Heikki Hiilamo

Health effects of indebtedness: a systematic review

BackgroundIn the aftermath of the global financial crisis, millions of households have been left with debts that they are unable to manage. Indebtedness may impair the wellbeing of those affected by it for years to come. This systematic review focuses on the long-term consequences of indebtedness on health.MethodsThe method used in the paper is a systematic review. First, bibliographic databases were searched for peer-reviewed articles. Second, the references and citations of the included articles were searched for additional articles.ResultsThe results from our sample of 33 peer-reviewed studies demonstrate serious health effects related to indebtedness. Individuals with unmet loan payments had suicidal ideation and suffered from depression more often than those without such financial problems. Unpaid financial obligations were also related to poorer subjective health and health-related behaviour. Debt counselling and other programmes to mitigate debt-related stress are needed to alleviate the adverse effects of indebtedness on health.ConclusionsThe results demonstrate that indebtedness has serious effects on health.

Implementation of effective cigarette health warning labels among low and middle income countries: State capacity, path-dependency and tobacco industry activity

We investigates the effects of ratifying the WHO Framework Convention of Tobacco Control (FTCT), state capacity, path-dependency and tobacco industry activity on the implementation of effective health warning labels (HWL) on cigarette packs among low and middle income countries (LMIC). Using logistic regression in separate analyses for FCTC Article 11 compliant HWLs and graphic HWLs (GHWL), we found that the odds of FCTC compliance increased by a factor of 1.31 for each year after FCTC entered into force in the country (p < 0.01). The odds of passing GHWLs increased by a factor of 1.46 (p < 0.05) per year after FCTC entered into force. The weaker the capacity of the states were, the less likely they were to have implemented FCTC compliant HWLs (p < 0.05). The countries with voluntary HWLs in 1992 were less likely (OR = 0.19, p < 0.01) to comply with FCTC 21 years later (in 2013). The FCTC has promoted HWL policies among LMICs. Public health regulations require investments in broader state capacity. As the theory of path-dependency predicts voluntary agreements have long lasting influence on the direction of tobacco control in a country. Adopting voluntary HWL policies reduced likelihood of having FCTC compliant HWLs decades later. The fact that voluntary agreements delayed effective tobacco regulations suggests that policymakers must be careful of accepting industry efforts for voluntary agreements in other areas of public health as well, such as alcohol and junk food.

Cross-Temporal and Cross-National Poverty and Mortality Rates among Developed Countries

A prime objective of welfare state activities is to take action to enhance population health and to decrease mortality risks. For several centuries, poverty has been seen as a key social risk factor in these respects. Consequently, the fight against poverty has historically been at the forefront of public health and social policy. The relationship between relative poverty rates and population health indicators is less self-evident, notwithstanding the obvious similarity to the debated topic of the relationship between population health and income inequality. In this study we undertake a comparative analysis of the relationship between relative poverty and mortality across 26 countries over time, with pooled cross-sectional time series analysis. We utilize data from the Luxembourg Income Study to construct age-specific poverty rates across countries and time covering the period from around 1980 to 2005, merged with data on age- and gender-specific mortality data from the Human Mortality Database. Our results suggest not only an impact of relative poverty but also clear differences by welfare regime that partly goes beyond the well-known differences in poverty rates between welfare regimes.

Rethinking relative measures of poverty

This paper attempts to develop an alternative measure for relative poverty. The aim is to combine information both on the depth of poverty and the number of people living in poverty. We seek, moreover, to establish a yardstick that would be relatively simple and easy to understand, so as to facilitate the use of such a new method in sociological poverty research and political decision making. The Cumulative Poverty Index (CUPI) indicates how many times poorer on average the poor households are, compared to all households on average (or the other way round: the ratio of the mean income of poor households to the mean income of all households). The empirical analysis demonstrates that CUPI seem to reflect changes in the incomes of the poor more accurately than do head-count ratios based on median income.

Is Income Inequality ‘Toxic for Mental Health’? An Ecological Study on Municipal Level Risk Factors for Depression

Most inequality research on the relationship between inequality and mental health has focused on cross-country variation. Findings from within-country data are mixed. We examined whether changes in municipal Gini index or in the share of people living in relative poverty were linked to changes in the use of antidepressants in several Finnish municipalities between 1995 and 2010. We found that more young adult females used antidepressants in municipalities where relative poverty had increased. Changes in municipal-level Gini index were not positively associated with changes in the use of antidepressants in the municipalities between 1995 and 2010. However, fewer elderly females used antidepressants in municipalities where the Gini index increased. In addition, more young adults used antidepressants in municipalities where the number of those not being educated or trained had also increased. An increase in the number of persons over 65 years of age living alone was positively associated with an increase in the use of antidepressants among elderly females.

