Original papers Edvard Johansson · Research Institute of the Finnish Economy, Helsinki, Finland A note on the impact of hours worked on mortality in OECD countries Eur J Health Econ 2004 · 49:335–340 DOI 10.1007/s10198-004-0244-3 Published online: 6. August 2004 © Springer Medizin Verlag 2004 Recent research has put into new light the impact that economic downturn has on individuals’ health [1, 2, 3, 4]. An analy- sis of United States data for the years 1972– 1991, for example, revealed that a one per- centage point rise in unemployment led to a 0.5–0.6% reduction in overall mor- tality, including a decline in deaths from heart disease by 0.5%, those from influen- za/pneumonia by 0.7%, and those from ve- hicle accidents by 3% [1]. Similarly, a stu- dy of 23 OECD countries over the period 1960–1997 found that a one percentage point rise in unemployment was associat- ed with 0.4% lower overall mortality and a reduction in the number of deaths from heart disease by 0.4%, those from influen- za/pneumonia by 1.1%, and those from motor vehicle accidents by 1.8% [3]. The- se studies have in common that instead of using a pure time series analyses, which was the case in many earlier studies (e.g., [5, 6, 7]), they employ fixed effects models. In these models the within-state or within- region variation in the unemployment ra- te is used together with other control vari- ables to explain the within-state or with- in-region variation in various measures of health, such as mortality rates. As can be guessed, the major problem with earlier ti- me series analyses is that they did not prop- erly control for confounding factors, and that a positive relationship between the unemployment rate and mortality may be spurious. In this context it is important to make a distinction between a transitory strength- ening of the economy and permanent eco- nomic growth. The key here is that a tran- sitory strengthening of the economy like- ly leads to a more intense use of existing stock of health and human and physical capital, whereas permanent growth results from improvements in technology that ex- pands production capacity. For example, in economic models of the demand for health (e.g., [8]) individuals maximize a utility function with health and other consumption as arguments subject to ti- me and budget constraints; in such mod- els permanently higher incomes are asso- ciated with better health as the budget con- straint is shifted out. It is likely that such results are due to the impact of a transito- ry strengthening of the economy. Indeed, it is reported that a sustained deterioration in economic conditions is associated with greater short-run than permanent reduc- tions in mortality [1]. What are the possible reasons that eco- nomic hardship, as reflected in higher un- employment rates, may actually improve health on average in the economy? First, it is possible that during economic expan- sion nonmarket “leisure time” becomes more costly, which makes it less worth- while for the individual to undertake ti- me-consuming health investments in exer- cise. Second, health may be an input to the production process. Hours of work may be lengthened to cope with increased de- mand, which may increase the risk of acci- dents. It is also likely that stress increases. Third, good times may increase the preva- lence of risky activities, for example, driv- ing and drinking [1]. Indeed drinking and vehicle accidents seem to increase in good economic times [9, 10, 11]. Research has also shown that other measures of health improve when the un- employment rate rises. In the United Sta- tes it has been found that a one percent- age point increase in the unemployment rate predicts a 1.5% fall in the prevalence of medical problems, a 3.9% decline in acute morbidities, and a 1.6% reduction in reports of “bed-days” during the pri- or 2 weeks. Some chronic conditions al- so become less common. For instance, a one percentage point increase in the un- employment rate was associated with a 4.3% decrease in ischemic heart dis- ease and an 8.7% reduction in interverte- bral disk disorders [2]. Furthermore, ev- idence from the years 1987–2000 from the Behavioural Risk Factor Surveillance System indicates that smoking, height-ad- justed weight, and leisure time physical inactivity decline when economic condi- tions worsen. Most interestingly, it has al- so been found that a reduction in num- ber of hours worked has a positive impact on health among the United States popu- lation. Specifically, working 1 h less per week is associated with a 0.011 percent- age point reduction in smoking, a 0.017 percentage point decline in severe obesi- ty, a 0.036 percentage point decrease in physical inactivity, and a 0.044 percent- age point decrease in multiple health risks [12]. Although, as seen above, there has be- en some research in this field to date, the- re is clearly a need for more research, par- 335 Eur J Health Econ 4 · 2004 |