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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Long term unemployment, income, poverty, and social public expenditure, and their relationship with self-perceived health in Spain (2007–2011)

Authors: M. Puerto López del Amo González, Vivian Benítez, José J. Martín-Martín

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

There is scant research that simultaneously analyzes the joint effects of long-term unemployment, poverty and public expenditure policies on poorer self-perceived health during the financial crisis. The aim of the study is to analyze the joint relationship between long-term unemployment, social deprivation, and regional social public expenditure on one side, and self-perceived health in Spain (2007–2011) on the other.

Methods

Longitudinal data were extracted from the Survey on Living Conditions, 2007–2010 and 2008–2011 (9105 individuals and 36,420 observations), which were then used to estimate several random group effects in the constant multilevel logistic longitudinal models (level 1: year; level 2: individual; level 3: region). The dependent variable was self-perceived health. Individual independent interest variables were long and very long term unemployment, available income, severe material deprivation and regional variables were per capita expenditure on essential public services and per capita health care expenditure.

Results

All of the estimated models show a robust association between bad perceived health and the variables of interest. When compared to employed individuals, long term unemployment increases the odds of reporting bad health by 22% to 67%; very long-term unemployment (24 to 48 months) increases the odds by 54% to 132%. Family income reduces the odds of reporting bad health by 16% to 28% for each additional percentage point in income. Being a member of a household with severe material deprivation increases the odds of perceiving one’s health as bad by between 70% and 140%. Regionally, per capita expenditure on essential public services increases the odds of reporting good health, although the effect of this association was limited.

