Welcome David Stuckler (University of Cambridge) (Twitter), Sanjay Basu (FSI Stanford Univ) (GlobalHealthHub.org) (Twitter) , and Host Mark Thoma (University Oregon) (Economist’s View) (Twitter)

The Body Economic: Why Austerity Kills: Recessions, Budget Battles, and the Politics of Life and Death

David Stuckler and Sanjay Basu’s new book The Body Economic: Why Austerity Kills is a thorough examination of the toll that recessions take on people’s health. They show, convincingly, that there are many, many channels through which health outcomes can deteriorate when the economy goes into a deep recession. They also show that the manner in which the government reacts to an economic downturn is a critical factor in determining health outcomes. Deterioration in health in a recession, though common, is far from inevitable.

When economists examine these types of questions, they are not able to conduct laboratory experiments to test their theories in the way that a chemist or physicist would do. Instead, economists must rely upon historical data and hope that “natural experiments” – historical episodes that have laboratory experiment like features – allow them to discriminate between different theories about the macroeconomy.

As David Stuckler and Sanjay Basu explain, the Great Recession provided us with an important natural experiment to examine how health outcomes in a recession vary with changes in government provided social services. Some countries, for example Italy and Greece, cut government spending on social services drastically. That is, they pursued what has come to be known as austerity. The idea was that cuts in spending would generate confidence in the country’s ability to pay its bills and an economic boom would follow. Other countries such as Iceland expanded spending, that is, they pursued Keynesian policies; and there were also countries such as the US that were essentially treading water. By examining differences in government policies, both in terms of the magnitudes and the composition, we can get information on how well the policies performed.

Stuckler and Basu present compelling evidence that austerity can have large negative effects on health, particularly among the most vulnerable citizens. The level of detail is quite impressive, they examined mounds and mounds of health data from around the world and the conclusion expressed in the title to their book is clear: austerity kills.

But what’s even more impressive is that they don’t just document the ways in which austerity is harmful to health, they also provide specific policies that can be used to offset these effects. For example, one of the biggest threats to health is homelessness. The homeless are far, far more likely to suffer from poor health since they don’t have insurance, a job, or the financial resources to obtain the care they need. The authors show, again convincingly, that countries and states that put more effort into providing public housing had far fewer health problems and deaths than countries that did little along these lines. They also show that access to publicly funded health care made a big difference, and that policies to reduce the number of foreclosures, a large source of homelessness, or provide employment can also help quite a bit.

These are just a few examples of many, many policies they identify that can improve health and save lives. Their conclusion – correct in my view – is that increased spending on health-related social services during recessions can save us money in the long-run. But even in countries like Greece where expanding social services is simply not possible, the research documented in the book provides very specific guidelines about how a country can cut spending yet minimize the negative health outcomes.

The Great Recession is not the only instance where nature has provided us with a natural experiment that can be used to compare health outcomes under austerity and Keynesian policies. As documented in considerable detail, the Great Depression also had both cross-state and cross-country variation in policy that can be used to assess what type of policy works best, and other events such as the Asian Financial crisis are similarly useful.

The clear picture that emerges is that austerity kills both people and economies, especially austerity that does not consider the policies and guidelines in this book. The right response to an economic downturn – one that gives us a faster, healthier recovery – is to provide people with jobs, housing, access to health care, and other social services they need to whether the storm.

 

[As a courtesy to our guests, please keep comments to the book and be respectful of dissenting opinions.  Please take other conversations to a previous thread. - bev]

128 Responses to “FDL Book Salon Welcomes David Stuckler and Sanjay Basu, The Body Economic: Why Austerity Kills: Recessions, Budget Battles, and the Politics of Life and Death”

BevW June 29th, 2013 at 1:56 pm

David, Sanjay, Welcome to the Lake.

Mark, Welcome back to the Lake, Thank you for Hosting today’s Book Salon.

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Mark Thoma June 29th, 2013 at 1:57 pm

Thanks, and welcome everyone

Sanjay Basu June 29th, 2013 at 2:00 pm
In response to Mark Thoma @ 2

Thank you for hosting

Mark Thoma June 29th, 2013 at 2:00 pm

Let’s start with the topic of the book. David and Sanjay, what is the main question the book addresses?

David Stuckler June 29th, 2013 at 2:00 pm

Hi Mark and Bev — a pleasure to join you

Sanjay Basu June 29th, 2013 at 2:03 pm

The main questions in my mind, joining David in the writing of the book, were: What works best for public health in a recession? That is, how best can we respond to the vulnerabilities of our patients, to minimize adverse health outcomes during recessions? Are there specific programs or policies that can keep us healthy and make us most resilient in hard times?

David Stuckler June 29th, 2013 at 2:03 pm

How do recessions and austerity affect people’s health?

Mark Thoma June 29th, 2013 at 2:03 pm

How long have the two of you been doing the academic research that led to this book?

David Stuckler June 29th, 2013 at 2:04 pm

and, yes, as Sanjay notes, which programs can help mitigate any potential negative effects?

Sanjay Basu June 29th, 2013 at 2:07 pm
In response to Mark Thoma @ 8

for some of the specific research that went into the book, I believe our first papers came out in 2007/2008. but the overall subject of financial policy and health has been a subject we’ve studied for about a decade.

dakine01 June 29th, 2013 at 2:07 pm

Good afternoon David, Sanjay, and Mark and welcome to Firedoglake this afternoon.

David and Sanjay, I have not had an opportunity to read your book so forgive me if you address this. I am one of the long term underemployed and while this is only anecdotal, I know I can feel the stress of things on my blood pressure and just constantly feeling tense. It is the double whammy of personal austerity (forced by circumstances) and the governmental austerity for the political stupidity

BevW June 29th, 2013 at 2:07 pm

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Mark Thoma June 29th, 2013 at 2:07 pm

I asked about the academic research because I wanted people to know this is the result of a considerable body of work.

David Stuckler June 29th, 2013 at 2:07 pm

We’ve been working for a decade to understand the underlying causes of ill health — specifically on how social, economic, and political factors affect health systems and outcomes.

bluewombat June 29th, 2013 at 2:07 pm

Possibly until the next census, we appear stuck with a majority of reactionary Republicans in the House of Reprehensibles. How can any sensible legislation you propose to fight austerity and boost public health have a chance of getting enacted with that Congress and a charming and articulate but feckless and ineffectual President?

Mark Thoma June 29th, 2013 at 2:08 pm

I think the book makes a clear cut case for the health hazards of austerity. That’s the wrong response to a recession from both an economic and health perspective (which are not independent). For one or both of you, what are the two or three primary ways in which a recession can impact health?

