Colledge M
Soc Sci Med. 1982;16(22):1919-27. doi: 10.1016/0277-9536(82)90391-4.
Does the impact of large scale and long term unemployment have a negative influence on the health of a community? This paper critically examines research evidence at a macro and micro level of analysis debating the major theoretical issues, and the difficulty in establishing causality between changing mortality patterns over time and fluctuations in the business cycle. It is argued that macro analysis cannot stand on its own as an explanation but needs to be combined with an understanding of the career progression of the unemployed and the stages of psychological transition that occur to bridge the gap between macro and micro environments, and give some understanding of the changes in health status that may be observed in a population following a period of unemployment or economic uncertainty. Both quantitative and qualitative research suggest that not only is the health of those actually at risk but also their immediate family and the community at large during a recession. From this proposition two significant factors emerge in the literature which could explain the association between unemployment rates and changing patterns of mortality. Firstly stress is highlighted in most of the research reviewed, and could be the linking factor for material reasons and also those of social well being. Secondly health status, like that of unemployment is not equally shared in the United Kingdom community, but rather shouldered on a class basis, the most consistent finding being an inverse relationship between economic status and mortality placing the burden squarely on the lower social economic groups who are most vulnerable to unemployment. Taken together all the evidence suggests the inferences made from the macro statistics despite the difficulties in demonstrating causality, suggesting a strong link between mortality rates and cycles of economic activity.
大规模长期失业对社区健康是否有负面影响?本文在宏观和微观分析层面批判性地审视了研究证据,探讨了主要理论问题,以及确定随时间变化的死亡率模式与商业周期波动之间因果关系的困难。有人认为,宏观分析本身不能作为一种解释,而是需要结合对失业者职业发展以及心理过渡阶段的理解,以弥合宏观和微观环境之间的差距,并对一段时间失业或经济不确定性之后人群中可能观察到的健康状况变化有所了解。定量和定性研究均表明,在衰退期间,不仅实际面临风险的人的健康,而且他们的直系亲属和整个社区的健康都会受到影响。从这一命题中,文献中出现了两个重要因素,可以解释失业率与死亡率变化模式之间的关联。首先,在所审查的大多数研究中都强调了压力,它可能是物质原因以及社会福祉方面的联系因素。其次,健康状况与失业情况一样,在英国社区中并非平均分布,而是基于阶层承担,最一致的发现是经济状况与死亡率之间呈反比关系,这使得负担直接落在最易受失业影响的社会经济较低群体身上。综合所有证据表明,尽管难以证明因果关系,但从宏观统计数据得出的推论表明死亡率与经济活动周期之间存在紧密联系。