From heart attacks to maternal care: the human cost of austerity in Greece

Austerity has caused more than just tear gas usage to rise - heart attacks have spiked in the republic.

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, the figure 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.

This post originally appeared on openDemocracy.

A stationary ambulance outside Kat Hostpial in Athens. Photo: Getty Images.
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Qatar is determined to stand up to its Gulf neighbours – but at what price?

The tensions date back to the maverick rule of Hamad bin Khalifa al-Thani.

For much of the two decades plus since Hamad bin Khalifa al-Thani deposed his father to become emir of Qatar, the tiny gas-rich emirate’s foreign policy has been built around two guiding principles: differentiating itself from its Gulf neighbours, particularly the regional Arab hegemon Saudi Arabia, and insulating itself from Saudi influence. Over the past two months, Hamad’s strategy has been put to the test. From a Qatari perspective it has paid off. But at what cost?

When Hamad became emir in 1995, he instantly ruffled feathers. He walked out of a meeting of the Gulf Cooperation Council (GCC) because, he believed, Saudi Arabia had jumped the queue to take on the council’s rotating presidency. Hamad also spurned the offer of mediation from the then-President of the United Arab Emirates (UAE) Sheikh Zayed bin Sultan al-Nahyan. This further angered his neighbours, who began making public overtures towards Khalifa, the deposed emir, who was soon in Abu Dhabi and promising a swift return to power in Doha. In 1996, Hamad accused Saudi Arabia, Bahrain and the UAE of sponsoring a coup attempt against Hamad, bringing GCC relations to a then-all-time low.

Read more: How to end the stand off in the Gulf

The spat was ultimately resolved, as were a series of border and territory disputes between Qatar, Bahrain and Saudi Arabia, but mistrust of Hamad - and vice versa - has lingered ever since. As crown prince, Hamad and his key ally Hamad bin Jassim al-Thani had pushed for Qatar to throw off what they saw as the yoke of Saudi dominance in the Gulf, in part by developing the country’s huge gas reserves and exporting liquefied gas on ships, rather than through pipelines that ran through neighbouring states. Doing so freed Qatar from the influence of the Organisation of Petroleum Exporting Countries, the Saudi-dominated oil cartel which sets oil output levels and tries to set oil market prices, but does not have a say on gas production. It also helped the country avoid entering into a mooted GCC-wide gas network that would have seen its neighbours control transport links or dictate the – likely low - price for its main natural resource.

Qatar has since become the richest per-capita country in the world. Hamad invested the windfall in soft power, building the Al Jazeera media network and spending freely in developing and conflict-afflicted countries. By developing its gas resources in joint venture with Western firms including the US’s Exxon Mobil and France’s Total, it has created important relationships with senior officials in those countries. Its decision to house a major US military base – the Al Udeid facility is the largest American base in the Middle East, and is crucial to US military efforts in Iraq, Syria and Afghanistan – Qatar has made itself an important partner to a major Western power. Turkey, a regional ally, has also built a military base in Qatar.

Hamad and Hamad bin Jassem also worked to place themselves as mediators in a range of conflicts in Sudan, Somalia and Yemen and beyond, and as a base for exiled dissidents. They sold Qatar as a promoter of dialogue and tolerance, although there is an open question as to whether this attitude extends to Qatar itself. The country, much like its neighbours, is still an absolute monarchy in which there is little in the way of real free speech or space for dissent. Qatar’s critics, meanwhile, argue that its claims to promote human rights and free speech really boil down to an attempt to empower the Muslim Brotherhood. Doha funded Muslim Brotherhood-linked groups during and after the Arab Spring uprisings of 2011, while Al Jazeera cheerleaded protest movements, much to the chagrin of Qatar's neighbours. They see the group as a powerful threat to their dynastic rule and argue that the Brotherhood is a “gateway drug” to jihadism. In 2013,  after Western allies became concerned that Qatar had inadvertently funded jihadist groups in Libya and Syria, Hamad was forced to step down in favour of his son Tamim. Soon, Tamim came under pressure from Qatar’s neighbours to rein in his father’s maverick policies.

Today, Qatar has a high degree of economic independence from its neighbours and powerful friends abroad. Officials in Doha reckon that this should be enough to stave off the advances of the “Quad” of countries – Bahrain, Egypt, Saudi Arabia and the UAE - that have been trying to isolate the emirate since June. They have been doing this by cutting off diplomatic and trade ties, and labelling Qatar a state sponsor of terror groups. For the Quad, the aim is to end what it sees as Qatar’s disruptive presence in the region. For officials in Doha, it is an attempt to impinge on the country’s sovereignty and turn Qatar into a vassal state. So far, the strategies put in place by Hamad to insure Qatar from regional pressure have paid off. But how long can this last?

Qatar’s Western allies are also Saudi Arabia and the UAE’s. Thus far, they have been paralysed by indecision over the standoff, and after failed mediation attempts have decided to leave the task of resolving what they see as a “family affair” to the Emir of Kuwait, Sabah al-Sabah. As long as the Quad limits itself to economic and diplomatic attacks, they are unlikely to pick a side. It is by no means clear they would side with Doha in a pinch (President Trump, in defiance of the US foreign policy establishment, has made his feelings clear on the issue). Although accusations that Qatar sponsors extremists are no more true than similar charges made against Saudi Arabia or Kuwait – sympathetic local populations and lax banking regulations tend to be the major issue – few Western politicians want to be seen backing an ally, that in turn many diplomats see as backing multiple horses.

Meanwhile, although Qatar is a rich country, the standoff is hurting its economy. Reuters reports that there are concerns that the country’s massive $300bn in foreign assets might not be as liquid as many assume. This means that although it has plenty of money abroad, it could face a cash crunch if the crisis rolls on.

Qatar might not like its neighbours, but it can’t simply cut itself off from the Gulf and float on to a new location. At some point, there will need to be a resolution. But with the Quad seemingly happy with the current status quo, and Hamad’s insurance policies paying off, a solution looks some way off.