THE IMPACTS OF ECONOMIC CRISIS ON THE PUBLIC HEALTH IN TURKEY: AN ARDL BOUNDS TESTING APPROACH

The main aim of this study is to evaluate the impacts of economic crises on the public health in Turkey. In this context, the impacts of 1994, 2001 and 2009 economic crisis on 10 indicators related to the public health in Turkey between 1974-2015 were investigated through the ARDL (Autoregressive Distributed Lag) bounds testing approach. As a result of the analyses made, it has been found that 1994 economic crisis affected the 3 of the 10 indicators significantly (p<0.05) in a negative way, namely, under-five mortality rate, crude death rate, crude suicide rate. In addition, there were no significant positive effects of the 1994 economic crisis on any variable (p>0.05). The 2001 economic crisis was found to have a significantly negative effect on 2 out of 10 variables as infant mortality rate and crude suicide rate. On the other hand, it was found that the 2001 economic crisis affected 5 variables significantly positive, which are maternal mortality rate, DPT, polio and measles vaccination rates and, death rates from traffic accidents. For 2009 economic crisis, there was no significant negative health affect (p<0.05). However, the 2009 economic crisis was found to have significantly positive effect on only infant mortality rate (p<0.05). Conclusively, in this study, it has been found that economic crises have both negative and positive impacts on the public health in Turkey. However, it is possible to say that vulnerable people such as infants and children are more affected from economic crises in terms of health. From the results of study, it can be said that the severity of crises, in what way the health-related behaviors will evolve, and the effects on the healthcare system within the scope of policy preference are also important factors in the impacts of economic crises on health.

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  • 1. Afroz B., Moniruzzaman S., Ekman D. S. and Anderson R. (2012) The Impact of Economic Crisis on Injury Mortality: The Case of the Asian Crisis. Public Health 126:836-838. 2. Alexander M., Harding M. and Lamarche C. (2009) The Human Cost of Economic Crisis. SIEPR Discussion Paper No. 08-29. https://siepr.stanford.edu/system/files/shared/pubs/08-29.pdf. (Accessed 20.06.2014) 3. Babych, Y. V. (2011) Political Regime Changes, Crises and Growth in Historical Perspective. Unpublished Ph.D. Thesis, The George Washington University, Columbian College of Arts and Sciences, USA. 4. Bahmani-Oskooee M. and Raymond C. W. N. (2002) Long-run Demand for Money in Hong Kong: An Application of the ARDL Model. International Journal of Business and Economics 1(2):147-155. 5. Barros P. P. (2012) Health Policy Reform in Tough Times: The Case of Portugal. Health Policy 106(1):17-22. 6. Belvis A. A., Ferre F., Specchia M. L., Valerio L., Fattore G. and Ricciardi W. (2012) The Financial Crisis in Italy: Implications for the Healthcare Sector. Health Policy 106(1): 10-16. 7. Benmarhnia, T., Zunzuneguia, M-V., Llácerb, A. and Bélanda, F. (2014) Impact of the Economic Crisis on the Health of Older Persons in Spain: Research Clues based on an Analysis of Mortality. SESPAS report, Gac Sanit. 28(S1):137–141. 8. Borowy I. (2011) Similar but Different: Health and Economic Crisis in 1990s Cuba and Russia. Social Science & Medicine 72(9):1489-1498. 9. Breuer C. (2014) Unemployment and Suicide Mortality: Evidence from Regional Panel Data in Europe. Health Economics 24(8):936-950. 10. Bulutay T. (1995) Employment, Unemployment, and Wages in Turkey. ILO, State Institute of Statistics, Ankara. 11. Cader A. A. and Perera L. (2011) Understanding the Impact of the Economic Crisis on Child and Maternal Health among the Poor: Opportunities for South Asia. ADBI Working Paper 293. Asian Development Bank Institute, Tokyo. 