EDITORIAL

Grim prospects for the unemployed Massive evidence indicates that unemployment kills people and seriously endangers their health in other ways.’.’ The case that unemployment is a significant risk to health is comparable to the case that smoking causes lung cancer. In both instances the weight of circumstantial evidence is so great that no other con- clusions appear valid. Precisely how the harmful consequences arise remains uncertain but they must result from combinations of poverty, stress, social disruption and alienation, adoption of unhealthy behaviours and the deterioration of mental health. Premature deaths among unemployed men result mainly from suicide, cardiovascular disease and acci- dents. The wives and children of older men have increased risks of dying. Less is known about unem- ployed women. They respond in ways different from men: for instance, with much less suicide.

Utilisation of medical services is increased for the unemployed. Part of this is due to physical problems but the mental effects are most devastating for young and old alike. Being deprived of work removes important personal attributes - social status and contacts, an income sufficient to maintain spending parity with working peers, and a sense of meaning and belonging within the mainstream of society. Feel- ings of powerlessness and poor self-esteem are accen- tuated by the stigma of unemployment. The result is an increased frequency of depression, anxiety, dis- turbed sleep, self-injury, domestic violence and suicide.

What the unemployed need most is jobs. The out- look is not promising. In the two decades since rising unemployment tarnished the image of The Lucky Country, little has been done to reverse the impact of relatively high unemployment rates. In fact, until quite recently unemployment has not had anything like the prominence on any political agenda that it has in recession-ridden older northern hemisphere democracies. Australian obsessions with economic rationalism and utilitarian book-keeping dictate that recession and unemployment are the necessary costs of keeping down inflation. Over the last year or so, tens of thousands of Australian workers and their families have paid with their jobs the price of reduc- ing the inflation rate below two per cent. Their plight has been worsened in the aftermath of the financial anarchy of the mid-1980s. which reversed the post- war trend toward income equalisation. So the income gap between rich and poor has increased, making life more difficult for the unemployed on reduced incomes.

Levels of officially registered unemployment of over 10 per cent (approaching one million working age Australians) have to be combined with at least an equivalent number of hidden unemployed. These - mainly women, older men and immigrants of non- English speaking backgrounds - are those who wish to work and would be working in times of full employ- ment but who, for whatever reason, are not officially listed as unemployed.

Prospects offered by political solutions for Australia’s ailing economy do not provide much hope for the unemployed. The federal treasurer’s expressed concern about this year’s rise in levels has not resulted in any substantial improvement. Alternative policies expressed in the federal coalition’s Fightback proposal are hard to interpret in any way other than indicating a depressing future for the unemployed, especially in the short term. Increasing difficulties would arise from the likely rise in costs of living essentials for low-income people; there is no certainty that more jobs will be created and the reverse is equally probable; public spending will be cut, with major reductions to the social secur- ity net and the training and assistance programs cur- rently available; there will be increased harassment and checks on unemployed people and bulk-billing under Medicare will be harder to obtain even for those eligible for it. Added to this depressing policy outlook is the absence of coherent alternatives to the relentless loss of jobs from the work place as people are permanently replaced by machines and positions are eliminated from the middle tiers of management.

All these issues matter to health professionals because any reduction in the burdens associated with unemployment lies initially in the hands of politicians and economists. Much of the compelling evidence for the health impact of unemployment comes frqm the United Kingdom, Scandinavia and Western Europe. ’ .p Nonetheless, Australian evidence is accumulating and was considered at the first Aus- tralian Conference on Unemployment and Health, organised by the Department of Public Health at the University of Sydney on 6 November 1992. In gen- eral, the picture was comparable to that in other industrially developed nations with relatively high levels of unemployment. Analyses of Australian aggregate data indicated increased rates among the unemployed of premature mortality and physical and psychological morbidity. There is growing infor- mation on the dynamics of mental distress among dif- ferent unemployed subgroups. The relationship between suicide and unemployment in males aged between 20 and 24 years was more direct than found elsewhere.

What can public health professionals do about all this? Action is needed at several levels. Within the health sector there is much to be done: to make poli- ticians and their advisers (and probably still a large proportion of health professionals) aware of the emotional, psychological, physical and social effects associated with unemployment; to reduce the still- prevalent stigmatisation and to encourage more appropriate resource allocation and a properly- informed workforce for areas and population groups heavily affected by recession and high unemployment rates. At the intersectoral level there needs to be con- tinued advocacy for increased public investment in employment creation and support programs together with more efficient networking among s u p portive authorities and agencies. Although overstaffing is an economically undesirable strategy,

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EDITORIAL

the balance needs to be struck between its adverse effects and the human consequences of unemploy- ment, especially in the public sector, during a period of recession. It should be emphasised that punitive victim-blaming policies that withdraw or unfairly complicate income support for the unemployed will only increase the existing burden of physical and mental ill-health and premature death. One of the main justifications for researching the health (and indeed all other adverse) consequences in Australia is to make quite clear the impact to those who favour economic solutions at the expense of the unem- ployed. Very importantly, it is essential to maintain

universal access to Medicare for those whose health is endangered. To force the unemployed and their fam- ilies into difficulties with affording or obtaining health care would be a cruel and unwarranted action.

Charles Kerr and Richard Taylor Department of Public Health

University of Sydney References

1. Smith R. Unemployment and health: an opportunity and a disas- ter. Oxford: Oxford University Press, 1987.

2. Warr PB. Work, unemployment and mental health. Oxford: Oxford University Press, 1987.

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