Economic Recession and Health: the Case of Greece

Transcription

1 Economic Recession and Health: the Case of Greece Dr. Filippos Filippidis School of Public Health Imperial College London 1

2 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 2

3 Background I 3

4 Background I 4

5 Background II 5

6 Background III Population (millions) GDP per capita ($ PPP) 25,331 37,299 Gini index Human Development Index Life expectancy (years) Infant mortality (per 1,000 live births) Health expenditure (% of GDP, 2009) Expenditure on pharmaceuticals (% of GDP, 2009) Practising doctors (per 1,000 population) Practising nurses (per 1,000 population)

7 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 7

8 GDP per capita ( ) GDP per capita, Greece Year Eurostat

9 Index (2009=100) Wages and Consumer Prices in Greece (2009=100) 120 Wage index Consumer Price Index Year Hellenic Statistical Authority

10 Unemployment % Unemployment in Greece Year Hellenic Statistical Authority

11 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 11

12 Effects of economic crises on health Decline in tobacco use Decline in road traffic accidents Decline in mean alcohol consumption increase among the unemployed Increased impact of communicable diseases Increase in suicides Variable effects on all-cause mortality Greater impact in vulnerable groups 12

13 13

14 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 14

15 Self-reported health, Zavras et al. EJPH

16 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 16

17 % of population who replied all or most of the time Self-reported mental health I 80% % 60% 61% 58% 67% 57% 50% 40% 30% 20% 10% 43% 46% 0% * Past 4 weeks Happy Calm and peaceful Full of life Eurobarometer 2006,

18 % of population who replied never or rarely Self-reported mental health II 80% 70% 70% % 60% 50% 56% 51% 52% 43% 40% 30% 20% 10% 0% * Past 4 weeks Down in the dumps Downhearted & depressed Worn out Eurobarometer 2006,

19 1-month prevalence of major depression Depression 12% Males Females 10% 8.8% 9.9% 8% 6.7% 6% 4% 2% 2.4% 3.8% 4.6% 0% Year Madianos et al. Soc Psychiatry Psychiatr Epidemiol 2011 Economou et al. J Affect Disord

20 Suicide in OECD countries (2008) OECD, Health at a Glance Europe

21 Mortality per 100,000 Suicides and homicide in Greece 4 Suicides and self-inflicted injury 0-64 Homicide and intentional injury Year Fountoulakis et al. Eur Arch Psychiatry Clin Neurosci 2012 Hellenic Statistical Authority 21

22 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 22

23 Infectious diseases West Nile virus outbreak ( cases/35 deaths) Malaria outbreak in southern Greece ( cases) Newly diagnosed HIV-1 infections (57.2% increase from 2010 to 2011) Bonovas et al, J Prev Med Hyg,

24 Standardised mortality per 100,000 Infectious diseases in Greece Year WHO Health for All Database

25 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 25

26 Price Consumer Index Transportation costs Price Consumer Index Fuel Road taxes - tolls Public transportation Year Hellenic Statistical Authority

27 Number of Vehicles Car sales in Greece 600, , , , , , Year Hellenic Statistical Authority

28 Standardised mortality per 100,000 Transport accidents in Greece Year WHO Health for All Database

29 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 29

30 Levels of Physical Activity in Greece I 100% Low Middle High 80% 22.1% 28.9% 19.8% 31.8% 24.6% 33.7% 60% 40% 43.5% 42.6% 38.3% 38.6% 31.5% 36.8% 20% 34.5% 28.4% 41.8% 29.6% 43.9% 29.5% 0% Higher SES Middle SES Lower SES Socio-economic status Physical activity levels according to IPAQ Filippidis et al (under review) 30

31 Levels of Physical Activity in Greece I Higher Middle Lower Socioeconomic status 31

32 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 32

33 Obesity in OECD countries (2008) OECD, Health at a Glance Europe

34 Year Overweight and obesity in Greece Normal weight Overweight Obese % 40.2% 18.4% % 40.3% 18.9% % 42.3% 18.2% 0% 20% 40% 60% 80% 100% Filippidis et al (under review) 34

35 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 35

36 Smoking in OECD countries (2008) OECD, Health at a Glance Europe

37 Tobacco control measures Partial smoking ban in public places (July 2009) Comprehensive smoking ban (July 2011) Tobacco tax increases Weak enforcement 37

38 Secondhand smoke in Greece Vardavas et al. J Aerosol Med Pulm Drug Deliv

39 Price Consumer Index Tobacco prices Tobacco Price Consumer Index Year Hellenic Statistical Authority

40 Prevalence of smoking in Greece I 60% 50% 40% 30% Males Females Total 52.4% 48.5% 43.1% 42.6% 34.5% 37.1% 45.7% 38.1% 31.1% 20% 10% 0% Year Filippidis et al (under review) 40

41 Prevalence of smoking in Greece II 60% 50% 40% 30% 44.4% Higher SES Middle SES Lower SES 48.8% 48.9% 38.9% 35.9% 44.0% 43.9% 39.7% 29.5% 20% 10% 0% Year Filippidis et al (under review) 41

42 Intention to quit smoking in Greece Schoretsaniti et al. Addict Beh

43 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 43

44 Price Consumer Index Prices of fruits & vegetables 120 Food Vegetables Fruit Year Hellenic Statistical Authority

45 Consumption of at least 5 portions of fruit & vegetables per day 12% % 8% 6% 4% 8.0% 9.8% 8.4% 8.9% 9.0% 2% 4.1% 0% Higher SES Middle SES Lower SES Socio-economic status Filippidis et al (under review) 45

46 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 46

47 Expenditure PPP$ per capita Health expenditure (PPP$ per capita) 3500 Pharmaceuticals Other Year WHO Health for All database

48 Households health expenditures Kondilis et al. Am J Public Health

49 Health services 59% of the population had to reduce the use of health services between 2011 and 2012 because of high costs and/or accessibility issues Increased numbers of outpatients and inpatients in public hospitals Unavailability of pharmaceuticals Disruptions in healthcare market National School of Public Health

50 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 50

51 Standardised mortality per 100,000 Infant mortality in Greece Year WHO Health for All Database

52 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 52

53 Causes of death in Greece, 2010 Institute for Health Metrics and Evaluation

54 Causes of DALYs in Greece, 2010 Institute for Health Metrics and Evaluation

55 Mortality per 100,000 All-cause mortality 800 Greece United Kingdom European Union Year WHO Health for All Database

56 Outline Background Economic recession in Greece Economic recession and health overview Health indices in Greece Self-reported health Mental health Infectious diseases Traffic accidents Physical activity Obesity Smoking Diet Health services Infant mortality All-cause mortality Conclusions 56

57 Conclusions Decline in road traffic accidents Increase in physical activity levels Decrease in tobacco use Deterioration of mental health No evident short-term effects on all-cause mortality Indications of widening inequalities 57

58 Long-term effects 58