Spain and Italy, two of the countries most affected early on by COVID-19, were also among the EU member-states that underwent severe and extended austerity measures following the last global economic recession. These measures significantly weakened publicly funded healthcare systems in both countries, and as it is particularly relevant to understanding the trajectories of pandemic, constrained public sector response.
The global financial downturn often characterized as beginning in 2007-2008 (Carballo-Cruz 2011) had a somewhat delayed effect in both Italy and Spain. By mid-2012 however, the economies of Italy and Spain were declining; unemployment (especially among youth); foreclosures; and evictions skyrocketed, and both governments began to disproportionately pass Eurozone-imposed austerity measures onto the autonomous regions of Catalunya and Sicily (Raventós and Wark 2012; Nastasi and Palmisano 2015; Navarro 2013), the regions where we work as anthropologists. Research conducted since the global financial crisis throughout Europe, but particularly in Italy and Spain, demonstrates that austerity damages health — largely by constraining public health system resources — in turn impacting both access to care, and the quality of care obtained (Basu et al. 2017; Legido-Quigley and Greer 2016; Ostrach 2017; 2020).
Italy’s austerity measures affected multiple public sectors, but arguably had the most profound impacts on the nation’s healthcare, education, and pension systems (Nastasi and Palmisano 2015). Transformations within the healthcare sector as a result of austerity measures included layoffs of nurses and other essential personnel, hiring and salary freezes for healthcare workers, shorter hospital stays and fewer hospital beds, higher user fees – deterring many would-be patients from seeking care – and fewer preventative healthcare visits, and worse nurse to patient ratios (Carney 2017). These transformations led to a “brain drain” effect in Italy’s healthcare sector, prompting many healthcare workers to migrate in search of work outside of Italy. Those who continued to work in Italy’s weakened healthcare sector reported increased levels of occupational stress linked to higher caseloads and higher numbers of “patients with social problems” (Palese et al. 2014: 168). With wide-sweeping cuts to public programs, high unemployment, and healthcare avoidance, chronic health conditions soared among Italian citizens. Unsurprisingly, such trends were especially pronounced in Italy’s southern regions where the public sector has been repeatedly neglected by decision-makers in the national government and underdeveloped in comparison with regions in the north (Carney 2017).
In the face of the economic crisis, Spain reduced national health and social services funding by nearly 14% and in late 2012 excluded unregistered migrants from all but emergency, prenatal, and pediatric healthcare (Legido-Quigley et al. 2013); by 2013 residents of Spain faced longer wait times for care (Navarro 2013). Within a few years, workers in the Spanish public health sector perceived that austerity measures, including reduced staffing levels in healthcare facilities, negatively affected the quality of care they were able to provide, and worsened outcomes for their patients (Cervero-Liceras, McKee, and Legido-Quigley 2015; Heras-Mosteiro, Sanz-Barbero, and Otero-Garcia 2016). Foreshadowing the current devastating impact of coronavirus on Spanish clinics and hospitals now under-staffed and under-resourced to meet local needs; health workers interviewed soon after austerity measures took effect predicted things would get worse (Heras-Mosteiro, Sanz-Barbero, and Otero-Garcia 2016).
It is thus no mystery that neither Spain’s nor Italy’s health systems proved able to keep up with the demands of caring for coronavirus patients; not because publicly funded healthcare is fundamentally unequal to the task — but because austerity following financial crisis hamstrung health systems otherwise intended to be egalitarian.
Should the economies of Italy and Spain collapse as a result of these recent public health demands, or the economic impact of responses to them, the EU must not implement additional austerity measures. Additional austerity measures would only exacerbate weaknesses in the healthcare systems of both countries and further compromise the public sector’s ability to cope with future public health emergencies.
Finally, it is also important to remember that “austerity” as a policy approach encompasses a particular set of practices and values and renders differential effects (Muehlebach 2016). The “winners” and “losers” of austerity regimes are always already pre-established. As ordinary citizens and the poorest of the poor are told that they have been living beyond their means and are subjected to the dismantling of essential safety nets, private interests are invited to check off their wish lists and to stuff their own pockets (Basu et al. 2017; Klein 2007; Pfeiffer and Chapman 2010). As world governments attempt to mitigate the effects of COVID-19, we should remain vigilant also of the very institutions where we work and under whose supervision we conduct research — and register the implications of such entities now contemplating or implementing austerity measures of their own.
Basu, Sanjay, Megan A. Carney and Nora Kenworthy. 2017. “Ten years after the financial crisis: The long reach of austerity and its global impacts on health.” Social Science and Medicine 187: 203-207.
Carney, Megan A. 2017. “‘Sharing One’s Destiny’: Effects of austerity on migrant health provisioning in the Mediterranean Borderlands.” Social Science and Medicine 187: 251-258.
Cervero-Liceras, Francisco, Martin McKee, and Helena Legido-Quigley. 2015. “The Effects of the Financial Crisis and Austerity Measures on the Spanish Health Care System: A Qualitative Analysis of Health Professionals’ Perceptions in the Region of Valencia.” Health Policy 119 (1): 100–106.
Heras-Mosteiro, Julio, Belén Sanz-Barbero, and Laura Otero-Garcia. 2016. “Health Care Austerity Measures in Times of Crisis: The Perspectives of Primary Health Care Physicians in Madrid, Spain.” International Journal of Health Services 46 (2): 283–299.
Klein, Naomi. 2007. The Shock Doctrine: The Rise of Disaster Capitalism. New York: Picador.
Legido-Quigley, Helena, Laura Otero, Daniel la Parra, Carlos Alvarez-Dardet, Jose M. Martin-Moreno, and Martin McKee. 2013. “Will Austerity Cuts Dismantle the Spanish Healthcare System?” Bmj 346: f2363.
Muehlebach, Andrea. 2016. “Anthropologies of Austerity.” History and Anthropology 27 (3): 359-372.
Nastasi, Giuseppe and Giuseppe Palmisano. 2015. The Impact of the Crisis on Fundamental Rights Across Member States of the EU. Country Report on Italy. Report commissioned by the LIBE committee, European Parliament. Accessed January 20, 2020: http://www.europarl.europa.eu/thinktank/it/document.html?reference=IPOL_STU(2015)510018
Pfeiffer, James and Rachel Chapman. 2010. “Anthropological Perspectives on Structural Adjustment and Public Health.” Annual Review of Anthropology 39: 149-65.
Palese, A., et al. 2014. “Financial austerity measures and their effects as perceived in daily practice by Italian nurses from 2010 to 2011: a longitudinal study.” Contemp. Nurse 48 (2): 168-180.
Megan A. Carney is an assistant professor in the School of Anthropology and director of the Center for Regional Food Studies at the University of Arizona. Her second book “Island of Hope: Migration and Solidarity in the Mediterranean,” based on several years of fieldwork in Sicily, is forthcoming with University of California Press. Follow her on Twitter @megan_a_carney.
Bayla Ostrach is appointed faculty in Medical Anthropology and Family Medicine at Boston University School of Medicine, currently working as a Research Scientist with UNC Health Sciences at MAHEC, based in Asheville. They have studied access to abortion via publicly funded health systems and migrants’ access to reproductive care in Oregon and Catalunya, as well as syndemics. They are the author of Health Policy in a Time of Crisis: Abortion, Austerity, and Access.
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