How did the number of cancer deaths change following the 2008 global economic crisis?
We found that the recent global economic crisis may have been associated with 260,000 additional cancer deaths in the OECD, between 2008 and 2010 alone.
Were you surprised by the number of deaths that you found?
Yes, because until now there hadn't been a clear association found between economic crises and cancer mortality.
Recessions had previously been linked to rises in suicide rates and heart attacks. Hypotheses underlying these associations suggest that unemployment can result in increased behavioral and physiological stress, leading to a heart attack, or shift in mental health that can cause someone to commit suicide.
The link between economic crises and cancer mortality rises are quite different; we believe that those who become unemployed may have reduced access to the care they need, leading to poorly managed cancer and in turn, greater mortality.
Please can you give an overview of your recent study analyzing the impact of the global economic crisis on cancer mortality?
We published a study in the Lancet looking at data from 1990 to 2010 across more than 70 countries. We looked at the association between rises in unemployment, changes in public spending on healthcare and cancer mortality.
We found there was a significant association between rises in unemployment and increases in cancer mortality. We also found that cuts to public health spending were associated with increased cancer mortality.
As we know, during an economic crisis, unemployment can rise. Depending on the policy measures that are in place, if there are austerity interventions, these can reduce the amount a country spends on healthcare; Greece would be an example of this.
We, in turn, conducted other analyses which found that universal health coverage was actually largely protective against the effects of economic hardship. If a country had universal health coverage, it experienced less additional cancer deaths due to the economic crisis.
As an illustration of that, between 2008 and 2010, we found that the United Kingdom had zero additional cancer deaths. By contrast, we found that the United States had up to 18,000 additional cancer deaths.
We believe this is partly because the United States doesn't have universal health coverage, which means that if you become unemployed, the quality of care that you receive is potentially worse and therefore the likelihood of death from cancer increases.
We also compared cancers that are largely treatable and have high survival rates if managed appropriately such as colorectal, breast, and prostate cancer, with cancers that we counted as untreatable, as they have very low survival rates, such as pancreatic and lung cancer.
We found that treatable cancers were far more sensitive to economic changes than untreatable ones. This, again, lent support to the fact that people may have had reduced access to the healthcare services and treatments they needed during the economic crisis, possibly explaining this sudden spike in cancer mortality.
Cancer can be very costly to manage because it can often involve radiotherapy, chemotherapy and surgery. Countries where healthcare is free at the point of access, such as the UK, partly mitigate the effects of the economic crisis on access to care, in contrast to systems relying on employer-based health insurance, where unemployment can therefore lead to reduced access to care.
By how much were public healthcare spending decreases associated with increased cancer mortality?
The specific numbers were actually quite small on a per 100,000 basis, however, this is specifically for cancer mortality. We estimate these figures to be significantly larger when looking at metrics beyond mortality, and when including other conditions also.
What further research is needed to prove cause and effect?
We only looked at data up to 2010, whereas of course the effects of the economic crisis have been long-standing; unemployment in several countries remains higher than pre-crisis levels, almost a decade on.
Even in this country, we are having to make economic and funding changes that are affecting the NHS, because of what occurred in 2008.
It would therefore be really interesting to conduct a follow-up study that looks at subsequent years, to better capture the long-term effects of the global economic crisis.
I also believe we can better explore other conditions. If this hypothesis is correct, whereby during an economic crisis people have reduced access to the healthcare services that they need, and healthcare services are less well funded, then other conditions could also be significantly affected.
How does your study impact discussions over universal health coverage?
Our study was well-received by the World Health Organization and we believe it adds to the growing evidence that supports universal health coverage and its capacity to protect the health of populations.
What needs to be done to make sure any future economic crises are not followed by increased cancer mortality?
Our study demonstrates that during times of economic hardship, we need to ensure that healthcare spending is protected.
We also need to try to support individuals who become unemployed, to make sure they receive the healthcare services they rightly need. The consequences otherwise could be fatal.
Where can readers find more information?
About Dr Mahiben Maruthappu
Mahiben Maruthappu is a London-based doctor and Senior Fellow to the CEO of NHS England, advising on over £100 billion of health spending.
He focuses on innovation, technology and prevention, co-founding the NHS Innovation Accelerator (NIA) and the NHS Diabetes Prevention Program, serving on the DigitalHealth.London and NHS Prevention boards.
He has advised a range of organizations, from startups to multilaterals, including the Swiss government, the Experiment Fund and the WHO.
Maruthappu has a strong interest in research with over 80 peer-reviewed publications and 50 academic awards. His work has been featured by BBC News and the international press.
He is Chairman of the UK Medical Students’ Association (UKMSA), and has authored three medical books. Maruthappu was educated at Oxford, Cambridge and Harvard universities; he was the first person from British healthcare to be included in Forbes’ 30 under 30.
New Lancet Commission on Breast Cancer: Transforming breast cancer care globally