What do we mean by “the body economic”? It is, of course, a response to the term “the body politic.” Here is the standard definition of body politic: “a group of persons organized under a single government authority; a people considered as a collective unit.” We adapt that format for body economic: “a group of persons organized under a common set of economic policies; the people whose lives are collectively affected by these policies.”
The body economic signifies not just the financial systems of which we are all a part, but the health effects of economic policies. As epidemiologists, we study the patterns, causes, and effects of disease. When we think of the body economic, we seek to understand how government budgets and economic choices affect life and death, resilience and risk, for entire populations around the world.
Of course economic policies are not the pathogens or the viruses per se that directly induce illness. Rather, they are the “causes of the causes” of ill health, – the underlying factors that powerfully determine who will be exposed to the greatest health risks. Economic forces determine who is more likely to binge on alcohol, catch tuberculosis in a homeless shelter, or spiral into depression. They can affect not just risk but also protections, determining who is more likely to get social support, maintain a roof over their head, or recover from a bad spell in life. That is why even a small change in government budgets can have large, – and possibly unintended, – effects on the body economic, for better or for worse.
If we take the truly democratic option, the first step is to identify those policies that are supported by evidence, and those that are not. With stakes so high, we cannot entrust our decisions to ideologies and beliefs. Often politicians on both the left and right peddle ideas based on preconceived social theories and economic ideologies, not facts, figures, and hard evidence. Only when citizens have access to, and engage with, the data can politicians be held accountable for their budget decisions, and for the effects of those decisions on life and death. This book we hope is the first step to democratizing the health choices of the body economic. To work, a path toward a healthier body economic must follow three key principles.
“First, do no harm” is the ancient law of the healing professions. Because social and economic policies have collateral effects on health and sickness, the doctors’ mantra a should become a requirement for all such politicians. For democracies to work, we need to know the full consequences of our policy choices. We need to evaluate public policies with the same rigor that we use to evaluate new drug treatment and medical devices.
Second, help people return to work. In hard times, having a stable job is often the best medicine. Unemployment and the fear of unemployment are among the most significant drivers of poor health that people face in an economic crisis.
Third, invest in public health. If a family member is sick and suffering, we do all we can to help. The same logic applies to the body economic. At a time when people are hurting from recession, politicians should act to protect people from the dangers of unemployment and poverty. They should enact laws that provide care based on people’s health needs, rather than their ability to pay. This approach would eliminate many costly hospitalizations caused by care provided too late. A recession may hurt people’s pocketbooks, but no one should lose access to healthcare because of an economic downturn. As citizens we should call on our governments to make decisions that safeguard public health. It is easy to lose sight of how important disease prevention programs are until it is too late.
To achieve a real, lasting human recovery, we must fundamentally change the way we think about what’s important. Economic growth is a means to an end, not the end in itself. The ultimate source of any society’s wealth is its people. Investing in their health is a wise choice in the best of times, and an urgent necessity in the worst of times.
David Stuckler, MPH. Phd and Sanjay Basu, MD, Phd
The Body Economic: Why Austerity Kills