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Does the crisis make us sick? About the economic and social determinants of health. Aaron Reeves University of Cambridge asr45@cam.ac.uk. 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

asr45@cam.ac.uk

thanks to
Thanks to...

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
  • Recession ->
    • Increased suicide
    • Decline in traffic accidents
  • Austerity ->
    • Increased rates of infectious disease
    • Increased suicide rates
slide5

Impact of 1% rise in unemployment on mortality

Suicide

Source: Stuckler et al 2009 Lancet

slide6

Rising Suicides

New member states

Old member states

- 9 out of 10 countries suicides rose

- About 3400 excess suicides

Source: Stuckler et al 2011 Lancet

slide8

New HIV cases in 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?
  • Social Protection austerity
  • Health care austerity
  • Austerity and economic growth
social welfare expenditure
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 Protection Change: 2007-2010

decrease

increase

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

  • Social spending up
  • Increase unemployment benefits
  • Decreasedisability benefits
slide14

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

slide15

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 greece
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
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.”

Highcopayment

Med copayment

Low copayment

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

slide21

New HIV cases in 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
slide23

Spain Mental Health Crises

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
  • 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
slide30
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.
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