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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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“Results showed that in countries with low social investment such as Spain, there was a positive correlation between unemployment and suicide; in countries with high social investments such as Sweden, however, a sharp increase in unemployment coincided in suicide reductions (Stuckler et al., 2009b).”
BackgroundEconomic Downturns, Retirement and Long-Term Cognitive Function Among Older Americans
Hessel, P., Riumalló‐Herl, C., Leist, A. K., Berkman, L. F., & Avendaño, M. (2017) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbx035 · Cited by 19
Park, G., Grignon, M., Young, M. C., & Dunn, J. R. (2022) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2022-219545 · Cited by 19
“18 19 While plausible, it should be interpreted with caution since social spending on healthcare and housing did not significantly moderate the link between housing cost burden and mortality rates.”
BackgroundUnemployment, Medicaid provisions, the mental health industry, and suicide
Pellegrini, L. C., & Rodríguez-Monguió, R. (2013) · The Social Science Journal · doi:10.1016/j.soscij.2013.09.013 · Cited by 19
Brydsten, A., Hammarström, A., & Sebastiån, M. S. (2016) · BMC Public Health · doi:10.1186/s12889-016-2917-0 · Cited by 19
“On the other hand, a recession may reduce work hazards and risk-taking behaviours, and may increase (non-market) leisure time, leading to short-term population health improvements [13].”
BackgroundHealth effects of the financial crisis: lessons from Greece
McKee, M., & Stückler, D. (2016) · The Lancet Public Health · doi:10.1016/s2468-2667(16)30016-0 · Cited by 19
Self-citationThe Relationship between Work and Health in Persons with Usher Syndrome Type 2
Ehn, M., Möller, K., Danermark, B., & Möller, C. (2016) · Journal of Visual Impairment & Blindness · doi:10.1177/0145482x1611000403 · Cited by 19
“It has also been shown that the unemployment rate correlates positively with suicide mortality (Nordt et al., 2015; Stuckler et al., 2009).”
BackgroundConceptualizations of suicide through time and socio-economic factors: a historical mini-review
Solano, P., Pizzorno, E., Pompili, M., Serafini, G., & Amore, M. (2017) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2017.57 · Cited by 19
“The current economic crisis has been positively related to suicide rates by several studies (Stuckler et al. 2009; De Vogli et al. 2012), though it is unclear whether economic downturns and unemployment may represent causal factors for suicide (Hawton & Van Heeringen, 2009; Luo et al.”
BackgroundInfluentialVos, P. D., García-Fariñas, A., Pérez, A. G. Á., Salva, A. J. R., Gorbea, M. B., & der Stuyft, P. V. (2012) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2011.02941.x · Cited by 19
“Since 2008, the worldwide recession has had profound economic, social and health consequences for many countries, such as unemployment, impoverishment and a dramatic drop of social and health care budgets (Stuckler et al. 2009, 2010; Marmot 2010).”
BackgroundPiumatti, G. (2017) · Medicina · doi:10.1016/j.medici.2017.09.001 · Cited by 18
Hessel, P., & Avendaño, M. (2013) · Annals of Epidemiology · doi:10.1016/j.annepidem.2013.08.001 · Cited by 18
“While recent research has emphasized the short-term effects of recessions on health [5, 6], there has been little emphasis on the permanent effects of economic recessions during the transition from school to work on health in middle and old ages.”
