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November 1, 2017

Why a big economic boom can cut mortality rates—but smaller booms may cost lives

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    Studies suggest that while strong economic growth can improve mortality rates over time, small economic booms lead to short-term increases in deaths, likely related to an increase in air pollution as more goods are produced, Austin Frakt writes for the New York Times' "The Upshot."

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    The connection between economic booms and higher mortality may seem counterintuitive, as economic growth usually correlates with a better standard of living, Frakt writes, but research backs the relationship. One study of European countries, for example, found that a 1 percentage point decrease in the national unemployment rate was associated with a 0.4 percent increase in the overall mortality rate, even after controlling for factors such as country-specific time trends, demographics, and year effects.

    A separate study examined different European countries just before and after the Great Recession, which began in 2007, and found that a 1 percentage point increase in the unemployment rate was associated with a 0.5 percent decrease in the age-adjusted mortality rate.

    One reason: Economic growth can lead to dirty air

    A study from Harvard University and the University of California-Los Angeles suggests a possible explanation for the trend: air pollution. The study found that two-thirds of the relationship between economic booms and increases in mortality can be explained by air pollution.

    The study also found that agricultural societies don't experience a comparable connection between growth and mortality. Further, before 1945—when the United States' economy was far more agricultural—there was no relationship between boom times and increased mortality.

    The researchers suggest that pollution leads to more deaths from respiratory illnesses, cardiovascular disease, and other heart conditions—all of which are sensitive to air pollution.

    Frakt writes that in countries that were hit hard by the Great Recession, like the Baltic States, Greece, and Spain, a study found that the mortality rate for respiratory disease dropped 16 percent from 2007 to 2010, compared to just a 3.2 percent drop in the four years leading up to the Great Recession.

    Other possible explanations

    According to Frakt, other factors beyond air pollution may also contribute to increased mortality in small boom times, such as more people dealing with workplace stress or encountering occupational hazards. Studies have also found that alcohol and tobacco consumption increases during economic booms, as do deaths from car accidents as more people hit the roads, Frakt writes.

    On the flip side, during recessions unemployed people may actually experience improved health as they have more time to exercise and eat healthy. One study found, for example, that higher unemployment was associated with a decrease in obesity rates as well as an increase in physical activity and healthier diets.

    Big booms still help in the long run

    But all of these effects are sensitive to the size of an economic boom, Frakt notes, as big booms may produce higher standards of living that pay off in better long-term health—and big depressions may cause lasting damage to health. One analysis showed, for example, that the economic booms in Japan during the 1960s and 1970s were associated with longer life spans, while the Great Depression was associated with shorter lives.

    The overall takeaway is this, according to Frakt: "[T]here's little question that long-term economic growth broadly improves the human condition. But not everyone enjoys the gains equally. In the short run, economic expansions can cut short the lives of some" (Frakt, "The Upshot," New York Times, 10/16).

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    Population health leaders know that health care delivery is incomplete without addressing the social determinants of health. But effective patient management cannot only include tasking care teams with addressing patients' social needs on top of their complex clinical needs.

    Instead, providers should also partner with community-based organizations already providing quality non-clinical support for a range of needs, from healthy food access to stable housing, to scale patient management beyond traditional care settings.

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