Faraz Vahid Shahidi

Why is There so Much Controversy Regarding the Population Health Impact of the Great Recession? Reflections on Three Case Studies

In the aftermath of the Great Recession, public health scholars have grown increasingly interested in studying the health consequences of macroeconomic change. Reflecting existing debates on the nature of this relationship, research on the effects of the recent economic crisis has sparked considerable controversy. On the one hand there is evidence to support the notion that macroeconomic downturns are associated with positive health outcomes. On the other hand, a growing number of studies warn that the current economic crisis can be expected to pose serious problems for the public’s health. This article contributes to this debate through a review of recent evidence from three case studies: Iceland, Spain, and Greece. It shows that the economic crisis has negatively impacted some population health indicators (e.g., mental health) in all three countries, but especially in Greece. Available evidence defies deterministic conclusions, including increasingly “conventional” claims about economic downturns improving life expectancy and reducing mortality. While our results echo previous research in finding that the relationship between economic crises and population health is complex, they also indicate that this complexity is not arbitrary. On the contrary, changing social and political contexts provide meaningful, if partial, explanations for the perplexing nature of recent empirical findings.

Welfare Capitalism in Crisis: A Qualitative Comparative Analysis of Labour Market Policy Responses to the Great Recession

Social policy responses to the recent economic crisis have varied considerably across advanced capitalist countries. This study aims to explain this cross-national diversity through a qualitative comparative analysis of labour market policy responses to the Great Recession across eighteen advanced welfare states. The results of the study suggest that theories of welfare state change that attribute theoretical centrality to political and institutional factors do not provide a compelling explanation for patterns of labour market reform observed since the onset of the economic crisis. Rather, they appear to be explained principally in terms of the variable fiscal capacity of the state. In particular, the study findings indicate that the presence of fiscal crisis has acted as a necessary (but insufficient) condition for the presence of recommodification, while the absence of fiscal crisis has acted as a sufficient (but unnecessary) condition for the absence of recommodification. These empirical developments suggest that there is a need for a scholarly return to the problematic relationship between capitalism and the welfare state.

Does social policy moderate the impact of unemployment on health? A multilevel analysis of 23 welfare states

BACKGROUND The magnitude of observable health inequalities between the unemployed and their employed counterparts differs considerably across countries. Few attempts have been made to test theoretical explanations for this cross-national variation. Moreover, existing studies suffer from important theoretical and methodological limitations. This study addresses these limitations and investigates whether differences in the generosity of social protection policies and in public attitudes towards those policies explain why unemployment-related health inequalities are steeper in some societies than in others. METHODS Multilevel logistic modelling was used to link contextual-level variables on social protection policies and public attitudes in 23 European countries to individual-level data on self-rated health from the 2012 wave of the European Social Survey. RESULTS The magnitude of inequalities in self-rated health between the unemployed and their employed counterparts varies significantly across countries as a function of cross-national differences in the level of social protection awarded to the unemployed and the level of public support for the welfare state. CONCLUSIONS The results provide empirical support for the claim that governments can play a more active role in mitigating unemployment-related health inequalities by expanding the generosity and scope of social protection policies. Whether such an expansion of social protection will take place in the current climate of fiscal austerity is a political question whose implications merit the attention of population health scholars.

Economic crisis, unemployment and health: conceptual and methodological issues in the modelling of national contexts

The study by Laanani et al 1 is a welcome contribution to the growing body of empirical literature interrogating the relationship between the recent economic crisis, unemployment and suicide rates. We nevertheless find that their analysis suffers from three major conceptual and methodological shortcomings. First, despite making an important distinction between the direct and indirect effects of the recent economic crisis on suicide rates, we believe that the relationship between these effects is inappropriately specified in the analysis. According to the authors, the impact of the crisis on suicide rates is explained by an individual-level unemployment effect and a contextual-level crisis effect. To the extent that they are modelled in a distinctly additive fashion, both of these effects are thought to operate independently from the other. The authors distinguish between the two effects in order to parse out any potential bias caused by contextual features associated with the crisis, including an increase in perceived levels of job insecurity and political decisions such as budgetary cutbacks. They control for such contextual features with the intention of isolating the independent effect of unemployment on suicide rates. However, the authors neglect to consider the ways in which the latter effect itself varies as a function of the contextual factors for which they are attempting to provide a control.2 Ample evidence exists to suggest that unemployment does not transmit automatically from a decline in economic output. …

