I regret that time did not permit me to complete reading the statement on the 1971-72 Health Estimate. I did deal with a large number of subjects last week including the Estimate itself, the Supplementary Estimate, health contributions, programme budgeting, the pursuance of the Health Act and establishment of health boards, establishment of the family doctor service, vital statistics, infectious diseases, staff relations, general hospital development, the appointment of consultants, capital made available for building projects, psychiatric services, drug abuse policy, accommodation for the aged, community care for the aged, the public health nursing service, mental handicap and the child health service. Those matters were all dealt with last week and I now come to dental services.
Dental services will continue to be provided in the main by wholetime dental officers employed by the health boards. In recent years, due to better salaries and conditions of employment, recruitment of these officers has shown a marked improvement. There are now 141 dental officers, including senior dental officers, employed in the public dental service. This represents a 44 per cent increase as compared with four years ago when revised conditions of appointment were introduced. Most health boards have a number of senior dental officers whose duty it is to organise and supervise the operation of the public dental services in local areas; it is the policy of the Department to encourage health boards to create such posts where they are needed and thereby, to ensure that the services are organised and operated as efficiently as possible. It is recognised that the development of dental services for the eligible classes, in particular for school children, has been uneven throughout the country and the service is one which a number of health boards have, since their establishment, been critically reviewing.
Prevention is better than cure in the case of most human ailments but in no other case, perhaps, does this principle apply more than in relation to tooth decay. It is, therefore, important that children should be instructed, even from a very early age, to acquire good habits of dental care and oral hygiene. The dental health campaign conducted by the dental health education committee of the Irish Dental Association and the dental health programmes operated in some areas by public dental officers have made a valuable contribution in this field. Health boards will, in future, be expected to include dental health education as a regular part of their programme.
The programme for adding fluoride to public water supplies as a proven means of preventing much dental decay continues to make steady progress. So far 78 supplies have been fluoridated serving a total of 1.4 million persons or 47 per cent of the total population. All the major cities—Dublin, Cork, Limerick and Waterford—and almost all towns with a population of 10,000 or more are now on fluoridated water; 70 per cent of all the population using piped water supplies are now receiving the benefits of fluoridation and only the smaller supplies remain to be treated.
Preliminary research in Cork city has shown a marked reduction in caries in both the first and permanent teeth of the children who from birth were provided with fluoridated water. Also, the dental staff of the Eastern Health Board have made a survey of the dental condition of school children in the Dublin area who have been on fluoridated water for about six years. The preliminary findings of this survey, while awaiting full statistical assessment, show a significant reduction in caries among these children compared with the results of the similar survey made by the Medical Research Council in the area in 1961. For example, in the temporary teeth of the five and six year olds the reduction was 64 per cent and 52 per cent respectively and in the permanent teeth of the ten and 12 year olds there were reductions of 34 per cent and 32 per cent respectively.
In the more sparsely populated parts of the country which have not public water supplies suitable for fluoridation, a number of schemes have been initiated for applying fluoride by means of regular mouth rinsing by children under supervision with a suitable fluoride solution.
Generally it is accepted that about 3 per cent of primary school children suffer from speech defects and that about one half of these children would benefit from attention by a trained speech therapist. For adults suffering from speech defects due to brain injury or other conditions the provision of speech therapy is also desirable. The Dublin College of Speech Therapy was established in 1969 under the auspices of the National Rehabilitation Board to train speech therapists for the health services. The first three-year course at the college will conclude in June, 1972, and it is to be hoped that the students, who will then qualify, will take employment here.
Deputies will note that this year's Estimate includes a sum of £70,000 for health information. This is by far the largest amount devoted to this purpose in any one year and reflects the importance I attach to health education. Quite a number of our health problems are avoidable, but due to human ignorance or weakness —perhaps sheer indifference in some cases—many of us find ourselves in need of medical treatment of one kind or another, due, for instance, to cigarette smoking, excessive drinking, drug taking, lack of exercise, overeating or eating the wrong foodstuffs, and so on. This is where health educational measures can do much good.
Health education is approached in two complementary ways, firstly, by inculcating a proper and deepening understanding of life and health from childhood, through adolescence, into maturity and, secondly, by advising and warning groups at risk of the dangers associated with particular habits or practices. I think there is much room for improvement in both methods of approach in so far as concerns our existing arrangements for health education and I hope to introduce improved measures to educate the public more effectively in matters of health. Television can do much good in this field and we have made considerable use of this medium, with the co-operation of Telefís Éireann. I hope to see greater use being made of television in the field of health education.
