LAUSR

https://doi.org/10.1177/14034948211051912 © Author(s) 2021 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/ 403 9 821 0 12 journals.sagepub.com/home/sjp We welcome the study by Thor Norström and Iman Dadgar [1] which adds to the growing body of evidence that recessions do not inevitably cause mortality to rise [2] and may actually reduce it [3]. By looking at total, infant and 65+ all-cause mortality across 21 OECD countries from 1960 to 2016, they find that higher unemployment rates are associated with lower all-cause mortality in the short term, whereas higher GDP is associated with lower allcause mortality in both the short and long term. All these findings are intuitive and plausible. In the long term, it is well established that higher GDP is correlated with many improvements in the many social determinants of health, such as education and income, as well as health systems development [4]. In the short term, while the inverse association of allcause mortality with unemployment rates may seem counterintuitive [3], it has been attributed to shortterm reductions in alcohol consumption and road traffic deaths – both major causes of premature mortality. The key question remains: what do these findings means for policy and practice? And what do they mean now at a time of COVID-19 and its economic aftermath? First, economic shocks pose a clear threat to health and well-being. Looking at all-cause fluctuations can mask patterns which emerge in specific causes of death. For instance, during economic crises, suicides have tended to increase, even as road traffic deaths decline [5]. When economic changes are particularly large, unanticipated and fundamentally restructure people’s ways of living and being (as with COVID), and social support is weak or missing, the consequences for health are likely to be worse and enduring [5]. A prime example is the large increase in male mortality that occurred after the collapse of the Soviet Union, exacerbated by unemployment spikes and radical restructuring of Soviet firms [6]. While we should welcome any improvements in road safety, there is also a need to remain vigilant about preventing such ‘economic suicides’ – that is, suicides that would not have happened absent the presence of an economic shock. Second, for COVID, the economic consequences are highly unequal. Although the current recession has been deep, there are projections of a fast recovery in association with increasing vaccine uptake. Nortstrom and Dadgar’s findings suggest that attention will need to be paid to ensure an equitable recovery. In fact, their data indicate economic recovery itself could pose harm to people’s health. The latter is in line with previous research that has found unhealthy behaviours and road traffic accidents to increase with economic booms [3]. Third, it is not a question of if but when austerity measures will be put in place in the aftermath of COVID [7]. Past data show this is a far bigger threat to health than recessions per se. Many European countries have accumulated large debts and deficits How to protect people in response to COVID-19 economic downturns: Insights from past economic crises