Interview with David Williams, Harvard School of Public Health

We spoke with David Williams, Norman professor of public health at Harvard University, about the health effects of job loss and about what policies might help protect workers’ physical and mental well-being.

Williams:  It is clearly the case now that we’re living in a global environment. Some of the patterns of employment that existed in the past are gone forever. But what policy makers generally overlook is that these changes not only have economic costs, but health consequences too.

When someone loses their job, they’re losing their livelihood: the means that they use to support themselves as well as their families. But they’re also losing – for many people – a sense of who they are, of what gives them meaning in life and a sense of worth and value.

Take an individual who has others dependent on them for resources to survive. There’s the uncertainty of how you’re going to take care of your financial obligations and your responsibility to others. That becomes very stressful. But then there’s also the psychological component. For many people their job gave them a sense of identity and made them feel that they were making a worthwhile contribution to society.

When all that is taken away, you might see mental health problems like depression and anxiety or increases in obesity as someone becomes less active and uses food to comfort and soothe themselves. You also see increases in the consumption and abuse of alcohol, which in turn produce a range of negative effects, like cirrhosis of the liver and cirrhosis mortality, increases in accidents, and increases in other types of mortality as illness rates rise and so on. Sometimes there are higher rates of suicide directly.

You also have physical effects. There is research – for example, the Kasl study –that shows how just the anticipation of losing one’s job can lead to increases in blood pressure levels. Hope, in fact, is an important protector of health. You can see a cascading set of events that might lead to hypertension, kidney problems, diabetes, heart disease, even stroke. Which specific diseases we run into depends on an individual’s biological background, their family history and so on.

What we’re looking at is the disregulation of underlying biological systems in the body. As that becomes chronic, the level of stress and of multiple systems of the body not functioning right can lead to a broad range of chronic diseases. So a broad range of some of the more common chronic illnesses – both on the mental health dimension as well as in physical health dimension – can be driven by underlying stressors in life, such as those triggered by insecurity about employment and job loss.

And if you think about what’s happening to an individual, well, communities are made up of lots of individuals. So large-scale unemployment, large-scale job losses and large-scale declines in income, coupled with increases in what people call “precarious work” – work that is less stable and less secure – can have large effects at the community level.

Certainly, all of us have a responsibility to ensure the well-being of the population. We really need to stop and think about how our economic changes and policies have health consequences and can adversely impact individuals, families, communities, children. Then we can act and make a difference.

I think we need joined efforts from the government as well as the corporate sector. We do provide a safety net like Social Security for the elderly. We do provide Medicare for the elderly and those are programs that were implemented to ensure that there is a basic support system for everyone. So what can we do to provide extra support, extra cushioning for people who are dealing with greater levels of adversity from multiple sources? Are there other societies that are doing a much better job of providing that safety net, even with fewer resources?

I think all of that is very consistent with core American values and taking care of the most vulnerable in all populations. I mean, America is also about opportunity. Health is an important part of having the opportunity to make a difference and to provide for one’s own and provide for one’s family.