Economic crisis, unemployment and public health

Some public health research areas are following the economy. Unemployment is a typical example [1]. Studies on how macroeconomic changes affect health are another. These areas are in focus when the economic barometer is falling. But sometimes these two study areas arrive at contradictory results. Documentation about the negative health effects of individual unemployment abounds, but many studies of macroeconomic changes point at another result: that mortality increases during a boom and decreases during a recession. Numerous studies show that individual unemployment is associated with poorer health, both physically and psychologically [2,3]. With regard to the studies on macroeconomic change and health, the number of studies is much more limited. Very few studies have addressed the phenomenon of economic crisis in the meaning of a sharp transition to a recession. Most studies look at the correlation over time between trade and health, often measured as general or specific mortality. And in contrast to studies on the effect of unemployment among individuals, the macroeconomic studies use aggregate or ecological data. M. Harvey Brenner is one of the pioneers when it comes to the more sophisticated macroeconomic analyses of how trade and health correlate. Already in the 1960s he showed how economic change was followed by change in mental hospitalization in the state of New York in the USA [4]. With the help of time series analysis he later showed an inverse correlation between fluctuations in the economy and psychiatric morbidity in the whole of the United States – booms correlated with better health and recessions with an increase in mental morbidity [5]. His later studies confirmed this finding in a number of different countries [6,7]. These studies, however, have been criticized for a number of technical reasons, but also for not taking important confounding factors into consideration [8]. In 2005, there was a series of articles in the International Journal of Epidemiology discussing the findings of Tapia Granados, where for the time period 1900–1996 in the United States he found that economic expansions were associated with increasing mortality [9]. Brenner and others (e.g. Ralph Catalano) who previously had found different results [10] held a critical view of the report and its counterintuitive results [11,12]. The title of Catalano’s commentary was the question: ‘‘If economic expansion threatens public health, should epidemiologists recommend recession?’’ [12]. Ruhm later published results very similar to those of Tapia Granados, where he focused especially on deaths from coronary heart disease. He found that economic upturns correlated with an increase in coronary heart deaths – a drop in unemployment by one percentage point was estimated to raise coronary heart deaths by 0.75% [13]. On the other hand, such results could not be found in a similar Swedish study conducted by Gerdtham and Johannesson [14]. In this there was a significant countercyclical relationship between the business cycle and the mortality risk among men, i.e. mortality was lower during the boom than during the recession. No significant results were found for women. One of the most recent investigations within this field is a study by David Stuckler and collaborators using data from 26 European Union countries