Health and Crisis
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Transcript of Health and Crisis
!!
“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
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 • 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
1992
1993
1994
1995
1996
1997
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
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
• 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
• 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