Staying healthy in recession

Policymakers can avoid creating a health crisis by heeding the lessons learned from previous economic downturns, writes JOANNE HUNT

A RISE IN suicides and a fall in road traffic deaths – as a country in recession, these are the trends that Ireland can expect, according to a Cambridge medical scientist.

King’s College Cambridge sociology lecturer and Yale health policy and economics graduate Dr David Stuckler was in Dublin this month to address a conference organised by equality think-tank, Tasc. His message to participants was simple: “What happens in the economy matters for our health.”

Looking back over a century of booms and busts, Stuckler’s research traces the relationship between economic trends and the health of those buffeted by them. And though we may have failed to heed warning signs dating back over a century, he feels health policymakers can learn from the past to avoid a health crisis.

Stuckler’s historical safari begins by looking at the effect on health in the US during the Great Depression. “The Great Depression is very interesting. It’s true that suicide rates rose by about 40 per cent, but overall mortality rates fell by about 10 per cent,” he says.

“There are two important things happening that give us clues and one is that in the US, there had been prohibition on alcohol. When it was lifted in 1933 as part of an economic stimulus measure, death rates started to rise rapidly.”

He says the other big impact of economic policy on health at the time was the birth of the welfare state in the US. “It was a major extension of financial relief to the newly unemployed and studies we did found that those states that introduced more social welfare had lower rises in mortality and, in some cases, mortality rates fell.”

So it’s not so much recession as the social protection measures with which government responds to downturns that are the key determinant of population health. His comparison of the Great Depression to the post-Soviet depression decades later further makes this case.

“In Eastern Europe, far from prohibition there was a legendary drinking culture and cheap, industrial-strength alcohol flooded the region,” he says. “Also the reformers set out to shatter the Soviet era cradle-to-grave welfare system, so even though GDP fell in both situations by about 30 per cent, in Eastern Europe there was a devastating mortality crisis of about three million excess deaths.”

Stuckler says that the more rapid the economic changes in a country, the bigger the impact on that nation’s health. “We found that those countries that implemented very rapid economic changes had greater rises in suicides, homicides, heart attacks and alcohol-related deaths,” he says.

“So we have a basic model that financial crises is worse during rapid economic changes and when social welfare is weak and drugs and alcohol are widely available – that gives us some suggestions about what policies could help protect vulnerable groups now.”

Referring to his work published in the Lancet in 2009, Stuckler says while there had been a decline in suicides in Europe in the past decade, numbers started to rise in 2008 – an increase that pre-dates actual job losses.

But to Stuckler, this is no surprise. “There are a number of studies that find that being afraid of losing your job can be just as bad, if not worse than actually losing it,” he notes.

But there is much a government can do to assuage such anxiety and thereby minimise the impact on health.

“We looked at what happened to health in recession over the past three and a half decades in Europe. We found patterns broadly consistent with the Great Depression – rises in suicides and falls in road traffic fatalities,” he says.

“But we took the next step and looked at whether it was any different where governments invested in welfare such as housing support, disability, pensions, giving cash to people who had lost their jobs, welfare to work programmes that try to help get workers back on their feet.”

The good news for Minister for Social Protection Joan Burton’s JobBridge programme is that it’s active labour market programmes that reintegrate workers rather than cash payments that have the greatest protective effective on health.

As a cautionary tale, Stuckler points to Greece. “We’re starting to see some worrisome and alarming signs that are not just from the financial crisis but seem directly linked to austerity,” he says.

“A 50 per cent rise in HIV, a doubling of homicides and death rates, a massive increase in heroin use and prostitution, there are even reports of people deliberately self-infecting with HIV to get access to public benefits,” he says.

“Doctors’ salaries have been cut and people are reporting an inability to get access to medical care because wait times are increasing and there are reports of bribery of doctors to jump queues.

“We feel these findings pose a warning to other hard-hit countries like Portugal, Spain and Ireland of what could happen,” he says.

Stuckler’s message is of a strong link between investment in social welfare and health overall. “The basic point is that if policymakers wish to protect health, then it’s about much more than just spending on healthcare when people are already sick.

“Spending on social welfare can have as much if not a greater impact on health. Budget cuts can be a matter of life or death for ordinary people.”