European governments responses to the 2008 Great Recession

The Great Recession of 2008 was characterized by an economic and financial crisis with a decline in gross domestic product (GDP), high levels of unemployment, and a great impact on European countries and worldwide. Austerity measures taken by governments as a response to this crisis were characterized by reducing social spending and increasing taxation, although they were neither homogeneous nor similarly implemented at European level; some countries protected public sector programs and systems while others instituted large budget cuts in education, healthcare, and other public services. There was general agreement that some countries such as Greece, Spain, Ireland and the United Kingdom applied higher levels of austerity. These measures taken by governments would have an impact on the most vulnerable groups, mainly children and youth from disadvantaged families.

We conducted a systematic literature review to assess the impact of austerity measures taken by European governments on social determinants of child health, and child health outcomes.

Our results

The countries that applied high austerity levels showed an increase in material deprivation, child poverty rates, and low birth weight, compared to the pre-austerity period. Higher levels of social protection spending in the period 2008–2013 were associated with lower levels of child poverty. High austerity was reported also to be related to poorer access to and quality of services provided, mainly to disabled children. Reduction of public health expenditure was associated with a reduction of specific vaccination coverage in Italy.

Austerity and COVID-19

It is likely that the indirect effects of the pandemic will have profound impacts for child health in the long run

At the time when we carried out the review, we had not predicted the current COVID-19 pandemic. Early data suggests, unsurprisingly, that the pandemic is impacting the poor and vulnerable most, with stark socio-economic and ethnic inequalities in outcomes.  Although there are still many uncertainties regarding the pandemic, it seems that children are less prone to severe consequences of infection compared to adults. However, it is likely that the indirect effects of the pandemic will have profound impacts for child health, particularly poor children, in the long run.

In the acute phase of the COVID-19 crisis, key components of preventive child health services have been negatively affected, e.g. immunization. The unintended consequences of lockdown measures and social distancing are disproportionately affecting poor children, increasing hunger, mental health problems and the risk of abuse, neglect and non-accidental injury. Especially, closure of schools and (day)care facilities may have contributed to lower ‘visibility’ of neglect and domestic violence. In the long run, sustained austerity measures to be expected after the acute phase will damage the capacity of social welfare and health systems to respond.

We recommend governments at European and country level to apply policies that prevent the negative consequences of austerity measures

On the basis of our review, we hypothesize that those areas and countries that applied less austerity measures are in a better condition to respond to the healthcare and social needs of both children and the general population. Moreover, we recommend governments at European and country level to apply policies that prevent such negative consequences of austerity measures. In the near future important research challenges will be to see if the countries with fewer cuts in expenditure on public healthcare and social services are better able to protect health and well-being of children and families, especially in disadvantaged populations, from the consequences of the pandemic.