The impact of economic recession on municipal expenditure on public health in Denmark

Elizabeth Headley1-2

Henrik Brønnum-Hansen1

Lau Caspar Thygesen1

Marie Bergmann1  

1National Institute of Public Health of Denmark, University of Southern Denmark

2School of Public Health and Preventive Medicine, Monash University, Australia

Background Why study the impact of the financial crisis on

municipal expenditure on public health?

• Expenditure on public health is an important indicator of a country’s commitment to the health of its population.

• Lack of research examining variation in government expenditure on public health over the course of the Global Financial Crisis.

• In 2007 in Denmark, responsibility for health promotion and prevention transferred from the county level to the municipal level, with no formal monitoring of changes public health funding in the light of the economic recession.

Objective Overall: To inform decision making about public health funding,

specifically targeted towards municipalities that have a funding deficit for health promotion and prevention

Specifically: Firstly to determine the changes in the budgets, income and

expenditure on health promotion and prevention since 2007. Secondly to determine to what extent the changes are related to

the economic recession.

Hypothesis The financial crisis has restricted governmental funding for health

promotion and prevention in Danish municipalities.

Methods Quantitative analysis: We ascertained the temporal trends for budgets, income and

expenditure on ‘health promotion and prevention’ before and after the economic recession. Data source: ‘Statistiks Danmark’

Qualitative analysis: Telephone interviews: representative sample of municipalities (20

out of 98).Questions investigated the underlying municipal rationale for spending patterns, and the extent to which the financial crisis has influenced the income for health promotion and prevention. Thematic analysis of interview responses.

Results

2007 2008 2009 2010 20110

100,000,000

200,000,000

300,000,000

400,000,000

500,000,000

600,000,000

Denmark: 2007-2011Health promotion and preventionbudget, income and expenditure

Total expenditure

Total income

Total budget

Dani

sh cr

owns

(cur

renc

y)

Results Proportion of total budget and

total expenditure on ’health promotion and prevention’

Income: Health promotion and prevention

Region Hove

dstaten

Region Sj

ælland

Region Sy

ddanmark

Region M

idtjylla

nd

Region Nord

jyllan

d

ALL DEN

MARK0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

Income for health promotion and prevention

200720082009

20072008

20092010

20110

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

Denmark: 2007-2009Proportion of budget and expenditure

on health promotion and prevention (HP & HP)

Proportion budget on HP & HP(%)

Proportion ex-penditure on HP & HP(%)

Perc

en

tage

ResultsQualitative interviews:

Near-consensus agreement that the financial crisis has influenced the types and the degree of interventions able to be undertaken.

The financial crisis has been a peripheral, but decisive factor in influencing the income received for health promotion and prevention at the municipal level.

Implications & future directionPublic health is given a high priority, in spite

of the financial crisis.Expenditure on health promotion and

prevention increased between 2007-2009, as a deliberate action to offset the negative health impacts of the recession.

“Zero growth” public spending policy until 2015.

Greatest challenge for Denmark is to implement the most cost-effective and efficient ways of addressing the public health needs of the Danish population.

Thank you for your attention