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The Body Economic: Why Austerity Kills
Politicians have talked endlessly about the seismic economic and social impacts of the recent financial crisis, but many continue to ignore its disastrous effects on human health—and have even exacerbated them, by adopting harsh austerity measures and cutting key social programs at a time when constituents need them most. The result, as pioneering public health experts David Stuckler and Sanjay Basu reveal in this provocative book, is that many countries have turned their recessions into veritable epidemics, ruining or extinguishing thousands of lives in a misguided attempt to balance budgets and shore up financial markets. Yet sound alternative policies could instead help improve economies and protect public health at the same time.
In The Body Economic , Stuckler and Basu mine data from around the globe and throughout history to show how government policy becomes a matter of life and death during financial crises. In a series of historical case studies stretching from 1930s America, to Russia and Indonesia in the 1990s, to present-day Greece, Britain, Spain, and the U.S., Stuckler and Basu reveal that governmental mismanagement of financial strife has resulted in a grim array of human tragedies, from suicides to HIV infections. Yet people can and do stay healthy, and even get healthier, during downturns. During the Great Depression, U.S. deaths actually plummeted, and today Iceland, Norway, and Japan are happier and healthier than ever, proof that public wellbeing need not be sacrificed for fiscal health.
Full of shocking and counterintuitive revelations and bold policy recommendations, The Body Economic offers an alternative to austerity—one that will prevent widespread suffering, both now and in the future.
In The Body Economic , Stuckler and Basu mine data from around the globe and throughout history to show how government policy becomes a matter of life and death during financial crises. In a series of historical case studies stretching from 1930s America, to Russia and Indonesia in the 1990s, to present-day Greece, Britain, Spain, and the U.S., Stuckler and Basu reveal that governmental mismanagement of financial strife has resulted in a grim array of human tragedies, from suicides to HIV infections. Yet people can and do stay healthy, and even get healthier, during downturns. During the Great Depression, U.S. deaths actually plummeted, and today Iceland, Norway, and Japan are happier and healthier than ever, proof that public wellbeing need not be sacrificed for fiscal health.
Full of shocking and counterintuitive revelations and bold policy recommendations, The Body Economic offers an alternative to austerity—one that will prevent widespread suffering, both now and in the future.
240 pages, Hardcover
First published May 6, 2013
38 people are currently reading
1334 people want to read
About the author
David Stuckler
9 books7 followersDavid Stuckler, PhD, MPH, HonMFPH, FRSA is a Professor of Political Economy and Sociology at University of Oxford and research fellow of the London School of Hygiene and Tropical Medicine. He has written over 170 peer-reviewed scientific articles on global health in The Lancet, British Medical Journal and Nature in addition to other major journals. His book about the global chronic-disease epidemic, Sick Societies, was published by Oxford University Press in 2011. He is also an author of The Body Economic, published by Penguin Press in 2013 and translated into over ten languages. His work has featured on covers of the New York Times and The Economist, among other venues. Foreign Policy named him one of the top 100 global thinkers of 2013.
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December 29, 2025
Preamble:
--I first read this book when it was released in 2013. Re-reading it 12 years later, I now have much sharper tools to dissect the book’s brilliance and limitations in:
i)
ii) Public Health (esp. Epidemiology)
The Bad/Missing:
--Stuckler/Basu’s book is targeting technocrats who think they are “apolitical”, where “data” is the cure for political disagreements.
…For this audience, the book’s data-driven findings (using real-world case studies rather than just abstract economic theory) are indeed a revelation:
i) Economic crises should not be an excuse to cut social spending (on social needs, esp. health/education, in contrast to bailouts of the rich/military spending).
ii) In fact, public health can improve during economic crises; this is not due to the crises (duh) but due to extra social spending (stimulus) during crises.
iii) When social spending is cut (“austerity”), public health worsens.
iv) Social spending helps economic recovery, whereas cuts worsen recovery.
--It takes pervasive, well-funded capitalist propaganda to suppress these findings from common sense.
…Economic crises/poverty are not simply “natural”/“inevitable”; ruling classes weaponize poverty to secure cheap labour/resources. This book is too timid with class analysis and misses the longer context of capitalism:
i) The rise of capitalism’s degradation of public health, weaponizing poverty to create the labour market (note: most people today are propagandized to associate “capitalism” with mass consumerism, which primarily occurred only after WWII).
ii) Capitalist degradation led to proto-socialist resistance, including social spending (esp. on public health).
…Consider Hickel’s Less is More: How Degrowth Will Save the World:
[T]he long rise of capitalism, from 1500 right into the Industrial Revolution, caused dramatic social dislocation everywhere it went. The enclosure movement in Europe, the Indigenous genocides, the Atlantic slave trade, the spread of European colonisation, the Indian famines; all of this took a measurable toll on human welfare around the world. The scars remain starkly visible in the public health record. For the vast majority of the history of capitalism, [economic] growth didn’t deliver welfare improvements in the lives of ordinary people; in fact, it did exactly the opposite. Remember, capitalist expansion relied on the creation of artificial scarcity. Capitalists enclosed [privatized into a commodity] the commons – lands, forests, pastures and other resources that people depended on for survival [creating the land market] – and ripped up subsistence economies in order to push [dispossessed] people into the labour market [to fill “dark, Satanic mills” (William Blake, 1804)]. The threat of hunger was used as a weapon to enforce competitive productivity. Artificial scarcity quite often caused the livelihoods and welfare of ordinary people to collapse even as GDP grew.…With this class analysis/history of capitalism context, Stuckler/Basu’s revelations become “no shit, Sherlock” (along with useful case studies/ technical tools).
