2014 Shaping the Future of New York Fridays: 11:00-1:45 Boylan Hall, 2231

I have to admit, the first thing that came to mind when I started this week’s reading in Stuckler and Basu’s The Body Economic about flawed healthcare systems was the TV show “Breaking Bad”.  And I wasn’t the only one who noticed. Daily Beast journalist Tricia Romano discusses how the entire plot of the show is only effective and plausible because it is based in the realities of modern American health care systems, as is also discussed in Chapter 6 of our reading. The authors cite the “approximately 35,000 avoidable deaths due to the lack of healthcare insurance” from a 2009 study (99) and the “cost of a private healthcare insurance plan, which could be up to $ 25,000 per year for a two-person family” (100).  Romano points to the similar situation of the fact that the main character of the show, Walter White, begins illegally cooking and dealing methamphetamine in order to pay for the $90,000 cost of his cancer treatments not covered by his insurance, and adds that he was lucky to not be one of the real “55 million Americans” without any health insurance at all (Romano). On such a large scale, the health care system in America is dealing with huge amounts of money (98), manipulative insurance companies (100), public and political pushback (99), and a lot of unnecessary deaths, which begins to make the difference between navigating a scary and difficult drug underworld and trying to get insurance coverage for serious health issues look a lot smaller.

While last week’s reading juxtaposed the economic policies of Greece and Iceland, this week showed the use of similar policies of austerity in health care systems having the same effects in both the United States and the United Kingdom, suggesting that healthcare systems that operate under the rules and polices of austerity are inherently, structurally flawed and have repeatedly led to poor health even when existing in different environments. Although Stuckler and Basu tend to present facts with elements of political bias (such as their presentation and commentary on the story of “Diane” on pages 97-99) they come up with a convincing argument supported by solid data that austerity is a policy that tends to have negative and pressurizing effects on economies and health care systems.

While singular economies are in themselves a delicate balance of consumers and producers, demand and supply, our contemporary globalized economy has added complexity to fragility because it creates a system where all single economies are intertwined and interdependent. This means that when the balance is upset in even one country, all of the other countries are affected. The cases of Iceland and Greece and their responses to economic crisis, as discussed in Basu and Stuckler’s book The Body Economic, show the effects of proposing two different solutions to the same problem of economic instability and reveal not only the complexity of a globalized economy but also the direct impacts of economy on public health. While Iceland’s increase in public spending gradually led to positive economic growth, the policy of austerity adopted by the IMF and the Greek government led to declining economic growth and poor public health. In Greece, economic crisis and unsuccessful political solutions led to a vicious cycle of public health and economy; a poor economy indicated by high rates of homelessness, unemployment, and debt leads to overcrowding and collapse of healthcare systems, which leads to increases in diseases, which worsens public health factors of homelessness and unemployment, which further damages the economy, taking us right back to the beginning of the loop.

Besides the fact that economies and public health are closely related and have the possibility to create vicious cycles of poverty, what really stood out in the reading to me were the many occurrences of the government and economic institutions such as the IMF disguising, ignoring, manipulating, and even straight out denying data that proved a strong correlation between austerity and a public with worsening health and increasing instances of disease and poverty. Once the balance of Greece’s economy was disrupted, it was like trying to put Humpty Dumpty back together again, because its economy is so inextricably tied to public health and is so delicate that many solutions should have been attempted instead of using policies of austerity and then ignoring the fact that austerity feeds directly into the already existent vicious cycle of declining economies and deteriorating public health. However, because many nations and politicians are involved in our globalized economy act as interfering factors, such manipulation of data is unfortunately common to support the interests of politicians or companies above public health. We have seen examples of this in the denial of blood banks being contaminated with HIV in the U.S., in Presidents touting invalid statistics of “welfare fraud”, and in the public ignoring disparities between race and chances of getting arrested. Too often are minorities and other disadvantaged groups scapegoated for declining public health when in fact, an economy in recession leads to the poverty that creates issues with public health, further worsening economy and stability, feeding into a vicious cycle where facts are denied to maintain and improve the interests of politicians and companies. Economic crises are related to public health and to each other in such a way that one small difference in the way a country responds to recession can have enormous impacts on the eventual outcomes of economic and public health, as exemplified by the stories of Iceland and Greece.

The poor and disadvantaged in America are blamed for their own misfortune, often advised to “get a job” or simply to “stop being poor” (no really, someone actually said that), while in reality, they have little control over their own environments and are given much fewer options than middle-class whites when it comes to jobs, housing, and education.  If a community is viewed by the public eye as “blighted”—whether that be due to racism, classism, or a mix of both and other elements—then they receive less services. Les services leads to more decay, leading to even more social disapproval, leading to more decay, etc. In this way a complex systems of government forces, public opinion and social bias, and private interest groups can create vicious cycles of poverty and neglect in urban communities, using minority groups as scapegoats for the problems that arise from systematized urban decay.  In America, minority groups are discriminated against and deal with intense social bias, leading to higher rates of poverty, and so “planned shrinkage” (aka urban decay) is encouraged through public policy (such as the racist redlining and denial of municipal services to South Bronx residents as discussed in this weeks reading) and is favorable to politicians who want the wealthiest tax base possible. Urban decay also benefits private interest groups and companies, such as lending companies that charged higher loan rates in “declining” areas in order to control who could afford to move into that area, or retail and restaurants that are often put in place of the old, deserted urban communities. Most of all, urban decay benefits institutionalized racism.  After all, it’s not really about poverty, because even if you are wealthy and a minority, chances are you will still be discriminated against and forced to make decisions with both hands tied. Just as we have been finding more and more factors that are involved in the contemporary, subtle, and systematic racism that exists in U.S. housing practices and government policies, this weeks reading by Wallace highlights several more factors that contribute to another facet of this racism: “planned shrinkage”. These factors include rates of HIV/AIDS, lack of provision of basic services leading to increases in crowding and fires, rates of drug use, and erosion of community.  The key to these policies and to Wallace’s report is that none of these factors and events are simple cause-and-effect relationships, but that each factor is an essential piece to a complicated puzzle, where each factor aggravates and is aggravated by another factor, leading to a destructive “positive feedback” loop that destroys urban areas so that they can be cleared out, bleached, and replaced with high end stores and high tax paying citizens. It looks like although the days of the “Corbu combine” might be fading, even more dangerous racist, classist policies threaten to take its place. Which do you think is worse, and why?