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Chapter 5 | The impact of the crisis on the health system and health in Ireland
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support services in the past five years. Organizations such as the Samaritans
directly link the increased demand for their services with the broader economic
crisis (Samaritans, 2012). While tobacco consumption has been falling steadily
in Ireland since 2000, alcohol consumption started to decline with the onset of
the economic crisis (Department of Health, 2012a).
An important indicator of population health status is self-assessed health, which
has been found to be a good predictor of mortality and use of health care in
numerous international studies (Idler & Benyamini, 1997; van Doorslaer et al.,
2000; Burstrom & Fredlund, 2001). There is little evidence that perceptions
of health have declined over the period of the crisis in Ireland. Data from the
Quarterly National Household Survey show that while there was a decline
in the proportion reporting “very good” health over the period 2007–2010
(from 47% to 45%), the proportion reporting “good” health increased from
40% to 42%, and the proportion reporting “fair” or “bad/very bad” health was
unchanged (CSO, 2011). More recent data are not yet available.
While it is extremely difficult to infer causal relationships between economic
crises and health outcomes, behaviours or inequalities at the population level,
the trends observed are consistent with those found in previous analyses for other
countries. In general, there is no simple answer to the question of how economic
crises impact on health outcomes, behaviours and inequalities (Suhrcke, Stuckler
& Leone, 2009; Suhrcke & Stuckler, 2012). For example, Ruhm (2000) found
that total mortality and eight of the ten sources of fatalities exhibited a procyclical
fluctuation in the United States over the period 1972–1991, with suicides
representing an important exception. However, the association at the individual
level between lower income, unemployment and poor health is well established
(reviewed by Suhrcke & Stuckler, 2012). Recently, the impact of the economic
crisis on health outcomes in Ireland has been debated in a series of responses to
an editorial in the British Medical Journal on health and the economic crisis in
Europe (Carney, 2013; Jackson, 2013; Walsh & Walsh, 2013).
5. Discussion
5.1 Drivers of change
The core driver of change has been the need for fiscal consolidation. Public
expenditure on health increased rapidly in the pre-crisis period; nonetheless, by
2008, primary and community care services were poorly developed; the public
hospital system was experiencing capacity constraints and significant patient
safety concerns; and price inflation was well in excess of that experienced
in other sectors of the economy (and in most other EU Member States).
Nevertheless, the huge growth in health expenditure that had occurred during