INTRODUCTION

Background

A century of research has repeatedly found an association between adverse employment change – usually unemployment – and indicators of ill health, particularly behavioral and emotional disorders. However, the interpretation of this correlation has proved difficult. As noted in Chapter 2, at least three different mechanisms could account for it, each intuitively plausible: social causation, confounding, and selection.

Social causation views adverse employment change as the cause of ill health. The remaining chapters of this book will focus on this mechanism, with the others controlled. An ever-present rival explanation to both social causation and selection involves confounding by other variables. When the contributions of such confounding variables are removed, usually by statistical control, the initial association may weaken or disappear. Any prior variable that serves as a risk factor for both employment and health change could function as a confounder. For example, growing up in poverty may increase the risk of intermittent unemployment in adulthood because of educational inadequacies. In addition, it may increase the risk of ill health in adulthood as a result of inadequate health care in childhood or the acquisition of poor health habits.