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Tough austerity measures in Greece leave nearly a million people with no access to healthcare, leading to soaring infant mortality, HIV infection and suicide

A woman walks a closed branch Greek state health fund EOPYY in an Athens suburb

A woman walks a closed branch Greek state health fund EOPYY in an Athens suburb

Austerity measures imposed by the Greek government since the economic crisis have inflicted “shocking” harm on the health of the population, leaving nearly a million people without access to healthcare, experts have said.

In a damning report on the impact of spending cuts on the Greek health system, academics found evidence of rising infant mortality rates, soaring levels of HIV infection among drug users, the return of malaria, and a spike in the suicide count.

Greece’s public hospital budget was cut by 25 per cent between 2009 and 2011 and public spending on pharmaceuticals has more than halved, leading to some medicine  becoming unobtainable, experts from Oxford, Cambridge and the London School of Hygiene and Tropical Medicine (LSHTM) said.

Rising unemployment in a country where health insurance is linked to work status has led to an estimated 800,000 people lacking either state welfare or access to health services and in some areas international humanitarian organisations such as Médecins du Monde have stepped in to provide healthcare and medicines to vulnerable people.

The report, which is published today in the medical journal The Lancet, accuses the Greek government and the international community – which demanded swingeing cuts as a condition of bailing out the Greek economy during the debt crisis between 2010 and 2012 – of being “in denial” about the scale of hardship inflicted on the Greek people.

Health employees demonstrate outside the Health Ministry in Athens

Health employees demonstrate outside the Health Ministry in Athens (Getty Images)

Health employees demonstrate outside the Health Ministry in Athens (Getty Images)“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,” said senior author Dr David Stuckler, of Oxford University. “We hope this research will help the Greek government mount an urgently needed response to these escalating human crises.”

Greece was forced to make massive cutbacks to meet the terms of twin bailout packages, totalling €240 billion, offered by the European Commission, the European Central Bank and the International Monetary Fund, known as the Troika. Health spending was capped at six per cent of GDP.

Analysis of figures from the EU Statistics on Income and Living Conditions survey revealed a leap in the number of people with unmet health needs, the authors said. The cost of healthcare has been significantly shifted away from the state and towards patients, with new fees for prescriptions introduced and charges for out-patient visits to hospital raised from €3 to €5 .

Government disease prevention schemes have also been rolled back leading to the resurgence and revival of once rare infectious diseases – including malaria, which has returned to Greece for the first time in 40 years.

“There are a whole series of infectious diseases which have been kept at bay over the past 50 or 60 years by strengthened public health efforts,” Martin McKee, professor of European public health at LSHTM and one of the report’s co-authors, told TheIndependent. “If you lift up your guard, as the Greek example shows, they can very easily exploit those changes.

“The experience of Greece demonstrates the necessity of assessing the health impact of all policies carried out by national governments and by the European Union.”

People stand outside the

People stand outside the “Polyklikini”, one of the hospitals affected by overhaul of the health sector (Getty Images)

People stand outside the “Polyklikini”, one of the hospitals affected by overhaul of the health sector (Getty Images)Prevention and treatment programmes for illicit drug users faced major cuts, with a third of street work programmes halted in 2009-10, the first year of austerity. Reductions in the numbers of syringes and condoms distributed to known drug users has led directly to a spike in the rate of HIV infections in this community, the report said – from just 15 in 2009 to 484 in 2012.

Although reliable data on the health impact on the wider population will take several years to emerge, the Greek National School of Public Health reported a 21 per cent rise in stillbirths between 2008 and 2011, which was attributed to reduced access to prenatal services, and infant mortality also rose by 43 per cent between 2008 and 2010.

The suicide rate has gone up from around 400 in 2008 to nearly 500 in 2011.

Alexander Kentikelenis, researcher in sociology at the University of Cambridge and the report’s lead author, said that the Greek welfare state had “failed to protect people at the time they needed support the most.”

“What’s happening to vulnerable groups in Greece is quite shocking,” he told The Independent. “It’s quite straightforward to measure what has happened, it’s much harder to quantify the long-term health implications for the long-term unemployed and uninsured…Leaving health problems to get out of hand ends up costing a state much more in the long run.”

The Greek Ministry of Health and Social Solidarity did not respond to a request for comment.

Case study

The Metropolitan Community Clinic at Helliniko in Athens was founded in December 2011. It is run by volunteer doctors and provides free healthcare to people without medical insurance

Co-founder Christos Sideris told The Independent: “The healthcare situation in Greece is, unfortunately, dramatic. We have helped more than 4,400 patients, with more than 20,300 appointments in 26 months of operation. We look after more than 300 children below the age of three, and have helped 126 cancer patients to receive chemotherapy, in collaboration with a public hospital. This is not done in an official capacity, but by the people working there, every Wednesday after working hours, with donated medicines.

We have three basic rules: we accept no money from anyone, we have no party politics, and we do not advertise anyone for the help they are offering us. We only accept money from our own volunteers – there are 250 of them at the moment. These volunteers do fundraisers and give money to the clinic. The local municipality also helps us. Our medicines are all donated. There are more than 40 community clinics and pharmacies like us across Greece. They cannot solve the problem – we’re only here because there is a need for us to exist. We cannot substitute a public health system and we do not want to.”

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Greece’s 200% increase in HIV shows how disastrous austerity can be for public health

Austerity measures in Greece are raising red flags, and red ribbons. (AP Photo/Nikolas Giakoumidis)

Austerity measures in Greece are raising red flags, and red ribbons. (AP Photo/Nikolas Giakoumidis)

One day in late March 2013, European finance and health ministry officials met at the OECD’s Paris office to discuss how healthcare systems are faring in times of austerity.

