We are in the midst of a global recession as a result of the COVID-19 pandemic and attendant lockdown measures. Both the pandemic and the lockdown have each, on their own, worsened health outcomes. This fact has been relatively well covered by the media. What is missing from this discussion is that the resulting recession, forecast to be the largest in generations, will itself, in all likelihood, worsen health outcomes among the broader population.
By all accounts, the global economy has fallen off a cliff. Due to the shutdown of business-as-usual to contain the spread of the novel coronavirus, most major economies worldwide are anticipating sharp contractions in their economies. It’s unclear if this is a short-term, acute dip, or if we are at the very beginning of the worst recession ever recorded. Right now, what is clear is that many people are facing decreased household incomes or unemployment.
What does this mean for our health? Of course, the pandemic itself has worsened population health in ways we are only just beginning to understand. But, for a moment, let’s consider only the impact of the current economic recession on health.
Worsening mental health outcomes are often the first casualties of recessions: suicide rates tend to spike relatively rapidly in response to recessions. However, in their first few years, recessions can have a neutral, or even positive, impact on mortality rates overall. Rises in suicides are generally offset by decreases in road fatalities; with fewer people commuting to work, there are fewer road accidents. Further, with fewer people working, recessions often see fewer deaths as a result of fewer occupational hazards. Indeed, when looking at mortality rates alone in the immediate aftermath of recessions, some studies have declared that recessions actually improve health.
However, this short-term view may obscure the bigger picture. Study after study has found that money matters for health: each dollar someone earns is associated with a variety of improved health outcomes, from increased life expectancy to improved health-related quality of life. This relationship persists above and beyond what it takes to ‘buy’ better health. It is not simply that wealthier people have access to better homes, jobs and health care that contributes to them being healthier overall. It also appears, in part, that increased wealth is associated with decreased stress.
Feeling stressed is a fight-or-flight response, which, although evolutionarily useful, has been made less so by the exigencies of modern life. Instead of fleeing from predators or fighting our enemies, we now simmer at our desks, building up cortisol levels rather than burning them off. In turn, elevated cortisol levels over a long period are associated with increased blood cholesterol, triglyceride and blood sugar levels and higher blood pressure: the key risk factors for heart disease. The time horizon for these long-term health consequences to become evident is decades, not months or years. In this way, the long-term health consequences of economic stress can often be overlooked by researchers.
Recessions dramatically increase stress levels. Recent studies have established links between an acute loss of wealth and worsened health outcomes. Let’s not forget that this economic recession comes on top of a pandemic, which has acutely worsened health outcomes in very different ways. The closest (although not very good) analogue to this situation is the 1918 Spanish flu, when individuals entering the labour market during or immediately after the pandemic were worse off across their careers than people entering the labour market earlier or later. Of course, the impact of joblessness or job insecurity can be offset by strong social security systems, or worsened by weak ones.
Even so, there is strong evidence that experiencing a recession – particularly on the back of a pandemic – can leave deep scars on individuals’ careers and, ultimately, health outcomes. If history is a useful guide (and it usually is), our health is in trouble.
Correction: In the original blog post published on 6 November 2020, two sentences in the fourth paragraph mistakenly confused reduced health care as a result of COVID-19 with reduced care as the result of a recession. The post has been updated to correct the error.
Kristina Thompson is a PhD candidate in the Health Sciences department at the Vrije Universiteit Amsterdam. She is interested in the way that social and economic forces affect health outcomes (and vice versa). Her research focuses on the influence of the Eurozone’s Great Recession on health, as well as body height’s influence on later-life social, economic and health outcomes. She holds Master’s degrees in history (from the University of Cambridge) and health and society (from Wageningen University).