Through austerity measures imposed in response to its economic crisis, Greece made deep cuts to its public health system and spending. This led to reduced access to care, especially for vulnerable groups. Unmet medical needs increased significantly from 2007 to 2011, with financial barriers and transportation difficulties preventing many from receiving needed care. Indirectly, the austerity measures negatively impacted health by worsening economic conditions and increasing unemployment, mental health issues, child poverty, and suicides.
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the Advanced Training and Conference on Health Economics (24 June 2015, Budapest, Hungary)
The Threat of the covid‑19 pandemic to human rightsRula alsawalqa
The document discusses how Jordan responded to the COVID-19 pandemic and the effects on human rights. While Jordan largely contained the spread of the virus, the government's response faced criticism for undermining rights like freedom of expression. Labor rights were also threatened as weaknesses in Jordan's labor market and social protections were exposed. The pandemic exacerbated issues like unemployment, reduced wages, and lack of coverage for many workers. Going forward, Jordan needs to ensure its emergency measures do not infringe on basic rights and adopt a human rights-based approach for future crises.
The document discusses strengthening health emergency preparedness and response capacities in Armenia. It notes that the European Region is vulnerable to various health threats like infectious diseases, natural disasters, and conflicts. Health emergencies can cost lives and economic losses. Armenia faces specific threats including earthquakes, chemical hazards, and food/waterborne diseases. The Joint External Evaluation of Armenia found strengths but also capacities needing strengthening, like surveillance systems and points of entry infrastructure. Strengthening capacities is important for protecting lives, meeting international obligations, and contributes to development goals. The opportunity exists for Armenia to adopt a national action plan and receive WHO support to build a long-term, sustainable strategy.
The document summarizes elements of the WHO Regional Office for Europe's Health 2020 strategy. It discusses how the global health landscape has become more complex with populations living longer, migrating more, and noncommunicable diseases now dominating. Health 2020 aims to improve governance, invest in health through life courses, tackle major challenges like noncommunicable and communicable diseases, strengthen health systems and public health, and create supportive environments. It outlines priorities like working to reduce health divides and empowering people. The economic burden of chronic diseases in Europe is also summarized.
The document summarizes elements of the WHO Regional Office for Europe's Health 2020 strategy. It discusses how the global health landscape has become more complex with challenges like noncommunicable diseases dominating disease burdens. Health 2020 aims to improve governance, invest in health through a life course approach, tackle major health challenges, strengthen health systems and create supportive environments. Its four priorities are improving leadership for health, reducing health inequities, making people the focus of health systems, and supporting disease prevention. The strategy aims to work across sectors and policies to improve health for all Europeans.
Presentation made by Zsuzsanna Jakab, WHO Regional Director for Europe, at the meeting "Health in Action reforming the Greek National Health System to Improve Citizens’ Health", on 5 March 2014, Athens, Greece.
- European health systems face several challenges in the coming decades including aging populations, rising costs, and growing disease burdens that threaten sustainability.
- While EU member states retain control over health policy, the EU has tools like research funding, economic governance, and environmental policy that can positively influence health.
- The EU should do more to promote health across all policies, strengthen health system assessment and reform guidance, improve access to medicines and care, and foster innovation in areas like e-health and antimicrobial resistance. Coordinated action at EU level can help address common challenges and ensure affordable, high-quality healthcare for all Europeans.
This document summarizes social diseases and health issues in Germany. It discusses the prevalence of various cancers and respiratory illnesses in different regions, often linked to adverse environmental or occupational conditions. Mining regions in particular experience high rates of lung diseases. It also outlines trends in cardiovascular disease mortality and risk factors. Germany has a concentrated HIV epidemic, with the majority of cases occurring among men who have sex with men. Overall health spending accounts for around 15% of Germany's national income and the system employs over 2 million workers in outpatient care.
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the Advanced Training and Conference on Health Economics (24 June 2015, Budapest, Hungary)
The Threat of the covid‑19 pandemic to human rightsRula alsawalqa
The document discusses how Jordan responded to the COVID-19 pandemic and the effects on human rights. While Jordan largely contained the spread of the virus, the government's response faced criticism for undermining rights like freedom of expression. Labor rights were also threatened as weaknesses in Jordan's labor market and social protections were exposed. The pandemic exacerbated issues like unemployment, reduced wages, and lack of coverage for many workers. Going forward, Jordan needs to ensure its emergency measures do not infringe on basic rights and adopt a human rights-based approach for future crises.
The document discusses strengthening health emergency preparedness and response capacities in Armenia. It notes that the European Region is vulnerable to various health threats like infectious diseases, natural disasters, and conflicts. Health emergencies can cost lives and economic losses. Armenia faces specific threats including earthquakes, chemical hazards, and food/waterborne diseases. The Joint External Evaluation of Armenia found strengths but also capacities needing strengthening, like surveillance systems and points of entry infrastructure. Strengthening capacities is important for protecting lives, meeting international obligations, and contributes to development goals. The opportunity exists for Armenia to adopt a national action plan and receive WHO support to build a long-term, sustainable strategy.
The document summarizes elements of the WHO Regional Office for Europe's Health 2020 strategy. It discusses how the global health landscape has become more complex with populations living longer, migrating more, and noncommunicable diseases now dominating. Health 2020 aims to improve governance, invest in health through life courses, tackle major challenges like noncommunicable and communicable diseases, strengthen health systems and public health, and create supportive environments. It outlines priorities like working to reduce health divides and empowering people. The economic burden of chronic diseases in Europe is also summarized.
The document summarizes elements of the WHO Regional Office for Europe's Health 2020 strategy. It discusses how the global health landscape has become more complex with challenges like noncommunicable diseases dominating disease burdens. Health 2020 aims to improve governance, invest in health through a life course approach, tackle major health challenges, strengthen health systems and create supportive environments. Its four priorities are improving leadership for health, reducing health inequities, making people the focus of health systems, and supporting disease prevention. The strategy aims to work across sectors and policies to improve health for all Europeans.
Presentation made by Zsuzsanna Jakab, WHO Regional Director for Europe, at the meeting "Health in Action reforming the Greek National Health System to Improve Citizens’ Health", on 5 March 2014, Athens, Greece.
- European health systems face several challenges in the coming decades including aging populations, rising costs, and growing disease burdens that threaten sustainability.
- While EU member states retain control over health policy, the EU has tools like research funding, economic governance, and environmental policy that can positively influence health.
- The EU should do more to promote health across all policies, strengthen health system assessment and reform guidance, improve access to medicines and care, and foster innovation in areas like e-health and antimicrobial resistance. Coordinated action at EU level can help address common challenges and ensure affordable, high-quality healthcare for all Europeans.
This document summarizes social diseases and health issues in Germany. It discusses the prevalence of various cancers and respiratory illnesses in different regions, often linked to adverse environmental or occupational conditions. Mining regions in particular experience high rates of lung diseases. It also outlines trends in cardiovascular disease mortality and risk factors. Germany has a concentrated HIV epidemic, with the majority of cases occurring among men who have sex with men. Overall health spending accounts for around 15% of Germany's national income and the system employs over 2 million workers in outpatient care.
