Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Health and health behaviours before and during the Great Recession, overall and by socioeconomic status, using data from four repeated cross-sectional health surveys in Spain (2001–2012)

Authors: Xavier Bartoll, Veronica Toffolutti, Davide Malmusi, Laia Palència, Carme Borrell, Marc Suhrcke

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

The objective of this study was to estimate changes over time in health status and selected health behaviours during the Great Recession, in the period 2011/12, in Spain, both overall, and according to socioeconomic position and gender.

Methods

We applied a before-after estimation on data from four editions of the Spanish National Health Survey: 2001, 2003/04, 2006/07 and 2011/12. This involved applying linear probability regression models accounting for time-trends and with robust standard errors, using as outcomes self-reported health and health behaviours, and as the main explanatory variable a dummy “Great Recession” for the 2011/12 survey edition. All the computations were run separately by gender. The final sample consisted of 47,156 individuals aged between 25 and 64 years, economically active at the time of the interview. We also assessed the inequality of the effects across socio-economic groups.

Results

The probability of good self-reported health increased for women (men) by 9.6 % (7.6 %) in 2011/12, compared to the long term trend. The changes are significant for all educational levels, except for the least educated. Some healthy behaviours also improved but results were rather variable. Adverse dietary changes did, however, occur among men (though not women) who were unemployed (e.g., the probability of declaring eating fruit daily changed by −12.1 %), and among both men (−21.8 %) and women with the lowest educational level (−15.1 %).

Conclusions

Socioeconomic inequalities in health and health behaviour have intensified, in the period 2011/12, in at least some respects, especially regarding diet. While average self-reported health status and some health behaviours improved during the economic recession, in 2011/12, this improvement was unequal across different socioeconomic groups.
Appendix
Available only for authorised users
Footnotes
1
Income elasticity of 0.993 for fruits and vegetables, 1.052 for meat, 0.639 for fish; meaning for instance that a 10 % reduction of income will reduce expenditure of about 9.9 %, so fish appears to be more needed than the other. Uncompensated own price elasticity values are: −0.739 for fruits and vegetables, −0.656 for meat, and −0.184 for fish; meaning that a 10 % increase in fruit and vegetable prices reduces consumption about 7.4 % but only 1.84 for fish for the year 2003 from the Spanish Quarterly Household National Expenditure Survey 2003 [64].
 
