Will the recession be bad for our health? It depends

The recent financial and economic crisis has raised major concerns in the public health community that death, illness and disability will rise in both rich and poor countries across the globe, and that the operation of health systems will be compromised both by increased demand for treatment and reduced health budgets. Such fears are supported by, among others, a wealth of epidemiological evidence on the strong and positive associations at the level of the individual between lower income, unemployment and poor health (Catalano & Bellows, 2005; Clark & Oswald, 1994; McKee-Ryan, Song, & Wanberg, 2005; Murphy & Athanasou, 1999; Gallo, Bradley, & Dublin, 2004). The idea that the financial crisis will harm health also reflects the findings of the Commission on Social Determinants of Health published in 2008 (Marmot, Friel, & Bell, 2008), as argued in a recent article in the British Medical Journal (Marmot & Bell, 2009). Several researchers, however, argue the opposite: recession might actually improve health, at least in the short run. Research in the USA and Europe finds pro-cyclical worsening of mortality during expansions and improvement during recessions, with recession associated with lower road-traffic injuries and alcohol-related deaths and hospital admissions (Gerdtham & Ruhm, 2006; Ruhm, 2008; Tapia-Granados and Lonides, 2008). These studies have led some commentators to speculate, perhaps slightly with ‘tongue in cheek’, that “Good News: Recession may make you healthier!”(Bougerol, 2009) and that “recession may be a lifestyle blessing in disguise” (Cohen, 2009). This commentary aims to elucidate this seemingly contradictory evidence with a summary of the existing evidence on the actual and potential impact of recessions on health, in order to distil some lessons as to the expected health effects of the current crisis and as to how policy should respond, if at all. We find that the relationships involved are complex, but that some of the complexity may be reduced by highlighting a set of factors on the causal chain that influence the direction and magnitude of the resulting health effects