Skip to main content


Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

A Review of Health Consequences of Recessions Internationally and a Synthesis of the US Response during the Great Recession


The 2007 global economic recession was the most severe recession since the Great Depression of the 1930s in terms of declines in unemployment, labor force participation and gross domestic product in the United States. In order to guide future public health policies during economic downturns, we reviewed and synthesized the literature on the health consequences of the current and prior recessions focusing on the government response to the recession in the United States. We searched for primary literature in three academic and three policy databases using the indexed and free-text terms “recession”, “health”, “mortality”, “employment”, “unemployment”, “foreclosure”, “pensions”, fiscal”, “deficit”, “morbidity”, “avoidable mortality”, “amenable mortality”, “budget”, and “budget crisis” in various combinations. The search resulted in 172 English language studies published from 1 January 1980 through 1 April 2013 that met the inclusion criteria. The data synthesis was structured into two themes: new developments in our understanding of changes in morbidity or mortality risk related to recession or fiscal austerity, and public health system responses to the recession under fiscal constraints. We found consistent evidence that recessions, and unemployment in particular, can be significantly damaging to mental health, increasing the risk of substance abuse and suicide particularly for young men. We also found that the previously reported mortality declines during recessions may occur in only a few causes of death such as reduced automobile deaths. In addition, the expansion of Medicaid, Supplemental Nutrition Assistance Program, and unemployment benefits under American Recovery and Reinvestment Act of 2009 likely had substantial buffering effects on health, especially among poor women and their children. These programs often excluded young single men, who are at highest risk of substance abuse and suicide. Thus, these populations should be targeted during downturns or integrated into safety net programs before the next recession.


  1. 1.

    Grusky DB, Western B, Wimer C, (editors.). The Great Recession. New York (NY): Russell Sage Foundation Publications; 2011.

  2. 2.

    Monea E, Sawhill IV. Simulating the effect of the “Great Recession” on poverty. Brookings; 10 September 2009. Available from URL: (Accessed 3 October 2013).

  3. 3.

    Iglehart JK. Expanding eligibility, cutting costs —a Medicaid update. N Engl J Med. 2011;366:105–7.

  4. 4.

    Neumayer E. Recessions lower (some) mortality rates: evidence from Germany. Soc Sei Med. 2004;58:1037–47.

  5. 5.

    Bor J, Basu S, Coutts A, McKee M, Stuckler D. Alcohol use during the Great Recession of 2008–2009. Alcohol Alcohol. 2013;48:343–8.

  6. 6.

    Boyd DJ. The bursting state fiscal bubble and state Medicaid budgets. Health Aff (Millwood). 2003;22:46–61.

  7. 7.

    Beeuwkes Buntin M, Haviland AM, McDevitt R, Sood N. Healthcare spending and preventive care in high-deductible and consumer-directed health plans. Am J Manag Care. 2011;17:222–30.

  8. 8.

    Dooley D, Catalano R. Why the economy predicts help-seeking: a test of competing explanations. J Health Soc Behav. 1984;25:160–76.

  9. 9.

    Dooley D, Fielding J, Levi L. Health and unemployment. Annu Rev Public Health. 1996;17:449–65.

  10. 10.

    Catalano R, Goldman-Mellor S, Saxton K, Margerison-Zilko C, Subbaraman M, et al. The health effects of economic decline. Annu Rev Public Health. 2011;32:431–50.

  11. 11.

    Dooley D, Prause J. The Social Costs of Underemployment. New York (NY): Cambridge University Press; 2004.

  12. 12.

    Ruhm CJ. Are recessions good for your health? Q J Econ. 2000;115:617–50.

  13. 13.

    Ruhm CJ. Healthy living in hard times. J Health Econ. 2005;24:341–63.

  14. 14.

    Ruhm CJ. A healthy economy can break your heart. Demography. 2007;44:829–48.

  15. 15.

    Ruhm CJ, Black WE. Does drinking really decrease in bad times? J Health Econ. 2002;21:659–78.

  16. 16.

    Gerdtham U, Ruhm CJ. Deaths rise in good economic times: evidence from the OECD. Econ Hum Biol. 2006;4:298–316.

  17. 17.

    Miller DL, Page ME, Stevens AH, Filipski M. Why are recessions good for your health? Am Econ Rev. 2009;99:122–7.

  18. 18.

    Tapia Granados JA, Diez Roux AV. Life and death during the Great Depression. Proc Natl Acad Sei USA. 2009;106:17290–5.

  19. 19.

    Sullivan D, von Wächter T. Job displacement and mortality: an analysis using administrative data. Q J Econ. 2009;124:1265–306.

  20. 20.

