Tag Archives: employment

Why Austerity Kills

I think COVID-19 has made all of us realise just how deadly austerity is, but The Body Economic by David Stuckler and Sanjay Basu should be required reading for its death-dealing potential outside of pandemic conditions.

Please, can we not go backwards after this.

I am often nervous about anything that draws parallels too strongly between society and body, policy and medicine. But I think they do it really well here.

Austerity is medicine intended to reduce symptoms of debts and deficits, and to cure recessions. It cuts governmnet spending on healthcare coverage, assistance to the unemployed and housing support. At the start of the trial, its potential side-effects were not well understood (ix).

There is a wealth of work on the social determinants of health such as Marmot‘s review — there is nothing so new here but yet it can’t be repeated enough it seems.

Good health doesn’t start in hospitals and clinics; it starts in our homes and our neighbourhoods, in the food we eat, the air we breathe, and the safety of our streets. Indeed, a top predictor of your life expectancy is your zip code. (xi)

They study the impact of the economy on health and find that it is not recession but austerity that impacts it most negatively. ‘Recessions can hurt,’ they write, ‘but austerity kills (xx)’. Even the IMF has recognized this, reversing previous policy, writing that ‘austerity slows down economies, worsens unemployment, and hampers investor confidence.’ Yet how little has changed.

This book consists of chapter after chapter of evidence pulled from around the world (I love this scope around the world…) where divergent paths can be seen and tested to some degree, starting with the Great Depression in the US. States implemented the New Deal very differently, states taking fullest advantage of government supports and providing social services showing mortality rates far below those states which did not. They move on the the post-communist mortality crisis–which I am humbled to say I had never heard of. The authors show that the huge rise in mortality in men — the awful, heartrending rise in mortality — took place wherever in the former Soviet Union they pushed Shock Therapy, ‘a radical package of market reforms’ designed to push the transition to capitalism as quickly as possible. Primarily Harvard economists were behind this: Andrei Shleifer, Stanley Fischer, Lawrence Summers and Jeffrey Sachs. Russia, Kazakhstan, Kyrgyzstan followed this advice. Stiglitz was on the other side of this argument, pushing for gradual reform, Belarus, Poland and the Czech Republic followed this path.

The austerity imposed through shock therapy did not just cause a spike in mortality, it also significantly slowed economic recovery — even by its own justification (if there could be such a thing causing so many deaths), it failed. Milton Friedman himself admitted Stiglitz was right.

Another chapter on East Asia, again showcasing the deaths caused by IMF imposed austerity in Thailand, South Korea and Indonesia, as compared to Malaysia where austerity was resisted. Heartbreaking again.

On to the ‘Great Recession’, the approach taken by Iceland prosecuting bankers rather than imposing austerity. Quicker economic recovery, fewer deaths. Compare this to Greece. Compare this to the US, where they write:

A 2009 study found that people who lack medical insurance were 40 percent more likely to die prematurely than those who had it. During the great Recession, before the PPACA came into effect, there were approximately 35,000 avoidable deaths due to the lack of healthcare insurance (99).

People were dying, and at the same time

Profits of health insurance companies soared…In 2009 the top five US health insurance companies reported $12.2 billion in profits, a staggering increase of 56% over the figures for 2008. In 2009, a year that saw 2.9 million people lose coverage, insurance companies’ profits rose by 56 percent (101).

I haven’t read Kenneth Arrow, Nobel prize-winning economist, but he wrote in a 1963 paper that markets ‘often fail to deliver affordable, high-quality healthcare‘ (101). What they do instead, is make some people a whole lot of money.

Stuckler and Basu move on to Italy, the protests of the vidove bianche, or white widows of the increasing numbers of men committing suicide after losing employment. This opens a chapter on suicide and its connections to work, the ever increasing numbers of primarily men killing themselves after the imposition of austerity around the world. The way that governments, as they have done here in the UK, averaging out the numbers of deaths erase the spikes that demand attention.

From work to housing… They look at the unprecedented rise of the West Nile Virus during droughts, ultimately it was discovered that this had been caused by the foreclosure of homes and the breeding of mosquitoes in neglected pools. As an aside, West Nile Virus is a pretty terrifying disease.

This is not the only cost to health from the housing and foreclosure crisis. Housing is a precondition for good health — to be without it is to be among the most vulnerable groups.

