Austerity kills

I was a medical student. The SHO presented the case, and I asked what the patient did for a living. “He’s one of the three million.” It was the Thatcher era and unemployment was higher than it had been since the Great Depression. When I came to submit the title for my finals essay, I decided to write about unemployment and health. I was summoned to the Dean’s office. I wasn’t training to be a social worker, I was reminded. ‘An unusual case of Smith-Bland-Bloggs syndrome’ would be a more appropriate topic.

I stuck to my guns and wrote about the effects of unemployment on health. Clearly, being without work was associated with poor health, and some people were speculating that unemployment was the cause and not the consequence of illness. But they were sociologists, not doctors. Shortly after I qualified, Richard Smith, then the assistant editor of the BMJ, published ‘Occupationless Health’. Ten articles in the BMJ. The evidence might have been limited but the pain and misery of unemployment were visceral. Since then, there has been a lot of research and I guess that even the more traditional medical schools now recognise that unemployment is bad for your health. Psychological health deteriorates, with increases in suicide and parasuicide rates, especially among young men. Physical health is affected, with slower recovery from minor conditions, more consultations for chronic diseases and more hospital referrals. Poor health affects the whole family, and whole communities as businesses collapse. The pervading threat of joblessness, knowing that the breadwinner’s job is precarious, is almost as damaging. And unemployment is bad for us all, as governments save money by cutting public health budgets.

Every unemployment crisis is different. It was the Second World War that solved the problem of the 1930s. Combatants were promised jobs when they got home, and favourable economic conditions maintained high employment till the 1970s. But by 1979, the Tory election poster read ‘Labour isn’t working’, and by the time I wrote my essay whole industries were disappearing. In the ‘90s, statistics appeared to improve, but people were being encouraged to take early retirement, many of the new jobs were part-time, and the government was trying to reduce the unemployment figures by encouraging GPs to give the jobless sick notes. Then, as now, governments gained support for cuts in benefits by labelling the out-of-work as scroungers. Health Authorities set up programmes to help the unemployed, but all they could offer were sticking plasters.

The current crisis is different again. We are living longer, with more years to fill and more retirement to support. Women have joined the job market. Everyone expects a standard of material comfort undreamed of in the 1950s. The security of jobs for life has disappeared. Machines take on humans’ jobs. Inequality is increasing.

There are now families where no-one has had a paid job for several generations. “Ar ay miss, I’m going to be an artist when I leave school – drawing the dole.” So said a 15-year-old I taught in a Liverpool comprehensive school. Those kids weren’t interested in learning. All they could foresee was boredom, idleness and purposelessness. No wonder youths turn to drugs to give life some spice, and to gangs for a source of identity and respect.

In capitalist economies a degree of unemployment may be accepted as the inevitable price of economic growth. The USSR guaranteed every citizen a job; in Cuba they still do. But, as Cubans say, “We pretend to work and the government pretends to pay us.” Just so: make-work may be better than no work, but it is a poor substitute for a worthwhile job.

Many miners swore that their sons wouldn’t go down the pit. But after the pit closures of the 1980s they saw their jobs in a different light. Backbreaking and unpleasant, yes, but a reason to get up in the morning, a pay packet at the end of the week, a useful, and, until the advent of oil, an essential job. And being part of a team, the brotherhood all the stronger because miners shared the arcane hardships of the mines. All are important benefits of even the meanest of employment. Those one-industry communities, the mining towns of the Rhondda Valley, steel towns like Corby, plunged almost overnight from full employment to no employment, and their close-knit societies collapsed. Jobs in construction, which hitherto mopped up the jobless, are in short supply in a recession. The army is cutting back. Even jobs stacking shelves are hard to come by as disposable income shrinks.

There are jobs and there are people, but the numbers don’t match up, nor do the skills. A sheep shearer who ruins his knee twisting to grab a recalcitrant sheep can’t go back to his profession, but neither can he take up a vacancy for an early-Universe cosmologist even if it is within hobbling distance.

And more and more jobs are being mechanized. Even paying for your toothpaste in Boots. The people who are laid off as a result don’t stop existing when their jobs do. They still need housing and feeding and health care – more health care than when they were working.

As the cuts introduced to balance the UK budget bite ever deeper, we GPs will see more and more patients whose health is suffering because of unemployment. It feels inevitable. But is it? A new book, The Body Economic, published this week, shows that debt-burdened countries such as Iceland, or indeed UK in 1945, which decide to protect health and social spending not only protect their citizens’ health, but recover economically much faster than countries which have opted for austerity. Will our government take note?

I long ago mislaid my finals essay, but Richard Smith’s articles are still available on the BMJ website. The Body Economic: Why Austerity Kills, by David Stuckler and Sanjay Basu is published on 21st May 2013 by Allen Lane, ISBN-13: 978-1846147838

Judith Harvey

Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum, an LMC chair and a long-time supporter NASGP. Her charity, Cuba Medical Link, enables medical students to go to Cuba for their electives.

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