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    • br Acknowledgments The authors would like to acknowledge

    2018-11-05


    Acknowledgments The authors would like to acknowledge their funders, the Bill and Melinda Gates Foundation (Grant No. A121947), in supporting this work. In addition, the authors would like to thank Emily Treleaven and Kanksha Singh for helping with data collection activities.
    Background Following the collapse of the global financial markets in 2007, the initial months of 2008 witnessed the US and European governments entering into an unprecedented public rescue package for the banking sector (Gamble, 2009). This followed concern that whole national economies would collapse – and indeed the financial crisis resulted in the longest Prosaptide TX14(A) of global recession in the post-war era (Gamble, 2009). The common European response to the ensuing increase in national debt and increased unemployment has been the new politics of austerity, which has seen widespread programmes of public spending cuts (Kitson, Martin & Tyler, 2011). Subsequently, since 2010, the UK government has pursued the implementation of lower public spending and market led growth to reduce the national deficit. Public services, investment in public infrastructure and expenditure on welfare have been significantly reduced (Kitson et al., 2011). Previous research has shown that such significant changes in the economy can have important negative implications for population health and inequalities in health with increases in suicides, rates of mental ill health and chronic illnesses (Barr, Taylor-Robinson & Scott-Samuel, 2012; Stuckler & Basu, 2013). Unemployment increases during economic downturns and is itself strongly associated with greater morbidity and mortality (Bambra, 2011), particularly mental health problems, such as depression and stress (Janlert, 1997; Hagquist, Silburn, Zurbrick, Lindberg & Ringbäck, 2000), suicide and suicide attempts (Platt, 1986; Newman & Bland, 2007; Lewis & Sloggett, 1998). Recessions are also characterised by an increase in job insecurity and ‘precarious’ employment, both of which are associated with higher rates of stress, and mental ill-health (Ferrie, Shipley, Stansfeld & Marmot, 2002). Studies have found however, that there are important national policy variations in the effects of recessions and economic downturns on population health. For example, Stuckler and Basu (2013) found that the population health effects of recessions vary significantly by policy context with those countries (such as Iceland and the USA) which responded to the financial crisis of 2007 with an economic stimulus, faring much better – particularly in terms of mental health and suicides – than those countries (e.g. Spain, Greece and the UK) which chose to pursue a policy of austerity. Similarly, Hopkins (2006) found that in Thailand and Indonesia, where social welfare spending decreased during the Asian recession of the late 1990s, mortality rates increased. However, in Malaysia, where no cut-backs occurred, mortality rates were unchanged (Hopkins, 2006). Similarly, Stuckler, Basu, Suhrcke, Coutts and McKee (2009) study of 26 European countries concluded that greater spending on social welfare could considerably reduce suicide rates during periods of economic downturn. Further, the economic effects of austerity are not distributed evenly within a country or population, either spatially or socially. Within the UK, some areas (such as the north-east of England and more deprived local authorities) have experienced greater public budget reductions and been more affected by changes to welfare benefits than others (Beatty & Fothergill, 2016). This has disproportionately impacted on the availability of key services in these areas, widening social inequalities within them and spatial inequalities between them and other areas (Pearce, 2013; Bambra & Garthwaite, 2015). Health inequalities are intimately linked to social inequalities and so a widening of social inequality, as a result of austerity, may lead to a further exacerbation of social and spatial health inequalities. This of course also includes inequalities in mental health.