Can the Economic Crisis Create New Opportunities to Advance Public Health?

With General Motors on the brink of bankruptcy, the stock market on the skids, and consumer spending and employment in free fall, it's clear that the US economy is in for tough times. In the short run, this economic crisis will severely damage public well-being. Its burdens will fall most heavily on poor people and people of color. The crisis will exacerbate disparities in health and further weaken the public infrastructure and safety nets that support health.

But acknowledging the scope of the crisis should not prevent progressive health advocates from asking how we can use this critical moment to advance an agenda that will get at its basic causes. Most progressives concerned about health have focused narrowly on health care reform, obviously an important priority, rather than also address the deeper roots of our country's health deficits. By adding a health perspective to its economic critique, the progressive movement may be able to bring new constituencies into its campaigns for fairer economic policies and better protection against market excesses.

The current crisis can provide new opportunities to challenge three ideas that are fundamental causes of ill health: that the solution to all economic problems is more consumption; that we will not consider the sustainability of current lifestyles; and that corporations and markets are the ultimate deciders in our society.

For the last eight years, the Bush Administration's solution to all problems was for government to cut taxes and individuals to go shopping. Many observers still believe that only increased consumption can solve the current crisis and that public policy should once again persuade people to shop more. But as Nobel Prize winning economist Joseph Stiglitz has observed, "America's problem today is not that households consume too little; on the contrary ..., it is clear we consume too much." Stiglitz rejects public policies that encourage our spendthrift ways, arguing instead for social investment in rebuilding our infrastructure or investing in education and health care.

Progressives who care about health should oppose policies that encourage increased consumption as a solution in itself, since this consumption contributes to today's leading causes of illness, death and disparities - heart disease, diabetes, cancer and automobile accidents. For example, researchers estimate that if current trends in obesity and diabetes continue, our children and grandchildren will have shorter life spans than our generation, reversing a century of health progress. Corporate promotion of unhealthy food is a primary driver of the obesity and diabetes epidemics. By advocating for effective public oversight of the relentless promotion of unhealthy consumption, we can help to restore government's proper role in protecting public health.

As failing companies turn to the government for handouts, a reasonable quid pro quo is to require them to give up practices that sicken their consumers and the public. For example, if GM, Ford and Chrysler want more taxpayer dollars, then they will need to rapidly change production to emphasize fuel efficiency, mass transit vehicles and safety. Such a transformation could reduce pollution-related diseases, automobile injuries, and global warming as well as improve sales. The Apollo Alliance, a coalition of environmental, labor, and business groups that advocates for clean energy and sustainable economic growth, has long pursued these goals. Now is the time for Congress and the new President to put some muscle behind these aims. Similarly, if the food industry wants continued government subsidies, these will have to shift from less healthy products like corn and soy to healthier ones like fruits and vegetables.

Changing consuming lifestyles can also contribute to a more sustainable economy. Current patterns of consumer spending worsen climate change and exacerbate inequalities between developed and developing nations. In a speech on Wall Street last week, President George Bush told business leaders "Free-market capitalism is far more than an economic theory. It is the engine of social mobility, the highway to the American dream." For many in the world, however, the American dream has become their nightmare, contributing to an inability to afford the necessities of life, growing health disparities and the threat of continuing environmental disasters. By joining in the development of more sustainable and equitable alternatives to Bush's dream, we can insist that solutions to the economic crisis must also leave a more sustainable world and protect the health of future generations.

Finally, the economic crisis provides an opportunity to reconsider the role of corporations and government. John Dewey once said that "Politics is the shadow cast on society by big business". By shrinking that shadow, we promote democracy and health. If our government can decide in a few days to spend $700 billion to rescue our financial system, why can't it support more equitable and effective health care or food systems with the same urgency? If legislators and the public support stronger regulations against irresponsible lending, why can't government also stop pharmaceutical companies from selling inadequately tested medicines or the food industry from promoting unhealthy food to children? Restoring the credibility and capacity of the Food and Drug Administration, moving food policy from the Big Food-friendly Department of Agriculture to the more health conscious Department of Health and Human Services can be steps in the right direction.

By joining efforts to level the political playing field through reforms of campaign finance, lobbying, and expansive protection of commercial speech, advocates for health can contribute to an environment in which our constituents voices can make a difference. By emphasizing health gains that can be achieved by an active government that is willing to stand up to corporate interests, progressives working across a variety of crucial issues can ensure that their efforts will promote the well-being of vulnerable communities.

In sum, the current economic crisis will have profound effects on our political and economic systems, on how corporations make decisions, on the relationship between markets and government and on the well-being of the world's population. By finding new ways to advance an agenda that will improve public health in this climate, progressives can broaden their support during this difficult period.@hunter.cuny.edu>