Dáil Éireann debate -
Wednesday, 18 Jun 2003

Vol. 568 No. 6

Written Answers. - Disadvantaged Status.

Seán Crowe

Question:

262 Mr. Crowe asked the Minister for Health and Children the exact official definition used by his Department of the terms disadvantage, disadvantaged area and disadvantaged community; and if he will make a statement on the matter. [17021/03]

Minister for Health and Children (Mr. Martin):

There is no precise legal definition of disadvantage, disadvantaged area or disadvantaged community in the legislation under the remit of my Department. Section 45(1) of the Health Act 1970 sets out in broad terms categories of persons who will have full eligibility for health services. Under this Act, determination of eligibility for medical cards is the responsibility of the chief executive officer of the appropriate health board, aside from people over the age of 70 years who are automatically entitled to a medical card. Medical cards are issued to persons who, in the opinion of the chief executive officer, are unable to provide general practitioner, medical and surgical services for themselves and their dependants without undue hardship.

The Deputy will appreciate that, in the area of an individual's health, a flexible understanding of disadvantage is required. Income guidelines are drawn up by the chief executive officers to assist in the determination of a person's eligibility. However, the guidelines are not statutorily binding and, even though a person's income exceeds the guidelines, a medical card may still be awarded if the chief executive officer considers that his-her medical needs or other circumstances would justify this. It is open to all persons to apply to the chief executive officer of the appropriate health board for health services if they are unable to provide these services for themselves or their dependants without hardship.

My Department participates in the RAPID and CLÁR programmes and, in so doing, accepts the definitions of disadvantaged areas used by the Department of Community, Rural and Gaeltacht Affairs. In its 2003 letters of determination to each health board and in other correspondence to the health board chief executive officers, my Department has asked each health board to prioritise its funding allocations in favour of RAPID and CLÁR projects wherever possible.

The National Health Strategy, Quality and Fairness: A Health System for You, includes the targets to reduce health inequalities which were developed in the course of an extensive consultation process for the review of the national anti-poverty strategy, NAPS. NAPS, for which the lead Department is Social and Family Affairs, is underpinned by the following definition of poverty:

People are living in poverty if their income and resources (material, cultural and social) are so inadequate as to preclude them from having a standard of living which is regarded as acceptable by Irish society generally. As a result of inadequate income and resources people may be excluded and marginalised from participating in activities which are considered the norm for other people in society.

This definition recognises the multi-dimensional and dynamic nature of poverty and exclusion and provides a coherent and integrated framework to address issues of disadvantage across a range of policy domains including health and personal social services.

This approach has enabled greater recognition of the social determinants of health and in particular of the links which research has shown to exist between poverty and health inequalities. This need for a whole system approach to health and health inequalities is emphasised in the national health strategy.

The report of the working group on the national anti-poverty strategy and health emphasised the importance of a community development approach to reducing health inequalities, that is, involving communities in needs assessment, planning, implementation and monitoring-evaluation. Under action 54 of the national health strategy, the Health Boards Executive, HeBE, last November published guidelines which set out a range of ways for the health sector to engage with communities.

In this regard, my Department recently co-hosted a conference with the Combat Poverty Agency to launch its building healthy communities programme, which has a special focus on community development approaches to reducing health inequalities. My Department is also supporting financially, in the context of the implementation of the primary care strategy, a number of research projects under the aegis of the building healthy communities programme.