How Austerity Kills the Public Health System


By DAVID STUCKLER and SANJAY BASU, NYT

EARLY last month, a triple suicide was reported in the seaside town of Civitanova Marche, Italy. A married couple, Anna Maria Sopranzi, 68, and Romeo Dionisi, 62, had been struggling to live on her monthly pension of around 500 euros (about $650), and had fallen behind on rent.

Angus Greig

Because the Italian government’s austerity budget had raised the retirement age, Mr. Dionisi, a former construction worker, became one of Italy’s esodati (exiled ones) — older workers plunged into poverty without a safety net. On April 5, he and his wife left a note on a neighbor’s car asking for forgiveness, then hanged themselves in a storage closet at home. When Ms. Sopranzi’s brother, Giuseppe Sopranzi, 73, heard the news, he drowned himself in the Adriatic.

The correlation between unemployment and suicide has been observed since the 19th century. People looking for work are about twice as likely to end their lives as those who have jobs.

In the United States, the suicide rate, which had slowly risen since 2000, jumped during and after the 2007-9 recession. In a new book, we estimate that 4,750 “excess” suicides — that is, deaths above what pre-existing trends would predict — occurred from 2007 to 2010. Rates of such suicides were significantly greater in the states that experienced the greatest job losses. Deaths from suicide overtook deaths from car crashes in 2009.

If suicides were an unavoidable consequence of economic downturns, this would just be another story about the human toll of the Great Recession. But it isn’t so. Countries that slashed health and social protection budgets, like Greece, Italy and Spain, have seen starkly worse health outcomes than nations like Germany, Iceland and Sweden, which maintained their social safety nets and opted for stimulus over austerity. (Germany preaches the virtues of austerity — for others.)

As scholars of public health and political economy, we have watched aghast as politicians endlessly debate debts and deficits with little regard for the human costs of their decisions. Over the past decade, we mined huge data sets from across the globe to understand how economic shocks — from the Great Depression to the end of the Soviet Union to the Asian financial crisis to the Great Recession — affect our health. What we’ve found is that people do not inevitably get sick or die because the economy has faltered. Fiscal policy, it turns out, can be a matter of life or death.

At one extreme is Greece, which is in the middle of a public health disaster. The national health budget has been cut by 40 percent since 2008, partly to meet deficit-reduction targets set by the so-called troika —  the International Monetary Fund, the European Commission and the European Central Bank — as part of a 2010 austerity package. Some 35,000 doctors, nurses and other health workers have lost their jobs. Hospital admissions have soared after Greeks avoided getting routine and preventive treatment because of long wait times and rising drug costs. Infant mortality rose by 40 percent. New H.I.V. infections more than doubled, a result of rising intravenous drug use — as the budget for needle-exchange programs was cut. After mosquito-spraying programs were slashed in southern Greece, malaria cases were reported in significant numbers for the first time since the early 1970s.

In contrast, Iceland avoided a public health disaster even though it experienced, in 2008, the largest banking crisis in history, relative to the size of its economy. After three main commercial banks failed, total debt soared, unemployment increased ninefold, and the value of its currency, the krona, collapsed. Iceland became the first European country to seek an I.M.F. bailout since 1976. But instead of bailing out the banks and slashing budgets, as the I.M.F. demanded, Iceland’s politicians took a radical step: they put austerity to a vote. In two referendums, in 2010 and 2011, Icelanders voted overwhelmingly to pay off foreign creditors gradually, rather than all at once through austerity. Iceland’s economy has largely recovered, while Greece’s teeters on collapse. No one lost health care coverage or access to medication, even as the price of imported drugs rose. There was no significant increase in suicide. Last year, the first U.N. World Happiness Report ranked Iceland as one of the world’s happiest nations.

Skeptics will point to structural differences between Greece and Iceland. Greece’s membership in the euro zone made currency devaluation impossible, and it had less political room to reject I.M.F. calls for austerity. But the contrast supports our thesis that an economic crisis does not necessarily have to involve a public health crisis.

Somewhere between these extremes is the United States. Initially, the 2009 stimulus package shored up the safety net. But there are warning signs — beyond the higher suicide rate — that health trends are worsening. Prescriptions for antidepressants have soared. Three-quarters of a million people (particularly out-of-work young men) have turned to binge drinking. Over five million Americans lost access to health care in the recession because they lost their jobs (and either could not afford to extend their insurance under the Cobra law or exhausted their eligibility). Preventive medical visits dropped as people delayed medical care and ended up in emergency rooms. (President Obama’s health care law expands coverage, but only gradually.)

