The effect of economic recession on population health

Trends in health and health inequality during the Japanese economic stagnation: Implications for a healthy planet

Introduction

Human health and wellbeing may depend on economic growth, the implication being that policymakers need to choose between population health and the health of ecosystems. Over two decades of low economic growth, Japan's life expectancy grew. Here we assess the temporal changes of subjective health and health inequality during the long-term low economic growth period.

Methods

Eight triennial cross-sectional nationally representative surveys in Japan over the period of economic stagnation from 1992 to 2013 were used (n = 625,262). Health is defined positively as wellbeing, and negatively as poor health, based on self-rated health. We used Slope and Relative Indices of Inequality to model inequalities in self-rated health based on household income. Temporal changes in health and health inequalities over time were examined separately for children/adolescents, working-age adults, young-old and old-old.

Results

At the end of the period of economic stagnation (2013), compared to the beginning (1992), the overall prevalence of wellbeing declined slightly in all age groups. However, poor health was stable or declined in the young-old and old-old, respectively, and increased only in working-age adults (Prevalence ratio: 1.14, 95% CI 1.08, 1.20, <0.001). Over time, inequality in wellbeing and poor self-rated health were observed in adults but less consistently for children, but the inequalities did not widen in any age group between the start and end of the stagnation period.

Conclusions

Although this study was a case study of one country, Japan, and inference to other countries cannot be made with certainty, the findings provide evidence that low economic growth over two decades did not inevitably translate to unfavourable population health. Japanese health inequalities according to income were stable during the study period. Therefore, this study highlighted the possibility that for high-income countries, low economic growth may be compatible with good population health.

Correlates of the country differences in the infection and mortality rates during the first wave of the COVID-19 pandemic: evidence from Bayesian model averaging

The COVID-19 pandemic resulted in great discrepancies in both infection and mortality rates between countries. Besides the biological and epidemiological factors, a multitude of social and economic criteria also influenced the extent to which these discrepancies appeared. Consequently, there is an active debate regarding the critical socio-economic and health factors that correlate with the infection and mortality rates outcome of the pandemic. Here, we leverage Bayesian model averaging techniques and country level data to investigate whether 28 variables, which describe a diverse set of health and socio-economic characteristics, correlate with the final number of infections and deaths during the first wave of the coronavirus pandemic. We show that only a few variables are able to robustly correlate with these outcomes. To understand the relationship between the potential correlates in explaining the infection and death rates, we create a Jointness Space. Using this space, we conclude that the extent to which each variable is able to provide a credible explanation for the COVID-19 infections/mortality outcome varies between countries because of their heterogeneous features.

Modeling the impact of financial hardship and age on self-rated health and depressive symptoms pre/post the great recession

Stressful life events such as a recession, could be devastating on a macro and micro level. Although there have been a number of articles written examining the health effects of the recession, little is known about age differences in the relationship between financial stressors and health pre and post the 2008 recession. Using the Health and Retirement study, we investigated the relationship between two forms of financial hardships, mental and physical health among middle aged (N = 4403) and older adults) (N = 2709). Our findings indicate that with regard to financial hardships experienced pre/post recessionary periods there are differences by age. Specifically, older adults tend to report having less financial hardship than their younger counterparts. Additionally, reduced medication use due to costs was a significant predictor of poor self-rated health among middle aged participants compared to older adults. These results highlight the selective impact of recessions on certain age groups. They also suggests that economic recessions may also produce short-term procyclical health effects. Future research should focus on the relationship between other sources of financial hardship among middle-aged and older adults pre/post-recession at shorter time intervals.

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This is a longitudinal study using the Health and Retirement Study data from 2006-2016.

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Examines the relationship between financial hardships and health outcomes before, during and after the great recession.

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Few studies have explored age differences and financial-related stressors pre and post the 2008 recession.

Business Data Categorization and Refinement for Application in Longitudinal Neighborhood Health Research: a Methodology

Retail environments, such as healthcare locations, food stores, and recreation facilities, may be relevant to many health behaviors and outcomes. However, minimal guidance on how to collect, process, aggregate, and link these data results in inconsistent or incomplete measurement that can introduce misclassification bias and limit replication of existing research. We describe the following steps to leverage business data for longitudinal neighborhood health research: re-geolocating establishment addresses, preliminary classification using standard industrial codes, systematic checks to refine classifications, incorporation and integration of complementary data sources, documentation of a flexible hierarchical classification system and variable naming conventions, and linking to neighborhoods and participant residences. We show results of this classification from a dataset of locations (over 77 million establishment locations) across the contiguous U.S. from 1990 to 2014. By incorporating complementary data sources, through manual spot checks in Google StreetView and word and name searches, we enhanced a basic classification using only standard industrial codes. Ultimately, providing these enhanced longitudinal data and supplying detailed methods for researchers to replicate our work promotes consistency, replicability, and new opportunities in neighborhood health research.

Assessing health outcomes in the aftermath of the great recession: a comparison of Spain and the Netherlands

Background

Across time and space, financial security has been shown to impact health outcomes, with the acute loss of financial security being particularly detrimental. We compare financial security’s association with health in Spain and the Netherlands. These countries respectively exemplify low and high levels of financial security, general trends that have been exacerbated by the Great Recession of the 2010s.

