Tiago Villanueva: Financial austerity and health in Portugal

Tiago_VillanuevaFinancial austerity in Europe has been a hot topic in the news lately. But the spotlight in Europe over the past few weeks has definitely been on a small and overlooked European country that is considered peripheral. Portugal, buried in debt, has just followed in the steps of Greece and Ireland by becoming the next country to request financial assistance from the International Monetary Fund and the European Union. The market pressure had become unsustainable over the last few days, with the economic crisis going hand in hand with a political crisis, following the resignation of Prime Minister Sócrates due to the rejection of his deficit cutting plan by Parliament.

If you come to Lisbon any day, you won’t notice any signs of an apparent financial crisis. There are more luxury cars roaming the streets than ever, restaurants are always full, and I’ve just read in the news that overseas travel places over the Easter holiday are fully booked. You will need to dig deeper to see signs of financial austerity. Most Portuguese doctors work as civil servants in the National Health Service, and have also suffered the 5% to 10% wage cuts that were enforced in January to public administration staff. The climate of austerity is particularly affecting the  middle, lower middle, the working class, and below. But while many people in the middle class are making ends meet by cutting down on a few amenities like going out for dinner, those in the lower rungs of the social class ladder are bearing the brunt of this crisis. And that is because they will tend to be those that have low-paid, unstable jobs, and who are thus very vulnerable to sacking. Unemployment has surpassed 11%, one of the highest rates in Europe, and the consequences of unemployment and poverty to health are well known and devastating. I’ve seen patients whose diabetes worsened significantly because they could not afford their diabetes medications anymore. It is equally dramatic to attend to patients who have just lost their jobs, and come in with depressive symptoms, but it is becoming a daily occurrence. And according to the Portuguese Society of Paediatrics, the national health service may face increasing pressure due to the fact that parents will stop resorting so much to private consultations with Paediatricians for their children because the family budget is tightening.

Among peers, one thing that concerns me a bit is that I’ve never heard so many colleagues contemplating a move to another country to work. Because there’s still plenty of demand and full employment for doctors in Portugal, I suspect that most are just venting their spleen due to the current situation, but I believe many will try to go for it. But the medical profession is still probably the “last bastion” of resistance, which is still relatively immune to all this austerity because, like I said, there is currently great demand for doctors. Also it is not so straightforward for doctors as it is for many other types of professionals to move to another country for professional reasons. Most young highly qualified professionals have been leaving Portugal in droves in search of greener pastures offering better salaries and better perspectives of personal and professional development. The moment that starts happening with doctors, I will be seriously worried. In the meantime, it is vital to foster access to care and provide quality care to the less fortunate and privileged.

In 1971, Dr Julian Tudor Hart coined the term “the inverse care law” in an article in The Lancet. It means that those who have more need of medical care are those that receive less care, and forty years later, that law fits like a glove in the current situation.

Tiago Villanueva is a newly qualified General Practitioner based in Portugal and former BMJ clegg scholar and editor, studentBMJ