The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis
The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis
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DOI：
10.1016/s0140-6736(09)61124-7
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发表时间：
2009-07-25
期刊：
影响因子：
168.9
通讯作者：
McKee, Martin
中科院分区：
文献类型：
--
作者：
Stuckler, David;Basu, Sanjay;McKee, Martin
背景人们普遍担心，目前的经济危机，特别是其对失业的影响，将对人口健康产生不利影响。我们调查了过去30年来经济变化对死亡率的影响，并确定了政府可能如何减少不利影响。方法我们使用多元回归，校正了人口老龄化、过去的死亡率和就业趋势，以及特定国家医疗基础设施的差异，以检验1970年至2007年26个欧盟国家的就业变化和死亡率之间的关系，以及不同类型的政府支出如何改变这种关系。在所有年龄段(0.49%，-0.04至1.02)，凶杀案上升了0.79%(95%可信区间0.06-1.52；全欧盟范围内潜在超额死亡3-80人[平均40人])。相比之下，道路交通死亡人数下降了1.39%(0.64-2.14；全欧盟范围内潜在死亡人数减少290-980人[平均为630人])。失业率增加超过3%对65岁以下的自杀者(4.45%，95%CI 0.65-8.24；欧盟范围内250-3220人潜在超额死亡[平均1740人])和酗酒死亡(28.0%，12.30-43.70人；1550-5490人潜在超额死亡[欧盟范围平均3500人])的影响更大。我们注意到，没有一致的证据表明，随着失业率的上升，全因死亡率会上升，尽管人们对经济危机的敏感度存在很大差异，这在一定程度上取决于社会保护的差异。对积极的劳动力市场方案的投资每增加10美元，失业对自杀的影响就减少0.038%(95%CI-0.004到-0.071)。解释失业率的上升与故意暴力导致的过早死亡的短期显著增加有关，同时减少了交通死亡。让工人留在工作岗位并让他们重新就业的积极劳动力市场计划，可能会减轻经济衰退对健康的一些不利影响。
Background There is widespread concern that the present economic crisis, particularly its effect on unemployment, will adversely affect population health. We investigated how economic changes have affected mortality rates over the past three decades and identified how governments might reduce adverse effects.Methods We used multivariate regression, correcting for population ageing, past mortality and employment trends, and country-specific differences in health-care infrastructure, to examine associations between changes in employment and mortality, and how associations were modified by different types of government expenditure for 26 European Union (EU) countries between 1970 and 2007.Findings We noted that every 1% increase in unemployment was associated with a 0.79% rise in suicides at ages younger than 65 years (95% CI 0.16-1.42; 60-550 potential excess deaths [mean 310] EU-wide), although the effect size was non-significant at all ages (0.49%, -0.04 to 1.02), and with a 0.79% rise in homicides (95% CI 0.06-1.52; 3-80 potential excess deaths [mean 40] EU-wide). By contrast, road-traffic deaths decreased by 1.39% (0.64-2.14; 290-980 potential fewer deaths [mean 630] EU-wide). A more than 3% increase in unemployment had a greater effect on suicides at ages younger than 65 years (4.45%, 95% CI 0.65-8.24; 250-3220 potential excess deaths [mean 1740] EU-wide) and deaths from alcohol abuse (28.0%,12.30-43.70; 1550-5490 potential excess deaths [mean 3500] EU-wide). We noted no consistent evidence across the EU that all-cause mortality rates increased when unemployment rose, although populations varied substantially in how sensitive mortality was to economic crises, depending partly on differences in social protection. Every US$10 per person increased investment in active labour market programmes reduced the effect of unemployment on suicides by 0.038% (95% CI -0.004 to -0.071).Interpretation Rises in unemployment are associated with significant short-term increases in premature deaths from intentional violence, while reducing traffic fatalities. Active labour market programmes that keep and reintegrate workers in jobs could mitigate some adverse health effects of economic downturns.