Summary of the impact

Research undertaken by Professor King and his research group on the political economy of public health has generated three types of impact: global media coverage; extensive debate among stakeholders and the general public; and influencing the political agenda.

Underpinning research

The Political Economy of Public Health is a new multi-disciplinary subfield at the intersection of sociology and public health. This research programme applies theories and methods from political, economic and comparative historical sociology to explain public health outcomes, as well as the governance of public health systems. The underpinning research was based at the Department of Sociology in Cambridge and carried out between 2006 and 2012 by Professor King and his group, in collaboration with leading public health researchers. The Political Economy of Public Health radicalizes and makes dynamic the "social determinants of health" school of social epidemiology made famous by Michael Marmot and Richard Wilkinson. It lays bare the social determinants of the "social determinants of health."

Professor King and the members of his research group have published on a wide range of topics within this research agenda. Due to space considerations, we can only discuss a selection of these publications.

In a series of articles, including publications in The Lancet, Professor King and his collaborators investigated the determinants of the seven million premature deaths that occurred throughout the post-communist world after the transition to capitalism. The crucial finding was that radical privatization was associated with heightened working-age mortality. In another article published in PLoSMED, Professor King showed that IMF mandated austerity programs led to a tuberculosis epidemic in Eastern Europe. Another member of King's research group, Alexander Kentikelenis, built on this work with an article in The Lancet, showing that the IMF-supported austerity programme in Greece led to increased suicides and HIV incidence. Related to these articles, King published an article showing that banking crises increased heart disease mortality. David Stuckler, a member of the research team and University Lecturer from 2011-2013, combined the findings from these papers for his book The Body Economic: recession, budget battles, and the politics of life and death, published in 2013. (Stuckler subsequently took up a position in Oxford in April 2013, but the research for and writing of The Body Economic was done while he was a lecturer in the Department of Sociology at Cambridge.) In two articles published in health policy journals, Professor King used political sociology research methods to study the way in which multinational drug companies influenced the scientific evaluation of, and the decision to reimburse, very expensive patent-protected drugs in Poland (so called `niche-busters'). This research was based on over 100 interviews with key stake-holders in the pharmaceutical policy domain and an analysis of several hundred scientific evaluations of drugs made by the Polish Health Technology Assessment Agency, as well as an analysis of conflict of interest statements of key decision makers. This research showed how multinational drug companies used their financial power to influence and co-opt every group of actors — from politicians to scientists to patient organizations — involved in the scientific evaluation process and reimbursement decisions. As a result, spending on `niche-busters' was rising to an unsustainable level, and more than half of such drugs that were recommended for reimbursement lacked positive scientific evaluations.

References to the research

Details of the impact

The study linking privatization to mortality created an awareness of the potential role of privatization on health outcomes in the general public and the economic policy community. The main article published in the Lancet was reported by over 200 media outlets globally. These included including key opinion shaping outlets for economic policy makers: the article was debated in the Financial Times (by Jeffrey Sachs), the New York Times (by Nobel laureate Joseph Stiglitz), and in the Economist. It was also debated by the general public on the NYT's website. The articles on pharmaceuticals in Poland reached a high position on the media agenda, as suggested by both their widespread coverage in popular and specialized media in Poland and the fact that in some instances they formed front-page stories. They were discussed by all major stakeholders involved in developing pharmaceutical policy in Poland. For example, Stanislaw Karczewski, Vice-Chairman and a member of the Health Committee of the Senate of the Republic of Poland, referred to the article on his websites (Karczewski 2011). The president of the Association of Innovative Pharmaceutical Companies stated: `The report...is an important document because it not only offers a diagnosis of the situation, but shows the underlying causes. What is key for us, though, are its conclusions and recommendations' (Toczyski 2012). The article was also commented on in the official bulletin of the Chamber of Physicians and Dentists: `They [the authors] seem to be saying to decision-and lawmakers in the field of drug reimbursement: "We can see you, you are in a candid camera"' (Knypl 2011). At the end of 2012, the Minister of Health announced the overhaul of the Agency for Health Technology Assessment, which was criticized in our articles. It is of course difficult to prove that this step was influenced by the publications or their coverage.