Methods

We exploit the Spanish (n = 1001) and Dutch (n = 1010) editions of the European Social Survey 7, conducted in 2014, and condense relevant financial security- and health-related survey questions into latent variables using factor analyses. Using the component loadings as quasi-weightings, we generate one financial security variable and three health variables (mental, physical and social). Then, we run ordinary least squares regressions interacting financial security and nationality, for each of the three health outcomes.

Results

In unadjusted models, we find that financial security (p < 0.01) is positively associated with the three health outcomes, while being Spanish relative to being Dutch (p < 0.01) is associated with worse health outcomes. However, the results of the interaction term show that being Spanish relative to being Dutch weakens the relationship between physical health and social health, although not mental health.

Conclusions

We find evidence that financial security’s influence on health outcomes may vary in different contexts. This may be an important aspect of determining the Great Recession’s influence on health outcomes. Our study is a first step in understanding how the relationships between financial security and health may differ in countries with different experiences of the Great Recession.

Effect of the Financial Crisis on Socioeconomic Inequalities in Mortality in Small Areas in Seven Spanish Cities

Background: The aim of this study was to analyze the trend in socioeconomic inequalities in mortality in small areas due to several specific causes before (2001–2004, 2005–2008) and during (2009–2012) the economic crisis in seven Spanish cities. Methods: This ecological study of trends, with census tracts as the areas of analysis, was based on three periods. Several causes of death were studied. A socioeconomic deprivation index was calculated for each census tract. For each small area, we estimated standardized mortality ratios, and controlled for their variability using Bayesian models (sSMR). We also estimated the relative risk of mortality according to deprivation in the different cities, periods, and sexes. Results: In general, a similar geographical pattern was found for the socioeconomic deprivation index and sSMR. For men, there was an association in all cities between the deprivation index and all-cause mortality that remained stable over the three periods. For women, there was an association in Barcelona, Granada, and Sevilla between the deprivation index and all-cause mortality in the third period. Patterns by causes of death were more heterogeneous. Conclusions: After the start of the financial crisis, socioeconomic inequalities in total mortality in small areas of Spanish cities remained stable in most cities, although several causes of death showed a different pattern.

The Effect of the Economic Crisis on Adolescents' Perceived Health and Risk Behaviors: A Multilevel Analysis

Background: Previous studies have analyzed the impact of economic crises on adult’s health and lifestyles, but evidence among children and adolescents is limited. The objective of this study was to analyze the impact of the economic crisis on self-perceived health and some risk behaviors in the Spanish adolescent population. Methods: We used data from four waves (2002, 2006, 2010, 2014) of the Health Behavior in School-Aged Children (HBSC) survey in Spain. Separate multilevel logistic and linear regression models were applied for health complaints, self-rated health, life satisfaction, smoking, alcohol consumption, and breakfast skipping. Annual change in Spanish regional unemployment rates was used as a proxy of the economic crisis. An increasing set of control variables were included, consisting of individual, socioeconomic, and family and peer relationships indicators. Median odds ratios were estimated to quantify the cross-region and cross-school variation. Results: Increases in unemployment rates were linked to a higher risk of poorer health and bad habits in the simplest models. The effect was no longer statistically significant when indicators of family and peer relationships were included, suggesting a protective effect against the impact of the economic crisis. Our findings also show that schools had a larger effect on health and lifestyles than regions. Conclusion: The child’s social context—family, peers, school, and region—play an important role on the effects of the economic crisis on health and risk behaviors.

Environmental Performance and Economic Growth in Middle East and North Africa Countries

BACKGROUND

Studies on environmental performance/quality and economic growth show inconclusive results.

OBJECTIVE

The aim of the present study is to assess the non-linear relationship between environmental performance and economic growth in the Middle East and North Africa (MENA) region from 2002-2018.

METHODS

A sample of fourteen (14) MENA countries was used in the present analysis. However, due to important differences between countries in this region, the whole sample was divided into two sub-samples; nine Middle Eastern countries (MEAS) and five North African countries (NAF). We performed the panel smooth transition regression model as an econometric approach.

DISCUSSION

Empirical results indicate a threshold effect in the environmental performance and economic growth relationship. The threshold value differs from one group of countries to another. More specifically, we found that the impact of environmental performance and economic growth is positive and significant only if a certain threshold level has been attained. Until then, the effect remains negative.

CONCLUSIONS

The findings of the present study are of great importance for policymakers since they determine the optimal level of environmental performance required to act positively on the level of economic growth. MENA countries should seek to improve their environmental performance index in order to grow output.

COMPETING INTERESTS

The authors declare no competing financial interests.

