Europe is now in its fifth year of austerity politics. Never mind that the European economy as a whole has been growing since mid-2009. Never mind that 23 out of 27 European countries posted positive growth figures in 2011. Austerity is the word of the day — of yesterday, today, and tomorrow.
The evidence is weak that austerity is good for the economy. Presidents and prime ministers may compete hand-over-fist for the European Central Bank’s MAP (“most austere politician”) award, but if austerity is meant to boost their economies they don’t have much to show for it. The biggest export from Greece, Ireland, Latvia, and Portugal over the past five years has been people.
An evidence-based approach to the evaluation of austerity would survey a range of areas that we care about — economics, yes, but also the arts, culture, education, emigration, health, and quality of life in general — and ask two questions. First: what is the expected effect? And second: how sure are we that the effects will be realized?
When it comes to economics, the expected effects of austerity are ambiguous. The promise is a future of robust economic growth, or at least the avoidance of severe economic decline. A lot of evidence, however, contradicts this promise. How sure can we be that austerity will be a success? Surely, not very sure.
When it comes to the arts, culture, and education, the effects of austerity are even more ambiguous. The promise is these will suffer in the short term but flourish in the long term as the positive economic effects of austerity kick in. The long-term benefit is ambiguous, but the short-term suffering is certain. From this standpoint, the austerity bargain doesn’t look so tempting.
But when it comes to health, the effects of austerity are clear. In the short term there will be serious suffering as hospitals are closed, the sick are denied care, and people turn to drugs and alcohol to deal with their problems. The promise is that these ill effects will be only temporary. They’re the price that has to be paid to lay the foundations of future growth.
Unfortunately, the evidence is very strong that the long-term health effects of austerity are even worse. There are three main pathways through which social conditions impact people’s health. Austerity will have negative material, behavioral, and psychosocial impacts on health for years to come.
From a material standpoint, austerity will harm health through cuts to healthcare and the deterioration of health infrastructure. Such measures produce short-term cost savings but long-term damage to health. For example, reduced diabetes care today puts more people in wheelchairs decades down the road. Europe’s long-term elder care challenges will only be made worse by short-term cuts to health funding.
From a behavioral standpoint, austerity is already pushing large numbers of people toward alcohol abuse, drug addiction, and even suicide. These problems particularly affect men who are thrown into unemployment. The short-term impact of unemployment is a waste of human resources; the long-term impacts of unemployment include liver disease, lung cancer, and kidney failure.
But recent epidemiological research shows that the psychosocial effects of austerity, though difficult to measure, are likely to be far more widespread and thus cumulatively far more damaging. Carefully conducted longitudinal research has shown that when people have little control over their lives they suffer from a wide range of diseases that can dramatically reduce life expectancy.
When people feel they have little or no control over their success in life they suffer chronically elevated levels of stress. Short-term stress can be good for you: stress can inspire people, spur them to action, and help them perform their best. Top athletes harness the human stress response to achieve a burst of energy at the critical moment in a competition. A little stress is the spice of life.
But just like too much spice, too much stress can cause an upset stomach. More than that, it causes high blood pressure, diabetes, stroke, coronary heart disease, and weakened immune systems. All these health problems are related to chronically elevated levels of the stress hormone cortisol, which is released when people experience feelings of helplessness.
The psychosocial impact of low control is difficult to measure for individuals but statistically very large in the population as a whole. For example, epidemiologists trace most of the post-Soviet collapse in life expectancy in Russia and Ukraine to the psychosocial impact of the chronic stress arising people’s sense of helplessness in the face of massive social change. Russia and Ukraine still haven’t recovered from the negative health impacts of the 1990s austerity.
The material, behavioral, and psychosocial impacts of austerity policies on population health are well-known and well-established. The effects are very large and we can be very sure that they will occur. Any economic gains from austerity — if they occur — will be more than outweighed by the health losses. The economic benefits of austerity are questionable at best, but the health costs of austerity are certain and grim.
The material and behavioral impacts of austerity on health are mainly limited to the countries where austerity policies are actually implemented. Greece, Ireland, Latvia, and Portugal have all seen cut-backs in healthcare and increases in unhealthy behavior. Whether or not this suffering is justified by the future benefits that these countries will enjoy, time will tell.
The psychosocial impacts of austerity, however, can occur even when people keep their jobs and health budgets remain intact. Even Germans and Swedes are feeling a loss of control over their futures these days. From a psychosocial standpoint, the threat of austerity may have almost as much an impact as austerity itself.
For the past five years European governments have used the threat of an uncertain future as a bludgeon with which to beat out of recalcitrant populations grudging support for a set of policies that are designed to benefit corporate and political elites. This threat is itself a dangerous weapon. Merely to wield it — even without striking — does irreparable damage to society, and to society’s health.
Austerity economics may be poor economics, but austerity politics is absolutely irresponsible politics. The governments of Europe should be approaching austerity policies reluctantly, as a last resort, and then only to the extent that they are financially unavoidable. They should not be promoting austerity.
For far more people than anyone realizes, austerity means death. If it is not the dramatic public suicide of today’s political protester, it will be the ten years too early death of tomorrow’s diabetic heart patient. Most of the deaths due to austerity may not occur for twenty or thirty years, but they will occur, and they will occur must earlier than they should have. When all the costs are counted, no possible economic benefit of austerity will turn out to have been worth the price.