David Stuckler June 29th, 2013 at 2:09 pm

All of our research goes through the process of peer-review for scientific publication. The book comprises more than 50 research articles, all which have been vetted by independent epidemiologists, economists, and statisticians at journals such as The Lancet, British Medical Journal, and PLoS Medicine

Sanjay Basu June 29th, 2013 at 2:10 pm
In response to dakine01 @ 11

Hi dakine01, I’m sorry to hear of the personal effects on you related to the recession and austerity. Indeed, one of the subjects we discuss in the book are a spike in stress-related causes of illness and disability, especially related to unemployment and underemployment.

Mark Thoma June 29th, 2013 at 2:11 pm
In response to bluewombat @ 15

Yes, but we shouldn’t stop trying to point out the true costs of the decisions Congress makes. In addition, as I hope we’ll get into later, this work is for a large number of countries, not just the US, and perhaps there’s hope of enacting better policy elsewhere.

Sanjay Basu June 29th, 2013 at 2:12 pm
In response to bluewombat @ 15

Thank you for your question bluewombat. I certainly won’t claim to have vast experience in the political process. But our hope is that by engaging in open discussion about the results of this research, we may be able to at least have a more informed democratic discussion. I think the history of the US leaves me with a lot of optimism regarding how much change is possible in spite of the harsh rhetoric that has engulfed our political process and particularly this discussion around debts and safety nets.

norecovery June 29th, 2013 at 2:12 pm

Suicide has not yet been mentioned. There have been reports of an increased rate in the U.S. Is this also true in other countries?

Mark Thoma June 29th, 2013 at 2:14 pm
In response to norecovery @ 21

And let me follow up the question with: do suicide numbers depend upon access to guns?

David Stuckler June 29th, 2013 at 2:14 pm
In response to dakine01 @ 11

Thank you for sharing your experiences. It is important to talk about mental health, especially now at a time when unemployment is still high in the US and Europe. About 1 in 3 men who lose work experience clinic symptoms of depression. People who are unemployed are twice as likely to end their lives. The stresses that you describe are a common observation. What we’ve learned, however, is that smart investments can help alleviate these risks. In some societies, such as Iceland, people who are unemployed do not report many of the concerns you describe. But in others, such as the US, UK, and Greece, there’s a strong correlation of unemployment and risks of depression and suicide

Sanjay Basu June 29th, 2013 at 2:14 pm
In response to Mark Thoma @ 16

Regarding the impact of recession on health, there appears to be several common themes between the Great Depression, East Asian Crisis, Russian crisis of the 1990′s, and the current “Great Recession”. A first theme is that aggregate statistics can be deceptive, for example overall mortality rates often decline in the context of lower traffic accidents (less people can afford to drive), but hidden beneath that are often spikes in suicides. Similarly we see divergence in alcohol use: some people drink less with less money in their wallets, but a significant and large group (particularly young unemployed men) start binge drinking. And depending on government responses, we see subsequent health effects associated with hunger, homelessness and infectious disease transmission in the context of reduced control programs (such as the malaria outbreak in Greece following the cuts to mosquito spraying budgets).

David Stuckler June 29th, 2013 at 2:16 pm
In response to norecovery @ 21

We’ve estimated that there have been over 10,000 ‘economic suicides’ over and above historical trends in Europe and North America since the recession began. For our US analysis, see: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961910-2/fulltext
The rates of increase tend to correspond to areas experiencing the greatest economic hardship and job losses – particularly in countries undergoing deep austerity measures and associated rises in unemployment

Sanjay Basu June 29th, 2013 at 2:17 pm
In response to norecovery @ 21

While we have seen increases in suicides in the context of unemployment increases, the correlation does not always mean causation–that is, while unemployment spikes have contributed to increased suicides in for example some US states and Spain and a number of other countries, one thing we discuss in the book is how Sweden appears to have mitigated this problem by specific unemployment programs that help people gain back unemployment (and, as a side effect, reduce depression and suicide). So they achieved both economic stimulus and health benefits simultaneously during large unemployment spikes in the 1990s. Similarly we see variations in suicide rates across the US in association with state-level policies around unemployment.

David Stuckler June 29th, 2013 at 2:17 pm
In response to Mark Thoma @ 22

Important question — a main strategy in suicide prevention is to reduce access to the means of suicide — the means of self-harm. I don’t have the literature on firearms and suicide offhand, but a substantial portion of suicides in the US are attributable to firearms. We often focus on the debate about homicide risks, but self-harm is the other aspect of ‘intentional harm’ that should be part of the public discussion on gun control

norecovery June 29th, 2013 at 2:18 pm

I hope you will invite Reinhart and Rogoff to read your book.

Sanjay Basu June 29th, 2013 at 2:19 pm
In response to Mark Thoma @ 22

while we ourselves have not done research on the suicide-gun control issue, our colleagues have summarized some of the evidence in recent papers on this question:
http://www.ncbi.nlm.nih.gov/pubmed/23153127

Mark Thoma June 29th, 2013 at 2:19 pm
In response to norecovery @ 28

If a country can expand spending in a recession, and most can — austerity is rarely forced — what’s the best place to spend the money? Conversely, in some cases where it is forced, e.g. Greece, spending more is not possible. In that case, I suppose these are also the services that should be the most protected?

bluewombat June 29th, 2013 at 2:20 pm
In response to Sanjay Basu @ 20

Ah, thank you for your response. (Mark, too.)

Mark Thoma June 29th, 2013 at 2:21 pm
In response to norecovery @ 28

Yes, they really should. It might open their eyes to the human costs of austerity.

David Stuckler June 29th, 2013 at 2:21 pm
In response to Sanjay Basu @ 20

Indeed – for our democracies to work, we need to know the health effects of our economic policies. Fiscal policy is a matter of life and death. Historically crises have been opportunities to rethink priorities in society. In the Great Depression, amid political pressure, President Roosevelt didn’t cut the budget massively, but instead launched the New Deal — founding the US system of social security. In the UK in the aftermath of world war II, at a time when the nation’s debt was >200% of GDP, the welfare state was founded – establishing the National Health Service and Universal Child Benefit – addressing the ‘Five Giants’ that imperil societies including Want, Idleness, and Disease

norecovery June 29th, 2013 at 2:22 pm

It would seem that drug use or abuse can be helpful or deleterious depending on the drug. For example, marijuana use definitely alleviates stress caused by “tough times”. Has this issue been analyzed, at least anecdotally?

BevW June 29th, 2013 at 2:23 pm
In response to David Stuckler @ 23

In some societies, such as Iceland, people who are unemployed do not report many of the concerns you describe.

What did Iceland to specifically to help their population?

