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Does the crisis make us sick? About the economic and social determinants of health. Aaron Reeves University of Cambridge [email protected]. Thanks to. Chris Meissner University of California Davis. Sanjay Basu UCSF. David Stuckler University of Cambridge. Martin McKee LSHTM. - PowerPoint PPT Presentation
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Does the crisis make us sick? About the economic and social determinants of health
Aaron ReevesUniversity of Cambridge
Thanks to...
Martin McKeeLSHTM
Sanjay BasuUCSF
Chris MeissnerUniversity of California Davis
David StucklerUniversity of Cambridge
Austerity and the economic crisis
• Recession ->– Increased suicide– Decline in traffic accidents
• Austerity ->– Increased rates of infectious disease– Increased suicide rates
Suicide
Impact of 1% rise in unemployment on mortality
Source: Stuckler et al 2009 Lancet
Suicide
Rising Suicides
- 9 out of 10 countries suicides rose
Source: Stuckler et al 2011 Lancet
- About 3400 excess suicides
New member states Old member states
Infection
New HIV cases in Greece
Note: Data on HIV, hep b and hep c are collected in 3 sentinel surveillance sites where these patterns have been confirmed
10-fold rise in HIV from injection drug use
Source: Paraskevis and Hatzakis 2011
Are these inevitable?
• Social Protection austerity
• Health care austerity
• Austerity and economic growth
Social protection austerity
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.
Social Protection Change: 2007-2010
• Social spending up
• Increase unemployment benefits
• Decrease disability benefits
increase decrease
Countries with no social protection spending data: Belgium, Iceland, Romania, and Switzerland.
Spain and Sweden
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
Source: Stuckler D et al. BMJ, 2010, 340.
Relation between deviation from country average of social welfare spending (excludinghealth) and all-cause mortality in 15 EU countries, 1980–2005
Healthcare austerity
Healthcare austerity
Healthcare austerity
Healthcare austerity: Greece
Source: EU-SILC: Kentikelenis et al., 2011, Health effects of financial crisis, The Lancet 2011; 378:1457-1458)
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.”
Source: Lusardi A et al. The economic crisis and medical care usage. Harvard Business School, 2010.
Med copayment
High copayment
Low copayment
New HIV cases in Greece
Note: Data on HIV, hep b and hep c are collected in 3 sentinel surveillance sites where these patterns have been confirmed
10-fold rise in HIV from injection drug use
Source: Paraskevis and Hatzakis 2011
Healthcare austerity
Spain Mental Health Crises
- 1.7-fold greater risk of depression in unemployed
Source: Gili, et al 2012 JECH
- 3.0-fold greater risk in mortgage payment problems
Prevalence Change, 2006 to 2010
Austerity, fiscal multipliers, and Economic growth
Fiscal Multipliers: The effect of public spending on the economy
Govt spending (+£1)Or
Austerity (-£1)
Fiscal Multiplier
How that investment or reduction effects
economy?
>1
IncreasedGrowth(GDP)
<1 ReducedGrowth(GDP)
Austerity and economic growth
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
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.