Conclusions

Long and very long term unemployment, available income and poverty were associated to self-perceived bad health in Spain during the financial crisis. Regional expenditure on fundamental public services is also associated to poor self-perceived health, although in a more limited fashion. Results suggest the positive role in health of active employment and redistributing income policies.
Literature
1.
Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet. 2009;374(9686):315–23.CrossRefPubMed
2.
Suhrcke M, Stuckler D. Will the recession be bad for our health? It depends. Soc Sci Med. 2012;74(5):647–53.CrossRefPubMed
3.
De Vogli R. The financial crisis, health and health inequities in Europe: the need for regulations, redistribution and social protection. Int J Equity Health. 2014;13:58.CrossRefPubMedPubMedCentral
4.
5.
Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, et al. Financial crisis, austerity, and health in Europe. Lancet. 2013;381(9874):1323–31.CrossRefPubMed
6.
McKee M, Karanikolos M, Belcher P, Stuckler D. Austerity: a failed experiment on the people of Europe. Clin Med (Lond). 2012;12(4):346–50.CrossRef
7.
8.
Pérez García F, Cucarella Tormo V, Hernández Lahiguera L. Servicios públicos, diferencias territoriales e igualdad de oportunidades. Valencia: Fundación BBVA-Ivie; 2015.
9.
10.
Muñoz de Bustillo R. Paisajes después de la batalla. El mercado de trabajo en España tras la Gran Recesión. Rev. Esp. Terc. Sect. 2016;32(Cuatrimestre I):17–45.
11.
Layard R, Nickell S, Jackman R. Unemployment: macroeconomic performance and the labour market. Oxford: Oxford University Press; 1991.
12.
Gradín C, Cantó O, del Río C. Unemployment and spell duration during the great recession in the EU. Int J Manpow. 2015;36(2):216–35.CrossRef
13.
Organization for the Economic Cooperation and Development. In it together: why less inequality benefits all. France: OECD Publishing; 2015.
14.
Goerlich Gisbert FJ. Distribución de la renta, crisis económica y políticas redistributivas. Bilbao: Fundación BBVA; 2016.
15.
Llano Ortiz JC. El estado de la pobreza. 5° informe. Seguimiento del indicador de riesgo de pobreza y exclusión social en España (2009–2014). Madrid: EAPN-España; 2015.
16.
17.
Romeu LR. Effects of short- and long-term unemployment on health satisfaction: evidence from German data. Appl Econ. 2006;38(20):2335–50.CrossRef
18.
19.
Urbanos RM, González B. The influence of the economic crisis on the association between unemployment and health: an empirical analysis for Spain. Eur J Health Econ. 2015;16(2):175–84.CrossRef
20.
Galić Z, ŠVerko Z. Unemployment, (re)employment, and health. Rev Psychol. 2008;15(1–2):3–10.
21.
22.
Couch KA, Reznik GL, Tamborini CR, Iams HM. Economic and health implications of long-term unemployment: earnings, disability benefits, and mortality. Res Labor Econ. 2013;38:259–305.CrossRef
23.
24.
Tøge AG, Blekesaune M. Unemployment transitions and self-rated health in Europe: a longitudinal analysis of EU-SILC from 2008 to 2011. Soc Sci Med. 2015;143:171–8.CrossRefPubMed
25.
Arber S, Fenn K, Meadows R. Subjective financial well-being, income and health inequalities in mid and later life in Britain. Soc Sci Med. 2014;100:12–20.CrossRefPubMed
26.
Abikulova AK, Tulebaev KA, Akanov AA, Turdalieva BS, Kalmahanov SB, Kumar AB, et al. Inequalities in self-rated health among 45+ year-olds in Almaty, Kazakhstan: a cross-sectional study. BMC Public Health. 2013;13:654.CrossRefPubMedPubMedCentral
27.
Aittomäki A, Martikainen P, Laaksonen M, Lahelma E, Rahkonen O. Household economic resources, labour-market advantage and health problems - a study on causal relationships using prospective register data. Soc Sci Med. 2012;75(7):1303–10.CrossRefPubMed
28.
Aittomäki A, Martikainen P, Rahkonen O, Lahelma E. Household income and health problems during a period of labour-market change and widening income inequalities - a study among the Finnish population between 1987 and 2007. Soc Sci Med. 2014;100:84–92.CrossRefPubMed
29.
Leskošek V. Social determinants of health: the indicators for measuring the impact of poverty on health. Slov J Public Health. 2011;51:21–32.
30.
Schütte S, Chastang J-F, Parent-Thirion A, Vermeylen G, Niedhammer I. Association between socio-demographic, psychosocial, material and occupational factors and self-reported health among workers in Europe. J Public Health (Oxf). 2014;36(2):194–204.CrossRef
31.
Saito M, Kondo K, Kondo N, Abe A, Ojima T, Suzuki K, et al. Relative deprivation, poverty, and subjective health: JAGES cross-sectional study. PLoS One. 2014;9(10):e111169.CrossRefPubMedPubMedCentral
32.
Kiely KM, Leach LS, Olesen SC, Butterworth P. How financial hardship is associated with the onset of mental health problems over time. Soc Psychiatry Psychiatr Epidemiol. 2015;50(6):909–18.CrossRefPubMed
33.
Pillas D, Marmot M, Naicker K, Goldblatt P, Morrison J, Pikhart H. Social inequalities in early childhood health and development: a European-wide systematic review. Pediatr Res. 2014;76(5):418–24.CrossRefPubMed
34.
Rajmil L, Fernandez de Sanmamed M-J, Choonara I, Faresjö T, Hjern A, Kozyrskyj AL, et al. Impact of the 2008 economic and financial crisis on child health: a systematic review. Int J Environ Res Public Health. 2014;11(6):6528–46.CrossRefPubMedPubMedCentral