Health education in schools needs development, in view of the young age at which children nowadays become aware of the problems of living and behaviour. Here I am thinking mainly of the need to inculcate in children a healthy regimen—starting with simple hygienic practices and taking account, at appropriate ages, of education about the ill-effects of cigarette smoking, excessive drinking, drug taking and such like problems.
As Deputies are aware, I have already embarked on a widespread publicity campaign aimed primarily at discouraging young people from smoking cigarettes, using television, radio, magazines, newspapers, posters and school film shows. Anti-smoking publicity on television and in the Sunday papers during the past year has featured some well-known sporting personalities —the footballers, Tom Prendergast and Steve Heighway, the Cork hurler Charlie McCarthy, the swimmer Vicki Smith and the boxer Mick Dowling. Further anti-smoking filmlets are currently appearing on television featuring some well-known parents in different walks of life—Charles Mitchel of Telefís Éireann, Tom Kiernan, the international rugby footballer, and Frank O'Farrell, manager of Manchester United football team. I feel sure that the influence of these well-known personalities against cigarette smoking will be persuasive and counteract the false image of cigarette smoking as an essential ingredient of modern sophisticated living.
I have thus dealt with the special anti-cigarette smoking campaign of my Department which is aimed primarily at the younger generation. This campaign has been given real impact by the fact that Radio Telefís Éireann have ceased to accept cigarette advertising on television with effect from the 1st April last.
There has been one other significant development which I feel I should report to the House. At my request the Irish Tobacco Manufacturers Advisory Committee have agreed voluntarily to put a warning notice on all packets of cigarettes which are sold in this country. The warning notice will read: "Government Warning— Smoking can damage your health." All advertisements in newspapers and magazines and on posters will carry a reminder that there is a warning on the packets. I am most grateful to the tobacco manufacturers for their public spirited co-operation in this matter.
I intend to continue and intensify the anti-smoking campaign aimed at our young people in view of the serious health hazards to cigarette smokers.
These hazards have been publicised time and again, and I have on several occasions quoted from reports of such reputable bodies as the British Royal College of Physicians about them. In a leaflet published by the US Public Health Service today's knowledge about the health consequences of smoking cigarettes is summarised in the following major conclusions:
1. Cigarette smokers tend to die at earlier ages and experience more days of disability than do comparable non-smokers in the population.
2. If it were not for cigarette smoking, practically none of the earlier deaths from lung cancer would have occurred; a substantial portion of the earlier deaths from chronic bronchitis and emphysema would not have occurred; and a portion of the earlier deaths of cardiovascular origin would not have occurred.
3. If it were not for cigarette smoking, excess disability from chronic respiratory and cardiovascular diseases would be reduced.
4. By quitting or significantly reducing their smoking, people could delay or avert a substantial portion of the deaths which occur from lung cancer, a substantial portion of the earlier deaths and excess disability from chronic respiratory diseases, and some portion of the earlier deaths and disability from diseases of cardiovascular origin.
This is a serious, sober statement on a widespread habit that is, without equivocation, a matter of life and death. Many cigarette smokers tend to ignore this warning, but, if they do, I am afraid they do so at their peril.
The Working Party on Drug Abuse, which reported to me earlier this year, devoted a chapter of their report to education and publicity on drugs. They recommended, among other things, that "information and advice in connection with drug abuse should be provided as a matter of urgency for parents, teachers and others who come in contact with young persons". I have accepted this recommendation, and I am happy to tell the House that my Department, in co-operation with the Department of Education, will hold seminars for post-primary teachers. These seminars will discuss the problems of drug abuse and alcoholism in a way that will, we hope, equip the teachers to give advice and guidance, in a balanced and helpful way, to teenage children. The first two of the series have been held already.
The working party considered the difficulties of communicating information on drugs to young persons and concluded that, as this point in time, there should not be any "crash" programme for schools or youth clubs and that there should not be any general use of the mass media in an educational campaign. I think this is a wise viewpoint as the wrong type of publicity about drug abuse could do more harm than good, in promoting curiosity rather than understanding among the young. The working party did, however, make some specific recommendations in regard to young people who had been identified as having abused drugs in regard to the identification of children at risk, et cetera. They recommended also that a group representing the Departments of Health and Education, the schools, the university departments and professional bodies should investigate the general question of communicating information on the dangers to young persons. These recommendations are being pursued in the Department.
