The Lancet, Early Online Publication, 10 October 2011
doi:10.1016/S0140-6736(11)61556-0Cite or Link Using DOI
Health effects of financial crisis: omens of a Greek tragedyAlexander Kentikelenis, Marina Karanikolos, Irene Papanicolas, Sanjay Basu, Martin McKee, David Stuckler, Email Address
Greece has been affected more by the financial turmoil beginning in 2007 than any other European country. 15 years of consecutive growth in the Greek economy have reversed. In adults, unemployment has risen from 6·6% in May, 2008, to 16·6% in May, 2011 (youth unemployment rose from 18·6% to 40·1%),1 as debt grew between 2007 and 2010 from 105·4% to 142·8% of gross domestic product (GDP; €239·4 billion to €328·6 billion) compared with the average change in the EU-15 (the 15 countries that were EU members before May 1, 2004) from 66·2% to 85·1% of GDP in this same period (€6·0 trillion to €7·8 trillion).2 Greece's options were limited, since its Government ruled out leaving the Euro, precluding them from one of the most common solutions in such circumstances: devaluation. To finance its debts, Greece had to borrow €110 billion from the International Monetary Fund and Eurozone partners, under strict conditions that included drastic curtailing of government spending. Whereas other countries in Europe (eg, France, Germany) now show signs of economic recovery, the crisis continues to evolve in Greece; industrial production fell by 8% in 2010.
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Compared with 2007—ie, before the crisis—2009 saw a significant increase in people reporting that they did not go to a doctor or dentist despite feeling that it was necessary (odds ratio 1·15, 95% CI 1·02—1·30 for doctors' visits; 1·14, 1·01—1·28 for dentists' visits [figure, webappendix p 2—3]), after correcting for differences in survey respondents including age, sex, marital status, educational attainment, and urban or rural residence. The main reasons for not seeking medical care did not seem significantly linked to an inability to afford care (0·87, 0·74—1·02), but to long waiting times (1·83, 1·26—2·64), travel distance to care (2·50, 1·35—4·63), waiting to feel better (1·93, 1·26—2·96), and other reasons not captured by the survey (1·54, 1·05—2·27).
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Τhere are signs that health outcomes have worsened, especially in vulnerable groups. We noted
a significant rise in the prevalence of people reporting that their health was “bad” or “very bad” (1·14, 1·02—1·28; figure).
Suicides rose by 17% in 2009 from 2007 and unofficial 2010 data quoted in parliament mention a 25% rise compared with 2009. The Minister of Health reported a 40% rise in the first half of 2011 compared with the same period in 2010. The national suicide helpline reported that 25% of callers faced financial difficulties in 2010 and reports in the media indicate that the inability to repay high levels of personal debt might be a key factor in the increase in suicides. Violence has also risen, and homicide and theft rates nearly doubled between 2007 and 2009. The number of people able to obtain sickness benefits declined (0·61, 0·38—0·98) between 2007 and 2009, probably owing to budget cuts, and further reductions to access and the level of benefits are to be expected once austerity measures are fully implemented.
A significant increase in HIV infections occurred in late 2010. The latest data suggest that new infections will rise by 52% in 2011 compared with 2010 (922 new cases versus 605), with half of the currently observed increases attributable to infections among intravenous drug users.19 Data for the first 7 months of 2011 show more than a 10-fold rise in new infections in these drug users compared with the same period in 2010.20 The prevalence of heroin use reportedly rose by 20% in 2009, from 20 200 to 24 100, according to estimates from the Greek Documentation and Monitoring Centre for Drugs.
Another indicator of the effects of the crisis on vulnerable groups is
increased use of street clinics run by NGOs. Until recently, these clinics mainly catered to immigrants, but the Greek chapter of Médecins du Monde estimates that the proportion of Greeks seeking medical attention from their street clinics rose from 3—4% before the crisis to about 30%.
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