35.
Groffen DAI, Bosma H, van den Akker M, Kempen GIJM, van Eijk JTM. Material deprivation and health-related dysfunction in older Dutch people: findings from the SMILE study. Eur J Pub Health. 2008;18(3):258–63.CrossRef
36.
Borrell C, Muntaner C, Benach J, Artazcoz L. Social class and self-reported health status among men and women: what is the role of work organisation, household material standards and household labour? Soc Sci Med. 2004;58(10):1869–87.CrossRefPubMed
37.
Blázquez M, Cottini E, Herrarte A. The socioeconomic gradient in health: how important is material deprivation? J Econ Inequal. 2013;12:239–64.CrossRef
38.
Maruthappu M, Ng KY, Williams C, Atun R, Zeltner T. Government health care spending and child mortality. Pediatrics. 2015a;135(4):e887–94.CrossRefPubMed
39.
Maruthappu M, Shalhoub J, Tariq Z, Williams C, Atun R, Davies AH, et al. Unemployment, government healthcare spending, and cerebrovascular mortality, worldwide 1981-2009: an ecological study. Int J Stroke. 2015b;10(3):364–71.CrossRefPubMed
40.
Bradley EH, Elkins BR, Herrin J, Elbel B. Health and social services expenditures: associations with health outcomes. BMJ Qual Saf. 2011;20(10):826–31.CrossRefPubMed
41.
Navarro V, Muntaner C, Borrell C, Benach J, Quiroga A, Rodríguez-Sanz M, et al. Politics and health outcomes. Lancet. 2006;368(9540):1033–7.CrossRefPubMed
42.
Bambra C, Eikemo TA. Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries. J Epidemiol Community Health. 2009;63(2):92–8.CrossRefPubMed
43.
44.
Maruthappu M, Ng K, Williams C, Atun R, Agrawal P, Zeltner T. The association between government healthcare spending and maternal mortality in the European Union, 1981–2010: a retrospective study. BJOG: Int J Obstet Gy. 2015;122(9):1216–24.CrossRef
45.
Maruthappu M, Da Zhou C, Williams C, Zeltner T, Atun R. Unemployment, public-sector health care expenditure and HIV mortality: an analysis of 74 countries, 1981-2009. J Glob Health. 2015;5(1):010403.CrossRefPubMedPubMedCentral
46.
Maruthappu M, Watkins JA, Waqar M, Williams C, Ali R, Atun R, et al. Unemployment, public-sector health-care spending and breast cancer mortality in the European Union: 1990–2009. Eur J Pub Health. 2015;25(2):330–5.CrossRef
47.
Shahidi FV, Siddiqi A, Muntaner C. Does social policy moderate the impact of unemployment on health? A multilevel analysis of 23 welfare states. Eur J Pub Health. 2016 Dec;26(6):1017–22.CrossRef
48.
Huijts T, McKee M, Reeves A, Stuckler D. PP45 job loss and self-rated health during the crisis: the mitigating effect of social protection expenditure in 23 European countries. J Epidemiol Community Health. 2014;68(Suppl 1):A65.CrossRef
49.
50.
Singh-Manoux A, Martikainen P, Ferrie J, Zins M, Marmot M, Goldberg M. What does self rated health measure? Results from the British Whitehall II and French Gazel cohort studies. J Epidemiol Commun H. 2006;60(4):364–72.CrossRef
51.
Robine JM, Jagger C, Egidi V. Selection of a coherent set of health indicators for the European Union. Phase II: final report. Montpellier (Francia): Euro-REVES; 2002.
52.
53.
Jylhä M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Sci Med. 2009;69:307–16.CrossRef
54.
Sargent-Cox KA, Anstey KJ, Luszcz MA. The choice of self-rated health measures matter when predicting mortality: evidence from 10 years follow-up of the Australian longitudinal study of ageing. BMC Geriatr. 2010;10:18–30.CrossRefPubMedPubMedCentral
55.
Kaplan GA, Goldberg DE, Everson SA, Cohen RD, Salonen R, Tuomilehto J, et al. Perceived health status and morbidity and mortality: evidence from the Kuopio ischaemic heart disease risk factor study. Int J Epidemiol. 1996;25:259–65.CrossRefPubMed
56.
van Doorslaer E, Wagstaff A, van der Burg H, Christiansen T, De Graeve D, Duchesne I, et al. Equity in the delivery of health care in Europe and the US. J Health Econ. 2000;19:553–83.CrossRefPubMed
57.
van Doorslaer E, Koolman X, Jones AM. Explaining income-related inequalities in doctor utilisation in Europe: a decomposition approach. J Health Econ. 2004;13:629–47.CrossRef
58.
Sáez M. Condicionantes en la utilización de los servicios de atención primaria. Evidencias empíricas e inconsistencias metodológicas. Gac Sanit. 2003;17:412–9.CrossRefPubMed
59.
Manor O, Matthews S, Power C. Dichotomous or categorical response? Analysing self-rated health and lifetime social class. Int J Epidemiol. 2000;29:149–57.CrossRefPubMed
60.
Aguilar-Palacio I, Carrera-Lasfuentes P, Rabanaque MJ. Salud percibida y nivel educativo en España: tendencias por comunidades autónomas y sexo (2001-2012). Gac Sanit. 2015;29(1):37–43.
61.
Haseli-Mashhadi N, Pan A, Ye X, Wang J, Qi Q, Liu Y, et al. Self-rated health in middle aged and elderly Chinese: distribution, determinants and associations with cardio-metabolic risk factors. BMC Public Health. 2009;9:368.CrossRefPubMedPubMedCentral
62.
Mcfadden E, Luben R, Bingham S, Wareham N, Kinmonth AL, Khaw KT. Social inequalities in self-rated health by age: cross-sectional study of 22457 middle-aged men and women. BMC Public Health. 2008;8:230.CrossRefPubMedPubMedCentral
63.
Norström F, Virtanen P, Hammarström A, Gustafsson PE, Janlert U. How does unemployment affect self-assessed health? A systematic review focusing on subgroup effects. BMC Public Health. 2014;14:1310.CrossRefPubMedPubMedCentral