Globalization has increased risks from international threats like pandemics, environmental degradation, and ethnic violence. Strategies are needed to deal with these threats through improved surveillance, distribution of medicines, and understanding the causes of conflicts. Preventive actions before crises occur are important but difficult for governments. Underlying economic issues from globalization like unemployment and inequality can contribute to these threats if not addressed through education, health programs, and infrastructure investment. International cooperation through organizations like WHO and UN is vital to strengthen global efforts against diseases and support national health systems.
The document discusses the contribution of international law to global health governance based on the experience of the WHO Framework Convention on Tobacco Control (FCTC). It notes that health has historically been neglected in international law but interest has grown since the FCTC's adoption in 2003. The FCTC negotiations showed that international law can promote global cooperation on public health issues transcending borders. Key lessons from the FCTC experience include assessing political support for health agreements and considering alternative legal designs and processes beyond just the final legal instrument.
This document evaluates the social and environmental accountability of the Nigerian pharmaceutical industry from 2009 to 2018. It analyzes social and environmental disclosures in the annual reports of sampled pharmaceutical companies using a modified word count content analysis. The results indicate low levels of social accountability addressing issues important to primary stakeholders, and an absence of environmental accountability. Stakeholder theory is used to explain the results, suggesting continued risks to human lives and the environment without policy changes. The study aims to contribute new insights on the social and environmental disclosure practices of the Nigerian pharmaceutical industry over a 10-year period.
The document summarizes the impact of the financial crisis in Europe on health and health systems based on a presentation given in Brussels. It finds that the crisis significantly increased risks of ill health, including higher suicide rates, alcohol poisoning, and mental illness. Most countries responded by lowering health spending, drug prices, and salaries while increasing user fees. The challenges of a prolonged crisis and need to balance quick responses with long-term reforms are discussed. Maintaining employment and investing in primary care are emphasized as important strategies.
The Covid-19 pandemic is affecting everyone around the globe and leaves none of us untouched. However, much of the focus in international media has been on the most affected countries and richer countries in East Asia, the European Union and the United States with less attention given to countries around the Baltic Sea, in Eastern Europe and the Caucasus. Since the FREE Network includes research and policy institutes in Belarus (BEROC), Latvia (BICEPS), Russia (CEFIR@NES), Poland (CenEA), Georgia (ISET), Ukraine (KSE) and Sweden (SITE), we are uniquely placed to provide a comprehensive regional perspective on the pandemic with examples of very different strategies implemented in the countries concerned.
In this presentation experts from FREE NETWORK provide a first overview of how countries in the region have fared in the pandemic and allow for a better understanding of what governments have done, how people have responded, how other countries are being portrayed in the national media, and what the current discussions focus on.
For more information please visit our website: https://freepolicybriefs.org/
- The initial spread of COVID-19 in Brazil was mostly affected by patterns of socioeconomic vulnerability rather than population age or health risk factors. States with high socioeconomic vulnerability had higher initial COVID-19 mortality despite efforts to expand health system capacity and enact policies.
- Over time, differences in policy response converged across states, while physical distancing and lower death rates became relatively greater in municipalities with the highest socioeconomic vulnerabilities.
- Existing socioeconomic inequalities in Brazil have affected the course of the COVID-19 epidemic, disproportionately burdening states and municipalities with high socioeconomic vulnerability. Targeted policies are needed to protect vulnerable populations.
In the paper, the author analyses three years of the rule of the left-wing SYRIZA in Greece.
She discusses the basis of the party’s historical victory in the parliamentary elections in 2015.
In addition, she analyses the course of negotiations with Greek creditors regarding the third
economic adjustment programme for Greece. She also points out the necessity of gradual resignation from anti-austerity agenda and social reactions against introduced reforms. In the final
part, the author of the paper outlines the current challenges of the Greek government.
This document discusses strengthening health emergency preparedness and response capacities in the Republic of Moldova. It notes that the European Region faces health threats from infectious diseases, natural disasters, and other emergencies. A Joint External Evaluation found that Moldova has some strengths in public health legislation but needs to strengthen specific capacities like surveillance systems, multisectoral coordination, and long-term preparedness planning. The WHO supports Moldova's response to health emergencies and recommends developing a national action plan to build sustainable emergency capacities as part of achieving universal health coverage.
Analysis of the efficiency of public policies in municipalities, with a popul...IJAEMSJORNAL
Pandemics, such as that of COVID-19, affect a large number of people, imposing new rules and social habits on them, aiming to modify the behavior that influences economic and social problems. In this context, the objective of this study was to be investigative, using the DEA tool (data envelopment analysis), seeking the efficiency of proposed and economic measures, seeking to assist them and also public policies in improving planning, trying to avoid problems such as those caused by the current pandemic. This is a cross-sectional and quantitative study, of an exploratory nature, carried out with data from the 10th. Region of the state of São Paulo, based on municipalities with 10,000, or more, inhabitants in the time interval from 05/03/2020 to 05/05/2021. This work is justified by the fact that the COVID-19 pandemic exposes structural weaknesses, economic differences and bottlenecks in the Brazilian health system, especially the lack or uneven distribution, in the territory, of health professionals and health professional, infrastructure, as well as limited production capacity, poor income distribution, the human development index and, still, the glaring differences in the GDP of the municipalities. It has been noted that 53% of the municipalities are deficient and that only 47% of them are above the average ideal efficiency rate of 0.823150. It is concluded, in this work, that the economic and social factors need to be better addressed and that social distance, the use of masks and personal hygiene must be encouraged by the representatives of the public power, in order to avoid a greater number of deaths.
This document summarizes the key points of the Commission Staff Working Document on prolonging the Action Plan on HIV/AIDS in the EU and neighbouring countries from 2014-2016. It discusses that while global HIV trends are declining, cases in Europe are rising. The original 2009-2013 plan achieved several goals but more work is needed on testing, treatment, harm reduction and addressing discrimination. This prolonged plan focuses on continued political leadership, treatment as prevention, and improving attention to co-infections like tuberculosis. An independent evaluation of the original plan will help inform future EU policy on HIV/AIDS.
Comprehensive report that covers emergency preparedness plan to handle covid 19.Muhammad Siddique
This document provides a comprehensive report and emergency preparedness plan for COVID-19. It summarizes the global and regional COVID-19 situation. It describes national strategies in the region for containment including case finding and testing, transmission scenarios, reporting, and clinical management. The strategies aim to enhance surveillance, conduct contact tracing, isolate confirmed cases, and provide clinical care, while recognizing constraints in resources and reporting.
Jan-Kees Helderman on NHS reform - a Dutch perspective The King's Fund
Jan-Kees Helderman, assistant professor in Comparative Governance and Public Policy at Radbouyd University Nijmegan, outlines how the Dutch health care system operates and reflects on the English health reforms.
The covid 19 crisis in nepal coping crackdown challengesNdrc Nepal
NDRC Nepal brings "The COVID-19 Crisis in Nepal: Coping Crackdown Challenges" issue 3, an occasional papers series on COOVID19 response in Nepal.
