In Greece, “that’s reflected in surveys that show a doubling in cases of depression; in psychiatry services saying they’re overwhelmed; in charity helplines reporting huge increases in calls,” Stuckler says.
The country’s healthcare system itself has also “signally failed to manage or cope with the threats it’s facing,” Stuckler says. “There have been heavy cuts to many hospital sectors. Places lack surgical gloves, the most basic equipment. More than 200 medicines have been destocked by pharmacies who can’t pay for them. When you cut with the butcher’s knife, you cut both fat and lean. Ultimately, it’s the patient who loses out.”
Such phenomena “are just a few of many effects we’re seeing. And with all this accumulation of across-the-board, eye-watering statistics, there’s a cause-and-effect relationship with austerity measures. These issues became apparent not when the recession hit Greece, but with austerity,” he says.
However, public health disasters such as Greece’s are not inevitable, even in the very worst economic downturns.
Stuckler and Basu began to look at this before the crisis hit, studying how large personal economic shocks — unemployment, loss of your home, unpayable debt — “literally could get under people’s skin, and cause serious health problems.”
The pair examined data from major economic upsets in the past: the Great Depression in the US; post-communist Russia’s brutal transition to a market economy; Sweden’s banking crisis in the early 1990s; the East-Asian debacle later that decade; Germany’s painful labor market reforms early this century.
“We were looking, at how rises in unemployment, which is one indicator of recession, affected people’s health. We found that suicides tended to rise. We wanted to see if there was a way these suicides could be prevented,” he says.
It rapidly became clear “there was enormous variation across countries,” he says. “In some countries, politicians managed the consequences of recession well, preventing rising suicides and depression. In others, there was a very close relationship between ups and downs in the economy and peaks and valleys in suicides.”
Investment in intensive programs to help people return to work — so-called active labor market programs, well developed in Sweden (where suicides actually fell during the banking crisis), but also effective in Germany — were a factor that seemed to make a big difference.
Maintaining spending on broader social protection and welfare programs helped, too: Analysis of data from the 1930s Great Depression in the US showed that every extra US$100 of relief in states that adopted the American New Deal led to about 20 fewer deaths per 1,000 births, four fewer suicides per 100,000 people and 18 fewer pneumonia deaths per 100,000 people.
“When this recession started, we began to see history repeat itself,” Stuckler says. “In Spain, for example, where there was little investment in labor programs, we saw a spike in suicides. In Finland, Iceland, countries that took steps to protect their people in hard times, there was no noticeable impact on suicide rates or other health problems. So I think we really noticed these harms aren’t inevitable back in 2008 or 2009, early in the recession. We realized that what ultimately happens in recessions depends, essentially, on how politicians respond to them.”