12. Catalano R. (2009) Health, Medical Care, and Economic Crisis. The New England Journal of Medicine 360(8):749-751. 13. Chang S. S., Gunnel D., Sterne J. A. C., Lu T. H. and Cheng A. T. A. (2009) Was the Economic Crisis 1997–1998 Responsible for Rising Suicide Rates in East/Southeast Asia? A Time–trend Analysis for Japan, Hong Kong, South Korea, Taiwan, Singapore and Thailand. Social Science & Medicine 68(7):1322-1331. 14. Christian P. (2009) Impact of the Economic Crisis and Increase in Food Prices on Child Mortality: Exploring Nutritional Pathways. The Journal of Nutrition 140(1): 177-181. 15. Ciftci F. (2009) The Effects of Capital Flows on Developing Countries’ Economic Growth in the Process of Globalization: The Case of Turkey. Unpublished Master Thesis, Muğla University Institute of Social Sciences, Muğla. 16. Ciftci F. and Yildiz R. (2015) The Economic Determinants of Foreign Direct Investment: A Time Series Analysis on the Turkish Economy. Business and Economics Research Journal 6(4):71-95. 17. Cruces G., Glüzmann P. and Lopez Calva L. F. (2011) Economic Crises, Maternal and Infant Mortality, Low BirthWeight and Enrollment Rates: Evidence from Argentina’s Downturns. World Development 40(2):303-314. 18. Cutler D. M., Knaul F., Lozano R., Méndez O. and Zurita B. (2000) Financial Crisis, Health Outcomes and Aging: Mexico in the 1980s and 1990s. NBER Working Paper No. 7746. 19. Engle R. F, Granger C. W.J (1987) Co-integration and Error Correction: Representation, Estimation, and Testing. Econometrica 55(2):251-276. 20. Erdem E., Ilgun M. F., Dumrul C. (2011) The Effect of Financial Pressure on the Banking Lending Policy: A Review under the 2008 Global Crisis on Turkey. Journal of BRSA Banking and Financial Markets 5(1):9-34. 21. Erdogan S. and Bozkurt H. (2008) The Relation between Life Expectation and Economic Growth: An Analysis with ARDL Model. The Journal of Knowledge Economy and Knowledge Management 3(1):25-38. 22. Eren A. (1995) Determining Factors of Foreign Direct Investment in Turkey and Econometric Approach. Unpublished Master Thesis, Gazi University Institute of Social Sciences, Ankara. 23. Ergenc Y. E. (2009) Causes of Economic Crisis and Solution Suggestions. http://www.endmuh.com/kariyer/ekonomi/dosyalar/ekonomik_kriz_nedenleri_ve_cozum_onerileri.pdf. (Accessed 01.04.2014) 24. EUROFOUND (European Foundation for the Improvement of Living and Working Conditions) (2014) Access to Healthcare in Times of Crisis. Publications Office of the European Union, Luxembourg. 25. Franco M., Bilal U., Ordunez P., Benet M., Marejon A., Caballeryo B., Kennelly J. F. and Cooper R. S. (2013) Population-wide Weight Loss and Regain in Relation to Diabetes Burden and Cardiovascular Mortality in Cuba 1980-2010: Repeated Cross Sectional Surveys and Ecological Comparison of Secular Trends. BMJ 346: f1515. DOI: 10.1136/bmj.f1515. 26. Fukuda-Parr S. (2008) The Human Impact of the Financial Crisis on Poor and Disempowered People and Countries. UN General Assembly: Interactive Panel on the Global Financial Crisis. 27. Gerdtham U. G. and Ruhm C. J. (2006) Deaths Rises in Good Economic Times: Evidence from the OECD. Economics and Human Biology 4(3):298–316. 28. Granados J. A. T. (2005) Recessions and Mortality in Spain, 1980–1997. European Journal of Population 21(4):393-422. 29. Gujarati D. N. (2004) Basic Econometrics (4th ed.). The McGraw-Hill Companies. 30. Gujarati D. N. (2011) Econometrics by Example. Palgrave MacMillan. 31. (HUIPS) Hacettepe University Institute of Population Studies (HUIPS) (1994) Turkey Demographic and Health Survey 1993. Hacettepe Printing Office, Ankara. 32. (HUIPS) Hacettepe University Institute of Population Studies (HUIPS) (1999) Turkey Demographic and Health Survey 1998. Hacettepe Printing Office, Ankara. 