Greek economic crisis: not a tragedy for healthBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e7988 (Published 27 November 2012) Cite this as: BMJ 2012;345:e7988
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Each year cardiovascular disease (CVD) causes 47% of all deaths in Europe and 40% in the European Union (EU), and is estimated to cost the EU economy almost €196 billion a year.1 Prior reports have seen that financial crisis and unemployment are linked to cardiovascular morbidity and mortality.2,3 Consistent with this, recent data suggest that the prolonged financial crisis has led to higher incidence of myocardial infarction in Messinia, especially among older individuals.4 However, a recent study suggests that the financial crisis did not affect cardiovascular death rates in Greece, although the authors mention that attention should be paid to the plateauing of cardiovascular mortality during 2011-2012.5 In light of the major socio-economic crisis taking place in Greece since the final quarter of 2008, we sought to investigate the possible impact of this crisis on the CVD, ischemic heart (IHD), and cerebrovascular disease mortality using the official Eurostat data.
In this short report, we present the last 10-year trends of CVD, IHD, and cerebrovascular disease mortality rates in Greece during 2004 to 2013 (Figure). Following a 7-year period of an overall 29.0% relative decrease (2004 – 2010), during the next two years with available data (2011 - 2012), the rate of the steady decline decreased in 2011 and ceased in 2012, and as a result total CVD mortality in Greece plateaued (Table 1a). In 2013, it started to decline again (Table 1a). Furthermore, IHD (Table 1b) and cerebrovascular disease mortality rates (Table 1c) after a 7-year period of an overall 32.7% and 37.2% relative decrease, respectively, they both plateaued during 2011 and 2012. However, in 2013 both IHD and cerebrovascular disease mortality rates started to decline again.
Despite the decrease in cardiovascular mortality rates in Greece during the last twenty years, these rates remain high among the Organization for Economic Co-operation and Development (OECD) countries (22nd highest for IHD and 3rd highest for cerebrovascular disease).6 The reasons could be Greece's very high smoking rates (2nd highest among OECD countries) and high childhood (the highest among OECD countries) and adult obesity (14th highest among OECD countries) prevalence rates.6
In conclusion, these findings suggest that the financial crisis caused cardiovascular death rates (both IHD and cerebrovascular disease) to plateau in Greece for the years 2011 and 2012. The decrease in death rates seems to have resumed in 2013. The same pattern has already been observed for child mortality rates.7 Plausible reasons for this could be the fact that although Greece has secured cheaper prices for many generic and patented drugs, access for patients has decreased due to widespread drug shortages as companies turned to markets with higher profits, increased copayments for prescription drugs, and lower relative affordability due to reduced personal incomes.8 A further reason could be that the economic crisis may unequally impact cardiovascular risk factors among different socio-economic groups.9 Another plausible reason could be the higher prevalence of depression during the crisis;10 etiological studies suggest that, on average, the presence of depression doubles the risk of developing new CVD.11
It is imperative for policy makers to recognize and prioritize these issues in order to design and implement policies necessary to protect against the humanitarian crisis that is taking place in Greece, and amongst others seems also to have negatively affected cardiovascular mortality.
1. European Cardiovascular Disease Statistics 2012. European Society of Cardiology [Internet]. 2012 [cited 2015 June 20]. Available from: http://www.escardio.org/static_file/Escardio/Press-media/press-releases/...
2. Gurfinkel EP, Bozovich GE, Dabbous O, et al. Socio economic crisis and mortality. Epidemiological testimony of the financial collapse of Argentina. Thromb J 2005; 3: 22.
3. Dupre ME, George LK, Liu G, et al. The cumulative effect of unemployment on risks for acute myocardial infarction. Arch Intern Med 2012; 172: 1731-1737.
4. Makaris E, Michas G, Micha R, et al. Greek socio-economic crisis and incidence of acute myocardial infarction in Southwestern Peloponnese. Int J Cardiol 2013; 168: 4886-4887.
5. Vlachadis N, Iliodromiti Z, Vlachadi M, et al. Cardiovascular mortality and the financial crisis in Greece: Trends and outlook. Int J Cardiol 2014; 176: 1367–1368.
6. Health at a glance 2013. OECD ilibrary [Internet]. 2013; Available from:
7. Michas G., Varytimiadi A., Chasiotis I., Micha R. Maternal and child mortality in Greece. Lancet 2014; 383: 691-692.
8. Michas G, Micha R, Mozaffarian D. Re: Greek economic crisis: not a tragedy for health. BMJ [Internet]. 2013; Available from: http://www.bmj.com/content/345/bmj.e7988/rr/694119
9. Filippidis FT, Schoretsaniti S, Dimitrakaki C, et al. Trends in cardiovascular risk factors in Greece before and during the financial crisis: the impact of social disparities. Eur J Public Health 2014; 24: 974-979.
10. Economou M, Madianos M, Peppou LE, et al. Major depression in the era of economic crisis: a replication of a cross-sectional study across Greece. J Affect Disord 2013; 145: 308-314.
11. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J 2006; 27: 2763-2774.
Competing interests: No competing interests
Does it constitute a tragedy for health, according to Professor Lycourgos Liaropoulos, the fact that all Oncology Departments in Greek public hospitals are depleted of antineoplastic drugs?
Tens of thousands of cancer patients in Greece imminently risk their lives.
All cancer patients' associations in Greece confirm these dramatic and dangerous shortages of indispensable pharmaceuticals.
Competing interests: No competing interests
According to the 2010 Global Burden of Disease Study, road traffic injuries are the eighth leading cause of death globally, and the leading cause of death among young people aged 15–29.1 Two years ago, we presented data showing that deaths from road traffic accidents have fallen in Greece as drivers have switched to less expensive means of transport or reduced their overall travel, mainly due to the unprecedented economic crisis (since the final quarter of 2008), which has brought an almost 100% increase in gas prices.2
Herein, I present data showing that this trend continues and has led to an astonishing 47.5% relative decrease in road traffic death rates for the country as a whole fell, from 13.9 road fatalities/ 100.000 inhabitants in 2008 to 7.3 in 2014 (Table 1).
Public health measures need to be strengthened, in order to sustain the positive effect of the Greek financial crisis on road safety in the long term, when the economy will start growing and vehicles will start moving on the road again.2
1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2095-128.
2. Michas G, Micha R. Road traffic accidents in Greece: have we benefited from the financial crisis? J Epidemiol Community Health 2013;67:894.