This study was carried out by Dr. Dhruba Gautam, Senior Research Fellow at National Disaster Risk Reduction Centre (NDRC) Nepal which had four interconnected objectives: (i) to assess existing policy provisions for relief management and distribution, (ii) to identify existing relief distribution mechanisms, (iii) to identify major gaps and challenges, and (iv) explore next steps and make recommendations. For secondary information, the study reviewed published documents, including government policies at the national and global levels, whereas primary information was gathered through virtual interviews and conferences with key informants in all provincial governments and in a few local governments. Among the mechanisms governments use to manage relief distribution are the management of relief funds, the selection of needy families, the development and distribution of relief packages, the adoption of a one-door policy, and the application of existing legal provisions. This study also explored gaps in these mechanisms and challenges faced during the relief management thoroughly. Some issues that raised questions included the criteria for selection and even the use of a targeted approach in principle and challenges included the procurement of relief materials and their quality and quantity as well as data management and monitoring. Once the data was on the table, this study made several key recommendations to each of the three tiers of Nepal’s government about how to systematize relief management now as well as how to carry over good practices into the future.
Health systems around the world - Memoona ArshadHuzaifa Zahoor
More people have gained access to essential health services such as immunization, HIV antiretroviral care, family planning, and malaria-prevention bed nets in the last decade. This is promising news, but development has been uneven: there are significant differences in service availability not only between countries, but also within them. Half the world's population can't afford the care it needs to stay safe on any given day.
The document summarizes a study on the socio-economic status of families affected by the 1984 Bhopal gas tragedy over a 30-year period. The study assessed differences in income, housing, education, health facilities, and asset possession between 1985 and 2015. A sample of 400 respondents from severely and moderately affected areas was surveyed. The results showed significant improvements in monthly income, home ownership, and access to education and healthcare over the 30 years since the disaster. However, some families remained in the same socio-economic position. The study concluded that while relief efforts had improved conditions for many victims, differences remained in socio-economic status even after 30 years.
The document discusses Greece's national healthcare system challenges including socioeconomic factors, a reduction in public financing leading to a deterioration in quality, and an increased dependence on the private sector. Measures taken to reduce healthcare expenditures, as required by an IMF agreement, focus solely on cost and not quality or outcomes. Key stakeholders like patients were not adequately consulted during negotiations around the measures.
To raise the public awareness about the work of the European Court of Human Rights (ECtHR), the Legal Resources Centre from Moldova (LRCM) has analyzed the Court’s work carried out in 2019. The document is based on the ECtHR’s annual report for 2019 and the analysis of the ECtHR’s case-law regarding
Moldova.
Leveraging Consumer-Facing Technologies to Improve Health OutcomesCognizant
The document discusses leveraging consumer-facing technologies to improve health outcomes. It describes how healthcare information technology (HIT) can help reduce medical errors, improve adherence to guidelines, and enable more effective disease management and remote patient monitoring. HIT includes electronic health records, computerized physician order entry, and other integrated data sources. The document also covers benefits of telehealth/telemedicine, which can improve access to care and reduce costs through reduced travel, hospitalizations, and mortality rates. Overall, the document advocates that HIT and telehealth can help improve quality of care while increasing efficiency and reducing costs.
The document discusses the roles of governments in responding to the COVID-19 pandemic. It argues that transmission of COVID-19 is largely due to failures by governments in planning, preparing for, and implementing effective pandemic responses. Key government responsibilities include regulating lockdowns and vaccines, coordinating healthcare systems, providing accurate public information, and ensuring access to testing and vaccines across communities. However, the success of government policies also depends on individuals following guidelines. While governments have broad powers to enact measures, commercial entities may prioritize profits over public health. Overall, the document maintains that governments should bear primary responsibility for curbing COVID-19 transmission given their regulatory authority and ability to coordinate responses on a large scale.
Globalization has increased risks from international threats like pandemics, environmental degradation, and ethnic violence. Strategies are needed to deal with these threats through improved surveillance, distribution of medicines, and understanding the causes of conflicts. Preventive actions before crises occur are important but difficult for governments. Underlying economic issues from globalization like unemployment and inequality can contribute to these threats if not addressed through education, health programs, and infrastructure investment. International cooperation through organizations like WHO and UN is vital to strengthen global efforts against diseases and support national health systems.
The document discusses the contribution of international law to global health governance based on the experience of the WHO Framework Convention on Tobacco Control (FCTC). It notes that health has historically been neglected in international law but interest has grown since the FCTC's adoption in 2003. The FCTC negotiations showed that international law can promote global cooperation on public health issues transcending borders. Key lessons from the FCTC experience include assessing political support for health agreements and considering alternative legal designs and processes beyond just the final legal instrument.
This document evaluates the social and environmental accountability of the Nigerian pharmaceutical industry from 2009 to 2018. It analyzes social and environmental disclosures in the annual reports of sampled pharmaceutical companies using a modified word count content analysis. The results indicate low levels of social accountability addressing issues important to primary stakeholders, and an absence of environmental accountability. Stakeholder theory is used to explain the results, suggesting continued risks to human lives and the environment without policy changes. The study aims to contribute new insights on the social and environmental disclosure practices of the Nigerian pharmaceutical industry over a 10-year period.
The document summarizes the impact of the financial crisis in Europe on health and health systems based on a presentation given in Brussels. It finds that the crisis significantly increased risks of ill health, including higher suicide rates, alcohol poisoning, and mental illness. Most countries responded by lowering health spending, drug prices, and salaries while increasing user fees. The challenges of a prolonged crisis and need to balance quick responses with long-term reforms are discussed. Maintaining employment and investing in primary care are emphasized as important strategies.
The Covid-19 pandemic is affecting everyone around the globe and leaves none of us untouched. However, much of the focus in international media has been on the most affected countries and richer countries in East Asia, the European Union and the United States with less attention given to countries around the Baltic Sea, in Eastern Europe and the Caucasus. Since the FREE Network includes research and policy institutes in Belarus (BEROC), Latvia (BICEPS), Russia (CEFIR@NES), Poland (CenEA), Georgia (ISET), Ukraine (KSE) and Sweden (SITE), we are uniquely placed to provide a comprehensive regional perspective on the pandemic with examples of very different strategies implemented in the countries concerned.
In this presentation experts from FREE NETWORK provide a first overview of how countries in the region have fared in the pandemic and allow for a better understanding of what governments have done, how people have responded, how other countries are being portrayed in the national media, and what the current discussions focus on.
For more information please visit our website: https://freepolicybriefs.org/
- The initial spread of COVID-19 in Brazil was mostly affected by patterns of socioeconomic vulnerability rather than population age or health risk factors. States with high socioeconomic vulnerability had higher initial COVID-19 mortality despite efforts to expand health system capacity and enact policies.
- Over time, differences in policy response converged across states, while physical distancing and lower death rates became relatively greater in municipalities with the highest socioeconomic vulnerabilities.
- Existing socioeconomic inequalities in Brazil have affected the course of the COVID-19 epidemic, disproportionately burdening states and municipalities with high socioeconomic vulnerability. Targeted policies are needed to protect vulnerable populations.
In the paper, the author analyses three years of the rule of the left-wing SYRIZA in Greece.
She discusses the basis of the party’s historical victory in the parliamentary elections in 2015.