Russo, G., Levi, M. L., Alves, M. T. S. S. D. B. E., de Oliveira, B. L. C. A., de Carvalho, R. H. D. S. B. F., Andrietta, L. S., Filippon, J., & Scheffer, M. C. (2020) · PLoS ONE · doi:10.1371/journal.pone.0241017 · Cited by 18
“Many scholars have in fact pointed out that government policy responses would have more profound effects on health systems than the economic recession itself [6], as in the past shrinking funding and rationing measures pushed health systems to the brink of collapse in recession-hit countries like Greece [7], Ireland […”
BackgroundHabu, H., Takao, S., Fujimoto, R., Naito, H., Nakao, A., & Yorifuji, T. (2021) · Journal of Epidemiology · doi:10.2188/jea.je20210066 · Cited by 19
Comparing mortality from covid-19 to mortality due to overdose: A micromort analysis
Lee, Y. L., Lui, L. M. W., Brietzke, E. M., Liao, Y., Lu, C., Ho, R., Subramaniapillai, M., Mansur, R. B., Rosenblat, J. D., & McIntyre, R. S. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.09.059 · Cited by 21
Regions with the Highest Suicide Rates for Children and Adolescents ? Some Observations
Kõlves, K., & Leo, D. D. (2014) · Journal of Child and Adolescent Behaviour · doi:10.4172/jcalb.1000e104 · Cited by 18
“Stuckler et al. [19] indicated that active labour market programmes might mitigate the adverse effect of unemployment on health.”
Thompson, A., Wright, A. K., Ashcroft, D. M., van Staa, T. P., & Pirmohamed, M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0174818 · Cited by 18
Maruthappu, M., Zhou, C. D., Williams, C., Zeltner, T. B., & Atun, R. A. (2017) · JRSM Open · doi:10.1177/2054270416685206 · Cited by 19
“The link between unemployment and an elevated incidence of suicide has also been well established.(7,8,10) Underpinning these observations are the detrimental effects that unemployment has on psychological health and wellbeing.”
BackgroundEconomic Crisis and Amenable Mortality in Spain
Nolasco, A., Pereyra-Zamora, P., Sanchis-Matea, E., Tamayo-Fonseca, N., Caballero, P., Melchor, I., & Vasallo, J. M. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15102298 · Cited by 18
The financial crisis and the expected effects on vaccinations in Europe: a literature review
Maltezou, H. C., & Lionis, C. D. (2015) · Scandinavian Journal of Infectious Diseases · doi:10.3109/23744235.2015.1018315 · Cited by 18
“pointed out [82], prevention services were deemed particularly susceptible to budget cuts as a result of fi nancial crisis compared with primary care.”
BackgroundImpact of road safety interventions on traffic-related occupational injuries in Spain, 2004–2010
López-Ruiz, M., Martı́nez, J. M., Pérez, K., Novoa, A. M., Tobı́as, A., & Benavides, F. G. (2014) · Accident Analysis & Prevention · doi:10.1016/j.aap.2014.01.012 · Cited by 18
Starace, F., Mungai, F., Sarti, E., & Addabbo, T. (2017) · PLoS ONE · doi:10.1371/journal.pone.0174135 · Cited by 17
Ali, L., Khan, S., Shah, S. J., Ullah, A., Ashraf, H., Ahmad, M., Begum, A., Han, H., Ariza‐Montes, A., Araya-Castillo, L., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312832 · Cited by 17
“Employment plays a key role in the sustainable development and improvement in health as unemployment leads to frustration and depression which ultimately led to suicide [33].”
BackgroundInfluentialDorn, F., Lange, B., Braml, M., Gstrein, D., Nyirenda, J. L. Z., Vanella, P., Winter, J., Fuest, C., & Krause, G. (2022) · Economics & Human Biology · doi:10.1016/j.ehb.2022.101198 · Cited by 17
Salve, F. D., Placenti, C., Tagliabue, S., Rossi, C., Malvini, L., Percudani, M., & Oasi, O. (2023) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2023.100475 · Cited by 17
“The causes can be attributed to the impact of pandemics on the world economy (Petrilli et al., 2022; Nordt et al., 2015; Stuckler et al., 2009), resulting in increased unemployment (International Labor Organization, 2020), as well as increased domestic violence and alcohol consumption (Gunnel et al.”
BackgroundThe state of global health in a radically unequal world: patterns and prospects
Labonté, R., & Schrecker, T. (2011) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984792.003 · Cited by 17
Urbanos-Garrido, R. M., & López‐Valcárcel, B. G. (2020) · Studies of Applied Economics · doi:10.25115/eea.v31i2.3284 · Cited by 17
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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