Tuesday, July 21, 2015

The bioethics of austerity

One of the more depressing aspects of the crisis in Greece is the cartoonish way the plight of the Greek people has been portrayed. It is as if ordinary Greeks had all taken out massive and reckless loans, and when asked to pay them back, they stubbornly refused. The nerve of such people! Do they want money for nothing? Can't they pay off their debts like us, i.e. hard-working sensible people? How lazy and irresponsible of them.

Africans may view all this with a sense of dรจja vu. In the years after independence, the ruling class of African countries brought their economies into debt, while rulers enriched themselves from revenue generated by the selling off of their natural resources to the developed countries in the North. In the 1980's and 1990's, the collection agencies of the international creditor community (i.e. the World Bank and the IMF) imposed 'structural adjustment programs' that involved reducing expenditures by the public sectors -- especially education and health -- opening up markets to foreign investment and establishing debt repayment schemes. This was austerity avant la lettre, whose effects in Africa were largely catastrophic and are still felt right up to this day. In this way, Africa was a laboratory for a new, 'bloodless' way of dominating and exploiting other countries, not by armed conquest, but by debt. Debt in this geopolitical context is not like the debt you incur when you voluntarily take out a loan to buy (say) a car. No ordinary African citizen voluntarily asked for despots and kleptocrats to siphon off national resources, run their country deep into the red, and then agree to repayment terms and conditions that gut their schools and hospitals. Africans are familiar with European powers doing this to them, and accusing them of laziness in the process.  Europeans doing it to one of their own: now that is new.

Just like the African case, the Greeks are getting hit ... right in the health sector. Crumbling infrastructure, doctor and nurse burnout and brain drain, use of cheap but unsafe materials, shortages of medical supplies, increasing inability of patients to pay for services: all the classic symptoms of austerity health care. The imposition of austerity will be predictably associated with avoidable morbidity and mortality -- and it is avoidable because austerity is a political construct, not a natural event. If the more powerful countries want to bail out or provide debt relief to certain countries or institutions, they can and they have. So they are at least partly responsbility for those consequences when they decide not to, both in the old African case and the new Greek one.

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