Sanjay Basu June 29th, 2013 at 2:25 pm
In response to Mark Thoma @ 30

Greece was certainly under a uniquely difficult set of political circumstances as part of the Eurozone. In terms of the ‘best place to spend’ of course different advocates for different public sectors will favor their sector of interest (e.g., transportation people will focus on the roads and bridge maintenance, public health experts on mosquito spraying and HIV prevention and health clinics, and teachers on education), but one ‘objective’ measure of how much a program may contribute to economic growth is the fiscal multiplier–the number of $ of economic growth received back for each $1 of government spending. While initially it was (wrongly) assumed that government spending would crowd out private markets during recession, the IMF and other groups recently recalculated the numbers from real data and found it to be >$1 per $1 spent. We got the same numbers and found that the multipliers differed by sector — so, for example, health and education happen to have large multipliers at the moment, and its possible to see different multipliers for different program areas to see what services might have the most growth potential. But as far as ‘protection’, in public health we see three particular areas being very protective against vulnerability: keeping people in jobs (active labor market programs), housing support programs, and food support programs.

Mark Thoma June 29th, 2013 at 2:25 pm
In response to BevW @ 35

I’ll wait for a response to the Iceland question — a very important example — before posing any more questions.

gigi3 June 29th, 2013 at 2:26 pm
In response to Sanjay Basu @ 29

Suicide statistics:

http://www.suicide.org/suicide-statistics.html

Over 50% with firearms.

Sanjay Basu June 29th, 2013 at 2:27 pm
In response to norecovery @ 34

I haven’t seen analyzed the differential effects of drug use in different times. The one subject we do see evidence about is the ‘compounding’ effects of multiple simultaneous ‘hits’ to people at the same time — that is, simultaneous alcohol and drug abuse and tobacco use, with some obviously sad outcomes.

David Stuckler June 29th, 2013 at 2:28 pm
In response to Mark Thoma @ 16

Three of the main mechanisms linking recession and health are through income, employment, and access to health/social services. Each has independent effects that depend on the social context. Losing a job in the US puts healthcare access in jeopardy. More than 5 million additional Americans lost healthcare access in the Great Recession. In contrast, in the UK’s universal system, employment has no effect on healthcare access. Instead, more people accessed healthcare during the recession in the UK.
There can also be some counterintuitive health benefits of recession. When people lose income, they may drink and smoke less, or walk instead of drive. In 2011, the US road traffic deaths reached a 60-year low, as people drove less to save money on fuel. That mirrors a pattern in the Great Depression of the 1930s, when road traffic deaths fell for the first time in the US.
The real danger is austerity. When politicians make deep cuts to effective programs, they can turn economic hardship into severe epidemics — as we find in eastern Europe in the early 1990s, Indonesia and Thailand in the Asian Financial Crisis, and Greece today

Llona Pajari June 29th, 2013 at 2:30 pm

Are there health benefits in determining one’s misfortune is not negligence but malice?

norecovery June 29th, 2013 at 2:31 pm

I have seen a range of responses to economic hardship (including my own). It seems community support is the most influential. I have spent time with young people who organized cooperatives to support one another, using Facebook primarily as a network, and they have been remarkably successful. The inverse circumstance of isolation may be the most damaging. So, there is a significant social aspect to how we cope with adversity, and those who have supportive family and friends and community are best able to cope. I have family members (not local) who are church members and they find support there. That could explain the seemingly large attendance of churches by disadvantaged groups such as blacks and latinos. Just thought I’d mention this… maybe you folks have some thoughts on it.

Sanjay Basu June 29th, 2013 at 2:31 pm
In response to BevW @ 35

Iceland was an interesting situation in which the country had technically the largest banking crisis in its history, relative to the size of the economy. All the major banks failed. But Iceland put austerity to a vote and the populace decided against it. In the context of actually increasing their spending on safety nets, Iceland preserved all of its health indicators, including mental health and happiness survey results [it's one of the happiest countries in the world], and undergoing stimulus instead of austerity, it recovered quickly. Of note, we couldn’t find negative health effects in Iceland during the recessionary time — except for a spike in respiratory complaints which corresponded to the volcano eruption.

Mark Thoma June 29th, 2013 at 2:31 pm

In the meantime, if anyone else out there has a question, please feel free to ask it.

norecovery June 29th, 2013 at 2:33 pm
In response to Llona Pajari @ 41

IOW it’s not your fault.

Sanjay Basu June 29th, 2013 at 2:35 pm
In response to norecovery @ 42

Indeed, we certainly find in the data that social support systems are a major contributor to ‘resilience’. This appears to be true, for example, in the data on which populations of men were more likely to drink heavily after the fall of the Soviet Union. Similarly we see more predisposition to depression and suicide among older men in the US who have lower scores on social support. The real question in my mind is how to augment social support when it is so informal and there’s “self-selection” going on in which people can go into a vicious cycle of social isolation and bad mental health/substance abuse outcomes. Some programs do seem to help with this, but also just overall community structure and neighborhood openness plays a part. You mention race/ethnic identity, and indeed one issue we see is that ethnic fractionalization plays a part in a lot of decisions about safety nets and how much support people feel in their communities.

David Stuckler June 29th, 2013 at 2:35 pm
In response to Mark Thoma @ 37

Iceland suffered the worst banking crisis, relative to the size of an economy, in history. All 3 of its biggest banks failed, and total debt rocketed to >800% of GDP. Forced to turn to the IMF for a bailout, it was being called on to make cuts of 50% of GDP in a short period of time. The public health system faced cuts of up to 30% – prompting the health minister to resign. Yet just before the austerity measures took effect, the president of Iceland called for a public referendum – a democratic option. In March 2010, 93% of Icelanders voted against financing bank bailouts with deep cuts. Instead, Iceland boosted its health spending, supporting its Universal Health Care system. Thanks to these support, there wasn’t a marked increase in unmet medical needs, even as the price of imported medicines rose. We found no significant increase in suicides or depression. And the unemployed who so commonly report being stressed and having suicidal thoughts, instead reported sleeping more and spending more time with their families. Iceland had implemented programmes to help people return to work and, where it was scarce, to create new jobs (so-called ‘active labour market programmes). Once rated the happiest nation in the world in 2006, again in 2011 Iceland was ranked as one of the happiest nations (the top for ‘positive affect’) by the UN World Happiness Report
To quote the Icelandic president: “We were wise enough not to follow the traditional prevailing orthodoxies of the Western financial world in the last 30 years. We introduced currency controls, we let the banks fail, we provided support for the poor, and we didn’t introduce austerity measures like you’re seeing here in Europe”

Mark Thoma June 29th, 2013 at 2:37 pm

What was the biggest error – health wise – is the US response to the recession?

norecovery June 29th, 2013 at 2:39 pm

There’s a very active element of “collapsniks”, “doomers”, “peak oilers”, etc. that seems to say there will not be a solution other than economic collapse due to the entrenched growth and extraction regime. Do you folks think we are headed for collapse of industrial civilization as we know it?

