Documents Stuckler, David 10 results

"Greece implemented the deepest austerity package in Europe during the Great Recession (from 2008), including reductions in severance pay and redundancy notice periods. To evaluate whether these measures worsened labour market participants' health status, we compared changes in self-reported health using two cohorts of employed individuals in Greece from the European Union Statistics on Income and Living Conditions. During the initial recession (2008–2009) we found that self-reported health worsened both for those remaining in employment and those who lost jobs. Similarly, during the austerity programme (2010–2011) people who lost jobs experienced greater health declines. Importantly, individuals who remained employed in 2011 were also 25 per cent more likely to experience a health decline than in 2009. These harms appeared concentrated in people aged 45–54 who lost jobs. Our study moves beyond existing findings by demonstrating that austerity both exacerbates the negative health consequences of job loss and worsens the health of those still employed."

"Background Many governments have introduced tougher eligibility assessments for out-of-work disability benefits, to reduce rising benefit caseloads. The UK government initiated a programme in 2010 to reassess all existing disability benefit claimants using a new functional checklist. We investigated whether this policy led to more people out-of-work with long-standing health problems entering employment.Method We use longitudinal data from the Labour Force Survey linked to data indicating the proportion of the population experiencing a reassessment in each of 149 upper tier local authorities in England between 2010 and 2013. Regression models were used to investigate whether the proportion of the population undergoing reassessment in each area was independently associated with the chances that people out-of-work with a long-standing health problem entered employment and transitions between inactivity and unemployment. We analysed whether any effects differed between people whose main health problem was mental rather than physical.Results There was no significant association between the reassessment process and the chances that people out-of-work with a long-standing illness entered employment. The process was significantly associated with an increase in the chances that people with mental illnesses moved from inactivity into unemployment (HR=1.22, 95% CI 1.03 to 1.45).Conclusions The reassessment policy appears to have shifted people with mental health problems from inactivity into unemployment, but there was no evidence that it had increased their chances of employment. There is an urgent need for services that can support the increasing number of people with mental health problems on unemployment benefits"

"The 2008 global financial crisis, precipitated by high-risk, under-regulated financial practices, is often seen as a singular event. The crisis, its recessionary consequences, bank bailouts and the adoption of ‘austerity' measures can be seen as a continuation of a 40-year uncontrolled experiment in neoliberal economics. Although public spending and recapitalisation of failing banks helped prevent a 1930s-style Great Depression, the deep austerity measures that followed have stifled a meaningful recovery for the majority of populations. In the short term, these austerity measures, especially cuts to health and social protection systems, pose major health risks in those countries under its sway. Meanwhile structural changes to the global labour market, increasing under-employment in high-income countries and economic insecurity elsewhere, are likely to widen health inequities in the longer term. We call for four policy reforms to reverse rising inequalities and their harms to public health. First is re-regulating global finance. Second is rejecting austerity as an empirically and ethically unjustified policy, especially given now clear evidence of its deleterious health consequences. Third, there is a need to restore progressive taxation at national and global scales. Fourth is a fundamental shift away from the fossil fuel economy and policies that promote economic growth in ways that imperil environmental sustainability. This involves redistributing work and promoting fairer pay. We do not suggest these reforms will be politically feasible or even achievable in the short term. They nonetheless constitute an evidence-based agenda for strong, public health advocacy and practice."

"The Body Economic is the first, agenda-shaping, look at the human costs of financial crisis - the culmination of ten years' work by two pioneering researchers - Sanjay Basu and David Stuckler. The global financial crisis has had a seismic impact upon the wealth of nations. But we have little sense of how it affects one of the most fundamental issues of all: our physical and mental health.
This highly significant new book, based on the authors' own groundbreaking research, looks at the daily lives of people affected by financial crisis, from the Great Depression of the 1930s, to post-communist Russia, to the US foreclosure crisis of the late 2000s. Why, it asks, did Sweden experience a fall in suicides during its banking crisis? What triggered a mosquito-borne epidemic in California in 2007? What caused 10 million Russian men to 'disappear' in the 1990s? Why is Greece experiencing rocketing HIV rates? And how did the health of Americans actually improve during the catastrophic crisis of the 1930s? The conclusions it draws are both surprising and compelling: remarkably, when faced with similar crises, the health of some societies - like Iceland - improves, while that of others, such as Greece, deteriorates. Even amid the worst economic disasters, negative public health effects are not inevitable: it's how communities respond to challenges of debt and market turmoil that counts. The Body Economic puts forward a radical proposition. Austerity, it argues, is seriously bad for your health. We can prevent financial crises from becoming epidemics, but to do so, we must acknowledge what the hard data tells us: that, throughout history, there is a causal link between the strength of a community's health and its social protection systems. Now and for generations to come, our commitment to the building of fairer, more equal societies will determine the health of our body economic."

