In our country, the rate of healthy survival after 65 for women is two and a half years lower than the OECD average, while for men it is slightly lower. That is, for women the unrestricted, healthy life expectancy is about 7.5 years compared to an OECD average of 10 years. The nasty tagging belongs to assistant professor of Health Economics at the Department of Public Health Policy of the University of Western Attica, Kostas Athanasakis, who gave an interview to Fm Agency and Tania Madouvalou on the occasion of his speech on “Challenges arising from the climate crisis for the sustainability and resilience of health systems”, at the Panhellenic Public Health Conference 2024, which is being held from Thursday at the School of Public Health of PA.DA. As the professor explained, the difference compared to the OECD is great, because it actually hides a pattern of morbidity, which at these ages is also a matter of health service use.

The control of risk factors is a key parameter for a sustainable health system

“Healthy life expectancy after 65 is an extremely important parameter for the robustness of health systems. In particular, in Greece where the percentage of the population over 65 is constantly increasing, this parameter will determine how much the health system will be burdened in the future. Therefore, the control of risk factors, the control of chronic morbidity and the achievement of the goals of the therapeutic process, especially in chronic morbidity and multimorbidity, are very basic elements for a sustainable health system. The big problem in Greece at the moment, according to Mr. Athanasakis, is the exposure to risk factors such as smoking and obesity, which have created a very special pattern in morbidity, which is expressed in multimorbidity. “Health systems have structural challenges arising from societal changes. Greece has one of the highest percentages of people over 65 years of age. We don’t just get sick because we get older. But it just so happens that the oldest of us are sick more often. This means that the system has to take care, so that the health after 65 is at a better level. We must neutralize the threats that will present morbidity in those years.”

68% increase in deaths in the last twenty years due to climate change

Regarding climate change, Mr. Athanasakis says it affects health systems on both sides of the equation. “On the one hand we have lost working hours, serious incidents that interrupt economic activity (eg Thessaly). It is indicative that high temperatures in 2021 removed from productive activity 470 billion working hours internationally. This is equivalent to about 0.7% of global GDP. Much more so in countries that are not prepared for this climate change and are of lower development. On the other hand, climate change is changing the way we request health services. For example, infectious diseases are on the rise. Heat-related deaths have increased by about 68% over the past two decades. The episodes caused by high temperature in cardiovascular or respiratory diseases are increasing, because the population is becoming more susceptible, since it is in contact with more days with high temperature compared to the past”.

Health systems are responsible for 5% of greenhouse gas emissions

Health systems according to Mr. Athanasakis are responsible for approximately 5% of total greenhouse gas emissions internationally. “In Greece, this percentage is 3.7% of the national footprint. A significant share of this, around 40%, comes from the operation of the structures and their energy needs. But most of it comes from the entire supply chain of health-related products and services.” But what do the experts propose for dealing with the effects of climate change, the professor is asked: “At the international level, the proposals first focus on the need to systematically collect data on the environmental footprint of health systems, to increase information on the optimal practices to reduce the impact of health systems on the environment, to strengthen the international regulatory framework and to strengthen transnational cooperation, as the problem is global and requires collective action”.

The measures to be taken in Greece

Especially for Greece, says Mr. Athanasakis, “as we recorded in the recent PHSSR study, among the measures we should take are:

  • to integrate into the evaluation of hospital administrations a series of indicators of energy efficiency and environmental impact of structures,
  • develop a comprehensive national policy to assess the future impacts of climate change on the health system in order to take proactive policies;
  • to integrate environmental policy criteria into all decisions concerning investments in the health system,
  • to involve local communities, such as regions or municipalities, in the issue of environmental sustainability in the context of health – and of course, to continue the effort we are currently making to improve the energy efficiency of health structures.’

The resilience and sustainability of health systems – Today’s challenges

Resilience and sustainability are two concepts that have entered the debate on policy and the future of health systems in recent years, says Mr. Athanasakis at another point in his interview. And he explains: “By the term sustainability we essentially mean that the health system can continue to do its mission, that is to improve the health of all of us uninterruptedly in the future. To ensure all those conditions that will make it able to offer in the future what we expect it to offer. With all the challenges facing health systems today, demographic ageing, epidemiological change, the introduction of health technologies and the relatively low availability of resources, we must ensure that the system can fulfill its mission. Resilience is a concept, which we also saw very well in the previous period with covid and it has to do with the ability of the system to be able to absorb crises. In other words, when a health crisis comes for any reason, the system can continue to function”.