[Probably the most thoughtful and insightful article you will see coming
out in the USA -- and Canada -- this year! - dr]
http://www.larouchepub.com/other/2006/3334ajph_bigmac_study.html
This reprint appears in the August 25, 2006 issue of Executive Intelligence
Review.
Impact of NYC's 1975 Fiscal Crisis on TB, HIV, and Homicide
by Nicholas Freudenberg, DrPH, Marianne Fahs, PhD, Sandro Galea, MD, DrPH,
and Andrew Greenberg, MS
The following are excerpts from an article which appeared in the March 2006
issue of the American Journal of Public Health, reprinted with permission
of the American Public Health Association. The full title is "The Impact of
New York City's 1975 Fiscal Crisis on the Tuberculosis, HIV, and Homicide
Syndemic." Footnotes have been omitted.
In 1975, New York City experienced a fiscal crisis rooted in long-term
political and economic changes in the city. Budget and policy decisions
designed to alleviate this fiscal crisis contributed to the subsequent
epidemics of tuberculosis, human immunodeficiency virus (HIV) infection,
and homicide in New York City...
One lesson from this historical analysis is that health advocates may need
to challenge the discourse of fiscal crisis directly. In 1975, New York
City and other cities did face real problems, but the decision to impose
the highest costs on the most vulnerable populations was a political
decision. Alternative solutions included looking for additional revenue,
such as from city income tax increases or financial service surcharges;
transferring some costs to higher, richer levels of government; and
imposing a moratorium on interest on loans to the city. These options would
have presented different economic, political, and health costs and
benefits. Had advocates been more successful in forcing consideration of
these options, the human costs of the fiscal crisis could have been
reduced.
Perhaps the principal lesson is that if the public health community is to
advocate effectively against budget and policy decisions that damage
health, it will need to identify constituencies that can bring new clout
into the political arena. In the late 19th and early 20th century,
progressive movements, labor unions, and wealthy reformers often worked
together to improve living conditions and health, in part because sectors
of the elite believed such reforms enhanced stability and promoted growth.
In 1975, such alliances were not strong enough to resist the EFCB's plan. A
key challenge for health advocates today is to create broad coalitions that
have the will and power to resist policies and budgets that can damage
health.
Another lesson may help public health professionals join the current debate
on the roles of government and markets in responding to social problems.
New York City's fiscal crisis spurred the call for allowing market forces
to solve social problems. Yet as the syndemic unfolded, it was the
government, not market forces, that ultimately contained TB, homicide, and
AIDS. TB rates began to drop in 1993 after a comprehensive DOH campaign
that cost more than $1 billion. Beginning in 1991, New York City began to
rebuild its police force, and by 1999, the city had almost double the
number of police officers employed in 1980. Homicide rates started to fall
in 1991, and by 1995 they had dropped below the 1970 level. Many factors
contributed to the decline in homicide, but it seems likely that increased
police presence was one. New cases of AIDS started to decline in 1993 after
city, state, and federal programs, including the Ryan White HIV CARE Act
and CDC prevention programs, made HIV prevention and new treatments ava
ilable to populations hardest hit by the epidemic. Once again, federal
policy and broader economic changes, such as the economic prosperity of the
1990s and the growth of job opportunities in the service sector, amplified
the impact of local policy decisions, although this time in a salubrious
direction... SNIP
http://www.larouchepub.com/other/2006/3334ajph_bigmac_study.html
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