Studying the impact of the Eurozone's Great Recession on health: Methodological choices and challenges

Europe's Great Recession provides an opportunity to study the impact of increased financial insecurity on health. A number of studies explored the impact of the Recession on health, but they often reached different conclusions. To understand the root of this debate, we undertook a systematic literature review. Articles were analysed thematically based on: geography, data type, operationalisations of wealth and health, and study design. A critical appraisal was also undertaken. Forty-two studies, published from January 2010 to October 2018, were included in our review. Twenty-six of the forty-two studies found that the Great Recession worsened physical health indicators in the Eurozone. In terms of geography, a large concentration of studies focussed on Spain and Greece, indicating that there may be a gap in understanding the health consequences for EU countries with less severe experiences of the Recession. Regarding data type, nearly all studies used secondary datasets, possibly meaning that studies were constrained by the data available. In terms of operationalisations of wealth and health, a majority of studies used single/simple measures of both, so that these multi-faceted concepts were not fully reflected. Further, fewer than half included studies used panel data, with the remaining studies unable to undertake more causal analyses. The results of the critical appraisal showed that lower-quality studies tended to not find a negative impact of the Recession on health, whereas higher quality studies generally did. In future, we recommend conducting cross-country comparisons, using (inter)nationally-representative panel data conducted over a minimum of a ten-year time horizon, and employing multi-faceted operationalisations of wealth and health. This could provide more common ground across studies, and a clearer indication of whether the Recession impacted health.

Predictors of Self-Reported Health Status of Ready-made Garment Workers in Bangladesh in Post Global Economic Recession Period

Introduction

There has been disagreement within academia in Bangladesh on whether the global economic recession of 2008-2009 came out as a bane or a boon to their economy and for their people, particularly workers in the ready-made garments (RMG) sector; therefore, we sought to conduct a study among currently employed and recently unemployed RMG workers to examine the influence of recession on their self-reported health status.

Methods

This cross-sectional study was conducted among 200 workers across 20 factories and 108 recently unemployed workers from different locations of Dhaka. Workers were selected based on a systematic sampling method from 20 randomly selected factories. Unemployed respondents were selected via snowball sampling. A questionnaire was prepared to cover different socio-demographic variables, which were then explored against an outcome variable of how the respondents rate their current health status (2009) compared with their past health status during the economic recession period (2008). A simple logistic regression was conducted for each of the independent variables with the outcome variable. Finally, all independent variables were loaded against the outcome variable, and multiple logistic regression was run.

Results

The only statistically significant predictor of self-reported health status was age, which indicated a 4% decrease (p = 0.05; 95% confidence interval (CI), 0.9203417 to 1.000015) in improved or better health with each year increase in age, holding other variables constant. Respondent health status was unchanged or even improved after the period of recession. The employed group had 1542.061 Taka (approximately $20) more average monthly family income than the unemployed group (two-sample t-test p-value 0.007), their health status was not affected (odds ratio (OR) 0.998; p-value 0.907).

Conclusion

The absence of an association between self-reported health status and economic recession is not uncommon, and explanations have been proposed for this phenomenon.

Do the unemployed hit the bottle during economic downturns? An empirical approach for Spain

BACKGROUND

This paper analyses the 2008 economic collapse in Spain with its long-lasting effects. Precisely, the ones associated with lifestyles. Thus, the aim of this paper is to examine to what extent economic downturns affect individual's drinking behavior when focusing on unemployed people.

METHODS

We use discrete-choice models and matching techniques. Data from the National Health Survey for 2006 and 2011-2012 provides a clear picture before and after the 2008 breakdown in Spain.

RESULTS

We find that drinking over the business cycle is a function of individual socio-demographic status. Besides, our empirical findings are consistent with the idea that following the crisis differences between unemployed and non-unemployed fell to at least in accordance with a lower overall consumption of alcoholic beverages.

CONCLUSIONS

Public policy design for drinkers would require both prevention and recovery from alcohol use strategies to be met towards health and labour pillars.

Did psychotropic drug consumption increase during the 2008 financial crisis? A cross-sectional population-based study in Spain

OBJECTIVES AND SETTING

Although psychotropic drugs are used to treat mental health disorders, little evidence analyses the effects the 2008 economic downturn had on psychotropic drug consumption in the case of Spain. We analyse these effects, considering both gender and employment situation.

PARTICIPANTS

We used the microdata from the face-to-face cross-sectional population-based Spanish National Health Survey for two periods: 2006-2007 (n=28 954) and 2011-2012 (n=20 509). Our samples included adults (>15 years old).

METHODS

The response variables are consumption (or not) of antidepressants or sedatives and the explanatory variables are the year of the survey, gender and employment status. Covariates are mental health problems, mental health index General Health Questionnaire (GHQ-12) and self-reported health outcome variables such as self-rated health, chronic diseases, smoking behaviour, sleeping hours, body mass index, physical activity in the workplace, medical visits during the past year, age, region of residence (autonomous communities), educational level, marital status and social class of the reference person. Finally, we include interactions between time period, gender and employment status. We specify random effects logistic regressions and use Bayesian methods for the inference.

RESULTS

The economic crisis did not significantly change the probability of taking antidepressant drugs (OR=0.56, 95% CI 0.18 to 2.56) nor sedatives (OR=1.21, 95% CI 0.26 to 5.49). In general, the probability of consuming antidepressants among men and women decreases, but there are differences depending on employment status. The probability of consuming sedatives also depends on the employment status.