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The $85 billion “sequester” that began on March 1 will cut nutrition subsidies for approximately 600,000 pregnant women, newborns and infants by year’s end. Public housing budgets will be cut by nearly $2 billion this year, even while 1.4 million homes are in foreclosure. Even the budget of the Centers for Disease Control and Prevention, the nation’s main defense against epidemics like last year’s fungal meningitis outbreak, is being cut, by at least $18 million.

To test our hypothesis that austerity is deadly, we’ve analyzed data from other regions and eras. After the Soviet Union dissolved, in 1991, Russia’s economy collapsed. Poverty soared and life expectancy dropped, particularly among young, working-age men. But this did not occur everywhere in the former Soviet sphere. Russia, Kazakhstan and the Baltic States (Estonia, Latvia and Lithuania) — which adopted economic “shock therapy” programs advocated by economists like Jeffrey D. Sachs and Lawrence H. Summers — experienced the worst rises in suicides, heart attacks and alcohol-related deaths.

Countries like Belarus, Poland and Slovenia took a different, gradualist approach, advocated by economists like Joseph E. Stiglitz and the former Soviet leader Mikhail S. Gorbachev. These countries privatized their state-controlled economies in stages and saw much better health outcomes than nearby countries that opted for mass privatizations and layoffs, which caused severe economic and social disruptions.

Like the fall of the Soviet Union, the 1997 Asian financial crisis offers case studies — in effect, a natural experiment — worth examining. Thailand and Indonesia, which submitted to harsh austerity plans imposed by the I.M.F., experienced mass hunger and sharp increases in deaths from infectious disease, while Malaysia, which resisted the I.M.F.’s advice, maintained the health of its citizens. In 2012, the I.M.F. formally apologized for its handling of the crisis, estimating that the damage from its recommendations may have been three times greater than previously assumed.

America’s experience of the Depression is also instructive. During the Depression, mortality rates in the United States fell by about 10 percent. The suicide rate actually soared between 1929, when the stock market crashed, and 1932, when Franklin D. Roosevelt was elected president. But the increase in suicides was more than offset by the “epidemiological transition” — improvements in hygiene that reduced deaths from infectious diseases like tuberculosis, pneumonia and influenza — and by a sharp drop in fatal traffic accidents, as Americans could not afford to drive. Comparing historical data across states, we estimate that every $100 in New Deal spending per capita was associated with a decline in pneumonia deaths of 18 per 100,000 people; a reduction in infant deaths of 18 per 1,000 live births; and a drop in suicides of 4 per 100,000 people.

OUR research suggests that investing $1 in public health programs can yield as much as $3 in economic growth. Public health investment not only saves lives in a recession, but can help spur economic recovery. These findings suggest that three principles should guide responses to economic crises.

First, do no harm: if austerity were tested like a medication in a clinical trial, it would have been stopped long ago, given its deadly side effects. Each nation should establish a nonpartisan, independent Office of Health Responsibility, staffed by epidemiologists and economists, to evaluate the health effects of fiscal and monetary policies.

Second, treat joblessness like the pandemic it is. Unemployment is a leading cause of depression, anxiety, alcoholism and suicidal thinking. Politicians in Finland and Sweden helped prevent depression and suicides during recessions by investing in “active labor-market programs” that targeted the newly unemployed and helped them find jobs quickly, with net economic benefits.

Finally, expand investments in public health when times are bad. The cliché that an ounce of prevention is worth a pound of cure happens to be true. It is far more expensive to control an epidemic than to prevent one. New York City spent $1 billion in the mid-1990s to control an outbreak of drug-resistant tuberculosis. The drug-resistant strain resulted from the city’s failure to ensure that low-income tuberculosis patients completed their regimen of inexpensive generic medications.

One need not be an economic ideologue — we certainly aren’t — to recognize that the price of austerity can be calculated in human lives. We are not exonerating poor policy decisions of the past or calling for universal debt forgiveness. It’s up to policy makers in America and Europe to figure out the right mix of fiscal and monetary policy. What we have found is that austerity — severe, immediate, indiscriminate cuts to social and health spending — is not only self-defeating, but fatal.

