Recessions and Public Health

Go Lean Commentary

A man needs three things to be happy: something to do, someone to love and something to hope for – declares the book Go Lean… Caribbean (Page 36).

CU Blog - Recessions and Public Health - Photo 1In this vein, there is a whole field of study referred to as Public Health Economics, a subset of Econometrics. One champion of this field is the European Public Health Association or EUPHA; this is an international, multidisciplinary, scientific organization, bringing together around 14,000 public health experts for professional exchange and collaboration throughout Europe. They encourage a multidisciplinary approach to public health. Imagine a group studying the link between a failing economy and increased medical ailments.

While the logical connection of economy-stress-illness may be common sense, the quantification of actual ailments is a science… and art.

The book Go Lean … Caribbean is not a book of science, but gleans from scientific concepts in communicating the plan to elevate Caribbean society. The book focus on economics, and relates that the resultant societal engines can be seriously impacted by public safety/health threats. The book thusly serves as a roadmap for the introduction and implementation of a regional sentinel for public health, the technocratic Caribbean Union Trade Federation (CU). The complete prime directives are described as:

  • Optimize the economic engines of the Caribbean to elevate the regional economy.
  • Establish a security apparatus to protect the resultant economic engines.
  • Improve Caribbean governance to support these engines.

The Go Lean roadmap immediately calls for the establishment of a federal Health Department, with a charter to manage the health care and medical dimensions of the Caribbean, in conjunction with, and on behalf of the member-states. This charter will include mental health in its focus, just as serious as any other areas (cancer, trauma, virus, immunizations). This direct correlation of physical and mental health issues with the economy, in this foregoing article, thusly depicts the need for this charter:

Subtitle: The impact of downturns on physical and mental health

Exam results capture pupils’ achievements but not their enjoyment of learning. Life expectancy does not say anything about quality of life. Similarly, statistics on unemployment rates and wage levels do not tell the full story of recessions. Social scientists are increasingly interested in the effects of downturns on public health.

These effects are unclear. There is some evidence that physical health may actually improve in downturns. One paper by Christopher Ruhm[a], now of the University of Virginia, looking at American data from 1972 to 1991, suggests that a one-percentage-point increase in unemployment reduced mortality by 4.6 deaths per 100,000 people. “With shorter working hours, people spend more time at home with their families and may be less stressed from overwork,” suggests Stephen Bezruchka of the University of Washington.

But there is also evidence that big economic crises are correlated with a deterioration in health. The Depression of the 1930s was associated with increases in malnutrition because people had less money to spend on food. In 1928, 14% of adults over 20 in Philadelphia were deemed to be suffering from malnutrition. By 1932 the figure had risen to 26%.

Social scientists are now scouring public-health data for clues about the impact of the recent crisis. A National Bureau of Economic Research paper [b] found that in America there has been a 4.8% increase in the likelihood of self-reported poor health for every one-percentage-point drop in state employment rates.

Some diseases have become more prevalent. In Greece incidence of HIV has risen, with a 50% increase in new infections in 2011 compared with 2010. The jump has been concentrated among injecting drug-users, and has been linked to large cuts to health services. Needle-exchange projects have been pared back, making transmission more likely.

CU Blog - Recessions and Public Health - Photo 2Mental health does appear to suffer during downturns. Mr Ruhm’s work found that suicide rates rose with unemployment. The East Asian crisis of the late 1990s was marked by a spate of suicides: in Hong Kong, Japan and South Korea the crisis was responsible for 10,400 more suicides in 1998 than might normally have been expected. Research on Spain indicates that in the current crisis the suicide rate has increased by 8%. The rise is concentrated among people who are most likely to have lost their job.

Working out how health is affected by recessions is made harder by time lags. Job insecurity may lead people to the bottle, which will have repercussions later. A recent paper co-authored by Paul Frijters at the University of Queensland[c] found that the latest recessionary period was associated with an almost 20% increase in alcoholism-related Google searches in America. Higher alcohol abuse today will worsen health outcomes over time.

Obesity is another slow-burning health problem. Higher unemployment leads to lower incomes, which can make it more difficult for people to eat well. Research from the University of Nebraska finds that “financial stress”—not being able to pay for essentials such as food or rent—is a strong predictor of obesity. In Australia the risk of being obese in 2010 was 20% higher among individuals who experienced financial stress in 2008 and 2009 than among those who did not experience it in either year. Policymakers should keep an eye on this growing body of research for guidance on how to marshal health-care resources when economies fall ill.


The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis“, by J. A. L. Bernal, A. Gasparrini, C.M. Artundo and M. McKee, The European Journal of Public Health, 2013

More Than 10,000 Suicides Tied To Economic Crisis, Study Says“, by Melanie Haiken, Forbes Magazine, quoting study published in June (2014) in the British Journal of Psychiatry.

Was the economic crisis 1997–1998 responsible for rising suicide rates in East/Southeast Asia? A time–trend analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand“, by S.S. Chang, D. Gunnell, J.A. Sterne, T.H. Lu and A.T. Cheng, Social science & medicine, 2009

Decomposing the Relationship between Macroeconomic Conditions and Fatal Car Crashes during the Great Recession: Alcohol-and Non-Alcohol-Related Accidents“, by C. Cotti and N. Tefft, The BE Journal of Economic Analysis & Policy, 2011

Exploring the relationship between macroeconomic conditions and problem drinking as captured by Google searches in the US“, by P. Frijters, D.W. Johnston, G. Lordan and M.A. Shields, Social science & medicine, 2013

Financial crisis and austerity measures in Greece: Their impact on health promotion policies and public health care“, by A.A. Ifanti, A.A. Argyriou, F.H. Kalofonou and H.P. Kalofonos, Health Policy, 2013