It wasn’t until nearly 400 years later that life expectancies in Britain finally began to rise […]. It happened slightly later in the rest of Europe, while in the colonised world longevity didn’t begin to improve until the early 1900s [from decolonization, as the colonizers’ competition led to world wars]. So if growth itself does not have an automatic relationship with life expectancy and human welfare, what could possibly explain this trend?
Historians today point out that it began with a startlingly simple intervention […]: [public] sanitation. In the middle of the 1800s, public health researchers had discovered that health outcomes could be improved by introducing simple sanitation measures, such as separating sewage from drinking water. All it required was a bit of public plumbing. But public plumbing requires public works, and public money. You have to appropriate private land for things like public water pumps and public baths. And you have to be able to dig on private property in order to connect tenements and factories to the system. This is where the problems began. For decades, progress towards the goal of public sanitation was opposed, not enabled, by the capitalist class. Libertarian-minded landowners refused to allow officials to use their property, and refused to pay the taxes required to get it done.
The resistance of these elites was broken only once commoners won the right to vote and workers organised into unions. Over the following decades these movements, which in Britain began with the Chartists and the Municipal Socialists, leveraged the state to intervene against the capitalist class. They fought for a new vision: that cities should be managed for the good of everyone, not just for the few. These movements delivered not only public sanitation systems but also, in the years that followed, public healthcare, vaccination coverage, public education, public housing, better wages and safer working conditions. According to research by the historian Simon Szreter, access to these public goods – which were, in a way, a new kind of commons – had a significant positive impact on human health, and spurred soaring life expectancy through the twentieth century.
The Good:
1) History – Stimulus:
--How can we afford social spending during economic crises?
…Well, during capitalism’s downturns, capitalists (driven by profit-seeking over social needs) become too pessimistic on achieving profitable sales to maintain production, strangling the economy further and thus fulfilling their pessimistic prophecy (rather than some harmonious Supply/Demand rebalancing where capitalists should invest more due to falling costs of labour/materials):
-nonfiction: And the Weak Suffer What They Must? Europe's Crisis and America's Economic Future
-fiction: The Grapes of Wrath
--Stuckler/Basu feature 3 case studies of successful intervention, where social spending was enacted in response to economic crises. We should keep in mind the class analysis question: how can the working-class organize to build bargaining power (Raising Expectations (and Raising Hell); My Decade Fighting for the Labor Movement)? What new opportunities/barriers do economic crises provide for this?
--Case Study #1: Great Depression’s US:
--The 1930s Great Depression originated in the US from rising inequality (class: public losing bargaining power while capitalists become more detached)/real estate bubble leading to a banking crisis.
--The book frames how the response to this crisis became the peak of US Left organizing, as mass discontent was mobilized to build working-class power: from the 1932 Ford Hunger March (which capitalists responded with the Ford Massacre) to the 1935 creation of United Auto Workers to the US Socialist Party organizing farmers (lost land) and factory workers (laid off).
…This pressured the Democrat’s FDR to enact the New Deal, i.e. spend on social needs rather than just bail out the rich: jobs programs/public works, Social Security, prevent foreclosures, food stamps, farmers support and public health programs. Note: this framing of bottom-up pressure is shared by Zinn’s A People's History of the United States.
…Since different states in the US implemented the New Deal to varying degrees, this offers a convenient “natural experiment” for researchers to control for confounding variables and isolate causation from correlation. Note: “convenient” because elite-driven politics is much more interested in propaganda than doing data-driven experiments on economic policies. My go-to intro on evidence-based research/epidemiology/statistics is Goldacre:
-Bad Science: Quacks, Hacks, and Big Pharma Flacks
-I Think You'll Find It's a Bit More Complicated Than That
…Using epidemiology’s tools, we filter out unrelated factors (confounding variables) and correct for our biases/heuristics, so we can isolate the relationship between social spending and public health:
i) Differences between the states: demographics/pre-existing health conditions/education/income, etc.
ii) Long-term trend of “Epidemiological transition”: the decline of infectious diseases (due to improved sanitation) and rise of non-infectious diseases.
iii) Car deaths: declined from less traffic during economic downturn.
iv) Alcohol deaths: apparently less deaths from prohibition, repealed to increase tax revenue.
v) Suicide rates: rise but huge variation and still relatively rare.
vi) Mild winters? Prior 1920s economic boom meant excess thus poorer health? Etc.
…With all these accounted for, Stuckler/Basu found more New Deal spending led to improved public health, despite the Great Depression. Unmentioned is how the New Deal continued to be sabotaged by the rich; it took the funding/supplying WWII to rescue US capitalism from the Great Depression.
--Case Study #2: Post-WWII’s UK:
--UK was devastated from WWII’s carnage and war-debts (esp. to the US). However, its working-class soldiers built bargaining power by being organized (via military service) and had public prestige (fighting fascism). We should add that women/minorities increased their own bargaining power filling in for factory jobs.
…So, instead of letting the rich fear-monger against social spending (“it will bankrupt the country!!!”), soldiers’ war-time healthcare was expanded to the rest of the UK public after the war: National Health Service (NHS).
…Medications became purchased in bulk, prescriptions regulated, doctors paid via fixed annual salaries (rather than number of patients seen/commissions), etc.
--Case Study #3: Great Recession’s Iceland :
--With another boom of rising inequality/real estate bubble bursting in the 2008 Financial Crisis, little Iceland’s banking sector crashed with its investments in US real estate speculation.
