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What is the evidence of the impact of the economic crisis on public health?. David Stuckler, PhD MPH Oxford and LSHTM With Marc Suhrcke, Sanjay Basu, Adam Coutts and Martin McKee. Disaster ?. Blessing ?. “Econocide to surge as recession bites” – BBC Mar 2009.
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David Stuckler, PhD MPH
Oxford and LSHTM
Marc Suhrcke, Sanjay Basu, Adam Coutts and Martin McKee
“Econocide to surge as recession bites”
– BBC Mar 2009
“Recession is a lifestyle blessing in disguise” – Times Oct 2008
not so bad?
Source: Hanley 1931 Life
Sources: NYT Oct 1930; AP 1932; WP 1930
- Income ↓ 30%
- All-Cause Mortality Rates ↓ 10%
- Suicide ↑40%
Alcohol and Surrogates
Prisons and Tuberculosis
- Income↓ 30%
- All-Cause Mortality Rates ↑ 20%
- Suicide ↑about 40%
Russia & Belarus
- Incomes fell but health stable
Source: Stuckler et al 2009 Mass privatisation and the post-communist mortality crisis Lancet
- Gov Spending↓ 8%
- Doctors ↓ 8%
- Directly Observed Therapy avg. ↓ 40%
- TB incidence ↑ 17%
Source: Stuckler et al 2008 IMF Programs and Tuberculosis outcomes PLoS Med
Drugs and Alcohol
No effect on all-cause mortality
Source: Stuckler et al 2009 Lancet
Spending> 190 USD no effect of unemployment on suicide
Source: Stuckler et al 2009 Lancet
Sources: Hopkins 2006 Health Policy; Chang 2009 Soc Sci Med
Stuckler, D., S. Basu, M. Suhrcke, A. Coutts, M. McKee. 2009. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. The Lancet. 374(9686):315-23
Stuckler, D., L. King, and M. McKee. 2009. Mass privatization and the postcommunist mortality crisis: a cross-national analysis. The Lancet. 373(9661): 399-407
Stuckler, D, S. Basu, M. Suhrcke, A. Coutts, M. McKee. 2009. The health implications of financial crisis: A review of the evidence. Ulster Medical Journal. 78(3): 142-5
Lock, K., D. Stuckler, K. Charlesworth, M. McKee. 2009. Potential causes and health effects of rising global food prices. British Medical Journal. 339:b2403
Stuckler, D and S. Basu. 2009. The International Monetary Fund's effects on global health: before and after the 2008 financial crisis. International Journal of Health Services. 39(4): 771-81.
Stuckler, D., S. Basu, and L. King. 2008. International Monetary Fund programs and tuberculosis outcomes in post-communist countries. Public Library of Science Medicine 5(7): e143
Stuckler, D., L. King and A. Coutts. 2008. Understanding privatisation's impacts on health: Lessons from the Soviet Experience. Journal of Epidemiology and Community Health 62(7): 664.
Stuckler, D., S. Basu, M. McKee, L. King. 2008. Mass incarceration can explain population increases in TB and multi-drug resistant TB in European and central Asian countries. Proceedings of the National Academy of Sciences. v105(36):13280-5.
Stuckler, D., C. Meissner and L. King. 2008. Can a bank crisis break your heart? Globalization and Health 4(1):1-12.
Stuckler, D. 2008. Population causes and consequences of leading chronic diseases: A comparative analysis of prevailing explanations. The Milbank Quarterly 86(2):273-326.
When the full record of the year 1931 is written, no chapter will be more striking than the one dealing with public health. The country was in the grip of the most serious industrial depression in a generation...By all the signs and all the precedents, hard times so seriously prolonged should have brought in their train disease and death.
Actually, 1931 was one of the healthiest years in the history of the country. The evidence is overwhelming.
– New York Times, Jan 5th, 1932
Sample and Period: 114 U.S. Cities, 1929-1937‘Shock’: Bank Suspensions: Federal Deposit Insurance Corporation – percentage of banks suspended in calendar year
Mortality: U.S. Bureau of the Census – Crude death rates for >30 causes
– Epidemiology: city-level, weighted U.S. urban populations
– Econometric: state-level, weighted U.S. state means
Economic and Demographic Controls:
–Urbanisation Rates, Literacy Rates, Percentage Black Ethnicity, Age-structure
Fixed Effects + Hodrick Prescott Filter
Thanks to Price Fishback for collecting data
Sample and Period: 26 Postcommunist CEE and FSU Countries, 1991-2002‘Shock’: Mass Privatization: EBRD and WB – transferring at least 25% of large-state owned enterprises to the private
sector within 2 years
– jump from 1 to 3 on EBRD large-scale privatisation index
Mortality: WHO and UNICEF – Age-standardised mortality rates in working-age men (15-59)
– Life expectancy, alcohol-related mortality rates, suicide rates
Economic and Demographic Controls: WB, EBRD, ILO
– Price liberalisation, Trade liberalisation, GDP per capita, Democratisation
Index, Dependency Ratio, Urbanisation Rates, Education Levels
Two Way Fixed Effects + Control Function
Russian Life Expectancy
“Despite economists’ reputation for never being able to agree on anything, there is a striking degree of unanimity in the advice that has been provided to the nations of Eastern Europe and the former Soviet Union (FSU). The legions of economists who have descended on the formerly Communist economies have provided advice very similar … The three “-ations”—privatization, stabilization, and liberalization —must all be completed as soon as possible.”
Lawrence Summers (1994: 252-253)
↑ Adult mortality
Reduced Social Provision
“… I was the person sent to Russia to live in the factories and feed back information to the bank. I spent months in the factories. In one, I slept in an empty ward in the sanatorium. I realised very quickly that the master plan of privatising Russian industry overnight was going to impose huge costs on hundreds of thousands of people. These factories were producing goods that once they were launched, no one would want in a too competitive market. They would have to slash tens of thousands of jobs. But also, these factories provided schools, hospitals, health care and retirement - cradle to grave. I raised these concerns in Washington, to say there weren't any safety nets in place. It became clear to me that it was really a political play, that they wanted to take assets out of the state's hands, so the Communist Party wouldn't come back.”
-- WB administrator overseeing Mass Privatization in Russia
- Hazard Dying: ↑~3-4-fold
- Odds Excess Vodka: ↑40%
Chance job loss next year:
10.4% if privatized
9.1% if Russian private
7.9% if foreign
6.2% if state
- 40% higher risk at private firm
Life expectancy at birth, in years
In writing about Stalinism, John Maynard Keynes observes that “We have a fearful example in Russia today of the evils of insane and unnecessary haste. The sacrifices and losses of transition will be vastly greater if the pace is forced…”
Yale Review, 1933