In addition, she analyses the course of negotiations with Greek creditors regarding the third
economic adjustment programme for Greece. She also points out the necessity of gradual resignation from anti-austerity agenda and social reactions against introduced reforms. In the final
part, the author of the paper outlines the current challenges of the Greek government.
This document discusses strengthening health emergency preparedness and response capacities in the Republic of Moldova. It notes that the European Region faces health threats from infectious diseases, natural disasters, and other emergencies. A Joint External Evaluation found that Moldova has some strengths in public health legislation but needs to strengthen specific capacities like surveillance systems, multisectoral coordination, and long-term preparedness planning. The WHO supports Moldova's response to health emergencies and recommends developing a national action plan to build sustainable emergency capacities as part of achieving universal health coverage.
Analysis of the efficiency of public policies in municipalities, with a popul...IJAEMSJORNAL
Pandemics, such as that of COVID-19, affect a large number of people, imposing new rules and social habits on them, aiming to modify the behavior that influences economic and social problems. In this context, the objective of this study was to be investigative, using the DEA tool (data envelopment analysis), seeking the efficiency of proposed and economic measures, seeking to assist them and also public policies in improving planning, trying to avoid problems such as those caused by the current pandemic. This is a cross-sectional and quantitative study, of an exploratory nature, carried out with data from the 10th. Region of the state of São Paulo, based on municipalities with 10,000, or more, inhabitants in the time interval from 05/03/2020 to 05/05/2021. This work is justified by the fact that the COVID-19 pandemic exposes structural weaknesses, economic differences and bottlenecks in the Brazilian health system, especially the lack or uneven distribution, in the territory, of health professionals and health professional, infrastructure, as well as limited production capacity, poor income distribution, the human development index and, still, the glaring differences in the GDP of the municipalities. It has been noted that 53% of the municipalities are deficient and that only 47% of them are above the average ideal efficiency rate of 0.823150. It is concluded, in this work, that the economic and social factors need to be better addressed and that social distance, the use of masks and personal hygiene must be encouraged by the representatives of the public power, in order to avoid a greater number of deaths.
This document summarizes the key points of the Commission Staff Working Document on prolonging the Action Plan on HIV/AIDS in the EU and neighbouring countries from 2014-2016. It discusses that while global HIV trends are declining, cases in Europe are rising. The original 2009-2013 plan achieved several goals but more work is needed on testing, treatment, harm reduction and addressing discrimination. This prolonged plan focuses on continued political leadership, treatment as prevention, and improving attention to co-infections like tuberculosis. An independent evaluation of the original plan will help inform future EU policy on HIV/AIDS.
Comprehensive report that covers emergency preparedness plan to handle covid 19.Muhammad Siddique
This document provides a comprehensive report and emergency preparedness plan for COVID-19. It summarizes the global and regional COVID-19 situation. It describes national strategies in the region for containment including case finding and testing, transmission scenarios, reporting, and clinical management. The strategies aim to enhance surveillance, conduct contact tracing, isolate confirmed cases, and provide clinical care, while recognizing constraints in resources and reporting.
Jan-Kees Helderman on NHS reform - a Dutch perspective The King's Fund
Jan-Kees Helderman, assistant professor in Comparative Governance and Public Policy at Radbouyd University Nijmegan, outlines how the Dutch health care system operates and reflects on the English health reforms.
The covid 19 crisis in nepal coping crackdown challengesNdrc Nepal
NDRC Nepal brings "The COVID-19 Crisis in Nepal: Coping Crackdown Challenges" issue 3, an occasional papers series on COOVID19 response in Nepal.
This study was carried out by Dr. Dhruba Gautam, Senior Research Fellow at National Disaster Risk Reduction Centre (NDRC) Nepal which had four interconnected objectives: (i) to assess existing policy provisions for relief management and distribution, (ii) to identify existing relief distribution mechanisms, (iii) to identify major gaps and challenges, and (iv) explore next steps and make recommendations. For secondary information, the study reviewed published documents, including government policies at the national and global levels, whereas primary information was gathered through virtual interviews and conferences with key informants in all provincial governments and in a few local governments. Among the mechanisms governments use to manage relief distribution are the management of relief funds, the selection of needy families, the development and distribution of relief packages, the adoption of a one-door policy, and the application of existing legal provisions. This study also explored gaps in these mechanisms and challenges faced during the relief management thoroughly. Some issues that raised questions included the criteria for selection and even the use of a targeted approach in principle and challenges included the procurement of relief materials and their quality and quantity as well as data management and monitoring. Once the data was on the table, this study made several key recommendations to each of the three tiers of Nepal’s government about how to systematize relief management now as well as how to carry over good practices into the future.
Health systems around the world - Memoona ArshadHuzaifa Zahoor
More people have gained access to essential health services such as immunization, HIV antiretroviral care, family planning, and malaria-prevention bed nets in the last decade. This is promising news, but development has been uneven: there are significant differences in service availability not only between countries, but also within them. Half the world's population can't afford the care it needs to stay safe on any given day.
The document summarizes a study on the socio-economic status of families affected by the 1984 Bhopal gas tragedy over a 30-year period. The study assessed differences in income, housing, education, health facilities, and asset possession between 1985 and 2015. A sample of 400 respondents from severely and moderately affected areas was surveyed. The results showed significant improvements in monthly income, home ownership, and access to education and healthcare over the 30 years since the disaster. However, some families remained in the same socio-economic position. The study concluded that while relief efforts had improved conditions for many victims, differences remained in socio-economic status even after 30 years.
The document discusses Greece's national healthcare system challenges including socioeconomic factors, a reduction in public financing leading to a deterioration in quality, and an increased dependence on the private sector. Measures taken to reduce healthcare expenditures, as required by an IMF agreement, focus solely on cost and not quality or outcomes. Key stakeholders like patients were not adequately consulted during negotiations around the measures.
To raise the public awareness about the work of the European Court of Human Rights (ECtHR), the Legal Resources Centre from Moldova (LRCM) has analyzed the Court’s work carried out in 2019. The document is based on the ECtHR’s annual report for 2019 and the analysis of the ECtHR’s case-law regarding
Moldova.
Leveraging Consumer-Facing Technologies to Improve Health OutcomesCognizant
The document discusses leveraging consumer-facing technologies to improve health outcomes. It describes how healthcare information technology (HIT) can help reduce medical errors, improve adherence to guidelines, and enable more effective disease management and remote patient monitoring. HIT includes electronic health records, computerized physician order entry, and other integrated data sources. The document also covers benefits of telehealth/telemedicine, which can improve access to care and reduce costs through reduced travel, hospitalizations, and mortality rates. Overall, the document advocates that HIT and telehealth can help improve quality of care while increasing efficiency and reducing costs.
The document discusses the roles of governments in responding to the COVID-19 pandemic. It argues that transmission of COVID-19 is largely due to failures by governments in planning, preparing for, and implementing effective pandemic responses. Key government responsibilities include regulating lockdowns and vaccines, coordinating healthcare systems, providing accurate public information, and ensuring access to testing and vaccines across communities. However, the success of government policies also depends on individuals following guidelines. While governments have broad powers to enact measures, commercial entities may prioritize profits over public health. Overall, the document maintains that governments should bear primary responsibility for curbing COVID-19 transmission given their regulatory authority and ability to coordinate responses on a large scale.
http://pwc.to/1bAPmr1
L'étude « Socio-economic impact of mHealth » est une étude prospective réalisée par PwC, qui s'appuie sur une quantité importante de données permettant d'analyser l'impact économique de la m-Santé dans les 27 pays de l'Union européenne.
