The Body Economic (22 page)

When the Conservative government came into power in 2010, the UK response became even worse. In 2012, the
British Medical Journal
published our paper showing that UK suicides had risen by more than 1,000 between 2007 and 2010 above pre-existing trends, corresponding to the continued rise in unemployment. Reporters soon contacted the UK Department of Health for a response. Its spokesman told the
In de pen dent
newspaper: “Losing a loved
one [to suicide] can be devastating and we want to make sure that we are doing all we can to prevent suicide by giving people the right support when they need it most. We will shortly be publishing our new suicide prevention strategy, which brings together expertise across healthcare, criminal justice and transport to maintain or even decrease the current rates of suicide.” This sounded encouraging. But then the Health Department spokesman continued: “However, suicide rates in England have been at a historical low and remain unchanged since 2005. The department uses three-year rolling averages for monitoring purposes, in order to avoid focusing unnecessarily on fluctuations instead of the underlying trend.”
²⁵

By now, this tactic should sound familiar: averaging-out deaths is the same technique The
Economist
used to cover up death rates in Russia. When using rolling averages, any large jump in death rates can seem like a smooth bump in the road instead of a shocking spike (indeed, the Department appeared to have chosen the three-year period specifically for this end, instead of some other date range like five years). The Department's comments were criticized by several university professors and statisticians, after which the statement quickly disappeared from their Internet webpage.

If it wanted to help its people, the British government could learn much from Sweden's experience. The UK would of course need to invest more in ALMPs and stop job losses from happening. But the Conservative government was doing precisely the opposite: austerity was creating an active labor-
destroying
program. The data revealed that the austerity program cut public-sector jobs in the most deprived regions of the country. Moreover, it was implementing policies that made it easier for the private sector to lay off people during the recession. As one unusually blunt 2010 report commissioned by the government explained, “some people will be dismissed simply because their employer doesn't like them,” but argued that this is a “price worth paying” to boost the economy, though the logic of how mass unemployment would drive economic growth was left unexplained.
²⁶

The consequences of the UK's real-world experiment with austerity soon became tragically apparent in its suicide data. As in the US, the Great Recession in the UK featured an initial spike in unemployment and job losses in 2007. As employment began to recover in 2009, suicides began to fall. But the following year, when the Conservative government came to power, the UK began a massive austerity program, which in 2012 alone cut 270,000
public-sector jobs. The UK then experienced a second wave of “austerity suicides” in 2012.
²⁷

It is said that those who don't learn from history are doomed to repeat it. Our models had predicted a repeat of suicide trends in Spain and Sweden, and we were now seeing their contrasting histories on playback into the present. Sweden and Spain both experienced large recessions, but suicides again rose substantially in Spain and actually fell in Sweden.

The range of observed suicide trends across the UK, the US, Iceland, Greece, Italy, Spain, and Sweden revealed that a rise in suicides can be averted during recessions. More suicides could have been prevented if the right steps were taken both before and during the recession to help people return to work.
²⁸
These suicides are only the tip of the iceberg; for each suicide there are an estimated ten suicide attempts and between 100 and 1,000 new cases of depression.
²⁹

As the Swedish and Finnish experiences demonstrate, unemployment may put people's mental health at risk, but suicides needn't inevitably follow. Nor should we wait for our healthcare systems to pick up the pieces when people become depressed or suicidal. Antidepressants may help some people deal with the consequences of unemployment. But wouldn't it be better to treat the cause of the problem rather than the symptoms? The Swedish invested proactively in programs that reached out to people who lost jobs and helped them develop an action plan for returning to work.

The sufferings of the White Widows of Italy and their husbands, “suicided” by austerity, must not be forgotten. The way forward is surprisingly clear in the data. The question is whether we will now take action.

The crows of Bakersfield started dying in May 2007.

Most Californians knew the town of Bakersfield as a hot little hellhole between San Francisco and Los Angeles—a pit stop for gas and cheap Indian food. It's a town that seemed destined to be ignored.

But when the crows of Bakersfield started dying, people started talking. First came the reports of children finding dead ravens floating in backyard swimming pools. Then other species of birds started falling out of trees. One local news crew filmed a swarm of swallows collapsing like little comets from the sky.
¹

The dying birds were frightening enough, but panic erupted when humans began developing strange symptoms. Some people had tremors. Others experienced a condition that doctors call “myoclonus”—a spasmodic, involuntary contraction of muscles that looked like the shudder of the possessed. Most became confused, and a few were paralyzed.
²

By the peak of that summer, several people had already presented at the Bakersfield Memorial Hospital with a constellation of these symptoms, which some thought might be polio, and others believed was surely the wrath of an angry God.

“Could it be over-heating?” wondered a doctor, attempting to calm nerves. That year had after all been exceptionally hot, and the winter the driest since
1988. The Kern River, typically rippling downstream from the Sierra Nevada mountains, had baked dry into a cracked muddy road. A truck driver from Arkansas had even collapsed and died of heat stroke at Bruce's truck stop on the eastern edge of town.
³

But after a few weeks, scientists from the California Encephalitis Project, a state laboratory supported by the Centers for Disease Control and Prevention (CDC), provided the Bakersfield doctors with a more rational explanation. Spinal fluid samples from the affected people tested positive for West Nile Virus.

West Nile Disease had appeared before in New York City and Texas, killing birds at first. Mosquitoes were the main vector for the disease, carrying the virus and transporting it from one victim to the next. Mosquitoes would become infected after biting the dead birds, carry the virus in their salivary glands, then transmit it to living birds, horses, and humans. In some people, West Nile infection led to a day of fever, body aches, and a rash; in others, particularly the elderly or those with weak immune systems, it caused a potentially fatal infection of the brain.

