SGOXXX10.1177/215824401246149 4614911SAGE OpenNikolaidis and Sakellaropoulos 2012

SAGE Open October-December 2012: 1­–15 Social Policy in Greece in the Interwar © The Author(s) 2012 DOI: 10.1177/2158244012461491 Period: Events, Conflicts, and Conceptual http://sgo.sagepub.com Transformations

George Nikolaidis1 and Spyros Sakellaropoulos2

Abstract This study gives an outline—by period—of the most basic social policy measures and health and welfare programs of the Venizelist political center. The periodization involves a breakdown of the above-mentioned policy into three separate phases whose distinguishing characteristics are then outlined—namely, the first period from 1910 to 1916 where the predominant feature is the attempt to develop a range of structures and services that might begin to try to cover the growing needs of the population of a geographically expanding Greece. In the second period between 1918 and 1920, this expansionist strategy of the social state would come to be regarded as too advanced by the Venizelist center itself, and on the basis of forms of social and political expression, including some previously developed inside the working class, attempts would be made to roll it back. In the third period between the years 1928 and 1932, which was to be marked by a greater sharpening of social conflict, the politics of the Liberals were to involve endeavors to carry out bourgeois modernization as a counter to the social crisis, efforts conducted in a spirit of pragmatism in a situation where a whole array of economic, social, and political parameters were limiting the potential for promoting implementable policy measures at that time. Moreover, in this final phase, all such social policy measures were characterized by obvious efforts to manipulate and control the political and social forms of organization of the popular classes. Starting from the above considerations, our analysis seeks to distinguish itself from views particularly prevalent among Greek politicians even today, as well as among sections of the electorate, that portray Venizelos as a representative of advanced social radicalism. But we also distinguish ourselves from those who regard him as an exponent of bourgeois modernization. Whereas the former view perceives Venizelos’ policies as part of a continuous linear course toward progress, the latter sees everything as the outcome of a bourgeois class strategy for modernization of economic and social processes. Both stances suffer from an inability to comprehend that social evolution develops unevenly, and above all is the product of social balances of forces that are overturned, modified, and transformed.

Keywords social policy, Greece, interwar, venizelism, modernization

Introduction defense of the interests of specific sections either of capital (private health care organizations and companies producing In this article, we shall attempt to show that the adoption of and dispensing medical and pharmaceutical products) or of the first forms of social welfare and health care policies by the broader social bloc of the dominant classes (including, the governments of Eleftherios Venizelos is merely one vari- for example, medical doctors). They also include pursuance ant of a general rule characterizing the developmental course of social control through regulation of the roles of the of the welfare state in capitalist countries; that is, it repre- “healthy” and the “sick” (Navarro, 1975, pp. 183-196; sents the historical transmutation of an institutional forma- Waitzkin & Waterman, 1974, pp. 36-64). The phenomenon is tion that is contradictory in terms of its social (class) content. thus contradictory: The contents of its functions are the result What we maintain is that social expenditures have a dual of and the starting point for social struggle (Gough, 1979). function. On one hand, they of course comprise gains of the dominated strata, the fruit of intense social struggles. But on the other hand, the state has managed, step by step, to incor- 1Institute of Child Health, Athens, Greece porate its own objectives, with the greater part of these 2Panteion University, Athens, Greece expenditures serving the needs of capital reproduction. Corresponding Author: Specifically, in the field of health, these goals embrace the Spyros Sakellaropoulos, Department of Social Policy, Panteion University, functions of regeneration of labor power, reducing the cost of Leoforos Syggroy 136, Athens 17671, Greece its reproduction in the case of public expenditure on health, Email: [email protected]

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Naturally, as will be understood, our position on the wel- Although the contradiction indicated above between the fare state and more concretely on the Venizelist political cen- reproductive utility for the ruling class within the capitalist ter is the corollary of our overall position on the role of the mode of production of the public health measures and the state in contemporary capitalism. Contrary to views inter- related popular demands and gains in many ways remains preting the state as a simple “neutral” instrument of class the most basic of the active contradictions within the social power and other conceptions that see it as a relation between policy measures, other secondary contradictions also coexist social classes, we present the state as the outcome of class with it, undergoing a parallel evolution. One of these is the struggle within a mode of production. The class identity of organic contradiction between the repressive and the protec- the state is inherent in its creation within each productive tive character of the policies under implementation. Thus, system—The latter is after all the matrix within which it as early as the beginning of the 19th century, when the first comes into existence. Thus, within the capitalist system, the manual of preventive medicine was published, J. P. Frank goal of the bourgeois state is to give long-term representa- (1780-1827) had clearly outlined the repressive character of tion to bourgeois class interests. The overall concern of the any likely intervention. “State power, as expression of the state is evidently not something static but continually takes general will of the community, bears the overall responsibil- account of modifications in the intrabourgeois power bal- ity for each concrete individual and should therefore maintain ance, the upgrading and downgrading of sections of capital, constant supervision of people from the cradle to the grave,” and the totality of expressions of class struggle. he says in his, in any case, most eloquently titled work, A Comprehensive Medical Police Force (Frank n.a.: 9). However, a number of organizations such as trade unions, local authori- General Outline of International ties, associations, and scientific bodies promoted the idea of Tendencies and Policies on Health, society as a whole being responsible for securing a healthy Welfare, and Social Policy After 1900 environment, particularly for the social classes for whom such an environment is a vital necessity (Bale, 1989). In this In the field of health, the inherently contradictory character historical period, the repressive aspect of social policy and of public health measures had become evident as early as the public health measures played a conspicuous role in shaping 19th century and indeed through the activity of outstanding dominant political orientations, particularly in the imperialist personalities from the world of bourgeois politics and from centers, which felt threatened by infectious and contagious the international academic community. Characteristically, on diseases, both in country areas and in the overseas posses- one hand, the founder of the cellular conception of the sions of the big European states. human organism and leader of the liberal opposition to Another secondary contradiction characterizing this Bismarck, R. Virchow, declared as early as the mid-19th period is the position of the medical profession and of the century that “the physician is the natural advocate of the hospital as a structure within the emerging health care sys- poor,” that “politics is medicine on a broader scale,” and that tem. It had already become evident from previous forms of “medicine is a social science” (Silver, 1987). On the other social organization that there is a special relationship between hand, Lord Balfour declared with revealing perspicacity in the medical profession and political and ecclesiastical power. 1895 that “social legislation is not just something different A. Gramsci (1949/1972) characteristically observes that from socialist legislation: It is the most effective antidote to it.” Similarly, in one of the first British manuals on workers’ between medicine and religion there have been, and medical problems, in 1925, there is an explicit (and pre- there continue to be, links in the form of certain orga- monitory) record of the remark that “chickens, racehorses, nizational functions, quite apart from the fact that circus monkeys, are fed, trained and kept at the peak of their wherever the doctor puts in an appearance, the priest physical abilities, so that the productivity of their particular also shows up. Many great religious personages were, functions will reward our efforts. The same principle applies and were considered, great healers; cf. the idea of the for human beings” (Rodberg & Stevenson, 1977, p. 112). miracle and resurrection of the dead. Even at the level This reparatory role of social policy and public health mea- of royalty the idea long prevailed [until after the sures was of course something with which its own protago- Middle Ages] that they were able to heal simply by nists were entirely familiar. Thus, for example, as typically laying their hands on the patient, etc. (pp. 55-56) recorded by a contemporary observer, “Even when in 1847 the Prussian government sent Virchow to investigate the These relationships were naturally transformed in accor- typhus epidemic in Upper Silesia”—an investigation that led dance with the concrete historicity of the individual social to the compilation of a report that Virchow himself consid- formations and the social conflicts that correspondingly ered his most important contribution to medical science arose. Quite frequently, such conditions had overdetermin- (Ackerknecht, 1998, pp. 193-195)—“the government was ing consequences for the particular forms assumed by the trying to exert repression on the masses of the peasant popu- various policies that were pursued in the countries of Europe lation crowding into the farms of the Junker landowners, and North America. Thus, on one hand, for example, in the whom it was supporting” (Elling, 1994, p. 289). United States, the conflicts—often of doubtful scientific

