Cited by 1,486Employment and Welfare StudiesUnemployment and Economic GrowthSuicide and Self-Harm Studies

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The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis

Stuckler, David, Basu, Sanjay, Suhrcke, Marc, Coutts, Adam, McKee, Martin·2009·The Lancet

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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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Hussain, M. A., Siersbæk, N., & Østerdal, L. P. (2020) · Social Choice and Welfare · doi:10.1007/s00355-020-01259-x · Cited by 10
Distress and burnout in young medical researchers before and during the Greek austerity measures: forerunner of a greater crisis?
Sifaki-Pistolla, D. I., Chatzea, V., Melidoniotis, E., & Mechili, E. A. (2018) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-018-1509-y · Cited by 10
Capability and adversity: reframing the “causes of the causes” for mental health
Smith, M. J. (2018) · Humanities and Social Sciences Communications · doi:10.1057/s41599-018-0066-z · Cited by 13
“Where positive effects occur, they seem to be in response to assertive mitigating action by government (Stuckler et al., 2009).”
Background
Crisis económica y salud: lecciones aprendidas y recomendaciones para el futuro
Oliva, J., Peña-Longobardo, L. M., López‐Valcárcel, B. G., Pérez, P. B., & Zozaya, N. (2019) · Cuadernos Económicos de ICE · doi:10.32796/cice.2018.96.6749 · Cited by 10
“Además, los programas y políticas laborales activas que mantienen y reintegran trabajadores al mercado podrían mitigar los efectos adversos del desempleo sobre la salud que se producen durante las recesiones económicas (Stuckler et al., 2009a).”
Background
Regional employment and individual worklessness during the Great Recession and the health of the working-age population: Cross-national analysis of 16 European countries
Niedzwiedz, C. L., Thomson, K. H., Bambra, C. L., & Pearce, J. R. (2019) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112377 · Cited by 10
“Similarly, a study of 26 European countries concluded that greater spending on social welfare could considerably reduce suicide rates during periods of economic downturn (Stuckler et al., 2009).”
Background
The effects of recent austerity on environmental protection decisions
Onyango, V., Gazzola, P., & Wood, G. (2019) · Management of Environmental Quality An International Journal · doi:10.1108/meq-01-2019-0025 · Cited by 10
Unfolding the relationship between mortality, economic fluctuations, and health in Italy
Cavicchioli, M., & Pistoresi, B. (2019) · The European Journal of Health Economics · doi:10.1007/s10198-019-01135-1 · Cited by 10
The effects of Chile’s 2005 traffic law reform and in-country socioeconomic differences on road traffic deaths among children aged 0-14 years: A 12-year interrupted time series analysis
Martínez, P., & Contreras, D. (2019) · Accident Analysis & Prevention · doi:10.1016/j.aap.2019.105335 · Cited by 10
The Increase in Suicide During the COVID-19 Pandemic
Le, H., Khan, B. A., Murtaza, S., & Shah, A. A. (2020) · Psychiatric Annals · doi:10.3928/00485713-20201105-01 · Cited by 10
Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study
Konieczna, A., Jakobsen, S. G., Larsen, C. P., & Christiansen, E. (2021) · Scandinavian Journal of Public Health · doi:10.1177/14034948211013270 · Cited by 11
“The findings of this research are consistent with previous studies of similar countries (Finland, Iceland, Sweden and Austria) where suicide rates did not increase and in some cases decreased during economic downturn [2, 6, 20, 21].”
Result
Relationships between Expenditure of Regional Governments and Suicide Mortalities Caused by Six Major Motives in Japan
Hasegawa, T., Fukuyama, K., & Okada, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010084 · Cited by 10
The Health Impact Fund: how to make new medicines accessible to all
Pogge, T. W. (2011) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984792.021 · Cited by 11
Economic crisis in Greece: risks and challenges for drug policy and strategy
Poulopoulos, C. (2012) · Drugs and Alcohol Today · doi:10.1108/17459261211263415 · Cited by 10
The impact of the 2008 recession on the health of older workers: data from 13 European countries
Axelrad, H., Sabbath, E. L., & Hawkins, S. S. (2017) · European Journal of Public Health · doi:10.1093/eurpub/ckx011 · Cited by 12
