Does the crisis make us sick? About the economic and social determinants of health

Aaron ReevesUniversity of Cambridge

asr45@cam.ac.uk

Thanks to...

Martin McKeeLSHTM

Sanjay BasuUCSF

Chris MeissnerUniversity of California Davis

David StucklerUniversity of Cambridge

Austerity and the economic crisis

• Recession ->– Increased suicide– Decline in traffic accidents

• Austerity ->– Increased rates of infectious disease– Increased suicide rates

Suicide

Impact of 1% rise in unemployment on mortality

Source: Stuckler et al 2009 Lancet

Suicide

Rising Suicides

- 9 out of 10 countries suicides rose

Source: Stuckler et al 2011 Lancet

- About 3400 excess suicides

New member states Old member states

Infection

New HIV cases in Greece

Note: Data on HIV, hep b and hep c are collected in 3 sentinel surveillance sites where these patterns have been confirmed

10-fold rise in HIV from injection drug use

Source: Paraskevis and Hatzakis 2011

Are these inevitable?

• Social Protection austerity

• Health care austerity

• Austerity and economic growth

Social protection austerity

Social welfare expenditure • “the provision by public (and private) institutions of benefits

to, and financial contributions targeted at, households and individuals in order to provide support during circumstances which adversely affect their welfare.”

• Includes spending related to: – family support programmes (such as preschool education, child care,

and maternity or paternity leave), – old age pensions and survivors benefits, – health care, – housing (such as rent subsidies), – unemployment benefits, – active labour market programmes (to maintain employment or help

the unemployed obtain jobs), and support for people with disabilities.

Social Protection Change: 2007-2010

• Social spending up

• Increase unemployment benefits

• Decrease disability benefits

increase decrease

Countries with no social protection spending data: Belgium, Iceland, Romania, and Switzerland.

Spain and Sweden

Social Protections Help…

Each 100 USD greater social spending reduced the effect on suicides by:

- 0.38%, active labour market programmes

Spending> 190 USD no effect of unemployment on suicide

Source: Stuckler et al 2009 Lancet

Source: Stuckler D et al. BMJ, 2010, 340.

Relation between deviation from country average of social welfare spending (excludinghealth) and all-cause mortality in 15 EU countries, 1980–2005

Healthcare austerity

Healthcare austerity

Healthcare austerity

Healthcare austerity: Greece

Source: EU-SILC: Kentikelenis et al., 2011, Health effects of financial crisis, The Lancet 2011; 378:1457-1458)

Cost of heath care and utilization

• “Reductions in routine care today might lead to undetected illness tomorrow and reduced individual health and well-being in the more distant future.”

Source: Lusardi A et al. The economic crisis and medical care usage. Harvard Business School, 2010.

Med copayment

High copayment

Low copayment

New HIV cases in Greece

Note: Data on HIV, hep b and hep c are collected in 3 sentinel surveillance sites where these patterns have been confirmed

10-fold rise in HIV from injection drug use

Source: Paraskevis and Hatzakis 2011

Healthcare austerity

Spain Mental Health Crises

- 1.7-fold greater risk of depression in unemployed

Source: Gili, et al 2012 JECH

- 3.0-fold greater risk in mortgage payment problems

Prevalence Change, 2006 to 2010

Austerity, fiscal multipliers, and Economic growth

Fiscal Multipliers: The effect of public spending on the economy

Govt spending (+£1)Or

Austerity (-£1)

Fiscal Multiplier

How that investment or reduction effects

economy?

>1

IncreasedGrowth(GDP)

<1 ReducedGrowth(GDP)

Austerity and economic growth

Key conclusions

• Recession -> poorer health• Austerity -> Increased suicide, heart disease

mortality, infectious disease

• Not inevitable– Social protection– Health care– Public expenditure (e.g. Health and social

protection) fosters economic growth

Data

• ‘In marked contrast to financial data, some of which are available instantaneously and others, such as economic growth, within a few weeks, data on mortality in many countries are delayed by several years’ (McKee et al., 2012)

• Even now the full extent of the crisis on health is obscured by lack of available data.