JOINT HEALTH UNIT
Inquire
Inform
Innovate
The Health Impact of the Economic Recession in
Rochdale Borough
January 2009
The Health Impact of the Economic Recession in
Rochdale Borough
Contents
Page
Introduction
3
Review of the Research
3
Rochdale Borough Context
4
Rochdale MBC Action
4
Employment Statistics
5
Health Impact Assessment of the Recession
6
-
Background to HIA
6
-
Limitations of the HIA
6
-
The HIA Process
6
-
The Health Impact Assessment
7
Conclusions and Recommendations
16
Appendix
Research review
17
2
The Health Impact of the Economic Recession in Rochdale Borough
Introduction
“Economic instability and insecurity increase the likelihood of
immoderate and unstable life habits, disruption of basic social
networks, and major life stresses  in other words, the relative
lack of financial and employment security of lower
socioeconomic groups is a major source of their higher mortality
rates. “ (Brenner 1979)
The above quote highlights the known link between economic instability and
decline and their impacts on the health of those affected. Almost 30 years ago,
Brenner described how high unemployment and unusually low rates of economic
growth impacts on society, but particularly how it disproportionately impacts upon
the poorer members of society. His research highlighted longer term impacts on
mortality due to lifestyle changes, but also the shorter term impact in relation to
mental health problems and increases in suicide and homicide. The NHS has a
responsibility to understand these impacts and respond to the needs of the
population.
Research – Links between Economic Recession and Health
A review of the literature has identified a significant amount of work that shows
the link between economic recession and health. A more detailed description of
some recent work is included in the appendix of this report. However some key
points include:
Studies have increasingly shown a link between recession and ill-health,
particularly depression, suicide, anxiety, cardiac disease and other medical
maladies1. According to a study from Stirling University, 40 per cent of
unemployed people suffer from psychological distress as a side-effect of
recession.
Professor Richard Wilkinson, a social epidemiologist at the University of
Nottingham believes that the health impact of job insecurity is ultimately linked to
stress and that “stress effects the cardiovascular system and the immune system
and in the long term it leads to a sort of 'rapid ageing' making you vulnerable to
all sorts of different things”.
A recently published study showed that
psychological distress such as anxiety, insomnia, depression, apathy and fatigue
can more than double the risk of developing type 2 diabetes in men2.
The most noticeable impact of the credit crunch so far has been on the housing
market. A study published last year by a team of researchers in Essex found that
struggling to pay increasing mortgage payments can have a detrimental effect on
1
2
The Times – www.timesonline.co.uk, “How to stay healthy in a sick economy”, 14th March 2008
BBC News - http://news.bbc.co.uk, “Can the credit crunch make us ill?”, 30th July 2008
3
mental health5. These psychological effects, measured after the crash in house
prices in the early 1990s, were found to be over and above those associated with
financial hardship in general and similar in magnitude to losing a job.
Rochdale Context
This report attempts to describe what the projected impact of the economic
recession is going to be in Rochdale Borough itself and what the implications
may be on the health of residents and therefore increased pressures on services.
The predictions are based on national trends which have been translated into the
local situation in relation to the employment market and other socio-economic
factors
It is important to note that Rochdale Borough already has a number of
communities that are very deprived. The Borough already has significant issues
in relation to economic deprivation and therefore the related issues concerning
lifestyle and health deprivation. There is already a high demand on services
meeting the particular needs of deprived communities. The impact of the
economic recession is therefore going to increase demand on current services
that are already meeting significant needs. Commissioners need to be aware
that front line services that are already established to meet the needs of the
population are likely to get busier. Commissioning teams that haven’t yet
established services to meet the apparent needs of those in the population, those
needs are likely to increase and demand for the service strengthen.
Rochdale MBC Actions to Overcome the Recession
Members of staff from the Performance and Development Unit at the Council with
in put from the Joint Health Unit have conducted a full review of the anticipated
impacts of the recession on the Borough along with some possible actions that
can be done to alleviate the anticipated challenges for council services ( the
action plan is included in the appendix of this document). In addition to this the
Council organised a “Beat the Crunch” seminar that brought together council
services, elected members and representatives from other partners to discuss
the implications and some of the ways in which the Borough can tackles the
impacts identified.
The Key Implications of the Borough have been identified as:For Our People 
Most deprived communities and vulnerable groups are likely to be worst
affected

Increased redundancies – far reaching implications, not just financial but
also health and wellbeing
For Our Economy 4