Mosquitoes had rarely caused problems in Bakersfield. Indeed, the last major outbreak of a mosquito-borne disease in Bakersfield was in 1952, when an astonishing 813 people died of Western equine encephalitis transferred by mosquitoes from infected horses. That episode led federal and state health departments to create a Mosquito-Borne Virus Surveillance and Response Plan. The CDC launched the California Encephalitis Project, a specialized lab dedicated to monitoring unexplained symptoms and deaths from around the state.

According to the CDC's data, this particular West Nile outbreak was unusual. The CDC team had found that hot weather usually reduced the chances of a West Nile outbreak, as the pools of water next to the Kern River, where mosquitoes normally bred, had disappeared. Western scrub jays and house finches, two bird species that carried the virus, had also been dying of thirst. The numbers of rural mosquitoes,
Culex tarsalis
, caught in traps by scientists were also below their 5-year averages. Given these conditions, 2007 should have been a very-low risk summer for West Nile.

Yet by the end of August, nearly 140 new human cases of West Nile had been confirmed in and around Bakersfield, a 280 percent increase from the previous year's 50 cases. Twenty-seven people had died. “Once we had one human case, it was almost like popcorn after that,” said Dr. Claudia Jonah,
the county's interim health officer. “In a year in which we should not have had any cases, we had the most in the nation.”
⁴

California Governor Arnold Schwarzenegger declared a state of emergency in the county. He was in the midst of busily writing IOUs to cope with California's major budget crisis. But in a desperate attempt to end the epidemic, he started a $6.2 million campaign to reduce the number of mosquitoes around Bakersfield.
⁵

Kern County Department of Health officials mass-mailed letters to Bakersfield homes and issued television warnings, urging all residents to stay indoors at dawn and dusk, when mosquitoes are most active. Even in the sweltering heat, Bakersfield's children and the elderly now donned long sleeves and trousers to avoid bites. Then, at 8:30 pm on August 9, planes descended in military-style flyovers across the town, blanketing homes and businesses in thick gray clouds of pyrethrin insecticide, a chemical derived from chrysanthemums.
⁶

To discover the causes of the epidemic, the Kern Mosquito and Vector Control team deployed a rapid-response outfit of epidemiologists from the University of California, led by mosquito expert Dr. William Reisen. Many possible explanations were considered. “Perhaps the current drought was crowding birds into smaller watering holes,” hypothesized Reisen's team, “where they were more likely to come into contact with mosquitoes?”
⁷

First the team requested an aerial scan of Bakersfield to probe for hot spots of dead birds and mosquito-breeding clusters. While airborne cameras provided no sign of dense watering holes where birds might be over-crowding, they did reveal an unexpected clue: clusters of rectangular green fuzz. On closer inspection, about one out of every six swimming pools, bird-baths and Jacuzzis in the town of Bakersfield had turned lime-green.

Quickly, Reisen's team set out to investigate, knocking on doors and ringing bells to find out if the pools and baths were sites of mosquito breeding. At each of the “green-fuzz residences,” they found no one home. Instead, they were greeted with “For Sale” and “Bank Owned Foreclosure” signs on nearly every lawn. The researchers had discovered the origins of the West Nile epidemic. Reisen's study found more than 4,000 larvae of mosquitoes infected with West Nile strains in 31 neglected pools.

Bakersfield was not just the epicenter of a West Nile outbreak, but also an epicenter of the nation's foreclosure crisis. Since the collapse of the US
housing market in 2006, home foreclosures in the United States had jumped by 225 percent, leading to the repossession of more than 6 million American homes. Bakersfield's situation was even worse; it was at the center of California's mortgage lending bubble, and soon became the center of the foreclosure meltdown that followed. The city had experienced a 300 percent rise in mortgage delinquency as the national foreclosure crisis began, ranking eighth among the worst-affected American cities. Almost two percent of Bakersfield homeowners had filed for foreclosure; the town of about 300,000 people listed more than 5,000 abandoned homes as the recession began. When people's homes were foreclosed and repossessed by bankers, their backyards were abandoned. Weeds overgrew, swimming pool water turned stagnant, and algae bloomed—creating the perfect breeding ground for mosquitoes.
⁸

But West Nile Virus was not the worst public health outcome of the foreclosure crisis. The gravest risks to public health came from the rise of homelessness. When people lose their homes and live on the streets or in substandard housing, their health deteriorates. The homeless experience constant stress, and are more likely to skip medications and visits to the doctor. In the worst cases, if they lose all forms of shelter, they face a heightened risk of assault, death from cold exposure, severe mental health problems, substance abuse, and of landing in jail, the hospital, or the morgue.
⁹

Public housing and housing benefits are the best medicine for counteracting the health risks of homelessness. But different governments responded in very different ways to the housing crisis brought on by recession, with dramatically different results for the health of their citizens. The United States and the United Kingdom both experienced political regime changes during the Great Recession. These transitions played a critical role in how the American and British governments responded to their foreclosure crises, with subsequently different outcomes for public health. With the American Recovery and Reinvestment Act of 2009, enacted by Congress and signed into law by President Obama, the US government began investing in social protection programs to stop foreclosures from leading to homelessness. Costly hospitalizations, premature deaths, and infectious disease rates related to homelessness were all significantly reduced in the subsequent months. By contrast, the Conservative government that came to power in 2010 in the UK, while not facing as severe a housing crisis as the US, began instituting radical measures, which
included cuts to housing support budgets. Homelessness increased following these measures, bringing with it a surge in avoidable hospitalizations and disease outbreaks.