Authors' reply

摘要

Roberto De Vogli is correct to say that the financial crisis has both proximal and distal causes. But in arguing that social epidemiologists must address the latter, he overlooks how we have been doing precisely that over the past 4 years. Indeed, we have consistently argued for a fundamental reassessment of the economic model that has created and perpetuated the current crisis, a view that at last seems to be gaining widespread acceptance. However, we should also note that our initial submission included much more on the distal causes he discusses but this was scaled back in response to reviewers' comments, although we believe that our views are still clear in the published paper. We are puzzled by Jose Ayuso-Mateos and colleagues' claim that suicides have not risen in Spain and Portugal, given the peaks in 2008 and 2010, respectively, that are apparent in their figure, corresponding to unemployment. However, their use of total suicide rates obscures the magnitude of the rise concentrated in working age men who are most affected by the financial crisis. At the onset of the crisis there was a step change in suicides in Spanish people of working age, which increased by almost 10% above the underlying trend. Meni Malliori and colleagues agree with our diagnosis of the cause of the rise in HIV infections but report their increased activity in response to it, a point they have made previously. However, our argument that the Greek response has been inadequate in the face of this increased need is supported by the fact that OKANA's (the Greek Organisation Against Drugs) budget has been cut by more than half.