Competing interests: No competing interests
When signs of worldwide economic crisis appeared in 2007, Greece was affected as much as any country globally. The next year, Greece entered the most serious socioeconomic downturn in the country’s modern history. Compared with a 2008 GDP of €233.2 billion, Greece’s GDP in 2013 plunged to €182.1 billion, a staggering 21.9% decrease.1 While the tremendous toll of the crisis on employment has received considerable attention,1 a second important victim has been the Greek health-care system. Financial crisis can pose great threats to health,2 and IMF programs have been strongly related with weakened health care systems.3 Major structural problems in the Hellenic health care system had already been accumulating for over a decade,4 and these were dramatically compounded by the economic crisis. Between 2009 and 2011, the Ministry of Health undertook restructuring measures that reduced total Ministry of health expenditures by 18.2%; an additional 6.2% budget cuts were implemented in 2012.5 Due to these measures, public hospital budgets were reduced by 20%;5 370 specialist units were either merged or closed down; public hospital beds were reduced by nearly 6%; hiring of new physicians was markedly curtailed; and nurse-to-patient ratios were substantially reduced.6,7 Further worsening matters, since the beginning of the crisis more than 4,000 medical doctors have emigrated due to massive cuts in wages, overtime remuneration, and other benefits.8 Simultaneously, rates of private health insurance have declined, admissions to public hospitals have increased, and admissions to private hospitals have decreased.9,10 Furthermore, although Greece has secured cheaper prices for many generic and patented drugs, access for patients has decreased due to widespread drug shortages as companies turn to markets with higher profits,11,12 increased copayments for prescription drugs,8 and lower relative affordability due to reduced personal incomes.13
The crisis has also directly increased the demand for health care. Self-reported general health in Greece has deteriorated during the period of the economic crisis.14,15 Mental health has particularly declined, including increases in suicidal ideation, attempted suicides, and completed suicide rates, which are now at record highs.16-19 The prevalence of major depressive disorders has more than doubled from 2008 to 2011, with people facing serious economic problems being most at risk.20,21
Economic factors also play an important role in the evolution of crime trends. In the European Union, each 1% rise in unemployment was associated with a 0.79% rise in homicides below age 65.22 Consistent with this, the homicide mortality rate in Greece has significantly increased during the crisis period.23
Rates of several communicable diseases have also increased. An HIV outbreak among intravenous drug users occurred in 2011 and worsened in 2012, increasing the total number of HIV infections reported in Greece from 530 in 2010 to 826 in 2011 and 1,001 in 2012.24 Insufficient provision of preventive services has been an important contributor to increased HIV transmission.25 Furthermore, many previously rare or absent infections have also now been reported, including malaria in 2011 and 2012,26,27 West Nile virus in 2010-201226,28,29,30 and rabies in 201231. The causes of these outbreaks of communicable diseases in the era of economic crisis can be multiple: higher rates of infectious contact under poorer living circumstances, illegally migrating populations that have a different disease epidemiology in their country of origin; reduced treatment availability and lower quality of the public health system resources; and poorly funded or ineffective public health interventions.26,32
The economic crisis and its effects on health do not spare any age groups. Prior reports have seen that financial crisis and unemployment are linked to cardiovascular morbidity and mortality.33,34 Consistent with this, recent data suggest that the prolonged financial crisis has led to higher incidence of myocardial infarction in Messinia, especially among older individuals.35 At the other end of the age spectrum, rates of stillbirth, infant and child mortality in Greece have also increased during the crisis.36 The latter may partly relate to fewer childhood immunizations due to the financial situation.37 Furthermore, births and marriages have markedly decreased over the crisis period further worsening the Greek demographic problem.38
Interestingly, consistent with prior reports in other countries,6,39,40 deaths and injuries from road traffic accidents have fallen in Greece as drivers have switched to less expensive means of transport or reduced their overall travel.41 Furthermore, consistent with findings in Iceland,42 two recent nationwide reports find that smoking prevalence in Greece has started to decrease. With the financial crisis as well as an increased cigarette excise tax, cigarette consumption has declined to 2,197 cigarettes/ person in 2011, a 21.4% decrease compared with 2007.43 Especially amongst young adults smoking prevalence has fallen, from 48% in 2006 to 35% in 2010.44 Yet, these improvements in road traffic injuries and smoking were unable to offset the remarkable declines in the capacity of the public health care system and the substantial increases in mental illness, cardiovascular and other chronic conditions, infectious disease, crime, and poor overall health. In 2011–12 there was an increase in mortality amongst people >55 years (about 2,200 excess deaths).45
In sum, the unprecedented economic crisis in Greece has brought with it a humanitarian crisis in health. The financial crisis has reduced the supply of health care, while simultaneously increasing demand across many areas. Kakouli et al have recently proposed a series of actions for the Greek government to help the collapsing public health system stand on its feet,8 whereas Stuckler and McKee had previously discerned that Greece’s National Health care system was under threat and asked for the political and financial solidarity of the Europeans.25 European civil society and professional organizations have stated that “indiscriminate reductions in health and social services today will both lead to late detection of illness and higher long-term costs and take away the much needed support that people in Europe need to be resilient and emerge quickly from the economic crisis”.46 Yet, unfortunately, until now neither the Greek government nor the EU have responded to these calls. Policy makers, both domestic and foreign, must recognize and prioritize these issues in order to design and implement policies necessary to protect the detoriating health status of the population.
1. Statistical Issues. Hellenic Statistical Authority, 2013. (Accessed 02/05/2013, at http://www.statistics.gr/portal/page/portal/ESYE.)
2. Horton R. The global financial crisis: an acute threat to health. Lancet 2009;373:355-6.
3. Stuckler D, Basu S. The International Monetary Fund's effects on global health: before and after the 2008 financial crisis. Int J Health Serv 2009;39:771-81.
4. Economou C. Greece: Health system review. Health Syst Transit 2010;12:1-177, xv-xvi.
5. Budget Ministry of Health 2012: Tables - Objectives. 2013. (Accessed 15/08/2013, at http://loverdos.gr/gr/index.php?Mid=68&art=2305.)
6. Karanikolos M, Mladovsky P, Cylus J, et al. Financial crisis, austerity, and health in Europe. Lancet 2013;381:1323-31.
7. Kalafati M. How Greek healthcare services are affected by the Euro crisis. Emerg Nurse 2012;20:26-7.
8. Kakouli T. "Troika" mandated austerity and the emerging healthcare crisis in Greece: an open letter to the Greek government. BMJ 2013;346:f2807.