Downloaded from by guest on June 4, 2016 Nikolaidis and Sakellaropoulos 3 merit and validity—between itinerant popular healers and a now upgraded locale for health provision. In the most the up-and-coming grouping of scientific hospital medicine developed countries, the hospital began to rise above its pre- (whose effectiveness nevertheless did not seem noticeably vious associations with manifestly charitable and palliative superior to that of its opponents) were settled through cen- functions (Ackerknecht, 1988). The use of the white tunic tralized repression by means of the notorious Flexner Report by medical personnel (even doctors working outside the (funded by the Carnegie and Rockefeller foundations)—a laboratory) became generalized, as part of an endeavor to report that made possible a suffocating control of medical secure the same acceptance as that enjoyed by specialists in staffing and the definitive hegemony of hospital medicine the key sectors of natural science. Various forms of collec- (Baer, 1989; Fox, 1986). On the other hand, in Europe, tive medical practice for profit made a dramatic entry onto the conflict was probably internalized within the body of the scene (Pefanis, 2004). Thus, although in the mid-18th professional medical cadres, leading to a polarization of the century, for example, popular prejudice had seen admission latter first into layers practicing their profession within into the hospital as something to be shunned, suggestive of newly established social-security organizations and second penury and ominous in its implications, in the first decades into layers confined to private medical practice involving of the 20th century, a polar shift in attitudes took place, gen- only a small part of the population (Honigsbaum, 1990). erating subsequent social pressure for construction of ever This internalization led to a proliferation of the attendant more hospitals in the countries of Europe and North America conflicts (between the prospect of measures of universal (Abel-Smith, 1964; Knowles, 1973). social policy and their rejection) throughout the political The conglomeration of conflicting conceptions and prac- strata of the various states and to the elaboration of a range tices, not to mention the way in which they were also of differentiated political positions on social legislation reflected, in part, in the legislation of various countries at within the conservative and liberal currents. The example is the turn of the 20th century, may go some way toward well known, for example, of Lloyd George’s clash with the explaining popular distrust of advanced forms of medical conservative Dr. Cox over the National Insurance Act 1911- treatment (Honigsbaum, 1990). Over time, this distrust does 1913 in Great Britain (Bynum, 1988). The disagreement seem to have undergone transformation and to have receded should nevertheless not be seen as typical of a more general with the increased prestige of the dominant conceptions and dispute between liberals and conservatives over social the prerequisite establishment of a homogeneously func- policy. Although, in most cases, it was the liberals who pro- tioning centralized state. Thus in countries with a history of posed the institution of measures for public health and social strong central authority buttressed by an entrenched ideol- welfare (Virchow himself led the liberal opposition to ogy, this type of contestation subsides and is reintegrated Bismarck, losing his university chair for his participation in smoothly and rapidly. This transition was naturally effected the insurrection of 1848), the confusion of roles, attitudes, in an overdetermined setting by means of an ideological and positions that prevailed at the time was much broader. subtext of scientism, hegemonic at a common-sense level, This historical period saw the emergence of conservatives and by acceptance and assimilation of its outlook by the adopting stances favorable to the social state (e.g., it was upholders of political and social order and the subordinate Bismarck, finally, who with the decree of November 17, social classes. By contrast, in social formations where the 1881, and the other decrees that followed it1 established the predominant school of medicine is imposed “from above,” model for the social insurance health system that remains in predicating dissolution of older therapeutic paradigms, and force to this day in most of Europe and many other countries where the state is constituted through operations more repres- in the world; Skoutelis, 1990) and also of liberals expressing sive in character and federalist in origin, without conspicuous opposition to such a prospect. involvement in everyday functioning (e.g., in the United During the same period, a radical modification took States), these challenges to the dominant medical model place regarding the character of medicine and the way it was would persist, metamorphosed into every manner of “paral- practiced as well as of the manner of dispensing health ser- lel” alternative health care practices with comparatively sig- vices. Whereas, that is to say, for a period that had lasted for nificant penetration, particularly among the popular strata over two centuries, hospitals had been primarily places of (Baer, 1989; Ehrenreich & English, 1979; White, 1990). refuge, institutions that—although philanthropic in charac- ter—had administered inferior-quality health care to the poor, with the more affluent social classes (and whoever Greece at the Turn of the 20th Century possessed the necessary means) systematically preferring However dramatic the evolving health, welfare, and social home treatment; at this point in time, the character of the policy situation in Greece proper in the early 20th century, it hospital underwent drastic change. The incorporation of nevertheless presented aspects of all aforementioned contra- (laboratory-based) technological innovations into diagnos- dictions. Figures of health statistics for the Greek population tic and therapeutic practice, and indeed the prestigious were among the worst in Europe and the legislative frame- achievements of the time in physics and chemistry, helped work nonexistent, given that since the time of the Bavarians’ prepare the ground for rapid growth of the hospital sector as reign in Greece, no new relevant legislation had been

