The Body Economic by David Stuckler Sanjay Basu

PREFACE
    Thank you for participating in this clinical trial. You might not recall signing up for it, but you were enrolled in December 2007, at the start of the Great Recession. This experiment was not governed by the rules of informed consent or medical safety. Your treatment was not administered by doctors or nurses. It was directed by politicians, economists, and ministers of finance.
    During this study, you were assigned, along with billions of others around the world, to one of two major experimental treatments: austerity or stimulus. Austerity is medicine intended to reduce symptoms of debts and deficits, and to cure recessions. It cuts government spending on healthcare coverage, assistance to the unemployed, and housing support. At the start of the trial, its potential side-effects were not well understood.
    When the austerity experiment began, your prognosis was grim and uncertain. The US housing market bubble burst in 2007, battering economies across the world. Some politicians, such as British Prime Minister David Cameron, decided to pursue austerity to reduce deficits. Elsewhere in Europe, the International Monetary Fund and the European Central Bank pressured governments in Greece, Spain, and Italy to experiment with austerity: cutting billions of dollars from social programs. If you received an experimental dose of austerity, you might have noticed some serious changes to your world.
    Meanwhile, other politicians chose to invest in health and social safety net programs. If you were in the stimulus group—that is, if you are currently living in Sweden, Iceland, or Denmark—your community was massively affected by unemployment and the recession, but was largely spared from austerity. Instead, stimulus funds were used to bolster health and social safety nets during the recession. If you lived in a stimulus country, you may not havenoticed many changes to your neighborhood, waiting lines at the hospital, food prices, or rates of homelessness.
    This experiment was not the first pitting stimulus against austerity. Eighty years ago, one of the largest such tests took place in the United States. As a way out of the Great Depression, President Franklin Delano Roosevelt proposed a raft of programs known as the New Deal, and Congress adopted them. The New Deal created jobs and strengthened the social safety net. But while many state governments in the US adopted the New Deal programs, others refused to implement them. They experienced wildly different outcomes as a result. Public health improved in pro–New Deal states but not in anti–New Deal states. Two decades ago, austerity was also tested in post-Communist Russia, and in East Asia, with strikingly similar results.
    These experiments provided critical insights about the central findings in this book: economic choices are not only matters of growth rates and deficits, but matters of life and death.
    The Body Economic is about data, and the stories behind those data. Over the past decade, we’ve been concerned about how our health is affected by economic crises—including this Great Recession. Our interest is not just academic—it is personal.
    Both of us have experienced financial vulnerability, and the health consequences that attend it. David dropped out of high school to follow his passion and play in a band. Music didn’t earn much money (and in retrospect, the band wasn’t that great), so he worked odd jobs waiting tables and doing maintenance work at an apartment complex to make ends meet. But when he was unexpectedly laid off, he couldn’t afford to pay rent. He variously lived in a tent, his car, and on friends’ sofas. When winter came, he started to get sick. Having suffered asthma since childhood, he caught bronchitis and then pneumonia—while out of work, he had no health insurance, money, or a place to go of his own. Eventually he was able to get back on his feet and go to college with the support of his