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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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Jackson, K., Kelemen, Z., & Nagy, Á. A. (2025) · Humanities and Social Sciences Communications · doi:10.1057/s41599-025-05858-w · Cited by 11
“Events like the COVID-19 pandemic and the war in Ukraine only added to this pressure, deepening existing cracks in household stability (Stuckler et al. 2009).”
Uphoff, E., Small, N., & Pickett, K. E. (2018) · Nicotine & Tobacco Research · doi:10.1093/ntr/nty083 · Cited by 6
Réflexion sur l’évolution à 10 ans des urgences pédopsychiatriques, CHRU-Nancy
Boyer, J., Cautenet, A., & Ligier, F. (2021) · L Encéphale · doi:10.1016/j.encep.2020.08.011 · Cited by 6
Cluster analysis of health systems in Europe according to life expectancy at birth
Top, M., & Çınaroğlu, S. (2021) · The International Journal of Health Planning and Management · doi:10.1002/hpm.3283 · Cited by 6
Economic conditions and health: Local effects, national effect and local area heterogeneity
Janke, K., Lee, K. C., Propper, C., Shields, K. K., & Shields, M. A. (2023) · Journal of Economic Behavior & Organization · doi:10.1016/j.jebo.2023.07.003 · Cited by 6
The financial crisis has an impact in sleep medicine: experience of a sleep clinic in Greece
Pataka, A., Chavouzis, N., Passa, K. F., Pitsiou, G., & Argyropoulou, P. (2013) · Sleep And Breathing · doi:10.1007/s11325-013-0838-z · Cited by 6
“During the period 2008–2011, an increased level of socioeconomic stress has been evident in Greece, and the austerity measures had an impact in health [2, 5].”
BackgroundEconomic hardship and suicides
Korhonen, M., Puhakka, M., & Virén, M. (2017) · International Journal of Social Economics · doi:10.1108/ijse-06-2016-0153 · Cited by 7
Sfakianoudis, K., Simopoulou, M., Rapani, A., Grigoriadis, S., Maziotis, E., Giannelou, P., Pantou, A., Vaxevanoglou, T., Fakiridou, M., Koutsilieris, M., et al. (2019) · Medicina · doi:10.3390/medicina55100654 · Cited by 6
“It is well established that the economic recession exerts a certain array of repercussions regarding the individual’s wellbeing and sustainably such as family planning and formation, divorces, mortality, and certainly fertility [10].”
BackgroundHealth status and the Great Recession. Evidence from electronic health records
Belotti, F., Kopinska, J. A., Palma, A., & Mortari, A. P. (2022) · Health Economics · doi:10.1002/hec.4551 · Cited by 6
Big Data and Artificial Intelligence for Global Health
Vayena, E., & Ferretti, A. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108692137.036 · Cited by 6
Chen, Q., Wei, H., & Zhi, Y.-P. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2021.833961 · Cited by 6
Garcia, M. R. V., Barros, C. R. D. S., Paiva, V. S. F., Corrochano, M. C., Júnior, D. A. B., dos Reis, N. D. S. M., & Plácido, D. S. (2022) · Revista Portuguesa de Investigação Comportamental e Social · doi:10.31211/rpics.2022.8.2.250 · Cited by 10
Welfare Attitudes in Crisis: The Role of Ideology in Healthcare Satisfaction in Portugal and Ireland
Popić, T., & Burlacu, D. (2022) · Journal of Social Policy · doi:10.1017/s0047279422000332 · Cited by 6
Emotionally Based Strategic Communications and Societal Stress-Related Disorders
Ćosić, K., Srbljinović, A., Popović, S., Wiederhold, B. K., & Wiederhold, M. D. (2012) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2012.0410 · Cited by 6
“Talk” about male suicide? Learning from community programmes
Robinson, M., Braybrook, D. E., & Robertson, S. (2013) · Mental Health Review Journal · doi:10.1108/mhrj-12-2012-0034 · Cited by 6
“Prolonged unemployment is also a major risk factor (Stuckler et al., 2009; McLean et al., 2008; Kinderman et al., 2008; Institute of Public Health in Ireland, 2011), with correlations between male suicide rates and rising unemployment across European and Asian countries (Cooper, 2011; Pritchard,…”
BackgroundStroke-attributable death among older persons during the great recession
Falconi, A. M., Gemmill, A., Karasek, D. A., Goodman, J. M., Anderson, B., Lee, M., Bellows, B., & Catalano, R. A. (2015) · Economics & Human Biology · doi:10.1016/j.ehb.2015.11.005 · Cited by 6
Influence of the sickness benefit reform on sickness absence
Aaviksoo, E., & Kiivet, R. A. (2016) · Health Policy · doi:10.1016/j.healthpol.2016.07.014 · Cited by 6
“Negative health trends after the recession have been observed in many European countries [34]; the number of people with good or very good self-rated health dropped in Great Britain; the amount of still births and costs related to infectious diseases rose in Greece; mood disorders and alcohol-related problems increase…”
BackgroundRothes, I., & Henriques, M. I. R. S. (2017) · OMEGA - Journal of Death and Dying · doi:10.1177/0030222817693530 · Cited by 8
Divergent policy responses to increasing vaccine scepticism in southern Europe
Kennedy, J., & Michailidou, D. M. (2017) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(17)30456-5 · Cited by 6
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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