    Martikainen P, Mäki N, Jäntti M. The effects of unemployment on mortality following workplace downsizing and workplace closure: a register-based follow-up study of Finnish men and women during economic boom and recession. Am J Epidemiol. 2007;165:1070–5.

  21. 21.

    Garcy AM, Vagerö D. The length of unemployment predicts mortality, differently in men and women, and by cause of death: a six year mortality follow-up of the Swedish 1992–1996 recession. Soc Sei Med. 2012;74:1911–20.

  22. 22.

    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;62:869–75.

  23. 23.

    Ahs A, Westerling R. Self-rated health in relation to employment status during periods of high and of low levels of unemployment. Eur J Public Health. 2006;16:294–304.

  24. 24.

    Morris JK, Cook DG, Shaper AG. Loss of employment and mortality. BMJ. 1994;308:1135–9.

  25. 25.

    Browning M, Heinesen E. Effect of job loss due to plant closure on mortality and hospitalization. J Health Econ. 2012;31:599–616.

  26. 26.

    Mustard CA, Bielecky A, Etches J, Wilkins R, Tjepkema M, et al. Mortality following unemployment in Canada, 1991–2001. BMC Public Health 2013;13:441.

  27. 27.

    Lavis J. Unemployment and Mortality: A Longitudinal Study in the United States, 1968–1992. Hamilton: Centre for Health Economics and Policy Analysis, McMaster University; 1998.

  28. 28.

    Bartley M. Unemployment and ill health: understanding the relationship. J Epidemiol Community Health. 1994;48:333–7.

  29. 29.

    Blakely T. Unemployment and mortality: learning from the past in times of resurging unemployment. J Epidemiol Community Health. 2010;64:3–4.

  30. 30.

    Schmitz H. Why are the unemployed in worse health? The causal effect of unemployment on health. Labour Econ. 2011;18:71–8.

  31. 31.

    Wagenaar AF, Kompier MA, Houtman IL, van den Bossche SNJ, Taris TW. Employment contracts and health selection: unhealthy employees out and healthy employees in? J Occup Environ Med. 2012;54:1192–200.

  32. 32.

    Lundin A, Lundberg I, Hallsten L, Ottosson J, Hemmingsson T. Unemployment and mortality—a longitudinal prospective study on selection and causation in 49321 Swedish middle-aged men. J Epidemiol Community Health. 2010;64: 22–8.

  33. 33.

    Bockerman P, Ilmakunnas P. Unemployment and self-assessed health: evidence from panel data. Health Econ. 2009;18:161–79.

  34. 34.

    Modrek S, Cullen MR. Health consequences of the ‘Great Recession’ on the employed: evidence from an industrial cohort in aluminum manufacturing. Soc Sei Med. 2013;92:105–13.

  35. 35.

    Virtanen P, Janlert U, Hammarström A. Suboptimal health as a predictor of non-permanent employment in middle age: a 12-year follow-up study of the Northern Swedish Cohort. Int Arch Occup Environ Health. 2013;86:139–45.

  36. 36.

    Suhrcke M, Stuckler D. Will the recession be bad for our health? It depends. Soc Sei Med. 2012;74:647–53.

  37. 37.

    Stevens AH, Miller DL, Page ME, Filipski M. The Best of Times, the Worst of Times: Understanding Pro-cyclical Mortality. National Bureau of Economic Research Working Paper No. 17657; December 2011.

  38. 38.

    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.

  39. 39.

    Stuckler D, Meissner C, Fishback P, Basu S, McKee M. Banking crises and mortality during the Great Depression: evidence from US urban populations, 1929–1937. J Epidemiol Community Health. 2012;66:410–9.

  40. 40.

    Swendsen J, Conway KP, Degenhardt L, Glantz M, Jin R, et al. Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction 2010;105: 1117–28.

  41. 41.

    Catalano R. An emerging theory of the effect of economic contraction on alcohol abuse in the United States. Soc Just Res. 1997;10:191–201.

  42. 42.

    Ben Lakhdar C, Bastianic T. Economic constraint and modes of consumption of addictive goods. Int J Drug Policy 2011;22:360–5.

  43. 43.

    Bolton K, Rodriguez E. Smoking, drinking and body weight after re-employment: does unemployment experience and compensation make a difference? BMC Public Health. 2009;9:77.

  44. 44.

    Brenner MH. Relation of economic change to Swedish health and social well-being, 1950–1980. Soc Sei Med. 1987;25:183–95.

  45. 45.

    Giatti L, Barreto SM, César CC. Informal work, unemployment and health in Brazilian metropolitan areas, 1998 and 2003. Cad Saude Publica. 2008;24: 2396–406.

  46. 46.

    Houdmont J, Kerr R, Addley K. Psychosocial factors and economic recession: the Stormont Study. Occup Med (Lond). 2012;62:98–104.