33. (HUIPS) Hacettepe University Institute of Population Studies (HUIPS) (2003) Turkey Demographic and Health Survey 2003. Hacettepe Printing Office, Ankara. 34. (HUIPS) Hacettepe University Institute of Population Studies (HUIPS) (2009) Turkey Demographic and Health Survey 2008. Hacettepe Printing Office, Ankara. 35. (HUIPS) Hacettepe University Institute of Population Studies (2014). Turkey Demographic and Health Survey 2013. Hacettepe Printing Office, Ankara. 36. HPC (Healthy Public Policy) (2011) Social Environments and Health. Concept Paper. Alberta Health Services, Edmonton. 37. Ifanti A. A., Argyriou A. A., Kalofonou F. H. and Kalofonos H. P. (2013) Financial Crisis and Austerity Measures in Greece: Their Impact on Health Promotion Policies and Public Health Care. Health Policy 113(1-2):8–12. 38. Johansen S. (1988) Statistical Analysis of Cointegration Vectors. Journal of Economic Dynamics and Control 12(2-3):231-254. 39. Johansen S. and Juselius, K. (1990) Maximum Likelihood Estimation and Inferences on Cointegration-with Applications to the Demand for Money. Oxford Bulletin of Economics and Statistics 52(2):169-210. 40. Kaplan G. A. (2012) Economic Crises: Some Thoughts on Why, When and Where They (might) Matter for Health – A Tale of Three Countries. Social Science & Medicine 74(5):643-646. 41. Karanikolos M., Mladovsky P., Cylus J., Thomson S., Basu S., Stuckler D., Mackenbach J. P. and McKee M. (2013) Financial Crisis, Austerity, and Health in Europe. Lancet 381(9874):1323–1331. 42. Kim H., Chung W. J., Song Y. J., Kang D. R., Yi J. J. and Nam C. M. (2004) Changes in Mortality after the Recent Economic Crisis in South Korea. Ann Epidemiol 14(6):442–446. 43. Kim N. and Serra-Garcia M. (2010) Economic Crisis, Health and Education in Jamaica. Paper for UNDP’s Regional Bureau for Latin America and the Caribbean project on “The Effects of the Economic Crisis on the Well-Being of Households in Latin America and the Caribbean. 44. Labonte R. (2009) The Global Financial Crisis and Health: Scaling up Our Effort. Canadian Journal of Public Health 100(3):173-75. 45. Lammintausta A., Immonen-Raiha P., Airaksinen J. K. E., Harald K., Ketonen M., Lehto S., Koukkunen H., Kesaniemi A. Y., Karja-Koskenkari A. and Salomaa V. (2012) Socioeconomic Inequalities in the Morbidity and Mortality of Acute Coronary Events in Finland: 1988 to 2002. AEP 22(2):87–93. 46. Lehto J., Vrangbaek K. and Winblad U. (2012) The Impact of the Macroeconomic Crisis on Nordic Health System Policies: Denmark, Finland, and Sweden, 1980-2012. http://www.kingsfund.org.uk/sites/files/kf/juhani-lehto-impact-global-recession-health-care-denmark-finland-sweden-kings-fund-sept12.pdf. (Accessed 13.07.2014) 47. Lopez Bernal J. A., Gasparrini A., Artundo C. M. and McKee M. (2013) The Effect of the Late 2000s Financial Crisis on Suicides in Spain: An Interrupted Time-series Analysis. European Journal of Public Health 23(5):732-736. 48. MacKinnon J. G. (1996) Numerical Distribution Functions for Unit Root and Cointegration Tests. Journal of Applied Econometrics 11(6):601-618. 49. Mattei G., Ferrari S., Pingani L. and Rigatelli M. (2014) Short-term Effects of the 2008 Great Recession on the Health of the Italian Population: An Ecological Study. Soc Psychiatry Psychiatr Epidemiol 49(6):851–858. 50. McClure C. B., Valdimarsdóttir U. A., Hauksdóttir A. and Kawachi I. (2012) Economic Crisis and Smoking Behaviour: Prospective Cohort Study in Iceland. BMJ Open 2: e001386. 51. McKee M. (2013) The Financial Crisis in the EU: Its Impact on the Health Sector. http://www.ose.be/files/midi_OSE/McKee_2013_Slides_OSENIHDISession_040213.pdf. (Accessed 23.02.2014) 52. Ministry of Development of Turkey (2014) Tenth Development Plan (2014-2018) Medical Device and Medical Material Working Group Report. Ankara. 