Economic Shocks and Health Resilience - Lessons from the Russian Federation

The project takes place in the context of the worst economic crisis in Europe since the Great Depression. This has already had an impact on health in the United Kingdom and elsewhere, with evidence showing the strong correlation between economic crises and worse health (Stuckler, Basu et al. 2011). There are fears this impact will increase given the persisting lack of economic growth, scarcity of job opportunities, and retrenchments of state services and support.

This project seeks to understand how some people are better able than others to survive and maintain good health despite experiencing similar levels of economic shock at the individual and household level. While there is a large literature on the factors that leave people vulnerable to ill health during hard times, there is much less on the factors that may protect health and wellbeing. In order to address this, we apply the concept of resilience. This has been defined as a 'dynamic process by which individuals, communities and societies positively adapt in a context of significant adversity'(Luthar 2000). It focuses on the effect that a shock (e.g. economic shock) has on the individual (i.e. the ability to bounce back). While there is a considerable body of research on resilience (Rutter 2006; Castleden, McKee et al. 2011), it has yet to be applied specifically to the relationship of economic shocks and health.

A challenge to the study of economic shock and resilience is that in most circumstances individuals exposed to significant external shocks comprise a relatively small proportion of the population. We have, however, identified an existing data source that overcomes this challenge. The Russian Longitudinal Monitoring Survey (RLMS) consists of panel data from 4,000 households between 1994 and 2010 which contains variables on health, economic status and resilience. The Russian population has faced a series of major economic crises and so has a much greater degree of exposure to shocks and variation of resilience factors than found in datasets in other countries, thus enabling us to ascertain effects which may be more difficult to observe in the United Kingdom and elsewhere.

The aim of our project is to understand the factors that promote or diminish people's resilience to economic shocks, using a quantitative case-study of the Russian Federation in the post-Soviet period (using the RLMS dataset). The first objective is to identify the factors that promote or diminish resilience to economic shocks. The second objective is to evaluate resilience factors at individual, household, community, and population levels using multi-level modelling.

We will firstly perform a systematic review to identify factors that modify health in times of economic crisis to identify potential factors influencing resilience to guide the RLMS data analysis. For the data analysis we will follow a retrospective cohort of persons who were employed in 1994 and follow their experiences until 2011 to evaluate individual and household characteristics and responses to comparable economic shocks (e.g. loss of a job) and the influence on their health outcomes (e.g. mortality, poor mental health). Potential resilience factors include education level, marital status, partner characteristics, social and political attitudes, social networks, labour market characteristics and social welfare support.

We believe the project will benefit policymakers in the United Kingdom, Europe, Russia and other countries experiencing economic crises by providing evidence to develop policies that support individual and household resilience to economic shock and so alleviating social suffering and improving health. The conceptual, methodological and empirical contributions of the project will also benefit researchers from the disciplines of public health, economics and sociology. We will maximise the project benefits through active engagement with the relevant policy and academic communities.

Potential beneficiaries of the research include populations in countries affected by economic shock, particularly the more economically vulnerable populations. These populations may benefit from improved physical and mental health outcomes and quality of life as a result of the research and an associated effective policy response. However, this clearly dependent on the project team engaging with policy agencies to inform and convince them of the key messages arising from the project findings and encouraging policy agencies to implement an effective policy response to try and maximise the factors supporting resilience among populations experiencing economic shocks.

In order for such benefit to occur, the key agencies that will need to benefit from the research include Government Ministries and department at the central and local level, WHO, The European Commission, the World Bank, and civil society organisations providing health and welfare support. Individuals at these agencies will benefit from the research by increasing their knowledge and understanding on the issue of economic shock, resilience and health and being able to utilise empirical findings to help develop appropriate evidence-based policies.

In order to ensure that the these agencies have the opportunity to benefit from the research we will utilise our professional networks such as at the European Observatory on Health Systems and Policies to raise understanding of the subject, the research, and the key policy messages. This can be achieved through a variety of activities such as presentations at key meetings, workshops, and conferences and placing articles in the Observatory's EuroHealth magazine that reaches a large number of legislators and their advisors. We will also utilise traditional and new media opportunities to increase coverage of the key messages arising from the research to engage as wide an audience as possible, including the general public. These activities can utilise the LSHTM External Relations department and the Press team.

Our work will also benefit academics by improving conceptual and methodological understanding and strengthening the evidence-base on economic shocks, resilience and health. The intension is that these academics should be from different disciplines, such as sociology, economics and public health and epidemiology. Publications of academic papers and presentations at conferences will help ensure that other academics have the opportunity to benefit from the research. The project will also include a one day workshop on economic shocks, resilience and health which will provide a multi-disciplinary forum to discuss the issues, methods, and findings addressed in the project. Please see the Academic Beneficiaries Section for further details.

These impact-related activities will take place as part of a broader impact strategy to develop a clear plan of activities, clear messages and activities targeted for specific audiences, and evaluating the pathways to impact through a range of indicators. Indicators of the success of activities to strengthen impact pathways include: the number of key meetings, workshops, and conferences in which the research findings have been presented or discussed; the successful completion of the LSHTM workshop and any associated outputs and spin offs; the number of academic publications and associated statistics; and types of media coverage.