9. Kondilis E, Giannakopoulos S, Gavana M, Ierodiakonou I, Waitzkin H, Benos A. Economic crisis, restrictive policies, and the population's health and health care: the Greek case. Am J Public Health 2013;103:973-9.
10. Karamanoli E. Debt crisis strains Greece's ailing health system. Lancet 2011;378:303-4.
11. Karamanoli E. Greece's financial crisis dries up drug supply. Lancet 2012;379:302.
12. Panic in Greek pharmacies as hundreds of medicines run short. The Guardian, 2013. (Accessed 07/05/2013, at http://www.guardian.co.uk/world/2013/feb/27/greece-blames-drug-companies....)
13. Davlouros P, Gizas V, Stavrou K, Raptis G, Alexopoulos D. DES thrombosis related to antiplatelet therapy noncompliance: A consequence of the Greek financial crisis. Int J Cardiol 2013;168:4497-9.
14. Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health effects of financial crisis: omens of a Greek tragedy. Lancet 2011;378:1457-8.
15. Zavras D, Tsiantou V, Pavi E, Mylona K, Kyriopoulos J. Impact of economic crisis and other demographic and socio-economic factors on self-rated health in Greece. Eur J Public Health 2013;23:206-10.
16. Economou M, Madianos M, Theleritis C, Peppou LE, Stefanis CN. Increased suicidality amid economic crisis in Greece. Lancet 2011;378:1459.
17. Economou M, Madianos M, Peppou LE, Theleritis C, Patelakis A, Stefanis C. Suicidal ideation and reported suicide attempts in Greece during the economic crisis. World Psychiatry 2013;12:53-9.
18. Fountoulakis KN, Koupidis SA, Grammatikopoulos IA, Theodorakis PN. First reliable data suggest a possible increase in suicides in Greece. BMJ 2013;347:f4900.
19. Michas G. Suicides in Greece: a light at the end of the tunnel. BMJ 2013;347:f6249.
20. Madianos M, Economou M, Alexiou T, Stefanis C. Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide. Soc Psychiatry Psychiatr Epidemiol 2011;46:943-52.
21. Economou M, Madianos 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 2013;145:308-14.
22. Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 2009;374:315-23.
23. Michas G, Varytimiadi A, Micha R. The Greek financial crisis and homicide rates: another reason to worry. J Epidemiol Community Health 2013;67:1073.
24. HIV/AIDS Surveillance in Greece. Hellenic Centre of Disease Prevension and Control, 2012. (Accessed 08/05/2013, at http://www.keelpno.gr/)
25. Stuckler D, McKee M. There is an alternative: public health professionals must not remain silent at a time of financial crisis. Eur J Public Health 2012;22:2-3.
26. 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.
27. Epidemiological Surveillance Report on Malaria in Greece. Hellenic Centre for Disease Prevention and Control, 2012. (Accessed 07/05/2013, at http://www.keelpno.gr/)
28. Report on the epidemic of West Nile Virus in Greece, 2010. Hellenic Centre for Disease Prevention and Control, 2013. (Accessed 07/05/2013, at http://www.keelpno.gr/)
29. Report on the epidemic of West Nile Virus in Greece, 2011. Hellenic Centre for Disease Prevention and Control, 2013. (Accessed 07/05/2013, at http://www.keelpno.gr/)
30. Report on the epidemic of West Nile Virus in Greece, 2012. Hellenic Centre for Disease Prevention and Control, 2013. (Accessed 07/05/2013, at http://www.keelpno.gr/)
31. Information on Rabies. Hellenic Centre for Disease Prevention and Control, 2013. (Accessed 07/05/2013, at http://www.keelpno.gr/)
32. Suhrcke M, Stuckler D, Suk JE, et al. The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence. PLoS One 2011;6:e20724.
33. Brenner MH. Economic changes and heart disease mortality. Am J Public Health 1971;61:606-11.
34. Dupre ME, George LK, Liu G, Peterson ED. The cumulative effect of unemployment on risks for acute myocardial infarction. Archives of Internal Medicine 2012:1-7.
35. Makaris E, Michas G, Micha R, et al. Greek socio-economic crisis and incidence of acute myocardial infarction in Southwestern Peloponnese. Int J Cardiol 2013;168:4886-7.
36. Michas G, Varytimiadi A, Chasiotis I, Micha R. Maternal and child mortality in Greece. Lancet 2014;383:691-2.
37. Mammas IN, Theodoridou M. Financial crisis and childhood immunization: when parents disagree. Acta Paediatr 2012.
38. Michas G, Papadopoulos S, Micha R. Austerity in Greece not only kills but also curtails births and marriages. BMJ 2013;347:f6639.
39. Fishback PV, Haines MR, Kantor S. Births, Deaths, and New Deal Relief during the Great Depression. Review of Economics and Statistics 2007;89:1-14.
40. Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. Effects of the 2008 recession on health: a first look at European data. Lancet 2011;378:124-5.
41. Michas G, Micha R. Road traffic accidents in Greece: have we benefited from the financial crisis? J Epidemiol Community Health 2013;67:894.
42. McClure CB, Valdimarsdottir UA, Hauksdottir A, Kawachi I. Economic crisis and smoking behaviour: prospective cohort study in Iceland. BMJ Open 2012;2.
43. Alpert HR, Vardavas CI, Chaloupka FJ, et al. The recent and projected public health and economic benefits of cigarette taxation in Greece. Tob Control 2013.
44. Filippidis FT, Vardavas CI, Loukopoulou A, Behrakis P, Connolly GN, Tountas Y. Prevalence and determinants of tobacco use among adults in Greece: 4 year trends. Eur J Public Health 2012.
45. Vlachadis N, Vrachnis N, Ktenas E, Vlachadi M, Kornarou E. Mortality and the economic crisis in Greece. Lancet 2014;383:691.
46. Open letter to the European Council. EU leaders must focus on sustainable equitable Europe that fosters, and is sustained by, a healthy population. European Public Health Alliance, 2012. (Accessed 15/08/2103, at http://www.epha.org/IMG/pdf/FINAL_letter_to_European_Council_SECURED.pdf.)
Competing interests: No competing interests
Hundreds of thousands of Greeks cannot even afford electricity any longer. 
Public Power Company (DEI) risks economic collapse from accumulated debt of unpaid electricity bills.
25% of Greek patients cut electricity in order to pay for necessary medications. 
Competing interests: No competing interests
145,000 students face malnutrition daily in Greek schools.
They are about 10% of the total number of those attending.
These are only daily documented figures: chronic malnutrition might be widespread.
Teachers alert Charities that provide free meals.
