Institute of Preventive Medicine, Environmental and Occupational Health

According to the last census Greece has a population of approximately 11,218 million people (OECD, 2010). Life expectancy for a person born in 2011 in Greece is 79,92 years in average (Central Intelligence World Library 2011). The death rate in Greece is 590/100.000 population (OECD, 2010).A significant gender gap exists in mortality rates, i.e., male mortality rates are 40% higher than female rates (OECD, 2010). Women have a higher life expectancy with 81,8 years in average, compared to 77 years for men (OECD, 2010). Greece has seen an increase of 3 years in life expectancy over the last 20 years. 

One of the most striking characteristic of the Greek population is the large number of senior citizens aged over 65 which is estimated at about 18.6% of the population in 2008 (OECD 2010). It is expected that by 2030 this number will reach 25.9% (WHO 2004). Greece also has one of the lowest birth rates in Europe which results to a natural population growth of zero. The birth rate has been constant since 1995, but due to migration the population of the country has grown in the last years (WHO 2004), with 7% of the total population originating from other countries (Greece Health System Review 2010).

Similar to the rest of Europe, Greek people die mostly from cardiovascular diseases among which the most frequent are diseases of pulmonary circulation and other heart disease closely followed by cerebrovascular diseases (WHO, 2005). More specifically, 77,8 in 100.000 die of ischaemic diseases (Eurostat, 2005). Cancer mortality remained static or increased between 1998-2008 (OECD, 2010). Stroke is the leading death cause in Greece (European Observatory, 2009).

Two of the main risk factors which expose Greeks to illness are:

• Smoking – According to WHO (2004) in 2000, Greeks consumed 56% more cigarettes per person compared to other Europeans. Almost 40% of adults smoke in Greece (OECD, 2010). Smoking prevalence among men was 45% and 29% for women. Greece has the highest adult smoking prevalence in the EU, i.e. 63% of households have at least one parent who smoked. Lung cancer mortality in Greece accounts for more than 5% of total mortality (European Observatory 2009).As far as adolescents’ smoking is concerned, according to WHO, the prevalence of smoking among young people between 2002 and 2005 was 13.8% (13.5% for boys and 14.1% for girls).

• Obesity - In Greece, about 28% of men and 30% of women are obese, which is a high percentage among European countries. Aggregate figures for 2005-2006 show that nearly one in five children in Greece is obese, with 25% of boys and 10% of girls being obese (OECD, 2010). More specifically, 20% of children aged 7-11 are obese (International Obesity Task Force 2005), while this is the case for the 18.8% among 15-year-olds. There has been an increase in obesity rates in both sexes, i.e. 5% increase between the years 2001-2006, whereas almost 15% of children are involved in weight reduction behavior (OECD, 2010).

Health System in Greece

The Ministry of Health and Welfare is the principle authority in developing and financing health policies (UN 2002). The public health system consists of a centralized service within the Ministry of Health as well as public health departments all over the country (UN 2002).

The Greek health care system is based on the National Health Service (NHS), on obligatory social insurance and to a smaller extent on private insurance. The Greek NHS provides universal medical coverage for the population residing legally in the country. Social insurance funds provide health care services to their benefiters, mainly primary health care services. Private practices, hospitals and maternity clinics also cover a significant percentage of demand. The health care system is financed by the state through taxes and by employers’ and employees’ contributions to the compulsory social insurance schemes. Private sources of funding represent more than half of total expenditure for health care. Out-of-pocket payments involve:

• co-payments and full payments for health care services provided by the NHS. For many NHS services as well as for medication the benefiter is required to contribute a fraction of the expenditure under a set of cost-sharing regulations. Those uninsured are required to pay the entire amount, often paying 50% of the expense in advance when hospitalized.
• payments to private physicians, diagnostic centres and hospitals.
• under-the-table payments, very common in secondary care.

There are three categories of hospitals: National Health Service public hospitals, IKA network hospitals, Ministry of Education and Ministry of Justice hospitals (military hospitals and prison hospitals) (UN 2002). In addition there are hospitals of non-profit character; supervised by the Ministry of Health, as well as private hospitals (UN 2002).

Health Inequalities: Access to health care may be reduced for lower income individuals because of financial barriers in the form of out-of-pocket payments. In Greece, such payments constitute over 40% of the total health costs. Informal payments may also compromise access for those who cannot afford to pay (European Observatory 2009). Moreover there are geographical barriers that pose limitations to the health services access, i.e., urban areas such as Athens and Thessaloniki are better served (UN 2002).