  47. 47.

    Kozman D, Graziul C, Gibbons R, Alexander GC. Association between unemployment rates and prescription drug utilization in the United States, 2007–2010. BMC Health Serv Res. 2012;12:435.

  48. 48.

    Makela P. Alcohol-related mortality during an economic boom and recession. Contemp Drug Probs. 1999;26(3).

  49. 49.

    Mark TL, Levit KR, Vandivort-Warren R, Buck JA, Coffey RM. Changes In US spending on mental health and substance abuse treatment, 1986–2005, and implications for policy. Health Aff (Millwood). 2011;30:284–92.

  50. 50.

    Novo M, Hammarström A, Janlert U. Smoking habits—a question of trend or unemployment? A comparison of young men and women between boom and recession. Public Health. 2000;114:460–3.

  51. 51.

    O’Dowd A. Recession could increase alcohol and drug addiction and mental health problems, watchdog warns. BMJ. 2009;339:b3361.

  52. 52.

    Reine I, Novo M, Hammarström A. Does the association between ill health and unemployment differ between young people and adults? Results from a 14-year follow-up study with a focus on psychological health and smoking. Public Health. 2004;118:337–45.

  53. 53.

    Sand J, Välikoski A, Nordback I. Alcohol consumption in the country and hospitalizations for acute alcohol pancreatitis and liver cirrhosis during a 20-year period. Alcohol Alcohol. 2009;44:321–5.

  54. 54.

    Vijayasiri G, Richman JA, Rospenda KM. The Great Recession, somatic symptomatology and alcohol use and abuse. Addict Behav. 2012;37:1019–24.

  55. 55.

    Wagenaar AC, Streff FM. Macroeconomic conditions and alcohol-impaired driving. J Stud Alcohol. 1989;50:217–25.

  56. 56.

    Walberg P, McKee M, Shkolnikov V, Chenet L, Leon DA. Economic change, crime, and mortality crisis in Russia: regional analysis. BMJ. 1998;317:312–8.

  57. 57.

    Cotti C, Dunn R, Tefft N. The Dow is killing me: risky health behaviors and the stock market. Social Science Research Network; 25 January 2013.

  58. 58.

    McClure CB, Valdimarsdottir UA, Hauksdottir A, Kawachi I. Economic crisis and smoking behaviour: prospective cohort study in Iceland. BMJ Open. 2012;2(5).

  59. 59.

    Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health effects of financial crisis: omens of a Greek tragedy. Lancet. 2011;378:1457–8.

  60. 60.

    Collis J, Grayson A, Johal S. Econometric analysis of alcohol consumption in the UK. HMRC working paper 10. H M Revenue & Customs; December 2010.

  61. 61.

    Ayers JW, Althouse BM, Allem J-P, Childers MA, Zafar W, et al. Novel surveillance of psychological distress during the great recession. J Affect Disord. 2012;142:323–30.

  62. 62.

    Banks MH, Jackson PR. Unemployment and risk of minor psychiatric disorder in young people: cross-sectional and longitudinal evidence. Psychol Med. 1982;12:789–98.

  63. 63.

    Barr B, Taylor-Robinson D, Scott-Samuel A, McKee M, Stuckler D. Suicides associated with the 2008–10 economic recession in England: time trend analysis. BMJ. 2012;345:e5142.

  64. 64.

    Brown DW, Balluz LS, Ford ES, Giles WH, Strine TW, et al. Associations between short-and long-term unemployment and frequent mental distress among a national sample of men and women. J Occup Environ Med. 2003; 45:1159–66.

  65. 65.

    Burgard SA, Seefeldt KS, Zelner S. Housing instability and health: findings from the Michigan Recession and Recovery Study. Soc Sei Med. 2012;75: 2215–24.

  66. 66.

    Caplan RD, Vinokur AD, Price RH, Van Ryn M. Job seeking, reemployment, and mental health: A randomized field experiment in coping with job loss. J Appl Psychol. 1989;74:759–69.

  67. 67.

    Carlisle D. Public health in a recession. Nurs Times. 2008;104:20–3.

  68. 68.

    Clark AE, Oswald AJ. Unhappiness and unemployment. Econ J. 1994;104:648–59.

  69. 69.

    Coile CC, Levine PB, McKnight R. New measures of the costs of unemployment: evidence from the subjective well-being of 2.3 million Americans. NBER Working Paper 16829. The National Bureau of Economic Research; February 2011.

  70. 70.

    Collier R. Recession stresses mental health system. CMAJ. 2009;181:E48–9.

  71. 71.

    Crombie IK. Can changes in the unemployment rates explain the recent changes in suicide rates in developed countries? Int J Epidemiol. 1990;19:412–6.

  72. 72.

