Health and Crisis

67
Health and Crisis REACH Towards a right to health without borders Izmir 8 to 18 July 2014

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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

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!!

REACH Towards a right to health without borders

Izmir 8 to 18 July 2014

What is health ?

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Situation today

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

Sierra Leone” !!!

WHO Commission on Social Determinants of Health

Μortality 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

government’s 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 Greece’s 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

urre

nt pr

ices

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 prescription€115 million

Increased co-payments for public inpatient care

Restriction of EOPYY’s 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 didn’t 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 <30 years (left scale)People severely materially deprived, % population (right scale)People at risk of poverty (adjusted 2005 risk-of-poverty threshold), % population (right scale)People at risk of poverty and/or social exclusion, % population (right scale)

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

op

ula

tion

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<0.0001 Madianos M, Economou M, Alexiou T, Stefanis C. 2011

One-month prevalence of Major Depression Episode, Greece 2008-9

15,3%

11,2%

6,8%5,4%

4,4%3,3%

0%

2%4%

6%8%

10%12%

14%16%

18%

I (high) II III IV (low)

Socioeconomic status Employed Unemployed Total*

% s

urve

y's

sam

ple 2008

2009

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

urv

ey'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

Οικονοµική κρίση και ψυχική υγεία στην Ελλάδα

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

Θνησιµότητα από αυτοκτονίες, ανθρωποκτονίες (άρρενες, 0-64 ετών), Ελλάδα 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

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

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1994

1995

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1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

θάνα

τοι α

νά 1

00,0

00 π

ληθυ

σµού

Έναρξη ύφεσης

Αυτοκτονίες

Ανθρωποκτονίες

Economic crisis and health: Greece 2008-2013

Greek Documentation and Monitoring Centre for Drugs. Annual reports on the state of drugs in Greece 2008-2011.

The health impact of economic crisis and fiscal consolidation. Greece

492406 397 434 442

565 573 517653 606 607

9541049

18 15 17 11 11 19 16 9 9 14 15

487

241

0

200

400

600

800

1000

1200

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 October2012*

nu

mb

er o

f n

ewly

dia

gn

ose

d c

ases

Total HIVIDUs

Newly diagnosed cases of HIV-1 infection reported in Greece, Jan 2000 – Oct 2012

IDUs: Injecting Drug Users, * 1 JAN – 31 OCTOBER 2012 Paraskevis D, Nikolopoulos G, Tsiara C, Paraskeva D, Antoniadou A, Lazanas M, et al 2011, KEELPNO. Epidemiological data on HIV infection in Greece (until 31/10/2012) www.keelpno.gr

The Greek health crisis

Malliori M, Terzidou M, Paraskevis D, Hatzakis A. 2011

Greek EAPs and austerity

-1.000

-900

-800-700

-600

-500

-400

-300

-200

-1000

100

200

Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

num

ber o

f em

ploy

ees

ExitsRecruitmentsTransfers

Movement of health personnel in public hospitals, Greece Feb-Dec 2012

Kondilis E et al (forthcoming)

Conclusions

the conventional wisdom that health, is a commodity

has devastating effects on the health status of the world population

•2. solutions – proposals – alternatives !

•2.1. social determinants !

•2.2. health services

•Global health

Conclusions

!Health is NOT a commodity

!Health is a social right

• The goal is NOT to develop health policies that favour the poor

!• But to impose policies targeting the social determinants of inequalities

•The socio-economic determinants of health could be changed if new policies are implemented targeting a democratic, socially just and sustainable development

The challenge…

The elaboration of new policies promoting health sustaining environments !Health as a social goal of the development

instead of being its product

WHO Conference Alma Ata - 1978

Right to health & health care Universal access Integrated health and health services strategy

Government responsibility Multi sectorial approach Participation

Comprehensive approach to health

Public Health Care Servicesproviding

equal access and utilisation for equal need

high quality of servicesdemocratic and accountable structure

and based on the PHC approach

could be a reality

Social Solidarity Clinic of Thessaloniki

50

IAHP www.healthp.org

People’s Health Movementwww.phmovement.org

• The socio-economic determinants of health could be changed if new policies are

implemented targeting a democratic, socially just and sustainable development

• The goal is NOT to develop health policies that favour the poor

!• But to impose policies targeting the social determinants of inequalities

!

Health is NOT a commodity !

Health is a social right