Downloaded from by guest on June 4, 2016 4 SAGE Open passed. Implementation of preexisting institutional frame- 1988), whereas on the later years of Venizelos’ era, a good work was deficient, primarily covering Athens and almost portion of academics in Medical School of Athens were nowhere else in the country supported by only minimal highly influenced by eugenics’ various doctrines focusing on funding available for the purpose. At the turn of the 20th the necessity of reversing the impact of the notion of “coun- century, the basic legislation covering health issues in ter-selection,” namely, the increased surviving opportunities Greece consisted of the royal decree of December 1, 1836, for the weakest members of society provided by civilization “On the Administration of Eleemosynary Establishments,” and its amenities, including introduction of social legislation and the royal decree of December 21, 1836, “On the (Troumbeta, 2008). Those advocators like Prof. Moutousis Municipal Police.” Under the general provisions of the and Prof. Koumaris were regularly crusading against social Bavarians for public administration in Greece, municipal protection measures for the poor and in favor of repressive authorities and philanthropic organizations exercised the key legislation forbidding marriage between the sick that could responsibilities on questions of hygiene, with the individual result in degenerated children. Among those was also one of foundations being administered by some of the correspond- the key figures of the Venizelist associates, serving also as ing affiliated municipal councils. Protection of public health one of his ministers of health, Dr. A. Doxiadis. On top of in a more general sense was entrusted on one hand to the these, the opinion of doctors in overall was also contradict- police and on the other hand—where scientific expertise was ing reforms (such as the introduction of social security) required—to the doctors’ conference. There were few scien- defending freedom of doctor’s choice by the patient and tifically trained medical doctors in the country, mostly com- being afraid of a potential decrease or at least regulation of ing from the upper strata of society and situated in the urban medical income (Zilidis 2008: 143). centers. Despite this fact, from the very outset (i.e., the 19th Of course, among medical doctors of the time, as well as century), there was a heavy popular demand for training in medical academics, there were fierce advocators of the intro- medicine, chiefly because of the high earnings the medical duction of social welfare measures, such as Prof. Savvas profession could command, notwithstanding the vehement who, being rather disappointed by the lack of public health condemnation directed against it on that account by the press perspective within Medical School of Athens, founded the of the day. At the same time, particularly in the provinces, Anti-Malaria League and became one of the founders of quacks and “empirical” doctors with dubious qualifications Athens’ School of Hygiene (Levett, 2008). These voices carried out therapeutic tasks for the mass of the population. were supported in due course by other prominent figures Functioning hospitals, mostly charitable in character and such as doctors campaigning for the hygiene necessity of under municipal supervision, were very few in number; con- modernizing the sweeping system of Athens (Mavrogonatou, ditions in them were terrible, and the standard of health ser- 2008), criminologists contradicting bills for mandatory ster- vices they provided was equally low. Despite the importance ilization of people suffering from infectious diseases theoretically attached to it as a means of protecting children, (Troumbeta, 2008), or social theorists advocating for the welfare remained at rudimentary levels (Kalliga, 1990); there socially beneficial character of health and social services. It were numerous claims, for example, that the high levels of is indicative of the tensions inflicted that all these aforemen- mortality in the nurseries and homes for the elderly of the tioned forces in favor of social welfare legislation along with time were primarily the result of the wretched prevailing Venizelos’ political leadership often had to call into interna- conditions and the rough behavior of personnel. Popular tional agencies and organizations to support their policy attitudes, as it is evidently recorded in various texts of reforms. Such interference was invited on several occasions contemporary literature, were characterized by generalized given also the troubled social context of Venizelos’ era (con- distrust of scientific medicine, while there is no shortage of stant war conflicts, massive immigration, and consequent testimony demonstrating laymen’s preference for “quackery.” humanitarian crises) as well as the overall prevailing It should also be noticed that the overall orientation of the approaches in the international scenery; these interventions academia during the period under study was characterized by included organizations and agencies such as the Rockefeller several contradicting views prevailing in Europe at the time. Foundation, the Nation’s League, Milbank Memorial Fund, For instance, academics like A. Christomanos, professor in the International Red Cross, International Labor Organization, Athens’s School of Polytechnics, were publicly contradict- some of which were often being contradicted by the local ing views on the necessity of hygienic reform of Athens’ medical society (Weindling, 2008; Zilidis, 2008). obsolete sweeping system on the grounds of a rather ques- To sum up, it seems that Venizelos’ administration comes tionable report confirming the quality of water and refuting to power at a time in which preexisting capacity of the its implication in typhoid epidemics (Mavrogonatou, 2008). Hellenic state in health and welfare sectors was quite lim- As far as medical academia is concerned, it seems that at ited; in addition, sociopolitical circumstances increased least for the first years of Venizelist administration, it was needs to be met dramatically, while necessary reforms mainly focusing on the battle against empirical doctors and toward modernization were received with controversial atti- its legal institutionalization as well as on issues regarding tudes. The slow emergence of a trend in the direction of centrally regulated fees for medical services (Kapanidis, change, linked to a variety of sociopolitical transitions in the

Downloaded from by guest on June 4, 2016 Nikolaidis and Sakellaropoulos 5 course of the period under discussion, acquires altogether The Period Between 1910 and 1916 different qualitative characteristics in the light of political reforms undertaken by Venizelos, which may be assigned to It is rather the case that during the first period of Venizelos’ a number of different categories depending on the govern- administration (1910-1916), an original attempt was made to mental period. The first period is distinctive for the numer- introduce state intervention into the relations between capi- ous indications of support for establishment of a series of tal and labor. This enterprise aimed at bringing about a series laws promoting the institutional framework of state interven- of moderate institutional transformations with the potential tion in social welfare, restructuring of the operational mode of (a) curbing certain excesses on the part of employers, of the medical profession, and recognizing the state’s respon- (b) putting the country on a course of convergence with the sibility for the supervision of public health (with Law 346 of advanced European societies, and (c) confining all the 1914). The main factors generating the necessity for a new changes within specific limits—such that they did not cause supportive social framework were the expansion of Greek any problems for the process of economic accumulation or national territory following the incorporation of Northern for entrepreneur profitability (Liakos, 1993). Greece, Epirus and Crete; the contraction of the agricultural It is worth mentioning that these governmental plans met population from 75% of the total in 1870 to 57% in 1920, with considerable resistance from representatives of busi- with the number of urban workers rising from 7,300 in 1867 ness circles. The Review of Enterprises and Light Industry to 60,000 in 1909; and the repeated involvements in war launched a barrage of invective against Venizelos; the operations (the Balkan Wars, the First World War, the Asia Federation of Enterprises and Light Industry made repeated Minor Expedition). The breadth of coverage of this support- representations to him, arguing that the labor legislation had ive social framework was later deemed too advanced, and been voted “hastily and impulsively,” that it encouraged the development of the workers’ movement led to attempts workers to be greedy and created problems in a country to curb it between 1917 and 1920 (second period). It was where “there is no social differentiation” (Fountanopoulos, nevertheless during this period too that a series of health and 1999, p. 102). Addressing the Society for Political Science welfare measures were taken, the most important being the and Statistics in 1916, the Piraeus industrialist Economides measures that would culminate in the establishment of the asserted, Health Ministry in 1917 (subsequently to be renamed the Ministry of Health and Social Welfare) and the legislative Some laws have been instituted for the protection of framework of medical care and social assistance for refu- workers, in part necessary and beneficial, in part inju- gees. The third period (1928-1932) was to be marked by the dicious and damaging. There must be industry if there worsening of social inequalities along with a numerical are also to be workers . . . The welfare of the workers increase of the available workforce due to the simultaneous must proceed in parallel with protection of industry decrease of the rate of emigration from Greece and the entry (Fountanopoulos 1999, p. 103). of refugees into the Greek labor market. This period was also characterized by an attempt to reorganize the state’s health Among the politicians, the more conservative voices foundations and above all the creation of the Social Insurance expressed similar sentiments. Theotokis workers were in any Foundation (IKA). Nevertheless, even this last-mentioned case not subject to exploitation, and most strikes took place specific legislative action suffered from numerous weak- for no reason. He was moreover unable to see any reason nesses: lack of state funding, absence of provision for unem- why children should not work. Rallis was opposed to legal- ployment, and long delays in its practical implementation. ization of strikes, postulating an “indissoluble partnership” In light of the above considerations, we shall seek to between workers and their employers. Gounaris judged the distinguish our views both from those (particularly preva- economy to be so underdeveloped that there could be no lent even today in Greek political circles and sections of the basis for a theory of contending classes. The parliamentarian electorate) portraying Venizelos as an exponent of an Georgios Kantianis maintained that, in Greece, there were no advanced social radicalism and from those who label him as workers, capitalists, or labor movement, a symbol of bourgeois modernization (Hadjiosif, 1988; Mavrogordatos, 1988). Our reason for making this distinc- but some people come from Europe, or listen to what tion is as follows: Whereas the former view sees Venizelos’ is said in Europe, and having no ability to judge or politics as a continuous linear course toward progress, compare, infect us with an illness—because an illness the second explains everything in terms of the bourgeoisie’s is what it is, both there and here. They come to inject strategy to modernize economic and social processes this sickness into the healthy, robust and flourishing in Greece. Neither of the aforementioned perspectives body of our community, to overturn a dispensation grasps the fact that social development unfolds unevenly from which we have until now derived only benefits. and in the final analysis is the outcome of the balance of They come to . . . instill suspicion, distrust and hatred social forces, which can be overthrown, modified and between employers and employees. (Hering, 2004, transformed. p. 929)