Supreme Court of India on Mass Carnage Gujarat 2002 #mustshare


” When the ghastly killings take place in the land of Mahatma Gandhi, it raised a very pertinent question as to whether some people have become so bankrupt in their ideology that they have deviated from everything which was so dear to him. When large number(s) of people including innocent and helpless children and women are killed in a diabolic manner, it brings disgrace to the entire society. Criminals have no religion. No religion teaches violence and cruelty-based religion is no religion at all, but a mere cloak to usurp power by fanning ill-feeling and playing on feelings aroused thereby. The golden thread passing through every religion is love and compassion. The fanatics who spread violence in the name of religion are worse than terrorists and more dangerous than an alien enemy.”

From the Supreme Court Judgement in the Best Bakery case. Justices Soraiswamy Raju and Arijit Pasayat 12.4.2004

 Other Direct Quotations from the Judgement

…..”When a large number of witnesses have turned hostile it should have raised a reasonable suspicion that the witnesses were being threatened or coerced.

……”Strangely, the relatives of the accused were examined as witnesses for the prosecution obviously with a view that their evidence could be used to help the accused persons.

…..”If the State’s machinery fails to protect (a) citizen’s life, liberties and property, and the investigation is conducted in a manner to help the accused persons, it is but appropriate that this Court should step in to prevent undue miscarriage of justice that is perpetrated upon the victims and their family members.

…….”Right from the inception of the judicial system it has been accepted that discovery, vindication and establishment of truth are the main purposes underlying (the) existence of courts of justice.

…….”If a criminal court is to be an effective instrument in dispensing justice, the presiding judge must cease to be a spectator and a mere recording machine by becoming a participant in the trial.

…….”Failure to accord fair hearing either to the accused or the prosecution violates even minimum standards of due process of law. It is inherent in the concept of due process of law that condemnation should be rendered only after the trial in which the hearing is a real one, not sham or  mere farce and pretence.

…….”Time has come when serious and undiluted thoughts are to be bestowed for protecting witnesses so that ultimate truth is presented before the court and justice triumphs and the trial is not reduced to mockery.

……”Legislative measures to emphasise prohibition against tampering with witness, victim or informant have become the imminent and inevitable need of the day. Conducts which illegitimately affect the presentation of evidence in proceedings before the courts have to be seriously and sternly dealt with.

……”Witness Protection programmes are imperative as well as imminent in the context of alarming rate of somersaults by witnesses with ulterior motives and purely for personal gain or fear for security. It would be a welcome step if something on those lines is done in our country.

…….”The entire approach of the high court suffers from serious infirmities, its conclusions lopsided, and lacks proper or judicious application of mind. Arbitrariness is found writ large on the approach as well as the conclusions arrived at in the judgement under challenge.

……”When the ghastly killings take place in the land of Mahatma Gandhi, it raises a very pertinent question as to whether some people have become so bankrupt in their ideology that they have deviated from everything which was so dear to him.

……’If one even cursorily glances through the records of the case, one gets a feeling that the justice delivery system was being taken for a ride and literally allowed to be abused, misused and mutilated by subterfuge. The investigation appears to be perfunctory and anything but impartial.

…….”The golden thread passing through every religion is love and compassion. The fanatics who spread violence in the name of religion are worse than terrorists and more dangerous than an alien enemy.

……’It is no doubt true that the accused persons have been acquitted by the trial court and the acquittal has been upheld, but if the acquittal is unmerited and based on tainted evidence, tailored investigation, unprincipled prosecutor and perfunctory trial and evidence of threatened/terrorised witnesses, it is no acquittal in the eye of law.

……”The modern day “Neros” were looking elsewhere when Best Bakery and innocent children and women were burning, and were probably deliberating how the perpetrators of the crime can be saved or protected.

…….”The high court appears to have miserably failed to maintain the required judicial balance and sobriety in making unwarranted references to personalities and their legitimate moves before the competent courts – the highest court of the nation, despite knowing fully well that it could not deal with such aspects or matters.

…….”We are satisfied that it is fit and proper case, in the background of the nature of additional evidence sought to be adduced and the perfunctory manner of trial conducted on the basis of tainted investigation, a re-trial is a must and essentially called for in order to save and preserve the justice delivery system unsullied and unscathed by vested interests.”

…..”A-13 to A-18 (all policemen) started fabricating false evidence and causing disappearance of evidence immediately after Bilkis lodged an oral complaint giving the names of the assailants and the details of the incident, with the intention of causing disappearance of evidence to screen the offenders.

….”The two doctors conducting post-mortem did not discharge their duties truthfully, sincerely and strictly in accordance with rules and procedure. By not collecting valuable pieces of evidence such as vaginal swabs, saliva, nail clippings and clothes of the deceased, A-19 and A-20 caused disappearance of evidence with the intention to screen the offenders.

