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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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“impacts of recent economic changes (12, 15, 16).”
BackgroundInfluence of economic crisis on dietary quality and obesity rates
Norte, A., Sospedra, I., & Ortiz-Moncada, R. (2018) · International Journal of Food Sciences and Nutrition · doi:10.1080/09637486.2018.1492523 · Cited by 36
“It is well-known that economic crisis may affect health outcomes (Stuckler et al. 2009) and these economic factors may also be determinants of nutritional status (Lo et al. 2009).”
BackgroundGovernment spending, recession, and suicide: evidence from Japan
Matsubayashi, T., Sekijima, K., & Ueda, M. (2020) · BMC Public Health · doi:10.1186/s12889-020-8264-1 · Cited by 36
Katikireddi, S. V., Niedzwiedz, C. L., Dundas, R., Kondo, N., Leyland, A. H., & Rostila, M. (2020) · International Journal of Epidemiology · doi:10.1093/ije/dyaa053 · Cited by 34
Avoiding negative vs. achieving positive outcomes in hard and prosperous economic times
Millet, K., Lamey, L., & den Bergh, B. V. (2011) · Organizational Behavior and Human Decision Processes · doi:10.1016/j.obhdp.2011.11.008 · Cited by 38
Bellis, M. A., Leckenby, N., Hughes, K. E., Luke, C., Wyke, S., & Quigg, Z. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-746 · Cited by 36
“, recession [22]), calendar events (e.”
Unemployment, suicide and COVID ‐19: using the evidence to plan for prevention
Deady, M., Tan, L., Kugenthiran, N., Collins, D., Christensen, H. M., & Harvey, S. B. (2020) · The Medical Journal of Australia · doi:10.5694/mja2.50715 · Cited by 35
Trade liberalization, social policies and health: an empirical case study
McNamara, C. L. (2015) · Globalization and Health · doi:10.1186/s12992-015-0126-8 · Cited by 35
“, [39]).”
BackgroundKawaguchi, H., & Koike, S. (2016) · PLoS ONE · doi:10.1371/journal.pone.0148288 · Cited by 35
“SMR has commonly been used to adjust for age and sex in previous studies about suicide rates and we used this index because of its high comparability [8, 14].”
BackgroundMethodSarti, S., & Zella, S. (2016) · Social Science Research · doi:10.1016/j.ssresearch.2015.12.010 · Cited by 37
Deterioration in health: What is the role of unemployment and poverty?
Vaalavuo, M. (2016) · Scandinavian Journal of Public Health · doi:10.1177/1403494815623654 · Cited by 35
“[13] Stuckler D, Basu S, Suhrcke M, et al.”
BackgroundMandavia, A. D., & Bonanno, G. A. (2018) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2018.12 · Cited by 34
“The longer-term impacts of economic adversity may also manifest in the form of incremental increases in suicide and alcohol abuse.(8) Research assessing the impact of natural disasters on people directly experiencing them has highlighted similar mental health deficits.”
BackgroundPérez, V., Elices, M., Vilagut, G., Vieta, E., Blanch, J., Laborda-Serrano, E., Prat, B., Colom, F., Palao, D. J., & Alonso, J. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.11.006 · Cited by 34
Lange, S., Cayetano, C., Jiang, H., Tausch, A., & Souza, R. O. E. (2023) · The Lancet Regional Health - Americas · doi:10.1016/j.lana.2023.100450 · Cited by 44
Government Health Care Spending and Child Mortality
Maruthappu, M., Ng, K. Y. B., Williams, C., Atun, R. A., & Zeltner, T. B. (2015) · PEDIATRICS · doi:10.1542/peds.2014-1600 · Cited by 37
Maruthappu, M., Ng, K., Williams, C., Atun, R. A., Agrawal, P., & Zeltner, T. B. (2014) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.13205 · Cited by 34
The Great Recession in Portugal: Impact on hospital care use
Perelman, J., Félix, S., & Santana, R. M. (2014) · Health Policy · doi:10.1016/j.healthpol.2014.12.015 · Cited by 39
Grigorakis, N., Floros, C., Tsangari, H., & Tsoukatos, E. (2018) · Journal of Policy Modeling · doi:10.1016/j.jpolmod.2018.02.006 · Cited by 34
Koltai, J., & Stückler, D. (2019) · SSM - Population Health · doi:10.1016/j.ssmph.2019.100521 · Cited by 34
COVID-19 Pandemic: Identifying Key Issues Using Social Media and Natural Language Processing
Oyebode, O., Ndulue, C., Mulchandani, D., Suruliraj, B., Adib, A. A. Z., Orji, F. A., Milios, E., Matwin, S., & Orji, R. (2022) · Journal of Healthcare Informatics Research · doi:10.1007/s41666-021-00111-w · Cited by 38
“Besides technology usage, governments can budget for additional measures to protect the finances of people and businesses such as keeping people employed through financial partnership with employers, providing stimulus packages, and facilitating quick employment for the jobless [88].”
Impacts on and Care of Psychiatric Patients during the Outbreak of COVID-19
Puangsri, P., Jinanarong, V., & Wattanapisit, A. (2021) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/1745017902117010052 · Cited by 37
Paul, E., & Fancourt, D. E. (2021) · The British Journal of Psychiatry · doi:10.1192/bjp.2021.130 · Cited by 33
Common Mental Disorders and Economic Uncertainty: Evidence from the COVID-19 Pandemic in the U.S.
Tham, W. W., Sojli, E., Bryant, R. A., & McAleer, M. J. (2021) · PLoS ONE · doi:10.1371/journal.pone.0260726 · Cited by 38
“Our findings support and complement previous results that economic downturns are related to deteriorating mental health [13, 25, 26].”
ResultMcAuliffe, C., Pumarino, J., Thomson, K., Richardson, C. G., Slemon, A., Salway, T. J., & Jenkins, E. (2021) · SSM - Population Health · doi:10.1016/j.ssmph.2021.100988 · Cited by 34
Costa‐Font, J., Karlsson, M., & Øien, H. (2016) · Health Economics · doi:10.1002/hec.3385 · Cited by 34
“…and outcomes (Ruhm, 2000, 2003, 2004; Cawley et al., 2015; Cawley and Simon, 2005), and besides, the previous literature suggests that unemployment is a better predictor of health outcomes and inputs than other measures of macroeconomic fluctuations (Cawley et al., 2015; Stuckler et al., 2009).”
Kim, J. I., & Kim, G. (2017) · Globalization and Health · doi:10.1186/s12992-017-0279-8 · Cited by 33
Child and Adolescent Mental Health Policies, Programmes and Infrastructures across Europe
Bielsa, V. C., Braddick, F., Jané‐Llopis, E., Jenkins, R., & Pūras, D. (2010) · International Journal of Mental Health Promotion · doi:10.1080/14623730.2010.9721822 · Cited by 33
“It deserves mention that economic crises have been shown to have discernable effects on the distribution of funding allocation in mental health arenas (Stuckler, 2009).”
BackgroundBlomqvist, S., Burström, B., & Backhans, M. C. (2014) · International Journal for Equity in Health · doi:10.1186/1475-9276-13-51 · Cited by 33
“This has been explained by a higher proportion of people in poor health in the labour force and consequently more people at risk of being sick-listed [24].”
Background
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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