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Mitigating the wider health effects of covid-19 pandemic response

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1557 (Published 27 April 2020) Cite this as: BMJ 2020;369:m1557

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Re: Mitigating the wider health effects of covid-19 pandemic response

Dear Editor

Douglas and colleagues (1) offer a welcome and reasoned assessment of how the lockdown that has shut down large sections of the UK economy, and indeed the world’s, is likely to ratchet up health inequalities in the absence of decisions to avoid further austerity and 'build a more sustainable and inclusive economy'.

However, they do not inquire into the political economy of such decisions. Even if the governing party wishes to repudiate the decade of austerity that compromised both social justice (2) and capacity to respond to the pandemic, the relevant policy choices may be dictated by the requirements of financial markets and the International Monetary Fund (IMF); the Fund may well function as a gatekeeper to those markets as it has done for much of the developing world in the past decades. (3)

Consequently, as I have argued, (4) the best model we have for the effects on wider health indicators may be the collapse of the Russian economy after the dissolution of the Soviet Union, whose direct effects were worsened by IMF “shock therapy” prescriptions. (5) A quarter century later, the effects of eventual economic recovery are still only partially reflected in improved Russian life expectancy, (6) perhaps as a result of the capital flight and dramatic increases in inequality that accompanied the recovery. We would do well to be warned.

References
(1) Douglas M, Katikireddi SV, Taulbut M, McKee M, McCartney G. Mitigating the wider health effects of covid-19 pandemic response. BMJ 2020 April 27;369:m1557.
(2) Alston P. Visit to the United Kingdom of Great Britain and Northern Ireland: Report of the Special Rapporteur on extreme poverty and human rights, A/HRC/41/39/Add.1 .New York: United Nations; 2019. https://undocs.org/A/HRC/41/39/Add.1.
(3) Kentikelenis A, Gabor D, Ortiz I, Stubbs T, McKee M, Stuckler D. Softening the blow of the pandemic: will the International Monetary Fund and World Bank make things worse? The Lancet Global Health 2020; doi: 10.1016/S2214-109X(20)30135-2.
(4) Schrecker T. No exit? The United Kingdom's probable Russian Future. Health as if Everybody Counted (second edition) [On-line]. 2020 April 18. https://blogs.ncl.ac.uk/theodoreschrecker/2020/04/18/no-exit-the-united-....
(5) Field MG, Kotz DM, Bukhman G. Neoliberal Economic Policy, "State Desertion," and the Russian Health Crisis. In: Kim JY, Millen JV, Irwin A, Gershman J, editors. Dying for Growth: Global Inequality and the Health of the Poor. Monroe, Maine: Common Courage Press; 2000: pp. 155-73.
(6) Shkolnikov VM, Andreev EM, Tursun-zade R, Leon DA. Patterns in the relationship between life expectancy and gross domestic product in Russia in 2005-15: a cross-sectional analysis. The Lancet Public Health 2019;4:e181-e188.

Competing interests: No competing interests

08 May 2020
Ted Schrecker
Professor of Global Health Policy
Population Health Sciences Institute, Newcastle University