Competing interests: No competing interests
Greece has been significantly affected by the global economic crisis, and since the final quarter of 2008 has entered the most serious financial downturn in the country’s modern history.1 In view of this financial crisis and the recent reports by the Hellenic Center for Disease Control and Prevention (HCDCP) that there is an epidemic of new HIV infections mainly due to an outbreak amongst intravenous drug users (IDUs),2, 3 I sought to evaluate the potential association between the financial crisis period (January 2008 to December 2012) and HIV infections, with the pre-crisis period (January 2003 to December 2007) of similar duration (5 years) as the referent.
Over the 10 years assessed (2003–2012), 6,549 HIV infections were recorded in Greece by year of notification, whereas 6,315 infections were recorded by year of diagnosis (table 1). Herein, I will further discuss the infections by using the date of HIV diagnosis since this limits the effect of reporting delays. The crude total number of new HIV infections for the 10 years was 6,315—5,218 in males (82.6%) and 1,090 in females (17.3%) (in 7 cases the gender was unknown). By period, 2,505 infections were recorded in the pre-crisis period, and 3,810 infections in the crisis period (a relative increase of 52.1%). Infections among males steeply increased from 1,983 to 3,235 (a relative increase of 63.1%). Furthermore, the infections in females increased from 515 to 575, albeit not as much (a relative increase of 11.7%).
New HIV infections seem to have steeply increased during the Greek crisis. This is further supported by the fact that although tests to determine recent infection are not routinely performed in Greece, 62 avidity tests were performed on a subsample of the IDUs detected in 2011 by HCDCP; of these 57% were determined to have been infected with HIV within the five months prior to testing.4 One of the main reasons that HIV spiked is that government needle exchange programs ran out of clean syringes for IDUs.5 The result is that in 2012 the annual reported number of HIV infections in IDUs comprised the majority (44.2%) of all reports that have been received.3 These findings further stress the urgent need to strengthen public health measures and not to not to panic as evidenced by the fact that recently “the Greek Government has brought back into force a regulation on the transmission of infectious diseases that runs counter to all international guidelines on HIV testing and breaches human rights”.6
1. Michas G, Varytimiadi A, Micha R. The Greek financial crisis and homicide rates: another reason to worry. Journal of Epidemiology and Community Health 2013;67(12):1073.
2. Hellenic Center for Disease Control and Prevention (HCDCP). HIV/AIDS Surveillance Report in Greece, 31 December 2011. Athens: HCDCP 2011.
3. Hellenic Center for Disease Control and Prevention (HCDCP). HIV/AIDS Surveillance Report in Greece, 31 December 2012. Athens: HCDCP 2012.
4. European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs and Drugs Addiction (EMCDDA). Meeting report: Detecting and responding to outbreaks of HIV among people who inject drugs: best practices in HIV prevention and control, Tallinn, 29–30 March 2012. Stockholm: ECDC 2012.
5. Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, et al. Financial crisis, austerity, and health in Europe. Lancet 2013;381(9874):1323-31.
6. The L. HIV testing in Greece: repeating past mistakes. The Lancet 2013;382(9887):102.
Competing interests: No competing interests
900,000 Greeks receive free food from donations. 
50% of Greek households cannot afford heating expenses. 
3,068,000 citizens are completely uninsured and do not have any access to healthcare. 
Greek Health Minister admits National Healthcare Service is not for all. 
I wonder how Professor Lycurgus L Liaropoulos managed to miss all these facts.
Competing interests: Dr Stavros Saripanidis is an active voluntary member of a non-profit organization that fights for women's rights.
An Open Letter to the Greek Government
I sincerely hope that the letter by Dr. Thomais Kakouli is read by the Greek Prime Minister, since it represents the plea of very many academics and health professionals. If read I hope that it is acted upon.
However, as pointed out by Martin McKee denial of the obvious health effects of crisis is part of the problem space and no where is it more acute as in Greece.
My one addition to the letter would be that austerity is government mandated with the Troika its willing instrument.
The concerns expressed are more than legitimate and reflect upon a climate where the obligation of citizens is a one way street, to shore up the state, at a time when the health sector is within a hair’s breadth of failing and the health of the Greek people is under threat.
The culprits are governance deficits, misguided policies, absence of professionalism and party peddling in lieu of systems and science.
After long-term and sustained efforts to extricate itself out of a state of functional limbo, a small school of public health, one of the first in Europe, with a prestigious past still fights for its institutional life.
The School's credits include the eradication of malaria and the control of tuberculosis, support for the NHS and specific activities in the Balkans and the wider region.
It conducted the first Balkan health forum with the support of the WHO and the EU, responded to provisions for public health in the Treaty of Maastricht and has lent a hand in the development of new schools.
It was a founding member of Association of Schools of Public Health in the European Region and has been an active member for half of its existence.
Its pedigree relates it to Schools in Ankara, London and Zagreb via the League of Nations and the Rockefeller foundation.
The Athens school got underway after a pandemic of dengue fever entered Greece from Syria via Lebanon to send shivers of fear through European capitals.
For more than 80 years it has transacted educational programmes, research and provided continual service to the state, within a legal framework, which clearly recognizing the nature of its higher educational level status in public health, under the umbrella of the Ministry of Health.
Paradoxically, ever changing reform has not yet found a way to place the National School of Public Health, since 1994, in the system of higher education. In the current climate it remains defenceless, its prestige threatened and its advancement further stalled.
In Greece, there exists a potential danger for the re-emergence of once controlled diseases such as malaria, rabies, and tuberculosis etc.
Who can say if or when dengue fever might strike again in the current fiscal? What will Europe do then?
Again, I would argue that much more attention should be given to disaster preparation and the establishment of an EU Center, Greece to monitor the encroachment of public health disaster, imprint and evolution.
Here and now, the historical school of public health should be upgraded and the Open Letter of Kakouli to the Greek should be heeded and acted upon by the Greek political world.
Politicians after all, are mainly responsible for the current mess in public health and for the ongoing creeping health disaster that threatens population health.
They should at least make some amends and help restore the autonomy of all health sector institutions and curtail the “brutal and self-defeating fiscal austerity”.
Re: Greek economic crisis: not a tragedy for health
Levett Jeffrey, Creeping Disaster - Austerity’s Rapid Rise, Health’s Slow Demise [To be presented 18th World Congress on Disaster & Emergency Medicine, Manchester, United Kingdom 28-31 May,2013]
Neighbors in the Balkans: Initiating a dialogue for health, (2000) Editors, A. Ritsatakis, J.Levett, J. Kyriopoulos, WHO/CoE/INTERREG, Exandas Press, Athens
Implementation of the Human Security concept in the Balkan region, Declaration, Brioni Island, Croatia, 2010 [Compiled and written by Jeffrey Levett] ECPD, UN University for Peace, Belgrade.