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Venizelos’ answer to these criticisms was that “if we do much lower than the ones officially calculated, viz. that not make these legitimate concessions to the workers today, could be imposed by a court of law; for many years there was tomorrow they will take much more from us through revolu- no adjustment to the amount paid and the arrangement did not tion” (mentioned in Kordatos, 1972, p. 232). cover all occupations or all diseases (Liakos 1993, p. 390). On the basis of the above, during this period, a whole Last but not least, during 1920, the Greek government constellation of measures were taken in respect of labor signed six international labor agreements that had been voted legislation. Thus, 1911 saw the establishment of the head- in Washington in 1919 and involved introduction of the 8-hr quarters for the industrial inspectors, who were given the day (which was nevertheless not generally implemented task of regulating working conditions. Around the same until 1935 under the Papanastasiou government), and limita- time, a law was passed covering employees’ hygiene and tions on women’s labor and child labor, unemployment, and safety during working hours. In 1912, a law was passed maternity benefits. regulating payment of salaries and daily wages. The same As far as workers’ self-organization is concerned, in year was also characterized by the passage of legislation on 1914, the passage of Law 281 on associations created a new child and women’s labor that made it illegal for children institutional framework for trade unionism. The constitu- under 12 to work, or respectfully for children under 14 if tional amendment of 1911 had already made it possible for they had not completed their basic education. The same law cooperatives to be established without the permission of the provided for limitations on total working hours for children authorities, and dissolved only after a judicial ruling. The between 12 and 14 years of age (up to 6 hr a day) and chil- most significant innovation of the law of 1914 was that it dren between 14 and 18 years of age (up to 10 hr a day and prohibited simultaneous participation of employers and up to 8 hr on Saturdays and the days before public holidays). employees in the same association, imposing this way cer- There was also a legal provision of mandatory rest breaks tain limits on the logic of the guild. At the same time, it from work, and working on Sundays was not permitted for protected Greek citizens’ right to freely enter into an asso- minors under the age of 16 and for women. Night work was ciation without prior permission from the authorities, while also prohibited for women and minors below the age of 18, an association could be dissolved only after some or other and there was also a ban on certain types of work and certain violation of the laws and even then only by order of the occupations. The same law established a number of mini- courts of law (Moudopoulos, 1988; Tsiros, 1997). mum social welfare measures: mandatory employment What has to be noted is that this entire development took booklets, obligation of employers to notify the authorities place under a very strict state control, with respect to the about minors and women who worked for them, and activa- provision for supervision of associations’ operations in mat- tion of the Corps of Labor Inspectors (Lixouriotis, 1988). ters pertaining to their conformity with the law, their spe- Later on, in 1913 and 1916, decrees were issued establish- cific articles of member association, and the management of ing the midday break in certain branches of production. Two their finances in the case of professional societies. It is char- new laws were passed in 1920, and the provisions of the acteristic that associations were obliged to submit to a International Labour Conference were adopted regarding supervising authority an annual statement of income and regulation of night work, which was banned in the industrial expenditures, an inventory of fixed and movable assets, sector for children below 14. Nevertheless, both the absence along with a membership list. Moreover, the supervising of administrative and organizational support for the instan- authority had to be present at the associations’ assembly tiation of the new legal framework as well as the existence meetings to monitor the legality of their proceedings. of a large number of exceptions, for example, for children Moreover, in the event that for whatever reason there were working in their family business, and also of ambiguities, grounds for initiation of legal action, the supervising author- meant that its implementation was extremely deficient, if ity could depose the association’s governing body. Trade not nonexistent. union activity, finally, was forbidden for civil servants In 1914, a new law attempted the codification of preexist- (Moudopoulos, 1988). ing labor legislation along with the establishment of Sunday During this first period of the Venizelist administration, as a nonworking day; however, this law had several excep- measures taken in the health sector were along the same tions for numerous different business sectors and cities. lines as the aforementioned ones in the welfare sector. For Another law, also regarded as significant, was passed in example, one of the first modernizing steps taken by the 1915 by means of which the notion of compensation for a government was, through Law 4063/1912, to institute a new work accident was introduced for the first time. It was also legislative framework on terms and conditions of medical determined that an employer was obliged to compensate a practice and hospital administration (1914), in consonance worker who suffered an accident at work, undertaking pay- with what was being done during the same period in other ment of his medical and pharmaceutical expenses European countries and in North America. The phenomenon (Leontaritis, 1980; Liakos, 1993; Tsiros, 1997). However, in being targeted by these immediate measures of the Venizelist reality, this law was a compromise between workers and administration was quackery, namely, the empirical practice employers: the prescribed levels of compensation were very of medicine, but there was also a focus on the problem of the

Downloaded from by guest on June 4, 2016 Nikolaidis and Sakellaropoulos 7 expanding (see below) hospitals and other health sector of distinguished citizens to undertake charitable work for institutions being staffed by individuals entirely unsuitable the first wave of war refugees as well as for the sick, for their work. Apart from their unsuitable personnel, these wounded, and crippled from the Balkan Wars. institutions also suffered from a serious lack of infrastruc- ture, with potentially tragic consequences. As a result, over- all child mortality is reported at that time to have amounted The Period Between 1917 and 1920 to 30.4, 10.6, and 6.7 children per 1,000 for the age clusters The restrictive measures included in the law of 1914 were of 2- to 5-, 6- to 10-, and 11- to 15-year-olds, respectively, not successful in repressing the workers’ mobilizations. The with general infant mortality at levels of 106 deaths per mushrooming of strikes during the period between 1917 and 1,000 births in the cities (Kapanidis, 1988). 1920 led to increases in wages, with the result that the But the crucial turning point on the legislative initiative of Venizelos government was led to adopt further restrictive Venizelos’ administration was undoubtedly the passage of measures against working class trade unionism (Liakos, Law 346 of November 1, 1914 “On the management of 1993). Law 1207/1918 gave the right to the Law Council, Public Health,” where for the first time in Greece the chari- and not the Court of First Instance, to dissolve workers’ table and local dimension of health services was abandoned associations if it was judged that their mobilizations of strik- and the state acknowledged its responsibility at the national ers endangered public order. This was a tangible regression level. This law, which was drafted by K. Savvas, an Athens from Law 281, where a strike was not grounds for dissolving University professor, and the then president of the medical an association (Liakos, 1993). congress, was imbued with a spirit of state superintendence A little later, with Law 2151/1920, it was decided that, in of the entirety of the country’s service sector by the central the event of a strike, within 2 days, a general meeting must be government. But due to the war and the related political convened, where if one quarter of the regular members did not instability, as well as due to the opposition it encountered attend, the meeting had to be called again within 24 hr and if, and the lack of provisional resources (human and financial) again, there was not a quorum, the governing board of the for implementing it, it remained a dead letter. association could not implement any decision for a month. Overshadowed by war, this period was at the same time The presence of representatives of the Greek Trade Union characterized as a period of expansion of hospital treat- Confederation or other federations at the relevant proceedings ment. As mentioned previously, before 1909 most hospitals was prohibited. It was also prohibited for individuals under in Greece were public and/or charitable institutions with the age of 18 to participate in secret ballots on strike-related serious deficiencies in infrastructure and personnel. The issues, and restrictions were imposed on the right to stand for epidemics, such as the cholera epidemic in Macedonia in election (Liakos, 1993; Moudopoulos, 1988). 1913 and eruptive typhus and plague in 1914, together with The same year, with the royal decree of May 15/20, new the Balkan Wars, rendered the situation tragic in most of restrictions were instituted such as election only of Greek them: overcrowded with patients who often slept on the citizens to administrative bodies of associations and the fact floor, wretched conditions of hospitalization, prevalence of that among the grounds for dissolution were utilization of a multiplicity of infectious diseases precisely because of assets for other than statutory purposes, such as, for example, the overcrowding, and the absence of even the most rudi- economic support for striking workers. mentary hygiene. At the same time (as early as the first Essentially, the establishment of the law on workers’ decade of the 20th century), an increase in the number of associations came as a by-product of the effort to modernize specialist hospitals began. Many hospitals were established the country’s institutions given that the move away from between 1909 and 1916, such as the “A. Syngros” hospital what had until then been a purely agrarian economy created (1909) and the Mt. Parnes Sanatorium (1914) in Athens, the a qualitatively new situation. This is the reason that during “Loimodon” (infectious diseases’) hospital (1912) and the the same period, 1914-1915, Venizelos implemented laws Psychiatric Hospital (1914) in Thessaloniki, the Psychiatric establishing commercial and industrial chambers, farming Hospital of Souda (1910), the Leper-house (1909) and Eye cooperatives, and agricultural chambers. All these reforms, Hospital (1914) of Chios, and the Mytilene Sanatorium in other words, were attempting to prepare the ground for (1915). In addition, a number of previously functioning active intervention by the state in the differences between hospitals were considerably expanded, the most famous of social classes and layers. When it was judged that these dis- which being the “Sotiria” Sanatorium, which received state putes had become particularly serious, there would be even funding for the first time exactly during this period. Other stronger state intervention to prevent challenges to basic such institutions were the “Dromokaiteio” Psychiatric aspects of the regime of private property. As Venizelos him- Hospital in Athens and the Spinalonga Leper Colony in self asserted in the parliament, “This struggle for improve- Crete. It was at this time (1909), also, that the First Hellenic ment of the day-to-day life of the working class will proceed Tuberculosis Congress was held. Moreover, at the same in step with the genuine progress of the country when we time, the Venizelos administration (while it was in Athens succeed in extricating the workers from the clutches of their and afterward in Thessaloniki) funded several committees new exploiters.” The reason for this was,

