathway from unemployment to poor health, then means-tested benefits probably are not going to improve this part. But also low quantity may conduce to poverty anyway. However are they having the same impact in all groups?
- And what is even more important, are they having the same impact everywhere? We have seen that in countries where gender role configurations are similar the impact of unemployment is similar for men and women…
- If we only have into account a sex stratified analysis we could give the message that unemployment has a slight effect on women, but an important effect on men. Actually results confirm a strong effect of gender roles, and also a strong effect of social class what is more interesting is the different effect of social class among men and women. And even more interesting the group of main earner women. It is also interesting the differential effect of unemployment benefits regarding social class among men – and family composition amonb women. We need to know what happens with migrant population, and its intersection with gender and social class. And we need to know
- If we only have into account a sex stratified analysis we could give the message that unemployment has a slight effect on women, but an important effect on men. Actually results confirm a strong effect of gender roles, and also a strong effect of social class what is more interesting is the different effect of social class among men and women. And even more interesting the group of main earner women. It is also interesting the differential effect of unemployment benefits regarding social class among men – and family composition amonb women. We need to know what happens with migrant population, and its intersection with gender and social class. And we need to know
- If we only have into account a sex stratified analysis we could give the message that unemployment has a slight effect on women, but an important effect on men. Actually results confirm a strong effect of gender roles, and also a strong effect of social class what is more interesting is the different effect of social class among men and women. And even more interesting the group of main earner women. It is also interesting the differential effect of unemployment benefits regarding social class among men – and family composition amonb women. We need to know what happens with migrant population, and its intersection with gender and social class. And we need to know
- If we only have into account a sex stratified analysis we could give the message that unemployment has a slight effect on women, but an important effect on men. Actually results confirm a strong effect of gender roles, and also a strong effect of social class what is more interesting is the different effect of social class among men and women. And even more interesting the group of main earner women. It is also interesting the differential effect of unemployment benefits regarding social class among men – and family composition amonb women. We need to know what happens with migrant population, and its intersection with gender and social class. And we need to know
- If we only have into account a sex stratified analysis we could give the message that unemployment has a slight effect on women, but an important effect on men. Actually results confirm a strong effect of gender roles, and also a strong effect of social class what is more interesting is the different effect of social class among men and women. And even more interesting the group of main earner women. It is also interesting the differential effect of unemployment benefits regarding social class among men – and family composition amonb women. We need to know what happens with migrant population, and its intersection with gender and social class. And we need to know
- If we only have into account a sex stratified analysis we could give the message that unemployment has a slight effect on women, but an important effect on men. Actually results confirm a strong effect of gender roles, and also a strong effect of social class what is more interesting is the different effect of social class among men and women. And even more interesting the group of main earner women. It is also interesting the differential effect of unemployment benefits regarding social class among men – and family composition amonb women. We need to know what happens with migrant population, and its intersection with gender and social class. And we need to know