A professor at the Athens Medical School has expressed pessimism on the future of Greeks’ health in view of the ominous news contained in a survey of 30,000 inhabitants of Greece. What emerges from comparative data of the study made within the framework of the European Program for Medical and Social Cooperation (EPIK) and conducted by the Laboratory of Hygiene and Epidemiology under the eye of Antonia Trichopoulou, wife of Professor Dimitris Trichopoulos of the University of Athens Medical School and Harvard University, is the spread of obesity in Greece over the past few years, resulting in one in three premature deaths, or 20 deaths a day. EPIK statistics show that over half of adult men are overweight. Among women, the problem increases after the age of 45, when the percentage of those with obesity problems doubles. The increase in obesity, coupled with Greeks’ heavy smoking habits and lack of exercise, makes for a time bomb. Nearly 60 percent of males aged 25 to 34 are smokers, while half of all men continue smoking until the age of 54. The proportion of smokers drops among older men, either because they quit smoking or because they die of its effects. In an interview with Kathimerini, Professor Dimitris Trichopoulos pointed out the confusion caused over health matters by the manifold messages sent from different directions, with «various motivation and of varying effectiveness.» «The message is simple,» he said. «Don’t smoke, exercise, avoid getting fat, keep arterial blood pressure under control, monitor cholesterol.» Only 10 percent of men and 7.5 percent of women exercise regularly, he added. «They might walk a little more, but it seems that this isn’t enough for obese people to lose weight. What is needed is a reduction in calorie intake and an increase in bodily activity.» Trichopoulos recommends sticking to the «Mediterranean diet, which is a model diet that has been consistently proven. It has been discovered by foreigners, who are trying to apply it, while we have progressively abandoned it.» But the survey is just the tip of the iceberg. Rising heath risks will later have an even bigger effect on mortality rates. «Unfortunately,» the professor said, «reality has not justified the optimistic view that genetics and molecular biology will provide a solution to all problems. It’s an open question if gene therapy will be able to influence even 1 percent of contemporary diseases, at least going by the facts up till now. It is difficult to pin diseases down to any one gene, because human beings have a large genome, and one gene can substitute for another. Of course, there are surprises, but given the state of contemporary research, they will stay surprises.» Good health not only depends on a person’s way of life and socioeconomic level, but also on healthcare systems and preventive measures. According to Trichopoulos, it relies on standards in medical training, which in this country «have suffered a blow» and on the quality of medical practitioners, which is not the same as it was in the past. Health system errors Professor, 30 years ago, Greece was first in the world in terms of life expectancy and now is 10th or 12th, as the EPIK survey showed. What do you think is the cause? People’s health is one-third due to how well-off they are, one-third due to preventive measures and one-third due to their healthcare systems and available treatments. We know that people who belong to higher socioeconomic strata and with a higher educational level will live longer. Poverty and illness go hand in hand, perhaps to a degree that we have yet to appreciate. So, while the socioeconomic level of European nations is constantly improving, with the exception of countries in Eastern Europe, the death rate is constantly dropping in Europe and Greece. Unfortunately, however, in our country this drop is not as rapid as in other countries, such as the Netherlands, Sweden, Norway, Iceland, Switzerland and Japan. And one wonders what is the reason for this progressive loss of edge. Do these countries have more advanced healthcare systems? I would say their people are better organized. I think that in Greece, one could seek the causes of this reverse trend as much in changed societal dynamics in the practice of medicine as in Greeks adopting a different way of life, because both as a state and as private citizens, we spend a lot of money on health. In this country, for example, more MRI scans are conducted than in most provinces of Canada put together. But it seems that despite the priority given by political parties and governments to health, the money is inefficiently spent. Mistakes were made. The National Health System’s (ESY) organizational reforms, despite the good intentions of those that set them in motion, were hasty and unsuccessful. It was a mistaken choice, in my opinion, to establish the Regional Health Councils. Since Greece is a small country, it has no need for regionalization. Why do none of us go for preventive measures, despite all advice to the contrary? First of all, because prevention is very much a balance of probabilities. If you are a smoker, you have a one-in-10 chance of getting cancer. People think, therefore: «Why should I be one of the 10? I’ll be one of the nine.» Secondly, because prevention bears fruit in the long term, while treatment is here and now. You have your sickness and you must take care of yourself. These reasons remove incentives for preventive measures on an individual level. In practice, we have ended up at the bottom of the European table in all points of prevention: We have the highest incidence of smoking, we are the most obese, the least fit. We have the highest percentage of people with high blood pressure in Europe and very high cholesterol rates. In tandem with obesity, the number of diabetics is rising. This means that things will get even worse in the future; they won’t get better. Due to a lack of vision, a perspective on healthcare planning that would have enabled us to see what the real problems were has been lost. We’ve become very absorbed in organizational problems, which are of marginal significance. So there is a need for a turn toward prevention. Who should undertake to teach us about health ? When health education is carried out by the competent authorities, it doesn’t have the awaited result. It should be up to the doctor, who knows that it is a priority, though an unpaid one, and by those that communicate with the world, television and the press. But who will determine policy in this area given the many and various messages, and the many and conflicting interests? There’s no need for anything more than a small group of two to three people. Even a qualified health minister would suffice. I give as an example obesity and all those slimming methods. Greece is full of institutes that recommend ineffective and, perhaps in certain cases, damaging diets. But the answer to obesity is very simple: «Eat less, walk or dance more.» Even though this approach is very simple, some muddy the waters in which others swim.