Sanjay Basu June 29th, 2013 at 2:40 pm
In response to Mark Thoma @ 48

It would be hard to give a quantitative answer to your question. In my opinion, the biggest error was that we failed to provide strong-enough healthcare safety nets at the time, and so many patients lost employer-sponsored health insurance but either didn’t qualify for Medicaid or were caught in Medicaid limitations. We did see many people defer preventive care in that context, and the complications of their illnesses apparently cost more to treat than to prevent in most cases.

David Stuckler June 29th, 2013 at 2:40 pm
In response to Llona Pajari @ 41

Interesting question – and quite a complex one. we haven’t investigated this question directly. just speculating here: there is evidence that mental health risks relate to people’s sense of control and ability to implement changes that they wish to see in their lives. if people blame themselves as agents of their own misfortune, they may feel like there is an option. but if they blame factors outside their control, they may feel hopeless and powerless to respond. however, the political consequences differ. when people blame themselves they tend to be less supportive politically of social policy interventions that can make a difference (a classic case is obesity), as compared to when they blame factors outside their control.

David Stuckler June 29th, 2013 at 2:42 pm
In response to norecovery @ 49

It is intriguing to seek the stock market reaching pre-crisis levels — if it was deemed to be a bubble at the time, then why would it be different now?
There are also concerns of a next bubble forming — this time in food, which has undergone massive fluctuations in prices that are disconnected from actual supply and demand for food but appear linked to speculation on food commodities — sanjay has some great links for reads on this, but see also our paper in the bmj: http://www.bmj.com/content/339/bmj.b2403.extract

Sanjay Basu June 29th, 2013 at 2:42 pm
In response to norecovery @ 49

The evidence base for the claim that short-term debt increases through stimulus result in long-term collapse has fallen apart. So while debt is important, there seem to be several misnomers about it, such as the confusion between an individual’s debt or a household’s debt (of course, we should all as individuals try to pay off our debts and minimize them) and government debt which mostly refers to internal trade and needs to be maintained at a rate of growth below the rate of growth in revenue but actually requires expansion during bad times and contraction during good times (the opposite of what a household would want to do).

Mark Thoma June 29th, 2013 at 2:42 pm

There are so many unexpected ways that recessions can affect health. I thought the Bakersfield story illustrates this perfectly. Maybe you could explain what happened there, and then I have a follow-up question – what was the most surprising way in which recessions affected health?

Llona Pajari June 29th, 2013 at 2:43 pm
In response to norecovery @ 45

No, is the health benefit of justice greater than that of unaccountability?

Sanjay Basu June 29th, 2013 at 2:44 pm
In response to David Stuckler @ 52

I agree with David’s comment about the worries involving food price speculation. We do appear to be in an era where bubbles in food prices are forming to an alarming degree, both 2008 and 2011 experienced really dramatic increases in food prices and subsequent price crashes. This is also increasingly an issue for poorer countries than the US and Europe.

David Stuckler June 29th, 2013 at 2:44 pm
In response to Mark Thoma @ 48

IN many ways the boost to social protections under President Obama is a sharp contrast with the massive cuts in Europe. Arguably support could have gone further, using a data-driven approach to guide investments to boost recovery and protect people’s health. Too often we blindly accept suffering in recessions. Rather than learn from the past evidence of the risks of suicides, and proactively put in place preventative measures, we have done relatively little to address the mental health consequences of the recession…
Now as the sequester takes effects, including cuts to effective programs such as the Women, Infant, and Children’s program, the US budgetary choices are creating new dangers…

norecovery June 29th, 2013 at 2:47 pm
In response to Sanjay Basu @ 53

Yes, I’m aware of the difference. My question about your opinion on collapse had to do with the fact that energy EROEI is diminishing rapidly, therefore energy cost taking into account externalities (including climate change) will limit growth, very possibly through crisis that is manifest in economic terms.

Sanjay Basu June 29th, 2013 at 2:49 pm
In response to Mark Thoma @ 54

regarding Bakersfield – a city not too far from us here in the West Coast – the city experienced a rather surprising outbreak of West Nile Virus despite being in the dry season. some savvy scientists realized that the massive numbers of unkempt foreclosed properties had stagnant water that served as a breeding ground for the mosquitoes, and illustrates the basic public health principle that it’s very hard to predict epidemics and the ways in which having a robust community infrastructure contributes to the risks of illness. [indeed, we often say in public health that a key statistical predictor of life expectancy is your zip code, since it captures a myriad range of social factors that determine more about your health outcomes than your doctor]. there were several other surprises about how recessions affect health. for me, one of the surprises was to see the ‘two Americas’ of alcohol drinking — that while many people bought one less “Two Buck Chuck” at Trader Joe’s during the recession due to less money in their wallet, this hidden population of binge drinkers appeared among young men: http://epianalysis.files.wordpress.com/2013/03/drinkingpatterns.png

Sanjay Basu June 29th, 2013 at 2:50 pm
In response to norecovery @ 58

I see what you’re saying regarding energy use. I haven’t looked into this branch of logic and data myself so I don’t feel qualified to answer about this aspect.

David Stuckler June 29th, 2013 at 2:52 pm

Some risks from recessions can be difficult to predict – reinforcing just how important it is to sustain funding of the Center for Disease Control in times of hardship.
The case of Bakersfield is a striking example. Crows started falling in June 2007, and people had strange symptoms in hospitals. Medical investigations found that people suffered from West Nile Virus – a mosquito-borne illness
The year wasn’t thought to be a high-risk period for the disease, judging from the hot weather conditions
An epidemiologic team had a clue – they ordered an aerial scan of bakersfield, finding what looked like ‘green fuzz’ in certain areas where the outbreak was concentrated.
on closer inspection, it turned out homes had been abandoned and backyard swimming pools infested with mosquitoes who thrived in stagnant water.
bakersfield was at the centre of the foreclosure crisis in the US -

Llona Pajari June 29th, 2013 at 2:52 pm
In response to David Stuckler @ 51

Yes, it would be interesting to see “social factors” contribution to ill health. It seems you have summarized a vicious cycle which escapes attention.

Perhaps those factors outside of our sphere of influence should concern us.

Mark Thoma June 29th, 2013 at 2:53 pm

I want to go back to the question about food prices, more specifically how health impacts differ in developing countries where issues such as food security are a big problem, but first perhaps — if you have these figures available — you could give us a sense of the magnitude of the health impacts just in the US. The increase in depression, suicides, heart disease, etc., etc.

