Background
Methods
Inclusion criteria
Exclusion criteria
Procedures
Data extraction and analysis
Results
Characteristics of studies and exposure measures
Type of study (first author, year) | Country/−ies | Exposure measure (year/s of study, source of data) | Outcome measure | Risk of bias (% of the total score-STROBE) |
---|---|---|---|---|
Average score = 72.1 | ||||
Cross-sectional | ||||
Horridge et al. 2019 [16] | 32 EU countries | Survey to professionals and families/children. Countries classified according to the level of austerity following the European Union’s Maastricht criteria (2016–17) | Healthcare services to disabled children. Requests on changes in the quality and characteristics of services in the last years | Intermediate (70.4) |
Trends over time - Repeated cross-sectional analysis | ||||
Chzhen et al. 2017 [17] | 30 EU countries (27 EU plus Iceland, Norway, Switzerland) | Spending on Social protection as a share of GDP (EU-SILC) (2008–13) | Relative and anchored (2008) child poverty rates | Low (78.75)a |
Gunnlaugsson 2015 [18] | Iceland | Governmental responses to the crisis (2004–14) | Social determinants and child health | Low (76.25)a |
Herranz-Aguayo et al. 2016 [19] | Spain and Portugal | Government investment in family function (EU-SILC) | Child poverty rates and AROPE taxes | Intermediate (62.5)a |
Nygard et al. 2019 [20] | 22 EU countries | Public expenditure on family cash benefits and in-kind transfer benefits (OECD) (2006–15) | Child poverty rates (EU-SILC) | Low (87.5)a |
Rajmil et al. 2018 [21] | 16 EU countries | Countries stratified in 3 austerity groups according to the CAPB (IMF) (2005–15) | Material deprivation, child poverty, perinatal outcomes (EU-SILC), (OECD) | Low (82.5)a |
Rajmil et al. 2015 [22] | Spain | Government responses to the crisis (2005–13) | Social determinants, child health, and HCS | Intermediate (67.5)a |
Robinson et al. 2019 [23] | England | Effects during and after the English inequality strategy (1998–2010 / 2011–17) | IM according to the Towsend index of deprivation area in quintiles | Low (83.7)a |
Toffolutti et al. 2018 [24] | Italy | Public health expenditure 2000–14 | MMR coverage by health region | Low (82.5)a |
Zografaki et al. 2018 [25] | Greece | Changes in perinatal outcomes centered on the long term trends (1980–2004 and 2004–14) | Perinatal outcomes at early (2008–10) and “established crisis” (2011–14) | Intermediate (67) |
Before-after approach | ||||
D’Agostino et al.2019 [26] | Italy, Greece, France, United Kingdom | Changes in social protection benefits (EU-SILC) (2009/14) | Monetary and non-monetary indicators of well-being | Intermediate (75)a |
Stefansson et al. 2018 [27] | Iceland | People own assessment of their ability to make ends meet (EU-SILC) (2009/14) | Material deprivation by dimensions, vulnerability | High (46.25)a |
Cohort study | ||||
Reinhard et al. 2018 [28] | Ireland | Cohort GUI; 3 waves included a question on reduction in social welfare benefits (2009/11/13) | Family living conditions; child health, etc | Low (82.9) |
Qualitative study | ||||
Stalker et al. 2015 [29] | Scotland | Survey to providers for disabled children, and focus groups with carers and children (2011–13) | Changes in access and quality of services after budget cuts | STROBE: High (47.7) EPICURE (intermediate risk) |
Risk of bias
Social determinants of child health (SDCH) (Table 2)
First author (year) | Main results |
---|---|
Rajmil et al. 2018 [21] | Material deprivation increased during the period 2012–15 in those countries with higher austerity (interaction austerity*period 2012–15 = B: 5.62: p < 0.001) |
Chzhen et al. 2017 [17] | Children were significantly less likely to be poor in countries with higher levels of social protection spending in 2008–2013, even after controlling for the socio-demographic structure of the population, per capita GDP and the working age unemployment rate. The effects of spending were larger and more precisely estimated for relative rather than anchored poverty, and it was not statistically significant in the last 2 years of the study (2012/13) |
Nygard et al. 2019 [20] | Child poverty: the coefficients for spending on in-kind benefits (B = −1.6) were negative and consistently stronger than for cash benefits (B = − 1.2), even when controlling for other variables. There was also a gradual downward trend in the strengths of both coefficients as well as in the R Squares over time, which indicates that both forms of spending have become less efficient in reducing poverty over the studied period. This result can at least partly be attributed to higher unemployment of parents and a lower up-take rate of services (such as childcare services), as well as to cuts in the generosity of cash transfers to families |