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If in the past the employer was the exploiter, and contrary viewpoint was heard from parliamentarians express- sometimes continues to be even today, there is now a ing their skepticism of the new institutional framework that new danger, namely that a noble idea, which includes threatened to undo the process of “natural selection” that improvement in the position of the workers, has been upholds the vigor of the nation. Notions of this type also diverted from its objective by those who seek the over- seem to have had resonance in the stance of political person- turn of society. (Liakos, 1993, p. 168) ages when it came to the question of settling the refugees now arriving in old Greece, something that could explain the It should nevertheless be noted that although the above- similar reactions to the decree of July 10, 1917, “On the Care mentioned rationale of Venizelos was laying the ground for of Refugees,” which entered into force at the same time as long-term reproduction of capital, the representatives of the the decree for establishment of the Ministry of Health Care. local bourgeoisie, at a loss to comprehend how times had In 1918, the section head of the Finance Ministry, K. changed, were evidently adopting a much more conservative Papakonstantinou, in a booklet printed at the National stance. From this perspective, the position of the Greek del- Printery, attempted to refute these views of individuals egation at the International Labour Conference in Washington opposing state welfare on the grounds that they interfere in 1919 is characteristic: with the “felicitous results of natural selection, whose ten- dency is to disencumber us of the weak, the infirm, the In Greece the labour problem is affected by climatic incompetent” (Kapanidis, 1988, p. 92). The same leitmotif conditions. The abundance of light, the clear skies, the was to be reiterated sometime later after the Asia Minor dry atmosphere, the extreme brightness of the sun, Disaster on the subject, much larger in scale, of the refugees inevitably make the worker there something different of the period 1922-1926. In this case, infertile and disease- from the worker in a country further north. He cannot ridden sites for resettlement were selected systematically on work with the same intensity and persistence, but on the the basis of precisely this criterion of step-by-step natural other hand he does not feel comparable fatigue when selection of those with the greatest “endurance.” working for more than eight hours. The effect of the Implementation of health and welfare policies was thus good climate is also evident in the frugality of his life- anything but the considered demand of the Greek commu- style, which has always been characteristic of the Greek nity of the day or indicative of the general social climate. race. The quantity of food consumed by a Greek worker This was even truer of the politicians who were its spokes- would seem insufficient to an American or European persons. The climate was often one of confusion, lack of worker. (cited in Leontaritis, 1980, pp. 58-59) clarity in goals and orientations, and in some of its manifes- tations also of social callousness and transparent ignorance Also of interest is the stance of the newly emergent (e.g., knowledge of the nonhereditary character of tubercu- workers’ movement toward these reforms. Its criticism losis dates back much further than the above-mentioned focused on the inconsistency between the promulgation of extract from the parliamentary record). It was doubtless the laws and their routine violation. The view taken was that dramatic and urgent external conditions (years of war and the bourgeois state could not withstand implementation of refugee movements) that necessitated the passing of some this legislation, which was why application of its most elementary measures, more so than the existence of a coher- important components (e.g., the 8-hr workday) was deferred ent hegemonic policy that the Venizelist governing center indefinitely (Fountanopoulos, 2002). was undertaking to carry out. This is in any case made abun- In the realm of health, this period marks a significant dantly clear by the expansion in the hospital care sector at turning point, namely, the establishment for the first time of this time: Again, it is special hospitals that obviously a separate Ministry of Health. As early as the time of his predominate, highlighting the isolationist proclivities of the government in Thessaloniki, Venizelos had inaugurated the public health policies under implementation. It was during “Supreme Health Care Directorate” with responsibility for this period that the hospitals for sexually transmitted dis- the health and welfare of the refugees, the disabled, and other eases were established in Thessaloniki and Mytilene (1917), victims of the protracted warfare in which the country had the sanatoria in Asvestohori, Syros, and in Chania (1920), been engaged. After prevailing over his opposition in 1917, the Infectious Diseases Hospital in Mytilene (1918), with at assisted by the threat of cannon fire from French warships the same time only a handful of general hospitals being riding at anchor off Piraeus, Venizelos formed a government opened for the purpose, primarily, of caring for the refugees, in Athens, subsequently proceeding to delink this directorate such as the one in Nea Ionia (1917), the “Evangelismos” of from the Finance Ministry. It is characteristic of the confu- Kavalla (1919), and others, of charitable character, such as sion of these times that first the portfolio was determined and the “French” hospital in Lavrio (1919). The situation was to then afterward the decree “On the Competences of the undergo dramatic change in the immediately following Ministry of Health Care and the Organization of Health years, with a much larger wave of refugees flooding into Services” (July 10, 1917) was promulgated. In the corre- Greece. Faced with the dimensions of the problems, the sponding debates in the Hellenic Parliament, every type of Greek state would be forced within a very brief period of

