May 17, 2013 6:38 pm

Death by a thousand cuts

A study of public health in times of recession

The Body Economic: Why Austerity Kills, by David Stuckler and Sanjay Basu, Allen Lane, RRP£20 / Basic Books, RRP$27.99, 240 pages

 

Austerity kills – and on a grand scale. So argue David Stuckler and Sanjay Basu in The Body Economic, a powerful attack on efforts to curb public spending since the financial crisis, which holds belt-tightening politicians responsible for a health catastrophe.

Stuckler, an Oxford political economist, and Basu, a medical epidemiologist at Stanford University, have been collaborating for more than a decade on the effects of recession and depression on public health. They had already mined a rich vein of data from the 1930s Great Depression, as well as the 1990s crises in the former Soviet Union and Asia, by the time they started work on what they call the Great Recession.

Their historical analysis provides a fascinating background to the more recent events. On the face of it, the Great Depression was good for Americans’ health. Mortality rates dropped by about 10 per cent, with a particularly sharp decline when incomes were falling most quickly from 1929 to 1933. The key short-term factor was a big fall in fatalities from road traffic accidents, as lack of money forced many motorists off the road. This was echoed – in a somewhat weaker form – eight decades later in the current recession.

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Stuckler and Basu also make some interesting points about the role of alcohol during the Depression. Prohibition was in place in the US until 1933 and, although enforcement was uneven, the authors calculate that it prevented 4,000 deaths – and would have prevented 7,300 had it been applied rigorously nationwide. (“Not that we’re advocating a return to Prohibition – just gleaning a lesson from it,” they add.)

The most important conclusion about the Depression in the US relates to the health impact of different responses. Inhabitants of states such as Louisiana, which took up Roosevelt’s New Deal enthusiastically and spent substantial sums on public health and social programmes, experienced larger declines in infectious disease, child mortality and suicides than people in states such as Georgia that were reluctant to make the same investment.

“What the Great Depression shows us is that even the worst economic catastrophe need not cause people’s health to suffer, if politicians take the right steps,” write Stuckler and Basu. They then turn to a series of case studies, contrasting what they regard as good (stimulus) and bad (austerity) responses to financial crises.

In the 1990s, Russia’s rapid privatisation programme and dismantling of Soviet-era social safety nets produced a catastrophic wave of death and illness, particularly among men, while the gentler transition in neighbouring Belarus maintained public health.

The most striking contemporary comparison is between Iceland and Greece. The latter, on a forced diet of severe austerity, has suffered not only more suicides and psychiatric illness but also a resurgence of infections such as HIV and even malaria. Iceland, adopting a less austere approach, has managed to protect health and social programmes – and avoided any increase in disease.

The Body Economic is not a wholly successful book. There is insufficient analysis of cultural, social and economic differences to justify the implication that Greece, say, could really have chosen the Icelandic course and emerged healthier than it has. The tone is sometimes irritatingly hectoring and self-righteous. And the authors fail to defend adequately their view that stimulus must always be the better course on economic as well as medical grounds.

Yet, by telling the stories of individual victims of austerity as well as analysing its impact at the population level, Stuckler and Basu provide a wealth of evidence that it is bad for our health. That is a valuable contribution to the current debate.

Clive Cookson is the FT’s science editor

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