People without homes tend to die forty years earlier than those with a roof over their heads. They often suffer from a raft of health problems and lack adequate access to healthcare. In addition, the homeless are at high risk of contracting infectious diseases like TB, which can then spread to the rest of the population. Poor health and homelessness are so closely linked that it is difficult to ascertain which came first, but the public health outcome is the same: a huge increase in the risk of death and avoidable suffering (127).

They describe people skipping medicines to be able to pay mortgages, a rise in hospitalisation leading to increased medical debt leading to increased likelihood of foreclosure. They write that the rise in foreclosures in communities strongly correlated to a rates of emergency room visits.

Heartbreaking.

Ultimately austerity has failed because it is unsupported by sound logic or data. It is an economic ideology. It stems from the belief that small government and free markets are always better than state interventions. It is a socially constructed myth–a convenient belief among politicians taken advantage of by those who have a vested interest in shrinking the role of the state, in privatizing social welfare systems for personal gain. It does great harm–punishing the most vulnerable, rather than those who caused this recession (140).

Well said. These are their recommendations:

To break the cycle of radical austerity programs, we need a New New Deal…To work, it must follow three key principles:

1. “First, do no harm” is the ancient higher law of the healing professions. Because social and economic policies have collateral effects on health and sickness, the doctors’ mantra should become a requirement for all such policies.

2. Help people return to work: In hard times, having a stable job is often the best medicine. Unemployment and the fear of unemployment are among the most significant drivers of poor health that people face in an economic crisis (143).

3. Invest in Public Health (144)

Stuckler, David and Sanjay Basu (2013) The Body Economic: Why Austerity Klls. Recessions, Budget Battles, and the Politics of Life and Death. NY: Basic Books.

The Importance of Residence: Willmott and Young on Bethnal Green

Michael Young and Peter Willmott’s Family and Kinship in East London is an incredible book, and I am just sorry I didn’t get round to reading it while working in East London though it has been on my list to read for what feels like forever. There are a number of critiques of the book, based primarily on the ‘rosy’ views of working class life. Looking backwards it is hard to tell of course, but it seemed to me it captures much of what continues to be good about working class life…and there is enough here to show that such closeness of community is many-sided and not to everyone’s taste. I thought back to Morrison’s writings on East London, which accentuated the narrowness of life, the gossip in those Mean Streets. I don’t know that either is wrong or right, they can sit together in the richness of how people experience life. For myself, it is always the generousness of my class that has impressed me. Anyway.

This is quite a stupendous piece of research. Amazingly I found a pdf of some of the original survey instruments (original link here, another copy of the docs here)… very cool. But what I love most is they seemed to have actually listened to people, rather than categorising them, and in their work to have explored the intersections of family, home and neighbourhood in quite brilliant ways.

This book is about the effect of one of the newest upon one of the oldest of our social institutions. The new is the housing estate, hundreds of which have been built since the war. In the last century people moved into the cities; in this they have been moving steadily out again, towards the countryside from which their ancestors came. (11)

They write too, that ‘We were least prepared for what we found in the borough’. Because what did they expect? The familiar tale of the ‘good old days’ now gone.  They believed old patterns of wide extended families and support networks had disappeared over the course of industrialization and modernisation undergone in East London, but instead:

We were surprised to discover that the wider family, far from having disappeared, was still very much alive in the middle of London. This finding seemed to us of more interest than anything we had been led to expect, all the more so when it transpired that the absence of relatives seemed to be as significant on the estate as their presence in the borough.

and the last line, a rather fascinating methodological note

We decided, although we hit on it more or less accidentally, to make our main subject the wider family. (12)

This is perhaps why I didn’t prioritise this book, being less interested in constructions of family and more in community and home. But I was terribly wrong about that. In addition to tackling the myth f the destruction of familial networks, they take on others. Bethnal Green’ 54,000 residents in 1955 were almost all working class, but only 8% of population found to be Jewish, ‘contrary to popular opinion‘. So on to what they did find.

Kinship in Bethnal Green

The begin with a review of earlier studies — Charles Booth among others, who described barefoot children, undernourished babies, young moths sick and hungry. The majority of these blamed poverty, blamed the poor, and above all men for spending money on things they shouldn’t, particularly nights down the pub etc. This is the image of the brutal working class man, tales of drunkenness and forced sex, bruises, pregnancies.

