The impact of economic crises on social inequalities in health: what do we know so far?

Abstract

Since 2008, Western countries are going through a deep economic crisis whose health impacts seem to be fundamentally counter-cyclical: when economic conditions worsen, so does health, and mortality tends to rise. While a growing number of studies have presented evidence on the effect of crises on the average population health, a largely neglected aspect of research is the impact of crises and the related political responses on social inequalities in health, even if the negative consequences of the crises are primarily borne by the most disadvantaged populations. This commentary will reflect on the results of the studies that have analyzed the effect of economic crises on social inequalities in health up to 2013. With some exceptions, the studies show an increase in health inequalities during crises, especially during the Southeast Asian and Japanese crises and the Soviet Union crisis, although it is not always evident for both sexes or all health or socioeconomic variables. In the Nordic countries during the nineties, a clear worsening of health equity did not occur. Results about the impacts of the current economic recession on health equity are still inconsistent. Some of the factors that could explain this variability in results are the role of welfare state policies, the diversity of time periods used in the analyses, the heterogeneity of socioeconomic and health variables considered, the changes in the socioeconomic profile of the groups under comparison in times of crises, and the type of measures used to analyze the magnitude of social inequalities in health. Social epidemiology should further collaborate with other disciplines to help produce more accurate and useful evidence about the relationship between crises and health equity.

Changes in social inequalities in disability-free life expectancy in Southern Europe: the case of the Basque Country

“…Indeed, some authors have shown that the relationship between the changes in the structural determinants and health inequalities is complex [44,45]. According to our results, the improvement of the socioeconomic indicators and the increase of social inequalities in disability and disability-free life expectancy in men occurred simultaneously.…”

Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010

“…However, efforts to reduce inequalities have not been stronger in Italy than in other countries 4. Other structural developments may have undone the effects of policies on health inequalities such as the economic recessions in some European countries in the early 1990s and the late 2000s,41 increases in income inequalities (eg, England),20 42 and changes of working conditions (eg, more work-related stress) 21. Nevertheless, the observed trends of inequalities in SAH are not consistent with the amount of effort made to reduce health inequalities in some countries.…”

Marked socioeconomic inequalities in hip fracture incidence rates during the Bone and Joint Decade (2000–2010) in Portugal: age and sex temporal trends in a population based study

“…Since 2007, the economic scenario has worsened as Portugal faced severe consequences of the global economic/financial crisis 36. Experience and evidence from past recessions show a negative impact of austerity policies on heath inequality 37. Recession periods can impact people’s lifestyles in several ways, which in turn might affect long-term HF rates, although we would expect that such an impact would reflect smooth changes in the trends of HF.…”