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Ireland's political and cultural magazine
— October – November 2013
OPINION sinÉad PenTOny
T
HE enjoyment of good health is unevenly distributed across
Irish society. People living in deprived communities and on
lower incomes experience poorer health and live shorter lives.
Evidence is emerging of the negative impacts of New Austerity
on the health and wellbeing of the population.
The differences in the experience of health among different sec-
tions of the population are known as ‘health inequalities’. Although
some people will live longer, healthier lives due to genetic or hered-
itary factors, ‘health inequalities’ refers to inequalities which are
unnecessary, unjust and avoidable, and can be addressed through
public policies.
Our income, education, environment, work and life opportunities
all have an impact on our health. All of these factors are intercon-
nected and many of them are socially, politically and economically
influenced. Government economic and social policies have a direct
impact on people’s lives.
In , the CSO published data from the census that
clearly illustrated the relationship between life expectancy and where
people live, and their social class. There is a six-year gap in life expect-
ancy between professional and unskilled men, and a four-year gap
for women (Chart ). More recently, Census results on ‘self-re-
ported’ health shows us the very high numbers of people in unskilled
sectors reporting poor health (Chart ).
The Institute of Public Health’s work on chronic diseases shows
higher rates of coronary heart disease and diabetes among the most
deprived fifth of the population compared to the rest.
Variations in life expectancy, health and social class raise issues
of relevance to budgetary policy. Austerity is the medicine that has
been used to restore the health of the economy, and five years on, the
benefits of the treatment have failed to materialise.
Over the last five years we have experienced a sharp rise in
unemployment, incomes have fallen and public services have seen
significant cuts to their budgets, while at the same time being expected
to deliver more with less. Poverty levels have risen, with almost one
quarter (.%) of the population experiencing two or more types
of ‘enforced poverty’, which covers essentials such as home heating,
Austerity makes us sick
It doesn’t work because it reduces growth, increases unemployment and
inequality and reduces the protection against personal economic shocks and
bad health. By Sinéad Pentony
hot meals and adequate clothing. Almost one in every five children
(.%) lives in a household experiencing relative income poverty.
Expenditure cuts affect those on low and middle incomes most.
These cuts impose medium and long-term distributional costs to
those least capable of bearing them. It is too early to see the impact
of austerity in health statistics, but this doesn’t mean that the prob-
lems aren’t there.
The Simon Community, for example, has recorded significant
growth in the numbers sleeping rough in Dublin city centre – a %
increase in the first half of this year compared to the same period in
. When people lose their homes and live on the streets or in sub-
standard housing, their health deteriorates.
New research into suicide has found that the global eco-
nomic crisis may have led to almost , additional suicides across
the world in , including almost in Ireland. Suicide chari-
ties report on the growing numbers of people using their services who
are finding it hard to cope with the effects of
the recession.
The latest results from the ‘Growing Up
in Ireland’ study show that a quarter of all
three-year-old children were overweight or
obese. There was evidence of a social gra-
dient emerging, with the least advantaged
social class having the highest proportion of
obese three-year-olds. The study also found
that by three years of age children from the
least-advantaged-social-class backgrounds
were significantly less likely to be rated as
very healthy compared with children from
other class backgrounds.
While economic policies are not directly
inducing illness, they are the “causes of the
causes” of ill-health – the underlying fac-
tors that powerfully determine who will be
exposed to the greatest health risks. David
Stuckler and Sanjay Basu in ‘The Body
Economic’, use evidence from countries
over many decades to show that austerity
measures don’t work and have a detrimen-
tal effect on health.
They found that the real danger to public
health is not recession but austerity. When
social protection budgets are slashed, economic shocks like losing a
job or a home can turn into a health crisis. A strong determinant of
our health is the strength of our social-welfare programmes. When
governments invest more in social protection – housing supports,
unemployment benefits, pensions and healthcare – health improves.
This is a cause-and-effect relationship seen across the world.
They argue that austerity has failed because it is an economic ide-
ology, that is not supported by data, which stems from the belief that
small government and free markets are always better than state inter-
vention. Stuckler and Basu’s analysis demonstrates how austerity has
choked off economic growth and deepened recessions.
They found that governments that have increased public-sector
spending have seen faster economic recoveries, which in turn helps
them to grow out of debt. But the greatest tragedy of austerity is not
that it has hurt economies, but the unnecessary human suffering that
austerity has caused.
Public spending in areas such as health, education and active
labour market programmes have a critical role to play in boosting
economic growth and improving public health. Health and educa-
tion have large fiscal multipliers, typically greater than three, which
means that every euro of government spending contributes an esti-
mated three euro in future economic growth.
Ireland’s public-spending ratio in GDP terms is average by EU
standards and there remains a substantial deficit in the public finances.
However, our tax take was the sixth lowest in the EU in , which
means (at a minimum) there is scope to protect existing levels of pub-
lic spending and address the deficit through taxation.
Social and economic policies have collateral effects on health and
we need to know the full consequences of our policy choices on the
health of the population. All public policies should be evaluated for
their impact on health and health inequalities. Avoidable health ine-
qualities are wrong, and if we can make policy decisions that reduce
health inequalities, this in turn will create a better and fairer soci-
ety for all.
Every
euro of
government
spending on
health and
education
contributes
an
estimated
three euro
in future
economic
growth
“
Professional
Managerial
Non-manual
Skilled Manual
Semi-Skilled
Unskilled
Other
Professional
Managerial
Non-manual
Skilled Manual
Semi-Skilled
Unskilled
Other
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
Professional Skilled Manual
Unskilled
60
50
40
30
%
20
10
0
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