Abstract
Since 2008, Western countries are going through a deep economic crisis whose health impacts seem to be fundamentally counter-cyclical: when economic conditions worsen, so does health, and mortality tends to rise. While a growing number of studies have presented evidence on the effect of crises on the average population health, a largely neglected aspect of research is the impact of crises and the related political responses on social inequalities in health, even if the negative consequences of the crises are primarily borne by the most disadvantaged populations. This commentary will reflect on the results of the studies that have analyzed the effect of economic crises on social inequalities in health up to 2013. With some exceptions, the studies show an increase in health inequalities during crises, especially during the Southeast Asian and Japanese crises and the Soviet Union crisis, although it is not always evident for both sexes or all health or socioeconomic variables. In the Nordic countries during the nineties, a clear worsening of health equity did not occur. Results about the impacts of the current economic recession on health equity are still inconsistent. Some of the factors that could explain this variability in results are the role of welfare state policies, the diversity of time periods used in the analyses, the heterogeneity of socioeconomic and health variables considered, the changes in the socioeconomic profile of the groups under comparison in times of crises, and the type of measures used to analyze the magnitude of social inequalities in health. Social epidemiology should further collaborate with other disciplines to help produce more accurate and useful evidence about the relationship between crises and health equity.
Highlights
Since 2008, Western countries are going through a deep crisis which has deeply penetrated into the economic, social, political and even ethical spheres of our societies
At present it is clear that the negative consequences of the crisis are being primarily borne by the most disadvantaged populations, who are concentrating the major risks of some crucial social determinants of health, such as unemployment and poverty [6]
We propose some ideas for a better understanding of what the effects of the current crisis and the austerity policies on health equity might be
Summary
Since 2008, Western countries are going through a deep crisis which has deeply penetrated into the economic, social, political and even ethical spheres of our societies. The studies examined the effect of various economic crises during the nineties of the last century –the Soviet crisis, the financial crisis in Southeast Asia and Japan, and the crisis in the Nordic countries- as well as of the Great Recession beginning in 2008 (Table 1) They used diverse outcome variables -overall mortality, causes of death, and physical and mental health- and socioeconomic variables –mainly educational level, social class and employment status-. In times of economic prosperity, the unemployed population is a small group of an especially disadvantaged socioeconomic profile, while in times of crisis, other less disadvantaged social groups can become unemployed, which would weaken the usual relationship between unemployment and ill-health [36], at least among men [18] This artificial phenomenon could avoid that an increase in health inequalities among the employed and unemployed is seen during recessions [12,18,19]. Only some of the studies include these kind of measures [13,24,25,26,30,32]
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