Introduction
Enduring political, economical and social changes will doubtless arise from the worldwide financial crisis that erupted in 2008. In all arenas, including the field of public health and cancer prevention, individual and policy decisions can be characterised by a damage control mentality or, alternatively, as an opportunity to correct mistakes and build a more solid foundation for the future. In this paper, we will briefly review the existing literature for clues on how the present crisis will affect cancer prevention with regard to personal lifestyle choices, exposure to environmental risk factors, decisions made in the private sector and public policy.
There are inherent difficulties in this type of analysis. First of all, it is clearly problematic to reach solid conclusions on the connection between economic crises and cancer mortality given the amount of time needed to account for the required induction period and the complexities involved in establishing causal links. Whilst much has been written on the causal mechanisms between unemployment and overall mortality (see Box 1), most of these studies have taken place in the United States (US) (with different social protection schemes) and have usually found clearer (and cyclical) links in the short-term. Because cancer can take decades to develop, different study models may be required to explore potential correlations. The heterogeneous array of pathologies encompassed under the umbrella term ‘cancer’ also poses challenges because recession can affect different cancers through different pathways. Finally, the financial crisis is affecting countries very differently; in Europe, the Netherlands and Norway have maintained stable unemployment rates near or below 4% whilst Spain, Ireland and Latvia have seen significant decreases in their working population (Fig. 1).Causal links between mortality and financial crisis.
The causal mechanisms between financial crisis and mortality are multi-faceted, potentially influenced by multiple factors:
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the strength of the social safety net,1 generally robust in European countries
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demographics, with specific groups (socially disadvantaged, the young2) being harder hit by crises
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liberalisation of employment laws, with subsequent decreases in the number of permanent contracts and job security in general
Regions such as the former Soviet states reacted to economic troubles with dramatic reductions in life expectancy. However, recent evidence points out that wealthy countries experience short-term improvements3, 4, 5, 6, 7 owing to less exposure to occupational risks and traffic accidents, as well as decreased opportunity cost of healthy leisure time activities.8 These findings overturn those of past studies,9, 10 which reached different conclusions by using simpler time series models.
In this article, we examine specific elements in isolation (for example, tobacco smoking or public investment in research) in order to identify general trends that provide policy makers with guidance for further action (Table 1). In some cases, such as for some lifestyle choices, we find that public policy may channel existing tendencies for clear added value. In others, including research and health system investments, we make the case that the resources not used now will lead to increased costs (both financial and human) down the road. In all cases, we argue that despite the scarcity of funds and the governmental priorities on economic recovery, cancer prevention is more relevant now than ever.