Health and Crisis

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Health and Crisis Benos REACH Towards a right to health without borders Izmir 8 to 18 July 2014

Transcript of Health and Crisis

  • Health and Crisis

    !!!!

    !!

    REACH Towards a right to health without borders

    Izmir 8 to 18 July 2014

  • What is health ?

    !

    !

  • Situation today

  • !!

    A girl born in Sweden will live 43 years longer than a girl born in

    Sierra Leone !!!

    WHO Commission on Social Determinants of Health

  • ortality 1 - 4 year olds

    Territory size shows the proportion of all deaths of children aged over 1 year and under 5 years old, that occurred there in 2002.

    www.worldmapper.org

  • GDP wealth

    Territory size shows the proportion of worldwide wealth, that is Gross Domestic Product based on exchange rates with the US$, that is found there.

    www.worldmapper.org

  • !!

    in Glasgow an unskilled working class person will have a lifespan 28 years shorter than a businessman in

    the top income bracket !

    Commission on Social Determinants of Health

  • Causes of the causes !

    Social determination of health !

  • Neoliberal globalisation

    Main characteristics Impacts

  • Neoliberal globalisation

    State withdraw

    Labor derregulation

    Unlimited mobility of capital, goods,

    services

    !

  • impacts of neoliberal globalisation

    increasing social inequalities increasing health inequalities ecological disasters wars & oppression marginalisation

  • Causes of the causes Social determination of

    health health services

    !

  • Causes of the causes Social determination of

    health Health Services

    availability !

    !

  • Causes of the causes Social determination of

    health Health Services Availability Accessibility

    economic barriers !

  • The inverse care law

    consumerism of health services addressed

    to young, healthy and rich people and rising expenditures

    !economic barriers leading to inadequate and spare health services for elderly, unemployed, immigrants and poor and rising unmet needs of the population

  • The Greek economic crisis

    Hellenic Statistical Authority. National Accounts (accessed December 2013), own calculations

  • The Greek Economic Adjustment Programmes - EAPs

    May 2010 (1st EAP) ! Loan: 110 billion ! Installments: the assistance to Greece was

    provided in quarterly installments ! Main Fiscal Target of the Program: reduction of

    government deficit from 14% of GDP in 2009 to below 3% GDP in 2014 through the implementation of fiscal consolidation measures worth of 11.3% GDP (approximately 25 billion) within a five year period !

    Structural Reform Targets: reforms of the pension system; public administration; labour market; state enterprises; reforms for the improvement in the business environment; privatization of public assets and enterprises (target 50 billion), government guaranteed bank bonds to the Greek private banks (55 billion)

    March 2012 (2nd EAP) ! Loan: 130 billion ! Duration of the Program: the program was

    extended until 2016 ! Main Fiscal Targets of the Program: reduction of

    governments overall deficit to 2% GDP in 2016 through the implementation of consolidation measures cumulatively worth of 30.6% GDP (approximately 65 billion) between 2010-6 !!

    Structural Reform Targets: completion of the reforms of the 1st program, recapitalization of private Greek banks (50 billion)

    Directorate-General for Economic and Financial Affairs (own calculations)

  • The Greek EAPs and healthcare reform

    Kondilis E et al (forthcoming)

    Health care reform is a crucial component of Greeces fiscal consolidation efforts

    (EC Occasional paper 87, October 2011) !! The Memoranda of Understanding (MoUs) that the Greek government signed with

    the Troika from May 2010 to May 2013 included 170 conditionalities related to healthcare:

    ! Fiscal consolidation conditionalities related to healthcare (40 austerity measures) ! Structural healthcare reform conditionalities (60 measures) ! Pharmaceutical policy conditionalities (70 measures)

  • Greek EAPs and austerity

    1970

    4489

    4977 4910

    3729

    0

    1000

    2000

    3000

    4000

    5000

    6000

    7000

    2010 2011 2012 2013 2014

    millio

    n , c

    urren

    t pric

    es

    Government Health Expenditure savingsSocial Security Health Expenditure savingsTotal Public Health Expenditure savings

    Public health expenditure savings (realized and projected) under the Greek EAPs

    Kondilis E et al (forthcoming)

  • Greek EAPs and austerity

    MoUs user fees conditionalities

    3-5 co-payment for outpatient services in public hospitals 30 million

    Extension of all day functioning of public hospitals 40 million

    Fee on prescription115 million

    Increased co-payments for public inpatient care

    Restriction of EOPYYs health benefit package 180 million

    Total 365 million

    Note: co-payments for pharmaceuticals and increased co-payments to private, contracted to SSFs providers are not included in the above table since Troika didnt quantify the subsequent projected savings resulting from these measures