Is Malnutrition Increasing?“, by E. Jacobs, American Journal of Public Health and the Nation’s Health, 1933

HIV-1 outbreak among injecting drug users in Greece, 2011: a preliminary report“, by D. Paraskevis, G. Nikolopoulos, C. Tsiara, D. Paraskeva, A. Antoniadou, M. Lazanas, P. Gargalianos, M Psychogiou, M. Malliori, J. Kremastinou and A Hatzakis, Euro Surveill, 2011

Are recessions good for your health?“, by C.J. Ruhm, The Quarterly Journal of Economics, 2000

Prolonged financial stress predicts subsequent obesity: Results from a prospective study of an Australian national sample“, by M. Siahpush, T.T.K. Huang, A. Sikora, M. Tibbits, R.A. Shaikh, G.K. Singh, Obesity, 2013

Health and Health Behaviors during the Worst of Times: Evidence from the Great Recession“, by E. Tekin, C. McClellan and K.J. Minyard, National Bureau of Economic Research, 2013

Appendix – Cited References:
a. Retrieved August 21, 2014 from:
b. Retrieved August 21, 2014 from:
c. Retrieved August 21, 2014 from:

The Economist Magazine (Posted 08-24-2013; retrieved 08-21-2014) –

Consider these crises:

  • Suicides
  • Alcoholism
  • Drug Abuse (Prescription & Illegal Street Varieties)
  • Rage

No one wants to live in a society where these mental health crises remain unmitigated. But the foregoing article relates that increases in many physical ailments (HIV, malnutrition, obesity, etc) also constitute a crisis. The book declares that “a crisis is a terrible thing to waste”, so the required mitigations start with this Go Lean roadmap.

A lot is at stake – from a declining quality of life all the way to early death.

The Go Lean roadmap immediately calls for the coordination of the region’s healthcare needs. This point is declared early in the Go Lean book, commencing with this opening pronouncement in the Declaration of Interdependence (Page 12), as follows:

ix.  Whereas the realities of healthcare … cannot be ignored and cannot be afforded without some advanced mitigation, the Federation must arrange for health plans to consolidate premiums of both healthy and sickly people across the wider base of the entire Caribbean population. The mitigation should extend further to disease management, wellness, obesity and smoking cessation programs.

There is no doubt that the Great Recession devastated Caribbean economies, but what were the affects on the region’s physical and mental health? If we want to minimize the “push-and-pull” factors that lead people to emigrate, we must answer this question very thoughtfully, then be prepared for the next crisis. This point was also anticipated in a further pronouncement in the Declaration of Interdependence (Page 13), as follows:

xxv.   Whereas the legacy of international democracies had been imperiled due to a global financial crisis, the structure of the Federation must allow for financial stability and assurance of the Federation’s institutions. To mandate the economic vibrancy of the region, monetary and fiscal controls and policies must be incorporated as proactive and reactive measures. These measures must address threats against the financial integrity of the Federation and of the member-states.

Go Lean … Caribbean therefore constitutes a change for the Caribbean. This is a roadmap to consolidate 30 member-states of 4 different languages and 5 colonial legacies (American, British, Dutch, French, Spanish) into a Trade Federation with the tools/techniques to bring immediate change to the region to benefit one and all member-states. This includes the monitoring/tracking/studying the physical and mental health trends. This empowered CU agency will liaison with non-governmental organizations (NGOs) and agencies like EUPHA, plus other foreign entities with the similar scope, like the US’s Center for Disease Control (CDC) and the World Health Organization (WHO).

The book details that there must first be adoption of such a community ethos, the appropriate attitude/spirit to forge change in the region. Go Lean details this and other ethos; plus the executions of the following strategies, tactics, implementations and advocacies to impact the region’s public health:

Community Ethos – Deferred Gratification Page 21
Community Ethos – Economics Influence Choices Page 21
Community Ethos – Privacy versus Public Protection Page 23
Community Ethos – “Crap” Happens Page 23
Community Ethos – Lean Operations Page 24
Community Ethos – Cooperatives Page 24
Community Ethos – Non-Government Organizations Page 25
Community Ethos – Ways to Improve Sharing Page 35
Community Ethos – Ways to Promote Happiness Page 36
Community Ethos – Impact the Greater Good Page 37
Strategy – Vision – Confederate 30 Member-States Page 45
Strategy – Mission – Reform   our Health Care Response Page 47
Strategy – Agents of Change – Aging Diaspora Page 57
Tactical – Fostering a Technocracy Page 64
Separation of Powers – Department of Health Page 86
Implementation – Ways to Deliver Page 109
Planning – Ways to Model the EU Page 130
Planning – Ways to Make the Caribbean Better Page 131
Planning – Ways to Measure Progress Page 148
Advocacy – Ways to Grow the Economy Page 151
Advocacy – Ways to Improve Healthcare Page 156
Advocacy – Ways to Impact Cancer Page 157
Advocacy – Ways to Better Manage the Social Contract Page 170
Advocacy – Ways to Foster Cooperatives Page 176
Advocacy – Ways to Improve Emergency Management Page 196
Appendix – Disease Management – Healthways Model Page 300
Appendix – Trauma Center Definitions Page 336

The foregoing news article links economic downturns to physical and mental health ailments – there is no denying. There is need for a permanent union to provide efficient stewardship for the Caribbean economy, security and governing engines – plus serve as a Health and Medical Sentinel.

Who will be that Sentinel? The Caribbean Union Trade Federation hereby submits for this job. The region’s stakeholders (people and institutions) are hereby urged to lean-in to this Go Lean roadmap, to make the Caribbean a better place to live, work, heal and play.

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