Is austerity a cause of slower improvements in mortality in high-income countries? A panel analysis

McCartney, G. , McMaster, R. , Popham, F. , Dundas, R. and Walsh, D. (2022) Is austerity a cause of slower improvements in mortality in high-income countries? A panel analysis. Social Science and Medicine, 313, 115397. (doi: 10.1016/j.socscimed.2022.115397) (PMID:36194952)

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Background: The rate of improvement in mortality slowed across many high-income countries after 2010. Following the 2007–08 financial crisis, macroeconomic policy was dominated by austerity as countries attempted to address perceived problems of growing state debt and government budget deficits. This study estimates the impact of austerity on mortality trends for 37 high-income countries between 2000 and 2019. Methods: We fitted a suite of fixed-effects panel regression models to mortality data (period life expectancy, age-standardised mortality rates (ASMRs), age-stratified mortality rates and lifespan variation). Austerity was measured using the Alesina-Ardagna Fiscal Index (AAFI), Cyclically-Adjusted Primary Balance (CAPB), real indexed Government Expenditure, and Public Social Spending as a % of GDP. Sensitivity analyses varied the lag times, and confined the panel to economic downturns and to non-oil-dominated economies. Results: Slower improvements, or deteriorations, in life expectancy and mortality trends were seen in the majority of countries, with the worst trends in England & Wales, Estonia, Iceland, Scotland, Slovenia, and the USA, with generally worse trends for females than males. Austerity was implemented across all countries for at least some time when measured by AAFI and CAPB, and for many countries across all four measures (and particularly after 2010). Austerity adversely impacted life expectancy, ASMR, age-specific mortality and lifespan variation trends when measured with Government Expenditure, Public Social Spending and CAPB, but not with AAFI. However, when the dataset was restricted to periods of economic downturn and in economies not dominated hydrocarbon production, all measures of austerity were found to reduce the rate of mortality improvement. Interpretation: Stalled mortality trends and austerity are widespread phenomena across high-income countries. Austerity is likely to be a cause of stalled mortality trends. Governments should consider alternative economic policy approaches if these harmful population health impacts are to be avoided.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Popham, Dr Frank and McMaster, Professor Robert and McCartney, Professor Gerard and Walsh, Dr David and Dundas, Professor Ruth
Authors: McCartney, G., McMaster, R., Popham, F., Dundas, R., and Walsh, D.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
College of Social Sciences > Adam Smith Business School > Management
College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
Journal Name:Social Science and Medicine
ISSN (Online):1873-5347
Published Online:29 September 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Social Science and Medicine 313: 115397
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3048231Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048231Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit