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Dáil Éireann debate -
Thursday, 26 Mar 1992

Vol. 417 No. 7

Ceisteanna—Questions. Oral Answers. - Dublin Mortality Rates.

Richard Bruton

Question:

8 Mr. R. Bruton asked the Minister for Health if his attention has been drawn to reports suggesting far higher death rates in disadvantaged areas of Dublin; and if he will outline his strategy to deal with this.

I presume the reports referred to by the Deputy relate to the community-based study carried out by the Eastern Health Board of behavioural risk factors for premature mortality in certain disadvantaged areas of Dublin The development of health promotion strategies for socially deprived areas is a major priority of the health promotion unit of my Department and of the Eastern Health Board.

The first phase of the development of such strategies was conducting baseline research to determine specifically the health risk profile in selected areas. The Eastern Health Board, with financial support from the health promotion unit, conducted a study of behavioural risk factors among young adults in areas with high mortality versus those in low mortality areas. The second phase, which is well advanced, is to develop specific interventions to address the behavioural risk factors involved, particularly nutrition, smoking, alcohol and exercise. In fact, the health board and the health promotion unit are already finalising details on a nutrition intervention programme in response to the findings of this study.

Incorporated in the current health promotion activities of the Eastern Health Board are programmes which are specifically targeted at socially deprived areas. These include: family development programmes aimed at first-time mothers in deprived areas which involve structured interventions promoting physical, mental and emotional health; the travellers programme which involves a mobile health clinic for travellers with medical and nursing personnel involved in health promotion; the healthy cities project. The health board, in association with the three Dublin local authorities, are involved in the World Health Organisation's healthy cities project which specifically involves anti-smoking strategies, exercise and sport for disadvantaged youth and, in association with the health promotion unit, the board are promoting an anti-smoking programme for use in general practice and by other health professionals.

On a national level the health promotion unit, as the Deputy is aware, is actively involved in major programmes on nutrition, exercise, alcohol use and anti-smoking.

Would the Minister not agree that it is not simply a matter of nutritional programmes and behaviour where circumstances in which mortality rates are twice those in some deprived parts of our city, compared with others? Would he not agree that the clear differential access to health care is a very significant factor? Would he not agree that intervention in this area requires specific ministerial action to ensure that primary care of the highest possible quality should be available? Apparently this is not being made available under the present capitation system because of the natural stress on doctors, paid on a capitation basis, who do not have a private practice. Would he agree there is need for a project, such as the Kilkenny project, to provide more comprehensive check-ups to groups in the target and age groups, at high risk of premature mortality? In short, would he not agree that he needs to address this matter in a much more decisive manner than has been apparent from the measures he has outlined to date?

Yes, but it is multifactorial; it includes employment status, education, cultural norms, housing, a number of other factors. The Deputy referred to primary care. I should say the GMS service is available to them. If the Deputy considers the capitation system unsatisfactory I should point out that it is at present the subject of consideration under a review of the GMS. Where this incidence is most prevalent in inner city areas we would hope that general practitioners would be able to provide this service in a more structured way, during proper hours. It would be my hope that that service would be provided. I shall examine the possibility of initiating a study on nutrition along the lines of the Kilkenny project. Where there is poverty there are nutritional problems, too. Poverty is one of the main problems so we need to deal first with that.

Is the Minister aware that there is an extremely low take up of immunisation schemes in certain socially deprived areas of Dublin city? Obviously this will have a knock-on effect on children as they grow up, and a number of deaths have occurred as a result. Does the Minister agree that community health care is the key area to be targeted? It is an area that is not sufficiently funded. Would the Minister agree that the problem could be solved to some extent by public awareness programmes administered by the health boards? More funding should be targeted towards community health care by way of a prerequisite to better health for people who live in socially deprived areas of the city. I am not talking solely about the inner city because, for example, there is an extremely low take-up in the Neilstown area of, in particular, the three-in-one vaccine.

What the Deputy has said is correct. I have instructed my Department to examine the Hickey report on the public health services. I hope the recommendations in that report can be implemented as soon as possible. This would ensure that public health doctors play a greater role in ensuring that people have their children vaccinated.

Greater attention is being given to primary care and community care. These are the areas where the problems arise. If more funds are directed to community care the health service will save money in the long term. That cannot be quantified in the short term but it is the proper way to approach the financing of the health service. This issue has to be made a priority.

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