Is Austerity Behind the Spike in Heart Attacks in Greece?
In Greece, austerity has caused more than just tear gas usage to rise. Heart attacks have spiked in the republic, in line with the economic crisis in the Eurozone, a new study shows. Studying 22,093 patients admitted to Kalamata’s General Hospital, researchers noted a distinct spike when comparing pre-crisis and crisis periods, especially amongst women. Pre-crisis (January 2004-December 2007) Kalamata recorded 841 heart attacks, compared to 1,084 between January 2008 and December 2011, an overall increase of 29%. In women, heart attacks rose by 39.2%, with acute myocardial infarctions spiking by 51%.
Dr Emannouil Makaris, presenting his findings at a research talk at the American College of Cardiology’s annual meeting, noted the particularly high increase in women was likely to be down to joblessness, and economic and domestic burdens: “Greek women have a higher unemployment rate than men, they are responsible for child care, and they also work outside the home - a formula for stress. Unemployment is a stressful event and stress is connected with heart disease, but other issues also come with financial difficulties. In these times a lot of people do not have money to buy medications or go to their primary care doctor. The cost to society is high.” Throughout the crisis, unemployment rates for women in Greece have been far higher than for men of similar ages. Amongst economically active women, the unemployment rate currently stands at 29.3%, whereas for Greek men, thefigure is 24.3%.
Amongst young women, the unemployment rate is even higher, at 65% - and that's a conservative estimate, not adjusting for those putting off seeking employment by continuing education, or the diaspora, who've emigrated to seek employment elsewhere. Women's employment in Greece tends not to get the coverage men's does – Greek ship-workers, for example, may garner a five minute segment on an evening news bulletin or a few broadsheet column inches when they haven't been paid for several months, or when there have been substantial redundancies. But women's work in Greece has traditionally been dotted around various parts of the public sector, which has been subject to a wide-ranging pay and hiring freeze. As part of the public sector reforms to secure the first bailout package, Greece agreed with the Troika to hire only one person for every five people exiting the civil service – this has since been revised to one recruitment for every ten people leaving or retiring. And especially for young women recently graduating, this means that the gender divide in employment looks set to widen for the duration of the recession, and for a good period beyond. On top of the recruitment freeze, weekly working hours have risen from 37.5 to 40 with salaries frozen rather than rising to reflect this.
So women's work in Greece is increasingly devalued – even if they can get it, and the precarity of work for those still in employment adds to the stress of the extended working week impacting upon health. Further proposed administrative reform, including the scheduled dismissal of an additional 150,000 civil servants has not yet materialised but the threat still looms as the pressure from the Troika is applied. Whilst few politicians in any political party deny that the Greek civil service is bloated and inefficient, it's also one of the biggest employers in a country that is experiencing rapidly rising unemployment, and mass redundancies at a time when the pensions of many Greek citizens have been slashed will be socially catastrophic.
The human cost of austerity has been tentatively documented across the globe, supporting Dr Makaris’s findings in Kalamata. A recent study in the United States found that unemployment significantly increased heart attack rates, even after adjustments for clinical, socio-economic, and behavioural risk factors. The more precariously employed an individual was, the greater their risk of heart attack, the study found: those who had been made unemployed more than once found their incidences of heart attack increased with each consecutive job loss. The study, which took place between 1992 and 2010, was able to track those made unemployed and found that individuals were significantly more likely to experience a heart attack in the first year of unemployment than those who had never been made unemployed. Those who were repeatedly made unemployed experienced greater risk, the more times they were made unemployed.