53. Montgomery S., Udumyan R., Magnuson A., Osika W., Sundin P.O. and Blane D. (2013) Mortality Following Unemployment during An Economic Downturn: Swedish Register-based Cohort Study. BMJ Open 3: e003031. 54. Musa S. (2014) An Impact of Exchange Rate Volatility on Nigeria’s Export: Using ARDL Approach. Unpublished Master Thesis, Çankaya University Graduate School of Social Sciences, Ankara. 55. Narayan P. K. and Smyth R. (2006). What Determines Migration Flows from Low-income to High-income Countries? An Empirical Investigation of Fiji-US Migration 972–2001. Contemporary Economic Policy 24(2):332–342. 56. Narayan S. and Narayan P. K. (2004) Determinants of Demand of Fiji’s Exports: An Empirical Investigation. The Developing Economies 17(1):95-112. 57. Neumayer E. (2004) Recessions Lower (some) Mortality Rates: Evidence from Germany. Social Science & Medicine 58(6):1037-1047. 58. OECD (2016) OECD Statistics: Health Status. http://stats.oecd.org/index.aspx?DatasetCode=HEALTH_STAT. (Accessed 23.08.2016) 59. Official Gazette (2010) Family Medicine Practice Regulation. Number: 27591, 25.05.2010, Official Gazette, Ankara. 60. Official Gazette (2011) Decree-law on the Organization and Duties of the Ministry of Health and Affiliates. Decision number: KHK/663, 02.11.2011, Official Gazette, Ankara. 61. Oskanbayev Y., Yilmaz M. and Chagirov D. (2011) The Impact of Macroeconomic Indicators on Stock Exchange Performance in Kazakhstan. African Journal of Business Management 5(7):2985-2991. 62. Otker-Robe I. and Podpiera A. M. (2013) The Social Impact of Financial Crisis: Evidence from the Global Financial Crisis. World Bank Policy Working Paper 6703. 63. Paxson C. and Schady N. (2004) Child Health and the 1988-1992 Economic Crisis in Peru. World Bank Policy Research Working Paper 3260. 64. Pesaran M. H, Shin Y. and Smith R. J. (2001) Bounds Testing Approaches to the Analysis of Level Relationships. Journal of Applied Econometrics 16(3): 289-326. 65. Phillips P. C. B. and Hansen B. E. (1990) Statistical Inference in Instrumental Variables Regression with I(1) Processes. Review of Economic Studies 57(1): 99-125. 66. Pirkola S., Sund R., Sailas E. and Wahlbeck K. (2009) Community Mental-Health Services and Suicide Ratein Finland: ANationwide Small-Area Analysis. Lancet 373(9658):147–153. 67. Pusti M. (2013) An Inquiry on the Anatomy of Crises and the Financial-Economic Crises of 2001-2008 in Turkey. Unpublished Master Thesis, Atılım University Institute of Social Sciences, Ankara. 68. Rachiotis G., Stuckler D., McKee M. and Hadjichristodoulou C. (2015) What has Happened to Suicides during the Greek Economic Crisis? Findingsfrom an Ecological Study of Suicidesand Their Determinants (2003–2012). BMJ Open 5: e007295. 69. Riva M., Bambra C., Easton S. and Curtis S. (2011) Hard Times or Good Times? Inequalities in the Health Effects of Economic Change. Int J Public Health 56(1): 3–5. 70. Ruckert A. and Labonte R. (2012) The Global Financial Crisis and Health Equity: Toward A Conceptual Framework. Critical Public Health 22(3):267-279. 71. Ruhm C. J. (2000) Are Recessions Good for Your Health? The Quarterly Journal of Economics 115(2):617-650. 72. Ruhm C. J. (2003) Good Times Make You Sick. Journal of Health Economics 22(4):637–658. 73. Salleh N. H. M., Othman R. and Ramachandran S. (2007) Malaysia’s Tourism Demand from Selected Countries: The ARDL Approach to Cointegration. International Journal of Economics and Management 1(3):345-363. 74. Sargutan A. E. (2009) Medical Device and Material Imports – Created Losses and Solution Recommendations. Rema Printing, Istanbul. 75. Schady N. and Smitz M. (2010) Aggregate Economic Shocks and Infant Mortality: New Evidence for Middle-Income Countries. Economic Letters 108(2):145-148. 