Health Reporting Training Project- HeaRT
01/11/2010 - 01/11/2012 Active
Education, Audiovisual & Culture Executive Agency – Lifelong Learning: Leonardo da Vinci, Grundtvig and Dissemination

Prolepsis coordinates this new 2-year EU co-funded project with the participation of 6 associated partners. HeaRT aims to develop high quality vocational training  offering knowledge and skills to journalists on health reporting. Especially given the impact media have on health perceptions and decision making, HeaRT aims to contribute to better quality health news.

Promote Vaccinations among Migrant Populations in Europe - PROMOVAX
22/05/2010 - 21/05/2013 Active
European Commission: Public Health Program 2008-2013

Prolepsis is coordinating PROMOVAX, a 3-year project with a consortium of 11 associated and 12 collaborating partners.PROMOVAXʼs general objective is to promote immunizations among migrant populations in Europe, thus contributing to the elimination of vaccine preventable diseases in the region and reducing social inequality in population's health. This project aims to complement EU policies on reaching hard-to-reach populations by adding to the knowledge of barriers among migrants concerning immunizations, developing immunization educational material for both health professionals and migrants and developing recommendations for policy-makers and stakeholders.

eu Families and Adolescents Quit Tobacco - euFAQT
01/11/2009 - 01/11/2012 Active
European Commission: Public Health Program 2008- 2013

Prolepsis is coordinating this 3- year project with a consortium of 6 associated and 3 collaborating partners. The project is co funded by the EAHC while Prolepsis has received financial support for the project from the Hellenic - KEELPNO. The main objective of the euFAQT is the promotion of a healthier smoke free way of life for European adolescents and their families. The project aims to complement EU policies on smoking by adding to the knowledge about smoking prevention and cessation in adolescents. It seeks to create a culture of prevention by promoting the benefits of smoke free environments, de-normalizing smoking and facilitating efforts for prevention and cessation.

Sunia Geel
01/03/2011 - 28/02/2013 Active

European Commission, Directorate General Justice, Freedom and Security: Daphne III Programme- 2007-2013 “To prevent and combat violence against children, young people and women and to protect victims and groups at risk”. Prolepsis participates as a partner in the new European Project “Sunia Geel” coordinated by the “Exchange House National Travellers Service” in Dublin, Ireland, with the participation of 4 partners. As a response to the need to protect women and children against all forms of violence, “Sunia Geel” focuses on domestic violence, in particular within minority groups. It aims to increase the knowledge and skills of both service providers and members of marginalized minority groups regarding combating domestic violence.

Crossing Bridges -Developing methodologies and building capacity to advance the implementation of Health in All Policies and achieve health equity
 01/01/2011 - 01/07/2012 Active
European Commission: Public Health Program 2008-2013

Prolepsis is an associated partner in this new European project coordinated by “EuroHealthNet” with the participation of 14 associate partners. The general objective of “Crossing Bridges” is to improve European citizens’ health and alleviate health inequalities through the active cooperation of different policy sectors other than health on a national, regional and local level.

European Workplace Alcohol – EWA
01/01/2011 - 31/05/2013 Active
European Commission: Public Health Program 2008 – 2013

Prolepsis is an associated partner in the new program “EWA”, coordinated by the Department of Health of the Government of Catalonia (GENCAT) in Spain, while the consortium comprises of 17 universities and organizations from various European countries. The general objective of the program is to develop effective methods of engaging with workplaces and their workforces, so as to raise awareness and bring about organizational and individual change that lead to safer alcohol consumption, and thus a reduction in alcohol-related absenteeism, presenteism and injuries.

A European network on cervical cancer surveillance and control in the new Member States - AURORA
01/12/2010 - 01/12/2013 Active
European Commission: Public Health Program 2008-2013

Prolepsis participates as an associated partner in this 3-year project coordinated by the Italian institute Osservatorio Nationale Sulla Salute Della Donna – Associazone with the participation of 15 associated partners.  The main objective of the project is the development and dissemination of innovative strategies for the prevention of cervical cancer. The main target group are women aged 30 to 69 years old as well as health professionals working in the area of cancer prevention, women’s associations etc.

Guidelines for the Prevention of Obesity at the Workplace – GPOW
May 2007-May 2009 Completed
European Commission: Public Health Program 2006

Guidelines for the Prevention of Obesity at the Workplace - GPOW is a DG SANCO project co-funded by the European Commission (under the responsibility of the Public Health Executive Agency – PHEA) also supported by TITAN Cement Factory. The project is coordinated by the Institute of Preventive Medicine, Environmental and Occupational Health – PROLEPSIS. The partnership comprises reputable European institutions with a strong background in public health, occupational medicine and workplace. The GPOW project aimed to examine the workplace environment as to its obesogenic nature and develop practical guidelines which were disseminated to a broad spectrum of stakeholders.

