Tens of thousands of Oregonians have lost their jobs and health coverage. The recession means there's less money for people to pay for medicine, doctor visits and food. Stress and fear are rampant.

You'd expect our health to suffer as a result, but a growing number of studies suggest the opposite occurs: The health of a population tends to improve slightly when the economy goes south. While some causes of death, such as suicide, increase during a recession, many others decrease. Among them: car crashes, industrial accidents, heart attacks and, in some cities, infant deaths.

"I was very surprised at first," said Christopher Ruhm, a professor of economics at the University of North Carolina at Greensboro. In studies over the past 10 years, Ruhm has consistently found death rates decline during recessions and rise when the economy expands. If unemployment rises 1 percent, he estimates the death rate will fall by about half a percent.

"I tracked things like unemployment and mortality and found that they were almost a mirror image of each other," Ruhm said.

Other researchers have found evidence of improved health during economic downturns in Cuba, Germany, Japan and Spain. Think of it as a silver lining -- and perhaps a measure of how much our unhealthy lifestyles and workaholic tendencies can get the best of us during boom times.



Some still on the fence

Some experts remain skeptical, in part because of overwhelming evidence that people who lose jobs suffer poor health because of it. Depression, anxiety, drug and alcohol abuse, and anti-social behavior become significantly more likely after a person gets laid off.

And economic stress can distract or prevent some people from maintaining healthy habits, said Ralph Catalano, a professor of public health at the University of California at Berkeley. In a recent study of women with newly diagnosed breast cancer, Catalano and colleagues found that during bad economic times, more cases were diagnosed in an advanced stage, suggesting women skipped or delayed getting mammograms.

Catalano questions the certainty of the statistical methods used by researchers who've reported a link between recessions and lower death rates. He said researchers using different methods to study the same times and places continue to reach conflicting conclusions about the overall effect of a shrinking economy.

"The old intuition, that bad economic times are bad for us, is probably closer to the mark," Catalano said.

Idea in doctoral paper

One of the first studies to make the case that recessions are good for health appeared decades ago, in 1977. The author, a doctoral student at the University of Pennsylvania named Joseph Eyer, argued that recessions give people a reprieve from the overwhelming stresses of modern work, and conversely that boom times promote social isolation and daily routines that undermine health by, for instance, promoting obesity and heart disease.

The "alienation of modern work," Eyer asserted, "promotes the polarization of life into enervating and emotionally draining toil, and the escape from work expressed in catatonic TV watching and overeating." But Eyer's articles spent more time attacking capitalism than advancing the science and performing statistical analysis.

And for decades, economists generally accepted the view that wealth created by a rising economy improves health for the majority. Ruhm, the University of North Carolina professor, assumed that was the case but decided to test the hypothesis after noticing that early studies on the question lacked statistical rigor.

"When I went to confirm the results, I found the opposite," Ruhm said. He first reported his findings in 2000. In a follow-up study, he and a European collaborator linked recession to lower death rates in 23 countries over the period from 1960 to 1997.

Jose Tapia Granados, a research scientist at the University of Michigan's Institute of Labor and Industrial Relations, said he thinks the evidence is overwhelming that death rates increase during boom times and decrease during recessions. That's what he found when he looked at the trends in the U.S. from 1900 to 1996, and in Japan since World War II. What's not clear, he said, is how an up or down economy shapes a population's health.

When industries are going full swing and consumers are spending more money, one major cause of death always increases: motor vehicle crashes. Last year, as the economy tanked, the number of people killed in traffic accidents fell by about 9 percent compared with the previous year. Traffic deaths totaled 37,313, down from 41,059 in 2007, according to the National Highway Traffic Safety Administration.

Heavier air pollution also might boost death rates during boom times. A 2003 study found that infant deaths fell significantly in cities where levels of air pollution fell during the 1981-82 recession. Counties with the largest declines in particulate air pollution showed the largest declines in infant deaths. The drop in pollution prevented about 2,500 newborns from dying nationwide, researchers from the University of California at Berkeley estimated.

People may also adopt healthier habits in response to the threats of a collapsing economy. Ruhm has shown that during recessions, alcohol consumption declines, mainly because heavy drinkers drink less. Smokers also cut back on cigarette consumption, Ruhm said. And people who have been inactive tend to exercise more.

Finding the "why"

Figuring out why these behaviors change is more complicated. Lack of money may force some people to cut back on fattening foods, alcohol and tobacco. Fear of getting fired may convince heavy drinkers to stay more sober.

Ruhm suspects that during times of economic crisis, many people cope by focusing on aspects of their lives they can control. "You can take that walk in the morning. You can eat healthier. You can do these things that are good for you."

Economists who are convinced that death rates decline during downturns do not claim that recessions are desirable. "There may be a silver lining, but there are still a lot of dark clouds," Ruhm said.

Eric Neumayer, a researcher at the London School of Economics, argues that the goal should be figuring out precisely how economic recessions and growth spurts change the health of an entire population. Writing in the International Journal of Epidemiology, Neumayer said society has paid much attention to the negative health effects of recessions for the unemployed, and rightly so. But he added, "maybe it's time to focus much more on how to mitigate the negative health effects of economic upturns."

Joe Rojas-Burke: 503-412-7073, joerojas@news.oregonian.com