Portal de Periódicos da CAPES

Financial crisis, austerity, and health in Europe – Authors’ reply

2013; Elsevier BV; Volume: 382; Issue: 9890 Linguagem: Inglês

10.1016/s0140-6736(13)61665-7

1474-547X

Marina Karanikolos, Bernd Rechel, David Stuckler, Martin McKee,

Health disparities and outcomes

Roberto De Vogli is correct to say that the financial crisis has both proximal and distal causes. But in arguing that social epidemiologists must address the latter, he overlooks how we have been doing precisely that over the past 4 years.1Stuckler D Basu S Suhrcke M Coutts A McKee M The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis.Lancet. 2009; 374: 315-323Summary Full Text Full Text PDF PubMed Scopus (944) Google Scholar Indeed, we have consistently argued for a fundamental reassessment of the economic model that has created and perpetuated the current crisis, a view that at last seems to be gaining widespread acceptance. However, we should also note that our initial submission included much more on the distal causes he discusses but this was scaled back in response to reviewers’ comments, although we believe that our views are still clear in the published paper.2Karanikolos M Mladovsky P Cylus J et al.Financial crisis, austerity, and health in Europe.Lancet. 2013; 381: 1323-1331Summary Full Text Full Text PDF PubMed Scopus (943) Google Scholar We are puzzled by Jose Ayuso-Mateos and colleagues’ claim that suicides have not risen in Spain and Portugal, given the peaks in 2008 and 2010, respectively, that are apparent in their figure, corresponding to unemployment. However, their use of total suicide rates obscures the magnitude of the rise concentrated in working age men who are most affected by the financial crisis.3Barr B Taylor-Robinson D Scott-Samuel A McKee M Stuckler D Suicides associated with the 2008-2010 recession in the UK: a time-trend analysis.BMJ. 2012; 345: e5142Crossref PubMed Scopus (308) Google Scholar At the onset of the crisis there was a step change in suicides in Spanish people of working age, which increased by almost 10% above the underlying trend.4Lopez Bernal JA Gasparrini A Artundo CM McKee M The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis.Eur J Public Health. 2013; (published online June 25.)https://doi.org/10.1093/eurpub/ckt083Crossref PubMed Scopus (163) Google Scholar Meni Malliori and colleagues agree with our diagnosis of the cause of the rise in HIV infections but report their increased activity in response to it, a point they have made previously.5Malliori M Golna C Souliotis K Hatzakis A Managing opioid dependence treatment and controlling for HIV incidence among injecting drug users in Greece: a case study of optimism in the face of adversity.Addiction. 2013; 108: 1174-1175Crossref PubMed Scopus (14) Google Scholar However, our argument that the Greek response has been inadequate in the face of this increased need is supported by the fact that OKANA’s (the Greek Organisation Against Drugs) budget has been cut by more than half.5Malliori M Golna C Souliotis K Hatzakis A Managing opioid dependence treatment and controlling for HIV incidence among injecting drug users in Greece: a case study of optimism in the face of adversity.Addiction. 2013; 108: 1174-1175Crossref PubMed Scopus (14) Google Scholar We declare that we have no conflicts of interest. Financial crisis, austerity, and health in EuropeThe 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. Full-Text PDF Financial crisis, austerity, and health in EuropeMarina Karanikolos and colleagues present an analysis (April 13, p 1323)1 of the determinants and health effects of the 2008 financial crisis, but miss the most important cause of the crisis. The authors state that the report of the US Government Financial Crisis Inquiry Commission is the most exhaustive analysis of the economic downturn. But is this really the case? Full-Text PDF Financial crisis, austerity, and health in EuropeMarina Karanikolos and colleagues1 state that suicide is becoming more common in Spain and Portugal; however, official data for suicides in both countries from the past 5 years do not lend support to this assumption. Full-Text PDF Financial crisis, austerity, and health in EuropeMarina Karanikolos and colleagues1 state that the increasing number of HIV cases in injecting drug users (IDUs) in Greece could be largely attributed to the low provision of preventive services and the disruption of needle exchange programmes since 2008. Although the statement would hold true for the pre-2011 period, the coverage of HIV preventive initiatives in IDUs has been increasing ever since, as a response to the outbreak and in the face of the fiscal crisis. Full-Text PDF