COVID-19 and the ecological crisis: What do they have in common?

This lecture transcript is divided in four parts. First, I examine the main public-health strategies in managing the COVID-19 pandemic. Although there are numerous factors capable of explaining national differences in COVID-19 mortality that are not attributable to merits or demerits of governments, I have identified five lethal errors (lack of preparation, misinformation, medicalisation, a policy approach based on a 'laissez-faire' attitude to the virus and social inequity) and four vital actions (testing, tracing, isolating with support, timeliness and immunisation) that best distinguish success or failure in tackling the pandemic. In the second part, I analyse the origin of SARS-CoV-2 and major risk factors for emerging zoonotic diseases (e.g. exploitation of animal wildlife, deforestation, agricultural intensification and climate change) to be addressed to prevent future pandemics. Then, I discuss the interrelationships between the COVID-19 pandemic and the ecological crisis in the context of the so-called neoliberal variant of capitalism. Both crises are largely determined by anthropogenic risk factors influenced by a model of economic development that prioritises infinite economic growth, free trade and a global self-regulating market over any other values of society (including human survival). An alternative economic approach, capable of creating a new balance between the health of humans, animals, and the environment (by modifying their structural drivers), is the most important antidote against new spillovers and climate change. It is the humanitarian immune response we need to protect global health from future pandemics and ecological collapse.

L'associazione tra fumo di tabacco e crisi economiche in Italia.

OBJECTIVES: to analyse the association between smoking behaviour and economic crises in Italy between 1993 and 2015. DESIGN: ecological study, carried out on data of the Italian National Institute of Statistics, by means of fixed-effect panel regressions. SETTING AND PARTICIPANTS: the rate of smoking prevalence (disaggregated by gender and age) and the unemployment rate (disaggregated by gender and referring to individuals aged 15 or more) were collected for each of the twenty Italian regions. Also, percentage fluctuations of the national real gross domestic product (GDP) were collected to identify the years of severe economic crisis. MAIN OUTCOME MEASURES: number of people who smoke per 100 people with the same features. RESULTS: among men, increased regional unemployment rate was associated with increased smoking behaviour only in the group aged 25-34 years. Differently, severe economic crises were associated with increased smoking in almost all age groups, except for men aged 15-24 years. A 1-point decrease in GDP was associated with 0.75 more smokers aged 15 years or more. The highest coefficient was reported among men aged 35-44 years, where a 1-point decrease in GDP was associated with 1.16 more smokers (every 100 men). This age group is also featured by the second highest prevalence of tobacco smoking (36.8%). Among women, a 1-point increase in the regional unemployment rate was associated with 0.08 less smokers every 100 women. Similarly, periods of severe economic crisis at national level were associated with reduced smoking behaviour among women aged 15 years or more, specifically those aged 15-24 years. Differently, women aged 25-34 and 65 years or more showed an association similar to that reported among men. In these groups, a 1-point decrease in GDP was associated with 0.67 and 1.08 more smokers every 100 women. While among the latter the prevalence of tobacco smoking is the lowest, among the former it is the third highest prevalence (21.69%). Therefore, increased smoking behaviour due to economic crises seems to occur especially among women aged 25-35 years old, as happens among men. CONCLUSIONS: men in almost all age groups and women aged 25-34 and 65 years or more represent vulnerable groups in which smoking behaviour may increase in times of economic hardship. Therefore, specific policies should be implemented to prevent this occurrence, as well as the negative health outcomes of tobacco smoking.

[Effects of the COVID-19 pandemic on health inequalities and mental health: effective public policies]. / Gli effetti della pandemia COVID-19 sulle disuguaglianze di salute e salute mentale: politiche pubbliche efficaci.

The aim of this article is to examine the effects of the COVID-19 pandemic on health inequalities and mental disorders and to analyse the most effective public policies in containing them. COVID-19, in addition to causing the worst health crisis since World War II, has generated a severe economic recession and a rise in unemployment. The poorer socioeconomic classes have been most affected by infections and deaths caused by the SARS-CoV-2 virus due to inequalities in working, housing and area of ​​residence conditions, psychosocial factors, and unequal access to health care. The pandemic crisis, in addition to causing psychiatric and neurological problems in people who have been hospitalized, appears to have increased the risk of psychological problems through various mechanisms such as social distancing, loss of a loved one, unemployment, and economic difficulties. In many countries, however, there was no significant increase in suicides in 2020 and there have even been decreasing temporal trends. It is possible that the crisis, in addition to creating stress and social isolation, may have promoted reciprocity, interpersonal help, and greater motivation to take care of one's health.The most effective policies in reducing COVID-19 mortality have the potential to limit the most adverse effects of the pandemic on health inequalities and mental health. Thanks to vigorous preventive interventions on the territory, based on testing, tracing, isolating, timely, countries who managed best the pandemic avoided prolonged and repeated lockdowns, protected public health and the economy. However, more vigorous social protection measures are needed in favour of those populations most affected by the health crisis and its socioeconomic effects. This pandemic offers the opportunity to learn lessons on the protection of public health and stress the need to adopt a syndemic model oriented towards prevention.

