Health is determined not only by genetic vulnerability but also by its interaction with the milieu in which a person or a group resides. The milieu is dependent not only on dynamic interaction between social, economic, geographical, and political factors determining the availability and distribution of resources but also on noxious stimuli in the environment. Psychiatric illnesses and poorer mental health have been linked to higher levels of economic disparity, social disadvantage, membership to marginalized groups, poor housing, and lack of opportunities: factors referred to as Social Determinants of Mental Health.
ECONOMIC DETERMINANTS OF HEALTH
In this era of market economy, economic factors play a major role in determining the social factors responsible for health. The growing number of respiratory ailments in children in Delhi National Capital Region is linked to poor air quality determined by economic factors, leading to crop burning and vehicular and industrial pollution. Only treating the bouts of exacerbations is not going to solve the problem, and we need to look into their root cause. Lifestyle choices such as exercise, food selection, alcohol, and smoking are much influenced by the economic policies and direct and indirect advertisements. Modern economy assumes that individuals make rational choices, but it is not applicable to children and adolescents. Furthermore, social media advertising and artificial intelligence are greatly influencing the individual’s choice. Health and wealth have coexisted and mutually facilitated each other at the individual level, but a discordance has always existed at the population level. For example, industrialization has led to economic growth but has caused several health hazards. COVID-19 has brought the choice between health and wealth to a newer conflict – practically, all pro-containment measures seem to have one adverse economic consequence or the other!
ECONOMY AND MENTAL HEALTH
In India, economic factors have been flagged as a major cause of mental distress and illness. Farmer suicide has raised many controversies, but its link with crop failure and debt trap is undeniable. National Crime Records Bureau reported 10% rise in suicides in pandemic year of 2020 leading to 1.53 lakh deaths which is more than 1.49 lakh deaths reported due to COVID-19. In comparison to 2019 NCRB data, suicides committed by daily-wage earners increased from 29,092 to 33,164, and suicidal acts by unemployed persons increased from 11,599 to 12,893.
Reduction of suicide deaths in Brazil following direct cash transfer is an eye-opener. A landmark study evaluated the impact of Programa Bolsa Familia (PBF), a conditional direct cash transfer program aimed to attenuate the effects of poverty on Brazilians. It was an ecological longitudinal study which examined panel data from 5507 Brazilian Municipalities over 9 years from 2004 to 2012. It was found that an increase in PBF coverage was associated with a reduction in suicide rates in Brazilian municipalities, even following adjustment for socio-economic, demographic, and social welfare factors. The effect increased when, alongside high coverage (equal to or greater than 70%), this level of coverage was maintained for several years.
In COVID era when economic inequalities have accentuated, it is time to do intersectoral research to fill the research gap for economic determinants of mental health and help and guide the government in taking policy decisions to reduce mental distress and illness. Mental illness is very much an individual experience and certainly a health sector responsibility, yet it needs society-wide attention and cross-government action. Policies in the fields of education, employment, social care, housing, criminal justice, poverty alleviation, social security (welfare) benefits, community development, immigration, and beyond need to be coordinated for improved outcomes in Mental Health.
1. Macintyre A, Ferris D, Gonçalve B, Quinn N What has economics got to do with it? The impact of socioeconomic factors on mental health and the case for collective action Palgrave Commun 2018 4 10
2. World Health Organization and Calouste Gulbenkian Foundation Social Determinants of Mental Health Geneva World Health Organization 2014
3. World Health Organization The Economics of the Social Determinants of Health and Health Inequalities: A Resource Book Geneva World Health Organization 2013
4. National Crime Records Bureau Accidental Deaths and Suicide in India New Delhi Government of India 2020
5. Alves FJ, Machado DB, Barreto ML Effect of the Brazilian cash transfer programme on suicide rates:A longitudinal analysis of the Brazilian municipalities Soc Psychiatry Psychiatr Epidemiol 2019 54 599–606
6. Knapp M, Wong G Economics and mental health:The current scenario World Psychiatry 2020 19 3–14