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

该奖项是根据2009年美国复苏和再投资法案（公法111-5）资助的。克里斯托弗·鲁姆（Christopher Ruhm）的一系列有影响力的论文证明了经济衰退对你的健康有益，或者更具体地说，州一级的死亡率是顺周期的。相关性的大小具有经济意义：文献中的一个典型估计表明，一个州的失业率上升一个百分点，该州的死亡率就会下降0.54%，这意味着每年死亡人数减少约12，000人。这一挑衅性的发现立即提出了这种关系背后的机制是什么的问题。可能包括：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，具有负面健康后果的商品消费的变化，与商业周期相关的外部性，如污染或交通死亡人数的变化，以及选择性移民。与此同时，将个人失业与个人死亡率联系起来的研究发现，经历失业的个人死亡的可能性更高。这些结果似乎与基于州级分析的结果不一致，除非与经济改善相对应的州级死亡率上升主要是由个人自身健康行为变化之外的因素驱动的。该项目的智力价值在于，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的变化中分离出个人自身行为的影响。这提供了一个关键环节，以协调国家一级和个人分析产生的估计。该项目更广泛的影响在于其对公共政策的影响：个人自身行为变化导致的健康变化与外部因素导致的变化相比，具有不同的相关政策规定。此外，关于失业影响的文献正在迅速增加，人们越来越认识到，失业的影响远远超过其对个人收入的影响。该项目实质性地推进了关于失业的文献。该项目的第三个广泛影响是，它增加了最近的努力，以了解和衡量商业周期波动的福利成本。 它通过以下方式研究这些机制：1）按年龄和死亡原因估计详细的死亡率-失业率相关性，2）估计自身群体与总失业率对群体死亡率的影响，3）观察医疗保健质量和数量的周期性变化。此外，它调查的可能性，非随机迁移在死亡率和商业周期之间的连接中发挥了作用，无论是通过诱导错误测量的人口增长因子，或通过产生的健康分布的国家组成的变化。由于初步分析表明，大多数顺周期关系是由老年人死亡驱动的，该项目侧重于了解老年人医疗保健选择的周期性（例如选择住在家里与选择养老院护理）。

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).