CONCLUSIONS

While the year of the financial crisis is not associated with the consumption of antidepressants nor sedatives, it has widened the gap in consumption differences between men and women. Although antidepressant use dropped, the difference in consumption levels between men and women grew significantly among the retired, and in the case of sedatives, risk of women taking sedatives increased in all groups except students.

Effects of the 2008 global financial crisis on population health

We compare the transmission channels through which the 2008 global financial crisis affected health. We find that postponing or skipping visits to the doctor after falling ill and stopping buying regular medication had the strongest negative effects on health, followed by a reduced consumption of staple foods, utilities being cut, being forced to move, and having to sell assets. In comparison, experiencing cuts in TV, phone, and internet services, as well as delaying payments for utilities had relatively weaker negative impacts. In contrast, having a household head or household member lose a job also had negative effects on health status, although this effect was relatively lower. Finally, a reduced flow of remittances had the weakest negative effect.

Promoting physical activity through primary health care: the case of Catalonia

BACKGROUND

In adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors).

METHODS

The intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance).

RESULTS

PHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a "healthy route" (Reach). The proportion of patients with at least one cardiovascular risk factor who were "sufficiently active" increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance).

CONCLUSIONS

In the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system.

Listening to doctors on patients' use of healthcare during the crisis: uncovering a different picture and drawing lessons from Portugal

Background

The consequences of financial crises on patients' use of healthcare have been widely discussed. This paper seeks to ascertain whether the position of key players, i.e. doctors, may reveal realities other than those officially reported about the 2008 financial crisis.

Methods

In 2013-14, a national survey of doctors was conducted in Portugal, which received international assistance in the wake of the financial crisis. An exploratory model comprising descriptive statistics, regression and independence analyses focused on doctors' experience of patients' use of medications, consultations, exams and treatment services, and whether they stopped treatments.

Results

According to doctors, an unspecified number of patients experienced difficulties using healthcare as more patients requested prescriptions for cheaper medications or simply stopped treatments. Significant variations were found according to speciality, years of practice and sector of activity.

Conclusions

Cost-containment mechanisms are regarded as necessary. However, the evidence indicated a side effect, i.e. a decrease in patients' ability to use healthcare, including in the National Health Service (NHS). It also highlighted the need to listen to health professionals as key informants on patient's behaviour and the daily functioning of health services.

North-South disparities in English mortality1965-2015: longitudinal population study

BACKGROUND

Social, economic and health disparities between northern and southern England have persisted despite Government policies to reduce them. We examine long-term trends in premature mortality in northern and southern England across age groups, and whether mortality patterns changed after the 2008-2009 Great Recession.

METHODS

Population-wide longitudinal (1965-2015) study of mortality in England's five northernmost versus four southernmost Government Office Regions - halves of overall population.

MAIN OUTCOME MEASURE

directly age-sex adjusted mortality rates; northern excess mortality (percentage excess northern vs southern deaths, age-sex adjusted).

RESULTS

From 1965 to 2010, premature mortality (deaths per 10 000 aged <75 years) declined from 64 to 28 in southern versus 72 to 35 in northern England. From 2010 to 2015 the rate of decline in premature mortality plateaued in northern and southern England. For most age groups, northern excess mortality remained consistent from 1965 to 2015. For 25-34 and 35-44 age groups, however, northern excess mortality increased sharply between 1995 and 2015: from 2.2% (95% CI -3.2% to 7.6%) to 29.3% (95% CI 21.0% to 37.6%); and 3.3% (95% CI -1.0% to 7.6%) to 49.4% (95% CI 42.8% to 55.9%), respectively. This was due to northern mortality increasing (ages 25-34) or plateauing (ages 35-44) from the mid-1990s while southern mortality mainly declined.

CONCLUSIONS

England's northern excess mortality has been consistent among those aged <25 and 45+ for the past five decades but risen alarmingly among those aged 25-44 since the mid-90s, long before the Great Recession. This profound and worsening structural inequality requires more equitable economic, social and health policies, including potential reactions to the England-wide loss of improvement in premature mortality.

The effect of metropolitan-area mortgage delinquency on health behaviors, access to health services, and self-rated health in the United States, 2003-2010

The recent housing crisis offers the opportunity to understand the effects of unique indicators of macroeconomic conditions on health. We linked data on the proportion of mortgage borrowers per US metropolitan-area who were at least 90 days delinquent on their payments with individual-level outcomes from a representative sample of 1,021,341 adults surveyed through the Behavioral Risk Factor Surveillance System (BRFSS) between 2003 and 2010. We estimated the effects of metropolitan-area mortgage delinquency on individual health behaviors, medical coverage, and health status, as well as whether effects varied by race/ethnicity. Results showed that increases in the metropolitan-area delinquency rate resulted in decreases in heavy alcohol consumption and increases in exercise and health insurance coverage. However, the delinquency rate was also associated with increases in smoking and obesity in some population groups, suggesting the housing crisis may have induced stress-related behavioral change. Overall, the effects of metropolitan-area mortgage delinquency on population health were relatively modest.

