Williams Callum, Gilbert Barnabas James, Zeltner Thomas, Watkins Johnathan, Atun Rifat, Maruthappu Mahiben
Department of History, University of Oxford, Oxford, Oxfordshire, UK.
Medical Sciences Division, University of Oxford, Green Templeton College, Oxford, Oxfordshire, UK.
BMJ Open. 2016 Jan 6;6(1):e007546. doi: 10.1136/bmjopen-2014-007546.
The relative health effects of changes in unemployment, inflation and gross domestic product (GDP) per capita on population health have not been assessed. We aimed to determine the effect of changes in these economic measures on mortality metrics across Latin America.
Ecological study.
Latin America (21 countries), 1981-2010.
Uses multivariate regression analysis to assess the effects of changes in unemployment, inflation and GDP per capita on 5 mortality indicators across 21 countries in Latin America, 1981-2010. Country-specific differences in healthcare infrastructure, population structure and population size were controlled for.
Between 1981 and 2010, a 1% rise in unemployment was associated with statistically significant deteriorations (p<0.05) in 5 population health outcomes, with largest deteriorations in 1-5 years of age and male adult mortality rates (1.14 and 0.53 rises per 1000 deaths respectively). A 1% rise in inflation rate was associated with significant deteriorations (p<0.05) in 4 population health outcomes, with the largest deterioration in male adult mortality rate (0.0033 rise per 1000 deaths). Lag analysis showed that 5 years after rises in unemployment and inflation, significant deteriorations (p<0.05) occurred in 3 and 5 mortality metrics, respectively. A 1% rise in GDP per capita was associated with no significant deteriorations in population health outcomes either in the short or long term. β coefficient comparisons indicated that the effect of unemployment increases was substantially greater than that of changes in GDP per capita or inflation.
Rises in unemployment and inflation are associated with long-lasting deteriorations in several population health outcomes. Unemployment exerted much larger effects on health than inflation. In contrast, changes in GDP per capita had almost no association with the explored health outcomes. Contrary to neoclassical development economics, policymakers should prioritise amelioration of unemployment if population health outcomes are to be optimised.
尚未评估失业率、通货膨胀率和人均国内生产总值（GDP）变化对人口健康的相对健康影响。我们旨在确定这些经济指标的变化对拉丁美洲各地死亡率指标的影响。
生态研究。
拉丁美洲（21个国家），1981 - 2010年。
采用多元回归分析评估1981 - 2010年期间拉丁美洲21个国家失业率、通货膨胀率和人均GDP变化对5项死亡率指标的影响。对各国在医疗基础设施、人口结构和人口规模方面的差异进行了控制分析。
1981年至2010年期间，失业率每上升1%，5项人口健康指标出现具有统计学意义的恶化（p<0.05），其中1 - 5岁年龄组和成年男性死亡率恶化最为明显（每1000例死亡分别上升1.14和0.53）。通货膨胀率每上升1%，4项人口健康指标出现显著恶化（p<0.05），成年男性死亡率恶化最为明显（每1000例死亡上升0.0033）。滞后分析表明，失业率和通货膨胀率上升5年后，分别有3项和5项死亡率指标出现显著恶化（p<0.05）。人均GDP每上升1%，短期和长期内人口健康指标均未出现显著恶化。β系数比较表明，失业率上升的影响远大于人均GDP或通货膨胀率的变化。
失业率和通货膨胀率上升与多项人口健康指标的长期恶化有关。失业率对健康的影响远大于通货膨胀。相比之下，人均GDP的变化与所研究的健康指标几乎没有关联。与新古典发展经济学相反，如果要优化人口健康指标，政策制定者应优先改善失业问题。