--3% of the Icelandic public was successfully mobilized in mass protests (I still need to unpack the magical 3.5% in Why Civil Resistance Works: The Strategic Logic of Nonviolent Conflict); they demanded (participatory) democracy and forced a referendum (unlike liberal elites like Locke/Milton Friedman who feared “the mob”: The Democracy Project: A History, a Crisis, a Movement) to reject austerity/paying financial creditors. Instead, Iceland increased social spending (improved recovery/public health without inflation issues), with a second referendum leading to jailing their key criminal bankers (Moore’s Where to Invade Next documentary has a good segment on this).
…see comments below for rest of the review…
December 31, 2015
Solid book/ read in a few hours. The basic principle of the book is to show how government spending on certain types of social safety net programs can keep people healthy AND benefit the economy. This runs counter to some popular and political thinking on the topic, so the authors collect and report data and evidence to make their case. I appreciated how they wrote in a view that would reach a popular audience but relied on their findings culled from some peer-reviewed pubs. This makes some of the more complicated sections easier to read
And understand, but there are still a decent amount of stats.
Ultimately I think this book would give anyone a basic understanding of the macro level links between public policy, health, and the economy. I appreciated all of the references at the end but would have also enjoyed the actual data tables as an appendix.
And understand, but there are still a decent amount of stats.
Ultimately I think this book would give anyone a basic understanding of the macro level links between public policy, health, and the economy. I appreciated all of the references at the end but would have also enjoyed the actual data tables as an appendix.
October 1, 2013
A clear indictment of conservative economic theology that has deadly consequences for the most vulnerable in society.
April 27, 2014
Very concise research by the two Authors confirms what most empathetic people would think of Government Austerity programs. They hurt the most vulnerable and have a major impact on their physical and mental health.
January 6, 2021
It should be fairly unsurprising that if you fail to provide the most basic needs to people, that it will affect their health in the most negative ways. This book is well-researched rebuttle to any neoliberal government or institution that claims that economic recovery comes through slashing social programs (yet often increasing the militarised police to quell subsequent dissent). Austerity has never worked for its stated goals, and this book provides plenty of evidence for that by framing it purely in terms of how it impacts social and individual health and wellbeing. The IMF and "conservatives" have blood on their hands. It should be more obvious now when during this pandemic, suddenly we could provide housing to the homeless and raise welfare above povery levels (albeit temporarily). I remain concerned that neoliberal ideology will start to cry that we must follow these thoroughly disproven practices in order to recover from these economic impacts. Anyone who thinks that cutting social support networks is a policy worth pursuing needs to read this and refute every fact and figure.
December 9, 2020
A little thin at times, The Body Economic highlights the faults with austerity and breaks neoliberal arguments with ease.
May 24, 2019
1.5 stars
There were a few parts early that I found interesting, especially regarding the Soviet cities, however that was not enough to help this book. The bias was too strong that it ruined credibility in my view. It read like a propaganda booklet or a sales pitch. It also ignored secondary and long term effects of policies. While there is valid criticism of how the IMF got involved in Europe and how banks that made risky loans were rewarded for helping create the recession, he draws wrong conclusion (that stimulus and increased public spending is always the answer). Countries have collapsed into hyperinflation by trying his response creating a far worse crisis through printing money to support these programs and economic stimulus.
While parts seemed like drawing too large of a conclusion based on a small sample size, other parts seemed just plain dishonest. Just as trying to look at Wichita or Tulsa (both cities with a larger population than Iceland) to see how an economic strategy could work, that would not be enough to declare one system as the only valid option. Comparisons between Iceland and Greece are too small in nature, and their systems were too separate to try and make the comparison that he did. I have always preferred comparisons between East and West Germany, and North and South Korea, as those are homogeneous populations in similar circumstances that have taken two very different paths, and led to very different results. The economic destruction in Germany after WWII was far greater than Greece or Iceland in the mid 2000's.
His discussion on how England has such a superior healthcare system made me think I was reading a satire. At the time he was praising the system there in the 50's-70's it was suffering a massive "brain drain" where many doctors were leaving the country to practice elsewhere. I was just waiting for the part where he would say how British dentistry was also a model to be emulated. His criticism of the response to the collapse of the USSR neglected that the key problem was that it was so heavily government run for 70 years it had created a time bomb. Surely the response could have been improved, but to skip over the primary cause for the problem just lacks too much. Russia around 1990 had an economy on par with the US in 1890. That was a major reason why transitioning had such a devastating impact.
The valid criticisms he made were overshadowed by neglecting long term effects, as well as other flaws. Those who support Keynesian economics and big government will enjoy this book. Most other people will find it frustrating at best.
There were a few parts early that I found interesting, especially regarding the Soviet cities, however that was not enough to help this book. The bias was too strong that it ruined credibility in my view. It read like a propaganda booklet or a sales pitch. It also ignored secondary and long term effects of policies. While there is valid criticism of how the IMF got involved in Europe and how banks that made risky loans were rewarded for helping create the recession, he draws wrong conclusion (that stimulus and increased public spending is always the answer). Countries have collapsed into hyperinflation by trying his response creating a far worse crisis through printing money to support these programs and economic stimulus.
While parts seemed like drawing too large of a conclusion based on a small sample size, other parts seemed just plain dishonest. Just as trying to look at Wichita or Tulsa (both cities with a larger population than Iceland) to see how an economic strategy could work, that would not be enough to declare one system as the only valid option. Comparisons between Iceland and Greece are too small in nature, and their systems were too separate to try and make the comparison that he did. I have always preferred comparisons between East and West Germany, and North and South Korea, as those are homogeneous populations in similar circumstances that have taken two very different paths, and led to very different results. The economic destruction in Germany after WWII was far greater than Greece or Iceland in the mid 2000's.
