The Impact of Fiscal Policies on the Socioeconomic Determinants of Health: A Structured Review

There has been considerable recent debate around the alleged impact of discretionary fiscal policies – especially austerity policies – on health and health inequalities. Assuming that most of the impact will have to run via the effect of fiscal policies on socioeconomic determinants of health (SDH), it is of interest to gain a further understanding of the relationship between fiscal policies and SDH. Therefore, the aim of this article is to review the recent evidence on the impact of discretionary fiscal policies on key SDH, i.e. income, poverty, education, and employment, in high income OECD countries. We find that there are no simple answers as to how fiscal policy affects those determinants of health. The effects of contractionary and expansionary fiscal policies on the analyzed SDH vary considerably across countries and will largely depend on the pre-crisis situation. Contractionary fiscal policies seem to have increased poverty, while their impact on income inequality will be influenced by the composition of the implemented measures. More empirical research trying to directly link fiscal policies to health outcomes, while taking into account of some of the mechanisms encountered here, would be worthwhile.