title: Are some populations resilient to recessions? Economic fluctuations and mortality during a period of economic decline and recovery in Finland.
abstract: This paper uses individual-level longitudinal data on working-age Finns to examine the health effects of economic fluctuations during a period of economic decline (1989-1996) and recovery (1997-2007) in Finland. We used a nationally representative, longitudinal sample formed by linking population, employment and mortality registers (n = 698,484; 7,719,870 person-years). We implemented a region fixed-effect model that exploits within-regional variations over time in the unemployment rate to identify the effect of economic fluctuations on mortality, controlling for individual employment transitions. Unemployment rates increased from 5.2 % in 1989 to 19.8 % in 1996, declining gradually thereafter and reaching 9.7 % in 2007. Results indicate that these large fluctuations in the economy had no impact on the overall mortality of most working age Finns. The exception was highly educated men, who experienced an increase of 7 % (Rate ratio = 1.07, 95 % confidence interval 1.04, 1.10) for every one-point increase in the regional unemployment rate during the period 1989-1996 due to increased mortality from cardiovascular disease and suicide. This increase, however, was not robust in models that used the employment to population ratio as measure of the economy. Unemployment rates were unrelated to mortality among females, lower educated men, and among any group during economic recovery (1997-2007). For most Finns, we found no consistent evidence of changes in mortality in response to contractions or expansions in the economy. Possible explanations include the weak impact of the recession on wages, as well as the generous unemployment insurance and social benefit system in Finland.
authors.affiliation: Department of Global Health & Social Medicine, King's College London, East Wing, Strand Campus, Strand, London, WC2R 2LS, UK. mauricio.avendano_pabon@kcl.ac.uk.|Department Social and Behavioral Sciences, Harvard T.H. Chan School of Public health, Boston, MA, USA. mauricio.avendano_pabon@kcl.ac.uk.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Avendano
authors.affiliation: Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland.
authors.forename: Heta
authors.initials: H
authors.lastname: Moustgaard
authors.affiliation: Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland.|Centre for Health Equity Studies (CHESS), Stockholms Universitet and Karolinska Institutet, Stockholm, Sweden.|The Max Planck Institute for Demographic Research, Rostock, Germany.
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality*; D057172:Economic Recession; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends*; D055500:Resilience, Psychological; D013405:Suicide; D014478:Unemployment / Q000706:statistics & numerical data*
keywords: Economic recession; Educational status; Mortality; Registries; Unemployment