Andrew Coates: The Human Consequences of Austerity

Apr 22, 2013

I live in upstate New York. If you're hearing this, chances are you do too.

One of my great friends at the university once casually remarked that it seemed the whole world came through our community. "Look deeply enough into anyone's family history and you will find a connection," she said. "Some part of everyone has been here one way or another."

Her consciousness about the connectedness of one community to the whole world reminded me of a fragment by Franz Kafka:

"You do not need to leave your room. Remain sitting at your table and listen. Do not even listen, simply wait, be quiet, still and solitary.

The world will freely offer itself to you to be unmasked, it has no choice, it will roll in ecstasy at your feet."

When the world is busy rolling up at our feet it reveals that upstate New York, like anywhere, has its own distinct and proud culture. From it, our own William Kennedy, Richard Russo, Lauren Groff and many others have spun great literature. Just think, for example, of the extraordinary catalogue of people who have come through Yaddo or Caffe Lena, both in Saratoga, or Bard College, just down the Hudson, and all that these people have shown us, collectively, about life and our world.

In other words, knowing one's community well can be, as my friend was pointing out, a way to understand the whole world.

We physicians have earned great scientific insight into health and illness in our patients. But we also gain great human insight -- how the conditions of everyday life impact the fate of our patients. 

Ultimately an understanding the culture and the economy of our community is inescapable if we are to serve our patients and our profession. This leads to a sense of connectedness with the whole world.

Lately I've been struggling to overcome a sense of shock as I learn about the living conditions and the daily life distress faced by my patients.

I feel a bit like Rip Van Winkle, for after several years away from hospital medicine I returned to full time. In the hospital an entire slice of life, a cross section of all cultures and classes and ages, streams into the building, for we all face a risk of acute medical illness. It has opened my eyes.

The ravages of drug addiction -- how it can tear families asunder; the weight of a serious illness upon a spouse -- how people forfeit their homes and their jobs because of a family health crisis; how temporary and part-time jobs, always with no sick time, force the postponement of necessary medical care, not only for the person with the difficult job, but for their children, their parents, anyone who depends upon them. These issues arise again and again and in the most personal way. 

Things have gotten worse in our community over recent decades -- and I am a frontline witness.

To illustrate our connectedness to the world, a study published this week in the American Journal of Public Health looked at the adverse health consequences of the economic recession and subsequent austerity measures in Greece over recent years. The team of Greek and American researchers found, for example, that between 2007 and 2009, suicide rates among men rose 22.7 percent.  Homicide mortality rates among men increased by 27.6 percent.

Mental disorders, substance abuse, and infectious diseases showed worsening trends. In turn, the government cut public health spending dramatically. In short, government austerity is bad for our health.

Meanwhile UNICEF published a study of child well-being in the 29 wealthiest nations. My friend Dr. Don McCanne pointed out that out of 29 nations Greece was ranked number 25. The United States was behind Greece at 26th.

As I read these studies the tears and sobs of my patients and their loved ones leapt to mind. The human stress of illness in the context of difficult economic times has been worsened by austerity here, just like Greece.

The same schemes of privatization, deregulation and cuts to public programs that have happened in Greece can be found in every community in upstate New York.

The people who make the decisions don't seem to understand the human consequences of austerity policies on top of the difficult economy.

But for those of us who know and love our home communities and our local culture -- whether upstate New York or Greece or anywhere -- the tragic health effects tear a hole in our hearts and our future.

Dr. Andrew Coates practices internal medicine in upstate New York. He is President of Physicians for a National Health Program.

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