A health crisis in Greece brought on by national austerity measures has driven up cases of HIV, suicide, major depression, and infant death, and left hundreds of thousands locked out the health system altogether, according to a report.
As part of a series of reforms brought in to manage the Greek crisis under an international bailout, public spending on health was drastically reduced, and at an unprecedented pace. According to the report, published in The Lancet, the country’s health has deteriorated so much since austerity began in 2009 that failure to access services and medicine has reduced the country to a series of “escalating human crises”.
Vulnerable groups have felt the force of the change, and funding cuts in treatment and prevention programmes has seen a ten-fold rise in cases of HIV in injecting drug user from just 15 in 2009 to 484 in 2012. Despite a documented rise in the prevalence of heroin use, street work funding was cut by a third. Tuberculosis cases among this group have also more than doubled since last year.
Austerity measures saw public spending on health capped to 6% of GDP, making it lower than any other pre-2004 European Union member, and the public hospital budget was reduced by a quarter between 2009 and 2011.
Mental health drop
Other shocking figures suggest there has been a near doubling of suicides, which increased by 45% between 2007 and 2011, while major depression has increased 2.5-fold between 2008 and 2011. Despite this, the researchers said, state funding for mental health dropped by over a half (55%) between 2011-12. Infant deaths also jumped by 43% in just two years between 2008 and 2010.
Health in Greece has nosedived and a scaling back of local government activities including mosquito-spraying programmes, have led to the re-emergence of locally transmitted malaria for the first time in 40 years, the researchers said.
Rural areas have also seen shortages of medicines and medical equipment, and reforms of public funding for expensive pharmaceutical drugs has had some “unintended results” like unobtainable drugs. One provincial survey suggested up to 70% couldn’t afford drugs they were prescribed.
Social clinics picking up pieces
Social health insurance coverage is linked to employment status, so high levels of employment mean an estimated 800,000 were locked out of the system, without unemployment benefits or the ability to access health services. Social clinics staffed by volunteer doctors have sprung up and Médecins du Monde has scaled up operations in the country.
Alexander Kentikelenis, research associate at Cambridge University and lead author of the study, said that while Greece was not a unique case when it came to austerity, the scale and pace of change in Greece was the most pronounced and had a tangible health and human cost.
“The point isn’t just the level of spending,” he said, “but the speed of the cuts. There were cuts arguably to be made for pharmaceutical [drugs] for example, but it has heavily constrained the capacity of the system to cope.”
The cut in hospital funding, for example, came as less people could afford private healthcare and would return to public care meaning spending here actually needed to go up not down.
Kentikelenis said their findings were just “the tip of the iceberg”. “This is what we can measure in the short run. Health data is usually around two to three years behind, so 2012 is the only second full year of austerity,” he said. “It’s been two years since then. What is most alarming is the rapidly increasing number of Greeks no longer accessing the health system.
"Unemployment in Greece is now about 28% and they are uninsured, which should generate a legitimate debate about what happens to these people in the long term. The leadership aren’t really discussing this.”
Necessary reforms
The authors acknowledged the problems that led to the crisis in the first place. They write: “There is broad consensus that the social sector in Greece was in grave need of reform, with widespread corruption, misuse of patronage, and inefficiencies and many commentators have noted that the crisis presented an opportunity to introduce long-overdue changes.”
Still, they said, “if the policies adopted had actually improved the economy, then the consequences for health might be a price worth paying. However, the deep cuts have actually had negative economic effects as acknowledged by the International Monetary Fund.”
They accused the government and officials of a culture of denialism, where scientific evidence for the impact of austerity painted a different picture to public claims. “In view of the detailed body of evidence for the harmful effects of austerity on health the failure of public recognition of the issue by successive Greek governments and international agencies is remarkable,.”
The response of the government has been in some cases unethical and counterproductive. In one example cited by the authors, health minister Adonis Georgiadis – the fourth health minister in the country in a period of just over a year – re-introduced a controversial law of forced testing for infectious diseases in drug users, prostitutes and immigrants, under police supervision.
Some good news
The Greek government has sought agreement for WHO support for planning health sector reforms and there are schemes that have been introduced to help people on the ground, such as a voucher system for uninsured citizens that can be used for up to three visits for a predetermined set of services in a four-month period, including prenatal examinations for pregnant women. However, these kinds of scheme were “very much on an ad hoc basis,” Kentikelenis said.
While there has been criticism of linking suicide rates and economic crisis in the country, Kentikelenis said they were interested in a clear upward trend in suicide, rather than absolute numbers, and incidence in new groups such as working-age women, which had doubled.
Daphne Kaitelidou, assistant professor in health management at Athens University, said: “One of the most emerging problems is the number of uninsured and unemployed which is constantly increasing, affecting access to healthcare.”
“Certain vulnerable groups have to deal with an increasing need … Cancer patients for example – one of the most affected by the crisis – report serious problems regarding waiting times and access to appropriate medicines. Chronically ill patients also report facing significant economic limitations or extended waiting lists.”
“However, quantifying the health effects of the economic crisis, especially in terms of mortality, is difficult due to lack of sound relevant data as the effects of economic recessions on the population health are visible in the long run.”
She said the Greek Ministry of Health’s agreement with the WHO would include the establishment of an evidence-based monitoring system.
David Stuckler, senior research leader at Oxford University and co-author of the study, said: “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 the Greek government mount an urgently needed response to these escalating human crises.”