Welfare in the Mediterranean Countries Republic of Cyprus Successes and future prospects for the Cyprus health policy Introduction The Cyprus Government committed itself to an active role in social policy when it stated in 1967 that “it recognizes that health, education and other social considerations affect and are interdependent on a vast complex of variables which determine both the social and economic welfare of the island”. At first, the Government had to face the problem of infectious illnesses, spread in a region full of marshy areas. Having defeated malaria and other infectious diseases, Cyprus nowadays faces the same health problems as the other developed nations: how to increase the number of research laboratories and the hospitals; improve the health services; develop technology in medical care. The Government is also investing in health promotion, which is seen as a lifelong benefit for the health of the population. Awareness of the hazards of unhealthy lifestyles is growing amongst the people, not only as a result of the national policies and practices, but also as a result of the diffusion of information at schools and other places and via the media. A major challenge is to reduce the rising costs of health care and the inequalities in access; to improve the quality and financing of the health care system in order to maintain the progress achieved so far in controlling communicable diseases; to reduce the incidence of chronic diseases and to sustain the environment in a way that safeguards the quality of life1. For this reason in 1977 was adopted, and launched at the Alma Ata Conference in 1978, the project “Health for all”2, because the differences in the health of people in different countries and within countries was considered politically, socially and economically unacceptable and was a common concern of all countries3. So, the concept of primary health care (PHC) was proposed as the most important instrument for achieving the main social target of health for all: the attainment, by the year 2000, by all people of the world of a level of health that would permit them to lead a socially and economically productive life4. In the same way, the introduction of a National Health Scheme in Cyprus, for which a comprehensive law was passed in 2001, is expected to place more emphasis on primary health care. In 1 Third evaluation of the implementation of the strategy of Health for All by the Year 2000. Nicosia, Cyprus, Ministry of Health, 1997. 2 Health for All in the 21st Century. (http://www.who.int/archives/hfa). 3http://www.emro.who.int/Publications/EMHJ/0604/22.htm 4 The state of the world´s children 2000. New York, United Nations Children's Fund, 2000. 2 the meantime, both the number of rural health centres and sub- centres and the number of doctors in the rural areas has increased significantly. This shows that today the central vision for “Health for All” in the 21st Century is the same in Cyprus as in the rest of the world5. The Ministry of Health of Cyprus is committed to the principle that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”. One of the principal objectives of Cyprus for the integration of environment, development and health is to protect and promote human health and well- being. The objectives of primary health care policy are the following: integrating preventive and curative services at the primary health care level; encouraging a team-based practice in rural and urban health centres; providing personal individual and family care; and, establishing a referral system from primary to secondary and tertiary care We also have to consider that the commitment of the Government in the field of welfare is extended into other spheres, such as the improvement of the quality of life for the population; the protection of work and working women; and, finally, the constitution of an equal health system for citizens and refugees from Turkish Cyprus. 1. Social Welfare A social welfare policy was introduced in Cyprus for the first time in 1946. After independence, social welfare became the responsibility of the Department of Social Welfare Services under the Ministry of Labour and Social Insurance6. By the 1970s, social welfare had evolved into a body of activities designed to enable individuals, family groups, and communities to cope with social problems. In the late 1980s, the State provided five main categories of service: delinquency and social defence; child and family welfare; community work and youth services; social services to other departments; and public assistance. In 1973, when every Cypriot citizen was made eligible for financial assistance “for the maintenance of a minimum standard of living, and the satisfaction of his basic needs”, and promised social services for solving “his personal 5 Intercountry consultation on accelerating health for all in the Region, Alexandria, Egypt, 22-29 March 1999. Alexandria World Health Organization Regional Office for the Eastern Mediterranean, 1999 6http://www.country-data.com/cgi-bin/query/r-3501.html 3 problems and the improvement of his living