The Economic Crisis and Its Ethical Relevance for Public Health in Europe - an Analysis in the Perspective of the Capability Approach

Policy responses to the economic crisis have manifest consequences to European population health and health systems. The aim of this article is to assess, by using the capability approach advanced by Sen, the ethical dimension of trade-offs made in health policy due to austerity measures. From a capability approach point of view, austerity measures such as reducing resources for health care, further deregulating the health care market or moving towards privatisation are ethically challenging since they limit opportunities and capabilities for individuals of a population. Public policies should thus aim to guarantee sufficient capabilities (options to access health care and possibilities to make healthy choices) for its populations. Prioritising those in need is a notion the capability approach particularly focuses on in its goal of supporting those with the least capabilities.

A comprehensive examination of U.S. laws enacted to reduce alcohol-related crashes among underage drivers

INTRODUCTION

To effectively address concerns associated with alcohol-related traffic laws, communities must apply comprehensive and well-coordinated interventions that account for as many factors as possible. The goal of the current research article is to examine and evaluate the simultaneous contribution of 20 underage drinking laws and 3 general driving safety laws, while accounting for demographic, economic, and environmental variables.

METHODS

Annual fatal crash data (1982 to 2010), policies, and demographic, economic, and environmental information were collected and applied to each of the 51 jurisdictions (50 states and the District of Columbia). A structural equation model was fit to estimate the relative contribution of the variables of interest to alcohol-related crashes.

RESULTS

As expected, economic factors (e.g., unemployment rate, cost of alcohol) and alcohol outlet density were found highly relevant to the amount of alcohol teens consume and therefore to teens' impaired driving. Policies such as those regulating the age of bartenders, sellers, or servers; social host civil liability laws; dram shop laws; internal possession of alcohol laws; and fake identification laws do not appear to have the same impact on teens' alcohol-related crash ratios as other types of policies such as those regulating alcohol consumption or alcohol outlet density.

CONCLUSIONS

This effort illustrates the need for comprehensive models of teens' impaired driving. After simultaneously accounting for as many factors as possible, we found that in general (for most communities) further reductions in alcohol-related crashes among teens might be more rapidly achieved from efforts focused on reducing teens' drinking rather than on reducing teens' driving. Future efforts should be made to develop models that represent specific communities.

PRACTICAL APPLICATIONS

Based on this and community-specific models, simulation programs can be developed to help communities understand and visualize the impact of various policy alternatives.

Understanding Recession and Self-Rated Health with the Partial Proportional Odds Model: An Analysis of 26 Countries

Introduction

Self-rated health is demonstrated to vary substantially by both personal socio-economic status and national economic conditions. However, studies investigating the combined influence of individual and country level economic indicators across several countries in the context of recent global recession are limited. This paper furthers our knowledge of the effect of recession on health at both the individual and national level.

Methods

Using the Life in Transition II study, which provides data from 19,759 individuals across 26 European nations, we examine the relationship between self-rated health, personal economic experiences, and macro-economic change. Data analyses include, but are not limited to, the partial proportional odds model which permits the effect of predictors to vary across different levels of our dependent variable.

Results

Household experiences with recession, especially a loss of staple good consumption, are associated with lower self-rated health. Most individual-level experiences with recession, such as a job loss, have relatively small negative effects on perceived health; the effect of individual or household economic hardship is strongest in high income nations. Our findings also suggest that macroeconomic growth improves self-rated health in low-income nations but has no effect in high-income nations. Individuals with the greatest probability of “good” self-rated health reside in wealthy countries ($23,910 to $50, 870 GNI per capita).

Conclusion

Both individual and national economic variables are predictive of self-rated health. Personal and household experiences are most consequential for self-rated health in high income nations, while macroeconomic growth is most consequential in low-income nations.

Gender Differences in Mental Health Outcomes before, during, and after the Great Recession

We examined gender differences in mental health outcomes during and post-recession versus pre-recession. We utilized 2005-2006, 2008-2009, and 2010-2011 data from the Medical Expenditure Panel Survey. Females had lower odds of depression diagnoses during and post-recession and better mental health during the recession, but higher odds of anxiety diagnoses post-recession. Males had lower odds of depression diagnoses and better mental health during and post-recession and lower Kessler 6 scores post-recession. We conducted stratified analyses, which confirmed that the aforementioned findings were consistent across the four different regions of the U.S., by employment status, income and health care utilization. Importantly, we found that the higher odds of anxiety diagnoses among females after the recession were mainly prominent among specific subgroups of females: those who lived in the Northeast or the Midwest, the unemployed, and those with low household income. Gender differences in mental health in association with the economic recession highlight the importance of policymakers taking these differences into consideration when designing economic and social policies to address economic downturns. Future research should examine the reasons behind the decreased depression diagnoses among both genders, and whether they signify decreased mental healthcare utilization or increased social support and more time for exercise and leisure activities.