A study of myocardial infarction and congestive heart failure rates in Argentina during the 1999-2002 financial crisis also recorded a marked increase in mortality and hospitalisations, with a distinct sloping off of cases in the three years recovery immediately following the crisis. Argentina’s economy contracted by 18% and the unemployment rate reached almost 25%, rivalling Greece’s current contraction of 20% since 2008 and unemployment rate of 26.3%. Although the study of the intersection of epidemiology and economics is relatively new, the study noted “the Argentine case is unique in that a major socio-economic collapse occurred in the absence of any natural disaster or war.” Though the Messinia study echoes the link between economic austerity and cardiac problems, the Argentinian study also points out that following the socio-economic difficulties experienced after the collapse of the Soviet Union, base life expectancy for both males and females dropped markedly. The economic crisis in Argentina echoes the current crisis in Greece in many ways – rates of unemployment were similar, economic contraction rates were similar, both countries experienced riots – but it's worth noting that Greece's recession is currently in its sixth year, and though some forecasters have claimed they should see signs of recovery in the first quarter of 2014, that seems supremely optimistic.
But austerity has affected women’s health in Greece other ways. Maternity care has also suffered in pregnancy and birth, as stress has increased and healthcare has deteriorated in Greece. In a letter to the British Medical Journal, researchers Nikolaos Vlachadis and Eleni Kornarou wrote “We are worried that the stillbirth rate will continue to rise because an increasing number of pregnant women are unemployed and without insurance, and thereby excluded from the Greek National Healthcare System’s obstetric care.” The birth rate in Greece also dropped by 15,000 in 2012, and this also seems to tally with a drop in marriage rates in Greece.
When it comes to financial hardship, medical costs are hard to control. It's common, therefore for those struggling to wait until it's no longer possible to put off seeking medical attention for a trip to the hospital or the GP. Greek doctors report struggling to source the most basic equipment in many hospitals in cities. Many hospitals have reported power cuts and major staff shortages as the government seek to cut costs wherever possible as the crisis deepens and drags on, year on year. Across Greece, hospitals, pharmacies and General Practitioners are feeling the strain. Public sector workers across the country have seen pay freezes, pay cuts and commonly, months with no pay at all. As Greeks lose their jobs, are forced to go without pay, or have their pensions cut they lose their health insurance and are unable to afford health costs. The New York Times reported on some of the situations doctors in Greece are faced with, such as the doctor who was presented with a woman who, unable to afford costly breast cancer treatment, only attended hospital when her tumour had broken through the skin.
After months of stalling negotiations over unpaid bills, the German pharmaceuticals group Merck halted supplies of cancer drug Erbitux to publicly owned Greek hospitals. This fuelled concerns that many other drug supplies would follow suit, as many pharmacies reported huge difficulties in gaining supplies of commonly prescribed drugs in large cities such as Athens and Thessaloniki. The Red Cross reported they were to gradually halve their supplies of blood to Greece by 2020 after delays in state payments, and state doctors across Greece reported they were owed back pay of 130 million euroswith Thessaloniki doctors refusing to treat any patients other than emergency cases until they were paid.
Asked at a lecture at the LSE about the rise in heart attacks, and what SYRIZA would do to support women in Greece, Alexis Tsipras answered “The truth is that yes indeed, women are the first victims of this crisis. Anyway, they were in a worse position in comparison to men even before the crisis. We do have a plan for unemployed women, unemployed mothers, but in order to implement such policies, first of all we have to get into the government.”Tsipras stopped short of proposing any concrete measures or policies that would directly improve the lot of women in crisis-stricken Greece. Because the solution is to improve the lot of all Greek citizens, and that involves accepting that austerity has a massive human cost, and arguing that human life is more important than balance books and markets.
The long term effects of this on women's health are unclear, and for the health of the population at large. It's already evident that life expectancy depends greatly on very fine socio-economic factors - a person in one neighbourhood in London can expect to live as many as eleven years longer than a person in a neighbourhood as little as one mile away. When it comes to countries with differing economies globally, the gap in longevity increases further. It remains to be seen how the Eurozone crisis will affect the long term health of citizens in the PIGS, who've typically been held up as doyennes of health, with their much vaunted heart-healthy Mediterranean cuisine. But if the Argentinian financial crisis and resulting heart attack rates, and now the spike in cardiac arrests in Kalamata are anything to go by, using the European south as a guinea pig for austerity is fatal, as well as economically illiterate.