Labonté Ronald, Stuckler David
Department of Public Health and Preventive Medicine, University of Ottawa, School of Epidemiology, Ottawa, Ontario, Canada.
Department of Sociology, University of Oxford, Oxford, UK.
J Epidemiol Community Health. 2016 Mar;70(3):312-8. doi: 10.1136/jech-2015-206295. Epub 2015 Sep 30.
The 2008 global financial crisis, precipitated by high-risk, under-regulated financial practices, is often seen as a singular event. The crisis, its recessionary consequences, bank bailouts and the adoption of 'austerity' measures can be seen as a continuation of a 40-year uncontrolled experiment in neoliberal economics. Although public spending and recapitalisation of failing banks helped prevent a 1930s-style Great Depression, the deep austerity measures that followed have stifled a meaningful recovery for the majority of populations. In the short term, these austerity measures, especially cuts to health and social protection systems, pose major health risks in those countries under its sway. Meanwhile structural changes to the global labour market, increasing under-employment in high-income countries and economic insecurity elsewhere, are likely to widen health inequities in the longer term. We call for four policy reforms to reverse rising inequalities and their harms to public health. First is re-regulating global finance. Second is rejecting austerity as an empirically and ethically unjustified policy, especially given now clear evidence of its deleterious health consequences. Third, there is a need to restore progressive taxation at national and global scales. Fourth is a fundamental shift away from the fossil fuel economy and policies that promote economic growth in ways that imperil environmental sustainability. This involves redistributing work and promoting fairer pay. We do not suggest these reforms will be politically feasible or even achievable in the short term. They nonetheless constitute an evidence-based agenda for strong, public health advocacy and practice.
2008年全球金融危机由高风险、监管不足的金融行为引发，常被视为一个独特事件。这场危机及其衰退后果、银行救助以及“紧缩”措施的采用，可被视为新自由主义经济学40年无节制试验的延续。尽管公共支出和对陷入困境银行的资本重组有助于防止出现20世纪30年代那样的大萧条，但随后实施的深度紧缩措施阻碍了大多数人口实现有意义的复苏。短期内，这些紧缩措施，尤其是对卫生和社会保护系统的削减，在受其影响的国家构成了重大健康风险。与此同时，全球劳动力市场的结构性变化、高收入国家就业不足的加剧以及其他地区的经济不安全状况，从长期来看可能会扩大健康不平等。我们呼吁进行四项政策改革，以扭转不平等加剧及其对公众健康造成的危害。首先是重新监管全球金融。其次是摒弃紧缩政策，因为从经验和伦理角度来看，该政策毫无道理，尤其是鉴于目前已有明确证据表明其对健康产生有害影响。第三，有必要在国家和全球层面恢复累进税制。第四是从根本上摆脱化石燃料经济以及以危及环境可持续性的方式促进经济增长的政策。这涉及重新分配工作并推动更公平的薪酬。我们并非认为这些改革在政治上可行，甚至在短期内也无法实现。尽管如此，它们构成了一个基于证据的议程，用于有力的公共卫生宣传和实践。
