Discussion 6: Health Status in the European Union

The Political Context of the Health Crisis in Greece

An Assessment of the Results of European Parliament Elections in Greece and European Union Under the Shadow of Economic Crisis

John Fanourgiakis 1

and Emmanuel Kanoupakis 2

Abstract

On January 1, 1981, Greece became the tenth member of the European Economic

Community and, 20 years later, on January 1, 2001, joined the euro area. In May of

2010 and February of 2012, Greece signed the first and the second economic adjust-

ment programs and adopted austerity policies throughout the public sector in order

to avoid the economic collapse, affecting residents’ income and health status. We

studied the questionnaires of polls conducted in Greece before the elections of the

European Parliament (May 25, 2014) and the “Europeans 2014” Eurobarometer’s survey in March of 2014. The responses of Greek voters from the Greek polls were

alarming, pointing out their declining personal economic situation and Greece’s

national economic situation, with a sense that the country was heading in the

wrong direction, declaring themselves unsatisfied and insecure. The responses of

Greek voters from the “Europeans 2014” survey were even more alarming. Health was the first priority for the voters. As the Greek polls and the

Eurobarometer’s survey forecasted, but more significantly as the results of the

Euro-elections showed, Greek voters preferred to put their hopes in something new.

International Journal of Health

Services

2016, Vol. 46(4) 642–655

! The Author(s) 2016

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DOI: 10.1177/0020731416660963

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1 Hellenic Open University, Parodos Aristotelous, Patras, Greece

2 University Hospital of Heraklion, Heraklion, Crete, Greece

Corresponding Author:

John Fanourgiakis, University Hospital of Heraklion, Dimokratias 67, Heraklion Crete PC 71601,

Greece.

Email: jfanourgiakis@yahoo.com

Keywords

Greece, European union, economic crisis, European parliament, European

parliament election

On May 18 and 25, 2014, elections took place in Greece for new local and peripheral authorities and for the European Parliament (EP). According to the 66/2014 decision of the Supreme Court of Greece (Areios Pagos), a total of 43 parties and coalitions claimed 21 thesis that corresponded to Greece in the European Parliament

1 from the total of 751, which are distributed to each

European member country based on the principle of digressive proportionality. Those 751 elected members of the European Parliament will represent for the next five years more than 500 million citizens from 28 member states of the European Union.

2

In the beginning of the 1980s, many Greeks and their political leaders opposed Greece’s entry into the European Economic Community (EEC). Progressively and as the country enjoyed the benefits from the EEC, the objec- tions decreased and finally ceased for this strategically political choice, which was accomplished on January 1, 1981, when Greece became the tenth member of the EEC. The doubts and criticism rose again when Greece joined the euro zone on January 1, 2002.

Undoubtedly, the access of Greece into the EEC represents a milestone in modern Greek history and the beginning of a new era for Greece in a very promising and challenging environment for economy, policy, and culture.

In the decade of the 1980s, with the financial support of the European Union and with many financial packages (e.g., integrated Mediterranean programs, followed by three Community Support Frameworks), the status of Greece chan- ged with major or minor infrastructure projects. It is a question whether the European Union in its current form would satisfy the vision of the fathers of the European Union for a united, peaceful, and prosperous Europe, a vision that inspired a diverse group of people into establishing the “united states of Europe” after the Second World War.

3,4 Currently, it is interesting, under the shadow of

the economic crisis, to explore how European citizens perceive the constitution of the European Union.

In this study we demonstrate the answers, given by Greeks and European citizens to the questionnaires of Greek polls and Eurobarometer 2014 that were conducted before the elections, offering us more specific and detailed informa- tion about the way people think of the European Union—how European citizens perceive not only their countries’ political and social scenery, but Europe’s as well, what they fear most as persons and as citizens, and if they still have faith in their ancestors’ European vision and the institutions.

Fanourgiakis and Kanoupakis 643

As far as Greece is concerned, it is interesting to see if the economic crisis has been depicted in peoples’ vote for the European Parliament after five years of austerity.

