Intended for healthcare professionals


Budget crises, health, and social welfare programmes

BMJ 2010; 340 doi: (Published 24 June 2010) Cite this as: BMJ 2010;340:c3311
  1. David Stuckler, researcher 12,
  2. Sanjay Basu, physician3,
  3. Martin McKee, professor of European public health4
  1. 1Department of Sociology, Oxford University, Oxford
  2. 2Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  3. 3Department of Medicine, University of California San Francisco and Division of General Internal Medicine, San Francisco General Hospital
  4. 4European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine
  1. Correspondence to: D Stuckler David.stuckler{at}
  • Accepted 27 May 2010

Governments may feel they are protecting health by safeguarding healthcare budgets, yet David Stuckler, Sanjay Basu, and Martin McKee argue that social welfare spending is as important, if not more so, for population health

The recession of 2008 has had profound economic consequences for many countries. How and when to reduce budget deficits was a major focus in the recent general election in the United Kingdom and continues to make headlines around the world. The new government has already begun to make large cuts in public expenditure,1 2 even though the UK’s projected underlying debt, as a share of gross domestic product (GDP), is less than that of other industrialised countries, it has longer than many other countries before it is required to refinance loans (table 1), and the actual deficit in 2009-10 was considerably less than expected. Leading economists have widely divergent views about whether the cuts will aid or hinder economic recovery,3 4 but have paid scant attention to the potential effects of reductions in health and social expenditure on population health.5 We examine historical data for insights into how lower levels of public spending might affect health.

View this table:
Table 1

 Summary of deficit, debt, and debt repayment in selected countries1

Wider view of health spending

What little discussion there has been about health in the current economic recession has focused on whether to ringfence NHS spending.6 This is a narrow perspective given the extensive evidence that population health is not only determined by healthcare expenditure but by many factors outside the health system. The evidence, most recently reviewed in detail by Michael Marmot in his report to the British government on health inequalities,7 has highlighted how investments in a variety of social policies benefit health. Thus, children who receive better education, have safe environments in which to …

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