Even though we may think the accounts overdrawn, and distrust the representativeness of the families they describe, we cannot ignore the historical evidence, all the more so since the notion still survives that the working-class man is a sort of absentee husband, sharing with his wife neither responsibility nor affection…(19)

But you look at the evidence drawn from their interviews, it is the falling death rate that seems the biggest factor in families remaining families — 29% of those born before 1890 came from homes broken up before they turned 15 by the death of a parent, as compared to 2% from divorce or separation. That is a crazy figure. It was still 19% for those born between 1921 and 1933, compared to 1% divorce and separation.

It had never occurred to me before to think seriously of how young people died, to understand what that meant for the living. To remember how soon this all began changing.

Still — things were improving — despite people living longer, more housing was being made available. In 1931 there were 3 households to every 2 dwellings. 1941, 4 households to every 5 dwellings. More space, less hard wear of space. More comfortable spaces you might want to spend time in as opposed to down the pub. It never occurred to me to think of that much either.

Nor labour patterns and rights, but of course those were also definitive.

The spread of the five-day week has created the ‘week-end’, a new term and a new experience for the working man. (24)

You can see, of course, why I should love this book, bringing all these structural factors together to understand just what life lived within their constraints might mean. It is also full of those details you only get with qualitative work. Like the descriptions of the rise of cinema and wireless — a lovely section on the impact it has had on naming children! No longer names that have always been in the family. Aspirations were changing in other ways — work for example. Primarily for sons, but I love the snark in this reply:

I’d like him to take up chemistry. It’s completely unproductive and therefore well paid. (29)

Young and Willmott continue:

A sizeable minority of men in Bethnal Green take a very different view from white-collar people about the status of manual work, placing jobs such as company director and chartered accountant towards the bottom of the scale and manual jobs, like agricultural laborer, coal miner, and bricklayer, towards the top. These men regard business managers with disfavour because ‘They’re not doing anything. They get their money for walking around’ … Agricultural laborers, on the other hand, they value highly because ‘you can’t do without grub’; coal-miners because ‘without coal, industry stops’; and bricklayers because ‘you’ve got to have houses’. But even some of the men that take this view are anxious that their children should get as good a technical education as possible. (29)

That is one of the best statements of how the world should work I have ever read.

Where People Live

Housing was always an issue given its scarcity, and there follows a long, and brilliantly detailed exploration of how and where people live. After marriage, if the new couple have no home of their own yet, they most often live with the wife’s parents — mother and daughter have a long term bond, can manage in the house together by custom. Willmott and Young write:

Their tenancy is the most valuable property-right many working-class people posses: where the property is privately owned, the rent is low and controlled by law. (33-34)

People inherited tenancies from their parents, sometime going back three generations. This was one of the positive aspects of remaining at home after marriage, but as Young and WiIlmott make clear, most people ‘don’t want to live with them, they want to live near them‘ (35). They include a brilliant quote from Sheldon’s, ‘The Medicine of Old Age’ about similar community in Wolverhampton:

The fact that no less than four per cent of the sample had children living actually next door is astonishing; and there is no doubt that this proportion would have been higher but for the general housing difficulties since 1939, for the opinion was frequently expressed by both generations that this is the best mode of life for the old people, since it enables them to preserve their independence and the married children to lead a separate life, while at the same time ensuring that help is at hand when needed. (36)

This study showed twice as many women as men living in same house with their parents, and twice as many in the same street or block. They talk about the matrilocality of the English working class, and spatially at least this is well born out. (37) They include brilliant little pieces of description of the neighbourhoods they are visiting, and the feel of life there, like their visit to:

a four-roomed house in Minton Street in the middle of the borough. The other houses (but not the two pubs, obviously newer) were all built in the 1870s, of brick which has become a uniform smoke-eaten grey. They are nearly all alike in plan; on the first floor two bedrooms, and on the ground floor a living room, a kitchen, and a small scullery opening on to a yard which has a lavatory at the end of it and patch of earth down one side. Many of the yards are packed with clothes hanging on the line, prams, sheds, boxes of geraniums and pansies, hutches for rabbits and guinea-pigs, lofts for pigeons, and pens for fowls. the only difference between the houses is the colour of the curtains and doorsteps which the wives redden or whiten when they wash down the pavement in front of their doors in the morning. Dilapidated but cosy, damp but friendly, in the eyes of most Bethnal Greeners these cottages are the place, much more so than the huge blocks of tenement buildings standing guard, like dark fortresses, over the little houses . On the warm summer evening of the interview, children were playing hop-scotch or ‘he’ in the roadway while their parents, when not watching the television, were at their open windows. Some of the older people were sitting in upright chairs on the pavement, just in front of the doors, or in the passages leading through to the sculleries, chatting with each other and watching the children at play. (38)

