I welcome the opportunity to outline to the House the steps the Government is taking to improve women's health and to inform Deputies about the preparations under way for a plan for women's health. Why do we need a special initiative on women's health? It is disappointing to report that in spite of the dramatic advances in women's health since the forties, the life expectancy of Irish women at birth is one of the lowest in the European Union. The reasons for this are complex. Mortality from heart disease in Irish women is among the highest of any of the European Union countries and is currently 70 per cent above the European Union average. Adding years to the life expectancy of Irish women is one of the major challenges facing the health services in the next decade. Women's health deserves special attention because it is at special risk during pregnancy and childbirth. Women's health may also be undermined because of the multiple roles which many are called on to play as a result of their economic dependence and gender based violence. Low self-esteem linked to social and economic attitudes to women's place in Irish society inhibits many women's full development and this impacts on their health. The high incidence of depression among women is perhaps a symptom of a deeper social problem. Since women rely on good public health and social services to maintain their health. We must be aware of women's vulnerability to illness and disability and actively work to promote their health.
Many health services for women tend to operate independently of each other, without common objectives or links. One gets the impression that our services are geared to deal with a breakdown in the system rather than with promoting the concept of the "well women". We need to focus on the health needs of women over their lifetime to identify how health services for women could be improved and to take action to ensure that Irish women enjoy the highest attainable standards of health.
I acknowledge the role the former Oireachtas Joint Committee on Women's Rights chaired by the former Deputy Monica Barnes played in raising awareness about women's health. In 1991 a deputation from the committee led by Deputy Monica Barnes met the Minister to outline to him the concerns of many women about the health services and the extent to which they were not responding to women's needs. Following that meeting a women's health committee was established in the Department of Health. This committee collected the information and research findings on women's health which formed the basis for current initiatives on women's health.
The former joint committee's concern about the response of the health services to women's health needs was echoed in the 1993 report of the Second Commission on the Status of Women. It recommended that the Minister for Health should publish a discussion document on women's health, that there should be widespread consultation on the contents and that the Government should adopt and implement a plan for women's health. The former Minister for Health, Deputy Howlin accepted this recommendation and a commitment was made in "Health Strategy, Shaping a Healthier Future" to the publication of such a document, to consultation and to a women's health plan. This commitment was given a new significance when it was included in our Government programme, A Government of Renewal.
Last June, the first part of his commitment was fulfilled by the publication by my colleague the Minister for Health, Deputy Michael Noonan of a discussion document, Developing a Policy of Women's Health. At the same time he initiated the second part of the commitment, the consultative process which will lead to the adoption by Government of a plan for women's health early next year. I was particularly pleased that prior to the publication of the discussion document, the Council for the Status of Women now renamed the National Women's Council of Ireland, agreed to assist with the consultative process on the discussion document so that the plan for women's health will be informed by the authentic and representative voice of women. Over 130 organisations are members of the National Women's Council representing over 300,000 women in the Republic.
The discussion document looks at the health services from a woman's point of view. It analysis the health status of Irish women and pinpoints the main causes of morality and morbidity among women. The main causes of premature death among Irish women — that is deaths among women under 65 years — are cardiovascular disease, cancer, especially of the breasts and lungs and accidents. Following the principles of the health strategy the document looks at the scope for preventing premature mortality and increasing health and social gain. The document points out that there is great scope for reducing premature mortality in women, principally by a reduction in smoking, by screening for breast and cervical cancer and by good nutrition. The discussion document examines health issues particular to women, such as childbirth and gynaecology, breast and cervical cancer and violence against women. It commends the high quality of care in our maternity services but advocates a more consumer friendly approach by the hospitals and staff involved in the care of expectant mothers. The challenge to our health and education services of teenage pregnancy outside a stable relationship is highlighted in the document.
The document identifies health issues which predominantly affect women, such as family planning and support for carers, and issues which affect women differently from men, including drug dependence, mental illness and dental health. It records recent initiatives on these issues and suggests where further action is needed. The problem of accessing health services by disadvantaged women such as women with disabilities, traveller women and women in advanced old age is discussed. The need for greater consultation and representation of women in the health service is highlighted and suggestions are made as to how the voice of women could be more clearly heard on the health services. The discussion document concludes by suggesting priorities for tackling the main health problems of women to be addressed in the plan for women's health to which the Government is committed.
