As the Greek government implemented austerity measures in response to a financial crisis, Greek suicide numbers doubled last year. And in London, tuberculosis rates grew by 8 percent from 2010 to 2011, a result of increased homelessness and drug use during the Great Recession. In “The Body Economic: Why Austerity Kills,” Oxford political economist David Stuckler and Sanjay Basu, an epidemiologist at Stanford University‘s Prevention Research Center, argue that austerity measures have public health consequences, including HIV outbreaks and increased rates of depression, suicide and heart attacks. The authors recently spoke with U.S. News about the relationship between fiscal policy and public health. Excerpts:
Why connect public health with austerity?
Basu: In the 1990s, there was an astounding series of studies that said, What if everybody had perfect health insurance? How many premature deaths in the U.S. among people less than 75 years of age could we prevent? And it turned out that the answer was only about 15 to 20 percent. The other 80 to 85 percent can’t be affected by medical care, meaning that health doesn’t start on the exam table in the ICU, but in our homes, in our neighborhoods, whether we smoke or drink too much, and the quality of our air, food and safety. One of the biggest determinants therein is the state of the economy and, in particular, whether we have safety nets during hard times.
How does austerity lead to a loss of life?
Stuckler: When effective services and supports that sustain health are withdrawn, they pose a direct risk. A clear example can be seen in Greece today. To meet the deficit reduction targets, the health sector in Greece has been cut by more than 40 percent. HIV infections have more than doubled as effective needle exchange program budgets were cut in half. There was a return of malaria after mosquito spraying programs to prevent the disease were also cut, covering the southern part of the country. Deep reductions of a pharmaceutical budget led several pharmaceutical companies to leave the country. There was subsequently a 50 percent increase in people reporting being unable to access medically necessary care.
What surprised you most in your research?
Basu: That there are some very well-researched, effective programs out there that can benefit both public health and the economy, but the academic research is so far afield from the public discourse. A lot of the discourse just assumes that the only way to reduce deficits is to cut budgets in the short term, and it’s quite hard to explain why that’s a bad idea and actually increases long-term budgets. That counterintuitive problem has created a lot of fallacies and makes it difficult to translate research into practice.
Do you expect to see public health consequences to spending cuts in the U.S.?
Basu: We already see them if we compare state-based responses to different kinds of unemployment crises since 2007. We can, controlling for pre-existing conditions, compare states that underwent more extensive budget cuts versus those that didn’t; and [we] saw a rise in suicide among those who were denied unemployment benefits.
Which current policies are most harmful to public health?
Basu: I think the indiscriminate cuts to safety net programs among the poor are particularly easy to implement and particularly dangerous for public health. [And] cuts to our nation’s best defense system against epidemics, the Centers for Disease Control [and Prevention] are particularly dangerous. We recently had the fungal meningitis outbreak, and without the CDC, it would’ve been hard to conceive of how we would’ve protected ourselves from having a dramatic expansion of that epidemic.
Are there any economic policies that don’t have daunting human costs?
Basu: In many areas of the world, we see pretty effective policies that simultaneously improve health and the economy. For example, in Sweden and Finland there are active labor market programs. They help enroll the newly unemployed into supportive job retraining and re-entry, and work with both firms and the newly unemployed. As a side effect, they seem to reduce suicide, depression and alcoholism, while also stimulating the economy and being, in some cases, net cost-saving.
Why should President Obama read your book?
Stuckler: The book shows that there is an alternative to austerity that’s grounded in evidence. And when governments pursue it, they can pave the way to a happier and healthier future for people. By making smart, evidence-based investments, not only is it possible to protect people’s most valuable asset – their health – but to chart faster economic recoveries and address fundamental threats of deficits and debt. A simple answer is because his choices and those of Congress are matters of life and death for millions of Americans.
“Pennsylvania has opened up its doors to fracking in ways that many other states in the U.S. have not,” said David Dausey, Ph.D., chair of the Mercyhurst University Public Health Department. “We don’t know enough about the environmental and human health effects of fracking and, as a result, Pennsylvania has become the home of experimental fracking.”
Dausey discusses his concerns in this month’s episode of The Dausey File: Public Health News Today.
