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Trends in social determinants of child health and perinatal outcomes in European countries 2005–2015 by level of austerity imposed by governments: a repeat cross-sectional analysis of routinely available data
  1. Luis Rajmil1,
  2. David Taylor-Robinson2,
  3. Geir Gunnlaugsson3,
  4. Anders Hjern4,
  5. Nick Spencer5
  1. 1 Retired, Barcelona, Spain
  2. 2 Department of Public Health and Policy, University of Liverpool, Liverpool, UK
  3. 3 Faculty of Social and Human Sciences, University of Iceland, Reykjavik, Iceland
  4. 4 Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
  5. 5 Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Dr Luis Rajmil; 12455lrr{at}


Objective To assess whether the level of austerity implemented by national governments was associated with adverse trends in perinatal outcomes and the social determinants of children’s health (SDCH) in rich countries

Design Longitudinal ecological study of country-level time trends in perinatal outcomes and SDCH and from 2005 to 2015.

Setting and participants 16 European countries using available data from the International Monetary Fund, the Organisation for Economic Co-operation and Development and Eurostat.

Main outcome measures Trends in perinatal outcomes (low birth weight (LBW); infant mortality) and the SDCH: child poverty rates; severe material deprivation in families with primary education; preschool investment in three time periods: 2005–2007, 2008–2010 and 2012–2015. Outcomes were compared according to the cyclically adjusted primary balance (CAPB, differences between 2013 and 2009) as a measure of austerity, stratified in tertiles. Generalised estimating equation models of repeated measures were used to assess time trend differences in three periods.

Results Countries with higher levels of austerity had worse outcomes, mainly at the last study period. Material deprivation increased during the period 2012–2015 in those countries with higher CAPB (interaction CAPB-period 2012–2015, B: 5.62: p<0.001), as did LBW (interaction CAPB-period 2012–2015, B: 0.25; p=0.004).

Conclusions Countries that implemented more severe austerity measures have experienced increasing LBW, and for families with primary education also increasing material deprivation, worsening the negative impact of economic crisis. Reversing austerity policies that impact children is likely to improve child health outcomes.

  • austerity
  • child health
  • perinatal outcomes
  • social determinants of health

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  • Contributors LR and NS were involved in the initial conception and design of the study. LR extracted data and NS, DT-R, GG and AH participated in the data analysis strategy. All authors were involved in the interpretation and discussion of results through call conferences. LR developed the first draft of the manuscript and all authors critically revised it and approved the final version. LR is study guarantor.

  • Funding DT-R is funded by the MRC on a Clinician Scientist Fellowship (MR/P008577/1). The study was not externally financed.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was not required for this study as it used routinely available aggregated data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are available on request to the corresponding author.