Editor's blog Wednesday 8 July: health in recessions, and Alain Enthoven on US health reforms

Those of you with longer memories will recall that I wrote about US economist Dr Christopher Ruhm's work on the health impacts of recessions a while ago.

Professor Ruhm's findings have been validated by EU-wide analysis research published in The Lancet.

It is perhaps unsurprising that the researchers find that a 3% rise in unemployment is linked with a 2.7% rise in heart attacks among men aged 30-44; increases of 2.4% in murders and suicides in those under 64; and time road traffic deaths drop 4.2% .

What is slightly intriguing is the disparity between Ruhm's findings on alcohol use (that that recessions cause people who already drink alcohol to drink less of it - and that the heaviest drinkers cut back most) and the European researchers' findings that deaths from alcohol abuse rise by 28% if unemployment rises 3%.

Why would this be? Cultural attitudes to the acceptability of drinking do differ between Europe and the US. This is probably one for anthropologists or sociologists - or an economist who can track price.

It could of course be the 'wet culutre / dry culture' duality explored in this interesting 2003 article  from US authors. They see the US as 'dry' (alcohol not integrated into everyday life consumption; consumed in binges) and most of europe as 'wet' (the opposite).

Enthoven on US health refroms
Meanwhile, Professor Alain Enthoven weighs in against the idea of creating a new government insurer in the US in an opinion editorial in the New York Times.

Enthoven is well-known for advising Margaret Thatcher on what became the NHS internal market reforms, and also as one of the influencers behind the failed Clinton plan to reform US healthcare in the 1990s.

His article calls for "not a new government-run insurer at all, but rather a government-chartered mechanism that would let employers and individuals buy health coverage from private insurers in a manner that uses the three most essential market forces — choice, competition and incentives — to reduce the price and improve care ... a public plan that will impose a stern and lasting discipline on our insurance market — and at the same time insure everyone, provide excellent benefits and offer abundant choices".

The necessary steps for US reform are, Enthoven says, to drive down costs and reduce inefficiency, error and waste in the system. It sounds familiar.