Sleep behavior and unemployment conditions

Recent research has reported that habitually short sleep duration is a risk factor for declining health, including increased risk of obesity, diabetes and coronary heart disease. In this study we investigate whether macroeconomic conditions are associated with variation in mean sleep time in the United States, and if so, whether the effect is procyclical or countercyclical. We merge state unemployment rates from 2003 through 2012 with the American Time Use Survey, a nationally representative sample of adults with 24h time diaries. We find that higher aggregate unemployment is associated with longer mean sleep duration, with each additional point of state unemployment associated with an additional average 0.83 min of sleep (p<0.001), after adjusting for a secular trend of increasing sleep over the time period. Despite a national poll in 2009 that found one-third of Americans reporting losing sleep over the economy, we do not find that higher state unemployment is associated with more sleeplessness. Instead, we find that higher state unemployment is associated with less frequent time use described as "sleeplessness" (marginal effect=0.05 at 4% unemployment and 0.034 at 14% unemployment, p<0.001), after controlling for a secular trend.

Assessing the short term health impact of the Great Recession in the European Union: a cross-country panel analysis

BACKGROUND

There are great concerns and some initial country-specific, descriptive evidence about potential adverse health consequences of the recent Great Recession.

METHODS

Using data for 23 European Union countries we examine the short-term impact of macroeconomic decline during the Great Recession on a range of health and health behaviour indicators. We also examine whether the effect differed between countries according to the level of social protection provided.

RESULTS

Overall, during the recent recession, an increase of one percentage point in the standardised unemployment rate has been associated with a statistically significant decrease in the following mortality rates: all-cause-mortality (3.4%), cardiovascular diseases (3.7%), cirrhosis- and chronic liver disease-related mortality (9.2%), motor vehicle accident-related mortality (11.5%), parasitic infection-related mortality (4.1%), but an increase in the suicide rate (34.1%). In general, the effects were more marked in countries with lower levels of social protection, compared to those with higher levels.

CONCLUSIONS

An increase in the unemployment rate during the Great Recession has had a beneficial health effect on average across EU countries, except for suicide mortality. Social protection expenditures appear to help countries "smooth" the health response to a recession, limiting health damage but also forgoing potential health gains that could otherwise result.

Adolescents' psychological health complaints and the economic recession in late 2007: a multilevel study in 31 countries

BACKGROUND

The recent economic recession, which began in 2007, has had a detrimental effect on the health of the adult population, but no study yet has investigated the impact of this downturn on adolescent health. This article uniquely examines the effect of the crisis on adolescents' psychological health complaints in a cross-national comparison.

METHODS

Data came from the World Health Organization collaborative 'Health Behaviour in School-aged Children' study in 2005-06 and 2009-10. We measured change in psychological health complaints from before to during the recession in the context of changing adult and adolescent unemployment rates. Furthermore, we used logistic multilevel regression to model the impact of absolute unemployment in 2010 and its change rate between 2005-06 and 2009-10 on adolescents' psychological health complaints in 2010.

RESULTS

Descriptive results showed that although youth and adult unemployment has increased during the economic crisis, rates of psychological health complaints among adolescents were unaffected in some countries and even decreased in others. Multilevel regression models support this finding and reveal that only youth unemployment in 2010 increased the likelihood of psychological health complaints, whereas its change rate in light of the recession as well as adult unemployment did not relate to levels of psychological health complaints.

CONCLUSION

In contrast to recent findings, our study indicates that the negative shift of the recent recession on the employment market in several countries has not affected adolescents' psychological health complaints. Adolescents' well-being instead seems to be influenced by the current situation on the labour market that shapes their occupational outlook.

Health and well-being of secondary school students in New Zealand: trends between 2001, 2007 and 2012

AIM

To describe indicators of health and well-being for New Zealand secondary school students; explore changes between 2001, 2007 and 2012; and compare these findings to international estimates.

METHODS

Three national health and well-being surveys of randomly selected New Zealand secondary school students were conducted. Data are presented as prevalence and variation over time (adjusted odds ratio (aOR)). Comparisons with international estimates were made with subsets of the data.

RESULTS

Between 2001 and 2012, students reported reductions in cigarette use (aOR 0.27, 95% confidence interval (CI) 0.23-0.32), alcohol use (aOR 0.39, 95% CI 0.33-0.46), marijuana use (aOR 0.37, 95% CI 0.31-0.43), sexual abuse (aOR 0.52, 95% CI 0.46-0.58), fighting (aOR 0.63, 95% CI 0.55-0.73), seatbelt use (aOR 1.47, 95% CI 1.31-1.65) and risky driving behaviours (aOR 0.39, 95% CI 0.33-0.45). Positive connections to school (perception that the school cares, aOR 1.22, 95% CI 1.10-1.35; liking school, aOR 1.55, 95% CI 1.33-1.82) and family (good family relationship, aOR 1.83, 95% CI 1.70-1.97) also improved. Indicators that did not improve and compared poorly with international estimates were protected sex (condom use at last sexual intercourse, aOR 0.77, 95% CI 0.68-0.87) and healthy life-style (daily physical activity, aOR 0.88, 95% CI 0.78-0.99; overweight/obese, aOR 1.09, 95% CI 0.92-1.31). Exposure to family violence (aOR 1.37, 95% CI 1.11-1.68) and depressive symptoms (aOR 1.03, 95% CI 0.91-1.17) also did not improve.

