Economic Crises Exacting Toll on Public Health

by Dr. CESAR CHELALA

The deteriorating global economic outlook for some countries is increasing concern among health experts on the effects that the economic crises will have on people’s health.

As the World Health Organization stated in 2009, “It is not yet clear what the current financial crisis will mean for low-income and emerging economies, but many predictions are highly pessimistic.”

In low-income countries, economic crises 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.

An article in the Lancet highlights those effects 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% in suicide rates and a 28.0% 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, and among callers to a national suicide help line 25 percent reported financial difficulties in 2010.

Also, a surge in intravenous drug use may explain 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.

Although in Greece patients with social insurance may visit general practitioners free of charge or attend outpatient clinics for a very low fee, there was a reduction of those visits in 2009 compared to 2007. At the same time, there was a 24 percent rise in public hospital admissions in 2010 compared to 2009 while admission to private hospitals declined by 25 to 30 percent during the same period. This situation may be a result of a 40 percent cut in hospital budgets, which have led to understaffing and occasional shortages of medicines and medical supplies.

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 view their health as “bad” or “very bad”, an increase of 14 percent from 2007 to 2009. To make matters worse, a third of the country’s outreach programs have been eliminated as a result of budget cuts in 2009 and 2010.

By many accounts, Greece’s public health care system is riddled with corruption and inefficiency. Often, patients offer doctors informal payments to receive treatment, particularly when they are not covered by the social insurance fund. In addition, hospitals frequently face shortages of materials and equipment. The present crisis may be an opportunity to improve the efficiency and service quality of the Greek public health system.

It is possible that the financial crisis many countries are now experimenting 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.

The situation in Greece may be a harbinger of things to come in other countries with similar social and health care systems that risk going through difficult economic situations, such as Cyprus. It is up to the governments in those countries to rationalize resources, increase efficiency and protect their most valuable asset: the health of its citizens.

Dr. Cesar Chelala is a co-winner of an Overseas Press Club of America award.

Dr. Cesar Chelala is an international public health consultant.

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