The mother is usually the one who helps get her daughter her own place after marriage — she is the one with connections through the rent collector and through friends. She knows who has died or who is moving out, if she is a good tenant the rent collector can assume her daughter will be too. This means empty apartments go to those from the local area due to this web of connections. Some charitable trusts who owned housing in the area had it as official policy that family gets first chance at flats opening up, in others while not official, that was generally the way things worked. Willmott & Young note too, some of the other arrangements that can be made to reduce animosity over flats where they are scarce, such as letting part to a family who also needs it etc.

This was very different from how the council operated, which is rather fascinating. Willmott &Young noted that at the time of writing the council owned a third of dwelling in the borough and that was increasing. The council worked off of lists not personal connection, and early version of today’s points and priority need. Preference was given to ‘slum’ dwellers and those with high need, and it is easy to see the argument for this, but also you can see what might be lost. In 1957, it was still true that

Bethnal Green suffers from a serious housing shortage. In time, we can hope, it will be much less acute… (42)

Mothers and Daughters

From the above, it is clear just important relationships are. Willmott and Young note the amount of time daughters spend with their mothers, and mothers with their daughters, how it makes no sense to talk about the household as such, particularly given how many meals people share. Again they quote Sheldon on Wolverhampton:

‘In at least 40 per cent of cases they must be regarded as part of a family group, the ramifications of which bear little or no relation to architectural limitations. (48)

I rather love how the family overflows and engulfs the limits of brick walls in that sentence.

There is a multitude of ways listed in which mothers and daughters help each other, but I found this sentence about work quite fascinating:

Part-time work is plentiful in Bethnal Green, both in the small local factories and in the tens of thousands of offices which have to be cleaned in the nearby City, and women are therefore less in need of help from relatives than they would be in many other places. (54)

This would change, I suppose, but it seems to me I have not read much at all that really looks at these employment patterns and the independence such work must have provided. While also being rather shit work.

Husbands and mothers

Another amazing description:

Once arrived in the Hanbury’s front room, most of the guests stood about rather stiffly, holding glasses of beer and sniffing the pickled onions. The Buxtons, that is the bridegroom’s family, were grouped by the window, looking disdainfully at the chipped china dogs on the mantelpiece, the worn linoleum on the floor and the pictures of country scenes which did not quite conceal the damp patches on the wall-paper. (62)

Things liven up though.

You’ll be happy to know that the study found sons to regularly check in on their mothers, it tended to be once a week, and it was often them dropping by on their own. Nice.

The Kinship Network

These are broad, reinforced by regular meetings, but often the mother/oldest sister at their centre, and they tend to dissipate after their death.

The Family in the Economy

More on the many jobs available — it is hard indeed not to think of them as better days:

You do not have to live in Bethnal Green, you only have to take a bus down the main street to notice that this is a place of many industries. You pass tailors’ workshops, furniture makers, Kearley & Tonge’s food warehouse, and near to Allen & Hanbury’s big factory. The borough has by itself a more diversified economy than some countries. But the borough has no frontiers: it belongs to the economy which stretches down both banks of the Thames. At its heart is the largest port in the world, which lines the rives for nearly twenty miles from London Bridge to Tilbury, and supports on every side a web of interconnected industries… (89)

More on immigration, some things don’t change.

Because the East End is a port, and near to the Continent, it is the place where for centuries foreigners have landed to escape from war and persecution in Europe. (89)

Immigration’s connection to employment, though becoming more tenuous

The Huguenots most famously, notes still hand-loom weavers in 1939 and the closure of the last Huguenot silk firm in 1955. Furniture, however, once a spin-off of this trade, still strong though showing signs of winding down…

Several chapters on they have another great story about the Huguenots, where a local resident showed them a document written about the time of the Revolution, some kind of petition to the Governors of the French hospital in Hackney (!) to employ, and treat, his granddaughter. Amazing. But I digress.

