Country/ Years Health setting studied outcome Study design Measure of economic or political crisis Economic recession in SE Asia Current economic downturn, 5% decrease in GDP Financial Crisis Global Global Recession Global Financial Crisis Global Financial Crisis SE Asia World USA USA 2000 2009 2009 2009 2009 2008 Financial Crisis 2008 General Financial crisis Interna- tional 2010 doi:10.1371/journal.pone.0020724.t002 Descriptive trend analysis Significantly lowered number of dispensed prescription drugs. HIV/AIDS HIV/AIDS Non- specific Non- specific Non- specific Non- specific Financing for HIV/AIDS policies Descriptive trend analysis Descriptive trend analysis Descriptive trend analysis Descriptive trend analysis Descriptive trend analysis Descriptive trend analysis Short survey Findings Reduction in HIV/AIDS budget by 24% in Thailand in 1998, by 50% in Indonesia in 1999, but no significant changes in morbidity patterns Possible interruption of treatment and hence resistance, denial of treatment. Increase in transmission and TB risk as a result. Recommended action plan for countries in order to mitigate the health impact of the financial crisis. Exploratory analysis of the impact of economic crisis on global health and the role that global health actors could play. The editorial lists the challenges that will be faced by the health sector due to the financial crisis. It covers a wide range of challenges and gives advice to health professionals. According to the survey conducted by University of New Hampshire survey centre, 1/3 of Americans had problems paying medical bills and or were unable to afford health care. Concerns regarding the possibility of decreases in HIV/AIDS funding. Examples given are Italy and Ireland who have reduced assistance for global HIV/AIDS programmes Source USAID 2000. UNAIDS. The global economic crisis and HIV prevention and treatment programmes: vulnerabilities and impact. Geneva: UNAIDS and World Bank, Global HIV/AIDS program, 2009. WHO. Financial Crisis and Global Health: Report of a high-level consultation. Geneva, 2009. The Lancet, 2009, Vol. 373, January 31, The global financial crisis: an acute threat to health. Horton, R. EDITORIAL. Social Medicine, 2009; 83 - Volume 4, Number 2, The Economic Crisis and Public Health, Barry S. Levy, Victor W. Sidel Saul S. In sour economy, some scale back on medications. New York Times, October 22, 2008. Available at: http://ww.nytimes. com. Accessed on October 22, 2008. 2. Lazar K. Medical costs still burden many despite insurance: Mass. survey finds people in debt, skimping on care. Boston Globe, October 23, 2008. Available at: http://www.boston.com. Accessed on October 23, 2008. Voelker R. One Casualty of Global Economic Crisis: Uncertain Finances for HIV/AIDS Programs. JAMA 2010; 303(3): 259–61 Table 2. Grey Literature and commentaries. Economic Crises and Infectious Diseases sometimes act as a wake-up call for society to address an issue that would otherwise be neglected. i. Transition Rate (Susceptible to Infected) We found evidence that crises often increased direct and indirect contact rates among human hosts or common vehicles and between human hosts and disease vectors (Figure 1) [13,34,46,47]. We also observed that crises can lead to changes in host behaviour that decrease host immunity [30,48,49,50,51,52]. As concerns direct human-to-human transmission, economic downturns may lead to increased crime, especially against property (although this can be mitigated by effective policing [53] and by increased social welfare spending, as occurred in the Great Depression [54]), as well as to increased prison populations. Prisons, in turn, have been shown to act as incubators for tuberculosis, for example, with overcrowding playing a key role, and subsequent spill-overs to the general population [12,13,34,55]. Indirect transmission through a common vehicle was documented in Uzbekistan subsequent to the breakup of the former Soviet Union [56]. High diarrheal disease rates during the summer months were recorded in Nukus, an administrative centre of a region in Uzbekistan. A randomized intervention trial using home chlorina- tion pinpointed the source of these high disease rates: cross- connections between the municipal water distribution system and sewer lines were implicated as the common vehicle in disease transmission. Leaky pipes and lack of water pressure are manifestations of a failing infrastructure, mismanaged during times of economic hardship, which can cross-contaminate the drinking water supply. The political, social and economic upheaval at the time resulted in deterioration of water treatment and distribution systems in Uzbekistan, with serious implications for public health. Environmental changes in vector habitats may occur due to economic downturns, which could increase contact rates between humans and disease vectors. One study found that mortgage foreclosures in the Californian housing market in California in 2007 caused homes with swimming pools to be abandoned, increasing breeding habitats for mosquitoes. This was linked to an unexpectedly early seasonal increase in West Nile Virus cases [46]. A study of the economic crisis in Kosovo in 1999–2000 found that economic dislocation resulted in the abandonment of food stores. Subsequent rises in rodent populations led to the emergence of tularaemia [47]. An ecologic study suggested that people in Central and Eastern Europe who returned to subsistence agricultural productions, in particular mushroom harvesting, were at greater risk of tick-borne encephalitis [13]. Behavioural changes induced by economic downturns may lead to increased exposure to disease. Loss of income, involuntary unemployment and job insecurity appear to lead to increased tobacco consumption, substance abuse and hazardous drinking, all of which could impair immunity [52]. For example, tobacco use increases the immediate risk of TB mortality and longer-term risk of TB spread and reactivation [35,51]. Alcohol can increase PLoS ONE | www.plosone.org 8 June 2011 | Volume 6 | Issue 6 | e20724