I live in the countryside and the local
farm is now selling the new season’s asparagus. I’ve a lot of friends to say
thank you to so I bought six boxes at £5 each, much cheaper than in the shops,
but coming to £30. This week’s Guardian
newspaper has a whole section of its Cook!
Magazine devoted to this wonderful though expensive vegetable. Today’s Guardian
carries a feature on a new report from a number of charities including Oxfam,
and Church Action on Poverty suggesting that half a million people in the UK are
now “forced to live on food banks for sustenance”. The report, 'Walking the
Breadline’ links the UK government’s swingeing cuts to the benefits system,
unemployment, low and falling incomes and rising food prices. The chief
executive of Oxfam is reported as saying that the cuts have gone too far,
“leading to destitution, hardship and hunger on a large scale. It is
unacceptable that this is happening in the seventh wealthiest nation on the
planet’. Indeed.
These kinds of inequalities, where I can
afford asparagus but where £30 is what many families might have to feed
themselves for a week, were pointed out by Wilkinson and Pickett’s ‘Spirit
Level’ and also by the Commission on the Social Determinants of Health. The
evidence in both is carefully constructed but one could say ‘it’s hardly rocket
science’ to suggest that where people do not have the basics, their health will
suffer. Another publication just out (on May 21st) brings the
political and epidemiological analysis up to date and considers the effects of
the austerity measures promulgated by some western democracies on public health. David Stuckler
and Sanjay Basu in ‘The Body Economic: Why Austerity Kills’ argues that there
is a cause and effect relationship between austerity measures and public health
declines, and that it is not recession per se but austerity measures that are
causing these declines in public health and wellbeing. The key is how governments
manage recession, so that a recession
could be as equally bad in two countries but the effects are better mitigated
by some governments than others.
They give the example of Iceland which
suffered a catastrophic banking failure, and its total debt went up to 800% of
GDP, far worse than debt faced by any European country today. But rather than
make austerity cuts, more money was pumped into health care, diets improved
through better use of local resources, investment was made in jobs and people
were protected from homelessness. There has been no rise in depression or
suicide and moreover, GDP growth exceeds 4% (higher than other European
countries suffering recession), and unemployment is below 4%. In 2011 Iceland
ranked the happiest in the world.
This is in contrast to Greece, where health
care funding has been cut by 40%. Suicide rates have increased by 60%, charity
helplines say they are facing unprecedented demand and rates of depression have
gone up dramatically. Greece is used as the most devastating example of the mismanagement
of recession, with HIV rates going up by 200%, infant mortality reportedly rising
by 40%, and even malaria returning. Ireland too, has seen huge rises in suicide
rates, and health care is being cut. Stuckler and Basu describe the false
economy of austerity measures and how many of the actions required are
counterintuitive. You could say to follow an alternative path to austerity
requires more imagination than many politicians can muster, and there appears
to be an appalling lack of health promotion thinking in terms of acting to prevent
the inevitable public health problems that follow increased inequality and the
concomitant failure to provide the basic determinants of health.
The historical approach of the book enables
us to see that for example, where Sweden and Finland endured huge financial crashed
in the early 1990s, their social safety nets were preserved, leading to no
increases in mental health problems or other public health disasters. All in
all, the analysis leads Stuckler and Basu to argue against austerity measures
and for stimulus measures. The decision taken by the Icelandic people in a
referendum, to reject the austerity measures suggested by the IMF, has been
vindicated. There are thus robust examples of where stimulus measures have
been shown to work, not only in restoring the health of economies, but also in
not damaging the health of people. There need not be a tension between fiscal
health and public wellbeing.
An article in the New York Times by the
book’s two authors sets out aspects of their argument: http://www.nytimes.com/2013/05/13/opinion/how-austerity-kills.html?pagewanted=all&_r=0
No doubt the book requires careful scrutiny
to assess the strengths of the arguments, and I am not well enough versed in
health economics to do so without a more in-depth consideration. But the book
makes ‘common sense’ to me and certainly other reports, such as that mentioned
in the first paragraph of this blog post, would support the need for stimulus
measures and highlight the shortsightedness of austerity measures. Another report just
out from the International Labour Organization, Global Employment Trends for Young People 2013, shows that for 15-24
year olds, unemployment has reached 13%; this masks the true level of
unemployment as so many young people are doing jobs for which they are
over-qualified or where there is a skills mismatch. Global youth unemployment is
reaching a ‘crisis peak’ such that many young people have given up hope of
finding any meaningful work. That societies are not using the valuable talents
and skills of young people is a personal tragedy as well as a huge loss to
those economies. Being meaningfully occupied is a vital dimension of health;
work is not the ‘be all and end all’, but it is a vital source of self-esteem,
identity and self worth. Moreover of course, it provides other vital social
determinants of health based on income and the ability to buy basic services,
social support, companionship and hope for the future. Lack of employment at young ages does not bode
well for creating happy young people who have an investment in the societies of
which they are a part. These last months have seen the death of Margaret
Thatcher who came into power when one in seven children in the UK were living
in poverty. When she left power, one in three children were living in poverty.
These kinds of inequality have not improved since, alongside it being the norm
for many never to find work. I cannot believe that the austerity measures of
the current coalition government are doing anything other than storing up more
future inequality and more public health consequences for many, if not most, of
those in the bottom half of the income range. Meanwhile those like me, in good
jobs, eat asparagus.
