Read more: 鈥�Greece in crisis: Saving a nation鈥�
EVERY morning a queue forms outside the Medecins du Monde clinic in central Athens. In it wait immigrants from Afghanistan and Algeria, Roma gypsies, homeless people 鈥� and, increasingly, Greek families.
Funded by charitable donations, the clinic is intended as a safety net for groups with no other way to access the Greek health system. In recent months, however, their ranks have swelled with Greeks who 鈥� unemployed and no longer covered by social security 鈥� have no other place to go for essential medical treatment.
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On Friday last week, children queued for the routine polio vaccinations needed to start school. A pregnant woman waited alongside an elderly man with heart problems who can鈥檛 afford the daily drugs he needs to keep him alive. 鈥淭wo years ago these people had a normal life,鈥� says Nikitas Kanakis, president of Medecins du Monde, which in the country.
Regardless of whether Greece leaves the euro, the country鈥檚 economic predicament only looks set to worsen in the near future. And as budget cuts take their toll on health services, some are predicting a humanitarian crisis. 鈥淭he system is at its limit,鈥� says Kanakis. 鈥淓very day we see more and more people asking for help.鈥�
鈥淭he system is at its limit. Every day we see more and more people asking for help鈥�
Previous crises provide clues as to what lies in store, and perhaps even insights into how Greece can prepare to face 鈥� or avoid 鈥� the worst.
When the Argentinian economy collapsed just over a decade ago, riots swept the country and hospitals in Buenos Aires faced severe shortages. Yet while the government cut overall health spending, they protected many in greatest need 鈥� funding maternal and child health, where there were improvements as a result. Prioritising vaccination, chronic disease and drug addiction yielded similar positives.
There may also be lessons from the restructuring of the Soviet Union and eastern Europe during the early 1990s, when mass unemployment resulted in increased rates of adult male mortality, particularly due to cardiovascular disease. That is partly because unemployment undermines morale, and people seek comfort in risky behaviours such as smoking and drinking, says , a health policy expert at the University of East Anglia in Norwich, UK. The public health toll is exacerbated by people having less money to pay for health services, making them more likely to delay treatment. 鈥淵ou鈥檙e going to see an increase in the pressure on healthcare systems at a time when they are struggling to do what they were able to do in the past,鈥� says Lloyd-Sherlock.
There are signs that this is already happening in Greece. Social security covers health costs for families of the employed, but those without jobs receive basic care for just one year after becoming unemployed. After this, they can pay 鈧�5 to visit a doctor, but must pay for prescriptions themselves.
Those costs may be deterring people from getting necessary treatment: compared with 2007, in 2009 15 per cent more people reported that they didn鈥檛 seek medical care when they needed it. More people also turned to hospitals for primary care, in part due to long waiting times elsewhere (The Lancet, ). That was likely a result of understaffing and shortages in medical supplies caused by 40 per cent cuts in hospital budgets, says , population health specialist at the University of Cambridge.
Still, the need for healthcare grows. Data collected by the Hellenic Centre for Disease Control and Prevention (HCDCP) in Athens revealed a spike in new HIV infections during early 2011 鈥� largely attributed to a rise among drug users. There have even been reports from addiction treatment programmes of in the belief that they will receive benefits of 鈧�700 per month, and a shortcut onto drug substitution programmes.
Meanwhile, Greece鈥檚 geographic position as the gateway to Europe from Asia and Africa poses its own problems. The potential harm of cuts to disease surveillance and control operations is clear: diseases rare elsewhere in the European Union 鈥� including West Nile virus and animal diseases such as foot and mouth 鈥� are common beyond Greece鈥檚 southern and eastern borders.
So is malaria, which Greece had eradicated in 1974. Yet in September there was an outbreak in a river delta area near Sparti that was once a hotspot for mosquito-borne infection. 鈥淲e have intensified efforts to deal with HIV, West Nile and malaria outbreaks,鈥� says Sotirios Tsiodras of the HCDCP. 鈥淭he question is whether we will be able to sustain these efforts.鈥�
Greece鈥檚 location isn鈥檛 the only thing that distinguishes the current crisis. For one thing, it has an older population, with around a quarter of people over 60. Prioritising screening for and treatment of common conditions like hypertension, diabetes and high cholesterol would be one of the most cost-effective strategies the Greek government could take, says Lloyd-Sherlock. 鈥淭his would be relatively cheap and have immediate benefits.鈥�
Protecting physical health should not be the only priority in a time of crisis, however. When Japan鈥檚 鈥渂ubble economy鈥� collapsed in 1998, overall health spending was protected. Yet there was a sharp increase in suicides (BMJ, ). A similar trend is evident in Greece, where suicides rose by 17 per cent between 2007 and 2009, and by 40 per cent in the first half of 2011 compared with the same period in 2010. Violence, theft and homicide rates have also risen since 2007.
But looking to the past also provides evidence that financial crises needn鈥檛 always spell sickness and despair. In 1992, unemployment in Sweden was 10 percentage points higher than it is in Greece, yet suicide rates fell. 鈥淐ountries that put more money into helping people get back into jobs quickly have lower rates of suicide during hard economic times,鈥� says Stuckler (The Lancet, ).
How Greece鈥檚 predicament will pan out is unknown, but previous crises suggest it is the older and more vulnerable members of society who will suffer most. 鈥淵ou probably won鈥檛 see images of malnourished children in feeding centres, which is what people think of in terms of a humanitarian crisis,鈥� says Lloyd-Sherlock. 鈥淲hat you will see is people who might have been expected to live into their 80s dying in their early 70s of relatively preventable conditions.鈥