David Stuckler June 29th, 2013 at 2:53 pm

for the study itself – for any readers interested in epidemiology & economics, see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630753/

norecovery June 29th, 2013 at 2:54 pm
In response to Sanjay Basu @ 59

A similar West Nile Virus outbreak phenomenon happened in Phoenix AZ a few years ago for the same reason, although authorities initiated a vigorous spraying program and fined the banks for not keeping up the swimming pools. That was one reason I moved back to CA, with great difficulty. Other factors included extremely prevalent Meth abuse and crime surrounding it, and also the political climate of fear caused by persecution of undocumented immigrants. Now, there’s a group that has been severely impacted by the recession!

David Stuckler June 29th, 2013 at 2:58 pm
In response to Llona Pajari @ 62

These social factors are a huge area of research. We often think of health as about ‘healthcare’. But the best estimates from the World Health Organization indicate that only about 15% of our health relates to drugs, medicines, and sickness care. The other 85% has to do with our social and economic environments. Good health starts not in our doctor’s offices, but in our communities – places where, as the WHO commission on social determinants of health explains, we age, are born, live, work, and play

Sanjay Basu June 29th, 2013 at 2:59 pm

As far as figures go: for depression, we have proxy measures which may be confounded a bit by surveillance biases. In the United States, use of antidepressants rose during the Great Recession to where 10 percent of the adult population were prescribed antidepressants during the recession. A study by Bloomberg Rankings found that rates of antidepressant prescriptions had a very strong correlation with unemployment rates. A more consistent number is suicides, which we found increased by about 4,750 over and above pre-existing trends, and corresponding to unemployment rates: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961910-2/fulltext
Preventable causes of hospitalization (a standard designation of common complications of preventable or easily treated diseases) also rose as did certain kinds of ER visits for preventable infections and similar conditions that could be prevented through primary care clinics.

Peterr June 29th, 2013 at 3:00 pm

Welcome David, Sanjay, and Mark!

I just gotten my hands on the book, but have not (alas) had time yet to delve into it. Given the comments above, it strikes me that the bulk of the controversy around austerity and health care comes from disagreement about the veracity of Kenneth Arrow’s 1963 observations about uncertainty and the welfare economics of medical care.

Those who push hardest for austerity are also those who push for market-driven solutions to health care problems — the market is the solution to every question — and though my economic studies were long ago, I have yet to hear that there has been any convincing refutation of Arrow’s basic contention that the uncertainties and mis-aligned incentives in the medical care market make market-based solutions less-than-optimal.

David Stuckler June 29th, 2013 at 3:01 pm
In response to norecovery @ 65

In some countries the persecution of undocumented immigrants has been direct. Spain’s politicians used a ‘royal decree’, bypassing democratic channels, to rewrite eligibility for the nation’s universal healthcare system to exclude undocumented immigrants. That’s creating a natural experiment – the early consequences are starting to be seen in Spain’s recent increase of about 180,000 people who for the first time report being unable to access medically necessary care since the recession began. We’ll be studying this case further, particularly with a view to informing debates on the costs and benefits of caring for immigrants in the US

Sanjay Basu June 29th, 2013 at 3:01 pm

One data source for examining this is the Michigan Recession and Recovery Study, which explores individual causes of ER visits and hospitalizations and specifically corrects for pre-existing conditions and examines the pathways from foreclosure and unemployment to health outcomes: http://www.npc.umich.edu/research/recessionsurvey/

norecovery June 29th, 2013 at 3:02 pm

Increased energy cost and climate change are huge factors in the availability of food. In fact, some people say the Arab Spring started as a result of food shortages and high cost due to the drought in Russia because they did not export any wheat that year.

Sanjay Basu June 29th, 2013 at 3:03 pm
In response to Peterr @ 68

Yes, we delve a bit into Arrow’s insights here, which we agree with. I have yet to see a refutation of Arrow’s thesis and you are correct about the issues regarding market failure in healthcare that he has highlighted. An overview of the ideas are posted here: http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

David Stuckler June 29th, 2013 at 3:04 pm
In response to Peterr @ 68

thanks for pointing out Arrow’s seminal work. there hasn’t been a refutation of his classic findings. yet that hasn’t stopped the UK from starting to privatise its national health service, despite its healthcare system being ranked at the top by the Commonwealth Fund, OECD, and WHO on dimensions of equity, affordability, and efficiency (spending 8% of GDP to cover its entire population, with >75% public satisfaction prior to the recession).
US healthcare companies are among the main pressure groups – including Mitt Romney’s Bain capital -seeking to open the UK NHS to profit-making
Perhaps a surprise for those of you who saw the UK’s ode to the NHS in the olympics that at the time of this praise, its foundations have begun to be dismantled..

Mark Thoma June 29th, 2013 at 3:04 pm
In response to Peterr @ 68

I certainly believe that those market failures exist, e.g. see my recent column 7 Important Examples of How Markets Can Fail. Thus, there is a role for government in the provision of health care.

This reminds me of something I wanted to ask about, the difference in health outcomes between countries with universal care, and those more oriented to the provision of health care by the private sector.

norecovery June 29th, 2013 at 3:05 pm

Thank you for all the great links. I will check them out, as well as your book.

David Stuckler June 29th, 2013 at 3:06 pm

Watch this space re healthcare debates; we’re in the process of writing a paper about ‘why markets fail’ in healthcare, with our UK colleagues Martin McKee and Ha-Joon Chang

David Stuckler June 29th, 2013 at 3:09 pm
In response to Mark Thoma @ 74

Thanks Mark – I flagged this partly in comment 40. One aspect depends on access. Do people keep coverage when they lose work? In the US people lost coverage when they lost work and were unable to qualify for government supported programmes. Another question is, how much does care cost? Where people pay more out of pocket for care, they have tended to cut back – sometimes facing perverse dilemmas in choosing between spending money for food or healthcare. In systems where care is based on ability to pay, more people lost access in the recession

norecovery June 29th, 2013 at 3:09 pm

There’s a good deal of evidence the profit based model for the economy ultimately is very destructive in human terms, as well as to the environment, is there not?

