Amy Clair

Data Resource Profile: The European Union Statistics on Income and Living Conditions (EU-SILC)

Social and economic policies are inextricably linked with population health outcomes in Europe, yet few datasets are able to fully explore and compare this relationship across European countries. The European Union Statistics on Income and Living Conditions (EU-SILC) survey aims to address this gap using microdata on income, living conditions and health. EU-SILC contains both cross-sectional and longitudinal elements, with nationally representative samples of individuals 16 years and older in 28 European Union member states as well as Iceland, Norway and Switzerland. Data collection began in 2003 in Belgium, Denmark, Ireland, Greece, Luxembourg and Austria, with subsequent expansion across Europe. By 2011, all 28 EU member states, plus three others, were included in the dataset. Although EU-SILC is administered by Eurostat, the data are output-harmonized so that countries are required to collect specified data items but are free to determine sampling strategies for data collection purposes. EU-SILC covers approximately 500,000 European residents for its cross-sectional survey annually. Whereas aggregated data from EU-SILC are publicly available [http://ec.europa.eu/eurostat/web/income-and-living-conditions/data/main-tables], microdata are only available to research organizations subject to approval by Eurostat. Please refer to [http://epp.eurostat.ec.europa.eu/portal/page/portal/microdata/eu_silc] for further information regarding microdata access.

Reductions in the United Kingdom's government housing benefit and symptoms of depression in low-income households

Housing security is an important determinant of mental ill health. We used a quasinatural experiment to evaluate this association, comparing the prevalence of mental ill health in the United Kingdom before and after the governments April 2011 reduction in financial support for low-income persons who rent private-sector housing (mean reduction of approximately £1,220 (

Living on the edge: precariousness and why it matters for health

2,315) per year). Data came from the United Kingdoms Annual Population Survey, a repeated quarterly cross-sectional survey. We focused our analysis on renters in the private sector, disaggregating data between an intervention group receiving the governments Housing Benefit (n = 36,859) and a control group not receiving the Housing Benefit (n = 142,205). The main outcome was a binary measure of self-reported mental health problems. After controlling for preexisting time trends, we observed that between April 2011 and March 2013, the prevalence of depressive symptoms among private renters receiving the Housing Benefit increased by 1.8 percentage points (95% confidence interval: 1.0, 2.7) compared with those not receiving the Housing Benefit. Our models estimated that approximately 26,000 (95% confidence interval: 14,000, 38,000) people newly experienced depressive symptoms in association with the cuts to the Housing Benefit. We conclude that reducing housing support to low-income persons in the private rental sector increased the prevalence of depressive symptoms in the United Kingdom.

The impact of the housing crisis on self-reported health in Europe: multilevel longitudinal modelling of 27 EU countries

The post-war period in Europe, between the late 1940s and the 1970s, was characterised by an expansion of the role of by the state, protecting its citizens from risks of unemployment, poverty, homelessness, and food insecurity. This security began to erode in the 1980s as a result of privatisation and deregulation. The withdrawal of the state further accelerated after the 2008 financial crisis, as countries began pursuing deep austerity. The result has been a rise in what has been termed ‘precariousness’. Here we review the development of the concept of precariousness and related phenomena of vulnerability and resilience, before reviewing evidence of growing precariousness in European countries. It describes a series of studies of the impact on precariousness on health in domains of employment, housing, and food, as well as natural experiments of policies that either alleviate or worsen these impacts. It concludes with a warning, drawn from the history of the 1930s, of the political consequences of increasing precariousness in Europe and North America.

The impact of housing payment problems on health status during economic recession: a comparative analysis of longitudinal EU SILC data of 27 European states, 2008-2010

Background: Many EU nations experienced a significant housing crisis during the Great Recession of 2008–10. We evaluated the consequences of housing payment problems for people’s self-reported overall health. Methods: We used longitudinal data from the EU Statistics on Income and Living Conditions survey covering 27 countries from 2008 to 2010 to follow a baseline sample of persons who did not have housing debt and who were employed (45 457 persons, 136 371 person–years). Multivariate linear regression and multilevel models were used to evaluate the impact of transitions into housing arrears on self-reported health, correcting for the presence of chronic illness, health limitations, and other potential socio-demographic confounders. Results: Persons who transitioned into housing arrears experienced a significant deterioration in self-reported overall health by − 0.03 U (95% CI − 0.01 to − 0.04), even after correcting for chronic illness, disposable income and employment status, and individual fixed effects. This association was independent and similar in magnitude to that for job loss (−0.02, 95% CI: −0.01 to − 0.04). We also found that the impact of housing arrears was significantly worse among renters, corresponding to a mean 0.11 unit additional drop in health as compared with owner-occupiers. These adverse associations were only evident in persons below the 75th percentile of disposable income. Discussion: Our analysis demonstrates that persons who suffer housing arrears experience increased risk of worsening self-reported health, especially among those who rent. Future research is needed to understand the role of alternative housing support systems and available strategies for preventing the health consequences of housing insecurity.