Downloaded from by guest on June 4, 2016 Nikolaidis and Sakellaropoulos 9 time to establish state hospitals in more than 35 towns confirmation that whatever reforms took place in the health throughout the country, with a capacity of more than 2,638 and welfare sector, they cannot be understood either as forms beds, a very significant number when one takes into account of bourgeois modernization or as product of the voluntarism that, on the basis of 1925 statistics, the total number of hos- of the Venizelos administration for the implementation of pital beds in Greece did not exceed 9,000 (Kapanidis, 1988). worker-friendly policies. The most notable feature of the Whatever timid legislative measures were implemented first period is in reality the emergence of a demand for to modernize the institutional framework for health care and establishment of a minimum framework of social protec- welfare, they still fell far short of producing any result that tion and the simultaneous attempt to keep that framework could be detected statistically. The flu epidemic of 1918 to from going beyond certain limits, which is why so many 1919, for example, spread death far and wide, particularly exemptions were included, with the law on children and among the refugee populations. Infant mortality (which is minors remaining essentially unenforced. Nevertheless, the considered among the most sensitive indicators of proper continuing evolution of the workers’ movement, the estab- functioning of the health services) was probably aggravated lishment of the General Confederation of Greek Workers rather than alleviated by the operation of institutions such as (GSEE), the creation of the Socialist Workers’ Party of the Municipal Infant Asylum (“vrefokomeio”) of Athens Greece, and the resonance of the Bolshevik Revolution in (also known, not unjustifiably, as the “vrefoktoneio” [“infant Greek society were to generate still greater anxiety in the butchery!”]), where, between 1915 and 1919, 3,920 deaths ruling classes, and for this reason, an attempt would be were recorded, that is, 82% of those admitted. In the years made to achieve further cutbacks in workers’ rights. that followed (1920-1924), with the much stronger social Moreover, in the realm of health, the policies were to be pressures that had come to prevail, the mortality rate in the fragmentary and governed by expediency, undermined by said institution rose to 92% of its inmates, with other infant shifting goals, ideas, and orientations, or by the uncertainty asylums in Greece recording mortality rates ranging from of funding for their implementation. The axis around which 50% to 99% of the infants admitted to them. A similar they appear to move was the supervisory and regulatory picture emerges from the detailed report of the American function of the state in a sector primarily humanitarian in Red Cross on Greek health care institutions in 1919 where character and the police-like repressive character of the attention is drawn to grave deficiencies in infrastructure, interventions that were carried out. The first attempts at staff, and medicines as well as to the inadequacy and unsuit- establishing a social state in Greece thus have much more ability of supplies of basic foodstuffs (Kapanidis, 1988). to do with the state of the social forces at that specific social Moreover, even the statute establishing the Ministry of conjuncture than they do with the personal aspiration of an Health focused primarily on the regulatory and supervisory individual or a hazily modernizing orientation of the politi- functions of the state in existing hospitals, necessarily cal center. leaving out of account integration of the organizational and operational characteristics of hospitals for refugees, whether pre-existing or newly established. What was being repeated, The Period Between 1928 and 1932, in a way, was the scenario of Law 346/1914, as the meager and the Creation of the IKA financial resources of the Greek state, the many and varied The creation of IKA,2 but more generally the policy mea- counterreactions, the political instability, the lack of provi- sures for health and welfare at that time, should be seen in sion for funding, the overly ambitious plans, all tended to correlation with the consequences of the global economic frustrate implementation of much of what had been projected crisis and the effects it had on the Greek economy and on paper. The application of a number of haphazard emer- society (Liakos, 1988), the additional labor power made gency measures to deal with the first wave of refugees from available by the mass influx of refugees, and the restrictions the Balkans Wars, without being integrated into the program- on migration to the United States (and by extension shrink- ming of the newly constituted Ministry of Health, led to a age of migrant remittances) that resulted from the change in situation of chaos long before the Asia Minor Disaster. This American migration policy from 1921 onward (Vergopoulos, state of affairs gave rise to the idea of a merger of the sepa- n.d.). At the same time, the cost of living doubled and tri- rate functioning services and agencies under the aegis of a pled (between 1922 and 1935, prices rose by 207% and single ministry. But although originating with the liberals, wages only by 83%), and the daily wage contracted the idea proved impossible to get through the parliament (between 1928 and 1932, it fell by more than 11%) and until later, following Venizelos’ fall from power, when it was workers had great difficulty meeting their obligations. It is passed by the government of Protopapadakis–Gounaris– estimated that not even one quarter of working class fami- Stratos in the form of Law 2882 of December 13, 1922, “On lies in 1930 were earning the minimum salary required to Reform and Extension of the Ministry of Health Under the support themselves (Vergopoulos, n.d.). Unemployment New Title of Ministry of Health and Social Welfare.” skyrocketed from 75,000 unemployed in 1928 to 237,000 in To venture an overall assessment of the 1910-1916 period 1932, that is, about 40% of the wage-earning population and the years between 1917 and 1920, there is arguably (Sakellaropoulos, 1991). One significant parameter is the

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Table 1. Insurance Organizations in Greece, 1925 to 1935

Year Funds No. of insured Pensioners Incomea Expenditurea Assets 1925 2,146 16,118 2,072 50,445 9,315 173,620 1930 105 199,303 18,215 745,740 220,135 1,894,957 1935 105 435,537 45,000 1,185,626 829,258 3,775,671 aIn millions of drachmas. Source: Supreme economic council as cited in Sakellaropoulos (1991). dynamic developed by the constantly spreading worker opened its doors in Athens, Patras, and Thessaloniki. It was mobilizations that mark the period 1927-1931 (Livieratos, not until 1951, however, that it succeeded in covering the 1987). We could mention characteristically that in 1927, the rest of the country (Tsalikis, 2001). tobacco workers’ strike that led to clashes with workers The conclusion to be drawn is that, in the case of IKA, being killed, injured, and imprisoned spread to other sec- the situation cannot convincingly be represented as a tors, with the result that the Kafantaris government banned consequence of Venizelist radicalism or of some ill-defined public meetings and created a wartime atmosphere with bourgeois modernization. The objections raised by many patrols in the streets and military guards at the premises of different sectors in the power bloc (Tsalikis, 2001) not only public utilities (Liakos, 1993). contributed to delaying implementation of the law but also It should be clear from the above that the time had come led to large numbers of important amendments being made. for adoption of a series of social policy measures, quite apart The ruling class evidently had very many serious misgiv- from the fact that owing to the situation as a whole and to the ings about the way IKA had been brought into existence.3 need for social insurance structures, the number of insurance At the same time, the removal of operating costs from the companies and insurance clients had risen dramatically, as is state budget suggests that the state was seeking more to evident from Table 1. play the role of mediator between the two poles of society This dynamic led to the establishment of the IKA by than to proceed with implementing broad income distribu- Venizelos in 1932 (Law 5733/1932). The objective was to tion policies. Last but not least, it is certain that if the organize a single insurance body for all wage earners that preceding workers’ struggles had not taken place, the would give them protection from old age, sickness, and infir- question of social insurance would have been posed in an mities—without this entailing provision against the problem altogether different manner. of unemployment. In the board of directors of IKA, there To return to the field of health, the recomposition of a was provision for equal participation by representatives of social entity with so many unresolved and urgent social employers and workers, as well as three state officials, and problems had already been handled to some extent through an inspectorate to supervise the progress of the institute. direct state intervention. Thus, after 1925, the image of the Finally, provision was made for future constitution of a country in relation to the interventions needing to be imple- Social Insurance Council to monitor the progress of social mented in the health field had undergone radical transforma- insurance and give its recommendations on the relevant ordi- tion in the direction of reducing the involvement of charities nances to be promulgated. On the subject of funding, the and increasing the involvement of the state. In 1928, of the position was taken that the state would not be able to contrib- 9,936 available hospital beds, 5,285 were in state hospitals, ute to the social insurance budget and that the ideal was for 1,949 in municipal hospitals, and 329 in university hospitals, social policy to be self-financing through subscriptions from with only 2,373 in hospitals run by charitable organizations. employers and workers, respectively, in a ratio of 6.3% and Fifteen years earlier, the total number of hospital beds had 5% of the salary, respectively (Tsalikis, 2001). There was been clearly smaller, and the proportions evidently skewed accordingly a provision for existing capital to be channeled in favor of institutions of public benefit run by charities. This into the health programs, into workers’ housing, and into tendency was, as we saw above, the outcome of the events of completion of production projects. This made it quite clear 1923 to 1924 but is also observable throughout the entire that the state was prepared to use the organization’s capital to period from 1924 to 1939. Proportionately, then, in 1922, the fund the budget (Liakos, 1993). overall number of hospital beds had risen to an overall total Preparation for this particular law was programmed to of 11,742, in which 6,208 of them were concerning public take 5 months. Finally, the coming to power of Tsaldaris in health care institutions (Kapanidis, 1988). 1933 led to suspension of operations on the project, and in The picture presented by the country in terms of indica- the 2nd year, to the voting of Law 6298/1934 to reduce the tors for health was nevertheless far from rosy. In his famous level of contributions. The organizational procedures that report, “The problem of the death-rate in Greece,” published had been programmed were completed after continual delays in 1940 in the Proceedings of the Academy of Athens, the in 1937, and in December of the same year, the institute “father” of Greek epidemiology V. Valaoras mentions that in