Laaser U., Donev D., Levett Jeffrey, Skopje Declaration, Public Health, Peace and Human Rights CMJ(2000)
Competing interests: None declared
Competing interests: No competing interests
We would like to respond to professor Liaropoulos by submitting an open letter to the Greek government written by a team of Greek academics and signed by more than a hundred Greek professors and PhDs, health professionals and doctors/phycisians.
Dr. Thomais Kakouli
“Troika”-Mandated Austerity and the Emerging Health Care Crisis in Greece: An Open Letter to the Greek Government
To the Prime Minister of Greece and President of New Democracy Party, Mr. Antonis Samaras
To the President of PASOK, Mr. Evangelos Venizelos
To the President of the Democratic Left, Mr. Fotis Kouvelis,
To the Minister of Health, Mr. Andreas Lykouretzos,
This letter is an attempt by Greek scholars and physicians to express their concern regarding the current, dire state of Health Care services in Greece.
Our country has fallen into a dismal state, and it is constantly challenged by extrinsic and intrinsic pressures, while the economic and social climate deteriorates further day by day. The Greek government, in total obedience to the irrational demands of the Troika, focuses on the obligations of the citizens towards the state, and seems to forget or ignore its own obligations towards its citizens. The Government has imposed a brutal and self-defeating fiscal austerity; in a confiscatory manner, it tries to collect extra revenue from an already impoverished and afflicted populace, while it neglects its main role, as specified by the Constitution: The Protection of the Rights and the Welfare of the Citizen Body.
In three short years, governments comprised of the current coalition parties have managed to reduce the country’s GDP by 25%, leading Greece to the deepest and longest-lasting economic depression in the history of the modern Western world. During the same period of time, the public debt expanded from 109% GDP to 170% GDP, unemployment rose from 8% to 27%, and youth unemployment now holds the world record at 58%. Incomes have been reduced by more than 40%, leading to a record number of families and individuals living below the poverty line. It is worth noting that the famous “haircut” (PSI), presented by the Government as a notable achievement, ultimately increased the public debt, while raiding the reserves of pension funds, reserves that were gathered painstakingly by the contributions of workers and pensioners.
One of the sectors that has been most hard-hit is Health Care. The Public Health system in Greece is now collapsing at all fronts. Having signed a memorandum of understanding with the unelected and unaccountable troika to reduce public health expenditures from 9.8% GDP (pre-crisis) to 6% GDP (the shrunken post-crisis GDP), the Greek government has instituted a number of measures which seriously undermine the health of the population. Removing health coverage from thousands of unemployed is definitely guaranteed to increase mortality in this segment of the population.
This policy of subservience to the Τroika’s demands has led to the closure or downgrading of Hospital units. For example, the hospital of the town of Kymi “Georgios Papanikolaou”, the hospital of the city of Thebes and many others in the provinces and in metropolitan centers have seen their medical personnel reduced, the staff remained unpaid for long periods of time, their medical equipment in progressive deterioration, and laboratories with increasing shortages in all kinds of consumables (syringes, bandages, reagents etc.). Patients now have to pay for consumables, for medical tests, and for surgeries. This is all on top of what they already paid through their insurance funds. Those who suffer from chronic diseases, such as chronic obstructive pulmonary disease, are forced to pay a 25% deductible for the cost of their medication, while prior to the crisis this deductible stood at 5%. Cancer and kidney failure patients suffer not only due to the increased costs of specialized treatments, but also the general rundown of these facilities, loss of key personnel and dramatic shortages in medications; unable to receive treatment at home anymore, they have to travel far away for dear life, and wait in endless queues in the corridors of bureaucratic health-insurance offices and/or hospital clinics. Patients in mental health units, such as Dromokaitio, face every day the alienation and indifference of a state that fails to support them. The staff and the resources in most psychiatric clinics are decreasing rapidly, while the number of patients is increasing (as this crisis is taking its toll). Psychiatric hospitals in Greece can no longer perform at the level required to provide even basic treatment to patients diagnosed with serious mental illnesses.
Furthermore, the establishment of a "standard rate" for surgeries is forcing patients to pay in advance approximately 20% of the value of materials and services. This “standard rate” makes both emergency and elective surgeries virtually unapproachable for a broad segment of the population. For example, on the basis of the newly introduced pricing, the cost for a hip replacement surgery at a public hospital approximates €1000; this cost is further increased by the remuneration of the surgeon, the anesthesiologist and other essential staff. Thus, the cost of this common surgery is currently unaffordable by an elderly patient with a basic pension of less than €600; such retirees would be unable to secure the funds, having to prioritize purchasing of basic foodstuffs, paying for rent and utilities, securing funds for heating, acquiring their regular medication, and affording sundry living expenses (and often this small pension supports an additional family member).
Beyond these specific destructive measures, one can easily figure out the impact on public health of the consecutive decreases in pensions and the confiscatory tax measures. Many poor pensioners have no choice but to forgo basic, life-saving drugs and healthcare monitoring, in order to afford just food and heating (the Government’s devastating policies in heating fuel are duly noted here). The pricing of basic goods has increased (not only by inflation but also by the drastic increases in VAT for even basic items), while incomes have been drastically reduced. The imposed increase of 500% or above on deductibles for drugs and doctor visits are simply making it impossible for many pensioners to maintain their assigned treatment. Certainly, the consequences here, especially for persons with serious and chronic diseases, are increased morbidity and mortality.
This rapid decline in the quality of care administered is complemented by the hemorrhaging of highly trained individuals; more than 4,000 highly trained Greek doctors have emigrated abroad because of their frustration with the degradation of the system and the successive cuts in wages, overtime remuneration and benefits. It is worth noting that the National Health System (ESY) in our country has operated efficiently, provided exceptional services and constituted an important achievement of our society prior to the onset of the crisis. It was the hard work of the doctors, the nurses, the pharmacists, the laboratory scientists and technicians, the administrators and the ancillary personnel of ESY that advanced the status of the public health in the country. This system is now bereft of basic resources, besieged at every level and plundered with your consent. Its members are fleeing in increasing numbers.
