Rapid Responses to:

RESEARCH: Tony Blakely, Martin Tobias, and June Atkinson Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies BMJ 2008; 336: 371-375 [Abstract] [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

No surprises

Andrew Montgomery   (15 February 2008)

Macroeconomic changes and socio-economic inequality in health: Further cross-national studies needed

Naoki Kondo, Ichiro Kawachi, and Zentaro Yamagata   (15 March 2008)

No surprises 15 February 2008
Andrew Montgomery, locum Auckland/Australia Send response to journal: Re: No surprises	I am not surprised by the findings of this study. I have by choice worked with low income populations over the last 10 years or so. The predominant and expanding problem affecting these people is obesity. In addition cigarette smoking is more prevalent in this group. The way forward is to aggressively attack the obesity epidemic via regulation of the food industry and taxation. Without such regulation we are doomed to a reversal of positive health trends. There is already evidence from America with regard to cardiovascular disease that the postive trend is turning negative. With regard to cigarette smnoking it would be very straight forward to reduce new entrants to the addiction by increasing the age of eligibility to smoke and limiting the number of outlets that sell tobacco. Competing interests: None declared
Macroeconomic changes and socio-economic inequality in health: Further cross-national studies needed 15 March 2008
Naoki Kondo, Research Fellow Harvard School of Public Health. 401 Park Dr. #436, Boston MA 02215, USA, Ichiro Kawachi, and Zentaro Yamagata Send response to journal: Re: Macroeconomic changes and socio-economic inequality in health: Further cross-national studies needed	Blakely et al demonstrated that following structural reforms in New Zealand economy from the late 1980s income-based inequalities in health widened in relative terms but not in absolute terms.(1) Their finding echoes a South Korean study which reported that health inequalities based on educational attainment widened in relative terms though not in absolute terms following the 1997-98 Asian financial crisis.(2 3) We also reported recently on the impact of the financial crisis in Japan on income- and occupation-based health inequalities.(4) The Japanese "natural experiment" revealed that following their financial crisis of the 1990s, health status among male white-collar workers (as well as home-makers) deteriorated in relative terms compared to those with other occupations. The structural reforms in Japan took the form of changes to the traditional hiring policies of Japanese companies, i.e. the erosion of guaranteed lifelong employment, the spread of performance-based pay systems, and the end of seniority-based promotion, also increased job demands due to corporate downsizing.(4) Unfortunately, differences in socio-economic measures among the studies to date do not permit us to carry out careful cross-national comparisons. The health impacts of rapid macroeconomic change may affect different segments of the population depending upon the causes of economic change, cultural context, different baseline economic conditions, and so on. A notable difference between the studies in New Zealand and Japan is that macroeconomic changes were associated with relative widening of income-based health inequalities in New Zealand, but not in Japan. In Japan, the principal axis of health inequality that was affected was based upon people's occupations. Information is currently too limited to discuss the potential societal, political, economic, and cultural factors explaining the between -nation differences in the impact of rapid macroeconomic changes on health inequalities. Further studies need to carefully examine these impacts through the use of a wider range of socio-economic measures including occupation, income, and education, as well as by demographic factors (e.g., race / ethnicity, gender, and area of residence). References 1. Blakely T, Tobias M, Atkinson J. Inequalities in mortality during and after restructuring of the New Zealand economy: repeated cohort studies. BMJ 2008;336(7640):371-5. 2. Khang YH, Lynch JW, Yun S, Lee SI. Trends in socioeconomic health inequalities in Korea: use of mortality and morbidity measures. J Epidemiol Community Health 2004;58(4):308-14. 3. Khang YH, Lynch JW, Kaplan GA. Impact of economic crisis on cause- specific mortality in South Korea. Int J Epidemiol 2005;34(6):1291-301. 4. Kondo N, Subramanian SV, Kawachi I, Takeda Y, Yamagata Z. Economic recession and health inequalities in Japan: Analysis with a national sample, 1986-2001. J Epidemiol Community Health 2008;(in press). Competing interests: None declared