Literature
1.
2.
3.
4.
Gili M, Roca M, Basu S, McKee M, Stuckler D. The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010. Eur J Public Health. 2013;23(1):103–8.CrossRefPubMed
5.
Bartoll X, Palència L, Malmusi D, Suhrcke M, Borrell C. The evolution of mental health in Spain during the economic crisis. Eur J Public Health. 2014;24:415–8.CrossRefPubMed
6.
Urbanos-Garrido RM, Lopez-Valcarcel BG. The influence of the economic crisis on the association between unemployment and health: an empirical analysis for Spain. Eur J Health Econ. 2015;16:175–84.CrossRefPubMed
7.
Lopez Bernal JA, Gasparrini A, Artundo CM, McKee M. The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis. Eur J Public Health. 2013;23(5):732–6.CrossRefPubMed
8.
Regidor E, Barrio G, Bravo MJ, de la Fuente L. Has health in Spain been declining since the economic crisis? J Epidemiol Community Health. 2014;68:280–2.CrossRefPubMed
9.
CSDH. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the commission on social determinants of health. Geneva: World Health Organization; 2008.
10.
11.
Simou E, Koutsogeorgou E. Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: a systematic review. Health Policy. 2014;115(2-3):111–9.CrossRefPubMed
12.
Suhrcke M, Stuckler D. Will the recession be bad for our health? It depends. Soc Sci Med. 2012;74(5):647–53.CrossRefPubMed
13.
Kondo N, Subramanian SV, Kawachi I, Takeda Y, Yamagata Z. Economic recession and health inequalities in Japan: analysis with a national sample, 1986–2001. J Epidemiol Community Health. 2008;62(10):869–75.CrossRefPubMedPubMedCentral
14.
Hiyoshi A, Fukuda Y, Shipley MJ, Brunner EJ. Inequalities in self-rated health in Japan 1986–2007 according to household income and a novel occupational classification: national sampling survey series. J Epidemiol Community Health. 2013;67(11):960–5.CrossRefPubMed
15.
Wada K, Kondo N, Gilmour S, Ichida Y, Fujino Y, Satoh T, et al. Trends in cause specific mortality across occupations in Japanese men of working age during period of economic stagnation, 1980–2005: retrospective cohort study. BMJ. 2012;344:e1191.CrossRefPubMedPubMedCentral
16.
Asgeirsdottir TL, Corman H, Noonan K, Olafsdottir T, Reichman NE. Was the economic crisis of 2008 good for Icelanders? Impact on health behaviors. Econ Hum Biol. 2013;13:1–19.CrossRefPubMed
17.
18.
Gallus S, Ghislandi S, Muttarak R. Effects of the economic crisis on smoking prevalence and number of smokers in the USA. Tob Control. 2013;24(1):82–8.CrossRefPubMed
19.
Harhay MO, Bor J, Basu S, McKee M, Mindell JS, Shelton NJ, et al. Differential impact of the economic recession on alcohol use among white British adults, 2004–2010. Eur J Public Health. 2013;24(3):410–5.CrossRefPubMed
20.
Bor J, Basu S, Coutts A, McKee M, Stuckler D. Alcohol use during the great recession of 2008–2009. Alcohol. 2013;48(3):343–8.CrossRef
21.
Charles KK, Decicca P. Local labor market fluctuations and health: is there a connection and for whom? J Health Econ. 2008;27(6):1532–50.CrossRefPubMed
22.
Gallus S, Odone A, Lugo A, Bosetti C, Colombo P, Zuccaro P, et al. Overweight and obesity prevalence and determinants in Italy: an update to 2010. Eur J Nutr. 2013;52(2):677–85.CrossRefPubMed
23.
Dave DM, Kelly IR. How does the business cycle affect eating habits? Soc Sci Med. 2012;74(2):254–62.CrossRefPubMed
24.
Catalano R, Goldman-Mellor S, Saxton K, Margerison-Zilko C, Subbaraman M, LeWinn K, et al. The health effects of economic decline. Annu Rev Public Health. 2011;32:431–50.CrossRefPubMed
25.
Colman G. National bureau of economic research. Exercise physical activity and exertion over the business cycle. Cambridge: Mass.: National Bureau of Economic Research; 2011.CrossRef
26.
Sweet E, Nandi A, Adam EK, McDade TW. The high price of debt: household financial debt and its impact on mental and physical health. Soc Sci Med. 2013;91:94–100.CrossRefPubMedPubMedCentral
27.
Lallukka T, Ferrie JE, Kivimaki M, Shipley MJ, Rahkonen O, Lahelma E. Economic difficulties and subsequent sleep problems: evidence from British and Finnish occupational cohorts. Sleep Med. 2012;13(6):680–5.CrossRefPubMedPubMedCentral
28.
Berkowitz L. Frustration-aggression hypothesis: examination and reformulation. Psychol Bull. 1989;106:59–73.PubMed
29.
Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet. 2009;374:315–23.CrossRefPubMed
30.
Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, et al. Financial crisis, austerity, and health in Europe. Lancet. 2013;381:1323–31.CrossRefPubMed
31.
Kondilis E, Giannakopoulos S, Gavana M, Ierodiakonou I, Waitzkin H, Benos A. Economic crisis, restrictive policies, and the population’s health and health care: The greek case. Am J Public Health. 2013;103:973–80.CrossRefPubMedPubMedCentral
32.
33.
Meghir C, Palme M. Educational reform, ability, and family background. Am Econ Rev. 2005;95(1):414–24.CrossRef
34.
Angrist JD. Mostly harmless econometrics : an empiricist’s companion. Princeton, NJ, Oxford: Princeton University Press; 2009.
35.
Euroepan Health Interviews Survey Guidelines. EHIS data delivery guidelines. EUROSTAT. Luxemburg. Last Update: 15 January 2010.
36.
Indicadores de salud. Evolución de los indicadores del estado de salud en España y su magnitud en el contexto Europeo. Ministerio de Sanidd Servicios Sociales e Igualdad. Madrid. 2013.
37.
Martikainen P, Aromaa A, Heliövaara M, Klaukka T, Knekt P, Maatela J, et al. Reliability of perceived health by sex and age. Soc Sci Med. 1999;48:1117–22.CrossRefPubMed
38.
Pietz K, Petersen LA. Comparing self-reported health status and diagnosis-based risk adjustment to predict 1- and 2 to 5-year mortality. Health Serv Res. 2007;42:629–43.CrossRefPubMedPubMedCentral
39.
