Health protection in times of
recession
The role of Active Labour Market
Programmes
Dr Adam Coutts
Policy importance
ALMPs form a core component in the delivery of
social protection, welfare-to-work policy and
broader policies of social mobility and poverty
alleviation.
ALMPs and labour market training interventions
are used to increase employability and reduce the
risk of unemployment. Include job search
assistance, basic skills training.
Becoming ever more important given increasing
unemployment across Europe and US.
Some recent evidence by Stuckler, Coutts et al
that they may protect the health of the unemployed
during unemployment surge and recession.
Unemployment-Mortality
1% rise in
unemployment
associated with:
- 0.8% ↑Suicide
- 0.8% ↑Homicide
- 1.4% ↓Traffic
death
No effect on allcause mortality
Source: From Stuckler et al 2009 Lancet
Some populations more vulnerable
Average Labour Market Protection: $88 per head
1985
1990
2000
15
1980
2005
1985
1990
8
6
2000
2005
Year
Year
Suicide Male
1995
4
25
20
15
10
1995
2
30
25
20
Suicide Rates per 100,000 (under 64)
12
11
10
9
8
1980
10
Sweden
Average Labour Market Protection: $362 per head
Unemployment Rate (Labour Force Surveys)
Spain
Suicide Male
Unemployment Rate
Unemployment Rate
United Kingdom
10
12
8.5
8
8
6
7.5
4
7
2
6.5
1970
1980
Source: From Stuckler et al 2009 Lancet
Suicide
1990
Year
2000
Unemployment Rate
2010
Unemployment Rate (Official)
Suicide Rates per 100,000 (under 64)
Average Labour Market Protection: $95 per head
Social Protections Help…
Each 100 USD
greater social
spending reduced the
effect on suicides by:
- 0.38%, active labour
market programmes
- 0.23%, family support
- 0.07%, healthcare
- 0.09%,unemployment
benefits
Source: From Stuckler et al 2009 Lancet
Spending> 190 USD no effect of
unemployment on suicide
But lack of evidence on ALMPs and health
and causal mechanisms
 Evidence on the effects of ALMPs and training programmes
deal almost exclusively with labour market outcomes such as
earnings, job outcomes and the cost-effectiveness of
programmes
Evidence on labour market status and health has focussed on
the health damaging effects of working conditions or of
unemployment.
Less evidence available on what happens to health when
there is an apparent amelioration in aspects of labour market
deprivation, such as reemployment and especially that
embodied within quasi-employment condition of ALMPs and
return-to-work schemes.
Policy makers have assumed that mechanisms designed to
move people from unemployment to employment are the key
factors in tackling poverty and improving health.
ALMPs and health
• Evidence which exists from such studies - Työhön job
search training Programme, Finland) and the Institute of
Social Research (Michigan) shows
• Reductions in psychological distress and depression
(Coutts 2005, 2009; Juvonen-Posti et al 2002; Melin and
Fugl-Meyer 2003; Vuori et al 2002; Vuori and Silvonen,
2005; Vuori and Versalainen 1999, Vinokur et al 2000;
Westerlund et al 2001)
• Increased subjective well-being (Andersen 2008);
• Higher levels of control/mastery (Creed et al 1999);
• Improvements in motivation and self-esteem through
feeling needed (Coutts forthcoming, 2005; Donavan et al
1986; Hagquist and Starrin 1996; Harry and Tiggemann
1992)
Causal mechanisms
• Models of Jahoda (1982), Warr (1987), Fryer
(1986) and Bandura’s (1997) self-efficacy model,
• Suggested that ALMPs and the training
programmes used to deliver them have the
potential to improve health, in particular that of
psychological
health
and
psychosocial
functioning, through the provision of the latent
functions/vitamins.
Latent and Manifest Benefits model
(Muller, Creed, Waters and Machin 2005)
• The LAMB scale has arisen from the lack of
consistency and questionable psychometric
properties in the scales (Access to Categories of
Work Experience and Significance of Work
Scale) used to measure the latent and manifest
benefits using the theories of Jahoda and Fryer,
making comparative studies difficult.
• LAMB measures: collective purpose, social
contact, social support, status, time structure,
activity and financial strain.
LAMB
• The LAMB subscales have strong internal
reliability, ranging from .74 (time structure)
to .93 (financial strain) (Muller et al 2003).
• Only been tested amongst unemployed
groups in Australia (Creed et al 2005;
Hoare and Machin 2010).
New Deal for Lone Parents - UK
•
•
•
•
•
•
Coutts examined the health impacts of two training programmes on lone
parents and whether the change in their psychosocial environment as
measured by the scale of the latent and manifest benefits of employment
explain health impacts.
Data: 62 lone parents participating in the programmes who were followed
longitudinally for five months.
Structured questionnaires comprising scales of psychological health, selfesteem, mastery, positive and negative affect, self-efficacy, were
administered to the programme participants at three time intervals - at the
beginning (0 months), during (2.5 months) and end of the training
programmes (5 months).
Results: entry into the training programmes improved the psychological
health and well-being of the training participants.
A clear and significant relationship was found between psychosocial
environment variables such as social contact (p<.001), collective purpose
(p=.047) and social identity (p=.043) and psychological health.
Material economic variables (financial strain) did not to contribute
significantly to health measures.
Improved psychological health
(GHQ)
Next steps (1)
• Need for systematic review of ALMPs and
health (Coutts 2009) NOT A COCHRANE
REVIEW!
• Need to generate rigorous evidence on
ALMPs as natural experiments using
European Union Statistics on Income and
Living Conditions (EU-SILC).
• Provides European wide picture of their
impact pre-post recession.
• Replicate LAMB in different labour market
contexts.
Next steps (2)
Policy importance
• Demonstrate cost-benefit and savings to health
services and treasury generated by ALMPs –
what is the social value of ALMPs to government
and individual? HMT Green Book
• Link to WHO Social Determinants of Health
agenda – demonstrate what works, why and for
who?
• Link to well being / happiness agendas of
various EU govs – Stiglitz-Sen Commission on
the Measurement of Economic Performance
and Social Progress
Governments must invest in ALMPs and
social protection not scale back!
• ALMPs will are vital in labour markets where there are
no jobs.
• Provide a mechanism by which to inoculate unemployed
against health damaging effects of unemployment.
• As governments across Europe seek to generate
maximum value and economic effectiveness from their
public services, there will be increased pressure to
identify the broader personal and social value of nonhealth sector government interventions.
Can governments reward ALMPs for their
health / well being impacts in addition to job
entry rates?
Useful references
•
•
•
•
•
Coutts A P (2009) Active Labour Market Programmes and health: an
evidence
base.
Marmot
Review.
Available
at:
http://www.marmotreview.org/AssetLibrary/pdfs/full%20tg%20reports/econo
mic%20active%20labour%20market%20full%20report.pdf.
Fujiwara D and Campbell R (2011) Valuation Techniques for Social Cost
Benefit Analysis: Stated Preference, Revealed Preference and Subjective
Well-Being
Approaches
http://www.hmtreasury.gov.uk/data_greenbook_news.htm
Fujiwara D (2010) Methodologies for estimating and incorporating the wider
social and economic impacts of work in Cost Benefit Analysis of
employment
programmes.
Available
at
:
http://research.dwp.gov.uk/asd/asd5/WP86.pdf
Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M (2011) Effects of the
2008 recession on health: a first look at European data. Lancet 378, pp.
124–125.
Stuckler, D, Basu S, Suhrcke M, Coutts A, McKee M (2009) ‘The public
health effect of economic crises and alternative policy responses in Europe:
an empirical analysis’. Lancet.