Warning: Austerity can seriously damage your health
18.04.13
Leaders in health policy and finance are meeting this week in Oslo to debate the health consequences of the economic crisis, under the auspices of a WHO Europe conference. It’s about time. Whilst the economic pros and cons of austerity have been hotly debated in the media the real, human effects of so-called ‘fiscal consolidation’ can sometimes get lost in the noise and econononsense. But as real as the health consequences of austerity are, they are hard to measure in the sort of terms that policymakers can take seriously. Numbers matter. And the reality is up to now we simply haven’t had the proof that cutbacks in healthcare have affected patient lives. That is changing – slowly – but changing.
In an excellent piece published in the lancet last month Karanikolos et al not only dissect the economic crisis itself, but set out the route through which policymakers should expect to see consequences for healthcare. Some of this is intuitive. The literature, for instance, had already established that in economic downturns we usually see increases in the number of suicides. On the other hand we also usually see a reduction in the number of deaths on the road (with people losing jobs in a recession, there are simply fewer people on the road). But this time around we’ve seen new problems, such as an increase in HIV and other infectious diseases that are much more closely linked to the rapid scaling back of public budgets.
Reporting on a recent study by Dr Emannouil Makaris, the Newstatesman this week reports that in one region of Greece a 29% increase in the rate of heart attacks from 2008-2011 based on a study of c.22,000 patients was recorded.
Not surprisingly the countries whose health systems are showing the most strain, according to Karanikolos et al, are those where austerity has bit the deepest – Greece, Portugal and Spain. Conversely Iceland, whose government rejected a strategy of cutbacks has managed its way through the crisis without major impact on health.
There has scarcely been a time when macroeconomic decisions have more directly affected patients. If Governments need to save money it’s hard for them to do so without hitting the large spending departments – and health is certainly one of those. But policymakers need to look at the evidence that is starting to emerge and reflect on whether or not they have gone too far. For Karanikolos et al the sting in the tail is aimed squarely at those in the Commission responsible for health policy:
“The Directorate-General for Health and Consumer Protection of the European Commission, despite its legal obligation to assess the health effects of EU policies, has not assessed the effects of the troika’s drive for austerity, and has instead limited EU commentary to advice about how health ministries can cut their budgets”.
Let’s hope that this week’s meeting in Oslo marks the start a more evidence-based dialogue on these matters.