The Political Environment in Greece

Through a televised address on September 2, 2009, the prime minister of Greece and leader of New Democracy (N.D.) Kostas Karamanlis, after five and a half years of governance, announced that under the pressure of the economic crisis and the inevitable measures that had to be taken, he would submit the govern- ment’s resignation and lead the country in early elections, on October 4 of the same year.

5

After the elections in October of 2009, the former opposition party, PA.SO.K., won the elections and formed a government. Prime Minister George Papandreou, under economic pressure, officially requested and finally received economic help from the European Central Bank (ECB), European Commission (EC), and International Monetary Fund (IMF).

6,7

The Greek parliament, in May of 2010, voted on the first economic adjust- ment program in exchange for a financial package of E110 billion, that is, 80 billion from the euro area and 30 billion from the IMF. That was followed, in February of 2012, by the second economic adjustment program

8 with an

additional E130 billion, in order to finance Greece’s external debt and to pay the country’s creditors, mainly European private banks. These programs included rapid reforms all over the public sector, spending cuts, and revenue increases, even in the fragile public health care sector.

9

It is worth mentioning that the previous government of N.D. and her leader, Mr. Antonis Samaras at first did not consent to the first economic adjustment program and suggested an alternative, a program in which reform of the tax system and reduction of tax rates, value-added tax, employers’ contributions, and public expenditures would gave the Greek economy a promising restart.

10

The debt crisis drove Papandreou’s government to resignation, and a broad- based government was formed with Loukas Papadimos (former president of the ECB and governor of the Bank of Greece) as prime minister, after the agreement of three parties (PASOK, N.D., and L.A.O.S.), which with their coalition obtained the Parliament’s majority on November 11, 2011.

After the elections on May 6, 2012, where no party had the required majority, a temporary government was formed by Panagiotis Pikramenos, president of the Council of State, with the agreement of the parties N.D., PASOK, and DIM.AR. At these elections, SYRIZA was the second party and Golden Down was the sixth.

After the elections on June 17 of the same year, N.D. was the first party but without the required majority in order to form a government. Under these circumstances, we had the coalition of three parties (N.D., PASOK,

644 International Journal of Health Services 46(4)

and DIM.AR) and Antonios Samaras, the leader of N.D., as prime minister. One year later, in June of 2013, DIM.AR withdraw its ministers from the government due to the abrupt closing of the national radio and television.

On January 25, 2015, SYRIZA won the elections and formed a government with the participation of AN.EL (right party) obtaining the Parliament’s major- ity. The last national elections in Greece were conducted on September 20, 2015, with SYRIZA and ANEL renewing their political alliance.

It is worth noting that after the military dictatorship in modern Greece history (1974), either PASOK or N.D. alternated in the government for all these years, managing EEC’s money and furthermore the country’s choices. Those were the two major parties and ideological opponents, defending differ- ent policies, social objectives, and beliefs. Their governments managed the European money—the loans and the life of Greeks.

The Economic, Social, and Health Environment in Greece

After 14 years of consecutive increases, the gross domestic product (GDP), at market prices, started showing (close to) zero growth rates in the fourth quarter of 2007, but finally closed with a positive growth (3.5). In 2008, the GDP pre- sented a negative growth rate (�0.2), while the free fall, as a result of the policies adopted to resist the crisis, continued in 2009 (�3.1), 2010 (�4.9), 2011 (�7.1), and 2012 (�7).

11 GDP at market prices decreased from E231,081.2 billion in

2009 to E222,151.5 billion in 2010 and from E208,531.7 in 2011 to E193,347.0 billion in 2012 and E182,054.2 billion in 2013.

12

Greeks, between 2007 and 2012, confronted a high decrease of their total household income, with one third of their total household income lost at about E4,400.00 per capita, four times bigger than the average of Eurozone countries.

