J Public Health
DOI 10.1007/s10389-015-0685-4
OVERVIEW
Unemployment, health and moderating factors:
the need for targeted health promotion
Alfons Hollederer 1
Received: 24 March 2015 / Accepted: 22 July 2015
# Springer-Verlag Berlin Heidelberg 2015
Abstract
Aim The aim of the review is to identify and assess moderator
variables for the association between unemployment and health.
Subjects and methods As a social determinant of health, mass
unemployment is a major challenge for public health. Health
promotion among the unemployed is underdeveloped. This re-
view examines meta-analyses using quantitative methods to
study the influence of unemployment on morbidity and mortality.
Results International meta-analyses consistently show that
both the risk of morbidity and of premature mortality is sig-
nificantly higher for unemployed persons compared to the
employed. A wide range of moderating factors is identified.
However, many of the discussed socio-demographic variables
were not confirmed by the latest statistical moderation analy-
ses, while other recently identified health variables and mac-
roeconomic factors were added. The overview shows that the
findings of moderating analyses on the effects of unemploy-
ment on health, premature mortality and suicide are quite
inhomogeneous.
Conclusion The interaction between unemployment and
health points to a need for prevention and health promotion.
The moderator analyses provide different insights for an ap-
proach of health promotion as well as for behavioural and
structural prevention.
Keywords Unemployment . Health . Health promotion .
Prevention . Health determinants . Health inequalities
* Alfons Hollederer
Alfons.Hollederer@lgl.bayern.de
1
Bavarian Health and Food Safety Authority (LGL), Institute of
Public Health, Schweinauer Hauptstraße 80,
90441 Nuremberg, Germany
Background
The global financial and economic crisis caused persistently
high global unemployment. Throughout the member coun-
tries of the Organisation for Economic Co-operation and De-
velopment (OECD), 45.9 million men and women were un-
employed in March 2014 and the unemployment rate
amounted to 7.5 % (OECD 2014). The risk of becoming un-
employed is not equally distributed among regions and social
groups. Especially young people, men and low-skilled
workers were often the first to lose their jobs during the crisis
(OECD 2013). Youth continue to face record unemployment
levels in many countries, with rates exceeding 56.8 % in
Greece and 53.9 % in Spain (OECD 2014). Involuntary mass
unemployment is a major challenge for public health. Unem-
ployment is one of the factors affecting the complex interre-
lationships of lifestyles, working and living conditions that
determine population health (Dahlgren and Whitehead 2006;
Bartley et al. 1999, 2006). The BCommission on Social De-
terminants of Health (CSDH)^ of the World Health Organiza-
tion (WHO) concluded that unemployment as a social deter-
minant of mental health constitutes both a differential expo-
sure at the individual level and a significant socio-economic
context factor (CSDH 2008). The social fabric is strained and
inequality in market incomes is raised by persistent high un-
employment (OECD 2013).
Introduction: unemployment and health
The extensive research efforts regarding the consequences of
unemployment for health are characterized by a number of
reviews published since last century’s first global economic
crisis up to the current one (Eisenberg and Lazarsfeld 1938;
Dooley and Catalano 1980; DeFrank and Ivancevich 1986;

