title: Financial crisis, austerity, and health in Europe.
abstract: The financial crisis in Europe has posed major threats and opportunities to health. We trace the origins of the economic crisis in Europe and the responses of governments, examine the effect on health systems, and review the effects of previous economic downturns on health to predict the likely consequences for the present. We then compare our predictions with available evidence for the effects of the crisis on health. Whereas immediate rises in suicides and falls in road traffic deaths were anticipated, other consequences, such as HIV outbreaks, were not, and are better understood as products of state retrenchment. Greece, Spain, and Portugal adopted strict fiscal austerity; their economies continue to recede and strain on their health-care systems is growing. Suicides and outbreaks of infectious diseases are becoming more common in these countries, and budget cuts have restricted access to health care. By contrast, Iceland rejected austerity through a popular vote, and the financial crisis seems to have had few or no discernible effects on health. Although there are many potentially confounding differences between countries, our analysis suggests that, although recessions pose risks to health, the interaction of fiscal austerity with economic shocks and weak social protection is what ultimately seems to escalate health and social crises in Europe. Policy decisions about how to respond to economic crises have pronounced and unintended effects on public health, yet public health voices have remained largely silent during the economic crisis.
authors.affiliation: European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Marina
authors.initials: M
authors.lastname: Karanikolos
authors.forename: Philipa
authors.initials: P
authors.lastname: Mladovsky
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cylus
authors.forename: Sarah
authors.initials: S
authors.lastname: Thomson
authors.forename: Sanjay
authors.initials: S
authors.lastname: Basu
authors.forename: David
authors.initials: D
authors.lastname: Stuckler
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
mesh_terms: D003695:Delivery of Health Care / Q000191:economics; D057172:Economic Recession; D005060:Europe / Q000453:epidemiology; D006115:Greece / Q000453:epidemiology; D006291:Health Policy / Q000191:economics; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D001523:Mental Disorders / Q000453:epidemiology; D011174:Portugal / Q000453:epidemiology; D011634:Public Health / Q000191:economics; D013030:Spain / Q000453:epidemiology