For the last 30-plus years, the dominant politico-economic theory in the West has been ‘neo-liberalisation’. Roughly, this believes in the pre-eminence of the market, that the market is always right, that government should be small and not provide services.
The response of neo-liberalism to bad times is austerity. A retrenchment of state services, and an emphasis on debt reduction.
What effects does austerity have on health? It’s not so easy at this stage to be factually certain, for statistics often have a significant lag. However, some trends are quite clear.
There has been a reduction in social care recipients in England (Figure and data from Danny Dorling, 2014, Inequality and the 1%):
Lack of social care can be expected to increase loneliness, and loneliness is clearly associated with poor mental health.
There is a clear increase in poverty, as ‘benefits’ are reduced; poverty is associated with feelings of shame, and this too is associated with poor mental health.
At the same time, funding for the NHS in England is not keeping up with inflation, and it is expected that there will be a real 4% reduction in funding. This hasn’t been achieved before, but clearly can only be approached if there are significant reductions in provision. And mental health services have always been a ‘Cinderella’.
An extra 23,400 people in England and Wales died between 2012 and early 2013, equivalent to a 5% rise in mortality. While this was blamed on flu, this is very unlikely. (In the pea-souper fog of 1952-53, there were 12,000 excess deaths, which were also blamed on flu. Again, incorrect.)
For the first time in many years, life expectancy for women in England now shows a decrease.
These can all be designated as ‘lead indicators’, and we can expect further data to show worsening levels of health as austerity continues.
All the UK political parties, except the Greens, are signed up to austerity. I’m not clear what the economic policies of SF and the DUP are—though for them, ‘flegs’ emblems, marches and bickering seem much more important than people’s health.
Robert Campbell is a retired surgeon.