does the crisis make us sick? about the economic and social determinants of health

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.