How do recessions impact our health?

As trade deal negotiations with the EU enter their final phase, new research has shown how the economic consequences of a threadbare Brexit deal - or no deal at all - will not only determine the future of key parts of the British economy, but also the future health of large sections of the UK's population.

A comprehensive analysis of historical data from previous recessions strongly suggests that the potentially adverse economic results of the current UK/EU trade deal talks will eventually determine the physical and mental health trajectories and life chances of millions of people in many different parts of Britain.

The economic problems, induced by abruptly leaving the EU is forecast to lead to increased unemployment, reduced real incomes and growing poverty across the UK – but the new historical survey of past recessions, carried out by The Independent, suggests that those impacts will also generate a series of health and societal problems.

In mental health terms, data from the 2008-2013 recession reveals with disturbing clarity how economic woes can increase the number of people suffering from depression and anxiety. During the last recession, clinical depression and anxiety among men rose by a third between 2008 and 2011.

Mental health data analysed by the UK's National Centre for Social Research suggests that the number of 16-24 year olds suffering from mental health issues  in England increased by almost a third between 2008 and 2009 – precisely the time that the unemployment and other consequences of the recession impacted. Between 2008 and 2013, the UK’s suicide rate also increased by 16 per cent.

Alcoholism has also increased during previous recessions. Although alcohol consumption overall is likely to reduce (due to reductions in disposable incomes) as Brexit-induced economic problems begin to impact, some heavy drinkers are likely to increase their consumption.

Health Survey for England data from the 2008-2013 Great Recession shows that, although alcohol consumption overall reduced, many men who had lost their jobs started binge-drinking.

Data from past recessions shows that domestic violence has increased during periods of increased unemployment, increased poverty and economic stress. In 2009, the last recession was almost certainly a major factor which halted a steady decline in domestic violence that had been underway over previous years - from a low of 309,000 cases of domestic violence in England and Wales in 2008/2009, it increased to 488,000 in 2012/2013. 

Recessions also tend to destabilise family relationships in more general ways - unemployment, housing problems and financial stress typically drive up divorce rates.

In the UK, the Great Recession halted a decline in the divorce rate. Between 2010 and 2013, there were around 20,000 additional divorces (before the divorce rate decline resumed again in 2014). Research published by three of Britain's top relationship charities (Relate, Relationships Scotland and Marriage Care) in 2017, revealed that of 5,000 couples interviewed, 26 per cent said money worries were the main factor putting a strain on their relationship.

As well, as causing deteriorations in mental health and human relationships, recessions also affect people's physical health and wider social behaviour.

The same unemployment-induced personal stress which generates mental health deteriorations can also affect physical health.

Stress can exacerbate pre-existing heart problems (and, in some cases, generates new ones), Brexit-induced economic problems over the coming years are likely to lead to substantial numbers of additional cardiovascular-related deaths.

“The evidence available to us suggests that times of recession impact the outcomes for people with heart and circulatory disease,“ said Kate Cheema, Director of Health Intelligence at the British Heart Foundation.

The detrimental recessionary effects on the incidence of cardiovascular disease had lethal consequences for millions of people in the UK. Indeed, as a result of the Great Recession, an estimated 2 million years of life were lost (representing around 100,000 additional premature heart disease deaths).

Meanwhile the dietary, smoking and weight-gain lifestyle changes often generated by recession-induced unemployment, poverty and personal stress also ultimately lead to increased levels of cardiovascular disease.

Like heart disease, previous recessions also correlate with adverse changes in diabetes-related deaths.

At the height of the 1990s recession, the at-that-time downward trend in diabetes prevalence temporarily reversed – and it did so again at the height of the 2008-2013 recession (and during its austerity-stricken aftermath). Indeed, the Great Recession brought to an end a 16 year long decline in the scourge of diabetes – and that led to an estimated 2200 additional premature deaths (representing a loss of around 40,000 years of life).

Historic data on smoking and diet also strongly suggests that the Brexit-related economic problems which are forecast to affect the UK over the coming years will result in hundreds of thousands of additional cancer cases and many thousands of additional cancer-related deaths.

Stress-induced increases in smoking, adverse changes to diet, and reductions in exercise are three key triggers for cancer formation – and all three often tend to be induced by human impacts caused by recessions.

