Year: 2016 Source: The Lancet.(2009).374 (9686):315Ð323. doi:10.1016/S0140-6736(09)61124-7 SIEC No: 20160371

Background There is widespread concern that the present economic crisis, particularly its effect on unemployment, will adversely affect population health. We investigated how economic changes have affected mortality rates over the past three decades and identified how governments might reduce adverse effects. Methods We used multivariate regression, correcting for population ageing, past mortality and employment trends, and country-specific differences in health-care infrastructure, to examine associations between changes in employment and mortality, and how associations were modified by different types of government expenditure for 26 European Union (EU) countries between 1970 and 2007. Findings We noted that every 1% increase in unemployment was associated with a 0á79% rise in suicides at ages younger than 65 years (95% CI 0á16Ð1á42; 60Ð550 potential excess deaths mean 310 EU-wide), although the effect size was non-significant at all ages (0á49%, −0á04 to 1á02), and with a 0á79% rise in homicides (95% CI 0á06Ð1á52; 3Ð80 potential excess deaths mean 40 EU-wide). By contrast, road-traffic deaths decreased by 1á39% (0á64Ð2á14; 290Ð980 potential fewer deaths mean 630 EU-wide). A more than 3% increase in unemployment had a greater effect on suicides at ages younger than 65 years (4á45%, 95% CI 0á65Ð8á24; 250Ð3220 potential excess deaths mean 1740 EU-wide) and deaths from alcohol abuse (28á0%, 12á30Ð43á70; 1550Ð5490 potential excess deaths mean 3500 EU-wide). We noted no consistent evidence across the EU that all-cause mortality rates increased when unemployment rose, although populations varied substantially in how sensitive mortality was to economic crises, depending partly on differences in social protection. Every US$10 per person increased investment in active labour market programmes reduced the effect of unemployment on suicides by 0á038% (95% CI −0á004 to −0á071). Interpretation Rises in unemployment are associated with significant short-term increases in premature deaths from intentional violence, while reducing traffic fatalities. Active labour market programmes that keep and reintegrate workers in jobs could mitigate some adverse health effects of economic downturns.