Why Economic Downturns have Favorable Effects on Mortality

Summary of working paper 9468
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During temporary economic downturns, smoking and weight decline, while exercise rises. Specifically, the drop in tobacco use is stronger for heavy smokers, the fall in body weight is larger in the severely obese, and exercise increases most among those who were completely inactive.

Healthy Living in Hard Times (NBER Working Paper No. 9468), author Christopher Ruhm examines how the "lifestyle behaviors" of smoking, weight gain, and exercise are affected by economic conditions. Smoking, the most preventable cause of disease in the United States, leads to roughly 430,000 premature deaths a year by increasing cancer, coronary heart disease, stroke, and respiratory illness. Obesity, the second leading cause of preventable death, is a major risk factor for hypertension, type-2 diabetes, coronary heart disease, stroke, gallbladder disease, and respiratory problems, causing an estimated 300,000 deaths a year. Regular exercise, however, is cited by the U.S. Department of Health and Human Services as a behavior that has a positive effect on overall health by lowering heart disease, diabetes, colon cancer, and osteoporosis. Exercise also increases muscle and bone mass, a key component for weight loss, and makes a person feel better overall.

Recent studies show that mortality decreases when the economy dampens, and Ruhm theorizes that lifestyle behaviors may account for the cyclical variations. In a 2000 study based on data from a 20-year period for all 50 states, he found that a 1 percent rise in unemployment reduced the total death rate by 0.5 percent. Three other studies have shown similar results: a fall in total fatalities during economic downturns for 50 Spanish provinces, 16 German states, and 23 OECD countries.

Ruhm tests his theory using data from the 1987-2000 Behavioral Risk Factor Surveillance System (BRFSS), an annual telephone survey administered by the Centers for Disease Control and Prevention. Almost 1.5 million people across the United States were interviewed over the 14-year period. The provided information on smoking, weight, and physical activity, as well as on demographic characteristics such as: age, sex, education, marital status, race, and ethnicity.

Ruhm classified people as current smokers if they smoked some days, or every day. A special category was reserved for individuals who smoked 40 or more cigarettes a day. Individuals were classified as overweight, obese, and severely obese if their body mass index (BMI) was at least 25, 30, or 35. People were termed regular exercisers if they participated in physical activity for at least 20 minutes three or more times a week. Physically inactive individuals were those who did not take part in any physical activity outside of their regular job.

The data reveal startling lifestyle behavior statistics. Almost one-fourth of those surveyed smoke, with 2 percent of the population smoking 40 or more cigarettes a day. The majority of adults surveyed, 54 percent, are overweight with 5 percent of the survey population severely obese. A total of 42 percent of the population do exercise regularly, but 29 percent engage in no leisure physical activity.

Ruhm links economic conditions -- as proxied by the average state unemployment rate over the three preceding months, from the Bureau of Labor Statistics' Local Area Unemployment Statistics (LAUS) database -- to lifestyle and demographic data. He also controls for seasonal variation, such as a decline in physical activity when the weather gets cold. Ruhm finds that during temporary downturns, smoking and weight decline, while exercise rises. Specifically, the drop in tobacco use is stronger for heavy smokers, the fall in body weight is larger in the severely obese, and exercise increases most among those who were completely inactive. A 1-point rise in unemployment reduces the estimated prevalence of smoking, severe obesity, physical inactivity, and multiple health risks by 0.6, 1.4, 1.5, and 1.8 percentage points, respectively. The 1-point increase in unemployment is predicted to decrease severe obesity among males, blacks, and Hispanics by 2.0, 3.1, and 4.3 percent, compared to 1 percent for both whites and females. But the pattern is reversed for cigarette smoking, showing a 1 percent increase in unemployment decreasing smoking among females by 0.8 percent, while males and blacks drop just 0.3 percent, suggesting that other mechanisms may account for the effects on smoking.

Ruhm tests two possible scenarios, free time and falling incomes, as reasons why individuals might adopt healthier lifestyles when the economy weakens. His data predict that working one fewer hour per week causes a slight (.011 percentage point) reduction in smoking but larger declines in severe obesity, physical activity, and multiple health risks (of .17, .31, and .044 points, respectfully). The author interprets these results as evidence that greater availability of non-work time may provide one reason for the healthier behaviors. According to the author, stronger effects for body weight and exercise than for smoking are reasonable, since longer work hours make it more difficult for people to participate in activities such as exercising and preparing home cooked meals, but cigarette smoking may reflect changes in job stress or in complementary behaviors such as drinking.

Finally, Ruhm notes that the results raise interesting questions about the poorly understood interactions between lifestyle behaviors. It makes sense, for example, that exercise increases when the economy declines because people have more free time; this effect might be reinforced if people are not working as hard on the job and thus are not so physically and mentally exhausted when they leave the office. Other indirect effects, such as changes in sleep, that accompany fluctuating work hours and affect health also could be a factor.

-- Marie Bussing-Burks