Historical data from the Office for National Statistics show that a long-term decline in smoking was abruptly halted by the recession of the early to mid 1990s and was halted again by the 2008-2013 Great Recession.

Other historical data suggests that fibre consumption (crucial for helping to prevent several types of cancer) decreased during the 2008-2013 Great Recession. This is revealed through fibre-rich fruit and vegetable consumption DEFRA statistics for those years.

Indeed, as the recession began to bite, and as poverty and prices rose, overall vegetable consumption, at recommended levels, fell by around 7% – with some particularly hard-hit sections of the population falling by 15%. Predicted Brexit-induced fresh vegetable and other food price rises next year could well have a similar impact.

Alcohol consumption, another trigger for cancer, also rose during the Great Recession in some communities most severely affected by the economic downturn.

The most serious alcohol-related impact around the peak of the Great Recession seems to have been a substantial increase – around half a million men – in the number of male moderate-to-heavy drinkers. There was clearly also a concomitant increase in drink-related hospital admissions (indeed an increase of around 9000 around the peak of the recession). With alcohol minimum unit pricing not currently applicable in England, alcohol related impacts next year and beyond could be even more serious.

A fourth great generator of cancer is obesity – and evidence from both the 1990s and the 2008-2013 economic downturns strongly suggests that recessions adversely affect the nature of many people's food consumption – and therefore increase obesity rates.

According to data from the Health Survey for England, in terms of overall male obesity, the Great Recession saw the number of obese people increase by around 1 million, an increase of approximately 9% for men and 6% for women.

In terms of severe obesity, recession-associated increases were even greater. The 1990s recession saw a dramatic 33% rise in the number of women effected (around 150,000 additional cases) – and a 133% increase among men (some 120,000 additional cases).

Then in the 2008-2013 recession, serious cases among men rose by 40% (150,000 additional cases) with cases among women up by 135,000 (a 35% increase).

It is impossible to know precisely how many additional cancer deaths, caused by all these factors, will occur as a result of the Great Recession. But cancer specialists believe that many thousands of lives have been lost and will continue to be lost due to lung, throat, bowel, breast, blood, pancreatic, kidney, liver and other cancers, triggered by lifestyle changes induced by the 2008-2013 recession and its increased poverty, income reduction, unemployment and personal and family stress.

“For most cancer types we know that people from more disadvantaged areas are both more likely to get cancer and are more likely to die from it. Any situation that increases the scale of deprivation in the UK could see cancer become a bigger problem in the long term,” said Dr Samuel Godfrey, Senior Research Information Manager at Cancer Research UK.

A potentially long-term economic down-turn or slow-down, triggered next year by Britain's end-2020 departure from the European Single Market and the customs union, is likely also to significantly damage the life chances of thousands of children. At least in the early stages of any such economic problem, the impact of the current pandemic is likely to be an exacerbating factor.

Tragically, reduced real disposable incomes and increased levels of unemployment and poverty will harm the brain development of foetuses during pregnancy in multiple ways (including depleted maternal nutrient intake, increased levels of smoking – and in some cases, increased alcohol consumption). Increased poverty will also impact children's cognitive development – especially in the first four years of life. Unemployment, financial stress and reduced disposable income not only adversely affect family nutrition – but also often lead to adult clinical depression and household stress which, in turn, reduces levels of attention given by parents to their young children. That reduced interaction then prejudices those children's cognitive development.

The increased marital instability and divorce rates, associated with recessions, also impact adversely on children and adolescents – and will, in many cases harm their subsequent psychological development. Some studies suggest that long-term depression and anxiety rates are higher in the sons and daughters of divorced couples.

However, as in past recessions, the current one, as it potentially deepens next year due to Brexit, will impact differently in different areas. Some regions and localities will be hit much worse than others.

The health and societal consequences of any longer term Brexit-induced economic problems over the coming decade are likely, therefore, to be distributed unevenly across the nation – and it is the current final phase of UK/EU negotiations that will ultimately determine the scale and nature of those impacts.

If you have been affected by any of the issues raised in this article, you can contact Mind on 0300 123 3393 or email info@mind.org.uk.

The Samaritans also offers support; you can speak to someone for free over the phone, in confidence, on 116 123 (UK and ROI), email jo@samaritans.org, or visit the Samaritans website to find details of your nearest branch.