Implementation of graphic health warning labels on tobacco products in India: the interplay between the cigarette and the bidi industries

Objectives To understand the competition between and among tobacco companies and health groups that led to graphical health warning labels (GHWL) on all tobacco products in India. Methods Analysis of internal tobacco industry documents in the Legacy Tobacco Document Library, documents obtained through Indias Right to Information Act, and news reports. Results Implementation of GHWLs in India reflects a complex interplay between the government and the cigarette and bidi industries, who have shared as well as conflicting interests. Joint lobbying by national-level tobacco companies (that are foreign subsidiaries of multinationals) and local producers of other forms of tobacco blocked GHWLs for decades and delayed the implementation of effective GHWLs after they were mandated in 2007. Tobacco control activists used public interest lawsuits and the Right to Information Act to win government implementation of GHWLs on cigarette, bidi and smokeless tobacco packs in May 2009 and rotating GHWLs in December 2011. Conclusions GHWLs in India illustrate how the presence of bidis and cigarettes in the same market creates a complex regulatory environment. The government imposing tobacco control on multinational cigarette companies led to the enforcement of regulation on local forms of tobacco. As other developing countries with high rates of alternate forms of tobacco use establish and enforce GHWL laws, the tobacco control advocacy community can use pressure on the multinational cigarette industry as an indirect tool to force implementation of regulations on other forms of tobacco.

Cherry picking: How sensitive is the relationship between inequality and social problems to country samples?

Purpose – In their income inequality theory (IIT), Richard Wilkinson and Kate Pickett posit that income inequality is at the heart of social “ills”. However, their critics argue that the hypothesis is biased and that “cherry picking” is used and support for the IIT is obtained by selecting a suitable sample of countries. The paper aims to discuss these issues. Design/methodology/approach – With a sample of 127 countries, the authors study to what extent the correlation between income inequality and social “ills” varies among countries sampled by geography, religion and income level. Findings – The results of the analysis show that the strength and sometimes the direction of connections between inequality and social “ills” vary according to countries’ cultural background and historical legacies. The IIT is not a universal law. However, it is on a firmer footing than competing explanations. Originality/value – The results contribute both to material and methodological debate on consequences of income inequality.

Do debts lead to disability pension? Evidence from a 15-year follow-up of 54,000 Finnish men and women:

While over-indebtedness has emerged as a new social risk among Europeans as a consequence of economic recessions, its associations with health and disability are poorly understood. This study utilises longitudinal, register-based data to assess the associations of over-indebtedness with disability retirement. Severely over-indebted people were identified from the Finnish credit information register. For each over-indebted person, one matched control was retrieved from the population register (total N: 54,494). Register data on socio-demographics, health-related factors and pensions were used to analyse the incidence of disability pensions due to different diagnoses among over-indebted people and their controls during the period 1995–2009 using Cox regression analysis. The analyses showed that over-indebtedness was strongly associated with the risk of disability retirement in all diagnostic groups. The associations were stronger among women than among men. The adverse effects of over-indebtedness on health and disability should be acknowledged. In addition to standard socio-demographic indicators, debtor status may add to our knowledge of the predictors of poor health. Policymakers should adopt measures to prevent over-indebtedness and to overcome its harmful effects.

Long-Term Educational Outcomes of Child Care Arrangements in Finland:

This study asks how Finnish 6-year-olds who stay at home before school start compare in educational outcomes with children who attend public day care. Earlier studies have shown that participation in public day care can enhance school performance especially among disadvantaged children. In Finland, the child home care allowance scheme supports the home care of 6-year-olds if they have a younger sibling under the age of 3 who is also not attending public day care. We used as outcome variables grade point average after compulsory school at age 15 to 16 and dichotomous variable measuring completion of further education by age 25. The study utilized data of the birth cohort 1987 (N = 4,928). The results show that staying at home before school start is associated with poorer school performance but not with completion of further education.

The NEET concept in comparative youth research: the Nordic countries and South Africa

ABSTRACT The NEET concept has become widely used internationally since its emergence in the UK almost two decades ago. This article reviews the adoption of the concept in two extreme contexts in terms of NEET rates, youth opportunities and youth welfare: the Nordic countries and South Africa. The article discusses the situations of NEET young people in the two contexts, and how the concept is used in the wealthy and relatively homogenous Nordic welfare states and in relatively poorer and racially divided South Africa. While the concept has been problematised in different ways in Nordic youth research, it has been more readily accepted by South African researchers. We argue that, in both contexts, the NEET concept can be taken as an invitation to look beyond individual life situations and biographies, and to focus on how structural forces such as the political economy shape young people’s lives. The NEET concept provides a way of discussing changing opportunity structures and how global social forces such as globalisation and neoliberalisation shape young people’s lives in different contexts. The NEET concept is useful in comparative youth research.