Sanjay Basu June 29th, 2013 at 3:10 pm
In response to Mark Thoma @ 74

We did see a greater ‘buffering’ effect of universal healthcare on people during the recession in those countries that provided such care but not in private sector-based healthcare markets. There have been several theories as to why the US for example pays more but ‘gets less bang for the buck’, ranging from theories about American obesity (but the cost-benefit ratio was already high before the rise in obesity), or older populations (but Japan has a greater fraction of elderly and Switzerland pays much more for nursing home care), and that its all technology R&D (but actually the marketing budgets of leading R&D firms are higher than the R&D and technology overuse is higher in some European countries than here despite popular misconceptions). The commonwealth fund has a nice overview of the issues, but essentially the amount to overcharging for the same services, as there’s little real competition in prices due to the market failures Arrow pointed out:
http://epianalysis.wordpress.com/2012/07/18/usversuseurope/

Mark Thoma June 29th, 2013 at 3:13 pm

This is something else that was touched upon when the multiplier came up, but I think it’s worth highlighting further.

To what extent does spending more on public health programs during recessions pay for itself in the long-run?

David Stuckler June 29th, 2013 at 3:14 pm
In response to norecovery @ 78

For healthcare – yes. The big debate in the US is how to extract the profit from the system — so reducing healthcare costs to levels on par with European nations…but there are powerful vested interests that, once embedded in the care system, are almost impossible to root out…

David Stuckler June 29th, 2013 at 3:15 pm
In response to Mark Thoma @ 74

great column – thanks for sharing

norecovery June 29th, 2013 at 3:19 pm
In response to David Stuckler @ 81

…until there is a pandemic, which becomes all the more likely because so many people are without regular care. I’d point to that as just one example of how profit-based economies are crisis prone.

David Stuckler June 29th, 2013 at 3:19 pm

The fiscal multiplier- a seemingly arcane statistic – is now at the heart of the debate on austerity versus stimulus. Recently the IMF has apologised to Greece, finding that austerity was mistakenly administered. When they used hard data to look at the effects of cuts, the chief economist reported that “we underestimated the negative effect of austerity on employment and spending power”, now advising the UK, for example, to pursue stimulus to public infrastructure. Their 180 turn came from finding that the fiscal multiplier was greater than 1 – meaning each $1 of investment led to more than $1 in return.

Peterr June 29th, 2013 at 3:20 pm
In response to Sanjay Basu @ 79

Quite the set of charts at that link!

Sanjay Basu June 29th, 2013 at 3:21 pm
In response to Mark Thoma @ 80

in terms of spending on public health, we see two trends: (1) that treating large-scale epidemics is quite a bit more costly than preventing them; for example, during the 1990′s, a drug-resistant TB epidemic in New York City cost over $1 billion to control but best estimates suggested that maintaining the TB program there would have averted it for about a tenth the cost (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470515/) and (2) the multipliers for public health are generally $1 for long term but vary to as much as $3 for some programs, in part due to employment benefits as so many people are involved in the health sector but also in the context of healthier worker populations when public health systems are preserved, which is a literature summarized in some prior reports (http://www.who.int/macrohealth/en/)

David Stuckler June 29th, 2013 at 3:21 pm

As Sanjay mentioned, we revisited this debate, recognising that not all areas of government spending affect the economy equally – a remarkable assumption in this debate. We looked at the fiscal multipliers of different types of government spending using comparative budget data. Our results found that health, education, and social protection had among the largest and most positive fiscal multipliers. In contrast, defence and bank bailouts tended to be smaller and in some cases negative, as the funds led to a trade deficit. Money in these sectors tended to flow to offshore tax havens or foreign contractors. For public health, we found each $1 of spending could yield up to $3 in return.

Mark Thoma June 29th, 2013 at 3:22 pm

How did 10 million Russian men disappear in the early 1990s?

bigbrother June 29th, 2013 at 3:22 pm

TO David Sanjay and Mark.

I took on low income housing http://www.clih.net with little success opposing NIMBY attitude. Our social services has been cut across the board in California along with federal funding. Along comes the housing bubble bust and we are flooded with more homeless migrants living in vehicles. Normal vacancy rates are 5 to 6%, we are almost zero now. That is not a recovery. What can be done? I go to county supervisors board meetings and pound the housing drum to no avail. I go to the 10 year plan to end chronic homelessness with zip progress.
Do you have strategies to correct these missing resources?
PS Thanks for making these stats known.

David Stuckler June 29th, 2013 at 3:23 pm

Greece is in the middle of a public health disaster. HIV prevention budgets were cut, and since 2010 new infections have risen more than 200%. After mosquito-spraying programmes were reduced, there was a large outbreak of malaria, which had been previously virtually eradicated since 1974. In some hospitals the financial situation is so dire that they cannot afford surgical gloves, gowns and basic equipment- threatening the emergence of drug-resistance and hospital-borne infections.

The irony is that Greece’s epidemics will now cost more to control than they would have been to prevent.

norecovery June 29th, 2013 at 3:24 pm

Kudos to you folks for standing up against neoliberal policy using sound arguments and facts!

Peterr June 29th, 2013 at 3:24 pm
In response to David Stuckler @ 81

In Arrow’s paper, the very first thing he says about defining the subject of his reflections after the opening paragraph is this: “It should be noted that the subject is the medical-care industry, not health.”

That distinction is often lost in political debates in the US. The Austerians presume that if the health-care industry is productive and profitable, then the result will be better health. As my lawyer friends might put it, that assumes facts not in evidence.

Which brings us back to this book . . .

David Stuckler June 29th, 2013 at 3:26 pm
In response to bigbrother @ 89

As our chapter on housing shows, these cuts are economically self-defeating. Counterintuitively, it’s expensive to be homeless. The city of Philadelphia found that each 100 persons housed saved the city over $400,000 dollars by reducing costs of hospital bills and jails on homeless persons. Such evidence has been found across U.S. cities and validated in randomized controlled trials. It may cost money up front to keep a roof over people’s heads, but if done correctly can pay for itself many times over

Peterr June 29th, 2013 at 3:27 pm

Sanjay and David, what has been the reaction to your book?

Specifically, I’m curious about how various cohorts of people may have reacted, and the differences between them: academic economists, academic public health researchers, in-the-trenches public health providers, politicians, . . .

