Dáil Éireann debate -
Tuesday, 30 Jan 2001

Vol. 529 No. 1

Written Answers. - Health Services.

Bernard Allen

Question:

602 Mr. Allen asked the Minister for Health and Children the steps he is proposing to take to deal with a situation, as set out by the Chief Medical Officer in his Department recently, that there is evidence that the less well off in society have poorer access to health services. [1394/01]

Minister for Health and Children (Mr. Martin)

International research has found that there are large differentials in mortality and morbidity between the higher and lower socio-economic groups and the conclusions from this research are that health inequalities are primarily a consequence of material differences in living standards.

The main principles underlying the 1994 Health Strategy are equity, quality of service and accountability. The strategy sets a framework for reorienting the health services to achieve health and social gain with a particular emphasis on improving the situation of people in the lower socio-economic groups. It states that the pursuit of equity must extend beyond the question of access to services and must also be concerned with variations in health status between groups.

In 1998, my Department commissioned the first nationally representative survey of lifestyle practices – the national health and lifestyle surveys – to provide baseline data to plan future interventions. This research reached similar conclusions as the health strategy. The data forms the basis of my Department's New Health Promotion Strategy for the years 2000 to 2005. This has specific strategic aims and objectives that will contribute to reducing health inequalities.

Many of the causal factors of health inequalities, such as poverty and unemployment, are outside the direct control of the health services. Inter-sectoral collaboration is required to tackle these problems. The Cabinet Committee on Social Inclusion and Drugs, chaired by the Taoiseach, includes Ministers from eight relevant Departments who meet regularly. Also, the NAPS inter-departmental group provides the principal strategic focus for the National Anti-Poverty Strategy. This strategy was published in 1997 and set out a programme to reduce poverty and social exclusion both in general and in a number of key policy areas. Substantial progress has been made in achieving the original targets. Although health or health targets were not included in the original NAPS targets, my Department has been involved in setting and reviewing annual work plans for NAPS. In addition, in the context of the new partnership agreement "Programme for Prosperity and Fairness", my Department will take part in a group to consider the setting of health targets to be included in the next phase of the National Anti-Poverty Strategy.

The Programme for Prosperity and Fairness contains a commitment to review the underlying methodology and existing targets of the National Anti-Poverty Strategy and where appropriate, to consider in consultation with the social partners possible new targets such as health. A working group on NAPS and health has been established. The group has met twice and it is expected to produce a final report by summer 2001.

The National Cancer Strategy set a target of reducing the proportion of deaths from cancer in the under 65 age group by 15%. Since the launch of the strategy, about £60 million has been invested in a range of service developments under the strategy, to the benefit of all, including in particular those socio-economic groups at a greater relative risk of contracting cancer due to environmental or lifestyle factors.

The recently launched cardiovascular health strategy had noted that the lower socio-economic groups seem to suffer disproportionately from heart disease. In this context two targets have been set for 2010. The medium term objective is to bring Irish levels of premature deaths from cardiovascular disease in line with the EU average at a minimum. The longer term goal is to reduce Irish rates to those of the best performers in the EU.

The waiting list initiative is aimed at ensuring that no adult has to wait longer than 12 months and no child longer that six months for access to an acute public hospital procedure. The achievement of these targets, which is being pursued through the implementation of a comprehensive set of short, medium and longer term measures, would represent an important improvement in access to care for those in the lower socio-economic groups, and others relying on public hospital services.

The overall budget for health services for 2001 is now over £5 billion. This represents a 48% increase over the past two years and is a clear recognition of the Government's commitment to provide a high quality health service directed at those most in need.

The £2 billion earmarked in the NDP for health capital for the seven year period 2000-06 represents almost a trebling of investment compared to the previous seven year period. This investment will provide a physical infrastructure to underpin a public health service characterised by ongoing improvements in quality and accessibility and will be a significant ingredient in improving the mortality and morbidity of the poorest groups in our society.

The ability of a society to create and maintain an environment which supports its people in attaining the highest level of health compatible with their natural endowment is one of the key indicators of the stage of development of a society and is recognised as such by its inclusion in the UN's list of human development indicators. Much work has already been done in Ireland on a multi-sectoral approach to poverty and social inclusion. It is essential that we continue to build and improve on the framework in place in the context of revised NAPS targets, NDP funding, and the commitments contained in the Programme for Prosperity and Fairness.

Question No. 603 answered with Question No. 562.