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

The readings this week discussed intervention in social policy, which ultimately affects public health. The success of of CCTs in Chile, Mexico, and Brazil reinforce the idea of public health and social issues being one. I really liked the idea of participatory budgeting that was mentioned in connection with Porto Alegre. This reminds me of the same democratic route that Iceland took after its banking crisis, and the success that was seen with that. It strengthens the idea that people know what is good for them, and including them in the decision-making is a good idea. The results of this type of budgeting show that it is policy-makers, and not the middle and upper class citizens, who tend to ignore those areas that need the most help, as those people voted to improve slum neighborhoods rather than their own.

I was a little confused about this statement: “Governments recognize that poverty lines do not accurately differentiate the poor from the non-poor”. Does this mean that those above the poverty line are still poor enough to require economic aid? If so, then poverty lines seems like an arbitrary number that convey little meaning in a practical sense.

I do wonder how we could implement CCTs in NYC, and how to remove the stigma that is associated with social benefit programs, so that we can target and improve the lives of those who need it the most in our city.

After discussing specific examples of countries that either implemented to rejected austerity principles in Parts I and II of The Body Economic, the authors explore specific social programs that affect health in certain countries. The more austerity measures a country uses, the more they will cut funding to those programs, and this directly affects the health of people in that country.

Most obviously, national healthcare is one program that affects the health of the people. The story of Diane illustrates what is wrong with the healthcare in the US today, and the authors seem to think the same could happen in the UK, with the NHS moving towards a more market-based system. This leaves me to wonder: surely policy-makers in the US realize the countries with national healthcare are the healthiest? I cannot accept that it is simple economics that keeps the US from going the way of Europe. Even “Obamacare,” isn’t exactly the same universal healthcare we keeping hearing people praise in countries like Denmark and Sweden. The US rejects anything like that, and I wonder why, since those countries are generally extremely healthy and (not to be punny) wealthy as well. Is it possible that such a universal system would not work on a country the size of the US? I cannot think of another country with the population of America that maintains a good economy and has a universal healthcare system. I know this isn’t the only piece in this puzzle, but it may play a role.

I also found it incredibly interesting that the foreclosure crisis in the US led to an outbreak of West Nile Virus. I feel like this is something that could have been easily overlooked, as it is not a direct result of forecloses, the way that homelessness and health problems associated with that are. I like the way the authors point out these connections and show us that the ramifications of changes in the economy can be far-reaching and unexpected.

The second part of The Body Economic brings us to familiar times: The Great Recession. Iceland and Greece are compared for the way they implemented different policies after the banking crisis, and those decisions had immense impacts on the citizens of those countries. Reading the chapter on Iceland was so interesting, as I had not known that the government essentially brought the issue of austerity and social programs to the people.

It seems obvious that ordinary people should not have to pay for the mistakes of rich bank executives who invested private money in risky investments. The idea that the government’s money should be used to repay private investors of a bank is ridiculous. But that would have happened, had Iceland followed the austerity recommendations of the IMF. Thankfully, it was brought to a vote, and the exact opposite occurred.

I really liked the way the authors brought in the mindset of philosopher John Locke and economist Milton Friedman to illustrate the world’s opposition to Iceland’s democratic move. Locke’s theory of the “tyranny of the majority,” which I had previously thought of as true in just about all cases, becomes such an oppressive view when looked at from the perspective of public health. It basically assumes that people are too stupid to vote for policies that will benefit them, which is ironic, because the “Wall Street option,” austerity, has been shown to be more deadly than anything the people voted for. Iceland’s economic recovery was a direct result of the decision to reject austerity, and put the people first. Allowing the banks to go under, instead of believing in the “too big to fail” mantra of the US, allowed Iceland to rebuild its economy, and encouraged accountability in the new banks that are now in Iceland. And that is before mentioning any of the health benefits of rejecting austerity. Perhaps we should take a leaf out of Iceland’s book.

In contrast, the situation in Greece broke my heart. The continued austerity recommendations from the IMF has caused such a terrible health and economic situation in the country, and it’s impossible to know how far-reaching the consequences will be. The rates of suicide and HIV are extremely alarming, and the social unrest is terrifying, but understandable.

Recent news says that Greece is slowly recovering, and at least according to ABC news (http://abcnews.go.com/International/wireStory/government-finances-improved-europe-2013-23435242), things are looking better. But you cannot bring back those whose lives were lost because of certain policies, and that is extremely sad.

I find it ironic that austerity, which looks at economy first, and health second, does not even improve the economies of those countries in which it is implemented. It is based upon principles like cutting spending, which sound effective, but sadly are only so in theory. The IMF really needs to take a look at what austerity has done to human life, and reevaluate their recommendations.