A fuzzy set approach to economic crisis, austerity and public health. Part II: How are configurations of crisis and austerity related to changes in population health across Europe?

Abstract

Aims: Based on the ideal type classification of European countries done in Part I of this paper, Part II explores whether the real ‘danger’ to public health is the interplay between austerity and crisis, rather than recession itself. Methods: We constructed two fuzzy sets of changes in population health based on a pooled file of European Union Statistics on Income and Living Conditions (EU-SILC) data (2008 and 2013) including 29 European countries. The linear probability analyses of ‘limiting long-standing illness’ and ‘less than good’ health were restricted to the age group 20–64 years. We performed fuzzy set qualitative comparative analysis (fsQCA) and studied whether configurations of ‘severe crisis’ and ‘austerity’ were linked to changes in population health. Results: Overall, the results of this fsQCA do not support the ‘crisis–austerity’ thesis. Results on ‘less than good’ health were highly inconsistent, while results on ‘limiting long-standing illness’, contrary to the thesis, showed a two-path model. Countries with either no severe crisis or no austerity were subsets of the set of countries that experienced deteriorated health. Results also show that several countries combined both paths. Conclusions: This fuzzy set analysis does not support Stuckler and Basu’s ‘crisis–austerity’ thesis, as those European countries that experienced recession and austerity were not consistently the countries with deteriorating health. There may be multiple reasons for this result, including analytical approach and operationalization of key concepts, but also resilient forces such as family support. We suggest more research on the topic based on more recent data and possibly other, or more, dimensions of austerity.