64.
Marmot M, Theorell T. Social class and cardiovascular disease: the contribution of work. Int J Health Serv. 1988;18(4):659–74.CrossRefPubMed
65.
Subramanian SV, Kawachi I. Income inequality and health: what have we learned so far? Epidemiol Rev. 2004;26(1):78–91.CrossRefPubMed
66.
Lim H, Kimm H, Song IH. The relationship between employment status and self-rated health among wage workers in South Korea: the moderating role of household income. Health Soc Work. 2015;40(1):26–33.CrossRefPubMed
67.
68.
69.
70.
71.
Goldstein H. Multilevel Statistical Models. 4th ed. West Sussex: Wiley; 2011.
72.
Goldstein H, Browne W, Rasbash J. Partitioning variation in multilevel models. Underst Stat. 2002;1(4):223–31.CrossRef
73.
Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, et al. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006;60(4):290–7.CrossRefPubMedPubMedCentral
74.
75.
Robins JM, Hernán MA. Estimation of the causal effects of time-varying exposures. In: Verbeke G, Davidian M, Fitzmaurice G, Molenberghs G, editors. Longitudinal data analysis. Chapter 23. London: Chapman and Hall; 2008. p. 553–99.CrossRef
76.
Heponiemi T, Elovainio M, Manderbacka K, Aalto A-M, Kivimäki M, Keskimäki I. Relationship between unemployment and health among health care professionals: health selection or health effect? J Psychosom Res. 2007;63(4):425–31.CrossRefPubMed
77.
Economou A, Nikolaou A, Theodossiou I. Are recessions harmful to health after all?: evidence from the European Union. J Econ Stud. 2008;35(5):368–84.CrossRef
78.
Lundin A, Lundberg I, Hallsten L, Ottosson J, Hemmingsson T. Unemployment and mortality—a longitudinal prospective study on selection and causation in 49321 Swedish middle-aged men. J Epidemiol Community Health. 2010;64(01):22–8.CrossRefPubMed
79.
McKee-Ryan F, Song Z, Wanberg CR, Kinicki AJ. Psychological and physical well-being during unemployment: a meta-analytic study. J Appl Psychol. 2005;90(1):53–76.CrossRefPubMed
80.
Paul KI, Moser K. Unemployment impairs mental health: meta-analyses. J Vocat Behav. 2009;74(3):264–82.CrossRef
81.
Roelfs DJ, Shor E, Davidson KW, Schwartz JE. Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality. Soc Sci Med. 2011;72(6):840–54.CrossRefPubMedPubMedCentral
82.
van Rijn RM, Robroek SJW, Brouwer S, Burdorf A. Influence of poor health on exit from paid employment: a systematic review. Occup Environ Med. 2014;71(4):295–301.CrossRefPubMed
83.
84.
Reeves A, Karanikolos M, Mackenbach J, McKee M, Stuckler D. Do employment protection policies reduce the relative disadvantage in the labour market experienced by unhealthy people? A natural experiment created by the great recession in Europe. Soc Sci Med. 2014;121:98–108.CrossRefPubMed
85.
Heggebø K, Dahl E. Unemployment and health selection in diverging economic conditions: compositional changes? Evidence from 28 European countries. Int J Equity Health. 2015;14:121.CrossRefPubMedPubMedCentral
86.
87.
Castro A, Espinosa I, Rodríguez P, Santos P. Relación entre el estado de salud percibido e indicadores de salud en la población española. Int J Clin Health Psychol. 2007;7:883–98.
88.
Sen A. The idea of justice. New York: Penguin Press; 2009.
89.
Åhs A, Westerling R. Self-rated health in relation to employment status during periods of high and of low levels of unemployment. Eur J Pub Health. 2006;16(3):294–304.CrossRef
90.
Drydakis N. The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: a longitudinal study before and during the financial crisis. Soc Sci Med. 2015;128:43–51.CrossRefPubMed
91.
Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9.CrossRefPubMed
92.
93.
94.
Catalano R, Bellows B. Commentary: if economic expansion threatens public health, should epidemiologists recommend recession? Int J Epidemiol. 2005;34(6):1212–3.CrossRefPubMed
95.
Gallo WT, Bradley EH, Falba TA, Dubin JA, Cramer LD, Bogardus ST, et al. Involuntary job loss as a risk factor for subsequent myocardial infarction and stroke: findings from the health and retirement survey. Am J Ind Med. 2004;45(5):408–16.CrossRefPubMedPubMedCentral
96.
Lawlor DA, Mishra GD. Family matters: designing, analysing and understanding family based studies in life course epidemiology. 1st ed. Oxford; New York: Oxford University Press; 2009.CrossRef
97.
Larson K, Halfon N. Family income gradients in the health and health care access of US children. Matern Child Health J. 2010;14(3):332–42.CrossRefPubMed
98.
Benach J, Yasui Y, Borrell C, Sáez M, Pasarin MI. Material deprivation and leading causes of death by gender: evidence from a nationwide small area study. J Epidemiol Community Health. 2001;55(4):239–45.CrossRefPubMedPubMedCentral
99.
Ayllón S, Gábos A. The Interrelationships between the Europe 2020 Poverty and Social Exclusion Indicators. Soc Indic Res 2016;1–25.
100.
101.
Metadata
Title
Long term unemployment, income, poverty, and social public expenditure, and their relationship with self-perceived health in Spain (2007–2011)
Authors
M. Puerto López del Amo González
Vivian Benítez
José J. Martín-Martín
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-5004-2

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