Comment

Oine: Going under

Mark Walport, the UK Governments new Chief Scientic Adviser, recently gave a lecture entitled Science advice in government: the next 5 yearsa work in progress. His opening slide was a list of priorities for his new role. First, Knowledge translated to economic advantage. Second, Infrastructure resilience. Third, Underpinning policy with evidence. Fourth, Science for emergencies. And nally, Advocacy and leadership for science. Walport has been criticised by someThe Guardians George Monbiot, for examplefor placing primacy on economic growth rather than human welfare. And it is surprising that the word people or citizens doesnt appear anywhere in his list of priorities. Look at the US Constitution: We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America. Here are ve basic functions of government that still hold true today, even for government science advisers. But look again at Walports list and you will see one strength: a set of propositions that are about science, knowledge, and evidence in the service of protecting societies. It is a pity that Greeces political class did not have the benet of this list, for in some ways it is superior to the US Constitution, and as timeless too. For Greeces genuexion in the face of what is now admitted to have been a disastrous blunder by the International Monetary Fund (IMF) has led to a catastrophic contraction of the Greek economyby 17%, against the 55% predicted by the IMF. The Fund now says that it got its sums wrong, that its economic projections were too optimistic. As a result, market condence was not restored...and the economy encountered a much deeper than expected recession with exceptionally high unemployment. Well, yes. *
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to cut rather than invest. Stuckler and Basu want to arm the public with the information they need to make informed, democratic choices about their economy and their health. The basic maths is disarmingly simple. If you invest in social programmes, such as health, you get a huge economic return on your investment. Health delivers wealth. And the opposite is true too, illustrated by Stuckler and Basu across several examples of economic strife, from the New Deal to Russias post-communist collapse. Anything you do to harm health will damage your wealth creating abilities. And this is what has so damaged Greece. IMF and the European Union imposed shock therapyan austerity that has led to a collapse in the health systemhas caused rising rates of illness and disease, including suicides, infectious diseases, and substance misuse, and so a reduced opportunity to draw on a t population to pull the economy out of its nosedive. Stuckler and Basu settle some old scores too. Je Sachs is criticised for being on the side of the shock therapists. To achieve a real, lasting human recovery, Stuckler and Basu write, we must fundamentally change the way we think about whats important. * So how might we rewrite Walports opening slide? Why not this: Knowledge translated to health, wellbeing, and security. The evidence shows that investments in health and wellbeing will bring economic dividends. Walports slide excises a crucial element in the causal chain between knowledge and economic success. And the product of those twin forces (knowledge for health) will be human securitya security dened not merely from a national perspective, but from the perspective of individuals, families, and communities. These are not idle arguments. In the UK, the next stage in our recovery, according to the respected Institute for Fiscal Studies, will be deepening inequality and poverty. Meanwhile in Greece, a small part of their democratic culture was last week extinguished when the government closed its public television broadcaster. Is this a glimpse of the futureausterity and the manufacture of crisis as a prelude to the gradual erosion of our freedoms? Well, yes. Richard Horton
richard.horton@lancet.com

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Greeces tragedy might have been averted, or at least cushioned, if their politicians had not only studied Walports list but also read The Body Economic, an extraordinary book by David Stuckler and Sanjay Basu. Their work is subtitled why austerity kills. But the intent is not simply a diatribe against governments that prefer
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www.thelancet.com Vol 381 June 22, 2013