The article by King linking IMF programmes to Tuberculosis received global media coverage and was viewed online 21,592 times, and downloaded 2,880 times (as of 27/09/13). Kentikelenis' work that extended this research to Greece has also received wide coverage in national and international media, and has had an impact on policy and public debates. His research formed the basis of an invited talk at a World Health Organization conference that led to the formulation of the organization's policy proposals to its members. A Member of the European Parliament, João Ferreira, asked the European Commission: `The steep decline in living conditions affecting the population of Greece is already being seen by specialists as an authentic "tragedy", this term being used in a study... headed by Alexander Kentikelenis... Does the Commission intend to ignore the social consequences of these programmes for much longer?' The Greek Minister of Health and various other officials responded to this work in the press and in academic journals. This work and the subsequent popular pressure led to the introduction of policies designed to offset some of the effects of the crisis. Kentikelenis is now in contact with the social affairs committee of the Greek Parliament and the WHO on these issues, as well as with NGOs in Greece and other European countries that have used his work to challenge government policies. For example, a Reuters article on Portuguese health policy reported: `Kentikelenis... said... "The government will think twice now before cutting further in [health spending]. Such spending has to be countercyclical. People need it the most in downturns, not when the economy is growing."'

Stuckler and Basu's book The Body Economic has received widespread media coverage and influenced the policy debate. The influential FT columnist Harry Eyes wrote that this book is `a powerful indictment of the unnecessary suffering and rising mortality rates associated with austerity policies unsoftened by remedial social programmes.' Eyes continues: `I hope the finance ministers read it, and try mixing with the ordinary people, who are the only ones who can bring about economic recovery'. A Guardian feature by Jon Henley under the headline `recessions hurt but austerity kills' generated 420 public comments on their website. The charity Royal Society for the Encouragement of Arts held a public lecture by Stuckler on `austerity kills' on 22^nd May 2013 which has had more than 1578 viewings on YouTube (as of 25/9/2013). CNN picked up on the research, reporting `If austerity had been a clinical trial, it would have been stopped.' Stuckler has also given much testimony on the health impact of austerity to legislative bodies and international institutions including The House of Commons (`Financial crisis and public health', United Kingdom House of Commons, 1 July 2009); and the World Health Organization (`The Body Economic', Oslo, Norway, World Health Organization, Health system in times of global economic crisis, ministerial conference, 16 April 2013).

Sources to corroborate the impact

1. http://www.bbc.co.uk/news/health-15220054
2. Chmielowska, Jadwiga. 2012. `A w mediach jeno ble,ble,ble... Dlaczego? Bo dziennikarstwo śledcze całkiem już upadło.' Wpolityce (24^th August). http://wpolityce.pl/artykuly/34710-a-w- mediach-jeno-blebleble-dlaczego-bo-dziennikarstwo-sledcze-calkiem-juz-upadlo.
3. http://www.plosmedicine.org/article/metrics/info%3Adoi%2F10.1371%2Fjournal.pmed.0050143;jsessionid=F943A6E2A112336B037EF7FBC4E829AA
4. http://uk.reuters.com/article/2012/08/13/us-portugal-drugs-idUSBRE87C0N120120813
5. Knypl, Krystyna. 2011. `Zalewa nas powielaczowe prawo produkowane przez NFZ, które obezwładnia lekarzy, szkodzi pacjentom i rozzuchwala urzędników'. Gazeta Lekarska (5^th December). Available online at www.oil.org.pl/xml/nil/gazeta/numery/n2011/n201112/n20111223.
6. Naczelna Izba Lekarska. Undated. `Ośrodek Bioetyki'. Available online at
   www.nil.org.pl/dzialalnosc/orodek-bioetyki.
7. Polska Newsweek. 2011. `Listę leków refundowanych tworzą lobbyści?' (14^th October) Available
   online at http://biznes.newsweek.pl/liste-lekow-refundowanych-tworza-lobbysci,83340,1,1.html.
8. Schneiderman, R.N. 2009. `Stiglitz on Death and Privatization in the Eastern Bloc.' New York Times. Available online at www.economix.blogs.nytimes.com/2009/01/16/stiglitz-on-death-and-privatization-in-the-eastern-bloc/.
9. http://www.europarl.europa.eu/RegData/questions/reponses_qe/2011/002175/P7_RE(2011)002175_EN.doc
10. Toczyski, Jerzy. 2012. `Kraj Nie nasza wina'. Tygodnik Powszechny (3 ^st January) Available online at http://tygodnik.onet.pl/1,73180,druk.html.