Child health in times of austerity as a result of the economic crisis that started in 2008

The life we live and our conditions to thrive are shaped by socioeconomic determinants. Upstream (macrolevel) factors include global forces and government polices – economic, welfare, health, education, housing, transport and taxation – and may either enforce the protection of health and well-being of populations or undermine them. Inequalities undermine health and their impact in recent years has come under rapidly growing scrutiny (1). They impinge negatively on the health and well-being of mothers and their offspring during intrauterine development, and all through the course of their lives, and these may be aggravated in times of economic recession (2). Since late 2008, many Western societies have experienced the full force of an economic backlash after several years of economic growth and prosperity and European countries, such as Greece, Spain, Portugal, Ireland and Iceland, have been hit hard by the crisis (3). Governments have been left in a difficult situation, as they need to address the abrupt downward trend of national gross domestic product and high debts and are under pressure to balance national budgets. At the same time, they face popular demands to safeguard the health and well-being of the population, the welfare services and social protection systems. In addition, there are demands for immediate action to address high unemployment rates and to focus on those who are most vulnerable, including families and children. The background to the crisis is different in each country, but subsequent austerity measures have come at a cost, not least for the health of children and their families (2). The current economic crisis illustrates the impact that upstream socioeconomic determinants may have on the health and well-being of populations. In an economic recession, many households live with financial pressures compounded by high unemployment rates and austerity measures taken by their respective governments. They may suddenly experience material deprivation while they slide below the poverty line, with associated risks for children’s health and well-being. How governments address these challenges may have an impact long after economic recovery. In the case of Iceland, there has been little evidence so far that the severe 2008 economic crisis has negatively affected most of the commonly used child health indicators (4). A striking exception is the increase in the proportion of infants born since 2009 with an International Classification of Diseases (ICD)-10 diagnosis of small-for-gestational age, and this needs further analysis. Yet, this observation is an example of the multitude of insidious interactions that an economic collapse, and subsequent austerity measures, may have on maternal and child health. Explanations for this encouraging overall positive child health outcome in Iceland following the economic collapse are complex, but include free and universally accessible preventive and curative maternal and child health services and the social protection measures taken by the Icelandic Government in the aftermath of the crisis (4). A literature review on the impact of the 2008 economic crisis on child health was published in 2014 and highlighted gaps in the knowledge on the subject (5). After systematically reviewing 22 studies, the authors concluded that the recession had indeed harmed children’s health, in particular those who were the most vulnerable before the crisis. However, the impact that was seen was not the same across the countries included in the review. The authors underscored the importance of carrying out more studies in different settings to guide evidence-based policies to counteract the negative impact an economic crisis may have on children’s health. Interestingly, the most consistent finding in the review was a negative impact on the food and nutrition consumed by households. With less employment opportunities, lower income and higher living costs, families may respond by reducing their food budget, resulting in a smaller number of meals and an inclination to purchase cheaper and lower-quality food. In this issue of Acta Paediatrica, Kleanthous et al. (6) publish results from their Greek West Attica Growth Study. Schoolchildren from four age groups, and mostly middleclass families, were weighed, with the first measurement in November 2009 and then every 6 months until May 2012, deep in the midst of the Greek economic crisis. In November 2009, the prevalence of obesity was 17.5% for 6to 7-year-old boys, and by May 2012, this had fallen to 15.5%. The figures for the girls in this age group were similar, at 21.4% and 16.0%, respectively. For 15to 16year-old boys, the prevalence of obesity was 8.4% in November 2009, compared with 3.9% in May 2012, and for the girls, it was 3.4% and 4.1%, respectively. The study was designed to gather data to construct velocity growth