Impact of government welfare policy in ameliorating health problems resulting from the Great Recession—specific impact on cardiovascular and cancer mortality

This paper investigates whether government welfare policy was instrumental in modifying the health-damaging effects of the Great Recession on mortality due to cardiovascular disease and cancer mortality in the US states. Government welfare expenditures from federal, state and local sources are examined as to the extent that they influenced heart disease, cancer and stroke mortality rates, by state, over 2000-2009. In addition, two of the primary variables that undergo substantial change during recessions are included in the model to predict three major sources of US mortality in the 21^stcentury: household income per capita declines and unemployment rate increases. Economic stress, especially involving depression and stress-coping mechanisms are suggested by the literature to be active, as well as smoking, alcohol use and dietary changes. Wage and salary declines, underemployment and unemployment are also assumed to reduce the use of health care as is loss of health insurance due to unemployment.

A model is developed in which government welfare expenditures, as well as household income and the unemployment rate, prominent indicators of recession, are used to predict mortality due to heart disease, cancer and stroke. Controls are used for percent of the population with government health insurance, smoking prevalence and the percentage of the African-American population among US states. Analysis involves pooled-cross-sectional time series analysis with random effects in order to deal with "slow-moving" variables such as percentages of state populations that are African-American.

Government welfare expenditures are strongly inversely related to mortality for each of the three major causes. Household income declines and unemployment increases are prominent predictors of cardiovascular and cancer mortality. All relations are statistically significant at the .0001 level.

Public health policy should include a specific focus on socioeconomic status of the population, especially where this involves the major causes of death. Such policy would include an emphasis on improving the economic status of low- and lower-middle income populations and a more robust and comprehensive enlargement of the social safety net.