By Teresa Seeman, Duncan Thomas, Sharon Stein Merkin, Kari Moore, Karol Watson, and Arun Karlamangla
PNAS – Proceedings of the National Academy of Sciences, March 27, 2018
Longitudinal, individual-specific data from the Multi-Ethnic Study of Atherosclerosis (MESA) provide support for the hypothesis that the 2008 to 2010 Great Recession (GR) negatively impacted the health of US adults. Results further advance understanding of the relationship by (i) illuminating hypothesized greater negative impacts in population subgroups exposed to more severe impacts of the GR and (ii) explicitly controlling for confounding by individual differences in age-related changes in health over time. Analyses overcome limitations of prior work by (i) employing individual-level data that avoid concerns about ecological fallacy associated with prior reliance on group-level data, (ii) using four waves of data before the GR to estimate and control for underlying individual-level age-related trends, (iii) focusing on objective, temporally appropriate health outcomes rather than mortality, and (iv) leveraging a diverse cohort to investigate subgroup differences in the GR’s impact. Innovative individual fixed-effects modeling controlling for individual-level age-related trajectories yielded substantively important insights: (i) significant elevations post-GR for blood pressure and fasting glucose, especially among those on medication pre-GR, and (ii) reductions in prevalence and intensity of medication use post-GR. Important differences in the effects of the GR are seen across subgroups, with larger effects among younger adults (who are likely still in the labor force) and older homeowners (whose declining home wealth likely reduced financial security, with less scope for recouping losses during their lifetime); least affected were older adults without a college degree (whose greater reliance on Medicare and Social Security likely provided more protection from the recession).
From the Discussion
Differences by age, educational attainment, and homeownership provide additional insights by exploiting two defining features of the GR. First, the collapse of the housing and stock markets resulted in dramatic declines in the wealth of those who owned housing and those who were invested in the stock market, including those invested through a retirement account. With homeownership at historically high levels and the shift out of company-provided retirement plans, many older adults were exposed to increases in economic insecurity that were both unanticipated and unprecedented in almost a century. Second, earnings opportunities of those in the labor market were negatively affected as the labor market froze, job insecurity spiraled, and real wages declined for many workers.
For those on medication, BP rose most for the younger cohort, irrespective of level of education, all of whom were more likely in the labor market and concerned about retirement in the coming years. BP also rose significantly for those in the older cohort who were better educated and so more likely invested in the stock market and owned their home (among the better educated, 78% owned their home but only 59% among the less educated owned their home). The effects were substantially and significantly smaller for one group on medication: those age at least 65 at the start of the GR who had not completed college. They are the least likely to be working and most likely to rely on Social Security for income rather than a retirement plan invested in the stock market; these people were, therefore, likely to be the least affected by the recession among the four demographic groups.
Patterns for glucose by education and homeownership for those not on medications are similar to the patterns for BP for those not on medication, with significant increases seen among the younger cohort, again irrespective of education or home- ownership. The pattern for glucose among those on medication differs from that for BP, with significant increases seen only among younger adults who do not have a college education and among older adults who own a home. These increases are very large: 11 to 15% relative to each individual’s prerecession trend, possibly reflecting the extent to which these groups were (i) more vulnerable with respect to glucose regulation, being on medication even before the recession, and (ii) among the most heavily impacted by (i) unemployment among the younger cohort [as unemployment rates climbed 16% for those who did not complete high school while never exceeding 5% for those who completed college] and (ii) housing market upheavals among the older cohort.
Our findings provide support for the hypothesis that the economic and social stresses associated with the GR had a deleterious impact on adult health as seen in increases in BP and glucose. Importantly, the patterning of the health changes shows that the worst of the health impacts is among subgroups likely more negatively impacted by the Great Recession: younger adults (who are most likely still in the labor force) and better educated older homeowners (who are most likely invested in the stock market as well as their home). Direct examination of homeownership confirms that older homeowners indeed had the largest increases in BP and glucose from pre- to post-GR. The smallest effects were seen for less educated and nonhomeowning older adults (i.e., those no longer in the labor force and without “investment” in the housing market).
By Don McCanne, M.D.
It is not surprising that the stresses of the Great Recession resulted in worsened blood pressure and blood glucose levels in American adults. But when looking at the subgroups, this study reinforces the importance of our social insurance programs – Medicare and Social Security.
Younger adults were stressed by a decline in earnings opportunities because of the freezing of the labor markets, spiraling job insecurity, and a decline in real wages. Older homeowners with private retirement accounts experienced decline in their investments, including a decline in the value of their homes, at a time that they were nearing retirement. Not unexpected, their health parameters were worse.
Of great importance is the fact that the least affected were those over 65 without a college education and who had little decline in wealth because they did not own their homes and were not as dependent on investments in private retirement accounts. They were protected by Social Security and Medicare, demonstrating the stability (if not the generosity) of social insurance programs when compared to private, individual investments.
Obviously an improved Medicare for all would provide everyone with social insurance covering health care regardless of the status of our economy. Social Security could also be improved to ensure basic income when unemployed, disabled, or retired. This study confirms, once again, that social insurance is good for our health. Private investment is great, but it should be built on a solid foundation of social insurance.
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