At the time of writing, in autumn 2013, the UK economy is showing signs of a recovery and the Chancellor is claiming victory for his austerity-based policies. However, the opposition claims that this recovery is just for the wealthy few. The debate on how to respond to the recession continues along ideological lines. In this book an economist and an epidemiologist explore government responses to financial crises through the lens of health outcomes. They argue that austerity is never the right prescription as it hinders return to growth and causes immense suffering to citizens’ health and well-being. Mental health outcomes feature prominently in these analyses. For instance, the authors report 1000 excess suicides in the UK due to the effects of this recession and a second wave of ‘austerity suicides’ in 2012. Historical data and examples from financial crises at different times from across the globe develop their argument against austerity. Examining the Great Depression of the 1930s they show that US states that embraced the New Deal stimulus measures had lower child mortality, suicide and infectious disease rates than those that did not. In the late 1990s as the ‘Asian Tiger’ economies collapsed those states that accepted international bailouts also had to accept austerity packages. Thailand reduced its spend on medication to prevent mother-to-infant transmission of HIV and could only cover 14% of the need. Half the infected children died before their 5th birthday. The book describes many other tragic consequences.
Iceland and Greece have taken different paths in response to the current recession and the authors explore the effects in some depth. They show that Iceland’s citizens, rejecting austerity, maintained high levels of health and happiness. Greece’s enforced austerity has seen 35 000 clinicians lose their jobs, waiting times increase, people presenting sicker; and suicide rates increasing by 20%. Chillingly, the Greek Health Minister blamed the health crises on the burden of immigrants.
The book is heavily annotated but reads well. Clinical examples lend a particularly poignancy. The authors give the story of an unemployed former teacher in the USA who delays seeking help for a toe-splinter because of the high costs of healthcare outside insurance, and then develops septicaemia and organ failure. Unsurprisingly, they champion Obama’s healthcare plan to extend health insurance and are concerned that the UK is moving towards a more market-based approach to health. They suggest that the free and universal access to healthcare in the UK, through the National Health Service, has protected its citizens from the worst effects of this recession.
In 1848 Rudolph Virchow observed that ‘medicine is a social science and politics is nothing more than medicine on a grand scale’. Readers of this Journal will find much that resonates with clinical practice in these difficult economic times. The statistics presented here will help elevate anecdote to evidence when discussing policy with those that hold power.