In Greece, Austerity Kills

A string of academic reports documenting in detail the impacts of austerity on health care and health outcomes in Greece have recently been released [1]. They show how European authorities, IMF and Greek government policies implemented in response to the economic crisis have led to deaths and attacks on the health of ordinary people. But there was nothing inevitable about those consequences. As the medical journal the Lancet stated: “Experience elsewhere in Europe shows that those countries which prioritise social protection (including health) in the midst of austerity, and favour fiscal stimulation, secure better outcomes for their populations.”

Austerity implies a combination of government spending cuts and tax hikes to shrink public deficits to revive economies facing the current downturn. But it doesn’t work, as Europe’s ongoing economic stagnation makes clear. Moreover, whatever government savings result from expenditure reductions, it is important to point out that they are built on “blood money,” as argued recently by Yanis Varoufakis, the well-known Greek economist.

The Greek economy shrank by 20 percent, between 2008 and 2012, due to austerity measures that cut public spending drastically, capping health expenditures at 6 percent of GDP, so that they are now lower than any other European Union members that joined prior to 2004. The public hospital budget was cut by 26 percent between 2009 and 2011.

But it is not as if the Greek government was trying to resist troika pressure – it is also pro-austerity. (The troika is the European Commission (EC), the International Monetary Fund (IMF) and the ECB, European Central Bank.) Varoufakis wrote recently that “the government is not interested in the slightest in playing tough with the troika,” but “only with its own people, trying to impress the troika with its ruthlessness.” For example, in 2012, Greece went beyond the troika’s demands for spending reductions in pharmaceutical expenditures and hospital operating costs. The then-minister of health, Andreas Loverdos, conceded that “the Greek public administration . . . uses butchers’ knives” to cut spending. The Lancet described the government’s attitude to the multiple health problems for which it is responsible as one of “denial.”

An important problem is the erosion of health-care coverage, which in Greece is linked to employment. Because unemployment has surged over the last few years and stands at 28 percent today, there are now about 800,000 people who are without unemployment benefits and health coverage. The situation is so bad that so-called social clinics staffed by volunteer doctors are currently operating in urban centers to make up for the lack of care.

As if this was not enough, stillbirths rose by 21 percent between 2008 and 2011 because of scaled down prenatal health services for pregnant women, while the long-term fall in infant mortality has been reversed, surging by 43 percent between 2008 and 2010.

The general deterioration of social life due to austerity is clear when the following statistics are considered. There are 2.8 million households in Greece, and 2.3 million have a debt to the Tax Office that they cannot service; 1 million households cannot pay their electricity bill in full; households’ disposable income has contracted 30 percent since 2010; the minimum wage has been reduced by 40 percent; social transfers have been cut by 18 percent; there are now 3.5 million employed people who support 4.7 million unemployed or inactive ones; and 35 percent of the population live at risk of poverty or social exclusion.

No wonder that deaths by suicide have thus increased by 45 percent between 2007 and 2011.

Prevention and treatment for illegal drug use have been cut, and the number of condoms and syringes distributed to addicts fell by 24 percent and 10 percent respectively. Predictably, new HIV infections among injecting drug users surged from 15 in 2009 to 484 in 2012, while the incidence of tuberculosis among this group has more than doubled between 2012 and 2013.

Also, incredibly, malaria has re-emerged in Greece for the first time in 40 years due to significant cuts in municipal budgets that have translated into reductions in mosquito-spraying programs.

Austerity shifts the burden of fiscal adjustment onto ordinary people, and accordingly, Greece has witnessed a shift of health-care costs toward patients, leading to reductions in access to care. User fees increased from 3 to 5 euros for outpatient visits and copayments for medicines have increased by up to 10 percent, on top of additional fees.

Public funding for mental health dropped by 20 percent between 2010 and 2011 and by an extra 55 percent between 2011 and 2012. This was made worse by the fact that the use of mental health services has increased by 120 percent due to problems linked with the recession and unemployment. For example, the prevalence of depression has more than doubled.

In short, it is not difficult to demonstrate that austerity kills and injures. One positive aspect of those problems is that their solutions are well-known: stop austerity, stimulate the economy, and increase funding for health care – otherwise, this modern-day Greek tragedy will go on.

1. Alexander Kentikelenis et al. (2014), “Greece’s health crisis: from austerity to denialism,” Lancet, 383, pp. 748-53; Nikolaos Antonakakis and Alan Collins (2014), “The impact of fiscal austerity on suicide: on the empirics of a modern Greek tragedy,” Social Science & Medicine (forthcoming); Amalia Ifanti et al. (2013), “Financial crisis and austerity in Greece: their impact on health promotion policies and public health care,” Health Policy, 113, pp. 8-12.