Fryer and Payne 1986; Warr et al. 1988; Ezzy 1993; Winefield
1995; Hanisch 1999; Kasl and Jones 2002; Kieselbach et al.
2006). All of the earlier reviews are descriptive in their ap-
proach. Their authors are unanimous in describing unemploy-
ment as a critical and stressful biographical event or phase that
may give rise to a wide variety of adverse responses such as
poorer mental or physical health. Kinicki et al. (2000) point
out, that coping with a job loss is a dynamic process. The
hypothesis of causality gained evidence as the number of em-
pirical longitudinal analyses increased that examined the
changes from the status of unemployment to employment or
vice versa. Unemployment impairs people’s health and many
moderating factors have come to bear in the literature. Differ-
ential unemployment research considered not only the differ-
ent risks of becoming unemployed, but also the inequality in
the distribution of psychosocial and health risks among this
group. Thus, such results can provide important insights for
intervention approaches and the definition of target groups for
health promotion efforts.
Scientific question about moderating factors
It remains an open research question as to how people can
best, and with the least damage to their health, master the
involuntary loss of their job and unemployment. There are
only a few studies like the one by Fryer and Payne (1984),
which is a qualitative study of unemployed people finding that
particularly proactive unemployed persons tend to suffer less
regarding mental health. Additionally, health promotion ap-
proaches for the unemployed are underdeveloped; however,
there are new activities initiating health promotion
programmes, e.g., in Germany (Brussig et al. 2014). A gap
in research that needs to be filled is the identification of the
problem groups among the unemployed. Empirical studies
about unemployment and health have been analysed with
quantitative, meta-analytical methods. A meta-analysis tries
to assess the entire body of research and standardizes the re-
sults of existing statistical surveys. Further, it allows the gen-
eralization of effect sizes and causal relationships and com-
bines the quantitative results of the entire field of research. The
moderation analyses can support the specification of target
groups among the unemployed to focus all health promotion
initiatives. The aim of this article is to provide an overview
about moderating factors on the effects of unemployment on
health and to outline implications for health promotion and
health policy.
Methods
This review examines meta-analyses about the influence of
unemployment on morbidity and mortality of the unem-
ployed. It aims to identify moderator variables and criteria
J Public Health
for health promotion approaches among unemployed.
Medline, PubMed, the Cochrane Library, GESIS SowiPort
and Google scholar were systematically searched for meta-
analytic studies or meta-analyses about unemployment and
health, which used quantitative methods for research. Criteria
for inclusion are that the meta-analyses published in English-
language scientific journals and the publication year of the
primary study is 1950 or later. The measurement of health
was done via an objective quantitative procedure. The indica-
tor variables of health were consistently used within the re-
search field and have established reliability and validity
claims, for e.g., the General Health Questionnaire (GHQ). It
includes a wide variety of psychological and physical health
variables with regard to their relevance to health of unem-
ployed—e.g., mixed symptoms of distress, depression, anxi-
ety, psychosomatic symptoms, and subjective well-being.
Results
Meta-analyses about unemployment and health
Empirical cross-sectional and longitudinal studies on unem-
ployment and health have been evaluated with the help of
meta-analyses. Three international meta-analyses using quan-
titative methods summarised the mental health impacts of
unemployment. This method allows the evaluation of
existing research and the harmonisation of statistical research
results achieved so far. The meta-analysis of Murphy and
Athanasou (1999) on the effects of unemployment applies
psychological testing methods to (only) 16 longitudinal stud-
ies from 1961 to 1995. They confirmed that unemployment is
related to impaired mental health, which was followed by a
large-scale meta-analysis by McKee-Ryan et al. (2005) and
by Paul and Moser (2009) that continuously expanded the
number of included studies.
McKee-Ryan et al. (2005) summarized the impacts of
unemployment on mental health and physical well-being in
their meta-analysis. Their literature search returned more than
5,000 English language articles on this topic, including 104
empirical studies that were suitable for their meta-analysis.
There were only 15 longitudinal studies involving 19 samples.
The majority of the included studies focused on mental health,
as this was the subject of three quarters of all correlation anal-
yses, while only a very small number of international studies
on physical health were available. McKee-Ryan et al. (2005)
identified 52 cross-sectional studies containing 64 indepen-
dent samples that compared unemployed and employed indi-
viduals. The meta-analysis shows that compared to the
employed population, unemployed people suffer from signif-
icantly worse mental health as well as from a less favourable
physical health status. The meta-analytic results are suggestive
that unemployment has a negative effect on mental health.
J Public Health
McKee-Ryan et al. (2005) were not able to prove a causal
relationship. They stated that the causal hypothesis is sup-
ported by the findings of the meta-analysis, because the