…..”No person, however big he may assume or claim to be, should be allowed, irrespective of the position he may assume or claim to hold in public life, to either act in a manner or make speeches which would destroy secularism recognised by the Constitution of India.

……”Communal harmony should not be made to suffer and be made dependent upon (the) will of an individual or a group of individuals, whatever be their religion, be it of minority or that of the majority.

………”Religion cannot be mixed with secular activities of the State and fundamentalism of any kind cannot be permitted to masquerade as political philosophies to the detriment of a welfare State. Religion sans spiritual values may even be perilous and bring about chaos and anarchy all around.”

PRESS RELEASE- Letter to Ambassador of Italy to India


H.E.Mr Daniele Mancini

Ambassador of Italy to India

New Delhi

segramb.newdelhi@esteri.it

 Cc:

Dr Staffan de Mistura

Under-Secretary of State for Foreign Affairs

Rome

ministero.affariesteri@cert.esteri.it

 On the Italian gunmen

 Your Excellency,

 I am writing this to you as an ordinary citizen working on multilateral treaties to convey  that the Italian government’s decision not to fulfill the commitment it has made through you to the highest judiciary of India and your continued ill-reading of the UN Convention on the Law of Sea (UNCLOS) represent a grave infraction of the rule of international laws and time-tested multilaterally accepted traditions. It is my fervent hope, your excellency, that your government has not returned to the creed of fascismo or the pervasive Italian mafia has not taken over the business of national governance.

 I was puzzled by your statement that the crime committed by the gunmen could be addressed as per Article 100 of the UNCLOS. I seriously doubt if you have read the treaty before making such a claim. While Article 100 commits States to cooperate in the repression of piracy on the high seas and in areas beyond national jurisdiction, Article 101 defines what is piracy and here I quote:

‘Article 101Definition of piracy

Piracy consists of any of the following acts:

(a) any illegal acts of violence or detention, or any act of depredation, committed for private ends by the crew or the

passengers of a private ship or a private aircraft, and directed:

(i) on the high seas, against another ship or aircraft, or against persons or property on board such ship or aircraft;

(ii) against a ship, aircraft, persons or property in a place outside the jurisdiction of any State;

(b) any act of voluntary participation in the operation of a ship or of an aircraft with knowledge of facts making it a pirate ship or aircraft;

(c) any act of inciting or of intentionally facilitating an act described in subparagraph (a) or (b)’.

 

In case you made the proposal after reading the Article 101, you are obviously accusing the innocent victims who were fishing in India’s Territorial Waters as being pirates, and that your excellency is a crime in itself.

 

The whole series of arguments your government has been making have been perverted, and entirely misleading about the well-meaning international laws. If the ship was not in the Territorial Waters as you have argued, then it was certainly in the Contiguous Zone. Under UNCOLS, a foreign vessel has only a right of ‘innocent passage’ through the Territorial Waters and the Contiguous Zone. And as per Article 19 explaining the meaning of innocent passage the treaty stipulates that ‘any exercise or practice with weapons of any kind’ by a foreign ship shall be considered to be ‘prejudicial to the peace, good order or security of the coastal State’ and hence shall not constitute innocent passage. And Article 27.1.a categorically states that the criminal jurisdiction of the coastal State prevails  ‘if the consequences of the crime extend to the coastal State’.  The simple and glaringly obvious fact that the coastal State jurisdiction does not apply to a crime happening entirely on board the ship, without affecting anyone outside,  has been deliberately misread by your government to argue that Indian jurisdiction does not apply in this case. That was laughable if not ridiculous. In the impossible event of this argument being validated, any country can send soldiers or terrorists to the coastal waters of Italy and shoot  from their ship at all possible targets and Italy will have to node to the jurisdiction of the flag State addressing this. Fortunately, international treaties are not framed to endanger national sovereignty in such manner, but indeed to protect it and that is what UNCLOS does too.

 

It was also interesting that you have raised the claim of protection of the gunmen under the Geneva Convention as PoW, which actually meant that their crime was an act of war. Our government should actually have proceeded along those lines.

