The Economic Crisis and its Effects on the Social Determinants of Health

With the economic crisis, the fight against unemployment in most countries 1 is coetaneous to the need to restrain public expenditure in closing budget deficits. As a consequence, spending cuts have started to affect a large number of decisions that directly or indirectly may be expected to have an impact on health. These effects are likely to be unevenly distributed among different groups within the population. Therefore, not just health levels but also its distribution may be at risk with the financial consequences of the crisis. The main message of this paper is to show first social concern on the nature of the trade-offs in redefining expenditure priorities. On the prescriptive side of our work we argue that in the present situation we should not focus so much on health expenditure as we should do on the social protection system as a whole. In addition, to fight against poverty (and not so much focusing on income inequality in itself) should be the most important consideration for health policy design. Thus, more selective, tailored made combination of integrated policies should be addressed. Fragile groups need to be prioritized at this stage in battling for poverty alleviation (poverty induces health losses) and for a sound job creation economy (workfare strategies require health at the same time that they produce health). Universal old-style welfare policies commonly lack focus, are not financially sustainable, and overall, they have lower redistributive impacts. Otherwise, random, not well understood, effects in welfare may result from these policies due to side effects from economic crisis, unemployment and changes in life style. Results may also depend on the type of groups benefiting from sustained social spending in practice. A welfare function is required in order to compare "losers" and "winners". This is a part of the second welfare theorem where non superior Pareto agreements are achievable, and lack of consensus may easily emerge, in designing health strategies since politics may not build the necessary consensus for policies.