The Economic Crisis That Benefits Your Heart

STUDIES SHOW THAT A CORRELATION BETWEEN MACROECONOMIC CONDITIONS AND HUMAN HEALTH EXISTS. BUT IT'S NOT ALWAYS THE EXPECTED ONE

by Aleksandra Torbica, Department of Policy Analysis and Public Management

What is the impact of economic downturns on health of the population is a pivotal policy issue that has attracted a lot of attention of scientific communities in both medical and economics fields.  Available research doesn’t provide a unique explanation of the phenomenon. According to the well-known “healthy living in hard times” paradigm economic crisis actually may be beneficial for our health for two main reasons. First, individuals behave better in periods of economic crisis because they are more afraid to lose their jobs and, when unemployed, they take more time for themselves, investing in self-improving and healthy activities. Second, during short-term economic upturns job-related stress might increase and have negative health effects and increase the risk of heart attacks.

On the other hand, a bulk of empirical evidence under the flag “this time is different” suggest quite opposite elucidation: in time of economic hardship and rising unemployment, individuals tend to be more stressed, depressed, and likely to undertake unhealthy behaviors that may negatively affect health outcomes. The most recent study published last month in the leading journal The Lancet shows that there is a strong positive association between the unemployment increases and rise in cancer mortality, but only in the countries without universal health coverage, suggesting that these types of healthcare systems protects the citizens from health consequences of the crisis.
Beyond offering inconclusive results on the direction of impact between economic crisis and health outcomes, available studies present two important limitations. First, the majority of these analyses is based on cross-country aggregated data that use macro-economic indicators to make inference on individual behavior. Second important limitation is reflected in the fact that none of the studies available makes an effort in understanding the mechanisms behind the associations found. In other words, how, which ways economic crisis affects health outcomes? Are we worse off because we have reduced access to health care due to decrease in health expenditure or because crisis induce us to engage in risky behavior leading to higher incidence of certain diseases? Or both?

One of the very few studies that made use of individual level data to investigate the impact of economic crisis on health has been recently published by two Bocconi researchers (Aleksandra Torbica and Simone Ghislandi) in collaboration with a prominent cardiologist (Aldo Pietro Maggioni), director of research division of the Italian Association of Cardiology. We focused our analysis on Acute Myocardial Infarction (AMI) since the determinants of heart attacks are well known and they are certainly affected by macroeconomic and environmental conditions. The results show that there is a clear and strong pattern between the strength of the crisis (measured through increase in unemployment rates) and hospitalizations for AMI from 2009 to 2012. Number of hospitalizations increased significantly in the areas where the crisis hit more strongly. More specifically, compared with the other hospitals in the country, in the 107 hospitals situated in the crisis-exposed areas, 30 additional (13%) AMI cases, 200 additional hospital days (13%) and 2 additional in-hospital deaths (17%) were observed. Moving down the “crisis intensity” scale, the role of the economic environment tends to lose importance in predicting changes in AMI occurrence. Hospitalizations for AMI remain stable (or decrease) in areas less affected by the crisis.  In these areas, the incidence of AMI does not increase (and can even reduce), as predicted by the “healthy living in hard times” literature. These findings shed new insights in the relationship between the crisis intensity and occurrence and the impact on AMI incidence: rather than being positive or negative across all value it is U shaped. In other words, a little bit of crisis may be even good for our health, but after certain point the impact becomes detrimental.