by Konstantina Briola,
It is well known that economic crisis can have complex and long-term consequences, both for the population and for the health sector in general. Since 2008, Greece’s economy has shrunk, along with other countries. During the crisis, it has been found that the health of citizens has been significantly affected, together with the health costs and the general health system. Some of the major changes that have taken place in society are unemployment, loss of income, job insecurity, inability to cover social security contributions, pressure on health budgets, etc. These changes appeared to have a significant effect on health.
The Organization for Economic Cooperation and Development (2011) defines life expectancy as «the average number of years someone could expect to live if he or she knew the specific mortality rates in a given country in a given year». Each country uses different methodologies to calculate life expectancy. In 2016, life expectancy in Greece was 81 years. Greece’s life expectancy increased from 70.1 years in 1967, to 81 years in 2016 (at an annual average rate of 0.30%).
Figure 1: Life expectancy in Greece (1960-2016)
However life expectancy, as a measurement, has one basic weakness: it cannot calculate whether those extra years of life are spent in good or bad health. For this purpose, the Health Expectation (or otherwise Healthy Life Years) was created. Particular interest in health expectancy is also reflected in a large number of studies conducted in a number of countries such as Belgium (VanOyenetal, 1996), Finland (Valkonenetal, 1997), and Great Britain (Kellyetal, 2000).
Health expectancy is an indicator that takes into account information on the health status of individuals. It focuses on quality over quantity (measured by life expectancy), as it relates to survival in good health.
Health expectancy can be calculated in three ways: The first is based on people’s subjective assessment of their health status (very good, good, moderate, bad, very bad), the second on chronic health problems (yes, no), and third in the limited activity of individuals (too restricted, not too restricted, not limited at all). The Healthy Life Years (HLY) index represents the number of years a person of a certain age is expected to live without any restrictions on their activities.
According to European Health and Life Expectancy (2018) data, the 2004-2005 Greek life expectancy at age 65 has increased by 1.3 years. In 2015, life expectancy was above the European Union average of 28 countries, with 0.1 years for women and 0.6 years for men. The HLY series, launched in 2004, shows that Greece in 2015 was below the EU average of 28 countries (9.4 for women and men).
Figure 5: Life expectancy (LE) and health expectancy (HLY) of women age 65 for Greece and the EU28 based on SILC (2004-2015)
Note: Republished from Robine, J. M. and Beluche, I., 2018, Scheme 1, p. 2, ©EHLEIS
Figure 6: Life expectancy (LE) and health expectancy (HLY) of men age 65 for Greece and the EU28 based on SILC (2004-2015)
Note: Republished from Robine, J. M. and Beluche, I., 2018, Scheme 1, p. 2, ©EHLEIS
In 2008, the financial crisis had serious consequences for public health. An economic downturn can cause an increase in population mortality through unhealthy lifestyles (such as drinking alcohol) and social stress, which in turn causes cardiovascular diseases, suicides, homicides, etc.
According to the World Health Organization (WHO) «mortality data shows the number of deaths by place, time and cause». Mortality data reflects the deaths recorded by national death registration systems.
In 2012, there were 116,670 deaths in Greece. Mortality data for the Greek population is provided by the Institute of Social and Preventive Medicine (2016). Mortality by all causes in Greece was 857.2 per 100.000 population in 2013 when in 2004 it was 1.047.8 per 100.000 population. It is a fact that there has been a steady decline in mortality rates, but at a slow pace.
Figure 7: Predicted mortality from all causes in Greece (2004-2013)
The infant mortality rate in 2009-2011 was about one third higher, 3.4 per 1000 births, compared to 2008, where it was 2.7 per 1000 births. However, according to ELSTAT data, it is noted that in 2013 there was an increase of 3.7% compared to 2012 which was 2.9%, while in 2014 the index remained at the same level as in 2013 (3.7%).
Table 2: Infant Mortality in Greece (2003 – 2014)
The global financial crisis at the end of 2007 had a significant impact on the majority of the population, not only in the economic sector but also at a social and psychological level. This situation has infiltrated the daily lives of individuals, automatically creating a series of mental illnesses and disorders. The World Health Organization, in 1948, defined Mental Health as «a state of emotional well-being in which the individual realizes his or her own abilities, can cope with the daily stress of life, live and work productively, comfortably and able to contribute to his community». Indeed, according to the WHO, mental illness is expected to be the second most common occurrence in 2020 after heart disease. The impact of the economic downturn on general health is not clear and seems to vary, as it is a multidimensional phenomenon in modern society. Usually, low educational attainment, low income, low skilled work, and social exclusion are associated with negative effects on physical, psychological and emotional health. Gilman et al (2002) concluded that people with low socioeconomic status are at greater risk in developing depression (1.69 to 2.07 times). In international literature, adverse economic conditions have been linked to a number of physical and mental problems. Epidemiological studies have shown that people with low incomes are 1.81 times more likely to be depressed than people with higher incomes. The University of Ioannina, through interviews (July 2009 to January 2010), showed that people with severe financial difficulties were three times more likely to develop severe psychopathology compared to those who did not. Correspondingly, job loss has been found to be associated with depression and anxiety symptoms, suicide and antisocial behavior. The Major Depression in 2008 was 3.3%, while in 2009 it was 6.8%, which means it increased 2.1 times. Those who reported suicidal ideation in 2009 were 5.2% and 6.7% in 2011. In addition, there was a 36% increase in the number of people who reported attempting suicide was 1.1% in 2009 and 1.5% in 2011.
Undoubtedly, the Greek economic crisis had many and varied social and economic impacts. During this period, public debt and unemployment increased, while public income and average family income declined. At the same time, households, and especially those belonging to the most vulnerable social groups, were affected by income reductions, public spending cuts, and high unemployment rates. At the same time, citizens’ health and access to health services also affected by the crisis, which is associated with the deterioration of health indicators and inadequate access to health services. It is noteworthy that the economic crisis is significantly affecting both the general health of the population and mental health.
It is imperative and necessary on the basis of existing conditions, due to the austerity policies implemented during the crisis, the need to redefine national health policy, with a clear priority on protecting vulnerable social groups and households and strengthening the national health system.
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