David Stuckler June 29th, 2013 at 3:29 pm
In response to Peterr @ 92

thanks Peter – a colleague of mine likes to say that politicians ‘don’t let facts get in the way of a good story’, and that unfortunately is how political debates tend to go…the evidence on austerity is clear, yet the supporters of an evidence-based alternative seem to be failing to communicate the narrative convincingly (at least here in the UK)

Sanjay Basu June 29th, 2013 at 3:29 pm
In response to bigbrother @ 89

Thanks for your question. To first speak anecdotally before getting to the data: as a physician who works in the various homeless clinics in the area, the changes you are describing are indeed profound and obvious; it’s really unsubtle, especially with people living in their cars in abandoned parking lots or behind ‘big box’ stores. I have been concerned about the amount of scabies and other diseases of ‘crowding’ that we’re having to treat, even among kids who are growing up in the back of vans [some of our schoolbuses are making stops at parking lots since these are basically semi-permanent 'encampments' of kids]. i’ve seen very little good coverage of this issue, except for this CBS 60 Minutes segment back from 2011: http://www.cbsnews.com/video/watch/?id=7389750n . Now as far as the data goes: among other cities, San Francisco does have a fairly advanced ‘housing and urban health’ program which is a ‘housing first’ policy that has been somewhat proactive on these issues. A few other cities like Chicago and Seattle have seen good results from very rapid rehousing programs, with the health effects in part including lower substance abuse rates ( http://jama.jamanetwork.com/article.aspx?articleid=183666 ). Such ‘housing first’ programs seem to be quite cost-effective and it does appear that these programs have been introduced in several cities with some degree of success.

David Stuckler June 29th, 2013 at 3:31 pm
In response to Mark Thoma @ 88

We’d be giving away the mystery of our 2nd chapter ;)

David Stuckler June 29th, 2013 at 3:32 pm
In response to David Stuckler @ 97

In the early 1990s, Russia suffered a devastating mortality crisis, of over 3 million excess deaths. It was unusual because most epidemics are concentrated in vulnerable groups – children, older persons – but the rise in deaths was in working-age men. The causes of death weren’t hunger or malnutrition, but heart attacks, suicides, and alcohol-related causes.

Peterr June 29th, 2013 at 3:32 pm
In response to David Stuckler @ 93

Do you all touch on the absence or presence of government regulations as a factor in mortality? Some of the anti-regulatory voices posit that regulations put an undue burden on private economic actors that far outweighs the social benefit the regulations ostensibly provide, or are an undue burden on personal freedom.

Of course, the cost of the absence of regulations can be pretty brutal, as the folks in West, Texas discovered when the local fertilizer plant blew up across the street from a school — a juxtaposition that is prevented elsewhere by zoning laws, but under Texas law, no local zoning rules could be enacted to prevent the co-location of these two facilities.

David Stuckler June 29th, 2013 at 3:34 pm

Yet not all countries in eastern Europe in the early 1990s had such a large rise in mortality rates at this time, such as Poland, Slovenia, and Belarus. And it was quite an important period – for the Soviet Union had just disintegrated, and countries began embarking on a transition to market-capitalism. It led to another massive natural experiment where a set of relatively similar countries made widely differing choices about how to implement market policies

Sanjay Basu June 29th, 2013 at 3:34 pm
In response to Mark Thoma @ 88

The Russian case was particularly disconcerting. There have been many theories about why young men in Russia seemed to have an alarmingly high death rate after the fall of the USSR. A lot of seems related to alcohol and ‘intentional harm’ [suicide/homicide], but a dramatic divergence or ‘natural experiment’ occurred in which those men in austerity-promoting regions seemed to do far worse in the recession that followed the USSR collapse than men in the non-austerity (non “Shock Therapy”) regions

Mark Thoma June 29th, 2013 at 3:35 pm

A comment rather than a question: I think a lot of these same principles apply to the health of the economy. For example, putting off work on maintenance, essentially preventative care, can end up costing us more in the long-run.

David Stuckler June 29th, 2013 at 3:35 pm

What we found is that countries that had the greatest rises in job losses, connected with radical free-market programmes (‘Shock Therapy’), had greatest increases in stress-related deaths, even after correcting for past trends, the level of economic collapse, among other potentially confounding factors

Mark Thoma June 29th, 2013 at 3:36 pm

I found that chapter to be both interesting and compelling.

David Stuckler June 29th, 2013 at 3:36 pm
In response to Mark Thoma @ 102

Indeed – our book highlights smart, evidence-based policies in housing, healthcare, and the labour market that are ‘win-wins’ – saving money while protecting people’s health.

Mark Thoma June 29th, 2013 at 3:38 pm

I think there was a question earlier about differential reactions to your book. Any comments on that?

Sanjay Basu June 29th, 2013 at 3:38 pm
In response to Peterr @ 94

Thanks for your question Peterr. The response has been fairly supportive–perhaps surprisingly so. Both academics/colleagues and in-the-trenches public health providers have said “Well great job writing a book about the obvious!” And they’re right – the peer-reviewed literature and academic discussion essentially seems to be a closed case on this issue for the most part. But the public discussion and the academic discussion are remarkably divorced, perhaps in part because of our failure as academics to engage in public discussion. The most common criticisms seem to be based on misunderstandings of debts and deficits from my anecdotal experience.

David Stuckler June 29th, 2013 at 3:38 pm
In response to Peterr @ 99

Thanks Peter – it depends on the product in question. Regulations -such as seat belts when driving – have saved many lives, although it was hotly debated at the time. Could we ever imagine going back to a world without seat-belts today? (well, perhaps with the advent of self-driving cars but even then..)
Similar food safety regulations are key for protecting food-borne diseases spread, especially around imported foods
When regulations work well to protect the nation’s health, they are often invisible and unnoticed – and when they don’t work well, we often end up picking up the pieces in healthcare

David Stuckler June 29th, 2013 at 3:41 pm
In response to Sanjay Basu @ 107

Sanjay touches on a very important point – a political question, and an ever-present one that public health researchers face: how can we better mobilise to get evidence into policy?
In the UK government has launched a ‘behavioural science unit’ in the governmment to use randomised trials to test the effects of alternative government policies and learn which work best — already showing signs of saving money. If only it would apply this approach to its austerity policies – a massive, untested experiment with the British population..
Had austerity been organised like a drug trial, it would have been stopped given evidence of its deadly side-effects

Mark Thoma June 29th, 2013 at 3:42 pm

What question should people like me ask you, but don’t? That is, what part of the message you are trying to get to politicians and the public gets the least attention?

Sanjay Basu June 29th, 2013 at 3:43 pm
In response to Peterr @ 99

You make a good point about regulations. We did encounter a number of historical periods in which regulations around ‘easy access to alcohol’ seemed to make a big difference to outcomes among people otherwise predisposed to heavy drinking in response to unemployment. The fertilizer plant example though eludes to a larger set of themes we didn’t get to, but indeed does appear to be a common theme here with regard to daily risks of living in dangerous environments and having poor access to safe working conditions–as our colleagues working in Appalachian health clinics will attest given the rates of illness among miners. One thing we haven’t discussed is the remarkable within-country inequalities in health outcomes in the US between different counties, which are not statistically explained simply by healthcare quality differences, but appear to be a vicious mix of poverty-related tobacco/substance abuse, violence and other neighborhood factors, as highlighted in a recent Institute of Medicine report.

