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Economic Recessions

Economic recessions periodically occur in all the world's economies. Despite the importance of recessions, there has been relatively little conclusive research conducted on their impact on a population's health and healthcare providers. Those few researchers who have studied the issue tend to break into two camps. In the one camp, economists and public health researchers argue that recessions and health are countercyclical; that is, as the economy deteriorates, more individuals become ill and seek out healthcare services thereby placing a strain on healthcare providers. In contrast, researchers in the other camp argue that recessions and health are procyclical; that is, as the economy deteriorates, fewer individuals have the economic resources to pursue unhealthy behaviors such as overeating, smoking, and consuming alcohol, which lead to improved health and decreased healthcare utilization. Both camps study the issue by focusing on mortality data and/or healthcare utilization data.

Definition of Economic Recession

Economic recession is defined in macroeconomic theory as two or more calendar quarters of consecutive decline in a nation's gross domestic product (GDP). The National Bureau of Economic Research (NBER) more broadly defines recession as a significant decline in economic activity spread across the economy, lasting more than a few months. Recession may also have accompanying declines in employment rates, among other measures of a nation's economic health such as business profitability, stock market performance, and inflation.

Definition of Health and Healthcare Measures

The study of economic recession effects on a population's health includes the analysis of aggregate health outcome statistics, such as the overall population mortality and disease-specific mortality and morbidity. Most researchers have studied the relationship of unemployment and population health using mortality data, while few have studied the relationship of unemployment and morbidity.

Mortality and Morbidity

Mortality, a commonly used public health index, is a very crude measure of the health of a population. The crude death rate is calculated as the total number of deaths in a year for a geographic area divided by the average midyear population expressed per 1,000 people. There are many ways to refine mortality rates, including adjusting for the population's age (age-specific death rate), causes of death (cause-specific death rate), and the period around birth (e.g., infant mortality rate, neonatal mortality rate, maternal mortality rate).

In the study of morbidity, defined as the relative incidence of disease, the earliest attempts by government to investigate disease occurrences were related to the need to contain serious infectious diseases, such as smallpox, diphtheria, and yellow fever. To this was added the goal of studying the distribution of diseases. In their focus on patients as individuals, practicing physicians are likely to be relatively unconcerned with their role in contributing to a community-wide network of information about disease. However, through the use of medical billing data, the incidence of disease across networks can be determined as patients present to healthcare facilities. Morbidity can therefore be analyzed by studying utilization of healthcare services and can be a useful measure of the effects of unemployment on a population's health over time.

Healthcare Utilization

The analysis of the effects of economic recession on the utilization of healthcare services generally focuses on inpatient hospitalization but may also include an analysis of outpatient services. Inpatient hospitalization (generally defined as an overnight stay in a hospital for more than 24 hours) analysis is more common given that data are uniformly and consistently gathered by hospitals through federal requirements for participating in the Medicare program. Data are captured in a uniform billing (UB) data set made available to researchers and practitioners typically through state public health departments or hospital associations. Outpatient data are less reliably captured and inconsistently reported on and therefore are not well suited for health services research.

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