His discussion on how England has such a superior healthcare system made me think I was reading a satire. At the time he was praising the system there in the 50's-70's it was suffering a massive "brain drain" where many doctors were leaving the country to practice elsewhere. I was just waiting for the part where he would say how British dentistry was also a model to be emulated. His criticism of the response to the collapse of the USSR neglected that the key problem was that it was so heavily government run for 70 years it had created a time bomb. Surely the response could have been improved, but to skip over the primary cause for the problem just lacks too much. Russia around 1990 had an economy on par with the US in 1890. That was a major reason why transitioning had such a devastating impact.
The valid criticisms he made were overshadowed by neglecting long term effects, as well as other flaws. Those who support Keynesian economics and big government will enjoy this book. Most other people will find it frustrating at best.
September 23, 2015
How Neoliberalism kills
Imagine Tom, a man who works from 9 to 5 in an office for a private company dealing with highly explosive equipment. He's done a really good job today managing to deliver over 240 dangerous chemicals to hospitals and clinics all over the country. However, he arrives back home to find out through the news that a roaring chaos is emerging within the confines of the financial market. What the heck! The prices of insurances are falling, the housing market is plummeting and the entire economy is soaring. The news bulletin stops to broadcast a live speech by the president. “It is hard times, dear Americans, Wall Street is undergoing profound changes and the financial crisis is imminent, however we do hope to have recovered soon by the end of this week' or something along those lines. It is 2007, and Tom is waiting, thinking about what this could mean for him. He's worried. He has two children and a partner with whom he shares their first house paid for by the mortgage they obtained from the bank...
follow my review and summary at http://www.chaufamarxista.com/how-neo...
Imagine Tom, a man who works from 9 to 5 in an office for a private company dealing with highly explosive equipment. He's done a really good job today managing to deliver over 240 dangerous chemicals to hospitals and clinics all over the country. However, he arrives back home to find out through the news that a roaring chaos is emerging within the confines of the financial market. What the heck! The prices of insurances are falling, the housing market is plummeting and the entire economy is soaring. The news bulletin stops to broadcast a live speech by the president. “It is hard times, dear Americans, Wall Street is undergoing profound changes and the financial crisis is imminent, however we do hope to have recovered soon by the end of this week' or something along those lines. It is 2007, and Tom is waiting, thinking about what this could mean for him. He's worried. He has two children and a partner with whom he shares their first house paid for by the mortgage they obtained from the bank...
follow my review and summary at http://www.chaufamarxista.com/how-neo...
October 25, 2014
I hoped this would be a tremendous book. And it is. What we can learn from the Global Financial Crisis is that how 'business' has been conducted in the past has failed. The continual emphasis of the economic over the social - or 'growth' over justice - has failed. It is time to think differently. It is time to be different.
David Stuckler and Sanjay Basu show that one of the primary costs of governmental austerity is preventative health policies. By hyper-fetishizing the present budget, the future is mortgaged. The authors show that the men and women who lost their houses and jobs also lost their health. The cost of that loss is paid in suicides, strokes, heart attacks and disability.
This book argues for a full economic and social costing of austerity. When this real budget is configured, Iceland becomes a model for a new way of thinking and living.
David Stuckler and Sanjay Basu show that one of the primary costs of governmental austerity is preventative health policies. By hyper-fetishizing the present budget, the future is mortgaged. The authors show that the men and women who lost their houses and jobs also lost their health. The cost of that loss is paid in suicides, strokes, heart attacks and disability.
This book argues for a full economic and social costing of austerity. When this real budget is configured, Iceland becomes a model for a new way of thinking and living.
December 28, 2014
Living in Malaysia and seeing the extent of the effects of the reform on social services shed some light to governance in Malaysia.
Although some of the actions conducted by the Malaysian government at that time was highly provocative, it's decision of a solid no to IMF was indeed a wise decision.
The book solidifies what successful government do to help spur the economy. It provides the facts and evidence to us.
However, it is important that books like this be read as in modern democracy, where the people choose the leaders.
Anyway, it was crafted very nice. I had the page turning until the end of each experiment. And the data was properly broken down and analysed that I have very little qualm in taking it.
All in all, a must read.
Although some of the actions conducted by the Malaysian government at that time was highly provocative, it's decision of a solid no to IMF was indeed a wise decision.
The book solidifies what successful government do to help spur the economy. It provides the facts and evidence to us.
However, it is important that books like this be read as in modern democracy, where the people choose the leaders.
Anyway, it was crafted very nice. I had the page turning until the end of each experiment. And the data was properly broken down and analysed that I have very little qualm in taking it.
All in all, a must read.
February 28, 2019
The great strength, and slight limitation of this book are both captured in a few sentences in the Conclusion:
"With stakes so high, we cannot entrust our decisions to ideologies and beliefs. As the mathematician W. Deming said: “In God we trust; all others must bring data.” Often politicians on both the left and the right peddle ideas based on preconceived social theories and economic ideologies, not facts, figures and hard evidence."
The authors’ use of facts, figures and hard evidence in “The Body Economic” allows them to convincingly demolish conventional neoliberal wisdom and establish a compelling case for their policy alternatives. There were no slips, no point where I felt their arguments were weak or unsupported by data.
Almost a third of the book is taken up with references. I checked some of them out. They were consistently relevant and high quality sources.
The structure of their argument, examining population health through a series of economic crises since the Great Depression, and comparing health outcomes for austerity versus reflationary policy responses, is intellectually elegant.
