“If austerity were tested like a medication in a clinical trial, it would have been stopped long ago, given its deadly side effects.”
— academics David Stuckler and Sanjay Basu, from their New York Times op-ed
In the past week, the academics David Stuckley (an Oxford sociologist) and Sanjay Basu (a Stanford epidemiologist) have published two fascinating and powerful pieces on the relationship between austerity and health. There was the New York Times op-ed from last week and today, there is a Salon essay. Both articles are adapted from their new book, The Body Economic: Why Austerity Kills. Stuckley and Basu argue that austerity economics is associated with higher mortality rates and worse health. They look at an array of evidence, including not only the current Greater Recession (or is it a Lesser Depression?), but the Great Depression, the Asian financial crisis, and “shock therapy” in the former Soviet Union and former communist countries in Eastern Europe. They come to the conclusion that the public health consequences of austerity are devastating, and that budget cuts during economic downturns causes countless suicides and other preventable deaths.
This argument is somewhat controversial. Other research, such as the work of economist Christopher Ruhm, suggests just that health and mortality rates improve during economic downturns. For example, during recessions there tends to be less driving (and therefore fewer auto-related deaths), and there are fewer deaths due to occupational hazards. There are also fewer heart-related deaths, which might be associated with less job stress.
But so far as I know, Ruhm did not specifically control for a possible austerity effect — that is, the impact of changes in public spending on health. As Stuckler and Basu note, health trends are often complex. A decline in mortality rates may be occurring because of a trend that is unrelated to the economy. For example, they say that, during the Depression, many of the changes in death rates were due to long-term, pre-existing trends such as declines in infectious diseases due to improved sanitation. Such trends masked the impact of macroeconomic conditions.
The Salon article mostly concerns the Great Depression, and in it, the authors persuasively argue that New Deal programs had a “momentous,” positive impact on public health. They say that the impact of the New Deal on health can be seen most clearly when you compare states that enacted New Deal policies with those that didn’t:
People in Louisiana and other states implementing New Deal measures benefited from significantly greater declines in infectious diseases, child mortality, and suicides, particularly when compared with people in states like Georgia and Kansas that didn’t implement these measures.
I’d like to see the quantitative studies the authors did, and I also would like to read their studies of all the historical and present-day cases they examine. But based on the two articles I’ve read so far, their argument seems all too plausible. As I mentioned here the other week, the suicide rate in the U.S. has continued to soar, and economic conditions — specifically, high unemployment and decreasing labor force participation rates — seem to be among the chief reasons. And it’s not hard to imagine that the economic anxiety, social isolation, depression, and lack of health insurance that frequently accompany unemployment spells don’t have a strongly negative impact on health. I look forward to reading Stuckler and Basu’s book to see if they successfully make the case for their overall argument. What I’ve heard from them so far is intriguing and more persuasive than not.