(English)

1. Economic Growth and Mortality:
Do Social Protection Policies Matter?
Usama Bilal, MD MPH
(ubilal@jhmi.edu www.usamabilal.info)
Department of Epidemiology
Johns Hopkins Bloomberg School of Public health
Grupo de Epidemiologia Social y Cardiovascular. Universidad de Alcala
Coauthors: Richard S. Cooper, Francis M. Abreu, Claudia Nau, Manuel Franco, Thomas A. Glass
Conflicts of Interest: Usama Bilal has received a fellowship from the Obra Social La Caixa
Currently Under Review at the International Journal of Epidemiology

2. © 2016/2017, Johns Hopkins University. All rights reserved.
Wenn die Krankheit der Ausdruck des unter ungünstigen Bedingungen verlaufenden
Einzellebens ist, so müssen Seuchen das Anzeichen grosser Störungen des Massenlebens sein.
Rudolf Virchow. Die Einheitsbestrebungen in der wissenschaftlichen Medicin. 1849
If disease is the expression of individual life under
unfavorable conditions, then epidemics are the
symptom of major disturbances in society.
Geoffrey Rose. Sick Individuals and Sick Populations. Int J Epidemiol 1985
‘Why do some individuals have hypertension’ is a quite
different question from ‘Why do some populations have
much hypertension, whilst in others it is rare’ To find the
determinants of prevalence and incidence rates, we need to
study characteristics of populations, not characteristics of
individuals

3. © 2016/2017, Johns Hopkins University. All rights reserved.
The Puzzle
Mortality HR in Unemployed vs Employed:
1.77 (1.05 to 2.98)
Mortality HR per 1% incr. in State Unemployment Rate:
0.91 (0.89 to 0.96)
Coronary Heart Disease Grows out of the economic needs of commodity production
under capitalism and continues because of the inability of the bourgeois state to
direct production toward social good […] The productive consumption of
commodities […] remains the basis of coronary risk

4. © 2016/2017, Johns Hopkins University. All rights reserved.
Economic
Growth
Mortality
“Commodity Production
Under Capitalism”
Social Protection
Policies

5. © 2016/2017, Johns Hopkins University. All rights reserved.
Objective
To explore the association between economic
growth and all-cause mortality across 21 OECD
countries and evaluate effect modification of the
business cycle-mortality association by social
protection policies

6. © 2016/2017, Johns Hopkins University. All rights reserved.
Methods
• Ecological analysis of time trends
• 21 countries (OECD), 1980 to 2010
• Outcome data: WHO Mortality Dataset
• Age-adjusted all-cause mortality per 100,000
people (both genders pooled)
• Other data: Comparative Welfare States Data Set
• Exposure: Harmonized Unemployment
• Modifier: % of GDP Spent on Public Social
Protection Policies

7. © 2016/2017, Johns Hopkins University. All rights reserved.
Detailed model
Change In
Unemployment
Change In Social
Protection Interaction
Increase in Mortality per 1%
increase in the Unemployment
rate within a Country
Increase in Mortality per 1% increase in the %
spent in Social Protection within a Country
Added increase in Mortality per 1% increase in the Unemployment Rate if the country
concurrently increases social protection expenditure by 1%
Group-Mean Centered Random Effects Model (~ fixed effects model)

8. Decreases in Social Protection Expenditure Increases in Social Protection Expenditure
At a 0% change in Social Protection Expenditure:
a 1% decrease in Unemployment is associated with
a 0.24% (95% CI: 0.07 ; 0.42) increase in mortality
At a 5% decrease in Social Protection Expenditure:
a 1% decrease in Unemployment is associated with a
0.45% (95% CI: 0.17 ; 0.73) increase in mortality
At a 5% increase in Social Protection Expenditure:
a 1% decrease in Unemployment is associated with
a 0.03% (95% CI: -0.21 ; 0.27) increase in mortality
EconomicGrowthDecreasesMortalityEconomicGrowthIncreasesMortality

9. © 2016/2017, Johns Hopkins University. All rights reserved.
Discussion
The association between economic
change and mortality is weakened in
countries that concurrently increase
social protection expenditure.

10. © 2016/2017, Johns Hopkins University. All rights reserved.
Future avenues
• Study specific policies and their buffering effect
• Study specific causes of mortality
• Switch scales: may this be a regional or local
phenomenon?

11. Thank you!
ubilal@jhmi.edu
Slides available (soon) at: www.usamabilal.info