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Impact of global economic crisis on cancer deaths

Global economic crisis linked to over 250000 higher-than-expected number of cancer deaths

Unemployment and reduced public-sector health spending following the 2008 global economic crisis were associated with increased cancer mortality, according to a new study led by academics at King’s College London and Imperial College London. The study, published in The Lancet, estimates that the recent economic crisis was associated with over 250000 higher-than-expected number of cancer deaths.

The study is the first global analysis to look at the effect of unemployment and changes in public-sector healthcare spending on cancer deaths, and suggests universal health care coverage may protect patients from the health consequences of rising employment and reduced public-sector healthcare spending.

Researchers used data from the World Bank and World Health Organisation to look at the link between unemployment, public health care spending and cancer mortality in over 70 countries, representing over 2 billion people. They looked at trends over 20 years, from 1990 to 2010.

Cancer accounted for 8.2 million deaths in 2012, and the number of cases is expected to increase from 14 million in 2012 to 22 million in 2030. The economic crisis beginning in 2008 saw a substantial rise in unemployment, and caused many countries to cut public-sector health care spending. Several studies have shown the impact of these changes on mental and physical health – for instance increases in suicide or cardiovascular disease.

Several cancers were included in the analysis - prostate cancer in men, breast cancer in women, colorectal cancer in men and women, and lung cancer in men and women. Cancers were classified as treatable (survival rates over 50%) or untreatable (survival rates less than 10%).

The study found that rises in unemployment were associated with an increase in deaths across all cancers but the association disappeared when universal health care was taken into account. The association between unemployment and cancer mortality was strongest for treatable cancers, and the authors say that this reinforces the importance of having access to care. A 1% increase in unemployment was associated with 0.37 additional deaths from all cancers per 100,000 people.

The study also found that cancer mortality decreased as public health expenditure increased. A 1% decrease in public healthcare spending as a percentage of GDP (gross domestic product) was associated with 0.0053 additional deaths from all cancers per 100,000 people.

Co-lead author Johnathan Watkins, a researcher at the Division of Cancer Studies at King’s said: ‘Our study has two clear major policy implications. First, it makes a strong case for universal health coverage and its potentially protective effect on unemployed populations during economic downturns. Second, if spending restrictions are not accompanied by proportionate improvements in efficiency, higher mortality levels may ensue.’

Professor Richard Sullivan, Director of the Institute of Cancer Policy, King’s Health Partners Comprehensive Cancer Centre who was an author on the study, added: ‘Unemployment does not just affect lives, it also dramatically affects health. And we now know from this work how detrimental this is to cancer. With rising unemployment across Europe politicians need to realise that this unacceptable state of affairs is directly contributing to worse cancer outcomes.’

The authors add that the study published today can only show an association between mortality, unemployment and public-sector spending, and cannot prove cause and effect. However, they say that the study found a chronological correlation - changes in unemployment were followed by changes in cancer mortality which they say lends support to a causal link. They also add that since high quality data was only available up until 2010, they were unable to analyse the longer-term effect of economic fluctuations on cancer mortality.

Notes to editors

For further information please contact Hannah Bransden, Press Officer at King’s College London, on +44 (0)207 848 3840 or email hannah.bransden@kcl.ac.uk

‘Economic downturns, universal health coverage, and cancer mortality in high-income and middle-income countries, 1990-2010: a longitudinal analysis’ by Maruthappu et al is published online in The Lancet on Wednesday 25 March 2016 at 23:30 UK time.

For more information about King’s College London, please visit King’s in Brief.