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.