Impact of the economic crises on suicide in Italy: the moderating role of active labor market programs.

PURPOSE: To analyze the association between unemployment and suicide in Italy during the years 1990-2014, with a peculiar focus on the great recession (GR) and the role played by social protection as buffering mechanism against the negative effect on health outcomes. METHODS: Fixed effects panel regressions were used to assess the association between changes in unemployment rate and suicide rates. Additional models investigated the role of active labor market programs (ALMPs) as possible moderators of the association. Analyses were carried out for both males and females, stratified by age and region. RESULTS: The negative time-trend displayed by suicide rate in Italy until 2007 was slowed down by changes in unemployment at the beginning of the GR, when this trend reversed and the rate of suicide started increasing. Male workers aged 25-64 and women aged 55-64 years were affected by both "normal" unemployment rate fluctuations as well as severe economic crises. Women aged 35-44 were only influenced by the latter. Men benefit from ALMPs mainly in Central Italy, while women did not benefit significantly from ALMPs. CONCLUSIONS: In Italy, economic downturns were associated with increased suicides mainly among men, while severe economic crises were associated with increased suicides among both men and women. ALMPs showed to be effective in moderating the association between unemployment and suicide among men aged 45-54 only in Central Italy. The overall small effectiveness of such programs may be due to lack of sufficient funding.

Impact of the economic crisis on health-related behaviors in Italy.

BACKGROUND: Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population. AIM: To assess the impact of the late 2000s economic crisis on health-related behaviors linked to population mental health in Italy. METHODS: Descriptive study. Health indicators came from the Italian Institute of Statistics database (years 2000-2015). Statistics performed by means of linear regression models. RESULTS: Increased smokers (ß = 1.68, p = .03), heavy smokers, that is, people smoking 11-20 cigarettes per day (ß = 2.18, p = .04) or more than 20 cigarettes per day (ß = 1.04, p < .01) and mean number of smoked cigarettes per day (ß = 0.56, p = .02) were noticeable. Also, prevalence of overweight increased (ß = 0.91, p = .04), while the Italian families' expenditure for alcoholic beverages decreased (ß = -812.80, p = .01). Alcohol consumption decreased (ß = -0.60, p < .01), especially in men (ß = -0.95, p < .01); binge drinking increased in years 2009-2010. No change was noticeable in the diet indicators collected. CONCLUSION: The economic crisis may have increased smoking, overweight and binge drinking in Italy (though data on the latter phenomenon are not conclusive), and reduced overall alcohol consumption.

The Potential Impact of the Transatlantic Trade and Investment Partnership (TTIP) on public health.

This article aims to examine the potential health effects of the Transatlantic Trade and Investment partnership (TTIP). Our review indicates that, although proponents of the TTIP claim that the treaty will produce benefits to health-enhancing determinants such as economic growth and employment, evidence shows that previous trade liberalization policies are associated with increasing economic inequities. By reducing Technical Barriers to Trade (TBT) and by promoting increased cooperation between US and EU governmental agencies in the pharmaceutical sector, the TTIP could result in improved research cooperation and reduced duplication of processes. However, the TTIP chapter on Intellectual Property (IP) and Trade-Related Aspects of Intellectual Property Rights (TRIPS) that expand and extend patent monopolies, and delay the availability of generic drugs, are likely to cause underutilization of needed medications among vulnerable populations. The TTIP's Investor to State Dispute Settlement (ISDS) arbitration system, a mechanism that allows transnational companies (TNCs) to sue governments when a policy or law reduces the value of their investment, is likely to generate a negative impact on regulations aimed at increasing access to healthcare, and reducing tobacco, alcohol consumption, and diet-related diseases. The Sanitary and Phytosanitary Standards (SPS) of the TTIP is expected to weaken regulations in the food and agricultural sectors especially in the EU, with potentially negative effects on food safety and foodborne diseases. Finally, the ISDS is likely to infringe the ability of governments to tackle environmental problems such as climate change deemed to be the most important global health threat of the century. Our review concludes by discussing policy implications and the effect of the TTIP on democracy, national sovereignty and the balance of power between large TNCs and governments. It also discusses the adoption of an evidence-based precautionary principle approach in dealing with the health impact of Free Trade Agreements (FTAs) as well as the harmonization of regulations, norms, and standards toward stronger health and environmental protection.