Firm closures

Doubts over business sustainability

Viability of some regeneration or physical development schemes may
need to be revisited
For Our Council –

loss of revenue

Increase or change in service demand

Business continuity risks

Medium / longer term impacts

Possible of reduced financial settlement
Impact on Employment in the Borough
One of the most significant impacts is likely to be in relation to employment.
There are communities in Rochdale Borough that already have some of the
highest levels of unemployment in the country. The Greater Manchester
Forecasting Model has published the employment outlook for the next 10 years in
Rochdale, including the following:
-
Unemployment is expected to increase by about 2500 people in the
Borough over the next 2 years
-
2007 rates of employment are unlikely to be seen again until 2018
-
It is anticipated that the recession will increase unemployment to 6500,
similar to the level last experienced in the 1990’s. This is further
exacerbated by the fact that the increase in unemployment comes so
quickly after a period whereby people had such easy access to very
high levels of credit i.e. – debt.
-
Within the more deprived communities in the Borough, the most
common employment sector is construction and manufacturing.
Manufacturing employment opportunities have continuously decreased
in the last 10 years and this trend is likely to continue. It is anticipated
that there will be little or no growth in construction opportunities in the
next 10 years.
5
Health Impact Assessment of the Economic Crisis
Background
Health Impact Assessment has been described as "the estimation of the effects
of a specified action on the health of a defined population". It is based on the
principles established for environmental impact assessments, and is also firmly
rooted in the principles of social justice and equity.
HIA is based on a holistic, social model of health that recognises the role of a
wide range of economic, social and environmental influences on the health of
individuals and communities. These determinants are as important, or in many
cases more important, than heredity and health care services
The World Health Organisation has defined Health as a state of complete
physical, mental and social well being and not merely the absence of disease
As discussed already in this report, it is anticipated that the economic recession
will have a significant impact on the health and well-being of residents in the
borough.
Limitations of this HIA
This Health Impact Assessment (HIA) is a rapid, basic version of what is normally
a longer term process. HIA is often conducted on a specific action or initiative to
look at the wider health implications of that initiative. In relation to the economic
recession, it is anticipated that there will be a number of different impacts many
of which will have several impacts on the health and well-being of the population.
Therefore this HIA is a guide to what the possible health implications might be
and further work is needed to look at some of the key recommendations for
action to mitigate the negative implications of the recession. This report can
therefore be used and amended by commissioning teams and other
organisations in the public and voluntary sector as a guide to the health impacts
and the related service needs that may result from them.
The Process
This HIA has identified some of the key changes / impacts of the recession and
estimated the impacts they may have on health. The impacts have been
organised under sub-headings relating to the key wider determinants of health.
Each impact has been given a risk rating of the likelihood of the predicted impact
occurring.
6
The Assessment of the Impacts
Predicted Health Impacts
Category of
Health
Determinant
Predicted
Change/Impact
Positive
Negative
Risk Definite (D),
Probable
(P),
Speculative
(S)
Mitigation/
Recommendations
Socio Economic Factors
Increase in mental health
problems linked to threat of
redundancy and unemployment
Business/
Employment
Employment
insecurity/ threat of
redundancies and
an overall increase
in unemployment
More sedentary lifestyle due to
an increase in the number of
people not going out to work
Increased number of people
eating poor diets due to
decrease in income
The increase in levels of stress
and depression is likely to lead
to increased numbers of people
smoking, and increased Alcohol
& Drugs misuse.
Definite
It is recommended that
mental health promotion
services are increased.
The PCT should also
monitor Mental Health
morbidity rates across the
borough to target services
accordingly.
Probable
There should be links
made between Revenue
and Benefits offices and
job centres to raise
awareness of mental
health issues and how to
get support
Probable
Service should look at
developing increased
opportunities for
volunteering schemes to
Probable
7
encourage people to
maintain active lives.
Increased number of suicide
rates
Increase in social isolation of
people who are no longer active
in the work place – linked
mental health issues related to
this
Viability of
physical
regeneration
development
being
considered
Possible delay in
physical
regeneration within
the Borough of
Rochdale due to a
decrease in the
public purse and
availability of
funding from
private investors
Speculative
Probable
Look at opportunities to
support access to cheap
fresh food initiatives and
nutrition and cooking skills
courses targeted at, at risk
residents
Probable
Increase in service
provision in relation to
smoking cessation
services and early
intervention support for
people with drug / alcohol
problems
A full HIA should be
conducted to look at the
wider implications of the
new development within
