When I first started my summer studying healthcare and medical innovation in Athens, Greece, certain things about the city immediately caught my attention. I saw people injecting heroin in public parks and leaving their used syringes lying in the street. A huge number of the Greek locals were smoking, even around young kids and in no-smoking zones. Almost no one recycled, and it was rare for a building to actually have its own recycling bins. Graffiti covered almost every open wall, even in the nice neighborhoods, and people drove so dangerously fast that I was terrified of crossing the street. I am a huge fan of ancient Greek history and philosophy, and I studied those topics extensively back in high school, but none of that education prepared me for what modern day Athens would actually be like. Quickly, though, I realized how much of a public health crisis Greece was facing, and I was eager to find out what had led the country to have so many of these problems.
A lot of major cities, like Chicago or New York, for example, have similar issues to Athens – drug use, gang violence, bad traffic, graffiti, etc. – but Greece is a unique case. When the United States housing and mortgage industries crashed in 2009, worldwide loaning agencies stopped loaning money to poor creditors, including the Greek government, which had been borrowing money and racking up government debt for the previous 30 years. The then Greek prime minister, George Papandreou, was forced to reveal how high their deficit had reached – 103.1% of its GDP, according to the United States’ National Bureau of Economic Research – and they had to default on their loans and receive a €300 billion bailout from the European Union and International Monetary Fund. With the massive bailout, the Greek government was forced to undergo certain “austerity measures,” which, according to a 2011 article by the BBC, included large cutbacks in public spending, increased taxes, and the banning of unionization, among other restrictions. Although the Greek government has officially paid off most of its loans and is now once again borrowing on international markets, in 2018 an article by The Economist claimed that the Greek economy is far from totally recovered, and that many people still feel the effects of 10 years of economic austerity, like a 20% unemployment rate and extremely low wages for the people lucky enough to actually have jobs.
The effect of the Greek economic crisis on healthcare is significant as well. According to an investigation by the World Health Organization and the European Observatory on Health Systems and Policies, from 2009 to 2012, the Greek government decreased their total health expenditure by €5.4 billion. Also, more unemployment led to an increase in people not covered by public health insurance (employment is required to obtain coverage), and, in 2013, two million uninsured Greeks lacked access to healthcare, although the government has now made programs to combat this problem. Even health professionals have had their wages significantly cut in the wake of the austerity measures – a 20% decrease in salary in 2010 alone. Public hospitals, which were already understaffed before the crisis, lost a lot of these workers to retirement and emigration, which only made it more difficult to treat all their patients.
I was introduced to these issues after several weeks of research and observation in Greece, and I was able to see these problems manifest firsthand in hospital settings, private clinics, and on the streets. A lot of it was deeply unsettling to me, and I craved to find a tangible solution to Greece’s problems. Eventually, I had the chance to interview Dr. Jeffrey Levett, the founding dean of the National School of Public Health in Athens and the current director of the Department of Public Health Management, to get his expert opinion on what needs to be done to help Greece’s public health crisis. What he told me changed my entire perspective on public health.
Specifically, I asked Dr. Levett the question: “What needs to be improved about the Greek healthcare system?” He responded with a brief history lesson.
He described to me how, in ancient Greece, at the first hospital of the Western world called Asclepion, the doctor priests of the god Asclepius had successfully created a healthcare system that treated all aspects of their patients – mind, body, and soul – through a truly holistic approach to medicine. Patients traveled from all over the world to visit the hospital in Greece, and when they arrived, not only were their specific ailments treated with different herbs and oils, but they also underwent a process known as Karthasis, roughly translating to “purification” in English. They cleansed themselves in beautiful bath houses, received long and relaxing massages to ease muscle pain, and were fed regularly with healthy, local foods. They were encouraged to exercise at the stadium, watch plays at the famous theater of Epidaurus, take in the beautiful scenery surrounding the hospital, and make art and poetry to relieve their negative emotions. All these therapies combined together to make Asclepion a center of full-body rejuvenation; patients were treated for their diseases, given time to relax and unwind from the stresses of life, and educated on how to live healthier lives.
This was the aspect of healthcare that Dr. Levett believed that Greece, and all other countries struggling with public health, totally lacked. To Dr. Levett, medicine, in the modern context, consists of doctors and nurses using high-tech, expensive machines to diagnose complicated diseases and treating sick people with similarly high-tech and expensive surgeries, drugs, and equipment. This sort of medicine isn’t necessarily bad, but it lacks the philosophical Karthasis component of healthcare that made Asclepion so successful.
Personally, I’ve never encountered a hospital, in Greece or America, with a food court that served reasonably priced, healthy foods, had a gym for people to exercise in, or offered their patients massages to ease their tension. Oftentimes, it feels like hospitals are built to be mazes, full of gross iridescent light and hallways that lead to nowhere; these feelings only exasperate the anxiety and hopelessness that patients experience being in the hospital. Despite the fact that multiple studies, including one in the Building and Environment journal, have found that increasing art around the hospital, installing more windows, displaying scenes of nature on televisions, and improving the acoustics of patient rooms all lead to better patient outcomes, hospitals still seem to be designed more like prisons than anything else. In comparison, when the ancient Greeks rode up on horseback to Asclepion, they found a beautiful hospital and temple set against a mountain vista and overlooking the water of the Saronic Gulf. When they arrived, they were given great food and time to unpack their stresses, and when they left, they were more fulfilled, more enthusiastic, and more lively people.
Although modern medicine has drifted far from the system established at Asclepion, the future of healthcare is still promising. Programs like the University of Florida’s Arts in Medicine Initiative show how people are trying to make hospitals more comfortable and less intimidating through art, music, and drama – therapeutic approaches very similar to those practiced in ancient Greece.
When I asked Dr. Levett what he imagined the perfect healthcare system looked like, he told me the following: “Perfect healthcare,” he said, “would care for patients from cradle to grave, not just when they visit the doctor.” The ancient Greeks were the closest people to achieve this ideal through their holistic and full-bodied approaches to treating the sick. They pioneered a system of healthcare where the patient experience came first, where doctors cared about their worries, lifestyle habits, diets, mental health, and they did everything in their power to make their patients feel tranquil and fulfilled. Hippocrates, the most famous doctor to work at Asclepion, once wrote: “Cure sometimes, treat often, comfort always.” One day, hopefully soon, modern medicine will achieve all three.
BBC Editors. (2011, October 19). Greek government austerity measures. BBC News.
Economou, C., Kaitelidou, D., Kentikelenis, A., Sissouras, A., & Maresso, A. (2014). The impact of the financial crisis on the health system and health in Greece, pp. 1–16, 22.
Gourinchas, P.-O., Philippon, T., & Vayanos, D. (2017). The Analytics of the Greek Crisis. NBER Macroeconomics Annual, 31(1), 1–6.
Huisman, E. R. C. M., Morales, E., van Hoof, J., & Kort, H. S. M. (2012). Healing environment: A review of the impact of physical environmental factors on users. Building and Environment, 58, 70–80. The Economist Editors. (2018, August 21). Is the Greek financial crisis over at last?
What is Arts in Medicine? (2019).