David Stuckler June 29th, 2013 at 3:44 pm
In response to Sanjay Basu @ 107

Some European politicians have sought to deny the evidence of the health effects of austerity — the Greek case is particularly worrisome, where we recount our debates with one Greek official who was leading the implementation of IMF austerity and healthcare reform programmes in Greece, Dr. Liaropoulos…

David Stuckler June 29th, 2013 at 3:46 pm
In response to Sanjay Basu @ 111

Thanks for raising the point about Appalachian miners. As shameless self-advertising, we’re about to release a series of papers in the International Journal of Health Services on mining and health (a leading driver of HIV and TB in southern Africa – there are few industries so consistently and powerfully connected with illness as mining activity). In global health there’s a major gap in developing a ‘global occupational health’
Regarding health inequalities, we have plans to extend some of the rich, fruitful research in the UK to the US – where, for example, occupational class has been given much less attention as a source of health inequalities. More on this to come from us soon!

Sanjay Basu June 29th, 2013 at 3:47 pm
In response to Mark Thoma @ 110

Thanks for this question. In my opinion, the most common focus of discussion is on what the health effects are of recession and austerity. But what I like to discuss most is what evidence we have for effective programs that promote “resilience”. I really have been overwhelmed by the data on which safety net programs seem to have indirect but very strong health benefits, and why some safety net programs have some positive aspects but also some perverse aspects. For example, the active labor market programs in Sweden/Finland [now testing in the US] seem to have remarkable benefits if enacted carefully. But also food stamps are an example of some benefits and some perversities. We see very helpful reductions in hunger, but also the ‘food stamp cycle’ as part of the food insecurity issues you mentioned. This cycle occurs in which people shortly after receiving their food stamp benefits tend to each calorie-dense [poorly nutritious, but cheap] food, increasing obesity and diabetes risks, in anticipation of running out of stamps later in the month. Even without increasing the budget, splitting the monthly cycle into bimonthly cycle appears, in pilots, to help reduce this perversity. These kinds of research questions are what we need to ask more of, since–as David mentioned–most of preventable death outcomes seem to be matters of community/neighborhood/social risks rather than simply healthcare failures.

Peterr June 29th, 2013 at 3:49 pm

I’m a Lutheran pastor in the Kansas City, Missouri area, with an economics degree to go along with my theological degrees. Reading your comment here reminds me of comments I often hear from the lobbyists from various religious groups: the poor have no lobbyists, except for us. That may be a bit of an overstatement, but not by much.

As a parish pastor, I learned long ago that one of the best indicators of local poverty are the shelves at local food pantries. When things are good, there’s plenty on the shelves and low demand for them; when things are bad, the shelves are emptied faster and donors are slower to re-fill them. And when yesterday’s donors become today’s clients . . .

“Picking up the pieces” is something all too familiar to me.

Mark Thoma June 29th, 2013 at 3:49 pm

On communication: I want to be sure people know that, although the book is based upon a considerable body of academic work, it is written for the general reader. It is not technically challenging, things are explained in an understandable way, and it is highly engaging and informative.

David Stuckler June 29th, 2013 at 3:53 pm
In response to Mark Thoma @ 110

We wrote the book to translate the research into plain English, as medical journals can be obscure. Media covered much of work, but mostly the negative stories, not the surprising sources of resilience. We wanted to share the evidence-base for alternative policy choices that can safeguard the ultimate source of America’s wealth: its people.

Sanjay Basu June 29th, 2013 at 3:54 pm
In response to Peterr @ 115

Yes, the lens of food supply is a really informative one, I agree. Along with the massive changes that are taking place in our national discourse on the quality and nature of food, the obesity/diabetes issues, and the questions about farming, it does appear that the rather more basic questions about hunger can be hidden or forgotten in the conversation.

BevW June 29th, 2013 at 3:54 pm

As we come to the end of this great Book Salon discussion,

David, Sanjay, Thank you for stopping by the Lake and spending the afternoon with us discussing your new book, and the effects of austerity on our health.

Mark, Thank you very much for Hosting this great Book Salon.

Everyone, if you would like more information:

David’s website, (Twitter)

Sanjay’s website, (Twitter)

and book

Mark’s website(s) (Economist’s View) (EconoMonitor) (Twitter)

Thanks all, Have a great weekend.

No Book Salon tomorrow. See you Saturday, July 6th.

If you would like to contact the FDL Book Salon: FiredoglakeBookSalon@gmail.com

Peterr June 29th, 2013 at 3:55 pm

Have you encountered any political voices who have taken interest in what you’ve put together? I’m thinking of elected officials, career government workers, or non-elected yet influential voices in the political world?

Mark Thoma June 29th, 2013 at 3:56 pm
In response to Sanjay Basu @ 114

I hadn’t heard of the food-stamp cycle. On your point about resilience, that’s one of the things i tried to highlight in the introductory post, that the book isn’t simply the documentation of the health effects in recessions under various policies. It is also prescriptive — it tells us what polices work best (and under what circumstances). I think the policy contributions are the most important part of the book.

Sanjay Basu June 29th, 2013 at 3:57 pm

Thank you for the interest and discussion about the book. Hopefully it will serve as part of the conversation to improve public health as we recover from this recession.

David Stuckler June 29th, 2013 at 3:59 pm
In response to Peterr @ 115

Thanks Peter – our work uses health data to bring to light the hidden stories of some of society’s most vulnerable and marginalised groups. Indeed as you point out the ‘American people need a lobbyist’, a point made in jest recently in the Onion but sadly seems to contain more than a kernel of truth in reality. Who will lobby for public health? As with so many ‘public goods’, there is a dearth of political support for public health, and often those who need help the most are the least equipped and resourced to participate in the political process.

David Stuckler June 29th, 2013 at 3:59 pm

Hi Bev – my website link is: http://users.ox.ac.uk/~chri3110/

David Stuckler June 29th, 2013 at 4:01 pm

Thank you all for your interest in our book and research – there’s much more to discuss. Please don’t hesitate to get in touch via email or twitter.

BevW June 29th, 2013 at 4:01 pm

David, Sanjay, Thanks for a great discussion.

Mark, Thank you again for a great salon.

Peterr June 29th, 2013 at 4:07 pm
In response to BevW @ 126

What Bev said.

Time flies when you’re having fun . . .

jimbo316 June 29th, 2013 at 5:49 pm

I lived in Indonesia during the Asian economic crisis ( and both long before and after) and it should be mentioned that the suddenly urban poor retreated back into the rural “social safety net” . For the developing world the rural- urban continuum is very much part of the typical household’s financial risk reduction strategy, something that Western societies have mostly lost, especially in the USA ( Europe somewhat less so).

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