SeriesFinancial crisis, austerity, and health in Europe
Introduction
The economic crisis that has engulfed Europe since 2008 has raised concerns about the health of ordinary people. Despite more than 100 years of research about the effects of economic turbulence on health, the relation between the two is not yet fully understood. We briefly review the origins of the financial crisis and examine what European countries have done in terms of health policy to respond, with a focus on changes to health systems. In the absence of comprehensive data for health during this crisis, we postulate what might be expected to occur on the basis of previous experiences, and review what has actually happened (as far as can be ascertained). We conclude with recommendations for the development of epidemiology of resilience1—ie, understanding how people, households, communities, and entire societies cope with difficult economic circumstances and shocks, and how public health policy can improve health outcomes in this context.
Section snippets
Causes of the financial crisis
The financial crisis was avoidable. The US Government's Financial Crisis Inquiry Commission2 is the most exhaustive analysis of the economic downturn. It focused on events in the USA, but these events are widely agreed to have triggered the crisis in Europe; however, specific problems in European countries exacerbated the situation. The Financial Crisis Inquiry Commission concluded that the crisis was caused by an overabundance of investments in mortgage-backed securities based on valuations of
Effects on health systems
Much work has been done to establish how health outcomes might be affected by economic crises, but little previous research has assessed what might happen to health systems.12 Thus, theory-based testable hypotheses should be developed for comparison with empirical data. When confronted by a fiscal crisis, policy makers might face pressure to maintain, decrease, or increase public expenditure on health (and could also reallocate funds within the health system).13 Changes to public expenditure on
Previous economic crises and expectations of health consequences
Research about the health effects of previous recessions has produced findings that might seem conflicting. Some aggregate data have shown that economic downturns might have few adverse effects on health overall in high-income countries and even that mortality might fall when the economy slows down and rise when the economy speeds up.21, 22, 23, 24 These effects on health have been noted, at least in the short term, in several settings; the extent of the effects varies by age group,25 sex,26
Changes to health
By contrast with the rapidity with which economic data are published, often several years pass before information about the health of populations becomes available. The most complete and accurate data are mortality estimates. Detailed data for causes, age groups, and different population groups can help to detect changes in mortality. Data for disease prevalence and incidence are less accurate and more difficult to compare between countries than are mortality data, and, on many occasions, are
Looking to the future
The first signs of recovery in the global financial sector were noted in 2009.102 However, the economy in many countries has not yet recovered, and 2012 growth is projected to be minimum in countries including France, Germany, and the UK, and negative in Iceland, Ireland, Italy, the Netherlands, Portugal, and Spain, among others. Greece is not expected to begin to recover before 2014. An absence of economic growth means loss of income and employment, and reductions in social assistance for
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