    Davalos ME, French MT. This recession is wearing me out! Health-related quality of life and economic downturns. J Ment Health Policy Econ. 2011; 14: 61–72.

  73. 73.

    Dollard MF, Winefield AH. Mental health: overemployment, underemployment, unemployment and healthy jobs. Adv Ment Health. 2002;1:170–95.

  74. 74.

    Fryer D, Fagan R. Toward a critical community psychological perspective on unemployment and mental health research. Am J Community Psychol. 2003; 32:89–96.

  75. 75.

    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. 2012;23:103–8.

  76. 76.

    Giuntoli G, South J, Kinsella K, Karban K. Mental health, resilience and the recession in Bradford. York: Joseph Rowntree Foundation; 25 July 2011.

  77. 77.

    Gordo LR. Effects of short-and long-term unemployment on health satisfaction: evidence from German data. Appl Econ. 2006;38:2335–50.

  78. 78.

    Gunnell D, Lopatatzidis A, Dorling D, Wehner H, Southall H, Frankel S. Suicide and unemployment in young people. Analysis of trends in England and Wales, 1921–1995. Br J Psychiatry. 1999;175:263–70.

  79. 79.

    Hagquist C, Silburn SR, Zurbrick SR, Lindberg G, RingbäckWeitoft G. Suicide and mental health problems among Swedish youth in the wake of the 1990s recession. Int J Soc Welfare. 2008;9:211–9.

  80. 80.

    Hyyppä MT, Kronholm E, Alanen E. Quality of sleep during economic recession in Finland: a longitudinal cohort study. Soc Sei Med. 1997;45:731–8.

  81. 81.

    Jenkins R, Fitch C, Hurlston M, Walker F. Recession, debt and mental health: challenges and solutions. Ment Health Fam Med. 2009;6:85–90.

  82. 82.

    Katikireddi SV, Niedzwiedz CL, Popham F. Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991–2010 Health Surveys of England. BMJ Open. 2012;2(5).

  83. 83.

    Knapp M. Mental health in an age of austerity. Evid Based Ment Health. 2012; 15:54–5.

  84. 84.

    Liem R, Rayman P. Perspectives on Unemployment, Mental Health, and Social Policy. Int J Ment Health. 1984;13:3–17.

  85. 85.

    Lindström M. Psychosocial work conditions, unemployment and self-reported psychological health: a population-based study. Occup Med (Lond). 55:568–71.

  86. 86.

    Maier R, Egger A, Barth A, Winker R, Osterode W, et al. Effects of short-and long-term unemployment on physical work capacity and on serum Cortisol. Int Arch Occup Environ Health. 2006;79:193–8.

  87. 87.

    McKee-Ryan F, Song Z, Wanberg CR, Kinicki AJ. Psychological and physical well-being during unemployment: a meta-analytic study. J Appl Psychol. 2005;90:53–76.

  88. 88.

    Novo M, Hammarström A, Janlert U. Do high levels of unemployment influence the health of those who are not unemployed? A gendered comparison of young men and women during boom and recession. Soc Sei Med. 2001;53:293–303.

  89. 89.

    Ostamo A, Lonnqvist J. Attempted suicide rates and trends during a period of severe economic recession in Helsinki, 1989–1997. Soc Psychiatry Psychiatr Epidemiol. 2001;36:354–60.

  90. 90.

    Owen K, Watson N. Unemployment and mental health. J Psychiatr Ment Health Nurs. 1995;2:63–71.

  91. 91.

    Pesonen TM, Hintikka J, Karkola KO, Saarinen PI, Antikainen M, Lehtonen J. Male suicide mortality in eastern Finland—urban-rural changes during a 10-year period between 1988 and 1997. Scand J Public Health. 2001;29:189–93.

  92. 92.

    Platt S. Unemployment and suicidal behaviour: a review of the literature. Soc Sei Med. 1984;19:93–115.

  93. 93.

    Rantakeisu U, Jönsson LR. Unemployment and mental health among white-collar workers-a question of work involvement and financial situation? International Journal of Social Welfare, 12(1):31–41.

  94. 94.

    Rantakeisu U, Starrin B, Hagquist C. Unemployment, shame and ill health— an exploratory study. Int J Soc Welfare. 1997;6:13–23.

  95. 95.

    Roberts H, Pearson JC, Madeley RJ, Hanford S, Magowan R. Unemployment and health: the quality of social support among residents in the Trent region of England. J Epidemiol Community Health. 1997;51:41–5.

  96. 96.

    Rodriguez E, Lasch K, Mead JP The potential role of unemployment benefits in shaping the mental health impact of unemployment. Int J Health Serv. 1997;27:601–23.

  97. 97.

