Does the crisis make us sick about the economic and social determinants of health
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Does the crisis make us sick? About the economic and social determinants of health. Aaron Reeves University of Cambridge [email protected] Thanks to. Chris Meissner University of California Davis. Sanjay Basu UCSF. David Stuckler University of Cambridge. Martin McKee LSHTM.

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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 Reeves

University of Cambridge

[email protected]


Thanks to
Thanks to... determinants of health

Chris Meissner

University of California Davis

Sanjay Basu

UCSF

David Stuckler

University of Cambridge

Martin McKee

LSHTM


Austerity and the economic crisis
Austerity and the economic crisis determinants of health

  • Recession ->

    • Increased suicide

    • Decline in traffic accidents

  • Austerity ->

    • Increased rates of infectious disease

    • Increased suicide rates


Suicide
Suicide determinants of health


Impact of 1% rise in unemployment on mortality determinants of health

Suicide

Source: Stuckler et al 2009 Lancet


Rising Suicides determinants of health

New member states

Old member states

- 9 out of 10 countries suicides rose

- About 3400 excess suicides

Source: Stuckler et al 2011 Lancet


Infection
Infection determinants of health


New HIV cases in determinants of health Greece

10-fold rise in HIV from injection drug use

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

  • Source: Paraskevis and Hatzakis 2011


Are these inevitable
Are these inevitable? determinants of health

  • Social Protection austerity

  • Health care austerity

  • Austerity and economic growth


Social protection austerity
Social protection austerity determinants of health


Social welfare expenditure
Social welfare expenditure determinants of health

  • “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 Protection Change: 2007-2010 determinants of health

decrease

increase

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

  • Social spending up

  • Increase unemployment benefits

  • Decreasedisability benefits


Spain and Sweden determinants of health


Social Protections Help… determinants of health

  • 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


Relation between deviation from country average of social welfare spending (excluding

health) and all-cause mortality in 15 EU countries, 1980–2005

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


Healthcare austerity
Healthcare austerity welfare spending (excluding


Healthcare austerity1
Healthcare austerity welfare spending (excluding


Healthcare austerity2
Healthcare austerity welfare spending (excluding


Healthcare austerity greece
Healthcare austerity: Greece welfare spending (excluding

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


Cost of heath care and utilization
Cost of heath care and utilization welfare spending (excluding

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

Highcopayment

Med copayment

Low copayment

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


New HIV cases in welfare spending (excluding Greece

10-fold rise in HIV from injection drug use

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

  • Source: Paraskevis and Hatzakis 2011


Healthcare austerity3
Healthcare austerity welfare spending (excluding


Spain Mental Health Crises welfare spending (excluding

Prevalence Change, 2006 to 2010

- 1.7-fold greater risk of depression in unemployed

- 3.0-fold greater risk in mortgage payment problems

Source: Gili, et al 2012 JECH



Fiscal multipliers the effect of public spending on the economy
Fiscal Multipliers: The effect of public spending on the economy

Increased

Growth

(GDP)

>1

Fiscal Multiplier

How that investment or reduction effects economy?

Govt spending (+£1)

Or

Austerity (-£1)

Reduced

Growth

(GDP)

<1



Key conclusions
Key conclusions economy

  • 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 economy

  • ‘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.


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