Effects of employment pattern and generosity of the safety net for workers on self-rated health across the EU: A multilevel, longitudinal analysis

Since the Great Recession, many high income countries have coped with debt conditions using austerity strategies to reduce social spending. This coincides with growing unemployment; and thus, need for social services like unemployment insurance. The SOPHIE project examined the relationship between employment-unemployment pattern over three years with self-rated health and presence of chronic conditions in year four in 23 countries using the European Union Statistics on Income and Living Conditions database (N=203546, enrolment between 2003 to 2007). A multilevel logistic regression approach simultaneously examined effects of employment pattern (at the individual level) and unemployment insurance system generosity (at the country level) on health after adjusting for a range of characteristics at both levels. We found a positive, dose-dependent relationship between increasing number of years unemployed and risk of poor self-rated health (67% increased odds for the fully unemployed versus fully employed, 95%CI 52%-84%) and presence of chronic conditions (53% increased odds for the same comparison, 95%CI 39%-69%). Unemployment insurance system generosity was not associated with health in the total sample; however, unemployment insurance system generosity had a significant interaction with employment pattern when the analysis was conducted on a sub-sample of 22 countries that excluded one of four influential outlier countries, Greece, United Kingdom, Latvia or Portugal. Policies to prevent unemployment would improve population health in Europe, and unemployment insurance system generosity has ameliorated some of the harmful effects of unemployment in most, but not all, European countries.