conditions”. The ultimate objective of these services was to make their recipients socially and economically self-sufficient . By the time of the Turkish invasion in 1974, public assistance expenditure was minimal, given full employment and comparatively high living standards7. The years immediately after the invasion saw a swelling of public assistance services. In fact, the importance of an effective social services system has been especially apparent in Cyprus since the Turkish invasion and military occupation of 1974. The uprooting of a third of the population created many social problems and increased dependence of vulnerable groups on the State. Initially, Government spending focused on meeting the basic survival requirements of refugees and others through cash grants and aid in kind. Since then it has gradually moved towards providing long-term housing services, free secondary education, health services, and a wage-related social insurance scheme, scholarships and loans for needy students to study abroad, infrastructural buildings such as new schools, hospitals and various welfare institutions such as old peoples’ homes, geriatric centres, community welfare centres, children’s and youth homes, hostels and day-care centres. By 1987, when the economy was fully restored, there were only 5,087 recipients of public assistance, half of whom were aged or disabled. Nowadays, the Social Welfare Services are the official agency for the provision and promotion of social welfare services8. They aim to promote the social well- being of individuals, families and communities within the governmental framework for social and economic development in the country. Programmes of the Social Welfare Services are implemented by the following services: 1. The Family and Child Services. 2. The Service for Public Assistance and the Elderly and Persons with Disabilities. 3. Through technical and financial assistance, the Community Work Service encourages the participa tion of civil society in the development of social services such as home-care, support services for substance abuse, day-care for preschool- and school-age children etc. In recent years, there has been an increase in non-governmental programmes due to their capacity to respond more efficiently and effectively to local social needs. 4. The Service for Staff Development and Programme Planning, which implements an ongoing staff training programme in the Services. 7http://www.cyprus.gov.cy/cyphome/govhome.nsf/0/65E78C2D007A54D9C2256A710039974 4?OpenDocument&languageNo=1 8 Social welfare, in http://www.countrystudies.us/cyprus/31.htm 4 The Social Welfare Services participate in committees and conferences of the European Union on issues related to their field of competence. Legislation, policies and programmes of the Social Welfare Services are already in line with those of the European Union. Nevertheless, there is a continuous effort to improve standards, according to international and European legal instruments, ratified by Cyprus in relation to the promotion of democracy, human dignity and social cohesion, especially now that Cyprus is a member of the EU. 2. Health in Cyprus Of the various aspects of the welfare system, the Cyprus health organization has had increased attention from the Government and a bigger share of public expenditure for the development of health services.9. Besides, the demand for health care in Cyprus is increasing. The number of elderly people is low but growing and creates new service demands. Technological changes, both in terms of equipment and pharmaceuticals, is rapid. Much of this is integrated and disseminated rapidly due to commercial incentives. Some new therapies, for instance new drug treatments after the onset of heart attacks, offer significant health gains at modest cost. This proves that the standard of health of the Cypriot population compares, nowadays, favourably with that of the population of developed countries. Besides, Cyprus has been successfully freed of common infections and parasitic diseases and Ytheea r pattern2001 of illness resembles that of developed industrial nations, with cardiovascular diseases, malignancies and car accidents predominating as the causes of death. It should be pointed out that Cyprus has successfully eliminated malaria in the past and more recently echinococciasis, through the implementation of special campaigns. Current educational and preventive programmes are proving successful in almost eliminating the incidence of thalassaemia, which was a severe health problem10. 2.1. Health services 9http://www.cyprus.gov.cy/cyphome/govhome.nsf/0/36037CA698754C7AC2256B8300340FD 0?OpenDocument&languageNo=1.10http://www.un.org/esa/agenda21/natlinfo/countr/cypr us/social.htm. 5 The tertiary or services sector is the fastest growing area and today accounts for about 75.7% of GDP and 70.7% of the gainfully employed population. The sector includes, tourism, transport and communications, trade, banking, insurance, accounting, real estate, public administration, education, business and legal services, and, last but not least, health.