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Book Review

‘The Body Economic’ by David Stuckler and Dr. Sanjay Basu

The Great Recession of 2007 rekindled the argument about how best to respond to economic contraction in the presence of significant deficits. It pitted those in favor of stimulus spending against those advocating deep cuts to government spending and programs. Although the latter group have suffered a setback in recent weeks after the findings of an influential economic paper were revealed to be based upon incorrect calculations, the debate rages on, mostly broken down along ideological and political lines.

In “The Body Economic,” David Stuckler and Dr. Sanjay Basu approach this question from an entirely new angle. It is not pure economics that interests them, and indeed, the question of which of the two paths is more likely to bring about a speedier and longer-lasting economic recovery is not one that comes up. Rather, they are concerned with the effects these policy decisions have on the health and well-being of the citizens of countries struggling with major economic crises. Stuckler and Basu are public health experts who have been studying this issue for years. Drawing upon their own scholarly work as well as that of others, they convincingly make the case that “recessions can hurt, but austerity kills.”

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Meticulously researched and richly annotated, “The Body Economic” is nonetheless a very accessible and engaging book. The authors succeed admirably in making the case that downsizing (or dismantling) the social safety nets that exist to protect those in need directly leads to increased sickness and death within the general population.

Perhaps the most striking example they provide is that of Russia in the immediate aftermath of communism’s collapse. In the space of just three years, the life expectancy of Russian men fell by seven years, from 64 to 57. They describe this as “the worst drop in life expectancy in the past half-century in any country that wasn’t an active war zone or experiencing a famine.” The explanation? Huge surges in alcoholism and in associated heart disease during this period.

The authors contrast the negative consequences of austerity on public health with the experiences of other countries that have chosen not to go that route. “Iceland went through the worst bank crisis of all time, but the population’s health actually improved,” similar to improvements in public health seen in Canada, Norway, Sweden, and Japan during periods of economic downturn.

Stuckler and Basu persuasively demonstrate that economic austerity adversely affects the health of all citizens, and not just of those who directly rely upon government-provided services. As obvious as it may seem, infectious disease recognizes no class boundaries and is a risk to everyone. One example they cite is the emergence of highly drug-resistant tuberculosis in Russia concurrent to the demise of the Soviet Union. Another is the increased spread of HIV in Thailand and Greece that occurred when austerity was forced on these countries as a condition for external financial aid.

We live in a time when more and more people receive information only after it has been filtered through the media of partisan news outlets, pundits, and bloggers. Without being able to transcend the rhetoric and to soberly assess the implications of what is being discussed, informed participation in debates such as this becomes very difficult. Stuckler and Basu have done us a great service by leaving ideology aside and presenting for us the consequences that these decisions have had for others and may have for us as well. While stimulus spending has held the upper hand in the United States during the current recession, it is by no means guaranteed that this will continue. The lessons contained within “The Body Economic” should be carefully considered by both policy makers and constituents, so we can avoid the tragic results seen in places where ideology and doctrine were allowed to trump one of the most basic principles of a functioning society: the implicit understanding that its members need to look out for one another in times of need.

Dennis Rosen, MD, is the author of “Successful Sleep Strategies for Kids” (a Harvard Medical School Guide).” He can be reached at dennis.rosen@childrens.harvard.edu.
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