Research done while in PwC Mexico. A short version was included as part of a PwC publication "Future of Pacific Alliance", that was presented at the presidental summit in Chile on July 2016.
The document discusses the changing epidemiological profile in Latin America, where noncommunicable diseases have emerged as the main health burden. It notes the high rates of diabetes and other chronic conditions in the region. While some communicable diseases persist, the analysis is shifting from acute to chronic diseases. The text advocates for integrating health services and empowering patients through continuous bidirectional communication across multiple channels. It presents the Telecommunication for Health initiative, which uses mobile phones, the internet and telephone to provide strategic services that achieve "last mile delivery" and increase patient information and self-management of diseases.
The 2019 edition of the Global Innovation Index (GII) focuses
on the theme Creating Healthy Lives—The Future of Medical
Innovation. In the years to come, medical innovations such
as artificial intelligence (AI), genomics, and mobile health
applications will transform the delivery of healthcare in both
developed and emerging nations.
The key questions addressed in this edition of the GII include:
• What is the potential impact of medical innovation on
society and economic growth, and what obstacles must
be overcome to reach that potential?
• How is the global landscape for research and development
(R&D) and medical innovation changing?
• What health challenges do future innovations need to address
and what types of breakthroughs are on the horizon?
• What are the main opportunities and obstacles to future
medical innovation and what role might new policies play?
This document discusses health and nutrition in the Philippines. It provides an overview of healthcare in the Philippines, including key indicators, personnel and facilities, diseases, and the goal of universal healthcare. It also discusses nutrition issues like malnutrition rates, the Scaling Up Nutrition initiative, and the Task Force Zero Hunger program. The document emphasizes the importance of ensuring healthy lives and nutrition at all ages to build prosperous societies and economies.
This document discusses disease management and financial alignment in the Netherlands' healthcare system. It provides background on the rise of chronic diseases and the need for coordinated care models. The Netherlands is moving towards a new "functional pricing" model for outpatient chronic care, representing the next step in disease management. The document outlines the Dutch healthcare system and trends towards vertically integrated care networks. It also discusses the history of disease management approaches in the Netherlands from early transmural care programs to the current emphasis on patient-centered chronic condition management.
This document discusses trends in the European healthcare sector. It covers:
1. Ten major forces driving change in healthcare, including rising costs, new technologies, and more empowered consumers.
2. Reforms to public healthcare systems in Europe to control costs while improving access and quality, such as increasing private sector involvement and competition.
3. The rise of private healthcare providers and new models of public-private partnerships in some countries.
Students are expected to select an industrialized country, other.docxdarwinming1
**Students are expected to select an industrialized country, other than the United States and the example given in the syllabus, identify and prepare a 1-page discussion document addressing key factors associated with the healthcare system in your country of choice. Both the report template and a sample discussion document are provided on pages 21 and 22 of the syllabus.
TEMPLATE FOR DISCUSSION DOCUMENT
HEALTH STATUS OF OTHER COUNTRIES
Name of the country:
Type of government:
Type of healthcare system:
Population:
Primary ethnic groups:
Access to Healthcare:
Quality of Care:
Cost of Care:
Emerging Health Issues or Challenges:
EXAMPLE
HEALTH STATUS OF PORTUGAL
Name of the country: Portugal
Type of government: Parliamentary democracy
Type of healthcare system: National Health System administered by the Ministry of Health,
blended with some employment-based health coverage
Population: 10,676,910 (2008 estimate)
Per capita gross domestic product (GDP): $21,800 (2007 estimate)
Principal ethnic groups: Mediterranean, Black African and European
Access to Healthcare: Because the system is administered by the national government, all
citizens have access to healthcare. The constitution stipulates that healthcare is to be provided
to all citizens. There is a Patient Charter that provides certain rights to everyone – the right to
be informed of one’s health status and to receive a second opinion; the right to refuse any
procedure; the right to privacy of one’s personal health records; the patient’s responsibility for
his/her health status, and to be forthcoming regarding health history. The national health
system provides direct acute hospital care, general practice, and mother and child care services.
Primary Care Centers represent a primary vehicle for dispensing health services. Patients must
register with a general practitioner (GP) within their defined geographic area.
Quality of Care: As of 2005, data indicate that Portugal has a higher life expectancy at birth
(78.2 years) than the United States (77.8 in 2004), but lower than France and the United
Kingdom (England). According to a recent study compared Portugal to other OECD countries in
the area of ‘amenable mortality’. Amenable Mortality is death that can be averted through the
presence and intervention of effective healthcare. Infant mortality has improved over the past
two decades, resulting in overall improving health status. There has also been improvement in
both the number of people on health care waiting lists, as well as in the length of time they
must wait before receiving health services.
Cost of Care: The national health system is financed out of general tax revenues, accounting for
approximately 60% of total tax revenue. The national health system also receives revenue from
hospital charges associated with private room charges, private insurance, fines, donations,
equipment and space rentals, etc. Out-of-pocket health costs are particularly high (23 % i ...
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Discussions Response please treat each Discussions Response separately Dalt.docxbkbk37
The COVID-19 pandemic has profoundly impacted healthcare systems globally. In the US, the financial strain of the pandemic has increased medical debt by over 25% according to one report. This large financial burden can negatively impact individuals' long-term health and lead to exhausted hospital resources. Governments and organizations must work to ensure equitable access to healthcare during and after the pandemic, such as through public funding and expanding telehealth. The Bradley/Piekoff COVID-19 Forum is a unique initiative that organizes regional healthcare providers to discuss issues related to COVID-19, allowing sector experts to address topics essential for those seeking medical support such as vaccine distribution. The forum also keeps communities informed of new virus developments and treatments through online resources.
Discussions Response please treat each Discussions Response separately Dalt.docxwrite31
The COVID-19 pandemic has profoundly impacted healthcare systems globally. In the US, the financial strain of the pandemic has increased medical debt by over 25% according to one report. This large financial burden can negatively impact individuals' long-term health and lead to exhausted hospital resources. Governments and organizations must work to ensure equitable access to healthcare during and after the pandemic, such as through public funding and expanding telehealth. The Bradley/Piekoff COVID-19 Forum is a unique initiative that organizes regional healthcare providers to discuss issues related to COVID-19, allowing sector experts to address topics essential for those seeking medical support such as vaccine distribution. The forum also keeps communities informed of new virus developments and treatments through online resources.
