What is politics if not medicine on a grand scale? How many policy makers really know that combining evidence from health care and economics, then austerity policies will be replaced by real growth?*
Researchers are often accused of being out of touch with real policy making; indeed, an often heard criticism is that results of research are difficult to implement into practice. However, might it also be the case that an evidence-based policy culture has not yet been fully adopted by the policymakers themselves?
The conclusion of Stuckler and Basu (‘The Body Economic’) is unequivocal: economic policies in which no special provision is made for health and health care, and focus on spending cuts, lead not only to worsening population health, but also to prolongation of the recession. That poor working conditions bring about poor health has been recognized since the time of Karl Marx at least. What remains controversial is the impact macroeconomic policies can have on public health. In their book, Stuckler and Basu provide a clear presentation of immediate and medium to long-term impacts of austerity in various settings. The main observation ought to be uncontroversial: cuts to healthcare provision lead to worsening population health, lead to a sick workforce, which does not pave the way for economic recovery.
In contrast to rhetoric currently being employed in Greece and across Europe, in which politicians constantly stress the ‘lack of alternative’ to the cuts, the research presented in The Body Economic shows that, at least from the point of view of public health, there is, in fact, an alternative, leading not only to faster economic recovery, but also to avoidance of negative health effects, such as increases in suicides, which, unfortunately are clearly associated with recessions. Perhaps the most striking of these alternatives are Active Labour Market Programmes (ALMPs). Rather than handing out unemployment benefits without further support, emphasis is placed in ALMPs on helping jobseekers return to work as quickly as possible. While these programmes do require an initial investment in order to run, it has been estimated that they in fact lead to a net saving for the state, in that long-term unemployment, and thus loss of social insurance payments, is greatly reduced. The important feature of these programmes for a country like Greece is that they have been shown to improve the psychological wellbeing of the unemployed making use of them, and they are correlated with a decrease in suicides during periods of recession.
Cuts to healthcare provision lead to worsening population health, lead to a sick workforce, which does not pave the way for economic recovery
In countries like Greece, the link between bad public finances and ill health is quite clearly evident. Since the beginning of the recession, there has been a huge increase in the incidence of depression, suicides and infectious disease outbreaks, to name but a few areas of public health affected. Rather than seeing the financial crisis as an opportunity to establish a strong health care system, as Beveridge did in the UK in 1948, the troika and those in the Ministries of Finance and Health instead chose to demolish the Greek National Health Service on the road to privatization. History shows that this is not a case of there not existing an alternative; this is a case of putting ideology before evidence.
Some of the above mentioned statistics are undoubtedly well known among the Greek Left. What has not yet been shown is the proposition of an alternative mode of thinking about social and economic policy. Alternative, in the sense that, rather than being ideologically driven, policy making should instead focus on ‘what works’. ‘What works’ in this recession is not increasing unemployment and cuts to health care provision, which only bring the economy further down the spiral and which, if treated as mutually exclusive are unlikely to bring about the desired result. The link between a healthy population and a healthy economy needs to be made very explicit in future policy documents and manifestos. This will not only drive the Left away from dangerous populism, it will also steer the country away from neoliberal and fascist ideologies.
* Despoina Biri is a researcher on inequalities in society and health, as well as methods of synthesizing data from research to use in health policy