For the last several years, Greece has been going through a protracted and damaging economic crisis that has had profound consequences on the health of the Greek people. The economic crisis has predominantly impacted the health of vulnerable populations, with a rise in suicides and deaths due to mental and behavioural disorders.
Although other European countries, such as Portugal, Italy, Ireland and Spain, have also experienced economic upheavals, the continuous downturn in Greece’s economy has had a more profound effect than in the other countries with a similar situation. As one Greek friend recently told me: “Greece is like an elevator that only goes down.”
Rather than promoting more protection for the poor in critical situations, the “Troika” (European Commission, European Central Bank and the International Monetary Fund) has forced the Greek government to adopt austerity policies that will inevitably lead to reduced access to basic human services, particularly among the poor.
The economic crisis has not been equally harmful to other sectors of society. For example, while those with higher incomes seem to have some protection from suicides in times of crisis, economic downturns create conditions of greater vulnerability. This is also due to increased dysfunction of the mental health services, seriously affected by the crisis. There is, in that regard, a paradoxical situation in which mental health services are less effective when they are most needed.
Although historically Greece had one of the lowest suicide rates in the world, recent years have seen a dramatic increase in their number.
“The passage of new austerity measures in June 2011 marked the beginning of significant, abrupt and sustained increases in total suicides and male suicides,” reports a 2015 British Medical Journal study. Overall, attempted suicides have increased by 36% between 2009 and 2011, and there has also been a parallel increase in the prevalence of people with major depressive disorders.
The increasing number of injecting drug users (IDUs) has resulted in rising numbers of people with human immunodeficiency virus (HIV) infections, who have also been impacted by disruptions of preventive programmes. Between 2009 and 2012, the number of new HIV infections among drug users rose from 15 to 484. According to the Lancet, the cases of tuberculosis in this population more than doubled between 2012 and 2013.
Greek hospitals are also on the brink of collapse. Government health spending fell 25% between 2009 and 2012, and spending on drugs dropped by 32% since 2010. Public hospitals have had to drastically cut their budgets, in some cases by as much as 50%, firing staff, cutting back on testing kits and supplies and abstaining from hiring new doctors to replace those who have retired or have left the country.
Health coverage has been affected by cost-cutting measures. Because health care in the country is linked to employment status or social security plans, rising unemployment levels and government social security cuts have left many people without health insurance. In addition, many middle income people who had private coverage are now turning to state hospitals. The influx of new patients is putting extra pressure on the already overburdened health care staff.
Greece, which was one of the countries with the highest rate of physicians per population in the world, has seen a mass exodus of health professionals to rich countries with fewer doctors. In Athens alone, some 4,000 doctors have left the city since the crisis began and spending cuts were imposed on the health sector, according to reports from the city’s medical association. There is also a high number of top scientists who have left the country.
The exodus of doctors has been aggravated by the shortage of drugs and medical supplies, as a result of drug companies’ suspension of supplies because of unpaid bills.
In addition, it is estimated that a third of graduate nurses will remain unemployed for up to four years after graduation, while emergency nurses are working overtime and with fewer resources.
Increases in certain illness, such as heart attacks and respiratory problems are associated with the chronic stress suffered by Greeks and worsening living conditions engendered by the crisis.
Not surprisingly, measures of self-rated health have also consistently fallen throughout the crisis. As a group of Greek scholars warned the government in an open letter: “You have no right to obtain credit by degrading the health of your compatriots and by sending to an early grave the most vulnerable among us.”
Dr Cesar Chelala is an international public health consultant for several organisations. He is also a winner of an Overseas Press Club of America award.