title: Effects of economic crises on population health outcomes in Latin America, 1981-2010: an ecological study.
abstract: OBJECTIVE
  The relative health effects of changes in unemployment, inflation and gross domestic product (GDP) per capita on population health have not been assessed. We aimed to determine the effect of changes in these economic measures on mortality metrics across Latin America.
  
  
  METHODS
  Ecological study.
  
  
  METHODS
  Latin America (21 countries), 1981-2010.
  
  
  METHODS
  Uses multivariate regression analysis to assess the effects of changes in unemployment, inflation and GDP per capita on 5 mortality indicators across 21 countries in Latin America, 1981-2010. Country-specific differences in healthcare infrastructure, population structure and population size were controlled for.
  
  
  RESULTS
  Between 1981 and 2010, a 1% rise in unemployment was associated with statistically significant deteriorations (p<0.05) in 5 population health outcomes, with largest deteriorations in 1-5 years of age and male adult mortality rates (1.14 and 0.53 rises per 1000 deaths respectively). A 1% rise in inflation rate was associated with significant deteriorations (p<0.05) in 4 population health outcomes, with the largest deterioration in male adult mortality rate (0.0033 rise per 1000 deaths). Lag analysis showed that 5 years after rises in unemployment and inflation, significant deteriorations (p<0.05) occurred in 3 and 5 mortality metrics, respectively. A 1% rise in GDP per capita was associated with no significant deteriorations in population health outcomes either in the short or long term. β coefficient comparisons indicated that the effect of unemployment increases was substantially greater than that of changes in GDP per capita or inflation.
  
  
  CONCLUSIONS
  Rises in unemployment and inflation are associated with long-lasting deteriorations in several population health outcomes. Unemployment exerted much larger effects on health than inflation. In contrast, changes in GDP per capita had almost no association with the explored health outcomes. Contrary to neoclassical development economics, policymakers should prioritise amelioration of unemployment if population health outcomes are to be optimised.
authors.affiliation: Department of History, University of Oxford, Oxford, Oxfordshire, UK.
authors.forename: Callum
authors.initials: C
authors.lastname: Williams
authors.affiliation: Medical Sciences Division, University of Oxford, Green Templeton College, Oxford, Oxfordshire, UK.
authors.forename: Barnabas James
authors.initials: BJ
authors.lastname: Gilbert
authors.affiliation: Department of Public Health, University of Bern, Bern, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeltner
authors.affiliation: Institute for Mathematical & Molecular Biomedicine, King's College London, London, UK.
authors.forename: Johnathan
authors.initials: J
authors.lastname: Watkins
authors.affiliation: Department of Global Health Systems, Harvard University, Cambridge, Massachusetts, USA.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.affiliation: NHS England, Redditch, UK.
authors.forename: Mahiben
authors.initials: M
authors.lastname: Maruthappu
mesh_terms: D000328:Adult; D002675:Child, Preschool; D005260:Female; D059066:Gross Domestic Product; D006801:Humans; D007223:Infant; D007250:Inflation, Economic; D007843:Latin America; D008297:Male; D009026:Mortality / Q000639:trends; D011634:Public Health / Q000191:economics*; D012044:Regression Analysis; D064890:Social Determinants of Health / Q000191:economics*; D012959:Socioeconomic Factors; D014478:Unemployment
keywords: HEALTH ECONOMICS; PUBLIC HEALTH