As an epidemiologist and a physician myself, I see on a daily basis the real and deep morality to statistics and their accurate collection, interpretation, and discussion.  Real people live and die on the basis of how we as citizens, policy makers, and clinical providers process data.   Indeed, all of us, regardless of our professions, are confronted with statistics about life and death on a daily basis.  What we or our policy makers rarely do, however, is analyze deeply these statistics and how they actually impact our lives.  This is the heart of the approach that Drs. Stuckler and Basu take to analyzing economic policies at times of recessions: what do data tell us, beyond rhetoric and intuition and biases, about how governments should respond? Interestingly, the answer to recessions is to focus less on deficits and make key infrastructure, public health, and employment investments.

Drs. Stuckler and Basu take a rigorous, insightful, and approachable look at the mountains of data that have accumulated as a result of the large-scale austerity experiment.  Building off a growing academic literature, they build a strong case for the subtitle of their book: that austerity both suppresses economic growth and decimates population health, that governments’ must maintain a rate of growth below the rate of revenue growth. This may sound like a political statement, making a political argument about a type of fiscal policy.  Indeed, their work has important policy implications.  However, the work at its heart is a profoundly moral one: how do we learn from evidence about life-saving or life-shortening economic policies?  Can we pursue policies that break our false dichotomies that government spending is not consistent with economic growth, or that public health investments, while they may have health benefits, might harm the economy?  Their data show clearly that these dichotomies are political creations, not descriptions of economic truths.

One of the most notable of the austerity experiments occurred in former Soviet Union states after the fall of communism.  While austerity was very much en vogue among economic advisors to post-communist states, there was wide variation in the degree to which countries pursued austerity.  Across twenty-five post-communist countries between 1989 and 2002, those countries that implemented rapid mass privatization suffered increased male job losses by 56% compared with those that pursued a gradualist path (for example, Belarus, who kept poverty rates below 2% during the transition).  Furthermore, countries like Kazakhstan, Latvia, and Lithuania that engaged in rapid austerity measures experienced significant drops in life expectancy over the course of five years, while gradualist neighboring countries fared much better in terms of public health outcomes.  One of the more striking findings was that there 10 million excess deaths among Russian men attributed to austerity measures in the immediate post-Soviet era; much of that was related to joblessness.  Drs. Basu and Stuckler make compelling arguments with data that the economic and health disasters after the fall of communism were not inevitable.

Similar findings are seen with the most recent economic recession. In discussing these cases, The Body Economic provides rich evidence that health, education and social protection programs have among the highest fiscal multipliers, or money received back in economic growth for each dollar invested.  Austerity measures that cut such programs therefore have profound economic effects.  The resulting health effects—both because of the lack of health programs and because of worsening economies—is felt in the loss of life. There were 35,000 avoidable deaths in the United States during the recent Great Recession due to a lack of healthcare insurance, with 6 million Americans joining the 40 million already without coverage during this time.  During the Greek financial crisis in which austerity measures were pursued, there was a 40% rise in infant mortality and 47% rise in unmet healthcare needs between 2008 and 2011.

Their lessons are important for individuals across the political spectrum.  They put forth evidence that economic growth and investing in a robust social safety net can be mutually reinforcing rather than, as many pundits would suggest, mutually exclusive.  At a time of decreasing confidence in government around the world, their data speaks to the relevance of governments in protecting decency, health, dignity, and economic prosperity. The data implore citizens to hold their governments accountable to a robust social safety net and pro-growth strategies (including utilizing fiscal multipliers to evaluate impact and growth) during recessions while demanding of governments to be more effective in how they deliver on these policies.   After all, these are not academic matters but rather questions of life and death, prosperity and poverty.

Duncan Maru, MD, PhD, is a physician, epidemiologist, and co-founder of Nyaya Health. He works as a resident physician in Internal Medicine and Pediatrics at Harvard where he is a fellow in the Global Health Equity Program.

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