Austerity is seriously bad for your health

{{(31 July 2013) Rates of HIV infection in Greece have increased by 200% since 2011. However, the recent response of the government was to re-introduce special powers for the police to detain people and test them for HIV. There is no proposal to reinstate the €15 million cut from the Okana drug treatment centre.}} This case exemplifies the issues exposed and analysed in the {Body Economic – Why Austerity Kills} by David Stuckler of Oxford University in the UK and Sanjay Basu of Stanford University in the US. Through an examination of statistics covering a series of major recessions and economic restructuring, the authors contrast the health outcomes where governments have intervened with instances where they have left it all to the market. Beginning with the slump in the USA in the 1930s, Stuckler and Basu look at the impact of the New Deal introduced by President Roosevelt which they argue had “a momentous effect on the public’s health. Although it was not designed with public health in mind, its support meant the difference between losing healthcare and keeping it; between going hungry and having enough food at the table; between homelessness and having a roof overhead. In providing indirect support to maintain people’s well-being, the New Deal was in effect the biggest public health program ever to have been implemented in the United States.” In their next case the authors uncover the devastating impact of the transformation of the Russian economy after the break up of the Soviet Union. The so-called shock therapists maintained that a short, sharp restructuring and shift to a market economy would lead to long-term economic growth. Stuckler and Basu’s assessment is stark. Not only is the health of Russian men still worse on average than it was in 1991 but: “The massive hit to public health in Russia is particularly tragic when it becomes clear that Shock Therapy didn’t achieve its other stated aims. Perhaps the 10 million deaths would be easier to stomach if the rapid transition to a market economy had improved the standard of living and health for Russians over time. But instead, Russia’s privatization programs served largely to create the country’s own version of “the 1 percent” – oligarchs with vast wealth and power.” The authors argue emphatically that responding to recession is a political choice and not a technical question that should be left to economic experts. Their next case study looks at Iceland where the reaction to the crisis involved an increase in social protection spending and initiatives on debt relief, particularly to help people stay in their homes. Stuckler and Basu note that even the International Monetary Fund acknowledged the impact of the Icelandic approach: “social benefits were safeguarded in line with the authorities’ post-crisis objective of maintaining the key elements of the Icelandic welfare state. This was achieved by designing the fiscal consolidation in a way that sought to protect vulnerable groups by having expenditure cuts that did not compromise welfare benefits and raising revenue by placing greater tax burden on higher income groups.” Returning to Greece, the authors highlight the impact of austerity measures on the health service and question why the troika set target to reduce health spending to 6% of GDP – lower than most other EU countries. They quote Dr Marc Sprenger, director of the European Centre for Disease Control and Prevention who said: “I have seen places where the financial situation did not allow even for basic requirements like gloves, gowns and alcohol wipes.” As health problems increased so did the pressure to cut costs. As Stuckler and Basu describe it: “Austerity was wreaking havoc on the health of the Greek people. The city of Athens was trying to cut health spending from 10.6 billion euros in 2009 to 7 billion in 2012 – in the middle of an HIV outbreak, a massive increase in homelessness, and a rise in suicide, among other problems.” They go on to make further comparisons in the way that different countries respond to downturns and crises noting how countries like Finland and Sweden have invested more in labour market measures to support the unemployed and get them back to work, in contrast to those countries where such measures are minimal and joblessness is left to rise with its consequent impact on health and wellbeing. The authors underline the need for action to protect the health of the population but also argue that: “Health, education and social protection programs have among the highest fiscal multipliers. In the case of the health sector, public investment boosts the economy by more than three dollars for every dollar spent.” The national health service in the UK recently celebrated its 65th birthday and so it is appropriate to recall that the system was set up just after the second world war when the country was facing massive economic challenges and enormous levels of debt. As the then Labour health minister Aneurin Bevan said: “We ought to take pride in the fact that, despite our financial and economic anxieties, we are still able to do the most civilized thing in the world – put the welfare of the sick in front of every other consideration.” {The Body Economic – Why Austerity Kills}, David Stuckler and Sanjay Basu, Allen Lane, £20 For further details click [here->http://www.penguin.co.uk/nf/Book/BookDisplay/0,,9781846147838,00.html?/The_Body_Economic_Sanjay_Basu]

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