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Health economics
Research
Effects of economic crises on population health outcomes in Latin America, 1981–2010: an ecological study
  1. Callum Williams1,
  2. Barnabas James Gilbert2,
  3. Thomas Zeltner3,
  4. Johnathan Watkins4,
  5. Rifat Atun5,
  6. Mahiben Maruthappu6
  1. 1Department of History, University of Oxford, Oxford, Oxfordshire, UK
  2. 2Medical Sciences Division, University of Oxford, Green Templeton College, Oxford, Oxfordshire, UK
  3. 3Department of Public Health, University of Bern, Bern, UK
  4. 4Institute for Mathematical & Molecular Biomedicine, King's College London, London, UK
  5. 5Department of Global Health Systems, Harvard University, Cambridge, Massachusetts, USA
  6. 6NHS England, Redditch, UK
  1. Correspondence to Barnabas James Gilbert; barnabas.gilbert{at}gtc.ox.ac.uk

Abstract

Objectives The relative health effects of changes in unemployment, inflation and gross domestic product (GDP) per capita on population health have not been assessed. We aimed to determine the effect of changes in these economic measures on mortality metrics across Latin America.

Design Ecological study.

Setting Latin America (21 countries), 1981–2010.

Outcome measures Uses multivariate regression analysis to assess the effects of changes in unemployment, inflation and GDP per capita on 5 mortality indicators across 21 countries in Latin America, 1981–2010. Country-specific differences in healthcare infrastructure, population structure and population size were controlled for.

Results Between 1981 and 2010, a 1% rise in unemployment was associated with statistically significant deteriorations (p<0.05) in 5 population health outcomes, with largest deteriorations in 1–5 years of age and male adult mortality rates (1.14 and 0.53 rises per 1000 deaths respectively). A 1% rise in inflation rate was associated with significant deteriorations (p<0.05) in 4 population health outcomes, with the largest deterioration in male adult mortality rate (0.0033 rise per 1000 deaths). Lag analysis showed that 5 years after rises in unemployment and inflation, significant deteriorations (p<0.05) occurred in 3 and 5 mortality metrics, respectively. A 1% rise in GDP per capita was associated with no significant deteriorations in population health outcomes either in the short or long term. β coefficient comparisons indicated that the effect of unemployment increases was substantially greater than that of changes in GDP per capita or inflation.

Conclusions Rises in unemployment and inflation are associated with long-lasting deteriorations in several population health outcomes. Unemployment exerted much larger effects on health than inflation. In contrast, changes in GDP per capita had almost no association with the explored health outcomes. Contrary to neoclassical development economics, policymakers should prioritise amelioration of unemployment if population health outcomes are to be optimised.

  • HEALTH ECONOMICS
  • PUBLIC HEALTH

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2014-007546

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