Invited Commentary: Are There Unrealized Benefits of Unemployment Insurance Among the Employed?

Abstract

Political statements about the relationship between the economy and health intensify during economic downturns and fade in times of prosperity. Population health researchers share this cyclical interest in that the numbers of peerreviewed publications on this topic increase during and immediately after recessions. In this issue of the Journal, Cylus et al. (Am J Epidemiol. 2014;180(1):45-52) follow in the "economy and health" research tradition and examine the relationship between US unemployment rates and suicide mortality. Their work makes a novel contribution in that they examine whether generous unemployment insurance benefits attenuate the relationship between economic downturns and suicide mortality in the United States. In this commentary, I assess the internal validity of their analysis, call into question some assumptions of their approach, and place their contribution within the context of the broader literature. I then argue that population-based and individual-based approaches in the "economy and health" field often work in concert to create knowledge and inform policy-makers.

Health Effects of Unemployment Benefit Program Generosity

“…By focusing on unemployment benefit program generosity at the state level, we circumvent the bias generated by selection into benefits in the aforementioned studies. 21,22 To identify this effect, we exploited variation in state unemployment benefit program generosity across US states and linked these to longitudinal individual-level data.…”

Cylus et al. Respond to "Unrealized Benefits?"

“…We thank Dr. Bruckner (1) for his thoughtful critique of our article (2), which highlights the many challenges involved in determining how social policies affect health. Dr. Bruckner raises several interesting methodological issues.…”

“…A valid point is that we cannot establish whether effects of unemployment benefit programs occur only among unemployed persons who actually receive benefits or whether benefit programs might prevent suicide among other populations who are not in receipt of benefits. In response, Bruckner suggests that we investigate effects of unemployment benefit programs in the population that is actually eligible to receive those benefits (1). We caution against this approach, for several reasons.…”