A PAPER published in today’s Lancet draws attention to the plight of many of Greece’s most vulnerable groups who are faced with cuts in the healthcare services they need urgently. Lead author Alexander Kentikelenis describes the situation as a ‘public health tragedy’.
Austerity measures in Greece, imposed following a bailout by the international community, have led to devastating social and health consequences for the country’s population, according to a report in today’s Lancet.
Greece’s health crisis: from austerity to denialism, a paper by Cambridge University sociologist Alexander Kentikelenis and colleagues, shows how rising demand for healthcare as a result of the cuts has coincided with a drop in the provision of services, leading to substantial unmet medical need.
In 2010, the Greek government agreed to an austerity package overseen by the European Union, the European Central Bank and the International Monetary Fund, known collectively as the Troika.
Since then, Greece has had the largest cutbacks to the health sector seen across Europe, as the bailout package capped public expenditure at 6% of GDP. The country’s public spending on health is now less than any of the other pre-2004 EU members.
‘The data reveal that the Greek welfare state has failed to protect people at the time they needed support the most.
‘A rapidly growing number of Greeks are losing access to healthcare as a result of budget cuts and unemployment,’ said Kentikelenis.
The authors of the paper acknowledge that Greece’s healthcare system was in need of reorganisation well before its economic plight came to the world’s attention.
However, they take the government to task for its denial that the health of the population has been affected as a result of the slashing of budgets.
At a time of increasing health need and falling incomes, Greece’s bailout agreement stipulated shifting the cost of healthcare to patients. The Greek government introduced new charges for visits to outpatient clinics and higher costs for medicines.
The authors’ analysis of the latest available data from the EU Statistics on Income and Living Conditions revealed a 47% rise in people who felt they did not receive medically necessary healthcare.
This increase was linked to a rising inability to afford care and the costs of travel to access health services, according to the authors. Rapidly increasing unemployment since 2009 meant a growing number of people no longer had any form of health cover.
‘Those without insurance would have been eligible for a basic package of health services after means testing, but the criteria for means testing have not been updated to take account of the new social reality,’ said Kentikelenis.
‘To respond to unmet need, social clinics staffed by volunteer doctors have sprung up in urban centres. Before the crisis such services mostly targeted immigrant populations, but now as many as half the patients are Greek nationals.’
The health problems are particularly pronounced among Greece’s most vulnerable groups who include the poor, the unemployed, the elderly, pregnant women and children, and those with mental health problems.
The paper describes the situation faced by these groups as a ‘public health tragedy’.
There has been a 120% increase in the use of mental health services at a time of funding cuts of 20% in 2010-2011 and a further 55% in 2011-2012. Suicides and the incidence of major depression have rapidly risen.
Austerity measures have also been linked to increased incidence of infectious disease. Notably in the first year of austerity, following cuts to outreach programmes, and to syringe and condom distribution for injection-drug users, a rapid rise of HIV infections was observed: from 15 in 2009 to 484 in 2012. The incidence of tuberculosis among drug users more than doubled in 2013.
Kentikelenis and co-authors point to the experiences of other countries – notably, Iceland and Finland – in surviving financial crises.
They argue that, by ring-fencing health and social budgets, and concentrating austerity measures elsewhere, governments can offset the harmful effect of crises on the health of their populations.
‘Although the Greek healthcare system had serious inefficiencies before the crisis, the scale and speed of imposed change have constrained the capacity of the public health system to respond to the needs of the population at a time of heightened demand,’ Kentikelenis said.
The paper Greece’s health crisis: from austerity to denialism by Alexander Kentikelenis (University of Cambridge), Marina Karanikolos (London School of Hygiene and Tropical Medicine), Aaaron Reeves (University of Oxford), Martin McKee (London School of Hygiene and Tropical Medicine) and David Stuckler (University of Oxford) was published by The Lancet on 21 February 2014.
Lead author of the study, Alexander Kentikelenis said: ‘The data reveal that the Greek welfare state has failed to protect people at the time they needed support the most. A rapidly growing number of Greeks are losing access to healthcare from budget cuts and unemployment.’
Senior author Dr David Stuckler from the University of Oxford said: ‘The Greek government – along with their European partners – appears to have been in denial about austerity’s severe impact on health. The cost of austerity is being borne mainly by ordinary Greek citizens, who have been affected by the largest cutbacks to the health sector seen across Europe in modern times. We hope this research will help the Greek government mount an urgently needed response to these escalating human crises.’
At a time of increasing health need and falling incomes, Greece’s bailout agreement stipulated shifting the cost of healthcare to patients.
The Greek government introduced new charges for visits to outpatient clinics and higher costs for medicines. General health services were also eroded, says the paper.
The authors’ analysis of the latest available data from the EU Statistics on Income and Living Conditions revealed a 47% rise in people who felt they did not receive medically necessary healthcare.
This increase was linked to a rising inability to afford care and the costs of travel to access health services, according to the authors. Rapidly increasing unemployment since 2009 meant a growing number of people no longer had any form of health cover, with an estimated 800,000 without unemployment benefits or the ability to access health services.
The paper details signs of the nation’s deterioration in health including:
• HIV incidence has risen in injecting drug-users more than 10-fold from 2009 to 2012
• Tuberculosis incidence among injecting drug users more than doubled in 2013
• State funding for mental health decreased by 55% between 2011 and 2012
• Major depression increased 2.5-fold between 2008 and 2011
• Suicides increased by 45% between 2007 and 2011
• Infant mortality jumped by 43% between 2008 and 2010
• The proportion of children at risk of poverty increased from 28% in 2007 to 30% in 2011
The study concludes that the Greek health-care system was in grave need of reform before the crisis, but the scale and speed of imposed change limited its capacity to respond to its population’s increased health needs.
The authors conclude: ‘The foundations for a well functioning health-care system need structures that are accountable and coordinated – not denialism. These findings suggest that the people of Greece deserve better.’