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

International Journal for Equity in Health

Antonio Escolar-Pujolar¹  Amaia Bacigalupe² 

[1] Local Health Authority, Cadiz, Spain;Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain

关键词: Health inequalities;    Economic crisis;   

Others  :  1146529
DOI  :  10.1186/1475-9276-13-52

 received in 2014-05-11, accepted in 2014-06-07,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Bacigalupe and Escolar-Pujolar; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Eurostat: Euro area unemployment rate at 11.8%. Eurostat News Release. 4/2013
• [2]Catalano R, Goldman-Mellor S, Saxton K, Margerison-Zilko C, Subbaraman M, LeWinn K, Anderson E: The health effects of economic decline. Annu Rev Public Health 2011, 32:431-450.
• [3]Edwards R: Who is hurt by procyclical mortality? Soc Sci Med 2008, 67:2051-2058.
• [4]Catalano R, Bellows B: Commentary: if economic expansion threatens public health, should epidemiologists recommend recession? Int J Epidemiol 2005, 34:1212-1213.
• [5]Suhrcke M, Stuckler D: Will the recession be bad for our health? It depends. Soc Sci Med 2012, 74:647-653.
• [6]OECD: Education at al Glance 2013: OECD Indicators. OECD Publishing; 2013.
• [7]Laparra M, Pérez B, (coords): Crisis and Social Fracture in Europe. Causes and Effects in Spain. Social studies Collection no.35, Barcelona: “La Caixa” Welfare Projects; 2012.
• [8]Solar O, Irwin A: A Conceptual Framework for Action on the Social Determinants of Health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). World Health Organization; 2010.
• [9]Stardfield B, Birn AE: Income redistribution is not enough: income inequality, social welfare programs, and achieving equity in health. J Epidemiol Community Health 2007, 61:1038-1041.
• [10]Regidor E, Martínez D, Astasio P, Ortega P, Calle ME, Domínguez V: Trends of socioeconomic inequalities and socioeconomic inequalities in self-perceived health in Spain. Gac Sanit 2006, 20:178-183.
• [11]Gili M, Roca M, Basu S, McKee M, Stuckler D: The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006–2010. Eur J Public Health 2013, 23:103-108.
• [12]Astell-Burt T, Feng X: Health and the 2008 economic recession: evidence from the United Kingdom. PLoS One 2013, 8:e56674.
• [13]Fukuda Y, Nakao H, Yahata Y, Imai H: Are health inequalities increasing in Japan? The trends of 1955 to 2000. BioSci Trends 2007, 1:38-42.
• [14]Harhay MO, Bor J, Basu S, McKee M, Mindell JS, Shleton NJ, Stuckler D: Differential impact of the economic recession on alcohol use among white British adults, 2004–2010. Eur J Pub Health 2013., 16doi:10.1093/eurpub/ckt134
• [15]Rajmil L, Medina-Bustos A, de Sanmamed MJ F, Mompart-Penina A: Impact of the economic crisis on children’s health in Catalonia: a before-after approach. BMJ Open 2013, 3:1-9.
• [16]Plavinski SL, Pavinskaya SI, Klimov AN: Social factors and increase in mortality in Russia in the 1990s: prospective cohort study. BMJ 2003, 326:1240-1242.
• [17]Hong J, Knapp M, McGuire A: Income-related inequalities in the prevalence of depression and suicidal behaviour: a 10-year trend following economic crisis. World Psychiatry 2011, 10:40-44.
• [18]Lahelma E, Rahkonen O, Huuhka M: Changes in the patterning of health? The case of Finland 1986–1994. Soc Sci Med 1997, 44:789-799.
• [19]Lahelma E, Kivela K, Roos E, Tuominen T, Dahl E, Diderichsen F, Elstad JI, Lissau I, Lundberg O, Rahkonen O, Rasmussen NK, Yngwe MA: Analysing changes of health inequalities in the Nordic welfare states. Soc Sci Med 2002, 55:609-625.