main result for mental health remained consistent over a
very large number of studies and data sources. Further, the
longitudinal studies indicate that a person’s mental well-
being drastically deteriorates when losing employment and
conversely is boosted when restarting employment. This in-
terpretation, however, has its limits, because of the scarcity
of longitudinal analyses.
The last and most important meta-analysis about
unemployment and health presented by Paul and Moser
(2009) covers 237 cross-sectional studies containing 323 in-
dependent samples that compared unemployed and employed
persons and 87 longitudinal studies with regard to mental
health, which in total far exceeds the number of studies
meta-analysed by McKee-Ryan et al. (2005). It provides evi-
dence that unemployment is associated with a deterioration of
mental health and that the overall effect is of medium size and
statistically highly significant. A major result of this meta-
analysis is that in the longitudinal studies the transition from
unemployment to employment sharply reduced the distress
symptoms (effect size d=−0.35). In contrast, job loss nega-
tively impacted mental health (effect size d=0.19), indicating
that mental distress symptoms not only correlate with unem-
ployment, but are also caused by it, although parallel selection
effects can be proved. The causality hypothesis is supported
by examinations concentrating alternately on employment and
unemployment. These results correspond consistently to the
meta-analysis by McKee-Ryan et al. (2005). In the cross-
sectional studies, unemployed persons exhibit significantly
more symptoms of mental distress than employed persons.
The effect sizes are medium and statistically significant for
unspecific distress symptoms and for depression and anxiety
symptoms, emotional well-being and self-esteem. The effect
size for psychosomatic symptoms (including physical health
aspects) is considerably smaller, although still significant.
The authors conclude that unemployment damages mental
health rather than physical health. It seems that no specific
Bunemployment syndrome^ can be found, because the ad-
verse effects on well-being can be proved for several mental
health indicators.
The relatively poorer health status of unemployed people is
manifested by a higher risk of premature mortality. The only
existing international meta-analysis on the relationship be-
tween unemployment and all causes of mortality, published
by Roelfs et al. (2011), investigated the data of over 20 million
people included in 42 studies. Accordingly, the group that had
experienced unemployment exhibited a 63 % significantly
higher mortality risk than the control group after controlling
for several covariates. Another meta-analysis of Milner et al.
(2013) confirmed the evidence on the relationship between
long-term unemployment and suicide or attempted suicide.
Moderator analyses
The health-related impact of unemployment is not homoge-
neous. The effects are also moderated by other variables. The
stock of unemployed persons consists of heterogeneous
groups of people. The moderation analyses of the meta-
analyses consider a large number of potential moderating fac-
tors to determine which are important. Moderator variables are
neither dependent nor independent variables; they are deter-
mined to verify retrospectively, whether the impact of the
independent variable unemployment on the dependent vari-
able health is affected by this characteristic. Table 1 summa-
rizes several tested moderator variables and informs about
their statistical significance, based on the meta-analyses de-
scribed in the preceding.
Socio-demographic attributes
Regarding the gender-specific difference between the
unemployment-induced health risks, the research remains con-
tradictory overall (Table 1). The calculated effect sizes are low.
In the past, the majority of studies on unemployment and health
focused only on unemployed men. Murphy and Athanasou
(1999), who found more present studies which examined the
negative impact of involuntary job loss on the health of unem-
ployed women and men, determined that the surveyed group’s
gender was irrelevant for the calculated effect sizes of unem-
ployment on health; however, the test in Murphy and
Athanasou (1999) is methodologically very weak, because on-
ly 16 studies were involved. McKee-Ryan et al. (2005)
analysed 104 empirical studies and concluded that the mental
health of unemployed men is slightly better than that of unem-
ployed women; however, they did not apply a moderator test
for gender, but merely a correlation analysis. No statistically
relevant difference between men and women was found for
subjective physical health related to unemployment; however,
on the other hand, based on 237 cross-sectional studies, Paul
and Moser’s meta-analysis (2009) showed that unemployment
affected the mental health of men more negatively than that of
women, and that this moderator effect was comparatively
strong. Paul and Moser (2009) assumed that, on average, un-
employed men suffer more often from illness compared to
unemployed women. All in all, the results of the three meta-
analyses seem to be inconsistent. Paul and Moser (2009) tried
to explain the differences with a lower number of studies than
in the meta-analyses of Murphy and Athanasou (1999) or
McKee-Ryan et al. (2005).
According to the meta-analysis of Roelfs et al. (2011), there
is also a significantly stronger association between mortality
and unemployment for men than for women (an increased risk
of 78 % vs. 37 %). The risk of morbidity generally increases
with age. In the meta-analyses of morbidity, age did not mod-
erate the negative effects of unemployment on mental health,
 J Public Health