Constructing a Housing Precariousness Measure for Europe

Although the recent Great Recession had its origins in the housing sector, the short-term health impact of the housing crisis is not well understood. We used longitudinal data to evaluate the impact of housing payment problems on health status among home-owners and renters in 27 European states. Multi-level and fixed-effects models were applied to a retrospective cohort drawn from the EU Statistics on Income and Living Conditions survey of employed persons, comprising those without housing arrears in the base year 2008 and followed through to 2010 (n=45,457 persons, 136,371 person-years). Multi-variate models tested the impact of transitioning into housing payment arrears on self-reported health (0-worst to 4-best), adjusting for confounders including age, sex, baseline health, and individual fixed effects. Transitioning into housing arrears was associated with a significant deterioration in the health of renters (−0.09 units, 95% CI −0.05 to −0.13), but not owners (0.00, 95% CI −0.05 to 0.06), after adjusting for individual fixed effects. This effect was independent of and greater than the impact of job loss for the full sample (−0.05, 95% CI −0.002 to −0.09). The magnitude of this association varied across countries; the largest adverse associations were observed for renters in Belgium, Austria, and Italy. There was no observed protective association of differing categories of social protection or of the housing regulatory structure for renters. Women aged 30 and over who rented appeared to have worse self-reported health when transitioning into arrears than other groups. Renters also fared worse in those countries where house prices were escalating. We therefore find that housing payment problems are a significant risk factor for worse-self reported health in persons who are renting their homes. Future research is needed to understand potential sources of health resilience among renters, especially at a time when housing prices are rising in many European states.

The Great Recession and inequalities in access to health care: a study of unemployment and unmet medical need in Europe in the economic crisis

There are concerns that the recovery from the Great Recession in Europe has left growing numbers of people facing precarious housing situations. Yet, to our knowledge, there is no comparative measure of housing precariousness in contrast to an extensive body of work on labour market precariousness. Here, we draw on a comparative survey of 31 European countries from the 2012 wave of European Union Survey of Income and Living Conditions to develop a novel housing precariousness measure. We integrate four dimensions of housing precariousness: security, affordability, quality and access to services, into a scale ranging from 0 (not at all precarious) to 4 (most precarious). Over half of the European population report at least one element of housing precariousness; 14.7  percent report two dimensions and 2.8  percent three or more (equivalent to ~15  million people). Eastern European and small island nations have relatively greater precariousness scores. Worse precariousness tends to be more severe among the young, unemployed, single and those with low educational attainment or who live in rented homes and is associated with poor self-reported health. Future research is needed to strengthen surveillance of housing precariousness as well as to understand what policies and programmes can help alleviate it.

Reductions in housing benefit increases symptoms of depression in low-income UK households

Abstract Background Unmet medical need (UMN) had been declining steadily across Europe until the 2008 Recession, a period characterized by rising unemployment. We examined whether becoming unemployed increased the risk of UMN during the Great Recession and whether the extent of out-of-pocket payments (OOP) for health care and income replacement for the unemployed (IRU) moderated this relationship. Methods We used the European Survey on Income and Living Conditions (EU-SILC) to construct a pseudo-panel (n = 135 529) across 25 countries to estimate the relationship between unemployment and UMN. We estimated linear probability models, using a baseline of employed people with no UMN, to test whether this relationship is mediated by financial hardship and moderated by levels of OOP and IRU. Results Job loss increased the risk of UMN [β = 0.027, 95% confidence interval (CI) 0.022–0.033] and financial hardship exacerbated this effect. Fewer people experiencing job loss lost access to health care in countries where OOPs were low or in countries where IRU is high. The results are robust to different model specifications. Conclusions Unemployment does not necessarily compromise access to health care. Rather, access is jeopardized by diminishing financial resources that accompany job loss. Lower OOPs or higher IRU protect against loss of access, but they cannot guarantee it. Policy solutions should secure financial protection for the unemployed so that resources do not have to be diverted from health.