Philipp Hessel

Have health trends worsened in Greece as a result of the financial crisis? A quasi-experimental approach.

BACKGROUND Health in Greece deteriorated after the recent financial crisis, but whether this decline was caused by the recent financial crisis has not been established. This article uses a quasi-experimental approach to examine the impact of the recent financial crisis on health in Greece. METHODS Data came from the European Union Statistics on Income and Living Conditions survey for the years 2006-09. We applied a difference-in-differences approach that compares health trends before and after the financial crisis in Greece with trends in a control population (Poland) that did not experience a recession and had health trends comparable with Greece before the crisis. We used logistic regression to model the impact of the financial crisis on poor self-rated health, controlling for demographic confounders. RESULTS Results provide strong evidence of a statistically significant negative effect of the financial crisis on health trends. Relative to the control population, Greece experienced a significantly larger increase in the odds of reporting poor health after the crisis (odds ratio, 1.16; 95% confidence interval, 1.04-1.29). There was no difference in health trends between Poland and Greece before the financial crisis, supporting a causal interpretation of health declines in Greece as a result of the financial crisis. CONCLUSION Results provide evidence that trends in self-rated health in Greece worsened as a result of the recent financial crisis. Findings stress the need for urgent health policy responses to the recent economic collapse in Greece as the full impact of austerity measures unfolds in the coming years.

The effect of social participation on the subjective and objective health status of the over-fifties: evidence from SHARE

ABSTRACT Increasing social participation among older individuals to increase health and wellbeing has become a distinct policy goal of many national governments and the European Commission. However, to date the evidence on how social participation affects health, both subjective and objective, remains limited, especially since most studies do not account for the reciprocal relationship. The aim of this study is to analyse how changes in social participation affect both the subjective and objective health of older Europeans as well as how changes in health status affect social participation. Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the results suggest that both the uptake as well as the continuation of social activities increase the chances of improvements in subjective as well as objective health. Furthermore, improvements in self-rated health as well as grip strength significantly increase the chances of taking up new activities as well as continuing with existing ones. Country effect is not as strong as expected and the benefits could be homogeneous across different cultures once we control for socio-economic status. Overall, the results stress the need for taking into account the reciprocal relationship between social participation and health. The paper highlights the importance of focusing on both uptake and continuation of social participation when devising policy aimed at improving healthy ageing.

Does retirement (really) lead to worse health among European men and women across all educational levels

OBJECTIVES Whereas the view that retirement would have negative effects on health is widespread, many existing studies may be biased because they do not sufficiently take into account the issue of reverse causation. Using a large longitudinal dataset for twelve Western European countries, this study uses an instrumental variables approach to assess effects of retirement on health. METHODS Longitudinal data for the years 2009-2012 for 75,722 men and 63,911 women from twelve Western European countries are derived from the European Union Statistics on Income and Living Conditions. Health outcomes used in this study are self-rated health, activity limitations and chronic conditions. Country- and sex-specific early- and full-pension ages are used as instruments. Models were stratified by sex as well as educational levels to assess potential effect heterogeneity. RESULTS Results obtained from conventional random-effects models suggest that retired men and women have higher chances of reporting bad self-rated health, activity limitations as well as chronic conditions. However, using an instrumental variables (IV) approach the results suggest that retirement can lead to health improvements in self-reported health as well as activity limitations among men and women. The health improvements associated with retirement among men and women exist across all educational levels. DISCUSSION Contrary to several previous studies, the results suggest that retirement may have health preserving effects. The positive effects of retirement and health exist for low as well as high educated men and women.

The income inequality hypothesis rejected

Publishers know academic books are not expected to sell much at all. Last year, however, Thomas Pikettys “Capitalism in the Twenty-First Century” [1] became the exception: by May 2014, this dense 700-page book arguing that inequality is not an accident but a structural feature of capitalism, was number one in the New York Times Bestsellers non-fiction list. While it may be unsurprising to find Dale Carnegies ‘How to Win Friends and Influence People’ in the list of bestsellers, it is certainly unusual for a tome about income inequality to become such a sensation. And yet, Pikettys book clearly stroked a raw nerve with the public: if inequality continues to rise by the rate observed over recent decades, Piketty argues, we will soon reach higher levels of inequality than those observed in nineteenth century Europe. This is not only a problem in its own right, but such levels of inequality may jeopardize the future of democracy [1, 2].

