by Jeffrey Levett
Families are anxious about the daily difficulties of making ends meet, the elderly about the provision of their monthly medications. Some are experiencing a hand-to-mouth existence and disruption to their life. Apprehension is growing with respect to circulating safely after sundown and putting food on the table.
Foreseen is the loss of two key societal freedoms implicit in human security, namely, freedom from fear and freedom from want, which are now suspended in an uneasy limbo under the weight of job layoffs, diminishing family resources, removal of social safety nets, and the influx of vulnerable refugees with their basic human needs. If vulnerability creeps upwards, health status can take a beating worse than any ever seen.
There is great anger in Greece both with the political world and with dysfunctional institutions (justice, education, health and environment). Health is being chipped away and wellbeing has been compromised. Home loss and homelessness can grow, chronic disease can become exacerbated, resistance to infection can diminish and an epidemic of mental health problems can emerge, while mental health is still a taboo topic of discussion. Chronos has been outdone as youth flees the country, the middle-aged desperately search for employment and the elderly watch their lifetime efforts go down the drain.
Official commentary is restricted to announcements of loans from Europe to pay salaries and pensions and Greece’s obligatory actions to improve governance and decrease deficit and debt. Yet officialdom must also protect the health of the nation since individual health is associated with income, and austerity erodes population health status.
Sustained austerity can bring the Greek nation to its knees. Only its proven resilience can save the day and prevent societal breakdown.
The problem mirrors national culture and must be transformed within the contexts of science, research and Europe. A new political agenda must stamp out tax inequality and tax evasion and ensure institutional function with transparency and accountability.
Short-sighted and self-serving politics, deficit spending and fund shunting, unchecked consumerism and political patronage within a two-party system must all end. Effective governance must encourage public service responsibility and efficient relations between investment, effort and productivity. An evaluation culture must emerge and pockets waiting to be filled sewn up instead. “Party thinking”, favouritism and corruption should be downsized and laws should have support structures for their practical application.
The health sector lacks policy. Its bureaucracy is embalmed in straitjacket legalism, its system is doctor-centred and its managerial model ossified. Service is characterised by low quality and patient dissatisfaction. Primary care is off the map, workplace health promotion has no teeth, public health is reluctantly supported, promotion of health is uncoordinated and the private-public mix is ‘parasitic’.
In the wake of the memorandum maelstrom, the captain of health must steer a course through dismal waters of troubled demography, citizen dissatisfaction and health erosion by the austerity measures and social unrest. He or she must pull against the current of an obsolete and wasteful organisational culture and push towards a more rational port of efficiency and effectiveness.
To re-engineer hospitals, a conflict management strategy must also be developed. In the new politic, health should have a high priority, its ministry modernised and its leadership being supported by access to a scientifically robust and independent research arm to inform policy.
To address the dangerous erosion of health resulting from the memorandum and loss of the two freedoms, responsibility should be taken for health disaster management. Greece has made major contributions to the UN Trust Fund for Human Security and chaired the Human Security Network, while Europe has only recently embraced human security.
Now is the time for Greece and the European Union to implement these principles as they relate to citizen safety and food security, containment of austerity-related health damage and societal crisis response. Dropping out of the eurozone is not an option and can only augment austerity and nudge Greece closer to disaster.
What is needed? An effectively governed nation that provides better care and social services to children and its elderly, education and jobs for youth and career adjustment opportunities for the middle-aged, as well as a more socially-oriented European Union with a value system that can rein in the shortcomings of its economic model.
Jeffrey Levett is professor of public health management, National School of Public Health, Greece, and of international health, European Centre for Peace and Development, Serbia
Tuesday, 5 July 2011
by Jeffrey Levett