Poorer public health, in other words, is not an inevitable consequence of economic downturns, it amounts to a political choice — by the government of the country concerned or, in the case of the southern part of the eurozone, by the EU, European Central Bank and IMF troika.
Stuckler seizes on Iceland as an example of “an alternative. It suffered the worst banking crisis in history; all three of its biggest banks failed, its total debt jumped to 800 percent of GDP — far worse than what any European country faces today, relative to the size of its economy. And under pressure from public protests, its president put how to deal with the crisis to a vote. Some 93 percent of the population voted against paying for the bankers’ recklessness with large cuts to their health and social-protection systems.”
And what happened?
Under Iceland’s universal healthcare system, “no one lost access to care. In fact more money went into the system. We saw no rise in suicides or depressive disorders — and we looked very hard. People consumed more locally sourced fish, so diets have improved. And by 2011, Iceland, which was previously ranked the happiest society in the world, was top of that list again,” Stuckler says.
What also bugs Stuckler — an economist as well as a public-health expert — is that neither Iceland nor any other country that “protected its people when they needed it most” did so at the cost of economic recovery.
“It didn’t break them to invest in programs to help people get back to work,” he says, “or to save people from homelessness. Iceland now is booming; unemployment is back below 4 percent and GDP growth is above 4 percent — far exceeding any of other European countries that suffered major recessions.”
Countries such as those in Scandinavia that took what Stuckler terms “wise, cost-effective and affordable steps that can make a difference” have seen the impact reflected not just in improved health statistics, but also in their economies.
Which is why, occasionally, the austerity argument angers him.
“If there actually was a fundamental trade-off between the health of the economy and public health, maybe there would be a real debate to be had,” he says. “But there isn’t. Investing in programs that protect the nation’s health is not only the right thing to do, it can help spur economic recovery. We show that. The data shows that.”
Drilling into the data shows the fiscal multiplier — the economic bang, if you like, per government buck spent, or cost per buck cut — for spending on healthcare, education and social protection is many times greater than that for money ploughed into, for example, bank bailouts or defense spending.
“That seems to me essential knowledge if you want to minimize the economic damage, to understand which cuts will be the least harmful to the economy. But if you look at the pattern of the cuts that have happened, it’s been the exact opposite,” Stuckler says.
So in this current economic crisis, there are countries — Iceland, Sweden, Finland — that are showing positive health trends, and there are countries that are not: Greece, Spain, now maybe Italy. Teetering between the two extremes is Britain, Stuckler says.