13

The impact on the macroeconomic level was that after four years of austere policies, in accordance with the Greek statistical service’s (EL.STAT) figures approved by Eurostat, Greece managed to achieve a primary surplus of E1.5 billion that was 0.8% of GDP in 2013. This was much higher than the initial estimates and targets set by the debt-laden country’s international lenders, the European Union and the IMF. The IMF’s forecast is that in 2016, Greece will reach a debt-to-GDP ratio of 175%, falling to 124% in 2020 and to 110% in 2022.

14–16

The unemployment rate in Greece for the first quarter of 2014 was 27.8% (females 31.4%, males 25%). The highest unemployment rate was recorded among young people between 15–24 years old; for young males, the unemploy- ment rate was 56.7%, and for young females the rate was 61.5%.

17

The economic and social consequences of the crisis dramatically increased the health needs. While the public expenditures decrease and social protection col- lapses, health is transformed to a commodity. In the first two years of the crisis,

Fanourgiakis and Kanoupakis 645

the number of homeless people has doubled, from 7,720 in 2009 to 20,000 in 2011,

18,19 changing, according to the evidence, the profile of the homeless

people. In Athens and Thessaloniki, non-governmental organizations provide the daily food for more than 20,000 people.

Poverty and inequalities in education, social protection, social welfare services, primary health services, medical examinations, and hospitalization, combined with the increasing number of homeless people and the explosive growth in unemployment, made many argue that Greece confronts a humani- tarian crisis.

20,21 Health issues are at the center of the political debate, putting

under serious consideration and criticism the impact of austerity measures on the Greeks (in both psychological and physical health) and raising concerns whether people who are suffering have access to the health care system or not.

In 2012, 116,670 deaths are registered in Greece, the highest number since 1949,

22 while in the same year, 100,371 live births are registered, the lowest

number since 1955. 23

All these evidences and the accompanying harsh reality made Greek public opinion become critical not only toward Greek political parties and coalitions, but also toward Europe in general, electing at the recent European elections as a first party SYRIZA and giving power to the extreme right party of Golden Down. The rise of the extreme right party of Golden Dawn was the most alarming sign of these elections. Analysts outside the European Union stated that they were not totally surprised at the significant gains of the extreme right parties in many countries at the European Parliament elections.

24

Even the fourth review of the second economic adjustment program for Greece

25 recognized the expansion of social nets as an urgent policy priority. It

also indicates the high unemployment rate, especially for young people, as a major challenge and suggests that a guaranteed minimum income scheme must be adopted, depending on the ability of the country’s finances. Given the economic narrowness, only with increased effectiveness and efficiency of welfare spending can a fiscally sustainable, integrated, and cost-effective welfare system be achieved. Effectiveness is about “doing the right thing”; for example, selecting the programs and actions that benefit the most through welfare spending. Efficiency is about “doing the things right”; that is, the full exploitation and proper distribu- tion of the programs selected, in order to obtain sustainable welfare spending.

Greek Questionnaires and European Survey Before the European Parliament Elections

Polls With Questionnaires That Were Conducted in Greece

Before the European Parliament elections, many nationwide polls took place either on behalf of Greek media or on behalf of the political parties involved. In almost all the polls, questions included the terms “health,” “health care,”

646 International Journal of Health Services 46(4)

“well-being,” and “social security” and how these terms were perceived or eval- uated by the voters (Table 1).

One PanHellenic Research Policy survey in Greece, conducted on May 23–27, 2013, asked the question “One year after the national elections and the new government, are you more optimist or pessimist on how things are going to be in your country the next two to three years?” Among respondents, 34.8% answered that they were “more optimist” or “the same optimist” about political developments and 64.5% declared “the same” or “more pessimist” (0.3% answered “I do not know / no answer”).

26

Table 1. Polls With Questionnaires That Were Conducted in Greece Before the

European Parliament Elections.

