London School of Hygiene & Tropical Medicine

Greece's health crisis is worsening as a result of continued healthcare budget cuts, according to a new study published in The Lancet. Researchers say the harmful effects of austerity are linked to the increasing inability of patients to access the health system, large rises in the incidence of infectious disease, and a deterioration in the overall mental health of Greek people.

The authors from the London School of Hygiene & Tropical Medicine, the University of Oxford, and the University of Cambridge say that Greece has had the largest cutbacks to the health sector seen across Europe, as the bailout package capped public expenditure at 6% of GDP. For example, from 2009 to 2011, the public hospital budget was reduced by over 25%. Greece's public spending on health is now less than any of the other pre-2004 European Union members.

Study co-author Martin McKee, Professor of European Public Health at the London School of Hygiene & Tropical Medicine, said: "Behind the economic statistics used to track Europe's financial crisis there lies a massive toll of human suffering that has, far too often, been ignored by our political leaders as they search for short-term fixes".

Senior author Dr David Stuckler, Honorary Research Fellow, London School of Hygiene & Tropical Medicine, added: "The Greek government -along with their European partners - appears to have been in denial about austerity's severe impact on health. 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 this research will help the Greek government mount an urgently needed response to these escalating human crises."

At a time of increasing health need and falling incomes, Greece's bailout agreement stipulated shifting the cost of healthcare to patients. The Greek government introduced new charges for visits to outpatient clinics and higher costs for medicines. General health services were also eroded, says the paper.

The authors' analysis of the latest available data from the EU Statistics on Income and Living Conditions revealed a 47% rise in people who felt they did not receive medically necessary healthcare. This increase was linked to a rising inability to afford care and the costs of travel to access health services, according to the authors.

Rapidly increasing unemployment since 2009 meant a growing number of people no longer had any form of health cover, with an estimated 800,000 without unemployment benefits or the ability to access health services. 

The paper details signs of the nation's deterioration in health including:

• HIV incidence has risen in injecting drug-users more than 10-fold from 2009 to 2012
• Tuberculosis incidence among injecting drug users more than doubled in 2013
• State funding for mental health decreased by 55% between 2011 and 2012
• Major depression increased 2.5-fold between 2008 and 2011
• Suicides increased by 45% between 2007 and 2011
• Infant mortality jumped by 43% between 2008 and 2010
• The proportion of children at risk of poverty increased from 28 in 2007 to 30% in 2011

Co-author Marina Karanikolos, Research Fellow at the London School of Hygiene & Tropical Medicine, said: "The prolonged crisis has subjected the Greek people to worsening health and loss of access to adequate healthcare. This will affect societal well-being for many years to come."

The authors note that experiences of other countries that have overcome financial crises, such as Iceland and Finland, suggest that by ring-fencing health and social budgets, governments can avoid some of the harmful effects of crisis taking their toll on the health of their populations.

The study states that the Greek health-care system was in grave need of reform before the crisis, but the scale and speed of imposed change limited its capacity to respond to its population's increased health needs.

The authors conclude: 'The foundations for a well functioning health-care system need structures that are accountable and coordinated - not denialism. These findings suggest that the people of Greece deserve better.'

Publication

• Alexander Kentikelenis, Marina Karanikolos, Aaron Reeves, Martin McKee, David Stuckler. Greece's health crisis: from austerity to denialism. The Lancet. DOI: 10.1016/S0140-6736(13)62291-6