Downloaded from by guest on June 4, 2016 Nikolaidis and Sakellaropoulos 11 the period between 1931 and 1935, Greece had the highest Health Care and Welfare in 1933 (Kapanidis, 1988). mortality rates of all the European countries from flu, typhoid One could therefore quite justifiably claim that these contra- fever, whooping cough, tuberculosis of other organs other dictions were key factors in the essential nonexistence than the respiratory system, and malaria. He also stated that of stable policy making right up until the outbreak of the Greece came a wretched second in mortality from scarlet mobilizations of workers and the general population in fever, pneumonia, and death in childbirth and fourth in 1936, followed by imposition of the Metaxas dictatorship mortality from tuberculosis of the respiratory system and with its need to project social policy as a means of offsetting gastroenteritis. In absolute figures, mortality in Greece from restrictions on political and social freedoms, and rights. a number of these diseases was 20 times higher than the cor- Throughout the preceding period, virtually all the country’s responding figures for the developed European countries. politicians seem to have been vacillating, swept up in the Despite the fact that infant mortality was not mentioned as dramatic events of the day, with their even more dramatic being extremely high in comparison with some other effects on the health care needs of the population. European countries, mortality among toddlers between 1 and Thus, as with the preceding periods of the Venizelist 4 years of age and children from 4 to 14 years came to 32.7 government, so in the period between 1928 and 1932, and 4.7 per 1,000, respectively, putting Greece again in the whatever reforms took place were overdetermined by the first place in the relevant European comparative statistical particularities of the social struggles and by the very nature listings. But even in the case of newborn babies, the of the bourgeois state, which is able to enlist individual distinguished epidemiologist questioned the validity of the social demands to serve the objectives of long-term repro- state records, submitting more modest calculations, which duction of capitalist relations. nevertheless put Greece in the second or third position in the relevant European statistics, after Hungary and, perhaps, Bulgaria. The finding that Greece was last on the list for Epilogue mortality from malignant neoplasms could likewise be given In conclusion, and for the entirety of Venizelos’ term in an unfavorable interpretation in the light of the well-known office, it can be asserted that its raising came at a time in statistical correlation between cancer and communities which previous provisos for welfare and health services in of “abundance” and affluence (mentioned in Louros, 1945, Greece were quite constraint. Moreover, definitely pp. 21-33). Venizelos’ administration apart from facing challenges of But at the institutional level, too, progress was slow, with primary industrialization and modernization of Greek much backtracking. Between 1920 and 1928, the Ministry of society had also to provide acute response to the outbreak Health Care changed ministers and orientation many times. of a huge humanitarian crisis inflicted by constant wars and It was abolished by the Pangalos dictatorship, only to be their consequent massive immigration waves. On top, reconstituted later. The dengue fever pandemic of 1928, disputes on the directionality of policies to be introduced which afflicted Venizelos himself, was instrumental in were constant in the political and scientific circles creating, heightening awareness of public health issues among politi- thus, discontinuities in robust policy implementation. In cians. On returning to government in 1928, Venizelos was to general, policy eventually pursued falls under the general create the subministry of health, which with the passage of rubric of bourgeois modernization but with much back- Law 4172/1929 again acquired the status of a full ministry. tracking and contradiction that are sometimes decisive for During his brief time as deputy minister (1928-1929), the final outcome in practice. Although the governing A. Doxiadis was to appeal to the League of Nations, acknowl- center in many cases appeared to perceive the requirements edging on one hand the enormity of the public health prob- of society and of the times, it was very far from embodying lem in Greece and, on the other hand, the inadequacy of the strategy of a coherent and structured liberal ruling national resources as a basis for dealing with it. The policy alliance: The contradictions appear to have permeated the directives issued, at least in their manner of implementation Venizelist camp and the opposing political groupings. Such by A. Pappas, now health minister, involved reductions in fragmentation in political orientation might be explained on expenditure on hospitals and ancillary services, and increases the grounds of contradictory character of directions (i.e., in in expenditure on prevention, hygiene, and the central super- strengthening or not social support, or contrary natural visory services of the new ministry. This policy was only selection) that were on debate at the time. The above- partially rescinded by Law 4737 of May 7, 1930, passed by mentioned permeability of ideas, viewpoints, and policies the same government and bearing the eloquent title as fol- on public health, welfare, and social policy, overdetermined lows: “On Financial Support for Public Hospitals and Similar by the great political and social events of the day (wars, Legal Persons of Public Law, Etc.” With Venizelos’ fall from social conflicts), led to the phenomenon, familiar in any power in 1932, these contradictions in health policy were case in Europe as a whole, of a variety of institutional mea- dramatically intensified4 with the renewed abolition of the sures being carried out by conservative governments, Health Ministry and some of its services in 1932, and despite having been proposed initially (but never fully recomposition of the again reunified Ministry of State implemented) by the liberal side of politics. The gradual

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“nationalization” of the hospital sector, its amalgamation modernization of the newly created modern Greek state. with health and welfare services, and the establishment of Indisputably, one part of this strategy was reconstitution of the country’s insurance system may be seen as examples of the social state and renewed concern for questions of health this. To put it in other words, the fragmented and multiply and welfare, much more so given the nature of the problems oriented totality of ideas and initiatives put forward during engendered by protracted wars and recurrent floods of refu- Venizelos’ era in Greece gradually was put into shape under gees. But for the Venizelist camp, the tendency shaping this the pressure of prevailing conditions also as reflected in policy was neither regular nor socially homogeneous, nor public pressure for social welfare reforms. uniform: There were breaks and inconsistencies, leaps The whole movement of the liberal side of politics per se forward and backtracking, and innovations and vacillations. seems to follow a trajectory ranging from collaboration with At the same time, in an era not only of warfare, territorial political radical political elements of the time (the “sociolo- expansion, and the redrawing of borders, but also of frequent gists” Panastasiou, Delmouzos, et al.) to attempting to place insurrections and revolutions within the geopolitical space of restrictions on the rising popular movement and its various Europe, autonomy at the political level is similarly evident in forms of political expression. Although in general terms, the the Greek social formation. Thus, with political instability an course between 1909 and 1932 seems to be in the direction ever-present element and given the extent of the noneco- of development, it can in no way be described as direct or nomic constraints that were the concomitant of such a period, linear. More specifically, health policies implemented the Venizelist center was able to realign relations at the throughout the period under examination along with novelty political and economic levels; in this way, reinforcing the and progressiveness are to some extent characterized also by historic role retrospectively attributed to it. Further historical repressive and restrictive conceptions expressed in individ- and social research may shed light on the specific terms and ual measures taken either by the liberals or by other political conditions of implementation of the critical political choices centers. Despite that—and on the terrain where Venizelism made at that time and on the individual decision-making cen- shares a common course with sections of social and political ters that contributed in whatever way. In any case, schematic radicalism—it was at this time that the concept of state representations of Venizelism either as a generalized social responsibility for public health, for medical care, and for radicalism or as an entirely bourgeois mode of government welfare was introduced onto the Greek political scene. The should perhaps be abandoned in favor of a more nuanced concept was to acquire even greater significance under the approach. Moreover, the deeper reasons for politicians elab- subsequent dictatorship of Metaxas. In addition, throughout orating policies for health, welfare, and social policy at that the period under examination, the social policy of the time must be sought more in the social processes, the con- Venizelist government is typically characterized by a lack of flicts, and the realignments of the time, and less in individual correspondence between what exists on the statute books and interventions, which may have broadened the horizons of the what is applied in practice. The reasons for this lack of cor- political agenda but in no way influenced it decisively. respondence, apart from the internal conflicts within the lib- erals, are to be sought in the political instability of the time Declaration of Conflicting Interests and in the consequences of the economic slump for Greek The author(s) declared no potential conflicts of interest with public finances. Constant changes in government as well as respect to the research, authorship, and/or publication of this direction of implemented policies were reflecting a wider article. social and decision-making indecisiveness of the Hellenic society and its governance at the time being. As a result, Funding many of the audacious reforms introduced by the Venizelists The author(s) received no financial support for the research and/or were to remain suspended in limbo or in a hybrid stage of authorship of this article. implementation until the sharpening of social conflicts with the revolution of 1936 and the imposition of the Metaxas Notes dictatorship effectively reordered the terms of the social con- 1. The decree was followed by institutional measures for insur- tract in Greece. ance against sickness in 1833, for work accidents in 1884, for In the final analysis, individual people as such have a less old age and infirmity in 1899, death in 1911, and unemploy- determining influence on developments in the historical evo- ment in 1927. Similar regulations were also established for lution of societies. What they tend more to do is to discern other countries, such as the introduction of insurance against underlying trends, grasp situations before it is too late, and sickness, infirmity, and unemployment in England in 1911 lend concrete form to—and then promote—tendencies and in France with equivalent legislation in 1928 and 1930 already existing in society itself and in the active contradic- (Skoutelis, 1990). tions and conflicting forces that comprise it. Certainly, 2. Above and beyond the creation of Social Insurance Founda- Eleftherios Venizelos was an outstanding personage of bour- tion (IKA), during that 4-year period in office, the Venizelos geois political life who was able to effect a distillation of the government proceeded to establish the Ergatiki Estia (1931), whole undertaking of national expansion and bourgeois which aimed at establishing accommodation for workers. But

