Struggles for Health in the Age of Austerity – seminar review

Often used to describe fiscal restraint, austerity implies a form of extreme economic sacrifice. However, in challenging economic environments, this severity is not felt by everyone, as austerity measures are not distributed equally throughout the population and “[their] effects on health are selective, cumulative, intergenerational and unequal.”

Photo: William Murphy via Flickr

Dr. Lori Hanson,
University of Saskatchewan

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Dr. Lori Hanson from the University of Saskatchewan, Canada, presented a fascinating breakfast seminar co-organized by the Centre for Development and Environment and the Centre for Global Health, UiO, on Friday the 9^th of June. Dr. Hanson described her experience dissecting the implications of budget cuts in the province of Saskatchewan in Canada in the context of health and equity.

Austerity is always selective, noted Dr. Hanson, and contrary to popular belief it is not inevitable - it is a deliberate political choice for addressing fiscal problems. The Global Health Watch describes austerity measures as Neoliberalism 3.0. Indeed, austerity is the third iteration of neoliberalism, concurred Dr. Hanson, with each replication intensifying the fundamental reorganization of the state. Contrary to the message that is commonly sold to the public, austerity is not a temporary measure to dig the economy out of adverse conditions or deficit, but rather, it has long-lasting effects on the system of organization of the state, which are difficult if not impossible to reverse.

The federal government of Canada delegates certain powers over matters concerning local or provincial issues such as taxation, property and civil laws to provincial governments. Health, education and social services fall primarily under provincial jurisdiction. In March, 2017, the Saskatchewan provincial government released a budget that dictated decreased or cut funding to many public services and programs in health care, education and transport, leading to privatisation of several previously state-owned services, and consequently job losses. Although economic hardship is felt by an entire country or province, the “tough decisions” discourse used by governments to justify introducing austerity policy is often unequally distributed among the population. Austerity measures have both losers, commonly the poor, marginalised, disabled, elderly, unemployed and those in insecure employment, and winners, those who benefit from privatisation and exploitation of state assets and services.

When policies across different sectors are implemented in the name of austerity, the effects are also complex and cumulative, says Dr. Hanson. Groups who are particularly disadvantaged by the downsizing of a variety of social services at once experience cumulative disadvantage stemming from multiple sources. These “multiple sufficient causes”, previously described by Glymour, Avendano and Kawachi, create a barrier for addressing inequity in health outcomes, because isolating and addressing any single cause will not be enough to enable the achievement of good health.

Broad citizen-based resistance is a way to remind the government of the power of civil society, express the struggle of ordinary people, and move closer towards governance based on justice and equity. Apart from the age-old process of change through electoral choice, civil movements need to concurrently organize to re-democratize unions, strengthen civil society organisations, and demonstrate moral choice in the form of street protests and other forms of civil disobedience, says Dr. Hanson. As these measures affect many different sectors spanning through health, education, housing and employment, no single sector can take on a government in isolation. Social and health activism urges action to capitalize on the “nutcracker effect” – “the power of the combination of top down and bottom up action on health equity”. Moreover, the principle of civil society is based on solidarity – recognising and taking on someone else’s struggle even if it does not affect you directly. Quoting activist scholar Keeyanga Yamahtta Taylor, Dr. Hanson ended noting the vital role of understanding and engaging “history, struggle, solidarity and hope”. Indeed, the importance of challenging unfair and unequal policy lies in the hands of civil society and the people, whose voice demands to be heard.