Elsevier

The Lancet

Volume 381, Issue 9874, 13–19 April 2013, Pages 1323-1331
The Lancet

Series
Financial crisis, austerity, and health in Europe

https://doi.org/10.1016/S0140-6736(13)60102-6Get rights and content

Summary

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.

Introduction

The economic crisis that has engulfed Europe since 2008 has raised concerns about the health of ordinary people. Despite more than 100 years of research about the effects of economic turbulence on health, the relation between the two is not yet fully understood. We briefly review the origins of the financial crisis and examine what European countries have done in terms of health policy to respond, with a focus on changes to health systems. In the absence of comprehensive data for health during this crisis, we postulate what might be expected to occur on the basis of previous experiences, and review what has actually happened (as far as can be ascertained). We conclude with recommendations for the development of epidemiology of resilience1—ie, understanding how people, households, communities, and entire societies cope with difficult economic circumstances and shocks, and how public health policy can improve health outcomes in this context.

Section snippets

Causes of the financial crisis

The financial crisis was avoidable. The US Government's Financial Crisis Inquiry Commission2 is the most exhaustive analysis of the economic downturn. It focused on events in the USA, but these events are widely agreed to have triggered the crisis in Europe; however, specific problems in European countries exacerbated the situation. The Financial Crisis Inquiry Commission concluded that the crisis was caused by an overabundance of investments in mortgage-backed securities based on valuations of

Effects on health systems

Much work has been done to establish how health outcomes might be affected by economic crises, but little previous research has assessed what might happen to health systems.12 Thus, theory-based testable hypotheses should be developed for comparison with empirical data. When confronted by a fiscal crisis, policy makers might face pressure to maintain, decrease, or increase public expenditure on health (and could also reallocate funds within the health system).13 Changes to public expenditure on

Previous economic crises and expectations of health consequences

Research about the health effects of previous recessions has produced findings that might seem conflicting. Some aggregate data have shown that economic downturns might have few adverse effects on health overall in high-income countries and even that mortality might fall when the economy slows down and rise when the economy speeds up.21, 22, 23, 24 These effects on health have been noted, at least in the short term, in several settings; the extent of the effects varies by age group,25 sex,26

Changes to health

By contrast with the rapidity with which economic data are published, often several years pass before information about the health of populations becomes available. The most complete and accurate data are mortality estimates. Detailed data for causes, age groups, and different population groups can help to detect changes in mortality. Data for disease prevalence and incidence are less accurate and more difficult to compare between countries than are mortality data, and, on many occasions, are

Looking to the future

The first signs of recovery in the global financial sector were noted in 2009.102 However, the economy in many countries has not yet recovered, and 2012 growth is projected to be minimum in countries including France, Germany, and the UK, and negative in Iceland, Ireland, Italy, the Netherlands, Portugal, and Spain, among others. Greece is not expected to begin to recover before 2014. An absence of economic growth means loss of income and employment, and reductions in social assistance for

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