Environmental and Occupational Health Program for the Region of Oinofyta
04/01/2010 - 01/01/2013 Active
 
A Health Observatory has been organized and is currently operating in the region of Oinofyta, with the aim of recording, analyzing and monitoring the health of all people living and/or working in the area. Oinofyta and the broader area of Asopos are facing significant problems concerning environmental damage caused by pollution. Environmental pollution is likely to endanger the health of residents and workers in the region, as well as public health. The Observatory aims to offer scientific data on the effect of these factors on human health. Prof Athena Linos is the scientific coordinator of the epidemiological study funded by the Center for Disease Control and Prevention (KEELPNO) and implemented by the University of Athens. Faculty from Harvard School of Public Health and Dartmouth Medical School are also among the collaborators involved in the study. Prolepsisʼ scientific team also contributes to the study.

Campaign on the Indoor Prohibition Of Smoking in the Workplace - July 2009

Prolepsis ran a national campaign including a large scale informational event, following the implementation of the new law that banned smoking in all indoor spaces and came into effect in Greece on July 1st, 2009. Around 200 people, including representatives of the State and the Greek Orthodox Church, as well as representatives of major employers and employees’ associations/bodies and unions, attended the event at Karatzas Megaron in Athens. Furthermore, informational material was disseminated to approximately 2.000 workplaces. The campaign was realized under the auspices of the Greek Ministry of Health and Social Solidarity and aimed to inform employers, employees, unions and the general public regarding the implementation of the antismoking law, focusing on the right all workers have to a healthy, smoke-free environment.

Series of educational events regarding protection measures against the New Influenza A(H1N1)

Prolepsis, as part of its continuing effort to protect the health of citizens and safeguard Public Health, organized a series of educational events to inform the public about preventive measures against H1N1. Specialized physicians informed the public in several events that took place in different areas of Greece in October – December 2009.  

Informational Events for Senior Citizens about Safe use of Medication as well as Safety and the Prevention of Accidents at Home.

Prolepsis organizes series of informational events for senior citizens about the safe use of medication and the safety and prevention of accidents at home in different municipalities across Greece.

Tsigonia A., Lagoudi A., Chandrinou S., Linos, A., et al. (2010). Indoor air in beauty salons and occupational health exposure of cosmetologists to chemical substances, Int J Environ Res Public Health; 7 (1):314-324

Tsigonia A., Tanagra D., Linos A., Merekoulias G., Alexopoulos E.C. (2009). Musculoskeletal disorders among cosmetologists. Int J Environ Res Public Health, 6 (12):2967-79

Riza E., Remoundos D.D., Bakali E., Karadedou-Zafiriadou E., Linos D., Linos A. (2009). Anthropometric characteristics and mammographic parenchymal patterns in post-menopausal women: a population-based study in northern Greece. Cancer Causes Control; 20 (2):181-91Linos A., & Kirch W. (Eds.). (2008). Promoting Health for Working Women. New York: Springer Publications

Karnaki P., Polychronakis I., Linos A., & Kotsioni I. (2008). Introduction to Health Promotion for Working Women: A Methodology. In Linos A., & Kirch W. (Eds.). Promoting Health for Working Women. New York: Springer Publications

Polychronakis I., Chatzis C., Kotsioni I., Riza E., Brand T., & Linos A. (2008). The legal context for workplace safety and health promotion: thinking of women. In Linos A., & Kirch W. (Eds.). Promoting Health for Working Women. New York: Springer Publications

Polychronakis I., Riza E., Karnaki P., & Linos A. (2008). Workplace health promotion interventions concerning women workers’ occupational hazards. In In Linos A., & Kirch W. (Eds.). Promoting Health for Working Women. New York: Springer Publications

Riza E., & Linos A. (2008). Screening at the workplace and female employees. In Linos A., & Kirch W. (Eds.). Promoting Health for Working Women. New York: Springer Publications

The DIRERAF Coordinating Team. (2008). Development of Public Health Indicators for Reporting Environmental/Occupational Risks Related to Agriculture and Fishery. Available electronically from: www.prolepsis.gr

The Alpha Omega Prolepsis Team. Safety at Home for Senior Citizens. Module Material and pamphlets. Available for downloading from: http://alpha-eu.de/index.php?id=14and www.prolepsis.gr

The Alpha Omega Prolepsis Team. Safe Use of Medication. Module Material and pamphlets. Available to download from:  http://alpha-eu.de/index.php?id=15and www.prolepsis.gr

