Another round of violent protests erupted in Greece last week, following the latest austerity cuts to public service jobs and pay. Meanwhile, the creeping consequences of austerity measures are beginning to show, with the nation facing a sharp increase in suicides and restrictions on access to health care.
A recent paper published in The Lancet presented results of surveys of more than 12,000 Greek people in 2007 and 2009, supplemented with more current information from research institutes and government agencies.
The picture, while not catastrophic, is grim, and demonstrates the sensitivity of health and health care to financial and economic fortune.
Greek citizens were less likely to seek help for medical or dental health concerns in 2009 than they were in 2007, before the financial turmoil began. This was principally because they could no longer access such services, as health facilities had closed and waiting times at remaining hospitals and clinics had lengthened.
Public hospital budgets have been cut by 40%, leaving health services understaffed and short of medical supplies. The private hospital sector has also been affected, with a 25% to 30% decline in admissions since the onset of the economic crisis.
The most recent data shows suicide rates rose by 40% in the first half of 2011, compared with 2010. The inability to repay debts may be a factor, with 25% of callers to Greece’s suicide helpline telling counsellors they were experiencing financial difficulties.
Changes in health and wealth
When national economic fortunes change – for the better or the worse – health status follows.
To explore this relationship, the World Health Organisation (WHO) established a commission in 2002, headed by the then Harvard academic, Jeffrey Sachs. His report cemented health as both an economic and development concern, and detailed the needs of poor nations. One billion people survive - and many don’t - on less than a dollar a day.
Later, the WHO set up a further commission to explore the social determinants of health, including environmental, social, commercial, and educational factors. It found these vectors tug in different directions, making health planning all the more difficult.
But what happens to an affluent nation’s health when it loses its wealth? This is less familiar territory, and the few examples are bleak.
When the USSR disintegrated, heart disease death rates soared and alcohol-related death and illness rushed in. Dispirited, futureless young men drank themselves into suicidal oblivion.
We are beginning to see a similar scenario unfold in Greece, albeit it’s less severe right now. At least Greece’s alcohol consumption has gone down, not up, although suicides are worryingly high.
Greece’s health system
Greece has struggled for decades to develop a health system that balances publicly-funded services with private and employer-funded health cover.
It established limited employer-based health insurance during its economic growth in the 1960s. Similar arrangements were later made for rural workers through government-supported insurance. But both were incomplete and universal health coverage was never achieved.
During the economic uplift of the 1960s and 1970s, private health services grew substantially. Meanwhile, government investment in health remained low, at 2% of GDP, similar to India’s spend today.
Grand plans for universal access to publicly-funded health care emerged again during the 1980s and then unravelled.
Since then, politicians and policy makers of every stripe have striven to coordinate, rationalise, decentralise and integrate health services to give Greek citizens universal access to health services. Their efforts have been met with resistance from established interests, especially private doctors and hospitals.
Today, Greece’s health-care system is a mixed public-private tangle. Pharmaceuticals are subsidised and visits to general practitioners attract government support. As in Australia, there is a network of government-funded and private hospitals and clinics.
Impact of the debt crisis
We won’t know the long-term consequences of Greece’s economic hardship for some time but we can assume that youth unemployment rates of around 40% will manifest in poorer health in the decades ahead.
Health, like goodwill, takes a long time to establish and can be lost quickly.
A wise general practitioner said to me, as I approached my senior years, “Whatever you do, don’t fall! And don’t become poor!” Greece, unfortunately, has taken a tumble and is struggling just to float in the stormy European economic ocean.