D’Agostino et al. 2019 [26] | The shares of the social benefits devoted to the Family/Children function were approximately double in the UK and France than those of Italy and Greece. The higher and lower level of expenses in family/children benefits were for Italy: 5.4% (2014) and 4.1% in 2010; Greece: 4.4% (2014) and 3.5% in 2012; France: 8.6% (2007) and 7.6% in 2014; UK: 11.3% (2010) and 10.3% in 2013. |
Herranz-Aguayo et al. 2016 [19] | In 2013, Portugal exceeds the average on EU child poverty by almost 3% and Spain by almost 7% points. In Spain, one in three households is below the poverty thresholds (33.9%), followed by Portugal (31.1%). In Spain and Portugal, the ability to reduce poverty rates is much lower, remaining below the EU average (EU-15: 9.6% and EU-27: 9.1%), since both countries only achieved to reduce by 7.4% the risk of poverty and social exclusion after social transfers |
Stefansson et al. 2018 [27] | Both children’s deprivation and economic vulnerability were measured at higher levels in 2014 than in 2009, though only the change in the latter was statistically significant. Rates of deprivation in individual dimensions was low and the overlap very limited, which may be indicative of low deprivation rates |
Gunnlaugsson 2015 [18] | Governmental responses gave prominence to redistribution, through taxes and the social protection system. A set of measures represented protection of children were specifically improved (mental health, maternity care, immunisation, etc.). Percentage of children living in poverty almost not modified |
Child health outcomes (CHO)
First author | Main results |
---|---|
Perinatal indicators and child health | |
Rajmil 2018 et al. [21] | LBW increased during the period 2012–15 in those countries with higher austerity (interaction austerity*period 2012–15, B: 0.25; p = 0.004) |
Zografaki et al. 2018 [25] | LBW increased (Standardised rate ratio, SRR = 1.07[1.06–1.09]), as well as preterm births (SRR = 1.39, [1.37–1.42] during established crisis. Some differences found according to maternal origin and age |
Gunnlaugsson 2015 [18] | Governmental responses gave prominence to redistribution, through taxes and the social protection system. A set of measures protected children and were specifically improved (mental health, maternity care, immunisation). A few indicators worsened (i.e. small for gestation age changed from 2 to 3.4%.) |
Robinson et al. 2018 [23] | Absolute inequalities on IMR increased in 1990–1999 (annual change between the most deprived local authorities and the rest of England = 0.03) decreased during the welfare strategy period 2000–2010 (−0.11) and increased in 2011–2017 (0.04). The analysis suggests that it is increases in public spending on healthcare and welfare that are associated with decreases in inequalities in the IMR. |
Reinhard et al. 2018 [28] | 48% in 2011 and 60% in 2013 reported a reduction in welfare benefits. Besides the effect of the crisis itself, it was associated with an increased risk of reporting asthma (β = 0.014, 95% CI: 0.004, 0.023) and atopy symptoms (β = 0.014, 95% CI: 0.001, 0.027). |
Rajmil et al. 2015 [22] | Great impact on health of vulnerable children related to cutting budgets on housing, access to HCS, preschool investment. Increasing number of children living in poverty. No impact on child health at general population level but to the most vulnerable groups |
Mental health, and disability | |
Horridge et al. 2019 [16] | Health care professionals reported worsening quality of services than 3 years ago: increased waiting times, and less time allocated to see each child compared to 3 years ago, and worse working conditions in the last year. Nine in every ten families reported worsening quality of services for their disabled children compared to 3 years ago. Families from countries with austerity cuts reported more difficult access to welfare support and benefits. |
Stalker et al. 2015 [29] | Reduction or withdrawal of services in a wide range of provision—social work, education, voluntary organisations, health and professions allied to medicine. Examples of services that were not provided or shortened. Closure of day centres. Voluntary sector survey: A Shift from Preventative Work to Crisis Intervention. Increase in unmet needs. Some families waited between one and 3 years for assessments or services on child mental health for diagnose, equipment and/or home extensions. Difficulty meeting the needs of children on the autistic spectrum was a recurring theme |
Preventive services | |
Toffolutti et al. 2018 [24] | PHE fell by 2% in the whole country between 2010 and 2014. By regions, each 1% annual reduction was associated to 0.5% (0.36–0.65) reduction on the coverage on MMR |