Subtitle: Recessions, Budget Battles and the Politics of Life and Death.
By David Stuckler and Sanjay Basu —

This book came out in 2013, and is frequently cited in discussions of austerity and the damage – short- and long-term – resulting from budget cuts, particularly at the national level. The book is organized in three sections: History, The Great Recession, and Resilience. The book focuses on the health impacts of budget cuts: not just cuts to health programs but broadly conceived impacts of austerity.

The book begins by describing the New Deal’s response to the Great Depression in the U.S., to the bump in mortality following the collapse of communism in the Soviet Union (driven by stress, alcohol, despair, and poor nutrition), and the Asian Financial Crisis.

The second and third parts of the book contrast Greece and Iceland (whose leaders rejected the IMF austerity prescription)

The authors use a combination of health data and reviewing economic data and public policy. Analyzing health indicators along with economic ones is an important, but difficult, endeavour. Questions of causality and of data quality dog any enterprise like this, and would be enormously difficult at a sub-national scale. (I once spent months trying to figure out how to measure access to healthcare in U.S. suburbs, and eventually abandoned the effort). There may be many other explanations for the difference between Greece – plagued by suicides and an HIV epidemic after EU-imposed austerity – and Iceland. The authors’ valiant and unsuccessful effort to get Greek politicians to take action on the spike in HIV – which they link to rising heroin use, unemployment, and the end of needle-exchange programs – raises questions about the relationship between multinational governance, local democracy, and science that can’t be simply answered. But the overall claims are well argued and documented, and bolster a hypothesis that most people would agree with on its face: a poor economy fuels poor health. Of course, so can a growing economy, as evidenced by the U.S.

The book’s U.S. segment features a common story of deferred healthcare leading to avoidable personal tragedy. The U.S. healthcare system has failed its citizens in good times and bad, but in recession more people may take such terrible gambles. This chapter is in the section on resilience, along with a chapter on the relationship between suicide and unemployment, and a chapter on U.S. homelessness that documents the rise of West Nile disease carried by mosquitos thriving in the pools of foreclosed and abandoned homes.

There is an anecdotal feel to the book, but many of the stories provide a compelling illustration of the misguided approaches to economic crisis that dominant the U.S. and Europe, and the way that austerity can backfire. It would be great if this study fuels more research into the relationship between health and public spending, especially research that moves beyond anecdotes and enables broader policy recommendations for public health spending in times of both boom and bust.