Published 5 October 2009, doi:10.1136/bmj.b4087
Cite this as: BMJ 2009;339:b4087

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Governments must act now to prevent slide into poverty and ill health after recession

¹ BMJ

Although the health and social effects of the 2008 financial crisis will not be felt at their fullest until 2010, governments must invest now in programmes to support the poorest and most vulnerable groups in their populations and help unemployed people find jobs, participants agreed at the European Health Forum in Gastein, Austria, last week.

No country has been immune from the economic crisis, and within Europe the Baltic states, Greece, Portugal, and Spain have been particularly hard hit, said Armin Fidler, lead health policy adviser at the World Bank. "Social budgets must be defended and health and social safety nets provided to protect the poor, single parent households, refugees, migrant workers, and marginalised ethnic groups," he said.

It was also essential to pursue "active labour market policies" to support unemployed people and generate new jobs. Without such action, he warned, "the gains of the past 15 years will be lost." He said that "those who have just climbed out of poverty will slide back into it," and health inequalities within and between countries will grow even further.

Some speakers, including Michael Marmot, director of the International Institute for Society and Health at University College London, said that the scale of the financial crisis was being exaggerated. "There is enough money to go round," he said. "It’s how we choose to spend and distribute it that matters." Governments should pursue "pro-poor" policies and recognise that the key drivers of health lie outside the healthcare system.

"Investment in good employment policy and practices and early child education and development programmes is good health policy," he said.

David Stuckler, a social epidemiologist from Oxford University, repeated the message: "We have spent around $30 000 [£19 000; 21 000] per head bailing out the banks, but investment in labour market programmes would cost only $130 per head and has the potential to prevent the adverse impact on health of unemployment."

Countries’ response to the economic crisis has differed, the meeting was told. Some of the richer countries in Europe, such as Norway, Germany, and Austria, have increased their health and social budgets. Poorer ones, including Latvia, Slovenia, Estonia, and Macedonia, where unemployment levels have reached 32%, have seen health and social budgets slashed as their gross domestic product has fallen.

Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, deplored the fact that no attempt is being made to systematically collate data on the recession’s effects on health and to evaluate the effect of policies to mitigate them. "We are debating the response to the crisis in an information vacuum," he said.

What evidence there is, he and others emphasised, is largely anecdotal. Small "snapshot" surveys carried out by the European Patients Forum were presented by its director, Nicola Bedlington. In Latvia suicide rates and mental health problems seem to be rising, and patients with chronic disease are forgoing treatment as the cost of copayments has tripled. The pay of public sector workers in Latvia, including health professionals, has been cut by around 10%.

In Romania a coalition of patients with chronic disease has reported that children with cancer and leukaemia are no longer getting the treatment they need.

Delegates agreed that the healthcare sector must respond to the crisis by cutting waste, inefficiency, and errors. Budgets could be maintained, some suggested, by imposing "sin taxes" on tobacco, alcohol, and fatty and sugary foods. Policy makers should also push for resources to be reallocated from hospital care to primary care and to community based health promotion and disease prevention programmes.

Robert Madelin, director general for health and consumer affairs at the European Commission, warned that advocacy would not be enough. "We also need to present ministers with evidence to show that investment in public health pays dividends," he said.

Cite this as: BMJ 2009;339:b4087

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