In this context, we call on the Greek government to keep and defend the value of health. There should be no cuts on funds required for the normal operation of the hospitals in Greece, both for those located in major metropolitan centers and for those in the islands and other remote areas of our country. We ask that you do not downgrade regional hospitals to just health centers. Such health centers will provide limited services and result in the collapse of public health in the provinces. Do not let these regional/provincial hospitals remain understaffed, manned simply by general practitioners or pathologists, bereft of key specialized personnel; your policies will degrade terminally what has been the key strength of these regional hospitals, a strength that contributed significantly to the improvement of public health in Greece in the last few decades. If your policies were fully enabled, key specialized personnel would only be found in large, crowded hospital conglomerates in metropolitan centers. Such a policy would force Greeks who need special attention, to travel farther and farther from home in order to secure proper care (thus further increasing the already unbearable costs), assuming that they can even afford it, a dangerous assumption in this current economic climate. The additional costs and the absence of timely specialized care would undoubtedly lead to increased morbidity and mortality in the provinces. A welfare state that respects its institutions and history, and cares about its continued existence in the future, should not even contemplate such drastic cuts in public health. Such actions can be expected by foreign-installed, occupation governments, not by a government of Greeks for Greeks.
Thus, we request the following actions by the Greek government:
1. The proper staffing, maintenance, and modernization of existing hospitals in the country, especially in the provinces and the islands.
2. The restoration of proper medical coverage of population groups, the collective health of which is specifically under threat by the current economic crisis. These groups include the long-term unemployed, the working poor, low-income pensioners, and others. For these population groups, you must introduce a substantial rollback of the increases in the cost of health care that you have instituted.
3. The creation of policies and incentives that will assist in the proper geographic allocation of physicians and nursing personnel of all specialties in order to avoid needless and counterproductive concentration of qualified personnel (often unemployed) in metropolitan centers.
4. The proper remuneration of physicians, nurses, laboratory scientists and technicians to avoid further depletion of these key personnel through emigration. The drastic cuts in wages, salaries and overtime pay must be rolled back. Otherwise, the exodus of qualified personnel will turn into a stampede, with disastrous consequences for public health
5. The introduction of policies that will assist in the ready availability of pharmaceuticals, consumables, laboratory supplies, and devices. The government should forgo unconvincing public releases about primary surpluses and regularly pay suppliers and pharmaceutical companies the full amount owed.
As the government of Greece, you have the responsibility for our country’s survival and the welfare of its citizens. You have no right to obtain credit by degrading the health of your compatriots and by sending to an early grave the most vulnerable among us. You are obliged to say NO to the demands of the unelected members of the “troika”, when obedience to these demands has devastating consequences for our country. If saying NO to Troika’s destructive demands means exiting the Euro Zone, then you must do so. Many of us believed in a united Europe, but the Euro Zone proved to be only a means of exploitation of the weaker nations by the stronger ones. The consequences of our continued participation in the common currency have become obvious by now. Along with the impoverishment of our country, you have made us forget not only the meaning of the word “pride”, but also the meaning of “dignity”. Despite the ongoing crisis, record unemployment, the rapid decline in GDP, the dramatic increase in poverty and hunger, the deteriorating health of the population, the sharp decline in birth rates, the wave of suicides and total loss of hope, you cling tenaciously to your policies of supplication and subjugation, while continuing to sell off public property and public companies at rock bottom prices.
The disastrous policies that undermine even the basic health of the Greek population must come to an end. As Greeks, we are able to survive the crisis and rebuild. However, to do so, having our physical health is a prerequisite.
1. Medical and support staff of the Metropolitan Social Clinic of Elliniko, GREECE.
2. Akritas Alkis, Professor, CS / KU, USA.
3. Albrecht-Piliouni Efrosini, Ph.D., International Programs, Foy Hall 316, Auburn University, Auburn, AL 36849, USA.
4. Almpoura Efstratia, MSc Developmental Psychologist, IED-Paris8, Vincennes-Saint Denis, Paris, & Harvard ES, Cambridge MA, Athens, GREECE.
5. Anastassopoulou Ioanna, Professor, School of Chemical Engineering, Department of Material Science and Engineering, Athens, GREECE.
6. Andreatos Antonios, Professor, Department of Computer Science, Department of Air Science, Air Force Academy, Athens, GREECE.
7. Antikas Theodoros, Ph.D., GREECE.
8. Apostolaki Aggeliki, MSc Psychologist, A.U.TH. Faculty of Philosophy, Department of Psychology, Thessaloniki, GREECE.
9. Argyrokastritis Ioannis, Associate Professor, Agricultural University of Athens, GREECE.
10. Argyropoulos Giannis, PhD, AT&T Labs
11. Aroniadou-Anderjaska Vassiliki, Ph.D., Associate Professor of Neurosciences, Bethesda, Maryland, USA.
12. Valaskakis Kimon, Ph.D., Ambassador of Canada (Ret), Professor of Economics (Emeritus), University of Montreal, CANADA.
13. Vallianatos Evangelos, Ph.D., Associate Professor, Pitzer College, USA.
14. Vartholomaios Tasos, MD, PhD, MFHom, GMC, UK, Registered Consultant Pathologist, Member of the Faculty of Homeopathy,UK
15. Vartholomaiou-McLean Athina, Ph.D., Professor, Sociology, Anthropology and Social Work, Central MI University 48859, USA.
16. Vichas George, Cardiologist, Head of the medical team of the Greek Metropolitan Social Clinic of Elliniko, GREECE
17. Vigot Jacques, DNSAP, in Plastic Arts, ENSBA, Paris. Artist-Painter, Educator in Painting and Drawing, Animation Center Les Halles-Le Marais, Paris Τοwnhall of the 1st Arr., Paris, FRANCE.
18. Vogiatzis Alexander, Former Associate Professor, University of Macedonia, GREECE.
19. Burriel Angela R., Professor, Veterinary Microbiology, University of Thessaly, GREECE.
20. Bucher Matthias, PhD, Assistant Professor, University of Crete, Chania, GREECE.
21. Georgopoulou Lito, Educator, GREECE.
22. Giannaki Efrosyni, Surgeon Dentist, Dental School of the National and Kapodistrian University of Athens, GREECE.
23. Yannacopoulos Spiros, Ph.D., P.Eng., Associate Dean and Director, School of Engineering, University of British Columbia, Okanagan Kelowna, BC, CΑΝΑDA.
24. Giannopoulos Panagiotis, Associate Professor, Department of Civil Engineering, University of Patras, GREECE.
25. Giannoukos Konstantinos, M.Eng., Doctoral Candidate, Faculty of Engineering, Division of Materials Mechanics and Structures, The University of Nottingham, UK.