In choosing priorities for inclusion in the plan for women's health, it is clear that the most serious causes of mortality and morbidity among Irish women should receive attention. There is no doubt that cigarette smoking is the single greatest cause of premature death and preventable illness among Irish women. There is a direct link between smoking and the very high level of mortality from heart disease among Irish women. I realise that smoking is not usually seen as a "women's" health issue but, given the scale of harm it causes to women, we must give a high priority to persuading as many women as possible to stop smoking and prevent as many girls as possible from taking up the habit. I will refer later to the most recent initiative on smoking.
Cancer claims the lives of thousands of Irish women each year. A proportion of these deaths could be prevented. We could wipe out most forms of lung cancer by persuading women to stop smoking. We could reduce deaths from breast cancer in women over 50 by one third by screening women aged 50 to 64 for the disease. We could prevent about 40 of the 75 deaths from cervical cancer each year by a programme of screening of women aged 30 to 50 years.
A further priority suggested in the document is making our maternity services more responsive to the expectations of mothers and partners for more individual care and greater involvement in decision making. Our services must also respond more effectively and in a more co-ordinated way to women who are the victims of domestic violence and rape.
We know that the health of women in the travelling community is much worse than that of other women and the document suggests that their health needs should receive particular attention in the plan for women's health. The under-representation of women at most levels in the health services also needs to be addressed, and more research is needed about women's health needs.
While there is much to be done in this country, the health problems of women in many countries of the world are so great that they demand our attention and assistance. Ireland has a long and distinguished record of aid to the developing world, much of which has benefited women. The discussion document suggests that we need to strengthen our commitment to improving women's health in the developing world and the emerging democracies of Eastern Europe.
These priorities were identified in the discussion document to focus discussion during the consultative process which will lead to a plan for women's health. I have no doubt that these priorities will be modified and possibly changed as a result of consulting women on what they consider to be the most important issues affecting their health.
The consultative process on the discussion document began immediately after publication. The first step in this process was a conference held on Friday, 30 June 1995 on the discussion document organised jointly by the Department of Health and the National Women's Council. Representatives of every organisation affiliated to the council were invited, as well as representatives of health boards, professional organisations and many voluntary bodies active in the field of health. Over 200 people attended the conference, which I had the pleasure of opening. Contributors included Noreen Byrne, Chairperson of the National Women's Council, Dr. Freda O'Neill, the Department's medical adviser on women's health, Maureen Gaffney, Chairperson of the National Economic and Social Council, and Deputy Frances Fitzgerald.
The conference was most successful. It confirmed the positive way in which the discussion document has been received by all those interested in women's health. Participants made useful suggestions about the way in which the consultative process should be carried out. They also identified issues which were not included in the discussion document but which they felt should be addressed in the plan.
Following the conference, the Secretary of my Department wrote to the chief executive officer of each health board about the discussion document and the consultative process. Health boards were asked to consider the discussion document at one of their regular meetings, to actively pursue consultation on the document and to nominate a senior member of staff to act as a coordinator for the consultative process. Each board has since appointed a coordinator to ensure that the consultative process is as wide and deep as possible. Each board is taking steps to consult women by way of well publicised public meetings, seminars and workshops on the document or issues in it. Women have been invited to make submissions on the document through local newspapers and local radio. A number of boards are consulting their own female staff on the document. As women and employees of health boards, they are a particular source of expertise on women's health and women's experience of the health services. I am glad that two health boards, the North-Eastern and North-Western, have, independently of the discussion document, consulted women about how health services for women can be improved. In these two boards, consultation on the discussion document will take place on a strong foundation.
My Department has also agreed with the National Women's Council on how consultation with women at regional and local level can best be organised. The aim is to tap the resources of the boards and women's organisations to make sure that as many women as possible are given an opportunity to comment on the document and identify priorities for the plan. The council is particularly keen that marginalised women are consulted and that the consultative process is as participative as possible.
With assistance from my Department, the council has employed a project officer to work closely with member organisations of the council and the health boards to ensure that the expectations of the National Women's Council of the consultative process are met.
Consultation is also taking place with other groups concerned with or involved in women's health. Submissions have been invited on the discussion document from interested organisations and individuals. On Friday, 20 October, the Department of Health, with the Congress of Trade Unions, held a joint conference of women's health which provided women trade unionists with the opportunity to examine the document in detail and express their views on the contents of the plan for women's health.
Following consultation on the discussion document, the Department of Health will begin developing a comprehensive plan for women's health for adoption by the Government early next year and implementation over the next few years. This plan will provide a focus for improving the health of Irish women, addressing the needs of women who are vulnerable to ill health and improving the responsiveness of the health services to women.
