While recessions can hurt, what ultimately matters is how politicians respond. And, when they respond to hardship with deep, indiscriminate cuts, they can turn economic suffering into epidemics.
– David Stuckler, The RSA, London, UK 2013
In their recently released book The Body Economic: Why Austerity Kills, Drs David Stuckler and Sanjay Basu examine the health impact of austerity policies, historically and cross-nationally. They document what many have suspected: austerity policies create natural experiments in public health, ones where the human costs are dramatic and alarming.
The authors detail the harrowing effects of cuts to public health and social welfare supports in Greece, where large new outbreaks of HIV infections have appeared, the first in Western Europe in over a decade. HIV infections have risen by more than 200% since 2011 when the cuts to front line services started to take effect. Malaria, which had been eradicated in Greece (since the 1970s) has now returned, following cuts to environmental control programs. Cuts to social programs in the UK have resulted in rise in homelessness and tuberculosis. Cross-nationally, an epidemic of suicides has universally followed the introduction of austerity measures and the reduction of public sector employment.
Importantly, they contrast these public health impacts of austerity with those where governments have taken another path, choosing continued investment in health and social welfare supports instead. The way in which Iceland managed to side step the expected and unexpected health impacts of recessions is instructive; they chose to invest in social programs at the height of the recession. Along with no increase in mortality or adverse social impacts, there have been some unexpected positive health impacts resulting from this policy approach: a decline in importing some foods has been linked with McDonalds pulling out of Iceland. This triggered a shift in food consumption away from fast foods and towards more home cooked and locally accessible foods such as fish.
Austerity measures may not be as dramatic in Canada as in some other jurisdictions. However, the well-documented increase in income inequality will worsen the impact of measures that are being implemented. We know that cuts in public sector employment, wages and benefits, and affordable housing can drive inequalities within and across communities, and worsen health outcomes. Limiting access to prevention programs, the loss of affordable health care (whether primary or ‘supplementary’ care, such as prescription medications, physical therapies, and ongoing mental health care support) can undermine the ability of people to deal effectively with health related issues.
Stuckler and Basu are clear; there are 3 principles that should guide our thinking:
- Do no harm. Economic and social policies impact our health in direct and indirect ways. The evidence is clear across settings, and over time.
- Help people return to work. Unemployment and precarious employment are critical drivers of poor health, especially in difficult economic climates. Supporting employment initiatives and fair wage practices helps to keep those drivers in check.
- Invest in Public Health. Committing to population health means investing in our health and social welfare safety net. When cuts are made to public health or social programs the effects are immediate and dangerous. We also know that investing proactively in our communities can help to offset even the sharpest of economic pressures for our communities as a whole, and most dramatically for populations that are marginalized or disadvantaged.
To learn more about the research discussed in the book The Body Economic: Why Austerity Kills, have a listen to a presentation by David Stuckler at The RSA in London, UK.