Intended for healthcare professionals


How will the financial crisis affect health?

BMJ 2009; 338 doi: (Published 01 April 2009) Cite this as: BMJ 2009;338:b1314
  1. M G Marmot, director of the International Institute for Society and Health,
  2. Ruth Bell, senior research fellow
  1. 1Department of Epidemiology and Public Health, London WC1E 6BT
  1. Correspondence to: M G Marmot m.marmot{at}

    Global recession is likely to damage our health as well as our wealth, but it also offers an opportunity to build a more equitable economic model as Michael Marmot and Ruth Bell explain in light of the G20 summit

    The financial crisis intrudes daily from the newspapers. The breakfast table is littered with quantitative easing and credit-default swaps, stimulus packages, and bank bailouts. But is there a link between the financial crisis dominating the front page and the health stories on the inside? The Commission on Social Determinants of Health certainly believed so. Its starting point was that the economic and social features of society are closely linked to the distribution of health within and between countries.1 The social determinants of health are the circumstances of daily life—the conditions in which people are born, grow, live, work, and age—and the structural drivers of those conditions (unfair distribution of power, money, and resources). Both the conditions of daily life and the structural drivers will be influenced by the financial crisis.

    Will there be no money?

    We cannot improve the living conditions of people who are relatively disadvantaged without money. For example, globally, nearly 1 billion people live in slums.1 In the Indian city Ahmedabad, it cost $500 (£350; €380) a household to make minimal improvements for people living in slums.2 Scaling up, it would cost $100bn to upgrade the world’s slums.1 A few months ago we wondered who would find such an outlandish figure for anything? But more than $5 trillion has since been found to bail out the financial sector in the rich countries. Clearly there is money for investments judged to be important.

    The crisis started in the high income countries but has not stopped there. Five billion people in low and middle income countries are at risk. Nancy Birdsall, …

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