76. Stuckler D., Basu S., Suhrcke M., Coutts A. and McKee M. (2009) The Public Health Effect of Economic Crises and Alternative Policy Responses in Europe: An Empirical Analysis. Lancet 374(9686):315-323. 77. Stuckler D., Basu S., Suhrcke M., Coutts A. and McKee M. (2011) Effects of the 2008 Recession on Health: A First Look at European Data. Lancet 378(9786):124–125. 78. Tangcharoensathien V., Harnvoravongchai P., Pitayarangsarit S. and Kasemsup V. (2000) Health Impacts of Rapid Economic Changes in Thailand. Social Science & Medicine 51(6):789-907. 79. Thomas S., Keegan C., Barry S., Layte R., Jowett M. and Normand C. (2013) A Framework for Assessing Health System Resilience in an Economic Crisis: Ireland as A Test Case. BMC Health Services Research 13(1):450. 80. TURKSTAT (2016a) Health Statistics. http://www.tuik.gov.tr/PreIstatistikTablo. do?istab_id=251. (Accessed 09.08.2016) 81. TURKSTAT (2016b) Mortality Statistics, 2015. TUIK Bulletin, Number: 21522. http://www.tuik.gov.tr/PreHaberBultenleri.do?id=21522. (Accessed 12.05.2016) 82. TURKSTAT (2016c) Transportation Statistics. www.tuik.gov.tr/PreTablo.do?alt_id=1051. (Accessed 29.08.2016) 83. TURKSTAT (2016d) Vital statistics. http://www.tuik.gov.tr/PreTablo.do?alt_id= 1060.(Accessed 04.08.2016) 84. TUIK (2016e) Vital statistics. http://www.tuik.gov.tr/PreTablo.do?alt_id=1060. (Accessed 11.10.2016) 85. Tuncsiper B. and Bicen O. F. (2013) The Effects of European Debt Crisis on Turkey's Exports. In: S. Sari, A. H. Gencer, I. Sozen (Eds.). Proceedings of International Conference on Eurasian Economies, pp: 486-495, 17-18.09.2013, St. Petersburg, Russia. 86. UNICEF (United Nations Children’s Found) (1991) The Impact of Economic Crisis and Adjustment on Health Care in Mexico. Unicef İnternational Child Development Centre, Innocenti Ocasional Papers, No:13. 87. Vandoros S., Hessel P., Leone T. and Avendano M. (2013) Have Health Trends Worsened in Greece as A Result of the Financial Crisis? A Quasi-Experimental Approach. European Journal of Public Health 23(5):727–731. 88. Wada K., Kondo N., Gilmour S., Ichida Y., Fujino Y., Satoh T. and Shibuya K. (2012) Trends in Cause Specific Mortality across Occupations in Japanese Men of Working Age during Period of Economic Stagnation, 1980-2005: Retrospective Cohort Study. BMJ 344: e1191. 89. Wang Y. S. (2009) The Impact of Crisis Events and Macroeconomic Activity on Taiwan’s International Inbound Tourism Demand. Tourism Management 30(1):75-82. 90. WFPHA (World Federation of Public Health Associations) (2009) Minimizing the Health Impacts of the Global Financial Crisis. Journal of Public Health Policy 30(2):243–247. 91. WHO (2009) Briefing Note for the Ministry of Health on Health and Crisis. World Health Organization, Regional Office for Europe, Copenhagen. 92. WHO (2011) Impact of Economic Crisis on Mental Health. World Health Organization Regional Office for Europe, Geneva. 93. WHO (2016) Health for All Database. http://data.euro.who.int/hfadb/. (Accessed 01.09.2016) 94. World Bank (2016a) World Development Indicators. http://databank.worldbank.org/data/reports.aspx?source=2&country=TUR#. (Accessed 04.08.2016) 95. World Bank (2016b) World Development Indicators. http://databank.worldbank.org/data/reports.aspx?source=2&country=TUR#. (Accessed 11.09.2016) 96. Yakisik H. and Cetin A. (2014) The Impacts of Education, Health and Level of Technology on Economic Growth: ARDL Bound Test Approach. Socio-economics 21(1):169-186. 97. Yildirim H. H. (2015) Health and Politics Articles (1th. Ed.) ABSAM Publications, Ankara. 98. Yucel F. and Kalyoncu H. (2010) Leading Indicators of Financial Crises and Affecting Channels of Countries’ Economies: The Case of Turkey. Journal of Finance 159:53–69. 99. Yurekli O. (2004) The Impact of Economic Crisis in Globalization Process on Developing Countries' Economies and Turkey. Unpublished Master Thesis, Suleyman Demirel University, Isparta.