I was a medical student. The SHO presented the case, and I asked what the patient did for a living. “He’s one of the three million.” It was the Thatcher era and unemployment was higher than it had been since the Great Depression. When I came to submit the title for my finals essay, I decided to write about unemployment and health. I was summoned to the Dean’s office. I wasn’t training to be a social worker, I was reminded. ‘An unusual case of Smith-Bland-Bloggs syndrome’ would be a more appropriate topic.
I stuck to my guns and wrote about the effects of unemployment on health. Clearly, being without work was associated with poor health, and some people were speculating that unemployment was the cause and not the consequence of illness. But they were sociologists, not doctors. Shortly after I qualified, Richard Smith, then the assistant editor of the BMJ, published ‘Occupationless Health’. Ten articles in the BMJ. The evidence might have been limited but the pain and misery of unemployment were visceral. Since then, there has been a lot of research and I guess that even the more traditional medical schools now recognise that unemployment is bad for your health. Psychological health deteriorates, with increases in suicide and parasuicide rates, especially among young men. Physical health is affected, with slower recovery from minor conditions, more consultations for chronic diseases and more hospital referrals. Poor health affects the whole family, and whole communities as businesses collapse. The pervading threat of joblessness, knowing that the breadwinner’s job is precarious, is almost as damaging. And unemployment is bad for us all, as governments save money by cutting public health budgets.
Every unemployment crisis is different. It was the Second World War that solved the problem of the 1930s. Combatants were promised jobs when they got home, and favourable economic conditions maintained high employment till the 1970s. But by 1979, the Tory election poster read ‘Labour isn’t working’, and by the time I wrote my essay whole industries were disappearing. In the ‘90s, statistics appeared to improve, but people were being encouraged to take early retirement, many of the new jobs were part-time, and the government was trying to reduce the unemployment figures by encouraging GPs to give the jobless sick notes. Then, as now, governments gained support for cuts in benefits by labelling the out-of-work as scroungers. Health Authorities set up programmes to help the unemployed, but all they could offer were sticking plasters.