    Sareen J, Afifi TO, McMillan KA, Asmundson GJG. Relationship between household income and mental disorders: findings from a population-based longitudinal study. Arch Gen Psychiatry. 2011;68:419–27.

  98. 98.

    Schaufeh WB. Unemployment and mental health in well-and poorly-educated school-leavers. Netherlands: Kluwer Academic Publishers; 1992.

  99. 99.

    Schuring M, Burdorf A, Kunst A, Voorham T, Mackenbach J. Ethnic differences in unemployment and ill health. Int Arch Occup Environ Health. 2009;82: 1023–30.

  100. 100.

    Schwefel D, John J, Potthoff P, Hechler A. Unemployment and mental health: perspectives from the Federal Republic of Germany. Int J Ment Health. 1984;13:35–50.

  101. 101.

    Solantaus T, Leinonen J, Punamaki R-L. Children’s mental health in times of economic recession: replication and extension of the family economic stress model in Finland. Dev Psychol. 2004;40:412–29.

  102. 102.

    Stuckler D, Basu S, McDaid D. Depression amidst depression: mental health effects of the ongoing recession. London; Personal Social Services Research Unit.

  103. 103.

    Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. Effects of the 2008 recession on health: a first look at European data. Lancet. 2011;378:124–5.

  104. 104.

    Taris TW. Unemployment and mental health: a longitudinal perspective. Int J Stress Management. 2002;9:43–57.

  105. 105.

    Turner JB, Turner RJ. Physical Disability, Unemployment, and Mental Health. Rehabilitation Psychol. 2004;49:241–9.

  106. 106.

    Valkonen T, Martikainen P, Jalovaara M, Koskinen S, Martelin 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;10:274–80.

  107. 107.

    Viinamäki H, Hintikka J, Kontula O, Niskanen L, Koskela K. Mental health at population level during an economic recession in Finland. Nord J Psychiatry. 2000;54:177–82.

  108. 108.

    Viinamäki H, Koskela K, Niskanen L, Arnkill R, Tikkanen J. Unemployment and mental wellbeing: a factory closure study in Finland. Acta Psychiatr Scand. 1993;88:429–33.

  109. 109.

    Viinamäki H, Koskela K, Niskanen L. The impact of unemployment on psychosomatic symptoms and mental well-being. Int J Soc Psychiatry. 1993;39:266–73.

  110. 110.

    Warr P. Work, Unemployment and Mental Health. Oxford University Press; 1987.

  111. 111.

    Weaver JD. Economic recession and increases in mental health emergencies. J Ment Health Adm. 1983;10:28–31.

  112. 112.

    Weich S, Lewis G. Poverty, unemployment, and common mental disorders: population based cohort study. BMJ. 1998;317:115–9.

  113. 113.

    Weston-Cox P. The impact of the economic downturn on environmental health services and professionals in North Carolina. J Environ Health. 2012;74:16–20.

  114. 114.

    Wight RG, Aneshensel CS, Barrett C, Ko M, Chodosh J, Karlamangla AS. Urban neighbourhood unemployment history and depressive symptoms over time among late middle age and older adults. J Epidemiol Community Health. 2013;67:153–8.

  115. 115.

    Winkelmann L, Winkelmann R. Why are the unemployed so unhappy? Evidence from panel data. Economica. 1998;65:1–15.

  116. 116.

    Yamasaki A, Sakai R, Shirakawa T. Low income, unemployment, and suicide mortality rates for middle-age persons in Japan. Psychol Rep. 2005;96:337–48.

  117. 117.

    Yoon J-H, Junger W, Kim B-W, Kim Y-J, Koh S-B. Investigating the time lag effect between economic recession and suicide rates in agriculture, fisheries, and forestry workers in Korea. Saf Health Work. 2012;3:294–7.

  118. 118.

    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. 2012;23:206–10.

  119. 119.

    Zunzunegui MV M F, Gauvin L, Raynault MF, Douglas Willms J. Community unemployment and immigrants’ health in Montreal. Soc Sei Med. 2006;63:485–500.

  120. 120.

    Koo J, Cox WM. An economic interpretation of suicide cycles in Japan. Contemporary Econ Pol. 2008;26:162–74.

  121. 121.

    Alvaro-Meca A, Kneib T, Gil-Prieto R, Gil de Miguel A. Epidemiology of suicide in Spain, 1981–2008: a spatiotemporal analysis. Public Health. 2013;127:380–5.

  122. 122.

    De Vogli R, Marmot M, Stuckler D. Excess suicides and attempted suicides in Italy attributable to the great recession. J Epidemiol Community Health. 2013;67:378–9.

  123. 123.

    Yamauchi T, Fujita T, Tachimori H, Takeshima T, Inagaki M, Sudo A. Age-adjusted relative suicide risk by marital and employment status over the past 25 years in Japan. J Public Health. 2013;35:49–56.

