The Body Economic (25 page)

Instead of spouting ideology, we give you facts, explanations, and hard evidence.
Figure C.1
demonstrates how austerity has choked off economic growth—deepening recessions. By contrast, governments that have increased public-sector spending have seen faster economic recoveries, which in turn helps them to grow out of debt.

F
IGURE C.1
Greater Public Spending, Faster Economic Recovery, 2009–2010
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The greatest tragedy of austerity is not that it has hurt our economies. The greatest tragedy is the unnecessary human suffering that austerity has caused. Olivia, Dimitris, Brian, Vladimir, Diane, and Kanya, are a few of the billions of people harmed by austerity. There is no economic recovery powerful enough to reverse the damage done to their bodies and their minds. The proponents of austerity promise that short-term pain leads to long-term gain. That promise has been repeatedly proven false in recessions both past and present.

Austerity is a choice. And we don't have to choose it.

In previous crises, during times of greater hardship than today, people chose to respond to recessions with programs like FDR's New Deal. The New Deal not only prevented public health disasters at a vulnerable time. It also generated some of the most vital social protection programs that continue today, such as Food Stamps and Social Security. After World War II, Britain's debt was over 400 percent of its GDP. Yet the UK did not cut its budget to reduce its deficits. It instead attacked what the economist and social reformer Sir William Beveridge called the “Five Giants”: Want, Disease, Ignorance, Squalor, and Idleness. In 1948, though the British economy was in shambles, the Labour Party launched hugely successful social protection
programs, including the National Health Service, and in so doing ended its debt crisis.

Today's response to economic hardship has largely been the opposite of the New Deal. In the US, in May 2009, President Obama implemented the American Reinvestment and Recovery Act, which helped many who needed it most. But that US federal stimulus has mostly ended, and politicians are now cutting public health programs, including those that both boost economic growth and prevent hardship during recessions. The British government under Cameron's Conservatives has begun transforming the National Health Service, once considered the world's model healthcare system, into a dysfunctional, market-based program. European Central Banks and the IMF continue imposing brutal austerity on Greece—spawning avoidable HIV and malaria epidemics.
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There is an alternative—the democratic option. Iceland suffered the worst banking crisis in its history and came under pressure to follow the dictates of austerity. But after people went into the streets to protest, Iceland's politicians took a radical step. They let the people decide—democratically—whether they would swallow the bitter pill of austerity to pay for their bankers' greed. The loud “No” heard round the world from Iceland was controversial, but history has vindicated the people's choice. Iceland's economy is stronger than before, and in spite of a massive recession, public health actually improved during the recession. Similarly, protesters at the Ford Hunger March during the Great Depression and the Malaysian food riots during the East Asian Financial Crisis also called on their governments to act against austerity. What started as the efforts of a few citizens developed into a social movement, ultimately enabling people to regain control over their body economic from independent bankers and the International Monetary Fund. They were able to transform their countries' futures. Never doubt the ability of organized citizens to make a difference.

If we take the truly democratic option, the first step is to identify those policies that are supported by evidence, and those that are not. With stakes so high, we cannot entrust our decisions to ideologies and beliefs. As the mathematician W. Deming said: “In God we trust; all others must bring data.” Often politicians on both the left and the right peddle ideas based on preconceived social theories and economic ideologies, not facts, figures, and hard evidence. Only when citizens have access to, and can engage with, the
data can politicians truly be held accountable for their budget decisions, and for the effects of those decisions on life and death. This book, we hope, is a first step to democratizing the health choices of the body economic.

To break the cycle of radical austerity programs, we need a New New Deal. The data show that it worked the first time and the other times it has been tried under different names. Economies bounced back, and people's health improved. Inherent in a New New Deal is a path away from austerity and toward a healthier body economic. To work, it must follow three key principles.

“FIRST, DO NO HARM”

“First, do no harm” is the ancient higher law of the healing professions. Because social and economic policies have collateral effects on health and sickness, the doctors' mantra should become a requirement for all such policies. For democracies to work, we need to know the full consequences of our policy choices. We need to evaluate public policies with the same rigor that we use to evaluate new drug treatments and medical devices. Then we can make informed decisions about the trade-offs: would you prefer a 0.3 percent lower short-term budget deficit or 2,000 more dead Americans? If, during the Great Recession, our policy makers and politicians had done their austerity math in this brutally honest way, they would have likely chosen different priorities.

To ensure that health is considered in all policies that affect it, we should establish public health review mechanisms. At the federal level, we could call it the office of Health Responsibility. There should be similar offices in government at almost every level. They would be similar to government agencies that protect the public from dangerous products and unsafe medications. The office of Health Responsibility would analyze government programs and disclose to the public how various policies affect public health.
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SECOND, HELP PEOPLE RETURN TO WORK

In hard times, having a stable job is often the best medicine. Unemployment and the fear of unemployment are among the most significant drivers of poor health that people face in an economic crisis. The stock market may be bullish again, but unemployment is still too high to constitute a truly democratic
recovery—that is, recovery for all, not just a few. Innovative programs like the active labor market programs (ALMPs) help the unemployed stay active during recessions. ALMPs prevent depression and suicide among not just the unemployed but also the employed who may be worried about losing their job. But ALMPs can also get people back to work, thus saving the government money in unemployment compensation and also increasing the labor supply, an engine of economic growth and recovery.