At the same time, the book is beautifully written. It reminded me of the work of another brilliant author, who is referenced at the back – Naomi Klein. The frequent use of an immediately-relatable vignette which expresses and illustrates the dynamics of a complex system is a common element.
I believe that the life experience of David Stuckler and Sanjay Basu – which they briefly describe in the Preface – were critical to the book’s exceptional power. “Both of us have experienced financial vulnerability”, they write, “and the health consequences that attend it”. Leading epidemiologists with access to the great resources at Oxford and Stanford Universities who can say the same, are few and far between.
But facts do not speak for themselves. They require interpretation. And data is only available when, and in the formats that it’s collected.
So despite the strong assertion in the book’s Conclusion, there can be no escape from “ideologies and beliefs”.
“Facts, figures and hard evidence” are not some more reliable alternative to “theories”. Theories are essential in generating questions for scientific investigation. They shape the choices about which data to collect and analyse. You can’t have the one, and not the other - which appears to what the authors proclaim, in the quote above.
And the problem isn’t “preconceived social theories and economic ideologies”, per se. It’s when politicians keep clinging to beliefs even after they’re disconfirmed by evidence.
The authors’ belief that they are eschewing “theories” actually means they’re captive to their own unexamined (or underexamined) theoretical assumptions.
The clearest evidence of this is in the one place where they do cite a theoretical source: “The Nobel Prize-winning economist, Kenneth Arrow, had found in a seminal 1963 paper that markets often fail to deliver affordable, high-quality healthcare”. This paper may be credible, but it is definitely a “preconceived social theory” of the kind they explicitly disavow.
Critically examining the book from this perspective, the recurrent passing mentions of John Maynard Keynes take on a greater significance. “Healthcare is different from other market good like cans of tuna”, the authors assert. The belief that a market economy is essentially benign to health, and that the problem lies mainly with policy settings within this framework, runs through the book – despite an absence of supporting data, and even given some evidence to the contrary.
It’s true that the book does not cite evidence of harmful health effects from production and distribution of cans of tuna within a market system, but it does appear to show that a market economy in housing, banking and finance, and employment (which doesn’t leave much excluded) is harmful to health.
Scandinavian examples of “Active Labour Market Policies” in the book, which have successfully mitigated some of this harm, could have been conceptualised equally well as a move towards “Decentralised Economic Planning”. But the authors’ aversion to “theories” leaves them unable to do this, or to join the dots in a way which might allow them to challenge their own “economic ideologies”. In this respect, despite a certain fuzziness, Naomi Klein’s work is clearly stronger.
Notwithstanding the proprtion of this review taken up with this point, it is a small gripe, really. As previously stated, “The Body Economic” is a beautifully-written book, which reflects and will continue to inspire democratic efforts to demolish today’s most harmful prevailing economic ideologies.
Highly, highly recommended.
"With stakes so high, we cannot entrust our decisions to ideologies and beliefs. As the mathematician W. Deming said: “In God we trust; all others must bring data.” Often politicians on both the left and the right peddle ideas based on preconceived social theories and economic ideologies, not facts, figures and hard evidence."
The authors’ use of facts, figures and hard evidence in “The Body Economic” allows them to convincingly demolish conventional neoliberal wisdom and establish a compelling case for their policy alternatives. There were no slips, no point where I felt their arguments were weak or unsupported by data.
Almost a third of the book is taken up with references. I checked some of them out. They were consistently relevant and high quality sources.
The structure of their argument, examining population health through a series of economic crises since the Great Depression, and comparing health outcomes for austerity versus reflationary policy responses, is intellectually elegant.
At the same time, the book is beautifully written. It reminded me of the work of another brilliant author, who is referenced at the back – Naomi Klein. The frequent use of an immediately-relatable vignette which expresses and illustrates the dynamics of a complex system is a common element.
I believe that the life experience of David Stuckler and Sanjay Basu – which they briefly describe in the Preface – were critical to the book’s exceptional power. “Both of us have experienced financial vulnerability”, they write, “and the health consequences that attend it”. Leading epidemiologists with access to the great resources at Oxford and Stanford Universities who can say the same, are few and far between.
But facts do not speak for themselves. They require interpretation. And data is only available when, and in the formats that it’s collected.
So despite the strong assertion in the book’s Conclusion, there can be no escape from “ideologies and beliefs”.
“Facts, figures and hard evidence” are not some more reliable alternative to “theories”. Theories are essential in generating questions for scientific investigation. They shape the choices about which data to collect and analyse. You can’t have the one, and not the other - which appears to what the authors proclaim, in the quote above.
And the problem isn’t “preconceived social theories and economic ideologies”, per se. It’s when politicians keep clinging to beliefs even after they’re disconfirmed by evidence.
The authors’ belief that they are eschewing “theories” actually means they’re captive to their own unexamined (or underexamined) theoretical assumptions.
The clearest evidence of this is in the one place where they do cite a theoretical source: “The Nobel Prize-winning economist, Kenneth Arrow, had found in a seminal 1963 paper that markets often fail to deliver affordable, high-quality healthcare”. This paper may be credible, but it is definitely a “preconceived social theory” of the kind they explicitly disavow.
Critically examining the book from this perspective, the recurrent passing mentions of John Maynard Keynes take on a greater significance. “Healthcare is different from other market good like cans of tuna”, the authors assert. The belief that a market economy is essentially benign to health, and that the problem lies mainly with policy settings within this framework, runs through the book – despite an absence of supporting data, and even given some evidence to the contrary.
It’s true that the book does not cite evidence of harmful health effects from production and distribution of cans of tuna within a market system, but it does appear to show that a market economy in housing, banking and finance, and employment (which doesn’t leave much excluded) is harmful to health.