• [20]Valkonen T, Martikainen P, Jalovaara M, Koskinen S, Martelin T, Makela P: Changes in socioeconomic inequalities in mortality during an economic boom and recession among middle-aged men and women in Finland. Eur J Public Health 2000, 10:274-280.
• [21]Lammintausta A, Immonen-Räihä R, Airaksinen JKE, Torppa J, Harald K, Ketonen M, Lehto S, Koukkunen H, Kesaniemi AY, Kärjä-Koskenkari P, Salomaa V: Socioeconomic inequalities in the morbidity and mortlity of acute coronay events in Finland: 1988–2002. Ann Epidemiol 2012, 22:87-93.
• [22]Lundberg O, Diderichsen F, Yngwe MA: Changing health inequalities in a changing society? Scand J Public Health 2001, 29:31-39.
• [23]Kachi Y, Inoue M, Nishikitani M, Tsurogano S, Yano E: Determinants of changes in income-related health inequalities among working-age adults in Japan, 1986–2007: Time-trend study. Soc Sci Med 2013, 81:94-101.
• [24]Bartoll X, Palència L, Malmusi D, Suhrcke M, Borrell C: The evolution of mental health in Spain during the economic crisis. Eur J Public Health 2013. in press
• [25]Kondo N, Subramanian SV, Kawachi I, Takeda Y, Yamagata Z: Economic recession and health inequalities in Japan: analysis with a national simple, 1986–2001. J Epidemiol Community Health 2008, 62:869-875.
• [26]Khang YH, Lynch JW, Yun S, Lee SI: Trends in socioeconomic health inequalities in Korea: use of mortality and morbidity measures. J Epidemiol Community Health 2004, 58:308-314.
• [27]Juárez S, Revuelta-Eugercios BA, Ramiro-Fariñas D, Viciana-Fernández F: Maternal education and perinatal outcomes among Spanish Women residing in Southern Spain (2001–2011). Matern Child Health J 2013. in press
• [28]Murphy M, Bobak M, Nicholson A, Rose R, Marmot M: The widening gap in mortality by educational level in the Russian Federation, 1980–2001. Am J Public Health 2006, 96:1296-1299.
• [29]Son M, Cho Y, Oh J, Kawachi I, Yi J, Kwon S: Social inequalities in life expectancy and mortality during the transition period of economic crisis (1993–2010) in Korea. Int J Equity Health 2012, 11:71. BioMed Central Full Text
• [30]Shim E, Cho Y: Widening social disparities in alcohol-attributable deaths among Korean men aged 40–59 years during the transitional period of the economic crisis (1995–2005). Int J Public Health 2013, 58:521-527.
• [31]Il-Ho K, Khang YJ, Cho SI, Chun H, Muntaner C: Gender, professional and non-professional work, and the changing pattern of employment-related inequality in por self-rated health, 1995–2006 in South Korea. J Prev Med Public Health 2011, 44:22-31.
• [32]Katikireddi SV, Niedzwiedz CL, Popham F: Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991–2010 Health Surveys of England. BMJ Open 2012, 17:2(5).
• [33]Lahelma E, Lundberg O: Health inequalities in European welfare states. Eur J Pub Health 2009, 19:445-446.
• [34]Curran C, Knapp M, McDaid D: Mental health and employment: an overview of patterns and policies across Western Europe. J Ment Health 2007, 16:195-209.
• [35]van de Berg GJ, Lindeboom M, Lopez M: Inequality in individual mortality and economic conditions earlier in life. Soc Sci Med 2009, 69:1360-1367.
• [36]Martikainen PT, Valkonen T: Excess mortality of unemployed men and women during a period of rapidly increasing unemployment. Lancet 1996, 348:909-912.
• [37]Klein N: The Shock Doctrine: The Rise of Disaster Capitalism. Ontario: Knopf Canada; 2007.
• [38]Bauman Z: Does the richness of the few benefit us all? Soc Eur J28/01/2013. [http://www.social-europe.eu/2013/01/does-the-richness-of-the-few-benefit-us-all/ webcite]