Despite this winding down of the furniture trade (though that was still existing in pieces when I worked there), they can still write:

East London is less vulnerable because it has many industries to lean on, and while it cannot avoid being harmed by a general contraction in trade. (91-92)

And they note that those in Bethnal Green able to take the job of their choice. It’s political leanings are no surprise:

Every constituency in East London returns a Labour member to Parliament and every council is controlled by the Labour Party, Bethnal Green regularly electing a complete slate of Labour Councillors almost as a matter of course, The people share their politics; they speak the same language with the same accents; they work with their hands; they have, in short, the same kind of life. These deep-lying bonds between members of a class are also bonds between members of the family. (94)

See? Good old days. Hard to imagine this as Labour now.

One change for the better? Things aren’t quite as openly racist as they used to be:

But for most people the Council is not the prize it was. Security does not now matter enough to offset the low pay. Mr Sanderson, a dustman, explained how far his job had sunk…

Things have got so bad that they recently started about a dozen black men. They’re got the rough and rebel from everywhere. One of the black men was sweeping roads with a cardboard box with eyeholes over his head. The foreman asked him what he was doing that for and he said “Well guv’nor, it’s cold.” If it’s a bad winter, they’ll pack up, go home, and make rum.” (96)

The docks a different story (though probably not in the matter of casual racism), ‘It is a matter of pride to belong to a docker’s family‘. (97) I love this story, though I can’t honestly tell if its racist or not:

There were many well-established families — in a nearby dock, one of these was…known as the ‘Flying Eighteen’, a group of brothers and uncles with legendary sensitivity to the ‘jungle drum beats which let them know a ship was coming up the Thames’. (98)

They always got there first. This closeness of community and family surely has its downside. The study looked at how unions and industries gave preference to members’ sons — Transport and General Workers’ Union, Billingsgate for fish, Covent Garden and Spitalfields for fruit and veg, and Smithfields for meat.  Printing, bookbinding and paper workers the same.

Kinship and Community

Willmott and Young meet some of these challenges head on, at least in terms of the wider white working class:

Since family life is so embracing in Bethnal Green, one might perhaps expect it would be all-embracing… Far from the family excluding ties to outsiders, it acts as an important means of promoting them… The kindred are, if we understand their functions aright, a bridge between the individual and the community… (104)

They give this amazing, cinematic description of Mrs ‘Landon’ doing her half-hour morning’s shopping and telling the name and background of everyone they pass. By her own record of who she saw in a week in the street that she considered herself to ‘know’, there were 63 in total, and 38 were the relatives of someone else she knew. It is in the street, the shop, the pub that people meet each other, NOT in the home, which remains private. But I think much more happened then in public that would now be considered things best kept private.

Again we have another  brilliant description of urban space:

The streets are known as ‘turnings’, and adjoining ones as ‘back-doubles’, Surrounded by their human associations, the words had a glow to them, ‘In our turning we‘, they would say, ‘do this, that, or the other.’ ‘I’ve lived in this turning for fifty years’, said one old man proudly, ‘and here I intend to stay’. The residents of the turning, who usually make up a sort of ‘village’ of 100 or 200 people, have their own places to meet, where few outsiders ever come — practically every turning has its one or two pubs, its two or three shops, and its ‘bookie’s runner’. They organize their own parties…some turnings have little war memorials… (109)

They mention a woman had lived in the same courtyard all of her 62 years, spoke of newcomers with only 18 years residence, shocked to hear the council thought of her court as a slum. Imagine.

Another quote from J.H. Robb Working Class Anti-Semite…I don’t quite know what that is about, will have to look it up, but the quote is a good one:

There is a further localism within the borough. People are apt to look for their friends and their club within a close range. The social settlements draw nearly all their members from within a third of  a mile, while tradition dictates which way borderline streets face for their social life. The main streets are very real social barriers… (110)

So in looking at what holds community together, they write:

The interaction between length of residence and kinship is therefore the crux of our interpretation. Neither is by itself a sufficient explanation. (115)

But above all it is place.

In ending this chapter…If we are to pick out one conclusion, it is the importance of residence.

Marriage, changes of life, all of it

A special cast is given to all these adjustments and readjustments by the fact that they are played out within a limited physical space.  (117)

What better way, they say, to study the importance of residence than to look at what happens to this thick web of connections when there is a change? So on to part two — the new council estate at ‘Greenleigh’, now the truth can come out of the name — the Debden Estate. Why did I think it was the Becontree Estate? Dear oh dear, but it matters not. That will be saved for part 2.

Young, Michael and Willmott, Peter ([1957] 1979) Family and Kinship in East London. Manchester: Penguin Books.