Scandinavian examples of “Active Labour Market Policies” in the book, which have successfully mitigated some of this harm, could have been conceptualised equally well as a move towards “Decentralised Economic Planning”. But the authors’ aversion to “theories” leaves them unable to do this, or to join the dots in a way which might allow them to challenge their own “economic ideologies”. In this respect, despite a certain fuzziness, Naomi Klein’s work is clearly stronger.
Notwithstanding the proprtion of this review taken up with this point, it is a small gripe, really. As previously stated, “The Body Economic” is a beautifully-written book, which reflects and will continue to inspire democratic efforts to demolish today’s most harmful prevailing economic ideologies.
Highly, highly recommended.
March 20, 2017
[In progress]
The Body Economic examines the effects that economic policies in response to recessions have on public health.
The question that drives this book is "why do health outcomes in some countries seem to improve during recessions while others worsen?" Previous orthodoxy on this question suggested that falling incomes encourage people to make healthier lifestyle choices - eating less, walking more rather than driving, etc. Yet this seems patently rubbish. Stuckler and Baju instead delve into the data and argue persuasively that the key factor that distinguishes countries that experience improvements in health from those that do not is whether or not they respond to recession with stimulus or austerity. In case after case, they find support for the fact that not only does stimulus appear to result in faster and more sustained recovery, but it also improves public health. Numerous cases that they consider bear this out:
- Comparisons between states that were pro and anti the New Deal in the wake of the Great Depression.
- Russia's experience transitioning to Capitalism and Poland's following the collapse of the Soviet Union.
- The experience of Indonesia, Korea, and Thailand following the Asian Financial Crisis compared to Malaysia.
- Iceland and Greece's differing experiences post the Great Recession.
The book then transitions into considering specific public health issues, in particular:
- The difference in outcomes between the NHS and the US healthcare systems – criticizing the latter as well as the Tory governments’ move towards a privatized system (particularly compelling is their argument surrounding why this reduces preventative early treatment and costs taxpayers more in the long run).
- The link between suicide and unemployment is examined by contrasting Spain and Sweden's assistance to the unemployed and champions Sweden's Active Labor Market Programmes as ways to get people back to work and cure the cause of depression. Seemingly works as depression fell in 90s recession and Great Recession in Sweden but rose in Spain and other European countries.
- Why reducing homelessness has major public health advantages (with the great example of why foreclosures in Bakersville California led to an outbreak of the mosquito borne West Nile outbreak despite a drought – because all those houses left swimming pools that stagnated and produced mosquito breading grounds).
The three broad conclusions Stuckler and Baju reach are:
i) Do no harm – all economic policies should be subjected to the same kind of scrutiny that medical practices are. This should be evidenced based as far as possible.
ii) Invest in reducing poverty and unemployment – the evidence clearly shows that attempts to tackle poverty and unemployment have positive long run impacts on both GDP and health care.
iii) Invest in public health – the average fiscal multiplier from public health interventions is 3 (meaning that every dollar invested creates 3 dollars of output).
The Body Economic examines the effects that economic policies in response to recessions have on public health.
The question that drives this book is "why do health outcomes in some countries seem to improve during recessions while others worsen?" Previous orthodoxy on this question suggested that falling incomes encourage people to make healthier lifestyle choices - eating less, walking more rather than driving, etc. Yet this seems patently rubbish. Stuckler and Baju instead delve into the data and argue persuasively that the key factor that distinguishes countries that experience improvements in health from those that do not is whether or not they respond to recession with stimulus or austerity. In case after case, they find support for the fact that not only does stimulus appear to result in faster and more sustained recovery, but it also improves public health. Numerous cases that they consider bear this out:
- Comparisons between states that were pro and anti the New Deal in the wake of the Great Depression.
- Russia's experience transitioning to Capitalism and Poland's following the collapse of the Soviet Union.
- The experience of Indonesia, Korea, and Thailand following the Asian Financial Crisis compared to Malaysia.
- Iceland and Greece's differing experiences post the Great Recession.
The book then transitions into considering specific public health issues, in particular:
- The difference in outcomes between the NHS and the US healthcare systems – criticizing the latter as well as the Tory governments’ move towards a privatized system (particularly compelling is their argument surrounding why this reduces preventative early treatment and costs taxpayers more in the long run).
- The link between suicide and unemployment is examined by contrasting Spain and Sweden's assistance to the unemployed and champions Sweden's Active Labor Market Programmes as ways to get people back to work and cure the cause of depression. Seemingly works as depression fell in 90s recession and Great Recession in Sweden but rose in Spain and other European countries.
- Why reducing homelessness has major public health advantages (with the great example of why foreclosures in Bakersville California led to an outbreak of the mosquito borne West Nile outbreak despite a drought – because all those houses left swimming pools that stagnated and produced mosquito breading grounds).
The three broad conclusions Stuckler and Baju reach are:
i) Do no harm – all economic policies should be subjected to the same kind of scrutiny that medical practices are. This should be evidenced based as far as possible.
ii) Invest in reducing poverty and unemployment – the evidence clearly shows that attempts to tackle poverty and unemployment have positive long run impacts on both GDP and health care.
iii) Invest in public health – the average fiscal multiplier from public health interventions is 3 (meaning that every dollar invested creates 3 dollars of output).
April 1, 2025
“Smart policy choices can boost growth without human costs. Those choices require up-front investment in public health programs. In other words, we can have good health, and tackle our debts too.”
“The real danger to public health is not recession per se, but austerity. When social safety nets are slashed, economic shocks like losing a job or a home can turn into a health crisis.”