Table 1 Moderating effects of the association between unemployment and health

Murphy and McKee-Ryan Paul and Roelfs Milner

Athanasou (1999) et al. (2005) Moser (2009) et al. (2011) et al. (2013)
Meta-analyses

Of morbidity/health Of all-cause Of suicide

mortality mortality

A. Socio-demographic characteristics
Gender NSS X X
Age NSS NSS X NSS
Socio-economic status/social class/blue vs. white collar X X NSS
Education NSS
Nationality/minority status NSS NSS
Marital/relationship status NSS
B. Employment-related variables
Length of unemployment X X NSS X
Different study sample type (graduate vs. adult/control group design) X X
Focus on job and occupation, employment commitment, etc. X
C. Health-related variables
(Earlier) health behaviour (BMI, smoking, drinking, drug use, other factors) X
Psychological interventions X
D. Macro-economic factors
Level of the unemployment rate NSS NSS
Social protection system for unemployment NSS X
Level of economic development X
Income inequality (Gini-index) X

X statistically significant moderator variable

NSS not statistically significant

compared to that of the employed population (Murphy and
Athanasou 1999; Paul and Moser 2009). With regard to age
only, Roelfs et al. (2011) found out that unemployment was
associated with an increased mortality risk for people under
the age of 50 years who were in their early and middle careers.
However, Milner et al. (2013) could not verify age as a mod-
erator effect of unemployment on suicide; nevertheless, this
result is limited by the small sample size.
In their meta-analysis on the mental health effects, Paul and
Moser (2009) found a slight moderating trend for social class.
People in the sample with blue-collar-jobs were more distressed
by unemployment than people with white-collar jobs. This
moderator effect became significant when the outlying studies
were excluded. The negative mental health effects of unem-
ployment were a little bit larger among persons with lower
education than among persons with higher education. Roelfs
et al. (2011) also reported that the mortality risk of unemployed
people correlates significantly with their socio-economic status.
Paul and Moser (2009) estimate a very weak trend for mi-
nority status as a moderator. Samples with a large percentage of
minority members had higher effect sizes on mental health than
the other samples. This moderator effect was not statistically
significant, which means that, e.g., immigrants usually have a
higher probability for unemployment, but not a greater risk for
health effects caused by unemployment. Paul and Moser (2009)
did not detect a moderating effect for marital and relationship
status on the mental health of unemployed persons.
Employment-related variables
The individual length of unemployment has a major influence
on a person’s health status. The overview in Table 1 provides
evidence for a strong influence of length of unemployment on
morbidity and suicide mortality. Both meta-analyses of Paul and
Moser (2009) and McKee-Ryan et al. (2005) demonstrate that
the adverse effects on mental health increase with the duration
of unemployment. This moderator effect was highly significant.
Milner et al. (2013) reveal that longer duration of unemploy-
ment was associated with higher risk of suicide and suicide
attempt. The risks of suicide and suicide attempt decrease in
those studies with follow-up periods between 12 and 16 years.
This finding is in line with the results found in the meta-analysis
of Roelfs et al. (2011) who suggest that the risk of all-cause
mortality increases with the duration of unemployment and
decreases with a follow-up period of more than 10 years after
unemployment; however, this effect was not significant.
Paul and Moser (2006, 2009) found a number of distress
symptoms in cases of incongruence between the living situation
J Public Health
of unemployed people and their strong employment commit-
ment. People, who are mainly oriented on their job or occupa-
tional life and who are focused on their professional role, men-
tally suffer more from unemployment. Moreover, the meta-
analyses yielded that different study sample types are associat-
ed with the measured outcome on health by unemployment—
e.g., control group designs (Roelfs et al. 2011) or school drop-
outs versus unemployed adults ( McKee-Ryan et al. 2005).
Health variables
Health interventions can be thought of as moderator variables
in the models (Table 1). Psychological interventions improve
the emotional status of unemployed people and lead to reduc-
tions of distress symptoms with medium-sized effects in the
meta-analyses of Paul and Moser (2009); however, these ef-
fects are not lasting. This research concentrated on psycholog-
ical intervention programs for unemployed people, but not on
health promotion studies.
