The deteriorating global economic outlook for some countries is increasing concern about the effects that the economic crises are having on people’s health. The crises now taking place in several European countries raise the possibility that a “cascade effect” of unpredictable but mostly negative consequences may affect people’s health and well being.
The economic crises affecting many countries have been exacerbated by additional factors such as an increasingly aging population, unhealthy lifestyles, rising costs of health care, and public health policies aligned more toward providing acute rather than chronic care.
Not only governments, however, determine how to respond to economic crises. The cases of Greece and Cyprus, for example, show that the countries are at the mercy of funding from the “Troika”: The European Commission, the European Central Bank, and the International Monetary Fund. According to experts, Cyprus needs now not only loans but grants from these institutions, given the country’s sharp deterioration in creditworthiness.
Economic crises, particularly in low and even middle-income countries, usually lead to reduction in demand for imports—including medicines and medical supplies and technology—and falling remittances from family members working outside the country. In addition, there is less government revenue to finance health and social services.
The Lancet highlights the situation in Greece, one of the European countries most affected by the ongoing global economic crisis. As a result of the economic crisis in that country, there has been a significant increase in unemployment, which rose from 6.6 percent in May 2008 to 16.6 percent in May 2011. Even more troublesome, youth unemployment rose in the same period from 18.6 percent to 40.1 percent.
Several studies have shown that unemployment increases both the risk of psychiatric and somatic disorders. For example, a strong correlation has been found between job loss and clinical and subclinical depression, substance abuse, anxiety and antisocial behavior. In addition, several studies have shown that prolonged unemployment increases mortality rates.
Although the case of Greece is paradigmatic, a study in the United Kingdom found that a mass rise in unemployment was associated with an increase of 4.45 percent in suicide rates and a 28.0 percent increase on deaths due to alcohol poisoning. Also, a study conducted in Denmark in 2011 found a significant association between unemployment and poor self-rated overall health and high levels of perceived stress.
In Greece, the inability to pay high levels of personal debt may be one of the explanations behind the increase in the number of suicides, which increased by 40 percent increase in the first six months of 2011 compared to the same period in 2010. During that same period, homicide and theft rates almost doubled. Among callers to a national suicide help line 25 percent reported financial difficulties in 2010.
A surge in intravenous drug use explains a rise of more than 1000 percent in HIV infections among drug addicts. In addition to intravenous drug use, prostitution and unsafe sex are also responsible for the increase in HIV infections in the general population, estimated to be 52 percent higher in 2011 than in 2010.
Another example of the effect of the economic crisis in Greece on vulnerable groups is the increased use of street clinics run by nongovernmental organizations like the Greek chapter of Médecins du Monde, which reports an increase in the percentage number of those seeking medical attention at its street clinics—from 3 to 4 percent before the crisis to about 30 percent now.
That the health situation has worsened as a result of the crisis is demonstrated by the number of Greeks who consider their health status as “bad” or “very bad,” an increase of 14 percent from 2007 to 2009. This is not surprising when one considers that in 2012 an estimated 10 percent of elementary- and middle-school students suffer from “food insecurity, facing hunger or the risk of it. As a result of budget cuts, a third of the country’s outreach programs have been eliminated, as Ministry of Health’s total expenditures fell by 23.7 percent between 2009 and 2011.
It is possible that the financial crisis many countries are now experiencing will lead to bigger income inequalities which are linked to differential health outcomes, including different rates of communicable diseases. For example, tuberculosis rates have the potential to increase in several European countries as a result of a deteriorating economic situation.
In Portugal, winter deaths in people older than 75 years increased by 10 percent in 2012 compared to 2011. Although some experts question the significance of this finding, others believe this increase may be due to reduced access to health services and poor diet.
In Spain, as a result of the current crisis there has been an increase in the prevalence of patients with mental health and alcohol abuse problems.
The situation in Greece may be an omen of things to come in other countries with similar social and health care systems that risk going through difficult times, as is the case of Cyprus, Portugal, Italy, and Spain. It is up to the governments in those countries to rationalize resources, increase efficiency and protect the health of its citizens.
Dr. César Chelala is an international public health consultant.
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