Central bank interest rate decisions, household indebtedness, and psychiatric morbidity and distress: Evidence from the UK
Boyce, C. J., Delaney, L. D., Ferguson, E., & Wood, A. M. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.03.003 · Cited by 12
“indirect societal-wide benefits to psychological health of having a stable economy with low unemployment (Reeves et al., 2014; Stuckler et al., 2009; Zivin et al., 2011) the tools that a central bank uses to achieve these economic objectives may themselves pose a direct psychological risk and this may in turn have an…”
Resisting austerity measures to social policies: multiple explanatory case studies
O'Campo, P. J., Freiler, A., Muntaner, C., Gelormino, E., Huegaerts, K., Puig‐Barrachina, V., & Mitchell, C. (2018) · Health Promotion International · doi:10.1093/heapro/day073 · Cited by 10
Reframing the Challenge of Promoting Population Mental Health
Barry, M. M. (2019) · Springer eBooks · doi:10.1007/978-3-030-23455-3_2 · Cited by 10
What can be said about lifestyle and psychosocial issues during the coronavirus disease pandemic? first impressions
Yıldız, E. (2020) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12560 · Cited by 11
How to Mitigate the Mental Health Care Consequences of the COVID-19 Financial Crisis
Cuellar, A. E., Mark, T. L., Sharfstein, S. S., & Huskamp, H. A. (2020) · Psychiatric Services · doi:10.1176/appi.ps.202000329 · Cited by 10
Public health in times of austerity
Borisch, B. (2014) · Journal of Public Health Policy · doi:10.1057/jphp.2014.7 · Cited by 10
“Several studies in Europe as well as in the United States (US) have demonstrated that economic changes affect mortality rates.(1) High unemployment is associated”
Well-being and economic conditions in Ireland
Walsh, B. (2011) · Arrow@dit (Dublin Institute of Technology) · Cited by 10
Economic Crises and Mental Health: Effects of the Great Recession on Older Americans
Cutler, D., & Sportiche, N. (2022) · National Bureau of Economic Research · doi:10.3386/w29817 · Cited by 10
Solidarity and trust in European Union health governance: three ways forward
RUIJTER, A. D., Hervey, T., & Prainsack, B. (2024) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2024.101047 · Cited by 9
Global spatiotemporal analysis of suicide epidemiology and risk factor associations from 2000 to 2019 using Bayesian space time hierarchical modeling
Rotejanaprasert, C., Thanutchapat, P., Phoncharoenwirot, C., Mekchaiporn, O., Chienwichai, P., & Maude, R. J. (2025) · Scientific Reports · doi:10.1038/s41598-025-97064-6 · Cited by 10
The longitudinal relationship between financial hardship and mental health - A systematic review of the evidence
Tibbetts, J., Chapman, C., O’Dean, S., Butterworth, P., & Slade, T. N. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100481 · Cited by 11
Government spending, political dynamics, and economic recovery: a cross-national analysis of fiscal resilience
Long, L., Rabab, B., & Jamil, M. N. (2025) · Research in Globalization · doi:10.1016/j.resglo.2025.100297 · Cited by 22
MORTALITY AND FINANCIAL CRISES
Gerry, C. J., Mickiewicz, T. M., & Nikoloski, Z. (2013) · Journal of International Development · doi:10.1002/jid.2982 · Cited by 9
Responding to the economic crisis: Europe's governments must take account of the cost of health inequalities
McKee, M. (2011) · Journal of Epidemiology & Community Health · doi:10.1136/jech.2010.129999 · Cited by 9
Self-citation
Life Expectancy during the Great Depression in Eleven European Countries
Bruckner, T. A., Noymer, A., & Catalano, R. A. (2013) · Population and Development Review · doi:10.1111/j.1728-4457.2013.00573.x · Cited by 9
Welfare generosity and population health among Canadian provinces: a time-series cross-sectional analysis, 1989–2009
Ng, E., & Muntaner, C. (2015) · Journal of Epidemiology & Community Health · doi:10.1136/jech-2014-205385 · Cited by 9

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)
ORCID: Basu, Sanjay
Suhrcke, Marc
Coutts, Adam
McKee, Martin
Venue: The Lancet
Publisher: Elsevier BV
Published: 2009-07
Volume: 374
Issue: 9686
Pages: 315-323
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(09)61124-7
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis

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