Low Wages as Occupational Health Hazards.

The history of occupational medicine has been characterized by ever-widening recognition of hazards, from fires in 1911 to asbestos in the 1960s, to job strain in the 1990s. In this essay, we argue for broadening the recognition further to include low wages. We first review possible mechanisms explaining the effects of wages on health or health behaviors. Mechanisms involve self-esteem, job satisfaction, deprivation, social rank, the "full" price of bad health, patience, and the ability to purchase health-producing goods and services. Second, we discuss empirical studies that rely on large, typically national, data sets and statistical models that use either instrumental variables or natural experiments and also account for other family income. Finally, we draw implications for laws governing minimum wages and labor unions.

National trends in main causes of hospitalization: a multi-cohort register study of the finnish working-age population, 1976-2010.

BACKGROUND: The health transition theory argues that societal changes produce proportional changes in causes of disability and death. The aim of this study was to identify long-term changes in main causes of hospitalization in working-age population within a nation that has experienced considerable societal change. METHODOLOGY: National trends in all-cause hospitalization and hospitalizations for the five main diagnostic categories were investigated in the data obtained from the Finnish Hospital Discharge Register. The seven-cohort sample covered the period from 1976 to 2010 and consisted of 3,769,356 randomly selected Finnish residents, each cohort representing 25% sample of population aged 18 to 64 years. PRINCIPAL FINDINGS: Over the period of 35 years, the risk of hospitalization for cardiovascular diseases and respiratory diseases decreased. Hospitalization for musculoskeletal diseases increased whereas mental and behavioral hospitalizations slightly decreased. The risk of cancer hospitalization decreased marginally in men, whereas in women an upward trend was observed. CONCLUSIONS/SIGNIFICANCE: A considerable health transition related to hospitalizations and a shift in the utilization of health care services of working-age men and women took place in Finland between 1976 and 2010.

The financial crisis, health and health inequities in Europe: the need for regulations, redistribution and social protection.

In 2009, Europe was hit by one of the worst debt crises in history. Although the Eurozone crisis is often depicted as an effect of government mismanagement and corruption, it was a consequence of the 2008 U.S. banking crisis which was caused by more than three decades of neoliberal policies, financial deregulation and widening economic inequities.Evidence indicates that the Eurozone crisis disproportionately affected vulnerable populations in society and caused sharp increases of suicides and deaths due to mental and behavioral disorders especially among those who lost their jobs, houses and economic activities because of the crisis. Although little research has, so far, studied the effects of the crisis on health inequities, evidence showed that the 2009 economic downturn increased the number of people living in poverty and widened income inequality especially in European countries severely hit by the debt crisis. Data, however, also suggest favorable health trends and a reduction of traffic deaths fatalities in the general population during the economic recession. Moreover, egalitarian policies protecting the most disadvantaged populations with strong social protections proved to be effective in decoupling the link between job losses and suicides.Unfortunately, policy responses after the crisis in most European countries have mainly consisted in bank bailouts and austerity programs. These reforms have not only exacerbated the debt crisis and widened inequities in wealth but also failed to address the root causes of the crisis. In order to prevent a future financial downturn and promote a more equitable and sustainable society, European governments and international institutions need to adopt new regulations of banking and finance as well as policies of economic redistribution and investment in social protection. These policy changes, however, require the abandonment of the neoliberal ideology to craft a new global political economy where markets and gross domestic product (GDP) are no longer the main national policy goals, but just means to human and health improvements.

The influence of market deregulation on fast food consumption and body mass index: a cross-national time series analysis.

OBJECTIVE: To investigate the effect of fast food consumption on mean population body mass index (BMI) and explore the possible influence of market deregulation on fast food consumption and BMI. METHODS: The within-country association between fast food consumption and BMI in 25 high-income member countries of the Organisation for Economic Co-operation and Development between 1999 and 2008 was explored through multivariate panel regression models, after adjustment for per capita gross domestic product, urbanization, trade openness, lifestyle indicators and other covariates. The possible mediating effect of annual per capita intake of soft drinks, animal fats and total calories on the association between fast food consumption and BMI was also analysed. Two-stage least squares regression models were conducted, using economic freedom as an instrumental variable, to study the causal effect of fast food consumption on BMI. FINDINGS: After adjustment for covariates, each 1-unit increase in annual fast food transactions per capita was associated with an increase of 0.033 kg/m2 in age-standardized BMI (95% confidence interval, CI: 0.013-0.052). Only the intake of soft drinks--not animal fat or total calories--mediated the observed association (ß: 0.030; 95% CI: 0.010-0.050). Economic freedom was an independent predictor of fast food consumption (ß: 0.27; 95% CI: 0.16-0.37). When economic freedom was used as an instrumental variable, the association between fast food and BMI weakened but remained significant (ß: 0.023; 95% CI: 0.001-0.045). CONCLUSION: Fast food consumption is an independent predictor of mean BMI in high-income countries. Market deregulation policies may contribute to the obesity epidemic by facilitating the spread of fast food.