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Greece's health crisis: from austerity to denialism - The Lancet - 02/2014
1. Health Policy
748 www.thelancet.com Vol 383 February 22, 2014
Greece’s health crisis: from austerity to denialism
Alexander Kentikelenis, Marina Karanikolos, Aaron Reeves, Martin McKee, David Stuckler
Greece’s economic crisis has deepened since it was bailed out by the international community in 2010. The country
underwent the sixth consecutive year of economic contraction in 2013, with its economy shrinking by 20% between
2008 and 2012, and anaemic or no growth projected for 2014. Unemployment has more than tripled, from 7·7% in
2008 to 24·3% in 2012, and long-term unemployment reached 14·4%. We review the background to the crisis, assess
how austerity measures have affected the health of the Greek population and their access to public health services,
and examine the political response to the mounting evidence of a Greek public health tragedy.
The Greek crisis
The Greek economy accumulated severe structural
troubles before the crisis. Between entry to the Eurozone
and the onset of the crisis, annual economic growth
averaged 4·2%,1
spurred by capital inflows.2
However,
overspending was concealed from public gaze with the
help of investment banks3
and by reporting of inaccurate
data.4
When the financial crisis hit US banks in 2008, the
Greek Prime Minister Kostas Karamanlis pronounced
the economy to be “armoured” against the risk of
contagion.5
However, subsequent events moved the
country to the epicentre of a financial storm. A new
government, elected in 2009, revised the deficit from a
projected 3·7% to 15·8% of gross domestic product
(GDP).6
As the scale of economic mismanagement
became apparent, borrowing costs shot up to unaffordable
levels. Much of the country’s debt was held by banks and
pension funds in other European countries that were
already fragile,7
and the international community feared
that Greece might be forced to default on its debt, with
profound implications for the global economy.
By early 2010, the Greek Government was in talks with
the international community about a possible bailout. In
May, the first package was agreed; in exchange for a
€110 billion loan, the government would implement far-
ranging austerity measures and structural reforms
overseen by the European Commission, the European
Central Bank, and the International Monetary Fund
(collectively known as the Troika). A second bailout was
agreed in October, 2011, demanding further cuts and
reforms but providing another €130 billion in funds, and
was voted in by an interim government in February, 2012.
Direct health effects of austerity
Background
Two main strategies can reduce deficits in the short term:
cutting of spending and raising of revenue. The Greek
Government used both at the behest of the Troika, albeit
with an emphasis on reduction of public expenditure.
3 years ago, we drew attention to the effects of the
austerity measures on the health of the Greek people.8
Cuts to public health spending
Greece has been an outlier in the scale of cutbacks to the
health sector across Europe.9
In health, the key objective
of the reforms was to reduce, rapidly and drastically,
public expenditure by capping it at 6% of GDP. To meet
this threshold, stipulated in Greece’s bailout agreement,
public spending for health is now less than any of the
other pre-2004 European Union members.2
In 2012, in
an effort to achieve specific targets, the Greek
Government surpassed the Troika’s demands for cuts in
hospital operating costs and pharmaceutical spending.10,11
The former Minister of Health, Andreas Loverdos,
admitted that “the Greek public administration…uses
butcher’s knives [to achieve the cuts].”12
The negative
effects of these cuts are already beginning to manifest.
Prevention and treatment programmes for illicit drug
use faced large cuts, at a time of increasing need associated
with economic hardship. In 2009–10, the first year of
austerity, a third of the street work programmes were cut
because of scarcity of funding, despite a documented rise
in the prevalence of heroin use.13
At the same time, the
number of syringes and condoms distributed to drug
users fell by 10% and 24%, respectively.14
These events had
the expected effects on the health of this vulnerable
population; the number of new HIV infections among
injecting drug users rose from 15 in 2009 to 484 in 2012
(figure 1),15
and preliminary data for 2013 suggest that the
incidence of tuberculosis among this population has more
than doubled compared with 2012.16
Although needle and
syringe distribution has since increased,17
partly in
response to media reports and popular pressure,
distribution is still well below the minimum target of
200 per drug user per year recommended by the European
Centre for Disease Control.14
In his first act at the end of
June, 2013, Adonis Georgiadis, the new Minister of Health
(the fourth in a little more than a year), re-introduced a
controversial law stipulating forced testing for infectious
diseases under police supervision for drug users,
prostitutes, and immigrants—a move that is not only
unethical but also counterproductive, because it deters
marginalised groups from seeking testing during HIV
outbreaks.18
The Joint United Nations Programme on
HIV/AIDS has called for the repeal of the law, because it
“could serve to justify actions that violate human rights”.19
Additionally, drastic reductions to municipality budgets
have led to a scaling back of several activities (eg, mosquito-
spraying programmes20
), which, in combination with
other factors, has allowed the re-emergence of locally
transmitted malaria for the first time in 40 years.21,22
Lancet 2014; 383: 748–53
Department of Sociology and
King’s College, University of
Cambridge, Cambridge, UK
(A Kentikelenis MPhil);
European Centre on Health of
Societies inTransition, London
School of Hygiene andTropical
Medicine, London, UK
(M Karanikolos MPH,
Prof M McKee DSc,
D Stuckler PhD); European
Observatory on Health Systems
and Policies, London, UK
(M Karanikolos, Prof M McKee);
and Department of Sociology,
University of Oxford, Oxford,
UK (A Reeves PhD, D Stuckler)
Correspondence to:
Alexander Kentikelenis, King’s
College 562, King’s Parade,
Cambridge CB2 1ST, UK
aek37@cam.ac.uk
2. Health Policy
www.thelancet.com Vol 383 February 22, 2014 749
Through a series of austerity measures, the public
hospital budget was reduced by 26% between 2009 and
2011,23
a substantial drop in view of the fact that
expenditure should have increased through automatic
stabilisers.24
Evidence of the health effects of these cuts,
at a time of increasing demand, is scarce, but staff
workloads have increased and waiting lists have grown
according to some accounts.8,25,26
Rural areas have
particular difficulties, with shortages of medicines and
medical equipment.27
Another key cost targeted by the Troika was publicly
funded pharmaceutical expenditure, for which reform
was necessary because of very high rates of prescription
of branded drugs.28
The stated aim was to reduce
spending from €4·37 billion in 2010 to €2·88 billion in
2012 (this target was met), and to €2 billion by 2014.29
However, there have been many unintended results and
some medicines have become unobtainable because of
delays in reimbursement for pharmacies, which are
building up unsustainable debts.30
Many patients must
now pay up front and wait for subsequent reimbursement
by the insurance fund.31
Findings from a study32
in Achaia
province showed that 70% of respondents said they had
insufficient income to purchase the drugs prescribed by
their doctors.32
Pharmaceutical companies have reduced
supplies because of unpaid bills and low profits.33
Cost shifting to patients
Despite the rhetoric of “maintaining universal access
and improving the quality of care delivery”29
in Greece’s
bailout agreement, several policies shifted costs to
patients, leading to reductions in health-care access.
In 2011, user fees were increased from €3 to €5 for
outpatient visits (with some exemptions for vulnerable
groups), and co-payments for certain medicines have
increased by 10% or more dependent on the disease.24
New
fees for prescriptions (€1 per prescription) came into effect
in 2014.24
An additional fee of €25 for inpatient admission
was introduced in January 2014, but was rolled back within
a week after mounting public and parliamentary pressure.
Additional hidden costs—eg, increases in the price of
telephone calls to schedule appointments with doctors—
have also created barriers to access.26
Another concern is the erosion of health coverage.