the centre of Rochdale
and look at ways in which
the health impacts can be
mitigated.
Increase efficiency and
effectiveness work across
the public sector
organisations.
Possible delay in
the effects of
increased noise
pollution during
the development
and increase in
traffic
This could have an effect on
the establishment of new joint
services within the Borough and
financial constraints lead to
Increase promotion of free
leisure activity sessions
for residents
8
.
Public Sector
financial
settlement
It is anticipated that
there will be a cut
in public spending
over the coming
years leading to
increased cuts in
health spending
and cuts in council
services
services cutting back to core
funded business.
Increase in preventative service
provision that may have been
covered by Council
Departments
Services will be under pressure
to manage the health
implications of the recession
while at the same time having
to make cuts in spending. This
will have significant impacts on
service planning and
prioritisation
Increasing the role of how
council services contribute to
tackling health will be more
difficult as they are required to
focus on traditional core
business.
VCSP Sector
Decrease in income
for third sector
organisations.,
impacting on their
contribution to
This could have a significant
impact on the health of
communities within which third
sector organisations deliver
some core services to hard to
Probable
Definite
Probable
Probable
Research into each area /
impact
Increase efficiency and
effectiveness work across
the public sector
organisations ensuring
services are focusing of
the right priorities in the
most effective way.
Work closely and quickly
with council services to
identify how they can
contribute to tackling
health inequalities through
ways of working rather
than developing new
services with associated
costs.
It is important that the LSP
monitor the impact of the
recession on the third
sector and react to
financial difficulties in
9
tackling health
inequalities in the
borough
Social Care
There is a risk in
relation to the
viability of privately
run care homes
and facilities that
are used by NHS
services for respite
and rehab
Increase in
acquisitive crime
due to higher levels
of poverty.
Crime
Increase in antisocial behaviour
Increase in alcohol
and drug related
crime due to
reach groups.
An increased
focus on
community based
care through
necessity could
be beneficial to
those able to stay
at home or
receive rehab at
home rather than
in a care home.
Increase in bed blocking
leading to increased waiting
lists for people to access
hospital based services.
Increases in the complexity and
severity of illnesses and
increases in mortality rates due
to treatment delays.
Speculative
Higher number of people
having to stay at home beyond
appropriate period of self-care
Negative impact on families and
stress levels if having to care
for relatives in their own home.
Increase in the number of
victims of crime and related
Probable
general fear of crime – having a
significant impact on mental
health of residents in these
areas.
Violent crime may also increase
as a result of increases in drug
and alcohol use
areas where third sector
organisations play a key
role in tackling health
inequalities
Council and PCT services
need to monitor financial
stability of private care
services and develop
contingency plans for
situations where beds may
become unavailable.
Community based health
services may be under
increased pressure to
provide home based care.
Service planning should
take this into account.
Increase joint working with
police to target areas of
high crime and support to
communities who are
experiencing increased
crime levels and
associated fears of crime.
Develop joint strategies
between Police and DAAT
10
increase rates of
substance misuse
Increase in loan
sharking
Increased cases of
domestic violence
services to early
intervention support for
those involved in
substance misuse linked
crime.
Provide relevant
counselling services for
victims and for specific
groups who live in fear of
crime.
Work with partner
organisations to identify
areas being targeted by
loan sharks and carry out
awareness raising
campaigns decrease
people using them.
Develop increased
partnership working
between the Police, social
care and health services
to identify those
experiencing domestic
abuse and provide
relevant services to
support people in that
situation.
11
Social and Community Influences
Family breakdowns
due to stress
Children and
Young People
Changes in
childhood
environment
(social
instability/unrest/p
eer
pressure/inability
to pay for leisure
activities)
Increase in the
number of children
in care
Increase in NEETs
It is anticipated that there will be
an increase in the number of
children in need of care and also
the number of children and
young people experiencing
mental health problems as a
result of their family based
problems
Increase in mental health
problems and demand for
CAMHS services
More traditional
outdoor
pursuits/decrease
in childhood
obesity
Probable
LSP to review services
across the borough for
CYP’s and monitor any
significant increases in
need and react
accordingly
Probable
Increase in CAMHS
provision/review of
services to assess
whether meeting current
need.
Increase
provision/accessibility of
after-school services
Speculative
Probable
Increase/review
counselling provision
Probable
An increase in NEETs could
lead to a range of problems with
regard to mental health of young
people not engaged in positive
aspects of society, increase in
Probable
PCT and council need to
review services for young
people – specifically for
NEETs. A joint approach
to enabling young people
12
anti-social behaviour and
substance misuse