Mortality due to mental and behavioral disorders associated with the Great Recession (2008-10) in Italy: a time trend analysis.

We estimated the proportion of deaths due to mental and behavioral disorders attributable to the Great Recession (2008-10) in Italy. Data on standardized death rates due to mental and behavioral disorders per 100,000 from 2000 to 2010 were provided by the Italian Health for All database. There were an additional 0.303 per 100,000 deaths per year (95% CI: 0.192, 0.478; P = 0.001) because of the crisis. Each annual decrease of €1000 in gross domestic product per capita was associated with an increase of 0.126 per 100,000 (95% CI: 0.046, 0.205; P = 0.004) deaths; every annual 1% increase in unemployment corresponded to an increase of 0.074 per 100,000 (95% CI: 0.032, 0.117; P = 0.002) deaths.

Obesity and occupational injury: a prospective cohort study of 69,515 public sector employees.

BACKGROUND: Obesity and overweight are suggested to increase the risk of occupational injury but longitudinal evidence to confirm this is rare. We sought to evaluate obesity and overweight as risk factors for occupational injuries. METHODOLOGY/PRINCIPAL FINDINGS: A total of 69,515 public sector employees (80% women) responded to a survey in 2000-2002, 2004 or 2008. Body mass index (kg/m(2)) was derived from self-reported height and weight and was linked to records of subsequent occupational injuries obtained from national registers. Different injury types, locations and events or exposures (the manner in which the injury was produced or inflicted) were analyzed by body mass index category adjusting for baseline socio-demographic characteristics, work characteristics, health-risk behaviors, physical and mental health, insomnia symptoms, and sleep duration. During the mean follow-up of 7.8 years (SD = 3.2), 18% of the employees (N = 12,204) recorded at least one occupational injury. Obesity was associated with a higher overall risk of occupational injury; multivariable adjusted hazard ratio (HR) 1.21 (95% CI 1.14-1.27). A relationship was observed for bone fractures (HR = 1.37; 95% CI: 1.10-1.70), dislocations, sprains and strains (HR = 1.36; 95% CI: 1.25-1.49), concussions and internal injuries (HR = 1.26; 95% CI: 1.11-1.44), injuries to lower extremities (HR = 1.62; 95%: 1.46-1.79) and injuries to whole body or multiple sites (HR = 1.37; 95%: 1.10-1.70). Furthermore, obesity was associated with a higher risk of injuries caused by slipping, tripping, stumbling and falling (HR = 1.55; 95% CI: 1.40-1.73), sudden body movement with or without physical stress (HR = 1.24; 95% CI: 1.10-1.41) and shock, fright, violence, aggression, threat or unexpected presence (HR = 1.33; 95% CI: 1.03-1.72). The magnitude of the associations between overweight and injuries was smaller, but the associations were generally in the same direction as those of obesity. CONCLUSIONS/SIGNIFICANCE: Obese employees record more occupational injuries than those with recommended healthy weight.

Perceived teacher unfairness and headache in adolescence: a cross-national comparison.

OBJECTIVES: The present study examines the prevalence of headache in early adolescents in 21 European and North-American countries and the role of perceived teacher unfairness in predicting this health complaint across different countries. METHODS: Data were taken from the "Health Behaviour in School-aged Children" study (HBSC), a World Health Organization cross-national survey on health behaviors in 11-, 13- and 15-year-old students. Headache and perceived teacher unfairness were measured through a self-administered questionnaire filled out by 115,212 adolescents. RESULTS: The overall prevalence of frequent headaches (at least once a week) was 28.8%, ranging from 18.9% in Slovenia to 49.4% in Israel. After adjusting for gender, grade, family affluence, school achievement, being bullied and lifestyles (drinking, smoking, eating and physical activity), teacher unfairness showed a significant association with frequent headache in all but two countries (Ukraine and Luxembourg). CONCLUSIONS: Our results show that headache is a common health symptom in European and North-American countries, even though there are substantial differences in its prevalence across countries. The study indicates that perceived teacher unfairness can be a significant predictor of frequent headache during adolescence, and this association is consistent across countries.