Social health-insurance coverage is linked to employment
status, with newly unemployed people aged 29–55 years
covered for a maximum of 2 years. Rapidly increasing
unemployment since 2009 is increasing the number of
uninsured people. Those without insurance are eligible
for some health coverage after means testing, but the
criteria for means testing have not been updated to take
into account the new social reality.34
An estimated
800000 potential beneficiaries are left without unem-
ployment benefits and health coverage.35
To respond to
unmet need, several social clinics (primary care practices
staffed by volunteer doctors) have sprung up in urban
centres.36
Médecins du Monde has scaled up operations in
Greece, and reports increasing numbers of Greek citizens
receiving health services and drugs from their clinics as
the economic crisis deepens;37
before the crisis, such
services mostly targeted immigrant populations.
To examine whether these policies have affected access
to health services, we analysed the most recent data from
the European Union Statistics on Income and Living
Conditions, a nationally representative survey.38
Comp-
ared with 2007 (a pre-crisis benchmark), a significantly
increased number of people reported unmet medical
need in 2011 (table 1). Inability to obtain care increased
most for older people. These changes mostly result from
increases in respondents reporting an inability to afford
care, or to reach services because of distance or scarcity
of transportation (table 2). Difficulty in transportation
overlaps with financial reasons, because hikes in the cost
of transport affect mobility, especially for the poorest
people, and patients who might have afforded private
clinics before the crisis now need to travel to access
publicly provided services.
Indirect health effects of austerity
If the policies adopted had actually improved the
economy, then the consequences for health might be a
price worth paying. However, the deep cuts have actually
had negative economic effects, as acknowledged by the
International Monetary Fund.39
GDP fell sharply and
unemployment skyrocketed as a result of the economic
austerity measures, which posed additional health risks
to the population through deterioration of socioeconomic
factors.
Mental health services have been seriously affected.
Rapid socioeconomic change can harm mental health,40
unless it is ameliorated by appropriate social policies.41
However, in Greece public and non-profit mental health
service providers have scaled back operations, shut down,
or reduced staff; plans for development of child
psychiatric services have been abandoned; and state
Figure 1: Instances of HIV infections by transmission category
IDUs=intravenous drug users. MSM=men who have sex with men. Figure based on data from the European Centre
for Disease Prevention and Control and theWHO Regional Office for Europe.15
2008 2009 2010 20122011
0
9 15 25
307
484
100
200
300
400
500
600
Numberofnewinfections
Year
IDUs
Unknown
Heterosexuals
MSM
3. Health Policy
750 www.thelancet.com Vol 383 February 22, 2014
For the Hellenic Statistical
Authority see http://www.
statistics.gr/portal/page/portal/
ESYE
funding for mental health decreased by 20% between
2010 and 2011, and by a further 55% between 2011 and
2012.42
Austerity measures have constrained the capacity
of mental health services to cope with the 120% increase
in use in the past 3 years.42
The available evidence points
to a substantial deterioration in mental health status.
Findings from population surveys suggest a 2·5 times
increased prevalence of major depression, from 3·3% in
2008 to 8·2% in 2011, with economic hardship being a
major risk factor.43
Investigators of another study44
reported a 36% increase between 2009 and 2011 in the
number of people attempting suicide in the month
before the survey, with a higher likelihood for those
experiencing substantial economic distress. Deaths by
suicide have increased by 45% between 2007 and 2011,
albeit from a low initial amount. This increase was
initially most pronounced for men, but 2011 data from
the Hellenic Statistical Authority also suggest a large
increase for women (figure 2).
Greece’s austerity measures have also affected child
health, because of reduced family incomes and
unemployment of parents. The proportion of children at
risk of poverty has increased from 28·2% in 2007 to
30·4% in 2011,45
and a growing number receive
inadequate nutrition.46
A 2012 UN report emphasised
that “the right to health and access to health services is
not respected for all children [in Greece]”.47
The latest
available data suggest a 19% increase in the number of
Could not afford Waiting list Could not take time Too far to travel Wanted to wait Other
OR (95% CI) p value OR (95% CI) p value OR (95% CI) p value OR (95% CI) p value OR (95% CI) p value OR (95% CI) p value
OR for reason for unmet
medical need 2011
relative to 2007
1·39
(1·19–1·61)
<0·0001 1·24
(0·83–1·85)
0·297 0·89
(0·58–1·37)
0·595 2·78
(1·64–4·70)
<0·0001 1·32
(0·82–2·10)
0·250 2·36
(1·58–3·51)
<0·0001
Age 16–81 years* 1·03
(1·02–1·03)
<0·0001 1·04
(1·02–1·07)
<0·0001 1·02
(0·99–1·04)
0·176 1·11
(1·07–1·15)
<0·0001 1·04
(1·02–1·06)
0·001 1·05
(1·03–1·08)
<0·0001
Age >65 years relative to
age ≤65 years
0·76
(0·58–0·99)
0·043 0·80
(0·37–1·70)
0·555 0·21
(0·080–
0·56)
0·002 0·63
(0·26–1·55)
0·319 1·33
(0·61–2·90)
0·480 0·28
(0·14–0·59)
0·001
Sex male relative to
female
0·75
(0·65–0·88)
<0·0001 1·08
(0·71–1·64)
0·716 0·98
(0·62–1·53)
0·925 0·73
(0·45–1·19)
0·209 1·21
(0·75–1·95)
0·426 1·07
(0·69–1·67)
0·749
Family status married
relative to unmarried
0·85
(0·72–1·02)
0·083 1·21
(0·72–2·02)
0·474 1·90
(1·05–3·44)
0·033 1·20 (0·70–
2·06)
0·511 0·86
(0·53–1·39)
0·533 0·74
(0·46–1·17)
0·197
Urbanisation rural relative
to urban
0·65
(0·56–0·75)
<0·0001 0·32
(0·21–0·48)
<0·0001 0·67
(0·43–1·04)
0·074 2·98
(1·57–5·63)
0·001 0·84
(0·53–1·35)
0·478 0·63
(0·43–0·93)
0·020
Education post-secondary
relative to secondary and
below
0·61
(0·49–0·77)
<0·0001 0·67
(0·38–1·17)
0·161 2·60
(1·66–4·07)
<0·0001 0·49
(0·16–1·46)
0·201 0·32
(0·12–0·83)
0·020 1·43
(0·84–2·46)
0·190
Pseudo-R² 0·034 ·· 0·062 ·· 0·046 ·· 0·18 ·· 0·064 ·· 0·047 ··
Analysis based on the European Union Statistics on Income and Living Conditions survey.38
Descriptive statistics are provided in the appendix. OR=odds ratio. *The OR for the age variable is the change in odds of
unmet need when age increases by 1 year.
