Densidad mineral ósea.

Deindustrialization has been an economic transition that has been extensively ex- amined within different contexts and geographies. Academic literature portrays strong diversities concerning the terminology, operationalization and therefore con- sequences of industrial decline. This diversity indicates that deindustrialization is a complex phenomenon and it can be quite challenging to draw definitive conclu- sions when measuring its influence. Furthermore, it has been mainly perceived as a transition operating across a single dimension. This thesis has reflected upon those complexities and recognized that deindustrialization has not been adequately conceptualized in the broader research area that links labour market transitions and health. This has been apparent not only through the evaluation of the literature review but also through the findings of the empirical chapters.

The following schema (Figure 7.1) is a modified version of the conceptual frame- work introduced in the literature review. It illustrates a dynamic operationalization of deindustrialization introduced in this thesis. This is achieved by summarizing the different dimensions of this event and the components of the association between industrial contraction, mortality and health. At a national level, deindustrialization occurs by various external and internal factors. In particular, global scale industrial competition results in the outsourcing of industries towards less-developed coun- tries that offer inexpensive labour and production procedures. On the other hand, internal factors, such as changing patterns of consumption towards more service- based goods as well as national market policies promoting the service sector, accel- erated this transition. Consequently, the progression and magnitude of this change has been uneven but sustained across and within countries.

Chapter 7. Conclusion and discussion 150

Figure 7.1A post-industrial era. The dynamic nature of deindustrialization

After Fielding (2010)

Looking at the top block of the schema, this transition has been accompanied by pe- riods of recession that accelerated the progression of the decline in manufacturing employment. Periods of recession have been associated with rises in suicide mortal- ity, whereas reduced employment in traditional industries, demonstrating an adverse environment, has been beneficial towards overall mortality. As unemployment is the main outcome of economic downturns, the generosity of social protection, towards the unemployed individuals, is an important determinant of alleviating or minimiz- ing the severity of business downturns and therefore industrial contraction.

Being unemployed or inactive results in economic disparities that can be evident across populations and individuals, however the severity of financial hardship de- pends on other components provided by welfare states. Those elements, such as overall national social security, unemployment benefits and job incentives, protect vulnerable population groups and differ across countries. As with overall business

Chapter 7. Conclusion and discussion 151 fluctuations, the uneven magnitude and progression of industrial contraction has disproportionately affected regions and population groups.

Moving towards regional variations (second block), the importance of an industry within a region expands beyond the boundaries of occupational engagement. By providing employment and financial prosperity to the residents of a region, the in- dustry became an element of social cohesion. Permanent employment, informal occupational relations and promotion prospects resulted in the formation of a cul- tural identity accompanied by cultural events, leisure activities and social gather- ings. This could suggest that the significance of an industry has grown through time, since it played a dual role for generations, as an employer and a formulator of cultural identity. As a result, the closure of industries has been accompanied by elevated levels of unemployment and inactivity. The implementation of regenera- tion processes, for example through the creation of new service jobs and re-training of ex-industrial employees, and the overall adaptation to a new economic path were not always successful. This resulted in high levels of overall socio-economic de- cline, whereas out-migration, especially of young employees, was common in an effort to find alternative employment. Regional deprivation, demographic change and concentrated morbidity have been constant elements of industrial contraction through time.

The transitional effects of industrial contractions have been apparent across individ- uals as well (third block). Male unemployment and inactivity contributed to the ero- sion of family structure, causing financial constraints, and the loss of male identity. This was further enhanced by the elevated female employment in service-related jobs. Women were considered more suitable for non-manual positions, whereas male ex-industrial workers were perceiving those positions as feminine and in many cases did not obtain the necessary skills (Benedict and VanderHart, 1997; Leidner, 1991). Furthermore, the transition towards service occupations were more appar- ent among young individuals and characterized by low salaries, skills-mismatches and short-term contracts. These elements resulted in overall job dissatisfaction and insecurity.

Beyond the different components of industrial decline and the different levels of its progression, this thesis introduced a new dimension: the immersion of a new labour market derived from the alterations of old industrial employment patterns. At a population level, the traditional industrial sector has been considered as an adverse

Chapter 7. Conclusion and discussion 152 working environment. Likewise, employment in this sector has been connected with various cancerous, respiratory and heart-related diseases. Nevertheless, at an indi- vidual level, the hazardous components of the industries have been counterbalanced by permanent and secure employment, inclusive benefits and promotional prospects within the industry. The long-lasting transition towards services revealed two major labour market changes.

First, industrial contraction gave rise to more technologically advanced industries that provided safer working conditions. This resulted in a reduction of occupational risks and therefore overall mortality. Furthermore, in a constantly changing work- ing environment, modern industries do not employ only semi-skilled or unskilled employees. They attract more highly-skilled professionals, since technological in- novations demand more skillful employees. Second, the expanding service sector entails numerous occupations and it could be initially considered a safer occupa- tional choice compared to industries. However, this thesis revealed that this is not necessarily true. The extensive diversity within services disguises hidden occupa- tional risks possibly concentrated around issues of income inequalities, duration of employment, skill mismatches, job-related strain and satisfaction. This thesis sug- gests that medical and technological innovations have reduced the physical risks of working environments. However, contemporary employment sectors disguise patterns of mental morbidity that should be further evaluated in future studies. In summary, literature so far has conceptualized deindustrialization as an event oc- curring across a single dimension, mainly regional, causing high levels of unem- ployment and inactivity. The morbidity and mortality implications of those path- ways have been extensively explored by including ecological information and spe- cific occupational groups. Overall, previous research has mainly considered indus- trial decline as a negative event causing deprivation and erosion of the community and family structure. This thesis has progressed beyond the current findings by con- ceptualizing deindustrialization as a transitional and dynamic event that functions in many levels, progresses unevenly and therefore disproportionately influences mor- tality and morbidity outcomes at a national, regional and individual level.

More precisely, the inclusion of a typology that measures the severity of indus- trial decline has contributed to the lack of comparative studies exploring this pro- gression. The magnitude of industrial decline has revealed that this event contains unique elements. For example, the vulnerability of certain countries, regions or

Chapter 7. Conclusion and discussion 153 individuals towards economic transitions is the combined effect of socio-economic and political factors that differ across countries. However, the typology has revealed common patterns of progression across countries influenced by business cycles. Regarding the mortality outcomes, this thesis has further advanced current knowl- edge by showing that industrial decline has contributed to the overall decline of mortality in the long-term, whereas rapid reductions of industrial employment in- crease suicides in the short-term. Relating to the morbidity implications, occupa- tional transitions, between industries and services, have demonstrated that the health implications of a changing labour market are quite complex. For example, the con- temporary industrial sector appears to have a protective effect against morbidity compared to the services. This thesis suggests that the changing labour market patterns have contributed to the alterations of morbidity patterns from physical to mental morbidity implications of employment.

This thesis concludes that the extent of those transitional effects could depend on how well-prepared the population was and how effective the transition-related pro- cesses were at national, regional and individual levels. Finally, this thesis addresses the necessity of re-defining the concept of deindustrialization, recognize the multi- dimensional nature of economic alterations and therefore re-evaluate the mixed con- sequences of industrial decline.