Fieldwork Question Answers

Responses

%

May 23–27,

2013

“One year after the national elections and the new

government, are you more

optimistic or pessimistic

on how things are going to

be in your country during

the next 2–3 years?”

“more optimist or the same optimist about the political

developments”

34.8

“the same or more pessimist”

64.5

“I do not know/no answer” 0.3

April 3,

2014

“Generally speaking, do you feel that the country is

heading in the right or in

the wrong direction?”

“at worst” 63.8

“to the best” 25

“it does not change anything” 10.8

“I do not know/no answer” 0.4

May 19–22,

2014

“In your opinion, our country is currently moving to the

right or to the wrong

direction.”

“at the wrong way” 57

“to the right way” 36

“I do not know/no answer” 7

April 29 to

May 6, 2014

“How satisfied do you feelwith your life today?”

“unsatisfied” 70

“satisfied” 30

“Howconfident do you feel when you think of your

future in the coming

years?”

“unsecured” 71

“secure” 26

May 10–14,

2014

“Do you believe that the

situation today is better

or not, compared to six

months ago?”

“not better” 68

“better” 23

“I do not know/no answer” 9

“Do you believe that Greece has entered a growth

track?”

“yes” 41

“no” 37

“I do not know/no answer” 22

Fanourgiakis and Kanoupakis 647

One nationwide poll, on April 3, 2014, asked the question “Generally speak- ing, do you feel that the country is heading in the right or in the wrong direction?” Answers included “At worst” (63.8%), “to the best” (25%), “It does not change anything” (10.8%), and “I do not know / no answer” (0.4%).

27

Another research project 28

conducted May 19–22, 2014, asked a similar ques- tion: “In your opinion, is our country currently moving to the right or to the wrong direction?” In this survey, 57% answered “at the wrong way,” 36% “to the right way,” and 7% “I do not know / no answer.”

In a research policy survey 29

conducted between April 29 and May 6, /2014, there were questions measuring the general political and social climate, life satisfaction, and social insecurity for the period 2012–2014. The results showed that in the question: “From the life you live today, how satisfied do you feel?”, 70% of respondents declared “unsatisfied” and 30% “satisfied.” Asked “How confident do you feel when you think of your future in the coming years?”, 71% declared “insecure” and only 26% declared “secure.”

Another PanHellenic political poll 30

conducted May 10–14, 2014, asked the question “Do you believe that the situation today is better or not, compared to six months ago?” Among respondents, 68% answered “not better,” 23% “better,” and 9% “I do not know / no answer.” Asked “Do you believe that Greece has entered a growth track?”, 41% answered “yes,” 37% answered “no,” and 22% “I do not know / no answer.”

According to the answers of these polls, the majority of Greeks feel that the country is heading in the wrong direction and as citizens they are frustrated and unsatisfied.

All the answers reflect the bad economic and psychological condition that Greeks are into which is triggered by the high levels of uncertainty in the econ- omy and the hard austerity measures. In none of the answers is there a major positive percentage or a glimpse of hope.

The predictions of the outcomes for the upcoming European elections were not even close to the official outcome of the elections, causing much controversy about their credibility. For days after the elections, that controversy was a topic of primary concern, and many expressed fears that the polls had been used to manipulate public opinion or those who had not yet decided on their vote.

“Europeans 2014” Eurobarometer’s Survey

Impressive are the results of the Special Eurobarometer R 415 (wave 81.2) “Europeans 2014” survey,

31,32 at the request of the European Commission,

which covers the population of the 28 E.U. member states. The fieldwork was just two months before the euro elections, March 15–24, 2014 (Table 2).

In this survey, 97% of Greeks characterized the situation of Greece’s econ- omy as “total bad” (65% European Union 28) and 3% as “total good” (33% European Union 28). In addition, 90% of Greeks tended not to trust the

648 International Journal of Health Services 46(4)

Table 2. Special Eurobarometer R 415 (wave 81.2) “Europeans 2014” Survey.

