Since 2008, the WHO Regional Office for Europe and the European Observatory on Health Systems and Policies have been monitoring the effects of the financial and economic crisis on health and health systems in Europe. The study Economic Crisis, Health Systems and Health in Europe: impact and implications for policy compiles the findings on how health systems in Europe responded to the crisis, covering the period between the onset of the crisis in Europe in late 2008 and Ireland’s exit from its EU-IMF economic adjustment program at the end of 2013.

The study provides insights into the sorts of policies that are most likely to protect health, ensure financial protection and sustain the performance of health systems experiencing fiscal pressure.

Resilience, changes and collaboration

It is evident that, when the crisis began, some health systems were much better prepared than others to cope with financial pressure. Factors that helped to build resilience included adequate levels of public spending on health or political will to tackle inefficiencies.

Although being prepared is important, policy responses to pressure are decisive.  Even in austerity, policy-makers have options. The wide range of responses demonstrates how countries facing severe fiscal pressure can introduce changes that secure financial protection and access to health care services for vulnerable groups of people, and that strengthen the performance of health systems and build resilience.

Previous crises showed that negative effects on population health and on health systems can be mitigated through timely policy action. However, the current crisis has shown that health policy-makers cannot do it on their own. To protect health and access to health services, work in partnership with those responsible for social and fiscal policy is needed.

Social policy promotes household financial security, while fiscal policy enables government to maintain adequate levels of social spending

Mental Health

Mental health has been the area most sensitive to economic changes so far. Since the onset of the crisis, suicides have increased across the EU, reversing a previous downward trend in many countries. There is also evidence that the prevalence of mental disorders has increased. While the evidence generally suggests that unemployment and financial insecurity increase the risk of mental health problems, there is a lack of consistent evidence on their effects on other health outcomes.

Overall, the limited data available suggest that the largest effects on health have been concentrated among those experiencing job loss and among some of the most vulnerable and least visible groups in society, including migrants, homeless people and drug users. Since the crisis began, leading health professionals have highlighted the human and economic costs of inadequate support for people with mental health problems. They have called for stronger social safety nets and active labor market programs; action to restrict access to the means of self-harm for vulnerable individuals; an expansion of family support programs; the provision of education, information and support programs targeting vulnerable groups; the development of community-based services; and ensuring universal access to health services.

The absence of up-to-date morbidity and mortality data at European level has made difficult to assess fully the immediate effects of the crisis and related policy responses on health. This contrast with the speed with which economic data are available is a stark indicator of where political priorities lie.

When monitoring health, it is important to go beyond broad national statistics. The evidence from this crisis and from previous recessions clearly shows how negative effects on health tend to be concentrated among more vulnerable groups of people, particularly people experiencing job loss, but also the groups identified above.

The full impact the crisis has had on public health is still unknown. Much of the data analyzed here refers to health states in which the period between exposition and outcome is very short, being mental disorders, suicide, infectious diseases or injuries. However, there are probably other added long-term effects on public health caused by financial insecurity, delayed access to health care services and errors in the management of chronic illness. These effects might not be recognizable for some time. To monitor closely public health, at a national and international scale, is therefore essential, as well as to develop active policies to mitigate adverse effects.


Source: Thomson S, Figueras J, Evetovits T, Jowett M, Mladovsky P, Maresso A, Cylus J, Karanikolos M, Kluge H. Economic Crisis, Health Systems and Health in Europe.World Health Organization.2015. Available at: