Reducing the impact of unemployment on health: revisiting the agenda for primary health care.

OBJECTIVE: To identify potentially effective strategies to be used in the primary health care (PHC) setting to prevent, detect and manage the health problems of unemployed people.
DESIGN: A narrative review of articles on PHC-based interventions for unemployed people that were published during the period January 1985 to February 2009.
RESULTS: Seven articles with a focus on improving the health of unemployed people through assessment, management and referral within PHC settings were identified. Four were based in Australia, and the others were from Canada and Europe. Most described interventions that incorporated strategies aimed at increasing general practitioners' awareness of the health problems of unemployed people and providing guidance on the management of these problems. One article included an evaluation of the impact of the intervention on health and social outcomes, but no impact was shown.
CONCLUSIONS: There have been few formal scientific investigations into the effectiveness of PHC-based interventions for unemployed people. GPs and other community health workers have a central role in preventing, and providing early management of, the health problems of unemployed people, and supporting return to work. People who are unemployed have poorer physical and mental health than those who are employed. Research should move from describing these health problems to developing interventions that are subject to rigorous evaluation.