Economic crises often leave sequels on the health of the public at large who suffer most directly. The studies carried out during these periods do indeed demonstrate this. However, the effects suffered by some countries, in the case of Spain and Iceland, were different.
According to the study Financial Crisis, austerity and health in Europe (Financial crisis, austerity, and health in Europe.) Conducted by Marina Karanikolosac, Philipa Mladovskyc, Jonathan Cylusac, Sarah Thomsonc, Sanjay Basud, David Stucklerd, Johan P Mackenbache and Martin McKee, the effects on public health of the economic crisis are visible, particularly in the countries most affected by the recession; however, Iceland to date has avoided the negative effects on health.
Strong social protection mechanisms (both official and unofficial) can alleviate some negative effects of the recession on health, such as an increase in suicides.
Austerity measures may exacerbate the short-term effects on public health of the economic crisis, for example by cutting costs or increasing the copayment on health care, which reduces access and diverts the economic burden to families themselves.
Political responses to a similar set of economic impacts varied across countries and resulted in different health outcomes, creating substance for future research on how economic changes affect health, how policy responses can alleviate risks and why some societies have more adaptability than others.
The economic crisis and the measures against it have pronounced and unintended effects on public health, until now experts in the field have largely been silent.
THE CASE OF SPAIN
Between 2006 and 2016, the prevalence of mental disorders in people who attended primary care increased significantly, particularly the problems of mood, anxiety, psychosomatic and alcohol-related; the increase in the prevalence of severe depression was the greatest of all. Gili and colleagues estimated that at least half of that increase in attending mental disorders could be attributed to individual or family risks of unemployment and difficulties in paying mortgages.
The loss of family income affects mainly the weakest and most vulnerable members of society.
In Catalonia between 2005 and 2010, the proportion of children at risk of poverty increased from 20.6% to 23.7% and that of those unemployed who lived which with their families going from 3.7% to 11.2% 78. Families are increasingly turning to non-governmental organisations (NGOs) in search of food, shelter, employment, legal advice and psychological support.
Closures of health services, reductions in the number of hospital beds and in the hours of work of professionals have been announced in Catalonia. Co-payments have been introduced for medications for pensioners and increases in the contribution to the co-payment by those who have higher incomes. In April 2012, a law that converted universal health coverage to employment-based coverage was introduced by royal decree (skipping parliament). A consequence of this rule was that hundreds of thousands of illegal immigrants would only have emergency, maternity and paediatric care.
THE CASE OF ICELAND
What would have happened if European governments had refused to rescue the collapsing banks? Each country is different, but Iceland's experience is instructive. In the mid-1990s, a few Icelandic bankers and politicians decided that the future prosperity of their country depended on it becoming a global financial centre. The strict banking regulations of the past were thrown out of the window and the banks tempted investors from many countries with interest rates that seemed too good to be true. A few experts, such as the British economist Robert Wade, predicted that there would be problems, but the global financial group rejected these calls for caution.
When the subprime mortgage market collapsed, Icelandic banks faced massive losses.
They appealed to the International Monetary Fund (IMF), which indicated a package of rescue measures by which the Icelandic government would assume responsibility for the losses of the banks, which would have meant 50% of the GNP between 2016 and 2023 that would have to be paid to the governments of the United Kingdom and the Netherlands. The Icelandic government agreed but the president refused to approve that operation. A referendum was held and 93% of the people rejected the rescue package. The creditors of the Icelandic banks were furious; the UK government invoked anti-terrorist legislation to freeze Icelandic assets. Iceland let the value of the Króna (Icelandic currency) plunge so that the price of imported products went through the roof and many Icelanders suffered significant reductions in their income. However, the effects on health were almost imperceptible. Suicides did not increase. When the crisis happened, the frequency of cardiac emergencies increased a little, but the peak subsided after one week.
A national health and well-being survey showed that the crisis had little effect on the nation's happiness.
How can the absence of negative effects be explained? First, Iceland ignored the advice of the IMF and, instead, invested in social protection. This investment was combined with active measures to get people back to work. Secondly, they improved their diet. McDonalds left the country because of rising import costs for onions and tomatoes (the most expensive ingredients in their burgers). The Icelanders began to cook more at home (particularly fish, raising the income of the country's fishing fleet). Thirdly, Iceland maintained its restrictive policies regarding alcohol, also against the advice of the IMF. Finally, the Icelandic people made use of their strong reserves of social capital, and all truly felt that they were united by the crisis. Although extrapolating this to other countries has to be done carefully, Iceland, challenging economic orthodoxy at every step of its response, has shown that there is indeed an alternative to austerity.