  124. 124.

    Milner A, Page A, LaMontagne AD. Duration of unemployment and suicide in Australia over the period 1985–2006: an ecological investigation by sex and age during rising versus declining national unemployment rates. J Epidemiol Community Health. 2013;67:237–44.

  125. 125.

    Dooley D, Prause J, Ham-Rowbottom KA. Underemployment and depression: longitudinal relationships. J Health Soc Behav. 2000;41:421–36.

  126. 126.

    WHO Regional Office for Europe. Impact of economic crises on mental health. Copenhagen: World Health Organization; 2011.

  127. 127.

    Hagquist C, Starrin B. Youth unemployment and mental health-gender differences and economic stress. Int J Soc Welfare. 2007;5:215–28.

  128. 128.

    Adelman RA, Nwanze CC. The impact of the economy and recessions on the marketplace demand for ophthalmologists (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2011;109:49–65.

  129. 129.

    Bambra C. Yesterday once more? Unemployment and health in the 21st century. J Epidemiol Community Health. 2010;64:213–5.

  130. 130.

    Benavides FG, Garcia AM, Sâez-Lloret I, Librero J. Unemployment and health in Spain The influence of socio-economic environment. Eur J Public Health. 1994;4:103–7.

  131. 131.

    Brenner MH, Mooney A. Unemployment and health in the context of economic change. Soc Sei Med. 1983;17:1125–38.

  132. 132.

    Burgard SA, Kalousova L, Seefeldt KS. Perceived job insecurity and health: the Michigan Recession and Recovery Study. J Occup Environ Med. 2012; 54:1101–6.

  133. 133.

    Cook D. Unemployment and health during a recession. Practitioner. 1985;229: 559–62.

  134. 134.

    Falck S. Recession blues. Coping with economic uncertainty. Respir Ther. 1983;13:71–2,76,89.

  135. 135.

    Franks PJ, Adamson C, Bulpitt PF, Bulpitt CJ. Stroke death and unemployment in London. J Epidemiol Community Health. 1991;45:16–8.

  136. 136.

    Freidl W, Fazekas C, Rami R, Pretis M, Feistritzer G. Perceived social justice, long-term unemployment and health. Soc Psychiatry Psychiatr Epidemiol. 2007;42:547–53.

  137. 137.

    Harris E, Harris M, Lee P, Powell Davies G. Taking action to address the health impact of unemployment: experiences from south-western Sydney. Health Promot J Austr. 1999;9:115–20.

  138. 138.

    Henriksson KM, Lindblad U, Agren B, Nilsson-Ehle P, Râstam L. Associations between unemployment and cardiovascular risk factors varies with the unemployment rate: The Cardiovascular Risk Factor Study in Southern Sweden (CRISS). Scand J Public Health. 2003;31:305–11.

  139. 139.

    Janlert U. Unemployment and blood pressure in Swedish building labourers. J Intern Med. 1992;231:241–6.

  140. 140.

    Junankar PN. Unemployment and mortality in England and Wales: apreliminary analysis. Oxford Econ Papers. 1991;43:305–20.

  141. 141.

    Kristjuhan U, Taidre E. The last recession was good for life expectancy. Rejuvenation Res. 2012;15:134–5.

  142. 142.

    Kwon S, Jung Y, Islam A, Pande B, Yao L. The impact of the global recession on the health of the people in Asia. In: Bauer A, Thant M, (editors). Poverty and Sustainable Development in Asia. Manila; Asian Development Bank; 2010. p.405–24.

  143. 143.

    Lahelma E, Rahkonen O, Huuhka M. Changes in the social patterning of health? The case of Finland 1986–1994. Soc Sei Med. 1997;44:789–99.

  144. 144.

    Lundberg O, Diderichsen F, Yngwe MA. Changing health inequalities in a changing society? Sweden in the mid-1980s and mid-1990s. Scand J Public Health Suppl. 2001;55:31–9.

  145. 145.

    Piette JD, Rosland AM, Silveira MJ, Hayward R, McHorney CA. Medication cost problems among chronically ill adults in the US: did the financial crisis make a bad situation even worse? Patient Prefer Adherence. 2011;5:187–94.

  146. 146.

    Weber A, Lehnert G. Unemployment and cardiovascular diseases: a causal relationship? Int Arch Occup Environ Health. 1997;70:153–60.

  147. 147.

    Weber A, Piechulek H. The impact of the global recession on the poor and vulnerable in the Philippines and on the social health insurance system. In: Bauer A, Thant M, (editors). Poverty and Sustainable Development in Asia. Manila; Asian Development Bank; 2010. p. 425–40.

  148. 148.

