A
report by Alexander Kentikelenis, Marina Karanikolos, Aaron Reeves,
Martin McKee, David Stuckler
Key
points
“Greece’s
economic crisis has deepened since it was bailed out by the
international community in 2010. The country underwent the sixth
consecutive year of economic contraction in 2013, with its economy
shrinking by 20% between 2008 and 2012, and anaemic or no growth
projected for 2014. Unemployment has more than tripled, from 7.7% in
2008 to 24.3% in 2012, and long-term unemployment reached 14.4%.”
“In
health, the key objective 748 of the reforms was to reduce, rapidly
and drastically, public expenditure by capping it at 6% of GDP. To
meet this threshold, stipulated in Greece’s bailout agreement,
public spending for health is now less than any of the other pre-2004
European Union members. ”
“In
2009–10, the first year of austerity, a third of the street work
programmes were cut because of scarcity of funding, despite a
documented rise in the prevalence of heroin use.13 At the same time,
the number of syringes and condoms distributed to drug users fell by
10% and 24%, respectively. These events had the expected effects on
the health of this vulnerable population; the number of new HIV
infections among injecting
drug users rose from 15 in 2009 to 484 in 2012 and preliminary data
for 2013 suggest that the incidence of tuberculosis among this
population has more than doubled compared with 2012. ”
“In his
first act at the end of June, 2013, Adonis Georgiadis, the new
Minister of Health (the fourth in a little more than a year),
re-introduced a controversial law stipulating forced testing for
infectious diseases under police supervision for drug users,
prostitutes, and immigrants—a move that is not only unethical but
also counterproductive, because it deters marginalised groups from
seeking testing during HIV outbreaks. The Joint United Nations
Programme on HIV/AIDS has called for the repeal of the law, because
it 'could serve to justify actions that violate human rights.'”
“...
drastic reductions to municipality budgets have led to a scaling back
of several activities (eg, mosquito- spraying programmes), which, in
combination with other factors, has allowed the re-emergence of
locally transmitted malaria for the first time in 40 years. ”
“Through
a series of austerity measures, the public hospital budget was
reduced by 26% between 2009 and 2011 ...”
“Despite
the rhetoric of 'maintaining universal access and improving the
quality of care delivery' in Greece’s bailout agreement, several
policies shifted costs to patients, leading to reductions in
health-care access. ”
“Rapidly
increasing unemployment since 2009 is increasing the number of
uninsured people. Those without insurance are eligible for some
health coverage after means testing, but the criteria for means
testing have not been updated to take into account the new social
reality. An estimated 800,000 potential beneficiaries are left
without unemployment benefits and health coverage. To respond to
unmet need, several social clinics (primary care practices staffed by
volunteer doctors) have sprung up in urban centres. ”
“...
cuts have actually had negative economic effects, as acknowledged by
the International Monetary Fund. GDP fell sharply and unemployment
skyrocketed as a result of the economic austerity measures, which
posed additional health risks to the population through deterioration
of socioeconomic factors. ”
“... in
Greece public and non-profit mental health service providers have
scaled back operations, shut down, or reduced staff; plans for
development of child psychiatric services have been abandoned; and
state funding for mental health decreased by 20% between 2010 and
2011, and by a further 55% between 2011 and 2012.”
“Findings
from population surveys suggest a 2.5 times increased prevalence of
major depression, from 3.3% in 2008 to 8.2% in 2011, with economic
hardship being a major risk factor. Investigators of another study
reported a 36% increase between 2009 and 2011 in the number of people
attempting suicide in the month before the survey, with a higher
likelihood for those experiencing substantial economic distress.
Deaths by suicide have increased by 45% between 2007 and 2011, albeit
from a low initial amount. ”
“Greece’s
austerity measures have also affected child health, because of
reduced family incomes and unemployment of parents. The proportion of
children at risk of poverty has increased from 28.2% in 2007 to 30.4%
in 2011 and a growing number receive inadequate nutrition. A 2012 UN
report emphasised that 'the right to health and access to health
services is not respected for all children [in Greece]'”.
“In
summary, although the adverse economic effects of austerity were
miscalculated, the social costs were ignored, with harmful effects on
the people of Greece .”
“The
cost of adjustment is being borne mainly by ordinary Greek citizens.
They are subject to one of the most radical programmes of
welfare-state retrenchment in recent times,
which in turn affects population health. ”
“Greek
Government officials, and several sympathetic commentators, have
argued that the introduction of the wide- ranging changes and deep
public-spending cuts have not damaged health and, indeed, might lead
to long-term improvements. Officials have denied that vulnerable
groups (eg, homeless or uninsured people) have been denied access to
health care, and claim that those who are unable to afford public
insurance contributions still receive free care .”
“In
view of this 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. Indeed, the predominant response has been denial that any
serious difficulties exist, although this response is not unique to
Greece; the Spanish Government has been equally reluctant to concede
the harm caused by its policies. This dismissal meets the criteria
for denialism, which refuses to acknowledge, and indeed attempts to
discredit, scientific research. ”
“...
after Iceland’s acute crisis in 2008, the country rejected advice
from the International Monetary Fund to slash its health-care and
social services budget and instead opted to maintain welfare policies
crucial to support its citizens, with no discernible effects on
health.”
“At the
time of writing, the Troika was in Athens to assess the
implementation of the bailout conditions, and €2.66 billion in cuts
were announced to the health and social security budget for the
following year.”
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