The HPROWOMEN Team. Development of an Educational and Training Tool for Workplace Health Promotion focusing on Women. CDROM

Linos A: Editorial, J Public Health, 2007; Vol. 15, No 4: 231-232 

Kouimintzis D, Chatzis C, Linos A: Health effects of livestock farming in Europe, J Public Health, 2007; Vol. 15, No 4: 245-254 

Jurewicz J, Kouimintzis D, Burdorf A, Hanke W, Chatzis C, Linos A: Occupational risk factors for work-related disorders in greenhouse workers, J Public Health, 2007; Vol. 15, No 4: 265-277

Kotsioni I, Chatzis C, Chronopoulou E, Linos A: Social and occupational health protection for self-employed farmers in the European Union, J Public Health, 2007; Vol. 15, No 4: 315-321

Alexopoulos EC., Chatzis C., & Linos A. (2006). An analysis of factors that influence personal exposure to toluene and xylene in residents of Athens, Greece. BMC Public Health 28(3),50, available for downloading from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16504175

Chatzis C., Alexopoulos EC., & Linos A. (2005). Indoor and outdoor personalexposure to benzene in Athens, Greece. Sci Total Environ, October 15; 349(1-3):72-80. doi:10.1016/j.scitotenv.2005.01.034

Linos A., Kotsioni I., & Papageorgiou E. (2005). Data mining: a new technique in medical research. Hormones (Athens) Oct-Dec;4(4):210-212. Available for downloading from: http://hormones.gr/preview.php?c_id=96

Kales SN, Linos A, Chatzis C, Sai Y, Halla M, Nasioulas G, & Christiani DC. (2004). The role of collagen IX tryptophan polymorphisms in symptomatic intervertebral disc disease in southern European patients. Spine 29 (11): 1266-1270 

The Euro- Med- Stat: Variations and increase in use of statins across Europe: data from administrative databases, Br J Med (2004) Febr; 328: 385- 386. doi:10.1136/bmj.328.7436.385

The Euro-Med-Stat Group. (2003). Monitoring expenditure and utilization of medicinal products in the European Union countries: a public health approach. European Journal of Public Health 13 (Supplement 3): 95-100. doi:10.1093/eurpub/13.suppl_1.95

Mack WJ, Preston Martin S, Dal Maso L, Galanti R, Xiang M, Franceschi S, Hallquist A, Jin F, Kolonel L, La Vecchia C, Levi F, Linos A, Lund E, McTiernan A, Mabuchi K, Negri E, Wingren G, & Ron E. (2003). A pooled analysis of case-control studies of thyroid cancer: cigarette smoking and consumption of alcohol, coffee and tea. Cancer Causes Control 14 (8): 773- 785. Available to download from: http://www.springerlink.com/content/r255577v10022527/fulltext.pdf

Markaki I, Linos D, Linos A: The influence of dietary patterns on the development of thyroid cancer, Eur J Cancer 2003, 39 (3): 1912- 1919. doi:10.1016/S0959-8049(03)00432-5  

Negri E, Ron E, Franceschi S, La Vecchia C, Preston Martin S, Kolonel L, Kleinerman RA, Mabuchi K, Jin F, Wingren G, Hallquist A, Levi F, Linos A, Fraumeni JF: Risk factors for medullary thyroid carcinoma: a pooled analysis, Cancer Causes and Control 2002, 13 (4): 365- 372. Available from: http://www.springerlink.com/content/wnb3hktpurdq4278/

Riza E, Dos Santos Silva I, De Stavola B, Bradlow HL, Serkovic DW, Linos D, Linos A: Urinary oestrogen metabolites and mammographic parenchymal patterns in postmenopausal women, Cancer Epidemiol Biomarkers Prev 2001, 10 (6): 627- 634. Available from: http://cebp.aacrjournals.org/cgi/content/full/10/6/627

Linos A, Riza E, Ballegooijen M: Introduction: Cervical cancer screening, Eur J Cancer 2000, 36 (17): 2175- 2176. doi:10.1016/S0959-8049(00)00307-5 
Riza E, Kyriakogianni-Psaropoulou P, Koumantakis E, Symiakaki H, Garas I, Linos A: Cervical cancer screening in Greece: Eur J Cancer 2000, 36 (17): 2227- 2232

Linos A, Riza E: Comparisons of cervical cancer screening programmes in the European Union: Eur J Cancer 2000, 36 (17): 2260- 2265. doi:10.1016/S0959-8049(00)00321-X

Health Center for Infectious Diseases Control

Greek Council for Refuges

Social Insurance Institute

General Secretariat of National Statistical Service of Greece

Ministry of Health and Welfare