"The financial crisis in Europe has posed major threats and opportunities to health. We trace the origins of the economic crisis in Europe and the responses of governments, examine the effect on health systems, and review the effects of previous economic downturns on health to predict the likely consequences for the present. We then compare our predictions with available evidence for the effects of the crisis on health. Whereas immediate rises in suicides and falls in road traffic deaths were anticipated, other consequences, such as HIV outbreaks, were not, and are better understood as products of state retrenchment. Greece, Spain, and Portugal adopted strict fiscal austerity; their economies continue to recede and strain on their health-care systems is growing. Suicides and outbreaks of infectious diseases are becoming more common in these countries, and budget cuts have restricted access to health care. By contrast, Iceland rejected austerity through a popular vote, and the financial crisis seems to have had few or no discernible effects on health. Although there are many potentially confounding differences between countries, our analysis suggests that, although recessions pose risks to health, the interaction of fiscal austerity with economic shocks and weak social protection is what ultimately seems to escalate health and social crises in Europe. Policy decisions about how to respond to economic crises have pronounced and unintended effects on public health, yet public health voices have remained largely silent during the economic crisis."

"Background During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care). Methods The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders. Results Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services. Conclusion Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy."

"Background Previous research suggests that the Great Depression led to improvements in public health. However, these studies rely on highly aggregated national data (using fewer than 25 data points) and potentially biased measures of the Great Depression. The authors assess the effects of the Great Depression using city-level estimates of US mortality and an underlying measure of economic crisis, bank suspensions, at the state level. Methods Cause-specific mortalities covering 114 US cities in 36 states between 1929 and 1937 were regressed against bank suspensions and income data from the Federal Deposit Insurance Corporation Database, using dynamic fixed-effects models and adjustments for potential confounding variables. Results Reductions in all-cause mortalities were mainly attributable to declines in death rates owing to pneumonia (26.4% of total), flu (13.1% of total) and respiratory tuberculosis (11.2% of total), while death rates increased from heart disease (19.4% of total), cancer (8.1% of total) and diabetes (2.9%). Only heart disease can plausibly relate to the contemporaneous economic shocks. The authors found that a higher rate of bank suspensions was significantly associated with higher suicide rates (?=0.32, 95% CI 0.24 to 0.41) but lower death rates from motor-vehicle accidents (?=?0.18, 95% CI ?0.29 to ?0.07); no significant effects were observed for 30 other causes of death or with a time lag. Conclusion In contrast with existing research, the authors find that many of the changes in deaths from different causes during the Great Depression were unrelated to economic shocks. Further research is needed to understand the causes of the marked variations in mortality change across cities and states, including the effects of the New Deal and Prohibition."