“Olivia remembers being on fire.
Eight years old, she was scared by the sound of dishes crashing onto the kitchen floor. Her parents were having another fight. She ran up the stairs to her bedroom and hid under a pillow. Exhausted from crying, she fell asleep.' She woke up with a splintering pain on the right side of her face. The room was black with smoke. Her bedsheet had erupted in flames. Screaming, she ran out of her room and straight into the arms of a firefighter who had raced up the stairs. He wrapped her tightly in a blanket. As she would later hear the nurses in the hospital whisper, her father had set the house on fire in a drunken rage.
It was the spring of 2009, during the ongoing Great Recession. Olivia's father, a construction worker, had been laid off. Millions of Americans had joined the unemployment rolls, and some turned to drugs or, like Olivia's dad, to alcohol.
Olivia's father ended up in jail. Olivia required extensive treatments for her burns and undoubtedly will need years of therapy to heal the mental scars from that horrible night.
But Olivia survived. Others were not so lucky.”
“Public health can be profoundly affected by economic shocks. But the real problem is the consequence of simple political choices.”
“What the Great Depression shows us is that even the worst economic catastrophe need not cause people’s health to suffer, if politicians take the right steps to protect people’s health.”
“Austerity is a choice. And we don’t have to choose it.”
“The real danger to public health is not recession per se, but austerity. When social safety nets are slashed, economic shocks like losing a job or a home can turn into a health crisis.”
“Olivia remembers being on fire.
Eight years old, she was scared by the sound of dishes crashing onto the kitchen floor. Her parents were having another fight. She ran up the stairs to her bedroom and hid under a pillow. Exhausted from crying, she fell asleep.' She woke up with a splintering pain on the right side of her face. The room was black with smoke. Her bedsheet had erupted in flames. Screaming, she ran out of her room and straight into the arms of a firefighter who had raced up the stairs. He wrapped her tightly in a blanket. As she would later hear the nurses in the hospital whisper, her father had set the house on fire in a drunken rage.
It was the spring of 2009, during the ongoing Great Recession. Olivia's father, a construction worker, had been laid off. Millions of Americans had joined the unemployment rolls, and some turned to drugs or, like Olivia's dad, to alcohol.
Olivia's father ended up in jail. Olivia required extensive treatments for her burns and undoubtedly will need years of therapy to heal the mental scars from that horrible night.
But Olivia survived. Others were not so lucky.”
“Public health can be profoundly affected by economic shocks. But the real problem is the consequence of simple political choices.”
“What the Great Depression shows us is that even the worst economic catastrophe need not cause people’s health to suffer, if politicians take the right steps to protect people’s health.”
“Austerity is a choice. And we don’t have to choose it.”
January 13, 2018
This book made me furious. Not because it’s bad: because it exposes the lack of interest in evidence-based policy displayed by many of our policymakers.
The authors take the differing global responses to the 2008 financial crash as an opportunity to conduct a “natural experiment, evaluating the effects of particular economic policies on citizen’s health. In short, they find that austerity is both disastrous and ineffective. In every country which responded to the crash by cutting spending, particularly on health programmes, people got iller, required more expensive care in the long term, and died earlier due to suicide, the effects of homelessness or stress-related disease. They tell the awful story of one US woman who, unable to afford health insurance, did not visit the doctor after getting a splinter in her foot. It went septic, led to multiple infections, and caused her to end up largely helpless in a care home. Had she been able to access free healthcare, she’d have been working and contributing to the economy instead of costing the state thousands of pounds every week.
By contrast, countries such as Iceland and Finland, which responded to the crash by investing in social protection programmes, saw no increase in illness, death or disease, and indeed began experiencing economic recovery more quickly.
If there was any sense in the world, the debate about austerity would be over, because the evidence is so clear that it doesn’t work. That’s what made me furious.
The authors take the differing global responses to the 2008 financial crash as an opportunity to conduct a “natural experiment, evaluating the effects of particular economic policies on citizen’s health. In short, they find that austerity is both disastrous and ineffective. In every country which responded to the crash by cutting spending, particularly on health programmes, people got iller, required more expensive care in the long term, and died earlier due to suicide, the effects of homelessness or stress-related disease. They tell the awful story of one US woman who, unable to afford health insurance, did not visit the doctor after getting a splinter in her foot. It went septic, led to multiple infections, and caused her to end up largely helpless in a care home. Had she been able to access free healthcare, she’d have been working and contributing to the economy instead of costing the state thousands of pounds every week.
By contrast, countries such as Iceland and Finland, which responded to the crash by investing in social protection programmes, saw no increase in illness, death or disease, and indeed began experiencing economic recovery more quickly.
If there was any sense in the world, the debate about austerity would be over, because the evidence is so clear that it doesn’t work. That’s what made me furious.
June 1, 2019
After living through the Great Recession in one of the countries that was most affected by it, I have directly witnessed the consequences of austerity explained in the book. Yet this book still managed to surprise me because I had bought into the terrible discourse espoused by the people in charge and believed that some of the consequences, like mass unemployment, decrease in public health quality/access, or increase in depression and suicide rates, were due to the crisis and recession themselves, or maybe even to the corruption of the political class.
Yet the evidence here proves that it is indeed all due to austerity policies, which not only don't help economic growth, but stop it. In Europe, they've even had the fun side effects of fueling far-right parties and encouraging Brexit. The authors present their peer-reviewed research in the socio-economic causes of epidemiology in an accessible way, so there is contrasted evidence of every kind you can imagine - financial crises across time and space, with the same patterns emerging again and again from policies based only on ideology and not usefulness.