Decrease in
healthy eating
during childhood
and adolescence
due to lower family
income
Increase in
uptake/need of free
school meals
Culture
Loss of VCS
funding for
organisations
funding social
activities and
community
projects
Increase in childhood obesity
Probable
Decrease in dental health
Probable
Improved nutrition
in deprived
communities/decr
ease in childhood
obesity
to get into employment
and education, while at the
same time supporting
mental health needs, is
required
Increase provision for free
school meals/better
subsidised school meals
for those who don’t qualify
for FSM’s
Health nutritionists to work
with schools to advise on
healthy school
meals/snacks
Speculative
Increased social stigma (link to
mental & emotional health
issues)
Decrease in community
spirit/wellbeing
Increase in sedentary lifestyles
Definite
Speculative
Supporting communitybased cultural activities
Speculative
Promoting other activities
and free leisure services
e.g. reading/sports centres
13
Community
cohesion
Communities
Increase in issues
becoming closer
relating to equity of through sharing
access to services services/increase
d sense of place
or belonging &
therefore
improved
wellbeing
Increase in social
exclusion and
isolation
Increase in mental health
problems including depression
Speculative
Promotion of mental
health services, working in
partnership with RMBC
and voluntary community
sector
Increase in violent crime
Speculative
Increase in self-harm/suicide
Speculative
Public sector
organisations need to look
at how they helping to
develop and support social
network to increase
community cohesion and
tackle social exclusion.
The public sector needs to
work closely with the
voluntary and community
sector to support this.
Living and working conditions
Housing and
homelessnes
s
Increase in number
of people
presenting with
housing debt
issues
Increase in
demand for social
housing and
private rented
Increase in mental health
problems including depression
and stress
Probable
Probable
Promotion of mental
health services, as above.
Increased collaboration
between housing officers
and health staff to help
identify households that
are experiencing mental or
physical health problems
due to their
14
housing
circumstances.
Increase in repossessions due
to mortgage
arrears
Increase in social
rented tenants
being evicted
Increased risk of
over-crowding
Increased levels of
homelessness
Probable
Increased risk of child neglect
leading to poor health/mental
health problems
Increased risk of poor physical
health linked to poor housing
conditions
Increase in incidence of
infectious diseases
Increase in health problems
linked to chaotic lifestyles of
homelessness – multiple health
and social care needs
Speculative
Speculative
Probable
Work with housing
providers to ensure quality
of housing is high and
ensure that tenants are
supported through
relevant service structures
to ensure that private
landlords are providing
quality accommodation
that is not causing
detrimental effects on
peoples health.
Health workers to become
aware of potential issues
for all family members of
housing problems and
develop suitable services
to meet those needs
Homelessness outreach
teams to increase support.
Hostel providers to assess
whether they are able to
meet increased demand,
as well as support workers
to get people back into
housing are in a position
to provide additional
services.
15
Conclusions & Recommendations
Mental Health
It is clear from the above description of the predicted impacts of the economic
recession on health, that this is a very complex issue, with a multiplicity of
potential impacts. The different health determinants described all have
interrelated health impacts. There is a key theme across the assessment that
relates to the impact the recession will have on people’s mental health. Arguably,
it is in this area that the focus of mitigation measures should be across services.
It is also very important to note that the impacts of the recession in relation to
increases in poverty and deprivation are already present in the Borough. The
Borough is already very deprived and the stated impacts above already have
significant influence on the health of residents in the Borough. The Borough has
some of the worst health deprivation levels in the country. The recession is going
to further exacerbate problems that already exist
Health Inequalities
As mentioned in the introductory section of this report, Rochdale Borough already
has a number of communities that are amongst some of the most deprived in the
country3. Within the Borough there are also high levels of health inequalities with
residents living in some areas having a life expectancy ten years lower than that
of residents living in other areas of the Borough. The Borough as a whole on
average has a lower life expectancy than Greater Manchester and lower than the
National average. It is important to note that the recession is likely to make this
problem worse rather than better as it effects those who are already more likely
to experience health deprivation. Significant and focused interventions will be
needed to help mitigate the impact of the recession on already deprived
communities.
Actions
With the above conclusions in mind, it is necessary for public sector and
voluntary and community sector partners to review the work that is already
ongoing to address the issues already present in the Borough. A decision needs
to be made as to whether already planned actions will be enough to overcome
the additional problems caused by the recession or whether there is a need to
review service plans and strategies to enable services to prioritise on the key
issues causing the greatest impact on health. This health impact assessment
