Can economic recession be good for your health?

The immediate post-communist economic collapse of some eastern European countries resulted in a dramatic decrease in life expectancy. There is evidence that mental health is negatively impacted during economic crisis, resulting in an increased suicide rate. Economic crises are surely bad for your health. Or are they?

We know that a richer country is not necessarily a healthier one when applied to across different countries (see for example US vs their Caribbean neighbours such as Cuba or Costa Rica). What may be less well known is that poorer can actually mean healthier, if we consider individual countries from a longitudinal perspective. But is that really so counter-intuitive? Believe it or not, numerous studies have established the counter-cyclical nature of the association between mortality and economic growth, with a suggested lag of about 2 years. Many health indicators improved in Cuba as a result of the "special period" in the nineties, including a decline in all-cause mortality and in the rates of death from diabetes and cardiovascular disease. Is it possible that we could see similar effects in the UK?

As usual, the devil is in the detail. The impact is greater for children and men than for women. And whether this impact is positive or negative very much depends on the relative impact of the affected conditions on the population's health. Cardiovascular risks factors tend to be better under control during crises and so is the case for motor vehicles accidents. On the contrary, mental health is negatively affected.

Below a few references for further reading:

Catalano R, Goldman-Mellor S, Saxton K, Margerison-Zilko C, Subbaraman M, LeWinn K, Anderson E. The Health Effects of Economic Decline. Annu. Rev. Public Health 2011. 32:431–50

Riva M, Bambra C, Easton S, Curtis S. Hard times or good times? Inequalities in the health effects of economic change. Int J Public Health. 2011 Feb;56(1):3-5.

Tapia Granados JA, Ionides EL. The reversal of the relation between economic growth and health progress: Sweden in the 19th and 20th centuries. J Health Econ. 2008 May;27(3):544-63.

Stuckler D, Meissner C, Fishback P, Basu S, McKee M. Banking crises and mortality during the Great Depression: evidence from US urban populations, 1929-1937. J Epidemiol Comm Health 2011

Stuckler D, Basu S, Suhrcke M, Coutts A, McKe M. The public health eff ect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 2009; 374: 315–23

Tapia-Granados JA. Economic growth and health progress in England and Wales: 160 years of a changing relation. January 2011. Working paper available at: http://sitemaker.umich.edu/tapia_granados/files/econ_growth___health_engl__wales_f-2.pdf

Barbara Starfield

I heard yesterday the tragic news that Barbara Starfield died this week. She was an outstanding researcher who provided the evidence for the multiple benefits of Primary Care. I would ow her so much as a Family Physician, but I will miss dearly Barbara much more as a mentor and a friend. She was a strong and inspiring woman, and she was the driving force that made me focus my research on Primary Care as an instrument for improving the health and conditions of populations. I had also the immense honour of privilege of working with her in research and in teaching and in both facets she simply excelled. I find it hard to imagine a world without Barbara. We will miss you so much.

Ann McPherson in memoriam

I was today at Ann's funeral at Wolvercote Cemetery. I knew I was paying tribute to an outstanding person, but it was later at the memorial at Balliol College when I just begun to grasp the magnitude of her contributions and her impact on those who were  around her.

Her work will be continued through a number of initiatives including Health Talk Online, Youth Health Talk, Teenage Health Freak, and the Oxford Health Experiences Institute (HEXI), supported by the Ann McPherson Tribute Fund, and others such as Health Care Professionals for Assisted Dying.

Do you want to work in the Health Services and Policy Research Group?

Would you like to join us and work at the University of Oxford in our top rated Primary Care Department? We are now recruiting for a Research Officer. You can find here further details in relation to this exciting opportunity. Application deadline is Monday 20 of June.

Integration is key to the success of NHS reforms

David Cameron delivered yesterday a telling speech suggesting that the Government was ready to change their approach to the reforms. It seems that the government has indeed listened to what the professionals and the public had to say about the reforms. Cameron aimed to appease unrest both within and outside General Practice by guaranteeing that both consultants and nurses will be involved in the commission process, that commissioning consortia will be expected to be fully operational only when they are ready, and not necessarily by April 2013 as previously envisaged, and that competition will be only pursued where it may benefits patient care and choice.

However, the most significant commitment was to ensure that the new system made integration of acre a priority: "clinical senates" consisting of senior medical professionals will oversee integration of NHS services across local areas and, even more astonishing, Monitor, the NHS watchdog that had been previously commissioned with the task of ensuring fair competition, will have a duty to promote integration of care.

Although not inherently opposed, the goals of higher integration and more competition seem difficult to reconcile. It is a shame that nobody dared to ask Mr Cameron what he meant by integration, such an elusive concept. But elusive or not greater integration is good your health.