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The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis
Abstract
Background There is widespread concern that the present economic crisis, particularly its effect on unemployment, will adversely affect population health. We investigated how economic changes have affected mortality rates over the past three decades and identified how governments might reduce adverse effects.Methods We used multivariate regression, correcting for population ageing, past mortality and employment trends, and country-specific differences in health-care infrastructure, to examine associations between changes in employment and mortality, and how associations were modified by different types of government expenditure for 26 European Union (EU) countries between 1970 and 2007.Findings We noted that every 1% increase in unemployment was associated with a 0.79% rise in suicides at ages younger than 65 years (95% CI 0.16-1.42; 60-550 potential excess deaths [mean 310] EU-wide), although the effect size was non-significant at all ages (0.49%, -0.04 to 1.02), and with a 0.79% rise in homicides (95% CI 0.06-1.52; 3-80 potential excess deaths [mean 40] EU-wide). By contrast, road-traffic deaths decreased by 1.39% (0.64-2.14; 290-980 potential fewer deaths [mean 630] EU-wide). A more than 3% increase in unemployment had a greater effect on suicides at ages younger than 65 years (4.45%, 95% CI 0.65-8.24; 250-3220 potential excess deaths [mean 1740] EU-wide) and deaths from alcohol abuse (28.0%, 12.30-43.70; 1550-5490 potential excess deaths [mean 3500] EU-wide). We noted no consistent evidence across the EU that all-cause mortality rates increased when unemployment rose, although populations varied substantially in how sensitive mortality was to economic crises, depending partly on differences in social protection. Every US$10 per person increased investment in active labour market programmes reduced the effect of unemployment on suicides by 0.038% (95% CI -0.004 to -0.071).Interpretation Rises in unemployment are associated with significant short-term increases in premature deaths from intentional violence, while reducing traffic fatalities. Active labour market programmes that keep and reintegrate workers in jobs could mitigate some adverse health effects of economic downturns.Funding Centre for Crime and Justice Studies, King's College, London, UK; and Wates Foundation (UK).
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“an economic recession may have an adverse impact on suicide rates ( Chang et al., 2013; Stuckler et al., 2009).”
From The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review (2021) · cites this paper as Stuckler et al., 2009
In the citing paper
“Each was based on different assumptions, but the models largely focused on the well-characterised impact on suicide rates of periods of economic recession and rises in unemployment ( Chang et al., 2013; Stuckler et al., 2009).”
From The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: a living systematic review (2020) · cites this paper as Stuckler et al., 2009
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BackgroundLewer, D., Meier, P. S., Beard, E., Boniface, S., & Kaner, E. (2016) · BMC Public Health · doi:10.1186/s12889-016-3265-9 · Cited by 174
“Likewise, other research has observed a strong relationship between unemployment and alcohol-related mortality [30].”
BackgroundEconomic crisis and mental health
Uutela, A. K. (2010) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e328336657d · Cited by 172
European report on preventing elder maltreatment
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“Researchers mainly focused on the role played by unemployment as a mediator agent [1–3], because unemployment and working conditions constitute major social determinants of health [4].”
BackgroundSocial Determinants and the Decline of Cardiovascular Diseases: Understanding the Links
Harper, S. B., Lynch, J. W., & Smith, G. D. (2011) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031210-101234 · Cited by 171
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Preventing suicide in the context of the COVID‐19 pandemic
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Woolhandler, S. J., Himmelstein, D. U., Ahmed, S., Bailey, Z., Bassett, M. T., Bird, M. E., Bor, J. H., Bor, D. H., Carrasquillo, O., Chowkwanyun, M., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(20)32545-9 · Cited by 172
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“Furthermore, it has been shown that economic crises like the 2008 financial recession and unemployment are associated with a deterioration in mental health (17), an increase in deaths from alcohol abuse (18), and an increase in binge drinking (19).”
BackgroundImpact of Business Cycles on US Suicide Rates, 1928–2007
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“other stress-related health outcomes, such as suicide (Ruhm, 2000; Tapia Granados, 2005; Stuckler et al., 2009; Stuckler et al., 2010), including evidence from current economic downturn (Reeves et al.”
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“Financial loss and unemployment status drives suicide-related consequences [29].”
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Pirkis, J., Dandona, R., Silverman, M. M., Khan, M. M., & Hawton, K. E. (2024) · The Lancet Public Health · doi:10.1016/s2468-2667(24)00149-x · Cited by 153
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Metadata
- Authors
- Stuckler, D., Basu, S., Suhrcke, M., Coutts, A., & McKee, M.
- Affiliations
- San Francisco General Hospital (US)
- University of East Anglia (GB)
- University of Oxford (GB)
- European Observatory on Health Systems and Policies (BE)
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2009-07
- Volume
- 374
- Issue
- 9686
- Pages
- 315-323
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2146860307
- Cited by
- 1,486
- References
- 42
- Citations by year
- 2026: 39 · 2025: 37 · 2024: 42 · 2023: 67 · 2022: 64 · 2021: 146 · 2020: 115 · 2019: 71 · 2018: 87 · 2017: 95 · 2016: 111 · 2015: 119 · 2014: 183 · 2013: 101 · 2012: 77
- FWCI
- 125.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della Ricerca - Bocconi (submittedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- World Bank Group
- Economic and Social Research Council (ES/G007462/1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Employment and Welfare Studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Unemployment and Economic Growth
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- unemployment, economic crisis, mortality, suicide, homicide, traffic fatalities, alcohol-related mortality, social protection, active labour market programmes, government spending, unemployment insurance, public health policy, premature mortality, EU member states, population aging, health infrastructure, health disparities
- MeSH terms
- Accidents, Traffic, Adolescent, Adult, Aged, Cause of Death, Europe, European Union, Health Expenditures, Health Policy, Health Status, Homicide, Humans, Middle Aged, Mortality, Population Surveillance, Public Health, Regression Analysis, Suicide, Unemployment, Effect Modifier, Epidemiologic, Multivariate Analysis, Age Distribution, Community Health Planning, Young Adult
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