Economic Downturns, Retirement and Long-Term Cognitive Function Among Older Americans

Objective Workers approaching retirement may be particularly vulnerable to economic downturns. This study assesses whether exposure to economic downturns around retirement age leads to poorer cognitive function in later life. Method Longitudinal data for 13,577 individuals in the Health and Retirement Study were linked to unemployment rates in state of residence. Random- and fixed-effect models were used to examine whether downturns at 55-64 years of age were associated with cognitive functioning levels and decline at ≥65 years, measured by the Wechsler Adult Intelligence Scale-Revised. Results Longer exposure to downturns at 55-64 years of age was associated with lower levels of cognitive function at ≥65 years. Compared to individuals experiencing only up to 1 year in a downturn at 55-64 years of age, individuals experiencing two downturns at these ages had 0.09 point (95% Confidence Interval [CI, -0.17, -0.02]) lower cognitive functioning scores at ≥65 years (3 years: b = -0.17, 95%CI [-0.29, -0.06]; 4 years: b = -0.14, 95%CI [-0.25, -0.02]; ≥5 years: b = -0.22, 95%CI [-0.38, -0.06]). Downturns at 55-64 years of age were not associated with rates of cognitive decline. Discussion Exposure to downturns around retirement is associated with a long-lasting decline in cognitive function in later life. Policies mitigating the impact of downturns on older workers may help to maintain cognitive function in later life.

The public health impact of economic fluctuations in a Latin American country: mortality and the business cycle in Colombia in the period 1980-2010

IntroductionStudies in high-income countries suggest that mortality is related to economic cycles, but few studies have examined how fluctuations in the economy influence mortality in low- and middle-income countries. We exploit regional variations in gross domestic product per capita (GDPpc) over the period 1980–2010 in Colombia to examine how changes in economic output relate to adult mortality.MethodsData on the number of annual deaths at ages 20 years and older (n = 3,506,600) from mortality registries, disaggregated by age groups, sex and region, were linked to population counts for the period 1980–2010. We used region fixed effect models to examine whether changes in regional GDPpc were associated with changes in mortality. We carried out separate analyses for the periods 1980–1995 and 2000–2010 as well as by sex, distinguishing three age groups: 20–44 (predominantly young working adults), 45–64 (middle aged working adults), and 65+ (senior, predominantly retired individuals).ResultsThe association between regional economic conditions and mortality varied by period and age groups. From 1980 to 1995, increases in GDPpc were unrelated to mortality at ages 20 to 64, but they were associated with reductions in mortality for senior men. In contrast, from 2000 to 2010, changes in GDPpc were not associated with old age mortality, while an increase in GDPpc was associated with a decline in mortality at ages 20–44 years. Analyses restricted to regions with high registration coverage yielded similar albeit less precise estimates for most sub-groups.ConclusionsThe relationship between business cycles and mortality varied by period and age in Colombia. Most notably, mortality shifted from being acyclical to being countercyclical for males aged 20–44, while it shifted from being countercyclical to being acyclical for males aged 65+.ResumenIntroducciónEstudios previos en países de altos ingresos indican que la mortalidad está relacionada con los ciclos económicos, pero pocos estudios han examinado cómo las fluctuaciones en la economía afectan la mortalidad en países de ingresos medios y bajos. Este estudio explota las variaciones regionales del Producto Interno Bruto per cápita (PIBpc) en el período 1980–2010 en Colombia para examinar cómo los cambios en el ciclo económico se relacionan con la mortalidad en adultos.MétodosLos datos sobre el número anual de muertes en población mayor de 20 años (n = 3.506.600), fueron agregados por grupos quinquenales de edad, sexo y región a partir de los registros individuales de mortalidad y se cruzaron con conteos de población para el período 1980–2010. Empleamos modelos de efectos fijos regionales para examinar si los cambios en el PIBpc regional se asocian con las oscilaciones en la mortalidad. Se analizaron por separado los períodos 1980–1995 y 2000–2010, así como por sexo, distinguiendo tres grupos de edad: 20 a 44 (que representan predominantemente jóvenes trabajadores), 45 a 64 (adultos trabajadores de mediana edad), y 65 años o mayores (adultos mayores en edad de jubilación).ResultadosLa asociación entre las condiciones económicas regionales y la mortalidad varían según el periodo analizado y la edad. De 1980 a 1995, los cambios en el PIBpc no se relacionaron con la mortalidad en edades de 20 a 64, pero se asociaron con reducciones de la mortalidad para los hombres mayores. Por el contrario, de 2000 a 2010, los cambios en PIBpc no se asociaron con la mortalidad en personas mayores, mientras que un aumento en PIBpc se asoció con una disminución de la mortalidad en las edades 20 a 44 años. La cobertura del registro de mortalidad mejoró con el tiempo; los análisis restringidos a regiones con mayor registro produjeron estimaciones similares, aunque con grandes errores estándar.ConclusionesLa relación entre los ciclos económicos y la mortalidad en Colombia varía según el período y los grupos de edad estudiados. Más importante aún, la mortalidad en hombres pasó de ser acíclica a contracíclica en el grupo de 20–44 años de edad, mientras que pasó de ser contracíclica a acíclica para los mayores de 65 años de edad.Palabras claveMortalidad; Recesión económica; Colombia; Países en desarrollo; Seguro de Salud.