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Does the crisis make us sick? About the economic and social determinants of health

Does the crisis make us sick? About the economic and social determinants of health. Aaron Reeves University of Cambridge asr45@cam.ac.uk. Thanks to. Chris Meissner University of California Davis. Sanjay Basu UCSF. David Stuckler University of Cambridge. Martin McKee LSHTM.

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Does the crisis make us sick? About the economic and social determinants of health

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  1. Does the crisis make us sick? About the economic and social determinants of health Aaron Reeves University of Cambridge asr45@cam.ac.uk

  2. Thanks to... Chris Meissner University of California Davis Sanjay Basu UCSF David Stuckler University of Cambridge Martin McKee LSHTM

  3. Austerity and the economic crisis • Recession -> • Increased suicide • Decline in traffic accidents • Austerity -> • Increased rates of infectious disease • Increased suicide rates

  4. Suicide

  5. Impact of 1% rise in unemployment on mortality Suicide Source: Stuckler et al 2009 Lancet

  6. Rising Suicides New member states Old member states - 9 out of 10 countries suicides rose - About 3400 excess suicides Source: Stuckler et al 2011 Lancet

  7. Infection

  8. New HIV cases in Greece 10-fold rise in HIV from injection drug use Note: Data on HIV, hep b and hep c are collected in 3 sentinel surveillance sites where these patterns have been confirmed • Source: Paraskevis and Hatzakis 2011

  9. Are these inevitable? • Social Protection austerity • Health care austerity • Austerity and economic growth

  10. Social protection austerity

  11. Social welfare expenditure • “the provision by public (and private) institutions of benefits to, and financial contributions targeted at, households and individuals in order to provide support during circumstances which adversely affect their welfare.” • Includes spending related to: • family support programmes (such as preschool education, child care, and maternity or paternity leave), • old age pensions and survivors benefits, • health care, • housing (such as rent subsidies), • unemployment benefits, • active labour market programmes (to maintain employment or help the unemployed obtain jobs), and support for people with disabilities.

  12. Social Protection Change: 2007-2010 decrease increase Countries with no social protection spending data: Belgium, Iceland, Romania, and Switzerland. • Social spending up • Increase unemployment benefits • Decreasedisability benefits

  13. Spain and Sweden

  14. Social Protections Help… • Each 100 USD greater social spending reduced the effect on suicides by: • 0.38%, active labour market programmes Spending> 190 USD no effect of unemployment on suicide Source: Stuckler et al 2009 Lancet

  15. Relation between deviation from country average of social welfare spending (excluding health) and all-cause mortality in 15 EU countries, 1980–2005 Source: Stuckler D et al. BMJ, 2010, 340.

  16. Healthcare austerity

  17. Healthcare austerity

  18. Healthcare austerity

  19. Healthcare austerity: Greece Source: EU-SILC: Kentikelenis et al., 2011, Health effects of financial crisis, The Lancet 2011; 378:1457-1458)

  20. Cost of heath care and utilization • “Reductions in routine care today might lead to undetected illness tomorrow and reduced individual health and well-being in the more distant future.” Highcopayment Med copayment Low copayment Source: Lusardi A et al. The economic crisis and medical care usage. Harvard Business School, 2010.

  21. New HIV cases in Greece 10-fold rise in HIV from injection drug use Note: Data on HIV, hep b and hep c are collected in 3 sentinel surveillance sites where these patterns have been confirmed • Source: Paraskevis and Hatzakis 2011

  22. Healthcare austerity

  23. Spain Mental Health Crises Prevalence Change, 2006 to 2010 - 1.7-fold greater risk of depression in unemployed - 3.0-fold greater risk in mortgage payment problems Source: Gili, et al 2012 JECH

  24. Austerity, fiscal multipliers, and Economic growth

  25. Fiscal Multipliers: The effect of public spending on the economy Increased Growth (GDP) >1 Fiscal Multiplier How that investment or reduction effects economy? Govt spending (+£1) Or Austerity (-£1) Reduced Growth (GDP) <1

  26. Austerity and economic growth

  27. Key conclusions • Recession -> poorer health • Austerity -> Increased suicide, heart disease mortality, infectious disease • Not inevitable • Social protection • Health care • Public expenditure (e.g. Health and social protection) fosters economic growth

  28. Data • ‘In marked contrast to financial data, some of which are available instantaneously and others, such as economic growth, within a few weeks, data on mortality in many countries are delayed by several years’ (McKee et al., 2012) • Even now the full extent of the crisis on health is obscured by lack of available data.

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