Abstract
Once in a while, unexpectedly, a book comes along which shakes your perceptions by getting you to think and look at things differently. This is such a book. In less than 150 pages, the authors – a statistician and a public health physician – have brought impressive evidence together to illustrate why austerity can kill. Using epidemiological data since the Great Depression of the 1930s and comparing this with the recent Great Recession, these authors provide easy-to-read and, more importantly, easy-to-digest information about the role economics plays in individuals’ health. They make a clear distinction between Body Politic and Body Economic – the latter is defined as ‘a group of persons organized under a common set of economic policies; a people whose lives are collectively affected by these policies’. They argue that economic policies are not the pathogens by themselves, but are the ‘causes of causes’ of ill health – the underlying factors to determine who will be exposed to the greatest health risks. They create vulnerabilities to which pathogens, be they psychological, social or biological, can infect. Economic forces affect not only the risk of developing illnesses but also remove some of the protective factors, such as housing, employment and social support. The debate as to whether cuts are beneficial to the economy and thereby to the health of people, or whether investment is better for the population, is put under close scrutiny by the authors, who believe that austerity does kill. The evidence provided is convincing. They are able to demonstrate from various settings around the globe that economic cuts are bad for the population’s health. They start with a number of case examples which bring a sense of purpose to their arguments. Their passion and seething anger is palpable right across the book.
Using data from the Great Depression, they point out that suicide rates went up but traffic accidents dropped – the simple explanation being that people could not afford cars or fuel. However, death rates also fell, and they point out that epidemiological transition may explain this variation across various states in the United States. They found that in 2010, traffic-related deaths dropped, largely due to less traffic on the roads. Not surprisingly, the policy debates related to alcohol and prohibition demonstrated reduction in deaths due to alcohol. The other policy shift was that the role of the government in economic investment and thereby in public health became more evident. Using examples from Russia’s mono-gorod, they report that unemployed males often disappeared from these townships after economic liberalisation in Russia. It was during this rapid shift to capitalism that men began to die at an increasing rate, which was dubbed ‘the post-communist mortality crisis’. Deaths were due to heart attacks, alcohol poisoning, suicide and homicide.
Their evidence of increased HIV infections among sex workers and drug users in Greece, where the needle exchange programme has been virtually decimated, along with the return of malaria, makes one wonder where policymakers’ priorities lie. Government debt is not like domestic debt, with which politicians are very keen to compare, thereby creating further illusions. They illustrate success in investment from Iceland using a recent different approach to managing debt crisis. Providing valuable evidence from the fall of Asian tiger economies, they compare differing responses by governments in Thailand and Malaysia, proving that austerity is bad for populations as well as for governments. This book deserves to be read and appreciated widely and should be compulsory reading for policymakers.