Re: Greek economic crisis: not a tragedy for health

5 December 2012

Dear Editor,

We were surprised by the conclusions of Prof. Liaropoulos concerning the health effects of the Greek economic crisis.1 His article contains a number of unreferenced assertions and contradictions, such as the statements that there is “no evidence of denial of services to patients” yet “many [people] are without cover” and the church, non-governmental associations and others are “rallying to help”.

We were also surprised that Prof. Liaropoulos failed to mention that he is an advisor to the Troika that is imposing austerity on Greece. He first suggests that our peer-reviewed research published in The Lancet, which reported evidence of a Greek health crisis, used dated information.2 In fact, it used the most up-to-date data at the time, which was collected after the crisis had already gone on for 2 years. He may not be aware that it has since been confirmed by Greek academics using 2011 data.3 His claim that “there is no evidence that [the economic crisis] has affected health” is at odds with the doubling in the prevalence of depression,4 while Eurostat data also show dramatic increases in unmet medical need and infant mortality.

Nor does he refer to the 2011 reports of increased infectious diseases, such as the large rise in HIV incidence among injecting drug users, associated with budget cuts including closure of needle exchange services,5 or re-emergence of malaria (for the first time since 1974)6 associated with cuts to mosquito spraying in the south of the country.7 Prof. Liaropoulos dismisses some evidence of harm as “anecdotal” but fails to comment how investigative journalists have had to fill the gap left by the failure by the European authorities to monitor adequately the full health effects of the measures they are imposing.8 While we do not dispute that the Greek health system has long needed reform,9 it should be informed by data on the health needs of the population.

Yours sincerely,
Alexander Kentikelenis, Marina Karanikolos, Irene Papanicolas, Sanjay Basu, Martin McKee, David Stuckler

1. Liaropoulos L. Greek economic crisis: not a tragedy for health. BMJ 2012;345:e7988.
2. Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health effects of financial crisis: omens of a Greek tragedy. Lancet. 2011 Oct 22;378(9801):1457-8.
3. Zavras D, Tsiantou, V, Pavi, E, Mylona, K, Kyriopoulous, J. Impact of economic crisis and other demographic and socio-economic factors on self-rated health in Greece. European Journal of Public Health 2012;in press.
4. Economou M, Medianos M, Peppou LE, Patelakis A, Stefanis CN. Major depression in the Era of economic crisis: A replication of a cross-sectional study across Greece. J Affect Disord. 2012 Aug 29. [Epub ahead of print]
5. Fotiou A, Micha K, Paraskevis D, Terzidou M, Malliori MM, Hatzakis A. HIV outbreak among injecting drug users in Greece: An updated report for the EMCDDA on the recent outbreak of HIV infections among drug injectors in Greece. Athens: European Monitoring Centre for Drugs and Drug Addiction, 2012.
6. Andriopoulos P, Economopoulou A, Spanakos G, Assimakopoulos G. A local outbreak of autochthonous Plasmodium vivax malaria in Laconia, Greece-a re-emerging infection in the southern borders of Europe? Int J Infect Dis 2012: doi:pii: S1201-9712(12)01262-3. 10.1016/j.ijid.2012.09.009
7. Bonovas S, Nikolopoulos, G. High-burden epidemics in Greece in the era of economic crisis. Early signs of a public health tragedy. J Prev Med Hyg 2012;53:169-71.
8. Daley S. Fiscal Crisis Takes Toll on Health of Greeks. (Accessed 3RD December 2012)
9. Mossialos E. Citizens' views on health care systems in the 15 member states of the European Union.Health Econ 1997; 6: 109-16.

Competing interests: None declared

David Stuckler, University lecturer

Alexander Kentikelenis, Marina Karanikolos, Irene Papanicolas, Sanjay Basu, Martin McKee, David Stuckler

University of Cambridge, Free School Lane

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