CONCLUSIONS

There have been important improvements in the health and well-being of New Zealand adolescents over a relatively short period. These findings demonstrate that population rates of adolescent risk behaviours are amenable to change. Current policy efforts should not lose momentum, while identified priority areas must be adequately resourced to ensure young people have opportunities to thrive now and in the future.

Economic recession and investment on human resource information systems (HRIS)

Purpose

The purpose of this paper is to examine the impact of an economic recession on human resource information systems (HRIS) investment decisions by asking: Are there high levels of disinvestment in HRIS during a recession? Are there low levels of trust and confidence in HRIS during a recession? Could there be an absence of concerted commitment in leveraging technology, even in the face of an economic crunch?

Design/methodology/approach

An HRIS impact questionnaire was used, targeting human resource and financial managers. The data obtained were analyzed using Statistical Programme for Social Sciences (SPSS).

Findings

The findings suggest that while a recession is acknowledged, the continued use of HRIS is not considered a risk factor that warrants cost cutting.

Originality/value

This is an original study. It will add value by indicating to management the significance of strategic decision making. The study also points out the need for further research in order to make more sense of certain variables.

Influence of the 2009 financial crisis on detection of advanced pulmonary tuberculosis in Osaka city, Japan: a cross-sectional study

OBJECTIVE

To investigate the association between the economic recession and the detection of advanced cases of pulmonary tuberculosis in Osaka city from 2007 to 2009.

DESIGN

A repeated cross-sectional study.

SETTING

Osaka city has been the highest tuberculosis burden area in Japan. After the previous global financial crisis, the unemployment rate in Osaka prefecture has deteriorated from 5.3% in 2008 to 6.6% in 2009.

PARTICIPANTS

During the study period, 3406 pulmonary tuberculosis cases were enrolled: 2530 males and 876 females; 1546 elderly cases (65 years and above) and 1860 young cases (under 65 years); 417 homeless cases and 2989 non-homeless cases.

OUTCOME MEASURES

Patients' information included the sex, age, registry, health insurances, places of detection, sputum smear test results, patients' delay, doctors' delay and the grade of chest x-ray findings. They were statistically analysed between 2007 and 2008, two years before and just before the financial crisis, and between 2008 and 2009, just before and after the financial crisis.

RESULTS

The total numbers of pulmonary tuberculosis cases were 1172 in 2007, 1083 in 2008 and 1151 in 2009. In health examinations for non-homeless people, higher number of cases in 2009 were sputum smear positive, had respiratory symptoms and showed advanced disease in chest x-rays than those in 2008, with a longer patients' delay. On the contrary, in health examination for homeless people, fewer cases of advanced pulmonary tuberculosis were found in 2009 than in 2008, with a shorter patients' delay. In clinical examinations, there was no trend towards a difference between non-homeless and homeless people.

CONCLUSIONS

Although homeless people might be protected by public assistance, tuberculosis prevention and control need to be reinforced for the non-homeless population after the financial crisis.

Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991-2010 Health Surveys of England

OBJECTIVE

To assess short-term differences in population mental health before and after the 2008 recession and explore how and why these changes differ by gender, age and socio-economic position.

DESIGN

Repeat cross-sectional analysis of survey data.

SETTING

England.

PARTICIPANTS

Representative samples of the working age (25-64 years) general population participating in the Health Survey for England between 1991 and 2010 inclusive.

MAIN OUTCOME MEASURES

Prevalence of poor mental health (caseness) as measured by the general health questionnaire-12 (GHQ).

RESULTS

Age-sex standardised prevalence of GHQ caseness increased from 13.7% (95% CI 12.9% to 14.5%) in 2008 to 16.4% (95% CI 14.9% to 17.9%) in 2009 and 15.5% (95% CI 14.4% to 16.7%) in 2010. Women had a consistently greater prevalence since 1991 until the current recession. However, compared to 2008, men experienced an increase in age-adjusted caseness of 5.1% (95% CI 2.6% to 7.6%, p<0.001) in 2009 and 3% (95% CI 1.2% to 4.9%, p=0.001) in 2010, while no statistically significant changes were seen in women. Adjustment for differences in employment status and education level did not account for the observed increase in men nor did they explain the differential gender patterning. Over the last decade, socio-economic inequalities showed a tendency to increase but no clear evidence for an increase in inequalities associated with the recession was found. Similarly, no evidence was found for a differential effect between age groups.

CONCLUSIONS

Population mental health in men has deteriorated within 2 years of the onset of the current recession. These changes, and their patterning by gender, could not be accounted for by differences in employment status. Further work is needed to monitor recessionary impacts on health inequalities in response to ongoing labour market and social policy changes.

Public health and medicine in an age of energy scarcity: the case of petroleum

Petroleum supplies have heretofore been abundant and inexpensive, but the world petroleum production peak is imminent, and we are entering an unprecedented era of petroleum scarcity. This fact has had little impact on policies related to climate, energy, the built environment, transportation, food, health care, public health, and global health. Rising prices are likely to spur research and drive efficiency improvements, but such innovations may be unable to address an increasing gap between supply and demand. The resulting implications for health and the environment are explored in the articles we have selected as additional contributions in this special issue. Uncertainty about the timing of the peak, the shape of the production curve, and decline rates should not delay action. The time for quick, decisive, comprehensive action is now.

