The cost of government spending cuts can be measured in human lives, reports Dick Skellington.
The Coalition Government is sticking to Plan A –A for Austerity – and carrying on regardless of any argument that insists other strategies may be more productive for delivering growth and economic stability. The next two years promise more cuts to welfare and local services as austerity bites. We have already witnessed a suicide by a woman so desperate about a bedroom tax designed to boost Government coffers, that she took her own life. But how common are such incidents? Is there a connection between austerity and a nation's public health?
In a new book The Body Economic, researchers David Stuckler and Sanjay Basu present a convincing case that such suicides, and a consequent rise in physical and mental ill health, are a product of the austerity regimes gripping many of the world's developed economics since the global financial crisis of 2008.
The book puts forward a weight of evidence suggesting that the kind of policies adopted by the Coalition Government, designed to alleviate debt and reduce the deficit, have devastating consequences on people's lives. If austerity had been run like a clinical trial, David Stuckler argues, it would have been discontinued. "The evidence of its deadly side-effects – of the profound effects of economic choices on health – is overwhelming."
Since 2008 in the United States over 5 million people have lost access to health care because they lost their jobs and with them their health insurance In Greece, one of the hardest hit nations in the downturn, ill-health demographics have shown a disturbing upward trend. Greece has experienced a 200 per cent increase in HIV cases, for example, and across worst hit nations such as Spain, Portugal and Italy, suicide rates have increased. In the UK Stuckler found that 10,000 families have been pushed beyond welfare and into homelessness by the austerity cuts to housing benefits.
Stuckler is a distinguished Oxford academic who specialises in exploring the connections between political economy and public health. His book is a chilling warning about the impact of future austerity measures. "Recessions can hurt. But austerity kills," he concludes.
The most extreme case is Greece. "There, austerity to meet targets set by the troika is leading to a public-health disaster," says Stuckler. "Greece has cut its health system by more than 40 per cent. As the health minister said: 'These aren't cuts with a scalpel, they're cuts with a butcher's knife.'"
For Stuckler what is most galling about the cuts is that they have been decided "not by doctors and healthcare professionals, but by economists and financial managers. The plan was simply to get health spending down to 6 per cent of GDP." Where did that number come from? he asks. It's less than the UK, less than Germany, and far less than the US.
Cuts in HIV-prevention budgets coincided with a 200 per cent increase in the virus in Greece, driven by a sharp rise in intravenous drug use against the background of a youth unemployment rate now running at more than 50 per cent and a spike in homelessness of around a quarter. The World Health Organisation, Stuckler says, recommends a supply of 200 clean needles a year for each intravenous drug user; groups that work with users in Athens estimate the current number available is about three.
The suicide rate in Greece was relatively low before 2008. Since then the rate has risen by an astonishing 60 per cent, while depression has doubled. Public health services have been overwhelmed and charities report a tenfold increase in cases. "There have been heavy cuts to many hospital sectors. Places lack surgical gloves, the most basic equipment. More than 200 medicines have been de-stocked by pharmacies who can't pay for them. When you cut with the butcher's knife, you cut both fat and lean. Ultimately, it's the patient who loses out."
While the book makes abundantly clear the cause-and-effect link between austerity and decreased levels of public health, such public health disasters are not inevitable, even in the very worst economic downturns. Stuckler's analysis of data from the 1930s Great Depression in the US shows that every extra $100 of relief in states that adopted the American New Deal led to about 20 fewer deaths per 1,000 births, and four fewer suicides and 18 fewer pneumonia deaths per 100,000 people.
"When this recession started, we began to see history repeat itself," says Stuckler. In Spain, for example, where there was little investment in labour programmes, there was a spike in suicides. In Finland and Iceland, countries that took steps to protect their people in hard times, there was no noticeable impact on suicide rates or other health problems.
So in this current economic crisis, there are countries – Iceland, Sweden, Finland – that are showing positive health trends, and there are countries that are not: Greece, Spain, now maybe Italy. Teetering between the two extremes, Stuckler reckons, is Britain.
According to Stuckler, The UK is "one of the clearest expressions of how austerity kills". Suicides were falling in this country before the recession, he notes. Then, coinciding with a surge in unemployment, they spiked in 2008 and 2009. As unemployment dipped again in 2009 and 2010, so too did suicides. But since the election and the Coalition Government's introduction of austerity measures – and particularly cuts in public sector jobs across the country – suicides are back.
Ministers seem unwilling to address the increase in suicides, arguing it is too early to conclude anything from the data. But based on the actual data, Stuckler is in no doubt. "We've seen a second wave – of austerity suicides," he says. "And they've been concentrated in the north and north-east, places like Yorkshire and Humber, with large rises in unemployment. We're now seeing polarisation across the UK in mental-health issues."
He cites, also, the dire impact on homelessness – falling in Britain until 2010 – of government cuts to social housing budgets, and the human tragedies triggered by the fitness-for-work evaluations, designed to weed out disability benefit fraud.
Stuckler calls on governments to set our economies on track. The book publicity blurb sums it up succinctly.
"We can prevent financial crises from becoming epidemics, but to do so, we must acknowledge what the hard data tells us: that, throughout history, there is a causal link between the strength of a community's health and its social protection systems. Now and for generations to come, our commitment to the building of fairer, more equal societies will determine the health of our body economic".
It is not to late. Almost, but not quite.
Dick Skellington 28 June 2013
The Body Economic: Why Austerity Killsby David Stuckler and Sanjay Basu is published by Allen Lane.
The views expressed in this post, as in all posts on Society Matters, are the views of the author, not The Open University.
Cartoon by Catherine Pain