In The Body Economic, the authors have asked themselves whether our governments were ignorant or corrupt when they applied austerity policies, and they've graciously accepted the former explanation. After reading it, I'd go with the latter.
Yet the evidence here proves that it is indeed all due to austerity policies, which not only don't help economic growth, but stop it. In Europe, they've even had the fun side effects of fueling far-right parties and encouraging Brexit. The authors present their peer-reviewed research in the socio-economic causes of epidemiology in an accessible way, so there is contrasted evidence of every kind you can imagine - financial crises across time and space, with the same patterns emerging again and again from policies based only on ideology and not usefulness.
In The Body Economic, the authors have asked themselves whether our governments were ignorant or corrupt when they applied austerity policies, and they've graciously accepted the former explanation. After reading it, I'd go with the latter.
July 12, 2024
La mera existencia de un libro "tan humano", es algo que se agradece profundamente. Los autores parten de datos económicos y estadísticas, para acabar centrándose en las repercusiones humanas que todas esas políticas (tanto de austeridad como de gasto público) han acabado teniendo en la sociedad en su conjunto y específicamente en la salud.
El libro es claramente pro-keynesiano, y aboga por un nuevo New-Deal en épocas de recesión.
Uno de los grandes puntos a favor de este libro, aparte de que es un libro que se lee fácilmente, es que contiene una gran cantidad de datos y gráficos que apoyan las tesis de los autores.
Y por comentar algo negativo, quizás es un libro algo repetitivo. Las ideas centrales del libro, y sobre las que apoyan todas sus premisas, se repiten de forma continuada en cada ejemplo que nos brindan los autores.
El libro es claramente pro-keynesiano, y aboga por un nuevo New-Deal en épocas de recesión.
Uno de los grandes puntos a favor de este libro, aparte de que es un libro que se lee fácilmente, es que contiene una gran cantidad de datos y gráficos que apoyan las tesis de los autores.
Y por comentar algo negativo, quizás es un libro algo repetitivo. Las ideas centrales del libro, y sobre las que apoyan todas sus premisas, se repiten de forma continuada en cada ejemplo que nos brindan los autores.
November 21, 2018
I had very different expectations of what this book would be about. The book is largely an exploration of austerity measures as a way to combat financial and economic crisis’s and why they shouldn’t be implemented (with plenty of criticism of the IMF in the process). As such the first few chapters didn’t sit well with me, but once I got what the book was actually doing I enjoyed it more. I think the Tagline is misleading and more emphasis should’ve been placed on the actual content of the book.
November 2, 2025
Me parece un libro fundamental que todos deberíamos leer. Un libro basado en hechos, con contraste, con fuentes, apoyado en publicaciones científicas.
La austeridad mata sin duda y todos los ciudadanos deberíamos enfrentarnos a ella cuando se propone desde un gobierno. Un gobierno que solo puede proponerla desde la ignorancia, porque ya se ha demostrado una y otra vez sus efectos negativos, tanto en la salud de las personas como en la propia economía que trata de salvar.
La austeridad mata sin duda y todos los ciudadanos deberíamos enfrentarnos a ella cuando se propone desde un gobierno. Un gobierno que solo puede proponerla desde la ignorancia, porque ya se ha demostrado una y otra vez sus efectos negativos, tanto en la salud de las personas como en la propia economía que trata de salvar.
July 24, 2017
Probably the most important public health book since The Spirit Level, this excellent study of austerity and its impact on health provides an enlightening array of examples, case studies and potential remedies for our economic ills.
The book is on the short side (144 pages of core content) but provides plenty of further reading and extensive notes.
The book is on the short side (144 pages of core content) but provides plenty of further reading and extensive notes.
June 2, 2020
data driven interdisciplinary approach to the intersection of public health and economic policy ... with the conclusion that austerity in times of recession/depression is counter-productive, leading to death and failing to stimulate the economy ... many examples of how government spending in moments of recession turn the economy around while preventing death
November 30, 2020
An absolute must read. A detailed and fully referenced review of natural history experiments outlining the impact of economic policies on health. Got 5 stars because it's scientific peer reviewed evidence- the authors published most of their data and findings in high tier international journals like the Lancet. It's not so much bias as acknowledging the evidence.
June 10, 2017
What did you think when Iceland voted against their creditors? What were your views on The crisis in Greece? Read this book to get a new perspective on austerity and privatization. A must read for any one slightly interested in healthcare and politics.
December 22, 2019
In depth analyses and case studies on how austerity literally and figuratively can increase morbidity and mortality. I am curious how violence against women can be utilized similarly as a metric. Lots to think about.
March 11, 2020
Un libro que con una base evidencial muy sólida, logra desnudar las falacias de las políticas de austeridad en tiempos de crisis económica, colocando el énfasis en el derecho humano a la salud y a una vida digna.
July 5, 2021
It's fairly pollyanna about some ghoulish systems but the overarching theme is solid. It's correct about the IMF and it lays out the history of austerity measures globally in a good fashion. The part where the book falters is when discussing the US.
October 14, 2021
A well-researched and articulated book, it covers the positive (Iceland, Malaysia, etc) and negative (Russia, Greece, etc.) examples from multiple crises, and offers a different angle from "Austerity: The History of a Dangerous Idea" by Mark Blyth, which was a great but more theoretical.
January 27, 2019
Fascinating take on austerity and the potential effects of government in healthcare and debt.
June 16, 2021
If you’re looking to understand how austerity and strong governments benefits health and well-being this book does a fab job of explaining
December 31, 2021
Really interesting insights!
February 8, 2023
Pretty removed from the title, hard to connect the dots.
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