The Impact of Economic Crises on Communicable Disease Transmission and Control: A Systematic Review of the Evidence

Abstract

There is concern among public health professionals that the current economic downturn, initiated by the financial crisis that started in 2007, could precipitate the transmission of infectious diseases while also limiting capacity for control. Although studies have reviewed the potential effects of economic downturns on overall health, to our knowledge such an analysis has yet to be done focusing on infectious diseases. We performed a systematic literature review of studies examining changes in infectious disease burden subsequent to periods of crisis. The review identified 230 studies of which 37 met our inclusion criteria. Of these, 30 found evidence of worse infectious disease outcomes during recession, often resulting from higher rates of infectious contact under poorer living circumstances, worsened access to therapy, or poorer retention in treatment. The remaining studies found either reductions in infectious disease or no significant effect. Using the paradigm of the “SIR” (susceptible-infected-recovered) model of infectious disease transmission, we examined the implications of these findings for infectious disease transmission and control. Key susceptible groups include infants and the elderly. We identified certain high-risk groups, including migrants, homeless persons, and prison populations, as particularly vulnerable conduits of epidemics during situations of economic duress. We also observed that the long-term impacts of crises on infectious disease are not inevitable: considerable evidence suggests that the magnitude of effect depends critically on budgetary responses by governments. Like other emergencies and natural disasters, preparedness for financial crises should include consideration of consequences for communicable disease control.

Social determinants of tuberculosis in Europe: a prospective ecological study

“…TB is considered to be a disease of the socially and economically disadvantaged, since its incidence is exacerbated by socioeconomic factors, inconsistent or partial treatment practices and immigration from countries in which the disease is endemic [6,9,10]. Reducing inequalities in TB incidence in Europe is, therefore, a goal that needs to be addressed, especially since the recent global financial crisis is expected to exacerbate health inequalities [11,12]. However, the relatively small contribution of TB to overall mortality and morbidity makes the statistical analysis not feasible on the individual level and an ecological study is needed.…”

Molecular typing of bacteria for epidemiological surveillance and outbreak investigation / Molekulare Typisierung von Bakterien für die epidemiologische Überwachung und Ausbruchsabklärung

“…More than 70% of these zoonotic diseases in humans originate from wildlife (Morse et al, 2012;Van Doorn, 2014). These shifts in infectious diseases are caused by the adaptation of microorganisms to changes in human behavior, demographics, and life style (Cascio et al, 2011); changes in economic development and land use (Suhrcke et al, 2011); loss of biodiversity (Swaddle and Calos, 2008;Ostfeld, 2009); global travel (Hufnagel et al, 2004); immigration (Schmid et al, 2008); air conditioning; crowded intensive care units in large hospitals; global environmental and climate changes (Semenza et al, 2012); evolution of susceptible populations, exotic pets, exotic foods and pathogen adaptation (Casadevall et al, 2011;Price et al, 2012); as well as advances in detection techniques Allerberger, 2012;van Doorn, 2014). With industrialization of food processing, worldwide shipment of fresh and frozen food and an increased demand for fresh bagged produce foodrelated outbreaks shifted from local, often family-based, outbreaks to multistate or multicountry outbreaks, often caused by a single source (Shane et al, 2002;Tauxe, 2002;Denny et al, 2007;Nygren et al, 2013;Schmid et al, 2014;Ruppitsch et al, 2015b;Inns et al, 2016).…”

Assessment of the Adequacy of Russia’s Information Resources to the Health Criteria of the Organization for Economic Cooperation and Development

“…A systematic review of the literature on the impact of economic crisis on communicable diseases identified 37 studies, 30 of which reported worse infectious disease outcomes (Suhrcke et al, 2011). These studies report higher rates of infection due to poorer living conditions, reduce access to therapies and treatment retention as reasons for worse outcomes.…”

“…However, it should be noted that a large number of these studies report on conditions in central and eastern European countries during the early 1990, at a time of economic and political turmoil. Studies from Germany, Japan and other OECD countries, reported fewer influenza and respiratory disease deaths during times when unemployment was high as opposed to low (Suhrcke et al, 2011). Nevertheless, a country's ability to respond to emerging risks is paramount to longterm health system goals.…”