Unemployment was associated with an increased mortality
risk for those with pre-existing health behaviours such as
smoking and alcohol consumption. Roelfs et al. (2011) sug-
gest ‘that earlier health problems were not, in a broad sense,
the common cause of both unemployment and mortality’.
Macro-economic factors
The meta-analysis of Paul and Moser (2009) in particular in-
cludes macro-economic factors (Table 1). The authors found a
moderating influence in the generosity of the social security
system in case of unemployment. Further, Paul and Moser
(2009) identified economic development and income equality
as additional important moderator variables. The effects of un-
employment are more drastic in poorer than in richer countries.
They are stronger in countries with high Gini coefficients as an
expression of income inequality than in countries in which a
smaller part of the population is living below the poverty line.
No significant moderating effect on health on unemployed was
identified for the unemployment rate in the two meta-analyses
of McKee-Ryan et al. (2005) and Paul and Moser (2009).
Discussion and conclusion
Moderator variables
Compared to the employed population, unemployed people
are characterised by a substantially worse health status. The
meta-analyses consistently identified a negative impact of un-
employment on morbidity and on premature mortality of ex-
posed individuals. After losing their job people tend to suffer
from impaired mental health, whereas their mental well-being
clearly improves as soon as they find their way back into
employment. According to the current state of research, vari-
ous influencing factors moderate the effect of unemployment
on mental or physical health and on mortality; however, the
general finding of this review is that the results for the mod-
erator analyses are very mixed. On one side, many of the
factors discussed in literature and descriptive reviews are not
confirmed by the recent statistical meta-analyses. Socio-
demographic attributes like age, nationality or minority status,
education, marital and relationship status did not significantly
moderate the effects of unemployment on mental health in the
analyses by Murphy and Athanasou (1999) or Paul and Moser
(2009). In addition, this review reveals strong heterogeneities
between moderator analyses related to morbidity and those
related to mortality. Unexpectedly, age does not seem to mod-
erate the negative effect of unemployment on health and sui-
cide but, based on the reviewed meta-analyses, it does effect
all-cause mortality. Conversely, the length of unemployment
is associated with impaired mental health and suicide, but not
with all-cause mortality. Many other factors are extensively
discussed in descriptive reviews and literature, e.g., resources
and strains, cognitive appraisal or coping strategies on person-
al activity level and availability of help (Warr et al. 1988;
Winefield 1995). On the other side, the meta-analyses did
not include all of these factors in the moderator analyses,
which is due to different definitions by authors in accordance
with their theoretical approach or the limitations of study sam-
ple designs for quantifying moderator effects. McKee-Ryan
et al. (2005) calculated many correlation statistics within the
group of unemployed without moderation analyses in relation
to employed population. The meta-analysis of McKee-Ryan
et al. (2005) identified a statistically relevant association with
mental health for resources and forms of stress or strain during
unemployment. In this analysis, a perceived financial strain
correlated with poorer mental health and a lower degree of life
satisfaction. Yet, another factor found to mitigate the negative
impact of unemployment on mental health was the social sup-
port of spouse or partner, family members, friends or others.
The meta-analysis of McKee-Ryan et al. (2005) also con-
firmed a correlation of a structured time schedule with mental
health. Also personal coping resources and related concepts
such as self-esteem, optimism, neuroticism, locus of control
are closely related to mental health and life satisfaction.
All in all, further research is needed to provide more infor-
mation about these factors and the size of their moderating
influence. Generally, what is still missing is a theoretical
framework that can capture to the full complexity of the rele-
vant variables that have so far mostly been considered in iso-
lation. Admittedly, though, there are hardly any findings on
salutogenetic influences and successful coping strategies. So
far, there are a few meta-analyses. Their specific approaches
and different theoretical concepts of analyzing the data might
influence the results. A wide range of health variables and
different quality criteria of instruments for measuring can be

