Protecting Health in Bad Economic Times
istered by doctors or nurses. It was directed by politicians,
Along with collecting data and pushing for better safety
economists, and ministers of finance.” So wrote David
nets, HSPH faculty are exploring ways to buffer people
Stuckler and Sanjay Basu in The Body Economic, making the
from the health impacts of economic downturns. Laura
case that economic policies can have profoundly toxic public
Kubzansky, for example, is looking at the biology of resil-
health impacts—or profoundly restorative effects when
ience. “What are the resources that would mitigate the
nations increase spending during economic downturns for
impact of stress?” she asks. “What are the assets that
programs such as health care, food stamps, and housing.
enable people to meet life’s demands in a hardier way?
But in American culture, this broad social perspective is a
Wouldn’t it be great if we knew the answers and put some
hard sell. “The idea that people can collectively act to change
proven protections in place before the next recession?”
things cuts against the American myth of self-sufficient indi-
More specifically, Kubzansky and other researchers
viduals who pull themselves up by their bootstraps,” says
are seeking to determine whether positive psychological
Krieger. “Linking economics to health, and suggesting that
factors and emotional states shield people from coronary
there’s a social production of disease, is not the mainstream
heart disease (CHD). Several studies have found that opti-
analysis—even as it’s very common in other countries.”
In essence, all of us who lived through the Great Recession are part of a massive experiment still underway. mistic people have about half as much risk of developing
Another argument for a broader frame of reference is the
CHD as their more pessimistic peers. Another study
fact that public health and economic prosperity is a two-way
has linked optimism to a slower rate of atherosclerotic
street. It’s not surprising that President Franklin Roosevelt’s
progression over a three-year period. And decades of
New Deal—the panoply of social and economic programs
health psychology research have demonstrated the posi-
enacted between 1933 and 1938 and credited with pulling
tive impact of social support—such as family, friends,
the country out of the Great Depression—has been described
neighbors, co-workers, pets, and governments and orga-
as a massive public health program. And as David Bloom,
nizations that can lend assistance—on physical well-being
the Clarence James Gamble Professor of Economics and
and longevity. As researchers identify individual-level
Demography, has shown, not only does wealth make health,
factors that promote resilience, they also want to under-
but health makes wealth—in part because healthier people are
stand the structural and social arrangements that promote
more productive and less likely to cost health care dollars. These
or hinder these advantages.
findings suggest that a national focus on improving Americans’
“What drives resilience in some individuals? What
health even in economic downtimes can be part of an overall
leaves others more vulnerable?” asks Williams. “Those are
economic stimulus.
the public health questions we need to answer.”
For public health practitioners, acting on lessons from the Great Recession will require both energy and ingenuity. “There
© Alison Wright / Corbis
A New Public Health Agenda
has to be an activist agenda,” says Viswanath, with academics
In essence, all of us who lived through the recent reces-
translating the evidence in ways that inform public discourse—
sion are part of a massive experiment that is still under
and, in turn, national programs and policies. “We are fixated
way. “Thank you for participating in this clinical trial. You
on the upstream factors—the recession and its direct economic
might not recall signing up for it, but you were enrolled in
costs. But the downstream factors—the terrible impact on
December 2007, at the start of the Great Recession. This
health—are already far along.”
experiment was not governed by the rules of informed
Amy Gutman is a senior writer for Harvard Public Health.
consent or medical safety. Your treatment was not admin-
25 Spring 2014