The Body Economic: Why Austerity Kills

Review of David Stuckler and Sanjay Basu, The Body Economic: Why Austerity Kills, New York, Basic Books, 2013, hb, 240 pp., $26.99, ISBN 9780465063987Unchecked outbreaks of Malaria and West Nile Virus. A rise in HIV infections caused by increasing heroin consumption and decreasing needle exchange programs. Drug epidemics and doubled suicide rates, in a climate of increasing violence between riot police and protesters. This is no generic "failed state," but Greece: a founding member of the euro, integrated within NATO and the European Union, and host to the 2004 Olympics. What accounts for its disastrous state? In The Body Economic, David Stuckler and Sanjay Basu set out to answer this question in an unconventional way. They examine the impact of economic crises upon public health and set out to discover what economic policies adopted during a recession make a difference for better or worse. Their book, then, is a hybrid: while it amounts to an assessment-and indictment-of an entire school of economics, the authors are public health experts from the universities of Oxford and Stanford. They are relatively uninterested in the familiar totems of GDP growth, trade deficits, and fluctuating bond spreads. Instead, Stuckler and Basu wade through the Public Health Service's archives to establish whether suicides and alcohol-related deaths rose during the Great Depression, or trace the spread of HIV in Thailand and Malaysia during the late nineties, when the former followed the IMF's guidelines and slashed its healthcare budget while the latter refused.Backed by a considerable body of research, Stuckler and Basu's conclusion is straightforward and indicting. Austerity policies-that is, the attempt to balance budgets in the middle of an economic crisis, partly by raising fiscal pressure but mostly by slashing welfare spending-not recession, constitute the leading threat to public health. Keep in mind the authors' maxim that any country's ultimate source of wealth is its population. Now consider economic crises cause unemployment, increasing poverty, and an overall worsening of living standards. Bleak prospects also fuel anxiety and can even lead to drug abuse. Safety nets exist, among other things, to safeguard public health in such times of need. If they are scrapped in the middle of a recession the outcome is, as The Lancet's editor Richard Horton makes clear, that "people will die" [1]. Stuckler and Basu lay out an argument that is both unsettling and intuitive. It exemplifies George Orwell's observation that seeing what is in front of one's own nose requires a constant struggle.The cases examined to prove the authors' point range from the economies hit by the 1998 Asian Crisis to the effects of the United States' dysfunctional healthcare system, including the Great Depression, Sweden's economic recession during the late eighties, and post-2008 Spain and Italy. Among the ones that focus on the impact of austerity policies, Russia and Greece rank among the most impressive. In the aftermath of the Cold War, the Russian state collapsed. The outcome was catastrophic: in the midst of an economic meltdown, hundreds of thousands died because a wrecked healthcare system proved unable to cope with a dramatic rise in alcohol consumption. Life expectancy plummeted to Third World levels. What caused this disaster, however, was not the dismemberment of the Soviet Union but the ensuing austerity program, conducted with enthusiastic support from the day's leading economists. This was a time when Larry Summers claimed the laws of economics were no different from those of engineering, and called for mass privatization and immediate spending cuts in Russia [2]. Jeffrey Sach's "What is to be done? " conveniently published eighty years after Lenin's original manifesto-but making the case for a neoliberal program-reads, in retrospect, almost as frivolous as Summers' bravado [3]. In the Greek case we also know that austerity turned out to be a disastrous idea. …