observed in primary studies on the effects of job loss, making
meta-analyses and their interpretation of results more difficult.
The research and discussion about premature mortality
among the unemployed is often not connected with parallel
morbidity research among the unemployed. Both strands of
research should be combined for the development of health
promotion approaches. Perhaps, the years of healthy life lost
for different subgroups of unemployed people could provide
indications for targeted health promotion and prevention. The
disability-adjusted life-years (DALY) are a metric of popula-
tion health. The sum of DALYs across unemployed people
can be thought of as a measure for the gap between current
health status and an ideal health situation where the
population lives to an advanced age, free of disease and
disability. WHO (2013) uses this measurement to assess the
Bburden of disease^.
Development of health promotion among the unemployed
The interactions between unemployment and health create a
need for specific measures for primary and secondary preven-
tion as well as health promotion strategies. The unemployed
face a vicious circle which is both characterized by selection
effects when looking for a new job as well as by causal health
effects due to unemployment. Health impairments are a rele-
vant hindrance to reintegration in the labour market.
There is no typical Bunemployment syndrome^. Evidence
of impaired health can be provided in a wide spectrum of
diseases. The meta-analyses show that the negative associa-
tions between unemployment and morbidity or mortality are
not uniform across all subgroups of the unemployed. The
moderator analyses reveal the need for a specification of pri-
ority target groups as well as strategies to reach these groups.
Comprehensive health promotion approaches have to reach a
wide range of target groups of unemployed people and to
cover a variety of health strategies. Access to health promo-
tion should be placed more on employment-related variables
and cognitive appraisal. Findings from the meta-analyses also
provide some evidence that people mainly oriented on their
job or occupational life and focused on their professional role
mentally suffer more from unemployment. This group should
be considered more in research and practise.
The individual length of unemployment has a major im-
pact on a person’s health status. The long-term unemployed
have a greater risk of health damage and of suicide compared
to those unemployed for only a short term. Health promotion
measures often target only long-term unemployed; however,
unemployed people with health problems and with
recognised disabilities bear a higher risk of long-term unem-
ployment. There is a need for developing health-risk profiling
for job seekers after the loss of a job, which can identify
problem groups at an earlier stage. The results of Roelfs
et al. (2011) point out that health-related behaviours present
J Public Health
at the beginning of unemployment should be regarded as
useful indicators for comprehensive prevention of addiction
and health promotion measures.
Rather unexpectedly, Paul and Moser (2009) and
McKee-Ryan et al. (2005) consistently show in their me-
ta-analyses that the unemployment rate is not associated with
the mental health of unemployed individuals. It suggests that
the unemployed suffer independent of the economic cycle,
regional labour markets and level of unemployment. It is ur-
gent to enhance health promotion that will support integration
into the labour market, because full employment is an excep-
tion which is seldom realised in OECD states.
Health in all policies
The fundamental problem for practical health promotion strat-
egies for the unemployed is that these strategies cannot influ-
ence unemployment as such, but only the indirect causes and
the moderator variables; thus, they can only have a socially
compensatory effect. Paul and Moser (2009) found in their
meta-analysis that intervention programmes have positive ef-
fects on mental health among continuously unemployed peo-
ple; however, they have to be carried out continuously over a
long period of time. The development of health promotion
models that include integration into the labour market is still
in its infant state. The number of practical projects for unem-
ployed persons with health impairments that have been eval-
uated is very low (2009). This is mainly due to the limited
human and financial resources of the prevention organizations
and the under-funding of intervention research. In times of
high unemployment, when social programmes must be ex-
panded, governments’ fiscal resources are drying up (OECD
2013), while in times of low unemployment, the problem does
not have much political relevance. Another difficulty is to
reach the unemployed themselves, especially by traditional
prevention and health promotion courses. Corresponding ef-
forts should be linked with employment promotion initiatives,
new settings should be opened up, e.g., at the institutions
providing employment or training courses, and health promo-
tion should be community-based. For their further develop-
ment, prevention and health promotion measures for the un-
employed need better framework conditions to break or at
least mitigate the vicious circle of unemployment and health
through health promotion and prevention measures.
While more health promotion approaches focusing on the
individual are required, these will not suffice by themselves.
As evidenced by the moderation analyses, a number of other
separate factors foster the negative effect of unemployment on
the unemployed’s mental health, such as the duration of un-
employment and the social protection system (Table 1). In
view of the fact that even in times of economic boom a natural
rate of unemployment remains in the industrial countries, the
question arises as to how the health of those most affected by
J Public Health
unemployment can be maintained and improved consistently
and not sporadically. In this context, a continuous health
impact assessment of unemployment seems to be necessary.
There is also a need for targeted health promotion as an
integral part of a general health promotion policy which has
already been postulated by WHO in its Ottawa Charter (1986)
or in the Health in All Policies Approach (Stahl et al. 2006).
Health promotion interventions would help the unem-
ployed to maintain or restore their health as well as their
ability to work; however, these measures can only work on
the moderating factors. They cannot abolish the real reasons
of mass unemployment. In view of the dramatically high rate
of youth unemployment, the European Commission (2012)
proposed a job guarantee for young people in the EU member
states. It is proposed that all young people shall receive a
good job offer, occupational training, an internship or a train-
ing course within four months after completing education or
training or losing their job. However, not only young people
but all of the unemployed deserve a relatively prompt em-
ployment perspective that would probably have an immediate
effect on their health.
Conflict of interest The author declares that he has no conflict of
interest.
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