"Background
Economic insecurity correlates with adverse health outcomes, but the biological pathways involved are not well understood. We examine how changes in economic insecurity relate to metabolic, inflammatory and liver function biomarkers.
Methods
Blood analyte data were taken from 6520 individuals (aged 25–59 years) participating in Understanding Society. Economic insecurity was measured using an indicator of subjective financial strain and by asking participants whether they had missed any bill, council tax, rent or mortgage payments in the past year. We investigated longitudinal changes in economic insecurity (remained secure, increase in economic insecurity, decrease in economic insecurity, remained insecure) and the accumulation of economic insecurity. Linear regression models were calculated for nine (logged) biomarker outcomes related to metabolic, inflammatory, liver and kidney function (as falsification tests), adjusting for potential confounders.
Results
Compared with those who remained economically stable, people who experienced consistent economic insecurity (using both measures) had worsened levels of high-density lipoprotein (HDL)-cholesterol, triglycerides, C reactive protein (CRP), fibrinogen and glycated haemoglobin. Increased economic insecurity was associated with adverse levels of HDL-cholesterol (0.955, 95% CI 0.929 to 0.982), triglycerides (1.077, 95% CI 1.018 to 1.139) and CRP (1.114, 95% CI 1.012 to 1.227), using the measure of financial strain. Results for the other measure were generally consistent, apart from the higher levels of gamma-glutamyl transferase observed among those experiencing persistent insecurity (1.200, 95% CI 1.110 to 1.297).
Conclusion
Economic insecurity is associated with adverse metabolic and inflammatory biomarkers (particularly HDL-cholesterol, triglycerides and CRP), heightening risk for a range of health conditions."

"Background: Detailed assessments of mortality by occupation are scarce. We aimed to assess mortality by occupation in the UK, differences in rates between England and Wales and Scotland, and changes over time in Scotland.
Methods: We analysed adults of working age (20–59 years) using linked census and death records. Main occupation was coded into more than 60 groups in the 2001 census, with mortality follow-up until Dec 31, 2011. Comparable occupation data were available for Scotland in 1991, allowing assessment of trends over time. We calculated age-standardised all-cause mortality rates (per 100 000 person-years), stratified by sex. We used Monte Carlo simulation to derive p values and 95% CIs for the difference in mortality over time and between England and Wales and Scotland.
Findings: During 4·51 million person-years of follow-up, mortality rates by occupation differed by more than three times between the lowest and highest observed rates in both men and women. Among men in England and Wales, health professionals had the lowest mortality (225 deaths per 100 000 person-years [95% CI 145–304]), with low rates also shown in managers and teachers. The highest mortality rates were in elementary construction (701 deaths per 100 000 person-years [95% CI 593–809]), and housekeeping and factory workers. Among women, teachers and business professionals had low mortality, and factory workers and garment trade workers had high rates. Mortality rates have generally fallen, but have stagnated or even increased among women in some occupations, such as cleaners (337 deaths per 100 000 person years [95% CI 292–382] in 1991, rising to 426 deaths per 100 000 person years in 2001 [371–481]). Findings from simulation models suggested that if mortality rates by occupation in England and Wales applied to Scotland, 631 fewer men (95% CI 285–979; a 9·7% decrease) and 273 fewer women (26–513; 6·7% decrease) of working age would die in Scotland every year. Excess deaths in Scotland were concentrated among lower skilled occupations (eg, female cleaners).
Interpretation: Mortality rates differ greatly by occupation. The excess mortality in Scotland is concentrated among low-skilled workers and, although mortality has improved in men and women in most occupational groups, some groups have experienced increased rates. Future research investigating the specific causes of death at the detailed occupational level will be valuable, particularly with a view to understanding the health implications of precarious employment and the need to improve working conditions in very specific occupational groups."

" There are concerns that the recovery from the Great Recession in Europe has left growing numbers of people facing precarious housing situations. Yet, to our knowledge, there is no comparative measure of housing precariousness in contrast to an extensive body of work on labour market precariousness. Here, we draw on a comparative survey of 31 European countries from the 2012 wave of European Union Survey of Income and Living Conditions to develop a novel housing precariousness measure. We integrate four dimensions of housing precariousness: security, affordability, quality and access to services, into a scale ranging from 0 (not at all precarious) to 4 (most precarious). Over half of the European population report at least one element of housing precariousness; 14.7  percent report two dimensions and 2.8  percent three or more (equivalent to ~15  million people). Eastern European and small island nations have relatively greater precariousness scores. Worse precariousness tends to be more severe among the young, unemployed, single and those with low educational attainment or who live in rented homes and is associated with poor self-reported health. Future research is needed to strengthen surveillance of housing precariousness as well as to understand what policies and programmes can help alleviate it."