Reeves Aaron, Karanikolos Marina, Mackenbach Johan, McKee Martin, Stuckler David
Department of Sociology, University of Oxford, United Kingdom.
European Centre on Health of Societies in Transition (ECOHOST), London School of Hygiene and Tropical Medicine, United Kingdom; European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, United Kingdom.
Soc Sci Med. 2014 Nov;121:98-108. doi: 10.1016/j.socscimed.2014.09.034. Epub 2014 Sep 20.
Unhealthy persons are more likely to lose their jobs than those who are healthy but whether this is affected by recession is unclear. We asked how healthy and unhealthy persons fared in labour markets during Europe's 2008-2010 recessions and whether national differences in employment protection helped mitigate any relative disadvantage experienced by those in poor health. Two retrospective cohorts of persons employed at baseline were constructed from the European Statistics of Income and Living Conditions in 26 EU countries. The first comprised individuals followed between 2006 and 2008, n = 46,085 (pre-recession) and the second between 2008 and 2010, n = 85,786 (during recession). We used multi-level (individual- and country-fixed effects) logistic regression models to assess the relationship (overall and disaggregated by gender) between recessions, unemployment, and health status, as well as any modifying effect of OECD employment protection indices measuring the strength of policies against dismissal and redundancy. Those with chronic illnesses and health limitations were disproportionately affected by the recession, respectively with a 1.5- and 2.5-fold greater risk of unemployment than healthy people during 2008-2010. During severe recessions (>7% fall in GDP), employment protections did not mitigate the risk of job loss (OR = 1.06, 95% CI: 0.94-1.21). However, in countries experiencing milder recessions (<7% fall in GDP), each additional unit of employment protection reduced job loss risk (OR = 0.72, 95% CI: 0.58-0.90). Before the recession, women with severe health limitations especially benefited, with additional reductions of 22% for each unit of employment protection (AORfemale = 0.78, 95% CI: 0.62-0.97), such that at high levels the difference in the risk of job loss between healthy and unhealthy women disappeared. Employment protection policies may counteract labour market inequalities between healthy and unhealthy people, but additional programmes are likely needed to protect vulnerable groups during severe recessions.
不健康的人比健康的人更有可能失去工作，但这是否受到经济衰退的影响尚不清楚。我们研究了在2008 - 2010年欧洲经济衰退期间，健康和不健康的人在劳动力市场中的表现，以及国家在就业保护方面的差异是否有助于减轻健康状况不佳者所经历的任何相对劣势。我们利用26个欧盟国家的欧洲收入和生活条件统计数据，构建了两个在基线时就业人员的回顾性队列。第一个队列包括2006年至2008年期间追踪的个体，n = 46,085（衰退前），第二个队列包括2008年至2010年期间追踪的个体，n = 85,786（衰退期间）。我们使用多层次（个体和国家固定效应）逻辑回归模型来评估经济衰退、失业和健康状况之间的关系（总体以及按性别分类），以及经合组织就业保护指数衡量的反对解雇和裁员政策力度的任何调节作用。患有慢性病和健康受限的人受经济衰退的影响尤为严重，在2008 - 2010年期间，他们失业的风险分别比健康人高1.5倍和2.5倍。在严重衰退（国内生产总值下降>7%）期间，就业保护措施并未降低失业风险（比值比 = 1.06，95%置信区间：0.94 - 1.21）。然而，在经历较温和衰退（国内生产总值下降<7%）的国家，就业保护每增加一个单位，失业风险就会降低（比值比 = 0.72，95%置信区间：0.58 - 0.90）。在经济衰退之前，健康受限严重的女性尤其受益，就业保护每增加一个单位，失业风险额外降低22%（女性调整后比值比 = 0.78，95%置信区间：0.62 - 0.97），以至于在高水平的就业保护下，健康和不健康女性之间的失业风险差异消失。就业保护政策可能会抵消健康和不健康人群之间的劳动力市场不平等，但在严重衰退期间可能需要额外的计划来保护弱势群体。
