During recessions, idled factories spew less pollution and fewer people commuting to jobs means fewer traffic deaths. Laid-off workers have more time to exercise and cook for themselves and less money to eat out.
All of these factors have led some economists over the past decade to overturn previous assumptions that recessions are bad for your health. They say economic downturns actually may be good for you.
But an Associated Press analysis of economic data and death rate estimates from the past two years suggests that view may not be true for the most recent recession. In the latest downturn, at least, economic stress is linked to worse health.
The reasons are obvious to Edward Hamm, a 46-year-old caddy in Orlando, whose work has slowed to a trickle. During the height of the economic downturn, he was diagnosed with Type 2 diabetes after weeks of being sick. He can't find a job that provides health insurance because of Florida's dismal unemployment rate of 12.3 percent. With no regular doctor, he gets sporadic treatment at a clinic run by the Orange County Health Department.
"What do I do?" Hamm said recently outside the clinic in Orlando. "I don't want it to get any worse."
It's too early for anyone to claim they have a definitive answer on whether the current recession has helped or hurt health in the United States, given that the data is still being collected.
The AP analysis looked at changes in death rate estimates provided by the U.S. Census from 2007 to 2009 compared to changes in the AP Economic Stress Index in every county and state during the same period. The analysis found that as economic stress went up, so did the death rate.
The AP's index calculates a score from 1 to 100 based on unemployment, foreclosure and bankruptcy rates. A higher score indicates more economic stress. The analysis showed that for every 6-point increase in a county's AP Stress score, there was a 1-percent bump in the mortality rate estimate.
While the Census death rate data are only estimates, and don't pinpoint causes of death, older studies that have reached the same conclusion, point to increases in cardiovascular disease and suicides. Death rates often are used as an indicator of health, but they don't capture the effects of illnesses or surgeries which can harm a person's quality of life without killing him.
There are visible reasons why economic downturns can make people's health worse, proponents of this theory said. Lost jobs can mean lost health insurance. People without money to spare skimp on buying medication they need or can't afford gym memberships. They are under higher stress.
"These things are going to directly impact your health," said Dr. Steve Cline, deputy state health director at the North Carolina Department of Health and Human Services.
Improvements for very young, old
Over the past decade, though, a growing body of research has suggested the opposite: that health improves during economic downturns and gets worse during economic expansions.
That recent scholarship shows that air pollution goes down during recessions because there is less industrial activity. People smoke and drink less, eat out less and exercise a bit more, said Christopher Ruhm, an economist at the University of North Carolina-Greensboro, who has become one of the best-known proponents of this theory. In a paper that got researchers a decade ago rethinking how economic cycles influence health, Ruhm concluded that a 1-percentage-point rise in joblessness was associated with a half-percent decrease in the total death rate.
"Part of the reason is that people may have extra time on their hands," Ruhm said. "You can control the things you can control, so one of things you might do is live a little healthier deliberately."
The health improvements may be most noticeable in the very young and very old. At-risk infants are less likely to die because of less pollutant matter in the air, according to some researchers.
Economist Ann Huff Stevens and her colleagues' research has shown that during good economic times the death rates increase most among the elderly. Her theory is that during economic booms there are fewer qualified people to work in nursing homes because so many better-paying jobs are available.
"Our suspicion is that it has something to do with labor shortages and quality of care in nursing homes," said Huff Stevens, an economist at the University of California-Davis. "If you look at nursing homes, they are always talking about how hard it is to get help, especially when the economy is robust."
The fact that some studies have reached opposite conclusions may be because some health conditions respond more quickly to economic stress than others, said Janet Currie, an economist at Columbia University.
"For instance, you might expect increases in heart attacks, strokes or high blood pressure, but no immediate increases in, say, cancer," Currie said in an e-mail.
For Susan Main, who lost her accounts-receivable job in September 2008, unemployment has given her more migraines and made her stomach acid reflex condition worse. The 48-year-old central Florida resident has less time to exercise since she spends her day filling out job applications and driving to interviews trying to find an administrative or human resources job.
She was forced to give up her usual acid-reflex drug that was covered under her old insurance plan when she switched to her husband's health plan, and she now has to use a less-effective drug.
"I find I have less time to exercise and do healthy things like that," Main said recently outside a job fair. "It's very stressful."