In anticipation of World Health Day on April 7, the World Health Organization (WHO) published a report showing rates of depression increased 18 percent between 2005 and 2015, now estimated to afflict over 300 million people worldwide. Approximately 800,000 people commit suicide each year. According to the WHO, poverty and unemployment are leading causes.
To be sure, mental health services are in critically short supply globally. While often correlated with poverty, mental illnesses can cause misery regardless of one’s socioeconomic status.
However, as a faculty member in Global Health Studies at Northwestern University, I find it striking that the WHO highlights poverty and unemployment as leading causes of depression, yet suggests exercise, school-based prevention programs, therapy and medication to solve it. If poverty and unemployment are major causes of depression, shouldn’t our remedies address economic drivers of poverty and unemployment, rather than narrowly focusing on school programs and exercise? Is expanding mental illness solely a health issue, or is it also a foreseeable response to expanding economic stress?
This gets at a fundamental issue with how global health is conceptualized at the highest levels. We prefer quick and “doable” solutions instead of addressing complex problems. We innovate around the dilemma — more antidepressants, more mental health services, more exercise — but we fail to address the underlying structural issues. At what point will we tackle drivers of globally expanding health problems?
We actually know quite a bit about why poverty spreads but often blame poverty, unemployment and inadequate social services on government corruption and incompetence. However, while this view has some merit, it is shortsighted, particularly in low and middle-income countries. In fact, institutions in wealthy countries carry significant responsibility for weakened economies worldwide, and thus for the rise of global health crises.
For instance, the International Monetary Fund (IMF) has been instrumental in expanding our neoliberal global economic system. Neoliberalism advocates “freeing” the market from government constraints through tax cuts, deregulation, privatization, reduced government spending for social services and reduced protections for workers — key tenets of Republicans’ plans to stimulate economic growth in the United States. Resulting economic growth is supposed to ensure that benefits “trickle down,” bringing everyone increased prosperity and the freedom to purchase whatever social services they desire.
Except decades of robust data prove neoliberalism is not all it’s cracked up to be, even by economic standards. The IMF itself — a major proponent of the ideology — states neoliberalism has been “oversold,” because it exacerbates inequality and unemployment. Neoliberalism has increased inequality in the United States as well. The US has worse income inequality than China, with an economically disastrous wealth gap. Due to decades of forced reforms tied to IMF and World Bank loans — often referred to as “conditionality” — poverty, inequality and unemployment have spread even more acutely in poorer countries.
If, as the IMF claims, the current global economic system increases the global wealth gap, and unemployment and poverty rates with it, it’s no surprise depression is up 18 percent worldwide. After all, one can only be so resilient when one can’t get work to feed one’s family.
Poverty and inequality, and subsequent depression, may seem like someone else’s concern, but the global spread of inequality and poverty potentially puts everyone at risk regardless of location or socioeconomic status.
For instance, the IMF has been imposing austerity conditions on countries undergoing economic crises for years as part of a neoliberal reform agenda meant to stimulate economic growth in the short term. In imposing austerity, the IMF restricted West African government spending on health systems. The result was massive human-resource shortages and weakened health systems, allowing Ebola to wreak havoc in West Africa, and threaten rich countries as well. The epidemic demonstrated that poverty is everyone’s problem, and not just for humanitarian reasons.
Beyond health crises, according to the World Bank (another major proponent of neoliberalism), employment and economic inclusion combat violent extremism. No degree of military expansion would help “win the battle against ISIS” (also known as Daesh) like economic stability would.
Perhaps it’s time to acknowledge the role of our current global economic system in exacerbating the very problems we’re trying to address, from extremism to mental health crises. Of course, there are no panaceas when it comes to mental health, but it’s time we began acknowledging some of the structural issues that fuel anxiety and depression.
Perhaps it’s time for economic innovations, instead of the tired claims around reduced government spending, tax cuts and deregulation.
Some of this innovation is already happening. Portugal made enormous economic gains on an anti-austerity agenda. Several countries, and even Silicon Valley, are experimenting with universal income, and have observed gains in prosperity and mental health. The results of these experiments may suggest new insights about ways to stimulate economic growth while avoiding crises that go along with it.
Global threats, from extremism to mental illness to humanitarian emergencies, can only be addressed if we take seriously the economic systems that foster them.