Question Answers

Greece

responses

% EU 28

*

How would you judge the current situation

in each of the following? The situation of

the (NATIONAL) economy?

“total bad” 97 65%

“total good” 3 33%

How much trust you have in certain institu-

tions? For each of the following institutions,

please note if you tend to trust it or tend

not to trust it.

The (NATIONALITY) Government tended not to trust the

national government

90 71%

(NATIONAL PARLIAMENT) tended not to trust the

national parliament

90 71%

The European Union tended not to trust the

European Union

81 59

“What do you think are the two most

important issues facing (OUR

COUNTRY) at the moment?”

unemployment 65 49

economic situation 47 29

rising prices / inflation 8 20

crime 9% (13% EU 28) 9 13

health and security system 13 13

taxation 21 12

immigration 5 11

pensions 4 10

the education system 2 8

the environment, climate,

and energy issues

0 6

“Personally, what are the two most important issues you are facing at

the moment?”

rising prices/ inflation 23 38

unemployment 28 21

taxation 35 17

the economic situation

(in our country)

29 16

health and social security 18 16

pensions 13 14

the education system 9 10

housing 1 6

the environment, climate,

and energy issues

1 6

(continued)

Fanourgiakis and Kanoupakis 649

national government (71% European Union 28), with the same proportion not trusting the national parliament (71% European Union 28) and 81% not trust- ing the European Union (59% European Union 28).

To the question “What do you think are the two most important issues facing (OUR COUNTRY) at the moment?”, the answers were: unemployment 65% (49% European Union 28), economic situation 47% (29% European Union 28), rising prices / inflation 8% (20% European Union 28), crime 9% (13% European Union 28), health and security system 13% (13% European Union 28), taxation 21% (12% European Union 28), immigration 5% (11% European Union 28), pensions 4% (10% European Union 28), the education system 2% (8% European Union 28), and the environment, climate and energy issues 0% (6% European Union 28).

To the question “Personally, what are the two most important issues you are facing at the moment?”, the answers were: rising prices / inflation 23% (38% European Union 28), unemployment 28% (21% European Union 28), taxation 35% (17% European Union 28), the economic situation (in our country) 29% (16% European Union 28), health and social security 18% (16% European Union 28), pensions 13% (14% European Union 28), the education system 9% (10% European Union 28), housing 1% (6% European Union 28), the environment, climate and energy issues 1% (6% European Union 28), crime 6% (5% European Union 28), immigration 1% (3% European Union 28), and terrorism 1% (1% European Union 28).

Official Outcomes of the Greek Elections

In recent elections for the European Parliament for all 28 members of the European Union, Greek voters sent 21 new members, from seven Greek parties, but not even one of the previous MEPs was reelected. SYRIZA (Coalition of the Radical Left) with 26.57% took six seats, N.D. took 22.72% and five seats, Golden Dawn (extreme right party) took 9.39% and three seats, ELIA (Olive Tree-Democratic Alignment) took 8.02% and two seats, To Potami (The River)

Table 2. (continued)

Question Answers

Greece

responses

% EU 28

*

crime 6 5

immigration 1 3

terrorism 1 1

Fieldwork: March 15–24, 2014. EU 28

*: 28 member countries (2014).

650 International Journal of Health Services 46(4)

took 6.60% and two seats, KKE (Communist Party of Greece) took 6.11% and two seats, and AN.EL (Independent Greeks) took 3.46% and one seat.

33

The new MEPs from the Greek parties joined the political groups of the European Parliament as follows: SYRIZA joined the group of European United Left/Nordic Green Left (GUE/NGL), N.D. the Group of the European People’s Party (Christian Democrats) (EPP), ELIA and Potami joined the group of the Progressive Alliance of Socialists and Democrats in the European Parliament (S&D), AN.EL. joined the group of European Conservatives and Reformists (ECR), and finally the members of KKE and Golden Dawn remained as non-attached members not belonging to any political group (NI).