A glossary of terms for understanding political aspects in the implementation of Health in All Policies (HiAP)

Health in All Policies (HiAP) is a strategy that seeks to integrate health considerations into the development, implementation and evaluation of policies across various non-health sectors of the government. Over the past 15 years, there has been an increase in the uptake of HiAP by local, regional and national governments. Despite the growing popularity of this approach, most existing literature on HiAP implementation remains descriptive rather than explanatory in its orientation. Moreover, prior research has focused on the more technical aspects of the implementation process. Thus, studies that aim to ‘build capacity to promote, implement and evaluate HiAP’ abound. Conversely, there is little emphasis on the political aspects of HiAP implementation. Neglecting the role of politics in shaping the use of HiAP is problematic, since health and the strategies by which it is promoted are partially political. This glossary addresses the politics gap in the existing literature by drawing on theoretical concepts from political, policy, and public health sciences to articulate a framework for studying how political mechanisms influence HiAP implementation. To this end, the glossary forms part of an on-going multiple explanatory case study of HiAP implementation, HARMONICS (HiAP Analysis using Realist Methods on International Case Studies, harmonics-hiap.ca), and is meant to expand on a previously published glossary addressing the topic of HiAP implementation more broadly. Collectively, these glossaries offer a conceptual toolkit for understanding how politics explains implementation outcomes of HiAP.

Do flexicurity policies protect workers from the adverse health consequences of temporary employment? A cross-national comparative analysis

Flexicurity policies comprise a relatively novel approach to the regulation of work and welfare that aims to combine labour market flexibility with social security. Advocates of this approach argue that, by striking the right balance between flexibility and security, flexicurity policies allow firms to take advantage of loose contractual arrangements in an increasingly competitive economic environment while simultaneously protecting workers from the adverse health and social consequences of flexible forms of employment. In this study, we use multilevel Poisson regression models to test the theoretical claim of the flexicurity approach using data for 23 countries across three waves of the European Social Survey. We construct an institutional typology of labour market regulation and social security to evaluate whether inequalities in self-reported health and limiting longstanding illness between temporary workers and their permanent counterparts are smaller in countries that most closely approximate the ideal type described by advocates of the flexicurity approach. Our results indicate that, while the association between temporary employment and health varies across countries, institutional configurations of labour market regulation and social security do not provide a meaningful explanation for this cross-national variation. Contrary to the expectations of the flexicurity hypothesis, our data do not indicate that employment-related inequalities are smaller in countries that approximate the flexicurity approach. We discuss potential explanations for these findings and conclude that there remains a relative lack of evidence in support of the theoretical claims of the flexicurity approach.

The implementation of Health in All Policies initiatives: a systems framework for government action

BackgroundThere has been a renewed interest in broadening the research agenda in health promotion to include action on the structural determinants of health, including a focus on the implementation of Health in All Policies (HiAP). Governments that use HiAP face the challenge of instituting governance structures and processes to facilitate policy coordination in an evidence-informed manner. Due to the complexity of government institutions and the policy process, systems theory has been proposed as a tool for evaluating the implementation of HiAP.MethodsOur multiple case study research programme (HiAP Analysis using Realist Methods On International Case Studies – HARMONICS) has relied on systems theory and realist methods to make sense of how and why the practices of policy-makers (including politicians and civil servants) from specific institutional environments (policy sectors) has either facilitated or hindered the implementation of HiAP. Herein, we present a systems framework for the implementation of HiAP based on our experience and empirical findings in studying this process.ResultsWe describe a system of 14 components within three subsystems of government. Subsystems include the executive (heads of state and their appointed political elites), intersectoral (the milieu of policy-makers and experts working with governance structures related to HiAP) and intrasectoral (policy-makers within policy sectors). Here, HiAP implementation is a process involving interactions between subsystems and their components that leads to the emergence of implementation outcomes, as well as effects on the system components themselves. We also describe the influence of extra-governmental systems, including (but not limited to) the academic sector, third sector, private sector and intergovernmental sector. Finally, we present a case study that applies this framework to understand the implementation of HiAP – the Health 2015 Strategy – in Finland, from 2001 onward.ConclusionsThis framework is useful for helping to explain how, why and under what circumstances HiAP has been successfully and unsuccessfully implemented in a sustainable manner. It serves as a tool for researchers to study this process, and for policy-makers and other public health actors to manage this process.