There is substantial body of research that focuses on pro- and counter-cyclical associations between health and economic status, unemployment or wider changes in the economy. A literature review shows a strong evidence of increased risk and severity of mental and behavioural disorders, as well as increased risk of suicides in populations that experience unemployment or loss of income (Catalano et al. 2011). In other health outcomes, the severity of impact of economic downturns varies between ages, sexes, timeframe and methodology of studies, indicators used to measure economic change, and the depth of recession.

Studies finding short-term pro-cyclical association (Ruhm 2000, Tapia Granados 2005) suggest that recessions have positive impact on health, due to increased leisure time for exercise while people tend to cut down on consumption of food, alcohol and tobacco, and reduction in negative effects of hazardous working conditions and work-related stress. However a number of individual-level studies, including those from Scandinavian countries (Eliason et al. 2009, Lundin et al. 2010, Osler et al. 2003, Martikainen et al. 2007, Martikainen et al. 1996, Gerdtham et al. 2005), the US (Sullivan et al. 2009) and the EU (Economou et al. 2008) reported the contrary effect, linking higher risk of mortality to being unemployed. A systematic review (Roelf et al. 2011) found that unemployment was associated with a significantly increased risk of all-cause mortality both in working age men and in women, among broad segments of the population. Those in low and middle stages of their career were at particularly high risk. The association between unemployment and mortality was significant in both short- and long- term, suggesting that stress and negative lifestyle effects associated with the onset of unemployment tend to persist even after restoring employment (Wahlbeck et al. 2012).

The immediate impact of financial crisis on mental health is mostly reflected in greater risk of mental and behavioural disorders, alcohol abuse and suicides among those who face unemployment or financial difficulties (Woelfs et al. 2011). Debts, inadequate income and mortgage payment problems lead to psychological distress and increase in mental disorders, such as depression (Brown et al. 2005, Taylor et al 2007, Jenkins et al. 2008). Unemployment, particularly long-term was associated with heavy drinking (Dee 2001, Janlert et al. 1992, Mossakowky 2008). Rapid (>3 percentage points) rise in unemployment in one year leads to significant increase in deaths from alcohol abuse in under 65s, which indicates that short-term negative effects of unemployment result in major psychological distress (Stuckler et al. 2009).

A recent systematic review and meta-analysis found strong association of long-term unemployment and greater incidence of suicide and attempted suicide, particularly within 5 years of job loss, but also in more distant future (Milner et al. 2013). Suicides have been particularly marked in the aftermath of severe economic crises, driven primarily by simultaneous rises in unemployment (Catalano et al. 2011). In the analysis of mortality in the EU in 1970-2007, a study found finds that two countries – Finland and Sweden – managed to unlink suicides from raising in unemployment in the early 1990s, most likely due to existing strong social protection mechanisms, including active labour market programmes (Stuckler et al. 2009). A longitudinal study from Sweden, however, found a post-recession increase in suicides in males, attributing this to the consequences of long-term unemployment (Garcy et al. 2013).

Studies on infant mortality(Bruckner et al. 2006, Bruckner 2008) have shown that deaths from unintentional injuries and SIDS increases as parents spend less time and effort in monitoring children during recession. However, caution is needed in generalising these results due to complexities with methodology and comparability.

Road traffic mortality has shown pro-cyclical pattern in relation to economic changes, with decrease in road traffic deaths coinciding with growth in unemployment (Ruhm 2000, Tapia Granados 2005, Stuckler et al. 2009). The reduction in traffic accidents and mortality is due to a drop in the volume of transport and the number of journeys made during recession.

Systematic review (Suhrcke et al. 2011) found evidence of worsening in communicable disease outcomes during recessions, particularly in relation to higher rates of infectious contact in poorer living circumstances, barriers to access therapy or poorer retention in treatment in majority of studies included. The review identified high-risk groups, which included migrants, homeless persons, prison inmates, as particularly vulnerable conduits of epidemics during economic crises. The key groups susceptible to infectious were the infants and the elderly.

Some positive lifestyle changes have been reported as overall alcohol consumption has been reducing during recessions (Dee 2001, Freeman 1999, Ruhm 1995) mainly among those individuals who remain in employment. However, as described above, the opposite has been noted for heavy drinking and for the unemployed.

Major crises of the past century

Previous research on the health of Americans during the Great Depression found that, while suicides were rising, overall mortality fell, driven by a decrease in infectious diseases and road-traffic accidents (Fishback et al. 2007) However, this research looked at the United States as a whole, and new research relating bank failures and mortality at state level found increases in suicides and falls in road-traffic deaths correlated with bank failures superimposed on underlying declines in infectious disease and increases in non-communicable disease that reflected the epidemiological transition and were unrelated to the crisis itself (Stuckler at al. 2010).

The break-up of the Soviet Union was followed by economic collapse in its successor republics. This had devastating consequences on population health across the region, with mortality increases of up to 20% in some countries. The declines in life expectancy were greatest in those countries experiencing the most rapid pace of transition (Stuckler at al. 2009) brought on by radical privatisation policies, a finding mirrored within different regions of Russia and across the former Soviet Union (Walberg et al 1998). To some extent, the adverse consequences were mitigated in countries with high levels of membership of trade unions, religious groups, or sports clubs, a widely used marker of social capital.

The impact of economic change on health outcomes depends on the extent to which the population is protected from self harm. The Great Depression coincided with Prohibition, which made it difficult to obtain alcohol. In contrast, after the break-up of the Soviet Union, wide availability of cheap alcohol in a variety of forms boosted the culture of heavy drinking at a time of rapid economic and social changes (Stuckler et al. 2009).


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