With regard to the problem of alcoholism, I have mentioned already that arrangements are in hand for distributing the Department's new leaflet "What Sort of Drinker Are You?" widely throughout the community. Press advertising of the problem of alcoholism has also been undertaken.
Alcoholic drinks are widely advertised, as Deputies know, and recently the Institute of Advertising Practitioners adopted a code of standards governing advertisements for alcoholic beverages. It seemed to me that this code could be improved in some respects, without being in any way unfair to the brewing and distilling interests, and some suggestions for improving the code have been put to the institute.
A publicity campaign to draw attention to the dangers of accidents in the home was undertaken during the past year, including a new illustrated leaflet on the subject. This leaflet was widely distributed at the Department's stand at the Ideal Homes Exhibition in the Mansion House a few months ago.
Food hygiene was another health topic on which the Department produced a new leaflet during the year, to coincide with a "clean food" campaign organised by the Irish Housewives' Association.
I should tell the House that I have been examining the possibility, indeed the inevitability, of promoting a health education centre. This will occupy my attention in the coming year.
The standard of food hygiene in the food trade is controlled under the Food Hygiene Regulations. Experience gained in the working of the regulations showed that certain amendments were desirable.
Under the regulations a person who is carrying on, or proposes to commence, a food business such as a restaurant, hotel or butcher's shop is required to obtain registration of his premises from the health board for this area. Up to this a premises had to be registered in full or not at all. This presented certain practical difficulties, for example, a licensed premises providing snacks or precooked meals for customers could not be expected to have full kitchen and cooking facilities. In practice, regard must be had in the reasonable operation of a registration system of this kind to the nature and extent of the business involved and, in order to provide an appropriate basis for this, an amendment has been made of the Food Hygiene Regulations.
Under the revised regulations health boards will have power to grant registration where the nature and extent of the food business carried on is appropriately limited to take account of the facilities and size of premises available. Should a proprietor exceed the limitations on the nature and extent of the food business after the registration has been granted or should a change occur in the extent of the facilities available. the chief executive officer of the health board has power to cancel the registration. The proprietor has a right to appeal to the Minister for Health against any such cancellation.
The regulations also require proprietors to provide sanitary conveniences for customers in restaurants and other registrable catering premises where such a requirement is reasonable and practicable. They also contain provision aimed at securing the establishment of more hygienic conditions in food stalls.
In October, 1967, a committee was appointed to consider and make recommendations on the measures which should be taken, in the interests of public health, to further and maintain a programme of education and training in food hygiene and in other related aspects of hygiene and for ensuring the education of school children in the basic principles of hygiene.
The membership included persons concerned with the catering and food manufacturing industries, the trade unions, the Irish Countrywomen's Association, the Irish Housewives' Association, a chief medical officer of health, a health inspector and officers of the Departments of Education, Health and Agriculture and Fisheries.
The report of this committee, which was published recently, covers a wide field. It points out that as a result of the implementation of the Food Hygiene Regulations, 1950, there had been a general upgrading of hygiene standards but that a great deal of further progress is necessary. It defines the object of a food hygiene programme as the ensuring of clean, safe and hygienic food premises in which food is prepared for human consumption and enumerates the hazards that need to be guarded against.
The committee refers especially to the great importance of education in bringing about an appreciation of the fundamentals of hygiene and recommended the setting up of a health education centre.
The committee's report represents a careful and thorough assessment of the many aspects of the field assigned to it for study and will be of great assistance to all concerned with the problem.
The report of the committee has been widely circulated and comments on its recommendations from interested bodies have been invited.
Our participation in the activities of international health organisations continues to increase. In the Council of Europe we are represented on the two principal health committees—the European Public Health Committee and the Partial Agreement Public Health Committee. We are also actively concerned with the sub-committees and working parties attached to these committees. This enables this country not only to benefit from the pooled expertise of the participating countries but also to contribute usefully from Irish experience, as in the case of the Working Party on the Problems of Implementation of Drinking Water Fluoridation, the report of which was recently published by the Council of Europe. We have joined as full members the Partial Agreement Public Health Committee and this has resulted in a considerable expansion of our commitments, particularly in the continuous and valuable exchange of information between member states which is a feature of that committee's work. The 23rd session of the Partial Agreement Public Health Committee was held in Dublin in April last.