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the construction of living quarters was secondary and supple- political spectrum and relevant to workers’ collective interests mentary to the basic goal of controlling trade unions through (chiefly the GSEE and the Greek Communist Party [KKE]). controlling housing (Koukoules, 1984). More specifically, workers enrolled in industry funds did not 3. Venizelos himself waged a great struggle to persuade peo- wish to be covered by IKA. They judged that notwithstanding ple that this approach contributed to protecting the bourgeois the higher cost of insurance, they were able to exercise con- order, and to reassure the recalcitrant industrialists: “To return, trol over the management of their reserves. In addition to this, however, to the promise I made that I will persuade the indus- unlike IKA, a number of funds—such as those of the bakers or trialists reacting against these changes that it is in their inter- tobacco workers—provided for insurance against unemploy- est to support them, I say this: if the introduction of social ment (Liakos, 1993). The GSEE, which had undergone con- insurance necessitates a 4% additional outlay on workers’ traction owing to the defection of the forces adhering to KKE wages, they should realize that if they manage to escape just politics, demanded that reforms be accelerated. They resisted one major strike demanding higher wages, they will have more the prospect of amendments under the pressure of lobbying than covered the expense entailed for them by the further 4% from private insurance companies and other business interests they would be paying for the securing of social insurance. It (Liakos, 1993). The strongest reactions came from the milieu is obvious that institutionalizing social insurance is a way of of the KKE. According to the Unifying General Confederation ensuring fewer strikes in the future than we will have if we of Workers, the confederation established by communist work- do not introduce this reform.” And elsewhere, “My words are ers, “Nothing leads to the conclusion that Venizelos wants to primarily addressed to the world of employers, because—as institute social insurance fund. On the contrary, all this shows I think I am entitled to say—if I have been widely calumni- that Venizelos has no intention of establishing social insurance ated for being of the Left and excessively pro-working class, funds because the capitalist oligarchy, of which he is a rep- I nevertheless belong to the bourgeoisie and it is not possi- resentative, has nothing to gain from them being established. ble to impugn my good faith when I declare that I serve, by Particularly today with the crisis it is not inclined to ‘waste’ whatever means appropriate, the existing social order” (cited money in this way because even in other countries where in Tzokas, 2002, pp. 191-193). The criticism emanating from social insurance systems have been in operation for years the employers’ circles was that through his promises to the work- capitalist establishment there is constantly downgrading them ing class, Venizelos was contributing to the exacerbation of and even abolishing them. The simple fact is that the Veni- class struggle, making him in effect responsible for labor zelos government is deceiving the workers” (Liakos, 1993, p. unrest. The view of the business world was that the repres- 499). Apart from this, on more specialized questions too, they sive mechanisms of the state were adequate for holding the condemned the government for not including unemployment working class in check so that there was no need for handouts insurance, for imposing through workers’ contributions a form and promises (Tzokas, 2002). At a meeting of the Chamber of taxation on the working class, for allowing sickness and dis- of Commerce and Industry (February 16-19, 1930), a recom- ability benefits and pensions to remain at very low levels, and mendation was made to the government that no new insurance for restricting insurance just to certain categories of worker funds should be created and existing ones should be abolished (those in stable employment and living in the large urban cen- (Tsalikis, 2008). At the Fourth Congress of Chambers of Com- ters; Liakos, 1993). merce and Industry in 1931, the decision was taken to declare that the business world would accept the expediency of social References insurance, but only for workplace accidents, while at the same Abel-Smith, B. (1964). The hospitals: 1800-1948. London, time rejecting insurance against sickness and demanding that England: Heinemann. insurance against old age and disability be subject to rigorous Ackerknecht, E. H. (1998). Paschalis-Iliadis [History of medicine]. scrutiny (Liakos, 1993). Reactions were to be seen also at the Athens, Greece: Marathia. level of politics qua politics, for the law was passed only by Baer, H. A. (1989). The American dominative medical system the Venizelists. The opposition abstained en bloc, challenging as a reflection of social relations in the larger society. Social its financial underpinnings. It took the view that the burden to Sciences & Medicine, 28, 1103-1112. the Greek economy would be much greater than what was pro- Bale, A. (1989). Medicine in the industrial battle: Early workers’ jected in the preamble to the legislation. What was proposed compensation. Social Sciences & Medicine, 28, 1113-1120. instead, without questioning of the importance of social insur- Bynum, W. F. (1988). Ideology and health care in Britain: Chad- ance, was another system where the emphasis would be more wick to Beveridge. 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Tzokas, S. (2002). Eleftherios Venizelos and the project of bour- Zilidis, C. (2008). Epidemiological reality in Greece in the inter- geois modernization 1928-1929: Building the Bourgeois State. war era and policy for re-organization of health services. In J. Athens, Greece: Themelio. Kyriopoulos (Ed.), Public health and social policy: Elefthe- Vergopoulos, K., (n.d.). The Greek economy from 1926 to 1935. rios Venizelos and its era (pp. 131-149). Athens, Greece: History of the Greek nation (Vol. 15, pp. 327-342). Athens, Papazisis. Greece: Ekdotiki Athinon. Waitzkin, H., & Waterman, B. (1974). The exploitation of illness in Bios capitalist society. Indianapolis: Bobbs-Merrill. George Nikolaidis is director of Department of Mental Health and Weindling, P. (2008). The league of nations, the Rockefeller foun- Social Welfare in the Institute of Child Health, specializing in pub- dation and public Health in Europe in the interwar period. In J. lic health, philosophy of psychiatry, and psychosocial services’ Kyriopoulos (Ed.), Public health and social policy: Eleftherios research. Venizelos and its era (pp. 79-96). Athens, Greece: Papazisis. White, W. D. (1990). The “corporation” of U.S. hospitals: What Spyros Sakellaropoulos is assistant professor in the Social Policy can we learn from the nineteenth century industrial experience? Department of the Panteion University, specializing in the subject International Journal of Health Services, 20(1), 85-113. state and political theory.

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