On the second day of the two-day conference, Greek finance ministry official Evdoxia Andrianopoulou read from a series of brown-colored PowerPoint slides riddled with details of attrition and savings. Greece’s cuts were deep, of the sort commonly seen in a corporate turnaround – but rarely on a government’s balance sheet, and almost never to healthcare expenses.

The takeaway from the meeting – according to two people who attended it – was that Greek officials knew that these huge cuts would result in the curtailing of essential services for their people. But the officials were working under the stress of having to meet a financial target set by their tri-party group of creditors: the European Commission, the International Monetary Fund, and the European Central Bank. And so they delivered.

According to an Austrian finance ministry official who attended the meeting, participants in the room “were in a state of shock” after Andrianopoulou concluded her talk. Another attendee who asked that he not be quoted said “a pin-drop silence” filled the room.

Meanwhile, across the Channel in London, academics were preparing to release a study in “The Lancet” on the healthcare crisis that has followed deep budget cuts in Southern Europe.

One of that work’s principal researchers, David Stuckler of Oxford University, warned that not just Greece, but also Spain and Portugal, faced a potential healthcare disaster due to their own steep budget cuts.

Yet of the three crisis-stricken countries, Greece seems to have suffered the most.

“Greece is an example of perhaps the worst case of austerity leading to public health disasters,” Mr. Stuckler explained in a telephone interview.

“After mosquito spraying programs were cut, we’ve seen a return of malaria, which the country has kept under control for the past four decades. New HIV infections have jumped more than 200 percent,” he noted.

Malaria returned because municipal governments lacked the funds to spray against mosquitoes. HIV spiked because government needle exchange programs ran out of clean syringes for heroin addicts. By Stuckler’s estimate, the average Greek junkie requires 200 clean needles in a given year.

“But now they’re only getting three a year each,” Stuckler said.

Athenian drug addicts sharing needles or malaria-carrying mosquitoes biting Spartans have put Greece in the media spotlight over the past few months. But a decidedly less headline-grabbing fact is this: cuts taken over the last two years could look even worse a few years from now.

“The thing about healthcare systems,” the OECD’s Ankit Kumar explained in a telephone interview, “Is you cut the money today, and start to see the cuts’ impact at least three to four years from now. You know that people aren’t getting their medications. But it takes a couple of years before this manifests itself in high levers of sickness, fewer people being able to work, and more people facing shorter lives. Given the consequences of what has happened in Greece, these outcomes are just going to get worse and worse.”

Some experts have suggested that Greece’s budgetary ax fell unduly hard on its healthcare sector, which was slated to grow at around 4 percent annually, but which has instead been jolted by a series of wage freezes, firings, and drug rationing programs. Economists around the world warned of the cuts’ consequences – but it was the Greeks themselves who opted for deep gashes to their healthcare system.

“IMF doesn’t say ‘you have to cut 10 percent of your economy, but you can’t close hospitals or schools.’ Where the cuts are made remains a country’s sovereign right,” Kumar explained.

This spring has been an important time for healthcare research in Europe because data now confirm – as if there was any doubt – that in healthcare, too, the gulf between Europe’s north and its south has continued to widen.

Last year, while Greece went about adjusting to its new slimmed-down healthcare reality, German’s ministry of health contacted the OECD for its help in studying the exact opposite problem. German healthcare costs were ballooning, but only a third of the growth could be linked to Germans becoming sicker or aging.

The OECD’s research on Germany was published this spring, at nearly the same time that the full picture of Greece’s healthcare tragedy came into form.

OECD researchers compared Germany to its peers, and came to a simple conclusion: German doctors seem to be prescribing treatments, operations, and hospital stays more often than might be medically necessary. That this is occurring while Germany’s neighbors just a two-hour plane ride away in Athens face the worse healthcare and societal crisis in their history only underscores the much publicized idea that Europe is growing apart.

One statistic was especially telling: the OECD average for hospital beds per 1,000 patients sits at 4.9; in the case of Germany, it’s 8.3. France has 6.4, while the U.S. has 3.1.

“The difference in the medical science between the United States, Germany, and France is not so great that it can justify 70 percent higher numbers in Germany than the OECD average,” Kumar said.

Kumar and his co-author, Michael Schoenstein, theorized that because Germany has more hospitals than it needs, doctors and hospitals appear to be steering patients towards more expensive in-patient procedures and then tacking on multiple night hospital stays in order to fill hospital beds and submit payments to Germany’s essentially unlimited system of insurance reimbursements.

“These are big institutions that want to be busy,” Kumar said. “After investing millions, and in some cases billions of dollars, into the infrastructure, no one wants to have these institutions running at 60 percent. They know that if hospitals aren’t full, someone’s going to point the finger and say ‘hold on a second, you’re running at 60 percent capacity regularly, why do you have all of these empty beds, we need to get rid of that.’”

***

The OECD lacks clear data on how many Greeks have been denied medical care during the country’s economic crisis. But anecdotal reports have shown that people are being deprived care.

The New York Times reported that “breast cancer patients often have to wait three months now to have tumors removed” and that at least 2,000 patients in need of bypass surgery haven’t been scheduled for procedures.

Could the solution to Greeks’ healthcare crisis be to send patients north to Germany’s hospitals? With Europe’s common market, citizens’ freedom of movement, couldn’t Greeks just fly north for treatment?

“Yes, EU citizens can travel to other EU countries for treatment,” OECD’s Michael Schoenstein explained, “But for planned treatments like cancer treatments, they need prior approval from their healthcare insurers at home. It’s theoretically possible, but practically very difficult.”

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