We also continue active co-operation with the World Health Organisation. On the occasion of the 1970-71 Estimates I referred to a pilot scheme of registration of ischaemic heart disease which we were carrying out in co-operation with the World Health Organisation. That scheme is continuing and it has recently been the subject of very favourable comment by WHO. Our association with these and other international organisations in the field of health brings this country the considerable benefits which derive from the exchange of information, the co-operative control of diseases and the opportunities for Irish doctors and paramedical medical officers to attend international seminars and to study abroad with the aid of fellowships. It also brings international recognition of the contribution which we are making towards the raising of the standard of health services in the world at large. This is seen in the increasing number of fellowship holders and others who visit this country to study Irish procedures.
The negotiations on Ireland's application for membership of EEC have not indicated any insuperable difficulties for us in the health sector. The steps necessary for effecting freedom of movement and freedom to practice in relation to medical and paramedical personnel have not been completed. This is essentially a matter of co-ordination of training and rules of practice and provision for the mutual recognition of qualifications. From now on we will be consulted regarding further proposed developments in these matters as in other matters and, of course, we will be in a position to influence directly the final form of the particular controls. We have kept in close touch with the professional and other interests involved in these matters and will continue to do so. In regard to directives already enacted by the EEC in matters which are the concern of my Department, officers of my Department have participated in the negotiations to ensure that the interests of this country are taken into account in the adjustments which the enlargement of the Communities will require. These principally relate to food additives, et cetera, proprietary medicines and social benefits for migrant workers.
Deputies will be aware that I recently established a National Social Service Council which held its inaugural meeting on the 1st October last. The council includes persons active in voluntary organisations and officers of local authorities and Government Departments. The majority of the members are people who have over the years participated in a prominent and positive way in voluntary activity and they represent a good cross-section of those in the community who have indicated their willingness to devote themselves to the service of others.
The primary function of the council is to promote the establishment of social service councils, to encourage and co-ordinate voluntary activity, and to help in its co-ordination with the activity of statutory bodies. The council will, I hope, be a focal point of voluntary social work activity in this country and will be a source of encouragement, assistance and advice to existing agencies. That the council will have a challenge is evidenced by the fact that in the whole of the Republic there are 37 social service councils operating reasonably full services and 32 councils mainly caring for the aged. The lists are in the notes circulated to Deputies.
The council will also provide a means through which the Government may be constantly aware of the views of those most concerned with social work problems and create a channel of communications through which the Government might seek the advice of those concerned with these problems.
To co-ordinate the work of Government Departments concerned with social work activity, a permanent inter-departmental liaison committee has also been established comprising representatives of the Departments of Finance, Social Welfare, Local Government, Education, Justice and Labour as well as my own Department. This committee will work in close association with the National Social Service Council.
It will be clear from recent pronouncements which I have made that I am deeply concerned about the extent of and the role of voluntary activity in our society. There have in recent years been many marked improvements in conditions in this country. The population, for the first time in many years, is rising; new industries have been established to replace those becoming obsolete and to provide for the many who are leaving agriculture and seeking alternative employment. There has been, despite rising prices and despite temporary setbacks in our plans, an increase in the general standard of living of the majority of our people. While we have not attained to the level of affluence which has developed in many other countries it is true to say that our progress in recent years is leading us in that general direction.
While this is so we cannot overlook that there are also in our society many who have failed to participate in full in this growth in living standards. One thinks, in particular, of those who are disadvantaged by age, those handicapped in one way or another through physical or mental ailment and those suffering from deprivation proceeding from economic or social causes.
Throughout our society in general there has been a growing awareness in recent years of the problems of such persons and groups of such persons and an increasing urge to take some practical steps towards meeting their needs. Some have found it possible to provide such services through the traditional voluntary agencies such as the St. Vincent de Paul Society or organisations which have a history of helping specific groups of people to live a better life. Others, particularly the young, have found outlets for their idealism in newly founded organisations providing specific services for groups whose needs have hitherto been unidentified or for whom no practical activity has in the past been undertaken. One thinks in this connection of such organisations as the Samaritans and the Simon Community which have been doing most valuable work for the dropouts from our society. There are many also who have found that their contribution can best be made in a general purpose such as a social service council or a community association whose primary function is to co-ordinate the activities of voluntary agencies in a particular area and to ensure that, by avoiding duplicating or parallel developments of similar activities, available voluntary resources are used to the best advantage, for the good of the under-privileged in our community.