    Kondilis E et al (forthcoming)

  • The Greek social crisis

    Kondilis E, Bodini C, De Vos P, Stefanini A, Benos A. 2013

    0%

    5%

    10%

    15%

    20%

    25%

    30%

    35%

    40%

    45%

    2004 2005 2006 2007 2008 2009 2010 2011 2012

    % la

    bour

    forc

    e

    0%

    5%

    10%

    15%

    20%

    25%

    30%

    35%

    40%

    45%

    % population

    Unemployed, % labour force (left scale)Long-term unmeployed, % labour force (left scale)Unemployed aged 15-29 years, % labour force aged

  • The Greek healthcare crisis

    Hellenic Statistical Authority and Greek Ministry of Health ESYnet (accessed May 2013), own calculations

    Utilization of public hospital services, Greece 2000-2012

    0

    500

    1.000

    1.500

    2.000

    2.500

    2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

    numb

    er of

    patie

    nts in

    thou

    sand

    s

    300

    350

    400

    450

    500

    550

    600

    number of patients in thousands

    Patients Discharged Public Hospitals (left scale)

    Visits Private Outpatient Departments Public Hospitals (right scale)

  • The Greek healthcare crisis

    Hellenic Statistical Authority, Living conditions in Greece (accessed April 2013), own calculations

    0%2%4%6%8%

    10%

    2004 2005 2006 2007 2008 2009 2010 2011 2012

    % p

    opul

    atio

    n

    People with self-reported unmet healthcare needs, % populationPeople of the lowest income quintile with self-reported unmet healthcare needs, % specific population group

    Self-reported unmet healthcare needs, Greece 2004-2011

  • The Greek health crisis

    Kondilis E, Bodini C, De Vos P, Stefanini A, Benos A. 2013

    2

    3

    4

    5

    6

    7

    8

    9

    10

    1990 1993 1996 1999 2002 2005 2008 2011

    Deat

    hs p

    er 1

    ,000

    live

    birth

    s

    Infant mortality rate, Greece 1990 - 2011

  • The Greek health crisis

    Kondilis E, Bodini C, De Vos P, Stefanini A, Benos A. 2013 Kondilis E, Ierodiakonou I, Gavana M, Giannakopoulos S, Benos A. 2013

    0123456789

    101112

    2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

    Dea

    ths,

    per

    100

    ,000

    pop

    ulat

    ion

    Total all ages Females all ages Males aged 30-34 years Males aged 50-54 years

    Suicide mortality by sex and age group, Greece 1998-2010

  • Economic crisis and health in Greece

    2008: n=2.197, 2009: n=2.192, *2009-2008 difference: p

  • Economic crisis and health: Greece 2008-2013

    2008: n=2.197, 2009: n=2.192, 2011: n=2256 Madianos M, Economou M, Alexiou T, Stefanis C. 2011

    Economou M, Madianos M, Theleritis C, Peppou L, Stefanis C. 2011

    Attempted suicides one month before the survey, Greece 2008-2011

    1,5%

    1,1%

    0,6%

    0,0%

    0,2%

    0,4%

    0,6%

    0,8%

    1,0%

    1,2%

    1,4%

    1,6%

    2008 2009 2011

    % s

    urve

    y's

    sam

    ple

    1,5%1,1%0,6%

    3,3%

    6,8%

    8,2%

    0,0%1,0%2,0%3,0%4,0%5,0%6,0%7,0%8,0%9,0%

    2008 2009 2011

    % s

    urve

    y's s

    ampl

    e

    Attempted suicides One month prevalence of Major Depression Episode

    Depression and attempted suicides

  • Economic crisis and health in GreeceSuicide, homicide and infectious diseases mortality rates and trends

    (men < 65y), Greece 1998-2009

    Kondilis E, Giannakopoulos S, Gavana M, Ierodiakonou I, Waitzkin H, Benos A. 2013

  • Economic crisis and health in Greece

    !Kondilis E, Ierodiakonou I, Gavana M, Giannakopoulos S, Benos A. 2013

    0123456789

    101112

    2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

    Dea

    ths,

    per

    100

    ,000

    pop

    ulat

    ion

    Total all ages Females all ages Males aged 30-34 years Males aged 50-54 years

    Suicide mortality by sex and age group, Greece 1998-2010

  • WHO. European health for all database (accessed March 2014),

    , (, 0-64 ), 1970-2011

    0,0

    1,0

    2,0

    3,0

    4,0

    5,0

    6,0

    1970

    1971

    1972

    1973

    1974

    1975

    1976

    1977

    1978

    1979

    198