Unemployment, health and health services in German-speaking countries

The links between unemployment and health are manifold: Employment may lead to illness: health problems (that may lead to unemployment) often result from unfavourable working conditions of the (previous) employment. Another factor is job insecurity: fear of job loss increases the incidence of disease, and this applies not only to people who are emotionally unstable. Illness may lead to unemployment: in many cases, unemployment is caused by previous health impairments, which, to a considerable extent, also explain the duration of unemployment. Unemployment may lead to illness: there is evidence that unemployment not only reinforces existing physical disease but also acts as a risk factor for new ones. This seems particularly true for problem groups such as the unemployed elderly as well as for infants and children of unemployed people. The relations between unemployment and mental health are strong, mainly in terms of depression and alcoholism. Unemployment may lead to health: short-time work and short-term unemployment may improve health by reducing previous stress, caused by employment or by an overload with social roles. Even in the case of long-term unemployment there are some positive health effects as long as a minimum of social security and alternative social roles are available and useful activities--minor agricultural jobs, illicit work--can be carried out. The links between unemployment, work and society can considerably be loosened by a number of social factors and personal characteristics of the people affected. Existing health services are not in a position to deal with disease stemming from employment or unemployment except through symptomatical and curative therapies. In addition to general medical care, which is guaranteed by the German health insurance system for the unemployed, too, therapeutical measures are especially important in cases of depression and alcoholism. As a rule, the medical profession has no knowledge of the links between health, work and unemployment; such knowledge, however, would facilitate prevention. Individual prevention and rehabilitation measures are of great importance to problem groups suffering from cumulative or indirect unemployment, i.e. to unemployed elderly as well as to children of unemployed parents. Since the unemployed tend to isolate themselves, extramural services are useful. Specific services for the unemployed only are certainly not as helpful as multi-functional social services, such as those being already rendered by some self-help organizations, churches and trade-unions. An anticyclical extension of these services is required; the existing health system may support them with professional expertise. The most cost-effective prevention of negative effects, side-effects and after-effects of unemployment and overwork comprises a 'fair' social organization of work as well as a socially 'just' distribution of the costs and benefits of work load and working time.