26. Giannoukos Stamatios, M.Eng., Research Assistant and Doctoral candidate, Department of Electrical Engineering and Electronics, University of Liverpool, UK.
27. Giokaris Nikos, Professor, Department of Physics, University of Athens, GREECE.
28. Gatzoulis Nina, Languages, Literature and Cultures University of New Hampshire, USA.
29. Dascalopoulos Stella S., MD, MSc, DIC, PhD, Assistant Professor in Medicine, Director, Vascular Health Unit, Department of Medicine, Division of Internal Medicine, McGill University, CANADA.
30. Dokos Socrates, Ph.D., Associate Professor, Graduate School of Biomedical Engineering, University of New South Wales, Sydney 2052, AUSTRALIA.
31. Dritsas Margarita, Emeritus Professor of Economic History, Greek Open University (Hellenic Open University), GREECE.
32. Eleftheriades George Savva, PhD, OAM, GCSCG, CETr, JP. – ExarchOSETrAu, New South Wales, AUSTRALIA.
33. Eleftheriades Evgenia, CLETr, CSH; - Sydney, New South Wales, AUSTRALIA.
34. Evangeliou Christos C., Professor of Philosophy, Honorary President of IAGP, Towson University, Towson MD, USA
35. Prof. Dr. Panayiotis Zavos, Dr., Professor, Director & Chief of Andrology, Andrology Institute of America, President & CEO, ZDL, Inc. USA, P.O.Box 23777, Lexington, KY 40523, USA
36. Zerva Evgenia, M.Eng., Doctoral Candidate, Process and Environmental Engineering Research Division, University of Nottingham, UK.
37. Dr. Zotou Vassiliki, Language and Linguistics in Education, University of Thessaly, Volos, GREECE.
38. Zografopoulos Gregorios, Dentist,Dental School of the National and Kapodistrian University of Athens, Florina, GREECE.
39. Ifestos Panagiotis, Professor, International Relations-Strategic Studies, University of Piraeus, Department of International European Studies, GREECE.
40. Theocharopoulos Anthony, Ph.D., Lecturer in Dental Technology, Cork University Dental School and Hospital, Wilton, Cork, IRELAND.
41. Ioannou Petros, Ph.D., Electrical Engineering, University of Southern California, Los Angeles, CA 90089-2562, USA.
42. Kaimara Polyxeni, MSc School and Evolutionary Psychology, MSc Public Health Specialization in Counseling and Guidance, Physical Medicine and Rehabilitation Center Florina, GREECE.
43. Kakouli Thomae, Ph.D., Lecturer in Biosciences, Department of Science and Health, Institute of Technology Carlow, Carlow, IRELAND.
44. Kakoullos Theophilos, Emeritus Professor, University of Athens, GREECE.
45. Father Lambros Kamperidis, Concordia University, Montreal Classics, Modern Languages and Linguistics, CANADA.
46. Carayannis Anastassios, PhD, Professor, Department of Applied Human Sciences, Concordia University, Montreal, CANADA.
47. Caranastassi Irini, PhD, Assistant Professor, Department of Greenhouse Crops and Floriculture, School of Agricultural Technology, TEI of Messolonghi, GREECE.
48. Karanis Panayiotis, Professor of Parasitology and Anatomy, Medical School, University of Cologne, 50937 Cologne, GERMANY.
49. Katsifarakis Costas, Professor, Department of Civil Engineering, Aristotle University, Thessaloniki, GREECE.
50. Kelandrias Panagiotis, Associate Professor, Department of Translation and Interpreting, Ionian University, GREECE.
51. Keromnes Luce, (CCI) School of Nurses-Managers of Pitié -Salpêtrière, Senior Manager of Health - retired, Paris, FRANCE.
52. Kontos John, Professor Emeritus, NKUA, GREECE.
53. Kopatou Stamatina, Professor of French in the French Institute of Athens (INFA), Greece. University of Languages and Literature Grenoble 3. Athens, GREECE.
54. Koudounas Constantine, Graduate Department of Physics UoA, MSc Marketing & Communication, Gold Coast, QLD AUSTRALIA.
55. Koutselini Mairi, Professor, University of Cyprus, CYPRUS.
56. Kranidioti Maria, Associate Professor, School of Law, University of Athens, GREECE.
57. Kriara Fenia, MSc Cultural Informatics and Communication, Aegean University, GREECE.
58. Kyriakou George, Professor, Demokrition University of Thraki, GREECE.
59. Koletis Theophilus M., Professor of Cardiology, University of Ioannina, GREECE.
60. Comodromos Petros, Lecturer, Department of Civil & Environmental Engineering School of Engineering, University of Cyprus, CYPRUS.
61. Kostantatos Demosthenes, Ph.D., M.Sc. M.B.A., Greenwich CT, USA.
62. Father Konstantelos Dimitrios I., Dr F. D.TH, Emeritus Professor of Byzantine History and Theology, Stockton College of New Jersey, Galloway, New Jersey, USA
63. Kostas Antigone, Doctor of Psychiatry, Greenwich CT USA
64. Lazaridis Christina, Ph.D, retired from Dupont Company, Wilmington DE, USA (and Heraklion, Crete, GREECE)
65. Lazaridis Anastasios, Eng.Sc.D, Professor Emeritus, Widener University, Chester PA, USA (and Heraklion, Crete, GREECE)
66. Lampropoulou Venetta, Professor, Special-Deaf Education, President of the International Congress on the Education of the Deaf, Deaf Studies Unit, Department of Primary Education, University of Patras, GREECE.
67. Lekanidou P., Emeritus Professor, UoA, GREECE.
68. Loutridis Abraham, MSc, PhD Candidate, Antenna and High Frequency Research Centre, Dublin Institute of Technology, Dublin, IRELAND
69. Μanios Ioannis, National and Kapodistrian University of Athens, Faculty of Dental Surgery, Surgeon Dentist, Athens, GREECE.
70. Melakopides Kostas, Associate Professor of International Relations (ret.), University of Cyprus, Nicosia, CYPRUS.
71. Michalakopoulos George, Assistant Professor, Department of Translation and Interpreting of the Ionian University, GREECE.
