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ObjectivesOur objective in this study is to evaluate the impact the Great Recession (2008–2014) had on self-perceived health in Spain.DesignWe use a longitudinal database (four waves of the Bank of Spain’s Survey of Household Finances (2005, 2008, 2011 and 2014)) with repeated observations of the same individuals before and after the Great Recession.InterventionsWe consider the Great Recession in a natural experiment and we introduce it as an explanatory variable in a mixed logistic regression model in which we explain the probability of a subject declaring poor health (fair, bad and very bad). In the model we control for both observed and unobserved confounders at both individual and family level.ResultsWe find an average downward trend in self-perceived health during the most severe period of the Great Recession (2009–2011). However, the fact that the adjusted measures are less volatile than the crude ones shows that variation in health status can be captured by either demographic or socioeconomic controls. In fact, there are significant differences in the impact the economic crisis had on health in terms of gender and age group. In particular, the (adjusted) risk of declaring poor health increases after the crisis began but only in those families in which the reference person is a woman younger than 45 years of age or a man aged 75 years or older.ConclusionsGiven our results, we discuss the link between financial wealth and self-rated health and how policy-makers could address the health inequalities that arise from adverse economic and financial shocks.

Original publication




Journal article


BMJ Open



Publication Date





e023258 - e023258