An ecological study of the determinants of differences in 2009 pandemic influenza mortality rates between countries in Europe

BACKGROUND

Pandemic A (H1N1) 2009 mortality rates varied widely from one country to another. Our aim was to identify potential socioeconomic determinants of pandemic mortality and explain between-country variation.

METHODOLOGY

Based on data from a total of 30 European countries, we applied random-effects Poisson regression models to study the relationship between pandemic mortality rates (May 2009 to May 2010) and a set of representative environmental, health care-associated, economic and demographic country-level parameters. The study was completed by June 2010.

PRINCIPAL FINDINGS

Most regression approaches indicated a consistent, statistically significant inverse association between pandemic influenza-related mortality and per capita government expenditure on health. The findings were similar in univariable [coefficient: -0.00028, 95% Confidence Interval (CI): -0.00046, -0.00010, p = 0.002] and multivariable analyses (including all covariates, coefficient: -0.00107, 95% CI: -0.00196, -0.00018, p = 0.018). The estimate was barely insignificant when the multivariable model included only significant covariates from the univariate step (coefficient: -0.00046, 95% CI: -0.00095, 0.00003, p = 0.063).

CONCLUSIONS

Our findings imply a significant inverse association between public spending on health and pandemic influenza mortality. In an attempt to interpret the estimated coefficient (-0.00028) for the per capita government expenditure on health, we observed that a rise of 100 international dollars was associated with a reduction in the pandemic influenza mortality rate by approximately 2.8%. However, further work needs to be done to unravel the mechanisms by which reduced government spending on health may have affected the 2009 pandemic influenza mortality.

Decline in the United States black preterm/low birth weight rate in the 1990s: can the economic boom explain it?

PURPOSE

Macroeconomic improvements have been posited as an explanation of the decline in the Black preterm birth rate during the 1990s. This study assessed whether decreasing unemployment explained the decline in preterm, low birth weight births (PT-LBW) for Black women.

METHODS

United States singleton births to non-Hispanic Black women ages 18 and over, conceived between 1990 and 2001, were pooled to examine PT-LBW trends by level of social advantage (approximated by education and marital status). The impact of the state-level unemployment rate in the first and second trimester of pregnancy was evaluated in multiple logistic regression models.

RESULTS

During the 1990s, PT-LBW declined 11% among disadvantaged (unmarried, less than high school educated) Black women. Although the unemployment rate and PT-LBW were positively related, decreases in unemployment did not explain the decline in PT-LBW. Instead, improvements in prenatal care utilization and smoking behavior largely accounted for the temporal trend.

CONCLUSIONS

Macroeconomic improvements, measured by unemployment, only marginally contributed to the Black PT-LBW trend in the 1990s. To effect further reductions, future studies should investigate other possible determinants of the proximate behavioral changes that did explain the trend (e.g., Earned Income Tax Credit expansions, increased, cigarette taxes/smoking legislation).

Feeling the cold: implications for nurse managers arising from the financial pressures in health care in England

AIM

The purpose of this short paper is to identify some of the implications and opportunities nurse managers in England face as a result of the current global economic recession.

BACKGROUND

Government borrowing and poor global economic conditions have combined to create a pound175 billion budget deficit in the UK. The National Health Service in England will be required to make substantial savings in order to help offset this shortfall.

KEY ISSUES

This is a brief critical commentary which examines some of the challenges and opportunities for nurse managers in England. It draws on a number of sources to identify key issues concerning nursing management arising from the financial pressures facing health care.

CONCLUSION

The next few years are going to be very difficult for nurses and their managers, however, the current situation also presents opportunities to advance the contribution and influence of nursing and nursing management.

IMPLICATIONS FOR NURSING MANAGEMENT

What nurse managers do next will be crucial in shaping the NHS response to the financial storm and the future nature of health care in England.

Health in financial crises: economic recession and tuberculosis in Central and Eastern Europe

The ongoing global financial crisis, which began in 2007, has drawn attention to the effect of declining economic conditions on public health. A quantitative analysis of previous events can offer insights into the potential health effects of economic decline. In the early 1990s, widespread recession across Central and Eastern Europe accompanied the collapse of the Soviet Union. At the same time, despite previously falling tuberculosis (TB) incidence in most countries, there was an upsurge of TB cases and deaths throughout the region. Here, we study the quantitative relationship between the lost economic productivity and excess TB cases and mortality. We use the data of the World Health Organization for TB notifications and deaths from 1980 to 2006, and World Bank data for gross domestic product. Comparing 15 countries for which sufficient data exist, we find strong linear associations between the lost economic productivity over the period of recession for each country and excess numbers of TB cases (r(2) = 0.94, p < 0.001) and deaths (r(2) = 0.94, p < 0.001) over the same period. If TB epidemiology and control are linked to economies in 2009 as they were in 1991 then the Baltic states, particularly Latvia, are now vulnerable to another upturn in TB cases and deaths. These projections are in accordance with emerging data on drug consumption, which indicate that these countries have undergone the greatest reductions since the beginning of 2008. We recommend close surveillance and monitoring during the current recession, especially in the Baltic states.