    Carlier BE, Schuring M, Lötters FJB, Bakker B, Borgers N, Burdorf A. The influence of re-employment on quality of life and self-rated health, a longitudinal study among unemployed persons in the Netherlands. BMC Public Health. 2013;13:503.

  149. 149.

    Hauksdöttir A, McClure C, Jonsson SH, Olafsson O, Valdimarsdottir UA. Increased stress among women following an economic collapse-prospective cohort study. Am J Epidemiol. 2013; epub ahead of print.

  150. 150.

    Kim JM, Son N-H, Park E-C, Nam CM, Kim TH, Cho W-H. The relationship between changes in employment status and mortality risk based on the Korea Labor and Income Panel Study (2003–2008). Asia Pac J Public Health. 2013; epub ahead of print.

  151. 151.

    Eliason M, Storrie D. Does job loss shorten life? J Human Resources. 2009; 44:277–302.

  152. 152.

    Eliason M, Storrie D. Job loss is bad for your health — Swedish evidence on cause-specific hospitalization following involuntary job loss. Soc Sei Med. 2009;68:1396–406.

  153. 153.

    Tsai SL, Lan CF, Lee CH, Huang N, Chou YJ. Involuntary unemployment and mortality in Taiwan. J Formos Med Assoc. 2004;103:900–7.

  154. 154.

    Ledermann S. Alcool, Alcoolisme, Alcoolisation: Mortalité Morbidité Accidents du Travail., vol. Institut National d’Etudes Démographiques, Travaux et Documents. Paris: Presses Universitaires de France; 1964. [In French]

  155. 155.

    The Henry J. Kaiser Family Foundation. Recession Prompting Increase in Number of People with HIV Seeking Public Services in California. KFF; 1 June 2009.

  156. 156.

    Arinaminpathy N, Dye C. Health in financial crises: economic recession and tuberculosis in Central and Eastern Europe. J R Soc Interface. 2010;7:1559–69.

  157. 157.

    Suhrcke M, Stuckler D, Suk JE, Desai M, Senek M, et al. The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence. PLoS One. 2011;6:e20724.

  158. 158.

    Winston CA, Navin TR, Becerra JE, Chen MP, Armstrong LR, et al. Unexpected decline in tuberculosis cases coincident with economic recession — United States, 2009. BMC Public Health. 2011;11:846.

  159. 159.

    Markowitz S, Nesson E, Robinson J. Are pink slips better than flu shots? The effects of employment on influenza rates. NBER Working Paper 15796. The National Bureau of Economic Research; March 2010.

  160. 160.

    Davis JA, Savage G, Stewart RT. Organizational downsizing: a review of literature for planning and research. J Healthc Manag. 2003;48:181–99.

  161. 161.

    Quinlan M, Bohle P. Overstretched and unreciprocated commitment: reviewing research on the occupational health and safety effects of downsizing and job insecurity. Int J Health Serv. 2009;39:1–44.

  162. 162.

    Fronstin P. The impact of the recession on employment-based health coverage. EBRI Issue Brief. 2010;342:1–22.

  163. 163.

    Gould E. Employer-sponsored health insurance erosion accelerates in the recession. Int J Health Serv. 2012;42:499–537.

  164. 164.

    The Henry J. Kaiser Family Foundation. Medicaid enrollment growth during the economic recession, December 2007 to December 2009. KFF.

  165. 165.

    Rowland D. Health care and Medicaid—weathering the recession. N Engl J Med. 2009;360:1273–6.

  166. 166.

    Holahan J, Cook A. The U.S. economy and changes in health insurance coverage, 2000–2006. Health Aff (Millwood). 2008;27:wl35–44.

  167. 167.

    Holahan J. The 2007–09 recession and health insurance coverage. Health Aff (Millwood). 2011;30:145–52.

  168. 168.

    Carrier E, Yee T, Garfield RL. The uninsured and their health care needs: how have they changed since the recession? Washington (DC); The Henry J. Kaiser Family Foundation; October 2011.

  169. 169.

    Cawley J, Simon KI. Health insurance coverage and the macroeconomy. J Health Econ. 2005;24:299–315.

  170. 170.

    Holahan J, Chen V. Changes in health insurance coverage in the Great Recession, 2007–2010. Washington (DC): The Henry J. Kaiser Family Foundation; December 2011.

  171. 171.

    Kaiser Commission on Medicaid and the Uninsured. Expansions in public health insurance and crowd-out: what the evidence says. The Henry J. Kaiser Family Foundation; 1 October 1999.

  172. 172.

    Holahan J, Bowen Garrett A. Rising unemployment, Medicaid and the uninsured. The Henry J. Kaiser Family Foundation; 9 January 2009.

  173. 173.

