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The Role of Social Determinants in Tackling Health Objectives in a Context of Economic Crisis

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The impact of the economic crisis on health through its social determinants has the greatest effect on disadvantaged, low income households as they are more vulnerable to falls in income and are more likely to suffer the employment effects of an economic crisis. They are subject to exclusionary processes that lead to worse health both in the short and long term.

The health impacts of an economic crisis include an increase in suicides, homicides and cardiovascular mortality, a fall in road traffic accidents, and worse infectious disease and mental health outcomes. Those who become unemployed have a greater risk of poor health than the employed, while employees may be affected by the rise in insecure and temporary work and a greater effort-reward imbalance. As the cost of living rises faster than incomes, more households fall below a minimum income necessary to live a healthy life. There are higher levels of poverty, greater income inequalities and more households with debt problems or other financial difficulties. Lower incomes lead to more homelessness and fuel poverty. All of these factors are associated with worse physical and mental health.

Health inequalities are likely to widen following an economic crisis, though policy responses can help to mitigate the impacts. Higher levels of social spending are associated with better health outcomes and reduced inequalities, whereas research suggests that austerity measures do not have positive health effects. Health equity impact assessments should be carried out on all policies. Specific policy areas covered in the recommendations include universal health coverage, active labour market programmes, a fairer tax system, homelessness prevention, housebuilding, debt relief and fuel poverty measures. Local interventions can also do much to improve daily living conditions, through improving public services and resilience to financial and other shocks.


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Correspondence to Sir Michael Marmot FRCP.

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Marmot, M., Bloomer, E. & Goldblatt, P. The Role of Social Determinants in Tackling Health Objectives in a Context of Economic Crisis. Public Health Rev 35, 9 (2013).

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Key Words

  • Economic recession
  • health
  • socioeconomic factors
  • employment
  • income
  • housing