I stress that this document is not an excuse to hold up developments which will promote women's health or reduce illness among women. Even since the discussion document was published, decisions have been taken on some issues where there is general agreement that progress should be made. Funding has been allocated for counselling women with crisis pregnancies and research has been commissioned on the reasons women with crisis pregnancies seek terminations abroad. A tribunal to assess compensation on an ex gratia basis of women infected with the hepatitis C virus as a result of receiving anti-D blood products is being established. On 6 October last, the Minister for Health, Deputy Noonan, announced the expansion of the breast cancer screening programme which has been piloted by the Eccles Street project. The first phase of the expanded programme will, it is hoped, be commenced by the end of this year. It will cover the Eastern, North Eastern and Midland Health Board areas. It will target 120,000 women in the age cohort 50 to 64, which represents 50 per cent of the national target population.
The Department of Health is putting in place the organisational structures and arrangements to support the commencement of the first phase.
I was pleased to honour a commitment in the health strategy, "Shaping a Healthier Future", when I launched the health promotion strategy in July last. It was the first document of its kind to be launched in Ireland. The health promotion strategy targets premature mortality amongst women and men. Most importantly it identifies goals and targets and it is in pursuit of these that a significant improvement in the health status of the population can be achieved. Improving the health status of women will receive a high priority in the implementation of the health strategy. It addresses the prerequisites for the success of a national strategy.
In this context it is vital to acknowledge that many people and organisations have a role to play in achieving improvements in health status. Health promotion takes place in the home, school, community and workplace and it is by co-ordinated, targeted actions in these settings that improvements will be made. Achieving better health status is in the interests of a large number of key organisations in the public, private and voluntary sectors.
Whilst the health promotion unit of my Department will play a pivotal role it it only by multi-sectoral involvement and participation that the healthier choice will become the easier one to make. It is the individual, equipped with appropriate knowledge and skills and supported by a healthy environment, whom I want to see enabled to exercise the healthier choice as a result of this strategy. Not only will individuals be more likely to enjoy their full potential in life but our country will benefit economically and socially. A multi-sectoral consultative committee on health promotion has been established and will soon begin to make a vital contribution to health promotion.
In recognition of the importance this Government gives to health promotion and the serious risk posed to the nation's health by smoking, I was pleased to launch a comprehensive action plan to reduce smoking in May this year. The five main features of this plan are: a reduction of 5 per cent in the advertising and sponsorship budgets of tobacco companies in Ireland from January, 1996; a strengthening and widening of the regulations which prohibit smoking in certain public places; a review of the voluntary code on smoking in the workplace — this initiative was put in place last summer and the feedback is being received from various companies from which a report should be completed in 1996; implementation of supports for the retail sector to assist it in observing the law on the sale of cigarettes to children. I look forward to the initiative in this area which will be launched later in the month by the health boards' chief executive officers with the support of the Irish Heart Foundation. There will be a continued development of health education programmes designed to increase awareness of the dangers of tobacco. Steps have already been taken with the development of the Smokebusters programme which is being made available to selected primary schools and the SCRAP programme for secondary schools which I launched recently. Both programmes us a peer-led education approach with a view to encouraging children and adolescents to develop the skills necessary to resist the pressure to become a regular tobacco user and to take responsibility for their own health.
As part of this plan, I launched a new media campaign last Monday which aims to persuade smokers to stop smoking and young people to avoid taking up the habit. The theme of the campaign is "say what you like — smoking kills!". The campaign is targeted at three groups of the population — young girls, smokers aged 30-45 and smokers in the lower income groups. We attach particular importance to stemming the uptake of smoking among girls and young women. We want to counteract the peer pressure on young girls to smoke and the inference of some tobacco advertising that it is sophisticated for women to smoke. We recognise the difficulties of persuading women in the lower income groups to give up smoking. For women on low incomes it is more than just a habit; it may be one of the few sources of pleasure in their difficult lives. We have engaged the Centre for Health Promotion Studies at University College Galway to undertake an indepth examination of the effectiveness of the campaign so that we can gauge the results and inform our decisions on future initiatives in this area.
I am proud to say that the discussion document, Developing a Policy for Women's Health, is the first of its kind to be produced by a Government of the European Union. The publication of this document opened, for the first time, a major process of consultation on the health needs of women and the capacity of present services to meet them. It represents an important step towards positive equality of women in the health sphere to which they are entitled as a matter of social justice. I am pleased that there is full and active participation in this process by a wide variety of organisations and people interested in women's health. I look forward to hearing the many views and observations the document will provoke and to seeing them reflected in the plan for women's health.