Economic Recessions and Public Health: a Causal Exploration of Mortality Patterns in Europe and Italy

This Ph.D. Thesis delves into the complex relationship between business cycles and mortality, examining the counterintuitive scenario where economic growth correlates with higher mortality rates (the so-called Thomas Effect), particularly in developed countries. Notably, the Thesis initially explores, employing the Difference-in-Differences methodology, the causal nexus between the Great Recession and mortality levels in Europe, with a particular focus on its impact on Lifespan Inequality. The results indicate that the Great Recession potentially not only improved aggregate mortality rates, but also ameliorated disparities in mortality outcomes. The analysis covers Europe before focusing on Italy, offering an in-depth look at the Italian scenario. The Italian case is examined as a distinct study due to its recent specific economic and healthcare dynamics. The Thesis employs an alternative causal inference methodology, Artificial Control, to examine how the Great Recession affected Italian Life Expectancy, revealing a significant post-crisis deceleration. Interestingly, the accompanying discussion contends that this merely constitutes an “apparent paradox” in relation to the Thomas Effect. Further, the Thesis investigates mortality trends in Italy from 1974 to 2019, focusing on the relationship of healthcare reforms and regionalization on Life Expectancy evolution across Italian regions. It employs sigma and beta convergence methodologies, along with a novel time-series variant of the latter to detect structural breaks in mortality trajectory. This analysis suggests that healthcare reforms may have played a role in halting the process of regional convergence, while simultaneously inducing gender-based heterogeneities. Finally, the Thesis expands its scope to include mental health in old age. It presents a study on the impact of the gender of the firstborn child on the cognitive health of aging parents, exploiting a natural experiment.