Table 2: Weighted relative ORs for changes in reason for unmet medical need during the past 12 months between 2007 and 2011
All respondents (n=24177) Age ≤65 years (n=17824) Age >65 years (n=6353)
OR (95% CI) p value OR (95% CI) p value OR (95% CI) p value
OR for unmet medical need 2011 relative to 2007 1·47 (1·30–1·66) <0·0001 1·40 (1·20–1·63) <0·0001 1·63 (1·32–2·00) <0·0001
Age 16–81 years* 1·03 (1·03–1·04) <0·0001 1·03 (1·03–1·04) <0·0001 1·03 (1·01–1·06) 0·001
Age >65 years relative to age ≤65 years 0·72 (0·58–0·89) 0·003 ·· ·· ·· ··
Sex male relative to female 0·83 (0·72–0·94) 0·003 0·80 (0·69–0·94) 0·007 0·89 (0·72–1·10) 0·295
Family status married relative to unmarried 0·90 (0·78–1·04) 0·16 0·87 (0·71–1·07) 0·187 0·95 (0·75–1·21) 0·667
Urbanisation rural relative to urban 0·65 (0·58–0·73) <0·0001 0·66 (0·57–0·76) <0·0001 0·63 (0·52–0·77) <0·0001
Education post-secondary relative to secondary and
below
0·76 (0·64–0·91) 0·002 0·84 (0·69–1·01) 0·068 0·39 (0·24–0·65) <0·0001
Pseudo-R² 0·04 ·· 0·03 ·· 0·03 ··
Analysis based on the European Union Statistics on Income and Living Conditions survey,38
cross-sectional datasets from 2007 (n=12346) and 2011 (n=12641).
24177 respondents in total provided complete sociodemographic data.We used a dummy variable for the crisis year 2011, age >65 years, sex (male), family status (married),
level of urbanisation (rural), and education (post-secondary), and weighted ORs for sampling. Descriptive statistics are provided in the appendix. OR=odds ratio. *The OR for
the age variable is the change in odds of unmet need when age increases by 1 year.
Table 1: Weighted relative ORs for changes in reporting unmet medical need between 2007 and 2011, adjusted for sociodemographic and other factors
See Online for appendix
4. Health Policy
www.thelancet.com Vol 383 February 22, 2014 751
low-birthweight babies between 2008 and 2010.23
Researchers from the Greek National School of Public
Health reported a 21% rise in stillbirths between 2008 and
2011, which they attributed to reduced access to prenatal
health services for pregnant women.48
The long-term fall
in infant mortality has reversed, rising by 43% between
2008 and 2010,49
with increases in both neonatal and
post-neonatal deaths. Neonatal deaths suggest barriers in
access to timely and effective care in pregnancy and early
life, whereas postneonatal deaths point to worsening of
socioeconomic circumstances.50,51
In summary, although the adverse economic effects of
austerity were miscalculated, the social costs were
ignored, with harmful effects on the people of Greece.36,52,53
Denialism
The cost of adjustment is being borne mainly by ordinary
Greek citizens. They are subject to one of the most radical
programmes of welfare-state retrenchment in recent
times, which in turn affects population health. Yet
despite this clear evidence, there has been little
agreement about the causal role of austerity. There is a
broad consensus that the social sector in Greece was in
grave need of reform, with widespread corruption,
misuse of patronage, and inefficiencies,24,54–58
and many
commentators have noted that the crisis presented an
opportunity to introduce long-overdue changes. Greek
Government officials, and several sympathetic comm-
entators, have argued that the introduction of the wide-
ranging changes and deep public-spending cuts have not
damaged health59,60
and, indeed, might lead to long-term
improvements. Officials have denied that vulnerable
groups (eg, homeless or uninsured people) have been
denied access to health care, and claim that those who
are unable to afford public insurance contributions still
receive free care.36,61,62
However, the scientific literature presents a different
picture. In view of this detailed body of evidence for the
harmful effects of austerity on health, the failure of
public recognition of the issue by successive Greek
Governments and international agencies is remarkable.
Indeed, the predominant response has been denial that
any serious difficulties exist, although this response is
not unique to Greece; the Spanish Government has been
equally reluctant to concede the harm caused by its
policies.63
This dismissal meets the criteria for denialism,
which refuses to acknowledge, and indeed attempts to
discredit, scientific research.64
During the first years of the crisis the international
community was largely silent about this issue, giving its
tacit support to the austerity pursued by successive Greek
Governments. One exception has been the European
Centre for Disease Control, which has long been
concerned about the health hazards of austerity.
The experience of other countries in dealing with crises
could have helped to guide policy makers. For example,
after Iceland’s acute crisis in 2008, the country rejected
advice from the International Monetary Fund to slash its
health-care and social services budget and instead opted
to maintain welfare policies crucial to support its citizens,
with no discernible effects on health.2
Ending the Greek health crisis
Recently, the European Commission has begun to meet
its Treaty obligation to assess the health effect of all
policies, including those of the Troika; it has the
necessary skills to do so in its Directorate General for
Health, but needs wholehearted support from the entire
Commission, especially its president.65
Two develop-
ments hold promise. In July, 2013, the Greek Government
signed an agreement with WHO for support in the
planning of health sector reforms;66
the government
needs to use the skills of WHO with the urgency
demanded by the present health situation. In September,
2013, the government launched a new health voucher
programme financed from European Union structural
funds to cover 230000 beneficiaries for 2013–14.67
The
programme was designed to address some health needs
of very poor patients losing access to care, especially the
growing number of people unemployed for 2 years or
more. Uninsured individuals can apply for a voucher
that can be used for up to three visits for a predetermined
set of primary care services in a 4-month period, and
includes prenatal examinations for pregnant women.
Alternative responses to the crisis would have allowed
Greece to pursue difficult structural reforms, while
preventing devastating social consequences. Experiences
from other countries that have survived financial crises
(eg, Iceland and Finland) suggest that by ring-fencing
health and social budgets, and concentrating cuts
elsewhere, governments can offset the harmful effects of
crises on the health of their populations. At the time of
writing, the Troika was in Athens to assess the
implementation of the bailout conditions, and
€2·66 billion in cuts were announced to the health and
social security budget for the following year.68
Although
the Greek health-care system had serious inefficiencies
Figure 2: Recorded deaths by suicide by year
Figure based on data provided by the Hellenic Statistical Authority.
2006 2007 2008 2009 2010 2011
0
100
200
300
400
500
600
Numberofdeathsbysuicide Year
Men
Women
5. Health Policy
752 www.thelancet.com Vol 383 February 22, 2014
before the crisis, the scale and speed of imposed change
have constrained the capacity of the public health system
to respond to the needs of the population at a time of
heightened demand. The foundations for a well
functioning health-care system need structures for
comprehensive accountability, effective coordination and
performance management, and use of the skills of
health-care professionals and academics—not denialism.
The people of Greece deserve better.
Contributors
AK, MK, and DS designed and wrote the Health Policy. MM contributed
to the design and interpretation of the findings. AR provided
background data and feedback. All authors have seen and approved the
final version of the report.
Declaration of interests
After this article was accepted for publication, AK was invited, as part of
an expert team, to provide technical advice to WHO on the issue of
health-care provision to those without insurance in Greece. The other
authors declare that they have no competing interests.
Acknowledgments
AK acknowledges financial support from the Greek Ministry of
Education (IKY) and the Onassis Foundation. DS is funded by a
Wellcome Trust Investigator Award 100709/Z/12/Z. The European
Union Statistics on Income and Living Conditions data were provided by
Eurostat, which has no responsibility for the results and conclusions of
this study. We thank Sanjay Basu for his comments.
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