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Book review: The Body Economic: Why Austerity Kills, By David Stuckler & Sanjay Basu

Poverty harms our health, for sure. Try to match policy to mortality, and the figures look fuzzier

The authors of this book make sure the reader knows that their research work has been peer reviewed. Yet they never point out that the work of economists with whose conclusions they disagree is peer reviewed too. This term means that a piece of work reaches a minimum acceptable standard to contribute to an academic journal. It certainly does not mean "correct", but that is what Stuckler and Basu want us to believe: not just that they are right, but that the academic establishment has awarded them a kite mark for truth. By omission, they let unwary readers believe their enemies have no such authority.

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What The Body Economic offers is not objective truth, but a subjective and flawed polemic. Its argument is that "austerity" directly causes ill health and increases mortality rates; but austerity does not mean simply a recession or depression. Rather, it is a label for specific kinds of policy reaction to an economic crisis. Any reductions in government spending on health care come under this heading, but so do any policies that seem to involve extending markets, from the ending of Prohibition in the US to privatisations in Russia to current IMF reforms in Greece.

The sections that link government spending on health, especially public health measures, to health and mortality outcomes are surely uncontroversial. It would also be hard to find anybody seriously challenging the suggestion that poverty and unemployment are bad for health. However, linking specific economic measures to broad health outcomes is a more tendentious matter, and there are serious gaps and inconsistencies in their arguments.

For example, they claim that economic outcomes are better in the US than the UK now because the US government has adopted stimulus policies and the UK government austerity policies. Many (not all) economists would agree. However, while Britons can all access NHS healthcare, tens of millions of Americans have no health insurance. So which matters more for health outcomes: the overall change in general spending ("fiscal stimulus"), or the level of spending on health (provision of services)? The argument skates between the two without making it clear.

The Body Economic does not display any familiarity with the heated economic debate about "austerity" measures. This would be no great omission if Stuckler and Basu were not making some big economic as well as health claims. And the economics in the book is breathtakingly naïve, for all that one camp of economists might agree with it. Just one piece of evidence is presented to support the assertion that higher public spending boosts GDP growth: a scatter plot showing the change in GDP per capita and government spending per capita in 2009-10 for a mildly random 27 countries. "Instead of spouting ideology," the authors write above it, "We give you facts, explanations, and hard evidence." Needless to say, there is no hard evidence in a correlation for a subset of the relevant countries over one year. This is just sloppy statistics. The whole argument among economists concerns longer-term effects on growth.

The book will do nothing to change the minds of people who believe that the policies labelled here as "austerity" will pay off in the longer term. Equally, people who already believe what it claims will feel vindicated. This is a shame because there is useful evidence buried under the rhetoric here. In these hard times, governments should make sure that spending is directed to where it will bring the greatest benefit, and public health is too often overlooked and underfunded - even in the best of times.

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