In all of these organisations there are those concerned who try to see the whole picture, the most desirable pattern into which to weave the many differing strands of voluntary work. The National Social Service Council will, I hope, be of great assistance in local areas in which there develops, among those engaged in voluntary activity, an awareness of the need to make their activity more effective through co-operation and co-ordination. It will be able, when it has settled down and recruited some staff, to provide specialised advice and assistance in an area in which, without such assistance, much time and effort could be wasted. The council will also be able to provide for voluntary organisation in the social service field an information service which will keep them abreast of developments in the statutory services and inform the voluntary agencies of the schemes and assistance and the help which can be made available by central and local statutory bodies.
It should also help in the important function of promoting sensitivity to social need and a desire to meet it. These are practical short-term steps which must be taken during the next year to improve the impact of voluntary endeavour on the problems of our society. There is also the broader, more general question of the total role of voluntary activity in the solution of social problems with which society is faced. We must try to develop a clear view of the respective roles of the State and other organisations; we must harmonise them and see that each component of the global effort to help the disadvantaged plays its part. We must develop an accepted attitude towards the extent to which the State should subsidise and financially assist voluntary organisations in discharging their activities. We must try to be clear on how best to encourage people to become involved in social activity in their communities and on the steps which can most appropriately be taken to achieve the defined aims.
All of these are matters which can legitimately be considered by the National Social Service Council but this is not, of course, the only body concerned with the evolution of a philosophy in this field. One such body recently established, for instance, is the Council for Social Welfare, appointed by the Catholic Hierarchy, which is considering broad general questions in this field in order to advise the Catholic Hierarchy of the steps which the church might appropriately take. Incidentally, I am glad to tell the House that, at my invitation, three members of that council are also serving on the National Council. I may also mention that I have been glad to note that the council recently held a conference on poverty which was attended by a widely representative body of people and at which there was a most useful dialogue on the subject of poverty.
A number of other national bodies are also actively concerned in the field of community social service and there is, of course, the pending reorganisation of the local government structure under which proposals have been made which would result in greater participation by communities in the evolution of local government policy.
All this shows a welcome apppreciation of the need for involvement of individuals and the general body of the public in the direction of our society and in the solution of its social problems. I think that the next two or three years will be a time of great development in this field and one during which, I hope, it will be possible to achieve advances, if not solutions, to many outstanding social problems which will find a general acceptance among all those, whether at central government, local government, church or voluntary level, who are involving themselves in the attempt to push forward towards the completion of what is, to my mind, a most pressing task.
I have frequently, in this House and outside, expressed my sincere thanks to the very great numbers involved in providing unpaid service to the community through membership of bodies set up under the aegis of my Department. It may come as a surprise to many Deputies to learn that there are some 30 such bodies with membership of from 30 plus down to ten. I have in the course of this speech mentioned some of them, the National Social Service Council for instance. My failure to mention others does not arise from any lack of appreciation of the tremendous service which they render to the community, a service which, if it were to be paid for, would cost the taxpayers and the ratepayers a vast sum of money annually. And here I can say also that since I became Minister for Health I have had occasion to invite large numbers of persons to serve, unpaid, I should stress, on such bodies and I could count on the fingers of one hand the number who declined my invitation. Further, in no case that I can remember was an invitation declined without a very good reason. To all of them I again offer my thanks.
Apart from those who are serving on the various bodies established under my Department's aegis, I must also pay warm tribute to the religious orders who faithfully continue the age-old practice of charitable service for their fellow citizens. There is no area of the country in which members of these orders are not to be found, working in our general hospitals, in homes for the mentally handicapped—perhaps the most exacting but equally the most spiritually valuable form of personal service one could give—in geriatric hospitals and in social service. And in mentioning social service I also express sincere appreciation of the work of the hundreds of good lay folk who are doing noble and most useful work for people in social need through the channel of community social service organisations, whether as members of voluntary charitable organisations, as public officers, or as simple lay men and women without formal affiliations. All these are making a most worthwhile contribution towards the health and well-being of the less fortunately circumstanced. We are very much in their debt.
As Minister for Health, I would naturally like to advance at twice the pace actually accomplished. At the same time, I offer to the House this year a report indicating real and substantial progress in all branches of the service and specific sanctioned plans for progress in the coming year.
If I were asked to give my No. 1 priority I would answer—the development of social service councils throughout the country.