Salas-Salvadó J, Rubio MA, Barbany M, Moreno B. Consenso SEEDO 2007 para la evaluación del sobrepeso y la obesidad y el establecimiento de criterios de intervención terapéutica. Med Clin. 2007;128(5):184–96.CrossRef
40.
Alvarez GG, Ayas NT. The impact of daily sleep duration on health: a review of the literature. Prog Cardiovasc Nurs. 2004;19:56–9.CrossRefPubMed
41.
Gallicchio L, Kalesan B. Sleep duration and mortality: a systematic review and meta-analysis. J Sleep Res. 2009;18:148–58.CrossRefPubMed
42.
Gorber SC, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res. 2009;11(1):12–24.CrossRef
43.
Milton K, Bull FC, Bauman A. Reliability and validity testing of a single-item physical activity measure. Br J Sports Med. 2011;45:203–8.CrossRefPubMed
44.
45.
Del Boca FK, Darkes J. The validity of self-reports of alcohol consumption: state of the science and challenges for research. Addiction. 2003;98 Suppl 2:1–12.CrossRefPubMed
46.
Anderson P, Cremona A, Paton A, Turner C, Wallace P. The risk of alcohol. Addiction. 1993;88(11):1493–508.CrossRefPubMed
47.
Cade JE, Burley VJ, Warm DL, Thompson RL, Margetts BM. Food-frequency questionnaires: a review of their design, validation and utilisation. Nutr Res Rev. 2004;17:5–22.CrossRefPubMed
48.
Mikkelsen TB, Olsen SF, Rasmussen SE, Osler M. Relative validity of fruit and vegetable intake estimated by the food frequency questionnaire used in the Danish National Birth Cohort. Scand J Public Health. 2007;35:172–9.CrossRefPubMed
49.
Sancho J, Reinoso, D. Delimitation of the rural area: a key issue in rural development programs. Estudios Geograficos. 2012;23:599–624.
50.
Domingo-Salvany A, Bacigalupe A, Carrasco JM, Espelt A, Ferrando J, Borrell C. Propuestas de clase social neoweberiana y neomarxista a partir de la clasificación nacional de ocupaciones 2011. Gac Sanit. 2013;27:263–72.CrossRefPubMed
51.
Warren JR, Hoonakker P, Carayon P, Brand J. Job characteristics as mediators in SES-health relationships. Soc Sci Med. 2004;59(7):1367–78.CrossRefPubMed
52.
Meltzer H, Bebbington P, Brugha T, Jenkins R, McManus S, Stansfeld S. Job insecurity, socio-economic circumstances and depression. Psychol Med. 2010;40(8):1401–7.CrossRefPubMed
53.
Martikainen PT, Valkonen T. Excess mortality of unemployed men and women during a period of rapidly increasing unemployment. Lancet. 1996;348(9032):909–12.CrossRefPubMed
54.
Valkonen T, Martikainen P, Jalovaara M, Koskinen S, Martelten T, Makela P. Changes in socioeconomic inequalities in mortality during an economic boom and recession among middle-aged men and women in Finland. Eur J Public Health. 2000;10:4.CrossRef
55.
Turner JB. Economic context and the health effects of unemployment. J Health Soc Behav. 1995;36(3):213–29.CrossRefPubMed
56.
Butterworth P, Leach LS, McManus S, Stansfeld SA. Common mental disorders, unemployment and psychosocial job quality: is a poor job better than no job at all? Psychol Med. 2013;43(8):1763–72.CrossRefPubMed
57.
Janlert U, Winefield AH, Hammarström A. Length of unemployment and health-related outcomes a life-course analysis. Eur J Public Health. 2004;25(4):662–7.CrossRef
58.
Vandoros S, Hessel P, Leone T, Avendano M. Have health trends worsened in Greece as a result of the financial crisis? A quasi-experimental approach. Eur J Public Health. 2013;23(5):727–31.CrossRefPubMed
59.
Zavras D, Tsiantou V, Pavi E, Mylona K, Kyriopoulos J. Impact of economic crisis and other demographic and socio-economic factors on self-rated health in Greece. Eur J Public Health. 2013;23(2):206–10.CrossRefPubMed
60.
Martinez-Sanchez JM, Fu M, Gallus S, Sureda X, La Vecchia C, Fernandez E. Variability in cigarette consumption according to the data source in Spain (1993–2009). Gac Sanit. 2013;27(1):61–3.CrossRefPubMed
61.
62.
Tekin E. Health and health behaviors during the worst of times: evidence from the Great Recession. NBER working paper series. 2013; working paper 19234.
63.
Nandi A, Charters TJ, Strumpf EC, Heymann J, Harper S. Economic conditions and health behaviours during the ‘Great Recession’. J Epidemiol Community Health. 2013;67(12):1038–46.CrossRefPubMed
64.
Gil JM, Angulo AM, Nadhem M. The Impact of Price Intervention Policies to Improve Dietary Quality in Spain. 2009 Pre-Conference Workshop, August 16, 2009, Diet and Obesity: Role of Prices and Policies 53337, International Association of Agricultural Economists. [Accessed 4 Januar 2014. http://​purl.​umn.​edu/​53337].
Metadata
Title
Health and health behaviours before and during the Great Recession, overall and by socioeconomic status, using data from four repeated cross-sectional health surveys in Spain (2001–2012)
Authors
Xavier Bartoll
Veronica Toffolutti
Davide Malmusi
Laia Palència
Carme Borrell
Marc Suhrcke
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2204-5

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Study protocol

ASPIRE: A multi-site community-based participatory research project to increase understanding of the dynamics of violence against immigrant and refugee women in Australia

Research article

Tobacco prevention policies in west-African countries and their effects on smoking prevalence

Research article

Evaluation of the impact of a mobile health system on adherence to antenatal and postnatal care and prevention of mother-to-child transmission of HIV programs in Kenya

Research article

A cross-sectional study of the magnitude, barriers, and outcomes of HIV status disclosure among women participating in a perinatal HIV transmission study, “the Nevirapine Repeat Pregnancy study”

Research article

The association of physical activity, body mass index and the blood pressure levels among urban poor youth in Accra, Ghana

Research article

Impact of migration origin on individual protection strategies against sexual transmission of HIV in Paris metropolitan area, SIRS cohort study, France