UK: Learn from the Global South - don't cut health

Tonight on the BBC I heard a fascinating and disturbing account of the necessity of the UK government cutting public expenditure due to the Financial Crisis. This is hardly surprising. But there is a clear lack of learning from previous Financial Crises in the Global South. If we can learn from the developing world, we might avoid tremendous suffering.

Let me save you the trouble of doing the background reading that I've been doing recently. In the past 50 years there have been dozens of macro-economic and financial crises in the developing world. There is no doubt (not by the IMF, not by the World Bank, not by any credible source) that financial crises impact the general society, and especially impact poor people. Some (respectable folks in Development Banks) estimate that macro-economic 'shocks' have been one of the chief causes of poverty. It's never just about the bankers (and governments frequently think it will be.) And, just in case you were wondering, bailing out bankers doesn't have a good track record in terms of restoring overall economic health.

There have been, literally, hundreds and hundreds of studies done on financial crises. Those that attend to social policy agree that 1) government ability to spend on the public will decrease because tax revenues will decrease because people are not earning as much and 2) when governments are able to put in strong social protection policies, this eases the pain of the crises (especially for poor people) and helps lead to a faster recovery.

Too often, governments take a long time in putting together the needed social protection policies. Which means that thousands suffer when they didn't have to. In the developing world, 'suffering' often can be translated into children dropping out of school, women are forced into the informal labor sector (read: prostitution), children are malnourished (which has devastating long term health impacts), babies die, etc. As the head of the Financial Times said yesterday, this recession is quickly turning into a Depression - it will continue to impact regular people. If we don't deal with acute situations, they quickly become chronic.

Frequently, the longer the governments wait to enact good social protection policies, the harder it gets (politically) to devise a good policy. Working with what you already have, even if it is not perfect, is a good and important start. Policies might include increasing scholarships, subsidizing basic food stuffs (corn, rice, cooking oil), increasing child-care programs, increasing school-lunch programs.

Time and again, research consistently points to the importance of focusing on health. That's because our bodies are essential. For poor people, their bodies are often their livelihood - manual labourers, housecleaners, mining, waiting tables - many basic, low-entry jobs require a functioning body.

Cutting health expenditures in a time of economic turn-down is one of the most disastrous things any government could do. It's really externalizing the cost of health care to the family level - which means to women, who are generally the care-takers.

I'm not saying no cuts in health should be made - cuts in pay could help some parts of the system, and attending to efficiency is important. But too many pay cuts leads to overworked and cranky staff unable to deliver good care, and privatization rarely ensures that vulnerable populations get the care they need. Learn from the developing world. Put health - and thus people first.