Jobs can be hard to find in times of recession, so economic stimulus is also needed to help create work. As Keynes argued, perhaps a bit tongue in cheek, it would be better to employ half the unemployed to bury fifty pound notes and the other half to dig them up again than to have people remain idle and on unemployment checks. If we wish to do more to activate workers and boost the economy, however, we have to enact the right kind of stimulus. Health, education, and social protection programs have among the highest fiscal multipliers. In the case of the health sector, public investment boosts the economy by more than three dollars for every dollar spent. Meanwhile, the fiscal multiplier for bank bailouts and defense spending is often negative. With this type of government spending, the economy shrinks, because the money tends to flow out of productive new business ventures that employ people, and to private bank accounts and offshore tax havens.
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THIRD, INVEST IN PUBLIC HEALTH

If any family member is sick and suffering, we do all we can to help. The same logic applies to the body economic. At a time when people are hurting from recession, politicians should act to protect people from the dangers of unemployment and poverty. They should enact laws that provide care based on people's health needs, rather than their ability to pay. This approach would eliminate many costly hospitalizations caused by care provided too late—as with Diane. A recession may hurt people's pocketbooks, but no one should lose their access to healthcare because of an economic downturn. As citizens we should call on our government to make decisions that safeguard public health. In the UK the opposite is being done, with the dismantling of the National Health Service.

It is easy to lose sight of how important disease prevention programs are until it is too late. The US Centers for Disease Control and Prevention, and
its counterparts in Europe, protect our communities from epidemics as varied as food-borne illnesses and tuberculosis, usually without any fanfare. The California Encephalitis Project helped Bakersfield curb its West Nile epidemic, but when a second outbreak happened in 2012, budget cuts left Bakers-field without critical assistance. This strong public-sector presence in health and healthcare is necessary to improve disease surveillance, speed up our response to epidemics, and prevent us from experiencing more tragedies. In the US, we have seen what happens when we cede health to the private sector. Public health departments are left to pick up the pieces when private companies fail to protect people during hard times. Public health programs need to be supported, not slashed, in times of great distress.

To achieve a real, lasting human recovery, we must fundamentally change the way we think about what's important. Economic growth is a means to an end, not the end in itself. This was Robert Kennedy's fundamental insight in his 1968 presidential campaign speech. What good is an increased growth rate, he asked, if it is hazardous to our health?

When we tell our children about the Great Recession, they will judge us not by growth rates or by deficit reductions. They will judge us by how well we took care of society's most vulnerable, and whether we chose to address our community's most basic health needs: healthcare, housing, and jobs.

The ultimate source of any society's wealth is its people. Investing in their health is a wise choice in the best of times, and an urgent necessity in the worst of times.

PREFACE

1
. See Robert Wood Johnson Foundation. 2009.
Breaking Through on the Social Determinants of Health and Health Disparities: An Approach To Message Translation
. RWJF Issue brief 7. Of course, everyone must die of something, but decades of public health research have shown that over half of all deaths are premature, from diseases that could have been prevented. One study concluded that “in the United States, perhaps 10–15 percent [of preventable mortality], could be avoided by better availability or quality of medical care.” The other 85–90 percent are attributable to sociological factors such as the environment and smoking. See J. McGinnis, P. Williams-Russo, J. R. Knickman. 2002. “The Case for More Active Policy Attention to Health Promotion,”
Health Affairs
v21(2): 78–93.

World Health Organization. 2013. The
Determinants of Health
. Available at:
http://www.who.int/hia/evidence/doh/en/

2
. Source for Figure P.1: EuroStat 2013 Statistics. Gross domestic product is seasonally adjusted and adjusted by working days. Baseline is 2nd quarter of 2008.

3
. Source for Figure P.2: Adapted from: D. Stuckler, S. Basu, M. McKee. 2010. “Budget Crises, Health, and Social Welfare Programmes,”
British Medical Journal
v340:c3311. Social welfare in purchasing-power-parity adjusted, constant 2005 US dollars per head of population. Life expectancy is at birth.

4
. In the US, road traffic deaths fell to 60- year lows when people drove less for reasons such as having less money to pay for gasoline.

5
. The
Gospel According to RFK: Why It Matters Now,
edited with commentary by Norman MacAfee (New York, 2008), p. 45.

INTRODUCTION

1
. Olivia was a patient seen by Sanjay's colleagues in the pediatrics department at a hospital in California. Her name and any potential details of her story that might identify her have been changed to protect her identity.

2
. About 770,000 additional Americans during the recession would binge on alcohol, as we found in Bor, et al. 2013. “Alcohol Use During the Great Recession of 2008–2009,”
Alcohol and Alcoholism.
Available at:
http://alcalc.oxfordjournals.org/content/early/2013/01/28/alcalc.agt002.short