34

In previous years, all necessary reforms in Greece were abandoned due to fears about the political cost. But with the country in a savage recession, people had to face the imposition of new taxes, massive horizontal salary cuts while their social security system was collapsing, and weakening social protection. It was a common belief that reforms had to be done, but whether these reforms and measures were equally distributed to citizens and were enough to boost revenue has triggered extensive controversy inside the country. All these factors definitely affected peo- ple’s votes and, for the first time in modern Greece’s history, a left-oriented party (SYRIZA) prevailed in the political scenery.

This reflected people’s need for a party that declares as its target the strength- ening of the structures and services of social welfare state and the building of a reliable system of social protection that will ensure free and equal access for all, especially the less privileged and vulnerable groups (refugees, immigrants, home- less, unemployed, and elderly). SYRIZA also claims that the term of profit from health should be expelled and that all people should have equal access to high-quality services.

35

It is worth noting that PASOK and SYRIZA do share a close ideological relation, but the differences between them are very interesting. SYRIZA stands for Coalition of the Radical Left. The Founding Congress of SYRIZA (July 10–14, 2013) defined it “as a party of the democratic and radical Left. . .The party comprises many different ideological currents and left cultures, building its identity on a synthesis of the values of the labour movement with those of the ecological, feminist and other new social movements”.

36 PASOK stands

for PanHellenic Socialistic Movement. The Founding Congress of PASOK (September 3, 1974) defined it “as a political movement that fights for National Independency, Popular Sovereignty, Social Liberation, and Democratic Process. . .dreaming of a Socialistic and Democratic Greece”.

37,38

Conclusions

As the results of the European Parliament elections showed, Greeks lost their reliability on politicians and constitutions and sent a message by electing

Fanourgiakis and Kanoupakis 651

SYRIZA, a new, left-oriented party with no government experience and by condemning the political parties that signed the memorandums and led the country to deep economic recession with a huge impact on economy, quality of life, and the health care system.

Comparing Greeks’ and other European members’ answers, we can easily see between the lines the disappointment of Greeks not only toward their local politicians, but also toward European constitutions, much higher than the per- centages given by the European members. What is interesting is that all European members, including Greeks, agree that the two most significant problems their countries must face are unemployment and economic situation. On personal level, Greeks seem to be more concerned about taxation while E.U. members are more concerned about rising prices / inflation.

The massive majority of European citizens are before the same economic recession and share more or less the same concerns about unemployment, health care system, immigration, demanding quality of life, decent medical health, education, and proper social services from their new elected members of the European Parliament, showing their genuine intention for a fair and economically prosperous European Union.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,

authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Author Biographies

John Fanourgiakis is a health economist from Heraklion, Crete, Greece. He received his BSc in economics in 2004 from the Aristotle University of Thessaloniki Faculty of Law, Economics and Political Science, Department of Economics, and his PhD in health economics from the University of Crete, Faculty of Medicine. He teaches economic and financial management of health services in the postgraduate program of healthcare management at Hellenic Open University. He also is a research fellow in the Department of Business Administration, School of Economics and Management, Technological

654 International Journal of Health Services 46(4)

Educational Institute, Agios Nikolaos, Crete. His research interests focus in many areas in the field of health technology assessment. Recently, he was desig- nated as a deputy manager at the University Hospital of Heraklion.

Emmanuel Kanoupakis is a medical doctor from Crete, Greece. He received his MD degree in 1989 from the University of Athens and his PhD in 2002 from the University of Crete. He is a specialist cardiologist-electrophysiologist and dir- ector of the National Health System in the Department of Cardiology at Heraklion University Hospital. He has written more than 60 peer-reviewed sci- entific articles and nine chapters in medical books and has presented more than 200 research abstracts in international scientific meetings. He has participated as an invited speaker at roundtables and lectures in international congresses, con- ferences, and training sessions. He is a fellow of the European Society of Cardiology and a member of the European Heart Rhythm Association.

Fanourgiakis and Kanoupakis 655