    Kaiser Commission on Medicaid and the Uninsured. Impact of the Medicaid Fiscal Relief Provisions in the American Recovery and Reinvestment Act (ARRA). Washington (DC): The Henry J. Kaiser Family Foundation; 1 October 2011.

  174. 174.

    Smith VK, Gifford K, Ellis E, Rudowitz R, Snyder L. Moving ahead amid fiscal challenges: a look at medicaid spending, coverage and policy trends results from a 50-state Medicaid budget survey for state fiscal years 2011 and 2012. Washington (DC): The Henry J. Kaiser Family Foundation; 1 October 2011.

  175. 175.

    The Henry J. Kaiser Family Foundation. Progress on health coverage is threatened as states continue to face growing pressures to control costs. KFF

  176. 176.

    Cohen Ross D, Cox L. Beneath the surface: barriers threaten to slow progress on expanding health coverage of children and families. The Henry J. Kaiser Family Foundation; 29 September 2004.

  177. 177.

    Young K, Garfield R, Clemans-Cope L, Lawton E, Holahan J. Enrollment-driven expenditure growth: Medicaid spending during the economic downturn, FY2007–2011. Washington (DC): The Henry J. Kaiser Family Foundation; 18 April 2013.

  178. 178.

    Roehrig C, Turner A, Hughes-Cromwick P, Miller G. When the cost curve bent—pre-recession moderation in health care spending. N Engl J Med. 2012;367:590–3.

  179. 179.

    Martin A, Lassman D, Whittle L, Catlin A. Recession contributes to slowest annual rate of increase in health spending in five decades. Health Aff (Millwood). 2011;30:11–22.

  180. 180.

    Smith VK, Gifford K, Ellis E, Rudowitz R, Snyder L. Hoping for economic recovery, preparing for health reform:a look at Medicaid spending, coverage and policy trends. Results from a 50-state Medicaid budget survey for state fiscal years 2010 and 2011. The Henry J. Kaiser Family Foundation; 2 September 2010.

  181. 181.

    Alker J, Mancini T, Heberlein M. Uninsured Children 2009–2011: charting the Nation’s progress. Georgetown University Health Policy Institute, Center for Children and Families; October 2012. Available from URL: (Accessed 7 October 2013).

  182. 182.

    Levit KR, Mark TL, Coffey RM, Frankel S, Santora P, et al. Federal spending on behavioral health accelerated during recession as individuals lost employer insurance. Health Aff (Millwood) 2013;32:952–62.

  183. 183.

    Baicker K, Taubman SL, Allen HL, Bernstein M, Gruber JH, et al. The Oregon experiment—effects of Medicaid on clinical outcomes. N Engl J Med. 2013; 368:1713–22.

  184. 184.

    Wilde PE. The new normal: the Supplemental Nutrition Assistance Program (SNAP). Am J Agricultural Econ. 2013;95:325–31.

  185. 185.

    US Department of Agriculture, Economic Research Service. American Recovery and Reinvestment Act of 2009. USDA ERS. Available from URL:

  186. 186.

    US Department of Agriculture, Economic Research Service. Allieviating poverty in the United States: the critical role of SNAP benefits. ERR132. USDA ERS; April 2012. Available from URL:

  187. 187.

    Coleman-Jensen A, Nord M, Andrews M, Carlson S. Household food security in the United States in 2011. ERR141. US Department of Agriculture Economic Research Service; September 2012. Available from URL:

  188. 188.

    Willard R, Shah GH, Leep C, Ku L. Impact of the 2008–2010 economic recession on local health departments. J Public Health Manag Pract. 2012; 18:106–14.

  189. 189.

    Cohen JM, Smith DL, Cotter C, Ward A, Yamey G, et al. Malaria resurgence: a systematic review and assessment of its causes. Malar J. 2012; 11:122.

  190. 190.

    Felland LE, Cunningham PJ, Cohen GR, November EA, Quinn BC. The economic recession: early impacts on health care safety net providers. Res Brief. 2010;15:1–8.

  191. 191.

    Tomkins S, Saburova L, Kiryanov N, Andreev E, McKee M, et al. Prevalence and socio-economic distribution of hazardous patterns of alcohol drinking: study of alcohol consumption in men aged 25-54 years in Izhevsk, Russia. Addiction. 2007;102:544–53.

  192. 192.

    U.S. Census Bureau. Households Doubling Up. U.S. Census Bureau; 2011. Availble from URL:

Download references

Author information

Correspondence to Sepideh Modrek PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Modrek, S., Stuckler, D., McKee, M. et al. A Review of Health Consequences of Recessions Internationally and a Synthesis of the US Response during the Great Recession. Public Health Rev 35, 10 (2013).

Download citation

Key Words

  • Recessions
  • Unemployment
  • Austerity
  • Morbidity
  • Mortality
  • Suicide