72. Moshakis Aristidis, B.ENG.,M.ENG. , Concordia University, Montreal, CANADA.
73. Moulopoulos Costas, Associate Professor, Department of Physics, University of Cyprus, Nicosia, CYPRUS.
74. Batzakas John E., Lecturer, University of the Aegean, GREECE
75. Bacalis Naoum, PhD, Institute of Theoretical and Physical Chemistry, National Research Institute, Athens, GREECE.
76. Baloglou George, Associate Professor Emeritus (SUNY Oswego), Thessaloniki, GREECE.
77. Balopoulos Victor, Assistant Professor Department of Civil Engineering, Democritus University of Thrace, GREECE.
78. Blytas Κ. George, Ph.D., Physical Chemistry/Chemical Engineering, Research Consultant, Royal Dutch Shell, retired, President, GCB Separations Consulting, Founder: The Hellenic Professional Society of Texas, Author: The First Victory, Greece in the Second World War, 2009, USA.
79. Bougas Ioannis, Professor of Statistics, Montreal, CANADA.
80. Briasouli Eleni, Professor, Department of Geography, University of the Aegean, Mytilene, Lesvos, GREECE.
81. Moraitis L. Nicholas, Professor of International Relations - Comparative Politics, University of California, Berkeley.
82. Negreponti-Delivani Maria, Ph.D., ex Rector and Professor of University of Macedonia, GREECE.
83. Notopoulou Julia, MSc Developmental Psychologist, IED-Paris8, Vincennes-Saint Denis, Paris. MFA Film and Film / Video, IED-Paris8, Vincennes-Saint Denis, Paris, Athens, GREECE.
84. Octeau Anne-Pascale, DNSAP, in Plastic Arts, ENSBA, Paris. Artist-Painter, Educator in Painting and Drawing, Paris, FRANCE.
85. Panoskaltsis Basil P., MS, MA, Ph.D., GREECE.
86. Papavasileiou-Alexiou Joanna, Assistant Professor of Counselling and Guidance University of Macedonia, Department of Educational and Social Policy, Thessaloniki, GREECE.
87. Papagiannis Gregorios, Ph.D., Byzantine Philology, Demokrition University, Thraki, GREECE.
88. Papadopoulos Nikos T., Emeritus Professor of Medicine Aristotle University, Thessaloniki, GREECE.
89. Papadopoulou Maria, CLETr, MSc, Civil Engineer, Larissa, GREECE.
90. Papathanasiou Maro, Professor in the Department of Mathematics, University of Athens, GREECE.
91. Papamarinopoulos P. Stavros, Professor, University of Patras, GREECE.
92. Paparodopoulos Nikolaos, former Lecturer, University of Aegean, GREECE.
93. Paul P. George, Associate Professor, Department of Electrical and Computer Engineering, Polytechnic School of Xanthi, University Campus Xanthi Kimmeria, Xanthi, GREECE.
94. Péré-Pasturel Sandrine, MSc Psychologist, IED-Paris8, Vincennes-Saint Denis, Paris, Varcheny, Nursing-Nurse Manager at Creche au Pont, Rhône-Alpes, FRANCE.
95. Petrakis Leonidas, PhD, Chairman and Senior Scientist (Retired), Department of Applied Science, Brookhaven National Laboratory, Now residing in California, USA.
96. Pirgiotakis George, ex Associate Professor, GREECE.
97. Retzios Anastassios, Ph.D., President, Bay Clinical R&D Services, LLC, San Ramon, California, USA.
98. Riga Aikaterini, Ph.D. Director of Nematology Laboratory and Senior Scientist, Verdesian Life Sciences, Pasco, WA, USA
99. Peter Roussos, Assistant Professor, Agricultural University of Athens, GREECE
100. Sakatcheff Veronique, MSc Cognitive-Behavioral Psychologist, IED-Paris8, Vincennes-Saint Denis, Paris, Toulon, FRANCE.
101. Sarri Maria, Surgeon Dentist UMFT Victor Babes, Athens, GREECE
102. Stamboliadis Elias, Professor, Department of Mineral Resources Engineering, Technical University of Crete, GREECE.
103. Stavrakaki Niki, ΜΕd., PhD, Professor of Education, IRELAND.
104. Stavropoulos George P., Cytologist, University of Athens, Athens, GREECE.
105. Stavropoulou Mika, Research Faculty, UoA
106. Stavropoulou Georgia, MA, MPhil. Los Angeles, CA, USA.
107. Stylianakis Vasilis, University of Patras, GREECE.
108. Tzamtzis Stavros - Dionisios, Psychologist, graduated from Aristotle University, Thessaloniki, GREECE.
109. Tsobanoglou George, PhD Sociology, Carleton, President, International Sociological Association, Research Committee on Sociotechnics & Sociological Practice (ISA-RC26), Associate Professor, University of the Aegean, Dept. of Sociology, Mytilini, Greece
110. Tsirka Anna, pediatric cardiology, Assistant Professor, Tufts University School of Medicine
111. Tsoutsoulopoulou A.M., EEDIP I English School of Humanities, University of Thessaly, GREECE.
112. Flessas George P., Professor, Department of Information & Communication Systems Engineering, Department of the Aegean, Karlovassi, Samow, Greece.
113. Floros Evangelia, Professor, Tel & GL Larissa, Department Decorators / Graphic Designers, Maintainers art, Design Free / Linear and specificity School of Architecture University of Thessaloniki, Larissa, GREECE.
114. Franzi Katerina T., Associate Professor of Informatics, Department of Mediterranean Studies, University of the Aegean
115. Fridas Stavros, Professor of Parasitology Immunology-AUTH, Thessaloniki, GREECE.
116. Halamantaris Pantelis, Ph.D., Ed.D. (HC), Professor Emeritus, Brandon University, Deputy Director, the University of Manitoba Centre for Hellenic Civilization, Brandon, Manitoba, CANADA.
117. Hamilos I. Apostolos, Surgeon Dentist, Dental School, Athens, GREECE.
118. Hamilou A. Ioannou, Surgeon Dentist, Univerzita Karlova v Praze-Charles Univeristy, Prague, Athens, GREECE.
119. Hatzis Aristotelis, A.U.TH. – N.K.U.A., Dentist, School of Dentistry, Aristotle University of Thessaloniki, ATHENS, GREECE.
120. Hatzis Labros ,MD, PhD, BPlast, Fellow, St John's College, Cambridge University, UK. S. Lecturer Royal College of Surgeons in Ireland, Dublin, IRELAND.
121. Hatzopoulos N. Ioannis, Professor, University of the Aegean, Department of the Environment, Mytilene, GREECE.
122. Christodoulou Nikoletta, Lecturer, Curriculum and Teaching, School of Education, University Frederick, Nicosia, Cyprus
123. Christou Theodore, Ph.D., Assistant Professor, Queen's University, Faculty of Education, CANADA.
Competing interests: No competing interests