Hydraulic fracturing or fracking is a controversial method to extract natural gas or petroleum from subterranean shale by using pressurized water to blast it open. Proponents of fracking have noted its potential for helping the U.S. achieve energy independence while also stimulating the economy and creating jobs. These proponents have met stiff resistance from environmental groups that claim fracking can result in air and water pollution and have adverse human health effects.
The discovery of Marcellus Shale coupled with Pennsylvania’s loose regulations and friendly relationship with the oil and gas industry have made it so that Pennsylvania has become a mecca for oil and gas industry interested in fracking, Dausey said.
He noted that the oil and gas industry along with the government have made it difficult, if not impossible, to conduct comprehensive scientific research on fracking. “Until we have real scientific research about the environmental and human health effects of fracking, we should regard all current fracking practices as experimental,” Dausey said.
He posited that people who live close to fracking sites have “every right to be concerned” about the potential health consequences of fracking.
Chemicals used in the fracking process contaminate millions of gallons of water, Dausey explained. Safe disposal is an environmental concern. Further, he said, the exact chemicals used in the process are unknown because of industry resistance to surrender trade secrets. Fracking also has the potential to contaminate drinking water from wells.
“There is a recent lawsuit in Pennsylvania that claims that Pennsylvania officials didn’t report toxic chemicals found in drinking water near a gas drilling site,” said Dausey. “If true, this raises a real concern about how Pennsylvania is regulating and monitoring the fracking occurring in the state.”
Dausey noted that fracking isn’t just a water pollution concern. It can also deliver methane emissions into the air; the exact levels are disputed but research suggests that it may result in acute and chronic health problems for people living close to a well. Dausey urged further research before fracking becomes more widespread.
“Keeping the public safe should be our number one priority,” he said. “It should take priority over profits, over jobs, over everything.”
Diabetes services are in crisis, with complications, such as amputations, at a record high, Diabetes Action has claimed.
New figures from the HSE show that in 2010 and 2011, there were 781 diabetes-related lower limb amputations, a 20% increase on the previous two-year period.
Some 190,000 people in Ireland have diabetes and according to the advocacy group, the condition is now the single biggest cause of amputation, blindness, kidney failure and stroke. Yet the HSE is ‘amplifying this public health disaster’ by failing to fill essential posts and make retinal screening available, despite the fact that funding has been available for this since 2010.
Commenting on the figures, consultant endocrinologist, Dr Kevin Moore, described leg amputation as the ‘greatest measure of failure in the treatment of diabetes’. However, he noted that this ‘occurs daily in our hospitals‘.
Furthermore, every week in Ireland, someone with diabetes goes blind as a result of related eye disease, diabetic retinopathy. And ‘promised advances’ in paediatric services to increase the availability of insulin pumps to young children ‘haven’t materialised’.
Dr Moore insisted that the HSE is failing people with diabetes ‘on every front’ and despite some work being done in this area, there has been ‘no impact on health outcomes’.
“Footcare, eyecare and paediatric services have all been funded in successive HSE Service Plans since 2010, however, of 16 footcare posts, nine remain unfilled, the promised retinopathy screening programme has stalled and paediatric nursing and dietetic posts in Cork, Limerick and Galway have not even been advertised,” he said.
Meanwhile, speaking about plans to move some diabetes care from hospitals into GP surgeries, Dr Moore insisted that this would ‘not be safe or acceptable until essential services, such as retinanl screening, are in place’.
“Most GPs are not trained in managing these complex aspects of diabetes care,” he said.
Also commenting on this issue, Dr Anna Clarke of Diabetes Ireland, said that while the government’s policy on chronic illnesses is based on integrated services, none of the elements required for this in the area of diabetes have been delivered.
“Most nurses applying for these posts will come from the hospital system and because of recruitment embargos they won’t be replaced when they leave. The posts may strengthen certain pilot primary care initiatives, but they will ultimately weaken already deficient services in hospitals where nursing posts will vanish,” Dr Clarke insisted.
Diabetes Action is calling on the Minister for Health to ‘show leadership and insist that the HSE deliver on its commitments’.