 

Even as you are venturing to go to unfortunate extents to protect the criminal gunmen, innocent Italians in India who have been visited by misfortune have been ignored by yourself and your government. When Italian citizens Mr Bosusco Paola and Mr Claudio Colangelo were abducted in Orissa in March last year your government did virtually nothing, in comparison to the huge risks you are taking on behalf of the gunmen, to seek their release.  An elderly Italian Mr Sebastiano Roserio Contiguglia had to die in Cuttak city two months ago as he could not afford to get adequate medical care. And remember your excellency, it was the Indian National Human Rights Commission of India and the state High Court that have asked for reports on the death of this Italian, the same judicial system that you seek to dishonour. Yourself or your government was nowhere to help this hapless Italian. Perhaps the tax paying Italian public is not aware of your double standards in dealing with Italian citizens abroad.

 

We all believe that the accused gunmen should not have been allowed to leave the country, given the ridiculous manner in which you were trying to handle the issue. I for one believed that the Italian government cannot be trusted and you proved me right. Your act of refusal to return the accused to India is an act of subversion of international laws and multilateral norms upon which the community of civilized nations conduct business. I must say tell you that this behavior is not characteristic of a legitimately constituted government, and you must immediately reverse your erroneous decision and demonstrate your civility to the world.

 

Assuring you of my highest consideration to the office you hold,

Sincerely

 

S.Faizi

Environmentalist

Trivandrum

91-9497012590

biodiversity@rediffmail.com

Member: Biodiversity Convention’s Expert Group on Biodiversity and Development

Board member: CBD Alliance www.cbdalliance.org

 

Ex-judges not in favour of #deathpenalty to rapists #Justice #Vaw


By , TNN | Dec 26, 2012, 03.14 AM IST

KOLKATA: With protesters in Delhi demanding death penalty to rapists, the Centre has appointed former Chief Justice of India JS Verma to head a committee that will review laws related to sexual assault. While the panel seeks suggestions from NGOs, jurists and the public on the present laws protecting dignity of women, a number of formerSupreme Court and high court judges feels death penalty won’t help. Life sentence will be a better punishment, they said.

While the committee seeks suggestions from the public, NGOs and jurists on the inadequacy of present laws on protecting the dignity of women, a number of former judges of Supreme Court and high court felt death penalty will not ultimately help. These legal luminaries felt death penalty can only endanger the rape victim, as rapists might try to kill the victim to wipe out evidence.

Former Supreme Court judge Justice V S Malimath, who headed the criminal justice reforms committee earlier, is against death sentence. “I do not support death sentence for rapists.

There is death sentence for murder, but has it helped to reduce murders? We make laws, but it cannot reform characters of rapists. Education is needed from childhood to inculcate moral values. Parents and school has to train to control the animal instinct in us,” he said.

Justice Malimath’s were echoed by Justice Ruma Pal, a former Supreme Court judge, said death penalty for rapists will not help. “The judge may not agree and can give benefit of doubt to the accused. It will be better if life sentence is the only punishment for rape. Investigations need to be time-bound in rape cases since delays are frequent and attempts are made to buy witnesses.”

“Women are not treated equally with men in our society, so children should be taught to respect women. Rape is not a question of sex, it is a question of power. There should be zero tolerance against persons negligent in handling rape cases. Investigating officers should be held accountable,” Justice Pal added.

Bengal human rights commission chairman and former Supreme Court judge Asok Kumar Ganguly felt use of DNA samples could help to nab rapists.

“There is a need to fast track courts to handle rape cases. Police need to be sensitized. Often rapists enjoy political patronage and the power of muscle and money,” Justice Ganguly said.

Justice M A Siddique, chairman of national commission for minority’s educational institutions and a former judge of Delhi High Court felt death penalty can only endanger the life of the rape victim, a fear shared by both Justice Ganguly and Justice Pal. “For removing evidence the rapists can try to kill the victim. Mostly rape is held in isolated place, who will save the victim?”

Views of justices Ganguly and Pal found support in Justice M A Siddique, chairman of the national commission for minority educational institutions and a former judge of Delhi high court. He felt death penalty will only endanger the life of the rape victim. “For removing evidence, the rapists can try to kill the victim. Mostly, women are raped in secluded places, who will save the victim?,” said Justice Siddique.

Some judges, however, felt the present laws were enough to handle rape cases. Justice R N Roy, former chief justice of Allahabad high court, said death sentence is for the rarest type of crime. The present laws are sufficient to handle rapists, he felt.

While Justice SM Soni, a former Gujarat high court judge and a former Lokayukta of Gujarat, said that there are enough laws to handle rape cases, Justice Shyamal Kumar Sen, former chairman of state human rights commission, said the court can opt for death penalty in the rarest of rare cases. Since there is a Supreme Court guideline, there is no need to change the law, said Justice Sen.

 

 

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