Austerity is a killer disease

No one should be surprised that the financial and economic crisis is taking its toll on people’s health right across Europe and North America. What would be a surprise, however, is if policy makers and politicians responded positively to shocking research findings.

Nine physicians have produced an analysis of the impact of the economic crisis on the health of ordinary people. Published in The Lancet, they conclude that the public health effects are already visible, particularly in the countries most affected by the recession and where drastic spending cuts have been imposed.

In Greece, the European Union and the International Monetary Fund has demanded that public spending on health should not exceed 6% of GDP. It’s the first time a country has lost control of what it spends on health.

Spending on drugs has been cut sharply while physicians have seen a 25% fall in their income. In 2011 alone, 370 specialist units were eliminated and 2,000 hospital beds were lost in Greece.

The incidence of mental disorders has increased in Greece and Spain and self-reported general health and access to health-care services have worsened in Greece. The number of suicides in people younger than 65 years has grown in the EU since 2007, reversing a steady decrease in many countries. The Greek Ministry of Health reported a 40% rise in suicides between January and May, 2011.   

In the member states that joined the EU in or after 2004, suicides peaked in 2009 and remained high in 2010, whereas a further increase was noted in 2010 in the 15 pre-2004 countries of the EU. In England, the increase in suicides in 2008-10 was “significantly associated with increased unemployment”, and resulted in an estimated 1,000 excess deaths.

In Spain, between 2006 and 2010, the prevalence of mental health disorders in people attending primary care increased significantly, especially those of mood, anxiety, somatoform, and alcohol-related disorders; the rise in the prevalence of major depression was the biggest.

“It is estimated at least half the rise in attendance with mental health disorders could be attributed to the combined risks of individual or family unemployment and difficulties with mortgage payments,” say the study’s authors.

Loss of family income particularly affects the weakest and most vulnerable members of society. In Catalonia between 2005 and 2010, the proportion of children at risk of poverty increased from 20·6% to 23·7%. In 2012, the Spanish government passed by royal decree a law that ties health coverage to employment. Hundreds of thousands of immigrants without papers will only have limited access.

Political economist David Stuckler, one of the authors of The Lancet research, and Sanjay Basu, an assistant professor of medicine and an epidemiologist at Stanford University,  have just published The Body Economic: Why Austerity Kills.

They say that more than 10,000 suicides and up to a million cases of depression could be attributed to the effects of the recession across Europe and North America. In Britain, some 10,000 families have been pushed into homelessness by the government's austerity measures, they believe. The Lancet study authors conclude:  

 Finally, public health voices have been largely absent from the debate about how to respond. Many health ministries have been silent. The Directorate-General for Health and Consumer Protection of the European Commission, despite its legal obligation to assess the health effects of EU policies, has not assessed the effects of the troika's drive for austerity, and has instead limited EU commentary to advice about how health ministries can cut their budgets.

 A small source of optimism is that European civil society organisations, including professional bodies, have spoken out about the adverse health effects of cuts to health and social spending. The question is whether anyone will listen.

With governments locked into imposing the burden of the crisis of capitalism on to ordinary people, you have to say that hands over ears is the order of the day.

Paul Feldman

Communications editor

Health advances under threat

Climate change is “the biggest global health threat of the 21st century”, according to the report of a year-long joint study by the University College London Institute for Global Health and the medical science magazine The Lancet. The gains made in the 19th and 20th centuries – countering infectious and pest-borne diseases, reducing malnutrition, improving infant and maternal mortality levels – could not only be lost, but put into reverse.

Summarising current research, the report sets out the threats to health and lives:

Hunger, illness, stunted growth and death due to under nutrition are set to worsen as climate change affects crops, forestry, livestock, fisheries, aquaculture, and water systems. Increases in extreme weather events will damage crops and disrupt farming. Sea level rise and flooding of coastal lands will lead to salination or contamination of fresh water and agricultural lands, and the loss of nursery areas for fishing. Drought, and changing patterns of plant and livestock diseases and pest infestations, reduction of income from animal production, decreased crop yields, lessened forest productivity, and changes in aquatic populations will all affect food production and security. The regions most likely to be adversely affected are those already most vulnerable to food insecurity and malnutrition

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Populations with no immunity will be exposed to new infections such as malaria, and dengue fever. One model suggests that up to 320 million more people could be affected by malaria by 2080. As ocean temperatures rise, increased plankton blooms could provide nutrients for the cholera virus. Flooding brings outbreaks of diarrhoea, leptospirosis and cryptosporidiosis.

Current public health systems could not respond to these challenges and of course the most vulnerable people are in poor countries with minimal health infrastructure. A new advocacy and public health movement is called for to bring together governments, international agencies, non-governmental organisations, communities, and academics from all disciplines to adapt to the effects of climate change on health.

You can see where these public health specialists are coming from. They want a return to the pioneering days of public health, for example when in 1854, John Snow (the father of public health) tracked the source of a cholera outbreak around Broad Street in London to an infected water supply. This marked the beginning of a struggle for the transformation of water and sewage which remains the bedrock of health in Britain. Then there were the studies that connected rickets and tuberculosis with poverty, which led to poor children getting free milk.

None of these struggles were won by researchers and doctors alone, but by campaigns involving individuals and groups, including trade unions and working people’s associations. Achievements were made in the teeth of opposition from vested economic and political interests.

The report’s authors acknowledge that, so far, climate change has been viewed “only through the lens of economics”, with no sign that governments are mobilising the professional, civil and social forces needed to respond. But the “lens” in question – or rather, the tunnel vision of globalised corporations in pursuit of profit – is the only vision that governments have.

Taking on the vested interests of agri-business, Big Pharma, and all the energy-guzzling corporate giants who are preventing action on climate change, means bringing scientists and doctors together with the rest of civil society to create an unstoppable movement for change. Just as Snow and his supporters had to go to war against the establishment to make gains in public health in the past, so today’s passionate advocates will find it impossible to achieve what is required without a transformation of the status quo, not only in but also beyond, health care systems.

Penny Cole
Environment editor