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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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Suicide, unemployment, and economic recession in Spain
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Lin, P.-J., Shiue, Y., Tzeng, G., & Huang, S.-L. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16081349 · Cited by 29
“Therefore, to support system operations, the government regularly invests financial revenues into the system [25]; conversely, health care in Germany is jointly undertaken by the central and local governments at all levels [24].”
BackgroundStückler, D., & McKee, M. (2012) · European Journal of Public Health · doi:10.1093/eurpub/ckr189 · Cited by 27
Self-citationAlcohol consumption and harmful drinking
Devaux, M., & Sassi, F. (2015) · OECD health working papers · doi:10.1787/5js1qwkz2p9s-en · Cited by 28
Fountoulakis, K. Ν. (2016) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.115.171785 · Cited by 27
Huebner, G. M., Hanmer, C., Zapata-Webborn, E., Pullinger, M., McKenna, E. J., Few, J., Elam, S., & Oreszczyn, T. (2023) · Scientific Reports · doi:10.1038/s41598-023-48181-7 · Cited by 26
The social determinants of suicide: an umbrella review
Gallagher, K., Phillips, G., Corcoran, P. E., Platt, S. D., McClelland, H., Driscoll, M. O., & Griffin, E. (2025) · Epidemiologic Reviews · doi:10.1093/epirev/mxaf004 · Cited by 33
Recession, recovery and suicide in mental health patients in England: time trend analysis
Ibrahim, S., Hunt, I. M., Rahman, M. S., Shaw, J. J., Appleby, L., & Kapur, N. (2019) · The British Journal of Psychiatry · doi:10.1192/bjp.2019.119 · Cited by 27
da Silva, L. E. S., Helman, B., Silva, D. C. D. L. E., de Aquino, É. C., de Freitas, P. C., Santos, R. D. O., Brito, V. C. D. A., García, L. P., & Sardinha, L. M. V. (2022) · Epidemiologia e Serviços de Saúde · doi:10.1590/ss2237-9622202200003.especial · Cited by 27
Suicide in Ireland: The Influence of Alcohol and Unemployment
Walsh, B., & Walsh, D. (2010) · Arrow@dit (Dublin Institute of Technology) · Cited by 26
Educational inequalities in health expectancy during the financial crisis in Denmark
Brønnum‐Hansen, H., Baadsgaard, M., Eriksen, M. L., Andersen‐Ranberg, K., & Jeune, B. (2015) · International Journal of Public Health · doi:10.1007/s00038-015-0726-3 · Cited by 26
“Some studies have focused on the differences between social welfare systems in the capability to protect against the effects of unemployment or economic crises in general (Bambra and Eikemo 2009; Stuckler et al. 2009; Mackenbach 2012; Karanikolos et al. 2013; Ifanti et al. 2013; Baumbach and Gulis 2014).”
BackgroundThe Great Recession, jobs and social crises: policies matter
Chowdhury, A., Islam, I., & Lee, D. (2013) · International Journal of Social Economics · doi:10.1108/03068291311291518 · Cited by 26
Addressing the unemployment–mortality conundrum: Non-linearity is the answer
Bonamore, G., Carmignani, F., & Colombo, E. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.12.017 · Cited by 26
“Somewhere in between these two views lies a group of papers that substantially find no evidence of a robust and systematic effect of unemployment on mortality (Gerdtham and Johannesson, 2005, Svensson, 2007, 2010, Stuckler, Basu, Suhrcke, Coutts and McKee, 2009).”
Personality and suicide risk: the impact of economic crisis in Japan
Tanji, F., Kakizaki, M., Sugawara, Y., Watanabe, I., Nakaya, N., Minami, Y., Fukao, A., & Tsuji, I. (2014) · Psychological Medicine · doi:10.1017/s0033291714001688 · Cited by 26
Health Disparities by Income in Spain Before and After the Economic Crisis
Coveney, M., García‐Gómez, P., van Doorslaer, E. K. A., & Ourti, T. V. (2015) · Health Economics · doi:10.1002/hec.3375 · Cited by 26
“There is a large literature that documents that worsening economic conditions are associated with reduced mortality (Ruhm, 1996; Stuckler et al, 2009), but more recent evidence is mixed.”
Russo, G., Pires, C. A. M., Perelman, J., Gonçalves, L. A. P., & Barros, P. P. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2151-1 · Cited by 27
The short-term impact of economic uncertainty on motor vehicle collisions
Vandoros, S., Avendaño, M., & Kawachi, I. I. (2018) · Preventive Medicine · doi:10.1016/j.ypmed.2018.02.005 · Cited by 26
“collision decline during economic downturns [25-30], few studies have examined whether daily fluctuations in economic uncertainty can be a source of stress and distraction that can”
BackgroundResultThe Health and Wellbeing Effects of Active Labor Market Programs
Coutts, A. P., Stückler, D., & Cann, D. J. (2014) · Well Being · doi:10.1002/9781118539415.wbwell048 · Cited by 26
Self-citationHiilamo, A., Hiilamo, H., Ristikari, T., & Virtanen, P. J. (2020) · Children and Youth Services Review · doi:10.1016/j.childyouth.2020.105772 · Cited by 25
Can Government Responses to Unemployment Reduce the Impact of Unemployment on Suicide?
Shand, F., Duffy, L., & Torok, M. H. (2021) · Crisis · doi:10.1027/0227-5910/a000750 · Cited by 25
Activation, health and well‐being: neglected dimensions?
Sage, D. J. (2013) · International Journal of Sociology and Social Policy · doi:10.1108/01443331311295145 · Cited by 25
Ruíz-Ramos, M., Córdoba-Doña, J. A., Amaia Bacigalupe, H., Juárez, S., & Escolar-Pujolar, A. (2014) · Gaceta Sanitaria · doi:10.1016/j.gaceta.2014.01.005 · Cited by 24
Visser, M., Gesthuizen, M., & Scheepers, P. L. H. (2013) · Social Indicators Research · doi:10.1007/s11205-013-0259-1 · Cited by 25
“People could lose their job, have a loss in financial resources or experience personal damage in the long run, reflected by feelings of stigmatization after a period of unemployment, unstable family relations or poor health and mental well-being (Keeley and Love 2010; Oberholzer-Gee 2007; Price et al. 2002; Reinhart a…”
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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