Why are Recessions Good for Your Health? Understanding Pro-cyclical Mortality

为什么经济衰退对您的健康有益？

• 批准号: 0922551
• 负责人: Ann Stevens
• 金额: $ 38.03万
• 依托单位: University of California-Davis
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-15 至 2013-07-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=0922551&HistoricalAwards=false
• 关键词: Why; Recessions; Good; Your; Health

This award is funded under the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).A series of influential papers by Christopher Ruhm document that recessions are good for your health or more specifically that state-level mortality rates are pro-cyclical. The magnitude of the correlation is economically meaningful: a typical estimate from the literature suggests that a one percentage point increase in the unemployment rate of a state is associated with a 0.54% reduction in the mortality rate of that state, which would translate into about 12,000 fewer deaths per year. This provocative finding immediately raises the question of what mechanisms are behind the relationship. Possibilities include: direct negative effects of employment such as occupational injuries or stress, changes in the opportunity cost of time associated with medical appointments or other time-intensive health promoting behaviors, changes in the consumption of goods that have negative health consequences, externalities associated with the business cycle, such as changes in pollution or traffic fatalities, and selective migration. At the same time, research linking individual job displacements to individuals own mortality finds that individuals who experience a job loss have higher probabilities of dying. These results would seem to be at odds with those based on state-level analyses, unless the increase in state level mortality rates that corresponds to improvements in the economy is mostly driven by factors external to changes in individuals own health behaviors. The intellectual merit of this project is that it improves our understanding of the mechanisms that lead to pro-cyclical mortality. Particular emphasis is placed on disentangling effects that result from an individuals own behavior from changes that are related to externalities associated with economic fluctuations. This provides a key link to reconciling estimates produced by state-level and individual analyses. The broader impacts of the project lies in its implications for public policy: changes in the health of individuals that result from changes in their own behavior have different associated policy prescriptions than changes that result from external factors. In addition, the literature on the effects of job loss is rapidly expanding, and it is increasingly understood that the impact of job loss reaches much further than its impact on individuals own income. This project substantively advances the literature on job loss. A third broad impact of the project is that it adds to recent efforts to understand and measure the welfare costs of business cycle fluctuations. It investigates these mechanisms by 1) estimating detailed mortality-unemployment rate correlations by age and cause of death, 2) estimating the effect of own group vs aggregate unemployment on group mortality, and 3) looking at cyclical changes in the quality and quantity of health care. In addition, it investigates the possibility that non-random migration plays a role in the connection between mortality and the business cycle, either by inducing mis-measurement of population denominators, or by generating compositional changes in the health distribution of states. Because the preliminary analyses suggest that most of the pro-cyclical relationship is driven by deaths among the elderly, the project focuses on understanding the cyclical nature of health care choices among the elderly (for example choosing to live at home vs. choosing nursing home care).

该奖项是根据2009年《美国复苏和再投资法案》(Public Law 111-5)资助的。Christopher Ruhm的一系列有影响力的论文证明，经济衰退对你的健康有利，或者更具体地说，州一级的死亡率是顺周期的。这种相关性的大小具有经济意义：文献中的典型估计表明，一个州的失业率每上升一个百分点，该州的死亡率就会下降0.54%，这将转化为每年大约减少1.2万人的死亡。这一具有挑衅性的发现立即引发了这样一个问题：这种关系背后的机制是什么。可能性包括：就业的直接负面影响，如职业伤害或压力，与医疗预约或其他时间密集型健康促进行为相关的时间机会成本的变化，对健康有负面影响的商品消费的变化，与商业周期相关的外部性，如污染或交通死亡的变化，以及选择性迁移。与此同时，将个人工作转移与个人自身死亡率联系起来的研究发现，经历过失业的人死亡的可能性更高。这些结果似乎与基于州一级分析的结果不一致，除非与经济改善相对应的州一级死亡率的增加主要是由个人健康行为变化以外的因素推动的。这个项目的学术价值在于，它提高了我们对导致顺周期死亡的机制的理解。特别强调的是，从与经济波动相关的外部性相关的变化中解开个人自身行为所产生的影响。这为协调国家一级的分析和个人分析产生的估计提供了一个关键环节。该项目的更广泛影响在于其对公共政策的影响：个人行为变化导致的个人健康变化与外部因素导致的变化具有不同的相关政策处方。此外，关于失业影响的文献正在迅速扩大，人们越来越多地认识到，失业的影响远远超过其对个人收入的影响。该项目极大地推动了有关失业的文献研究。该项目的第三个广泛影响是，它增加了最近理解和衡量商业周期波动的福利成本的努力。它通过1)按年龄和死因估计详细的死亡率-失业率相关性，2)估计自己组与总失业率对组死亡率的影响，以及3)观察卫生保健质量和数量的周期性变化来研究这些机制。此外，它还调查了非随机移徙是否可能在死亡率与商业周期之间的联系中发挥作用，这可能是因为它导致了人口分母的错误衡量，或者是通过改变各州健康分布的构成。由于初步分析表明，大多数顺周期关系是由老年人的死亡推动的，因此该项目侧重于了解老年人医疗保健选择的周期性(例如，选择住在家里还是选择养老院护理)。