again highlights the need for all public sector and voluntary and community
sector organisations to work in partnership to overcome the impacts of the wider
determinant of health.
3
http://www.communities.gov.uk/communities/neighbourhoodrenewal/deprivation/deprivation07/
16
Appendix 1
Recession and Health – Research Findings
Studies have increasingly shown a link between recession and ill-health, particularly
depression, suicide, anxiety, cardiac disease and other medical maladies4. According to
a study from Stirling University, 40 per cent of unemployed people suffer from
psychological distress as a side-effect of recession – many experts believe that this is
because work is quite good for our wellbeing4.
Unemployment has also been found to have a negative impact on people’s physical
health. Professor Harvey Brenner of the University of North Texas said that, “Three to
five years after the height of unemployment, we will begin to see an increase in illness
and the number of deaths”. He also found that a 10 per cent annual increase in
business failures resulted in a 0.3 per cent increase in cardiovascular illness years later4.
Professor Richard Wilkinson, a social epidemiologist at the University of Nottingham
believes that the health impact of job insecurity is ultimately linked to stress and that
“Stress effects the cardiovascular system and the immune system and in the long term it
leads to a sort of 'rapid ageing' making you vulnerable to all sorts of different things”. A
recently published study showed that psychological distress such as anxiety, insomnia,
depression, apathy and fatigue can more than double the risk of developing type 2
diabetes in men5.
A study carried out by Professor Danny Dorling, an expert in human geography at the
University of Sheffield found that 2500 deaths per year in the under 65s would be
prevented in a scenario where there was full employment. He says that “People are
twice as likely to die when they are not employed… It's not because people are poorer,
it's the risk of being made redundant which affects a person's chances of dying”5.
The effect of the economic crisis is already causing concern - research undertaken by
Bupa found that three-quarters of Britons are concerned that the credit crunch will have
a negative impact on their health and wellbeing as well as their personal finances. 90%
of people surveyed said that they expect money worries will lead to increased stress,
while four in five believe they may cause stress-related illness. They also found that
over one-third of Britons feel anxious about the security of their jobs and of those, two in
five are experiencing higher levels of stress as a result6.
The most noticeable impact of the credit crunch so far has been on the housing market.
A study published last year by a team of researchers in Essex found that struggling to
pay increasing mortgage payments can have a detrimental effect on mental health5.
These psychological effects, measured after the crash in house prices in the early
1990s, were found to be over and above those associated with financial hardship in
general and similar in magnitude to losing a job.
In August 2008, the charity Rethink commissioned a survey of almost 2000 people to
find out which stressful event poses the greatest threat to mental health. Home
The Times – www.timesonline.co.uk, “How to stay healthy in a sick economy”, 14th March 2008
BBC News - http://news.bbc.co.uk, “Can the credit crunch make us ill?”, 30th July 2008
6 www.money.co.uk, “Financial Downturn ‘Causing Health Problems’”, 16 th October 2008
4
5
17
repossession was people’s top concern with 46% of people fearing it could damage their
mental health7.
The link between mental health problems and debt is already a serious problem with
research showing that the more debts people have, the more likely they are to have
some form of mental disorder. One-in-six British adults are living with mental health
problems, and of these, one-quarter will experience debt or arrears. This is three times
the rate in the wider British population and equivalent to approximately 1.75 million
British adults8.
In response to the economic crisis, the mental health charity Mind has called for more
investment in services to help people cope with an expected surge in demand for
services. Paul Farmer, chief executive of Mind, said: "Financial health and mental health
are inextricably linked... Job insecurity, redundancy, debt and financial problems are all
proven to contribute to mental distress9”.
In May 2008, a Mind report showed that 91 per cent of people who experienced mental
distress said their problems got worse when they were struggling with debts and
finances9.
The Royal College of Psychiatrists has responded to the economic crisis by announcing
that it will be sending 100,000 health professionals special guidance on supporting
patients with debt and mental health problems. The guidance, entitled "Final Demand Debt and Mental Health", will provide advice for health workers on dealing with this issue
and will be distributed across the UK in early 200910.
Rethink - www.rethink.org, “Soaring repossessions could damage mental health of nearly half of us – new
survey reveals human cost of credit crunch”, 10th October 2008
8 Royal College of Psychiatrists - www.rcpsych.ac.uk, “100,000 mental health professionals to receive ‘debt
first aid’ advice”, 21st November 2008
9 HSJ, “Calls for more mental health funding as economic worries increase”, 21 st November 2008
7
Royal College of Psychiatrists - www.rcpsych.ac.uk, “100,000 mental health professionals to receive ‘debt
first aid’ advice”, 21st November 2008
10
18