Effects of economic downturns on child mortality: a global economic analysis, 1981–2010

OBJECTIVES: To analyse how economic downturns affect child mortality both globally and among subgroups of countries of variable income levels. DESIGN: Retrospective observational study using economic data from the World Bank's Development Indicators and Global Development Finance (2013 edition). Child mortality data were sourced from the Institute for Health Metrics and Evaluation. SETTING: Global. PARTICIPANTS: 204 countries between 1981 and 2010. MAIN OUTCOME MEASURES: Child mortality, controlling for country-specific differences in political, healthcare, cultural, structural, educational and economic factors. RESULTS: 197 countries experienced at least 1 economic downturn between 1981 and 2010, with a mean of 7.97 downturns per country (range 0–21; SD 0.45). At the global level, downturns were associated with significant (p<0.0001) deteriorations in each child mortality measure, in comparison with non-downturn years: neonatal (coefficient: 1.11, 95% CI 0.855 to 1.37), postneonatal (2.00, 95% CI 1.61 to 2.38), child (2.93, 95% CI 2.26 to 3.60) and under 5 years of age (5.44, 95% CI 4.31 to 6.58) mortality rates. Stronger (larger falls in the growth rate of gross domestic product/capita) and longer (lasting 2 years rather than 1) downturns were associated with larger significant deteriorations (p<0.001). During economic downturns, countries in the poorest quartile experienced ∼1½ times greater deterioration in neonatal mortality, compared with their own baseline; a 3-fold deterioration in postneonatal mortality; a 9-fold deterioration in child mortality and a 3-fold deterioration in under-5 mortality, than countries in the wealthiest quartile (p<0.0005). For 1–5 years after downturns ended, each mortality measure continued to display significant deteriorations (p<0.0001). CONCLUSIONS: Economic downturns occur frequently and are associated with significant deteriorations in child mortality, with worse declines in lower income countries.